Or. Admin. Code § 411-360-0190

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-360-0190 - Entry, Transfer, Exit, Closure, and Community Living Supports

(1) NON-DISCRIMINATION. An individual may not be denied services in an AFH-DD or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws.

(2) ELIGIBILITY. An individual who enters an AFH-DD is subject to eligibility as described in this section.

(a) To be eligible for services in an AFH-DD, an individual must meet the following requirements:

(A) Be an Oregon resident who meets the residency requirements in OAR 461-120-0010.

(B) Be receiving:

(i) A Medicaid Title XIX benefit package through OSIPM or HSD medical programs; or

(ii) A benefit package through the Healthier Oregon medical program.

(C) Be determined eligible for:

(i) Developmental disabilities services by the CDDP of the county of origin as described in OAR 411-320-0080; or

(ii) Services for Aging and People with Disabilities as described in OAR chapter 411, division 015.

(D) Meet the level of care as defined in OAR 411-317-0000.

(E) Not receive other Department-funded in-home, community living support, or other services in another residential setting.

(b) Individuals receiving Medicaid Title XIX through HSD medical programs for services in a nonstandard living arrangement as defined in OAR 461-001-0000 are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding:

(A) The transfer of assets as set forth in OAR 461-140-0210 through 461-140-0300.

(B) The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220.

(3) ENTRY.

(a) A provider considering an individual for entry into the AFH-DD must:

(A) Provide notification to the local CDDP of the intended entry prior to the individual moving into the AFH-DD.

(B) Be prior authorized to provide Medicaid-funded services to the individual if the individual is not private pay.

(C) Receive written permission from the Department prior to:

(i) An individual under age 18 moving into an AFH-DD with individuals age 18 or older; or

(ii) An individual 18 or older moving into an AFH-DD with individuals under the age of 18.

(D) Gather sufficient information to make an informed decision about the provider's ability to safely and adequately support the individual.

(b) A provider must participate in an entry meeting with an individual's case manager prior to delivering services to the individual for services to be funded in the AFH-DD.

(c) Prior to or upon an entry, a provider must demonstrate diligent efforts to acquire the following individual information from the referring case management entity:

(A) A copy of the eligibility determination document.

(B) A statement indicating the safety skills, including the ability of the individual to evacuate from a building when warned by a signal device and adjust water temperature for bathing and washing.

(C) A brief written history of any behavioral challenges, including supervision and support needs.

(D) A medical history and information on health care supports that includes (when available):

(i) The results of the most recent physical exam;

(ii) The results of any dental evaluation;

(iii) A record of immunizations;

(iv) A record of known communicable diseases and allergies; and

(v) A record of major illnesses and hospitalizations.

(E) A written record of any current or recommended medications, treatments, diets, and aids to physical functioning.

(F) A copy of the most recent functional needs assessment and previous functional needs assessment if the needs of the individual have changed over time.

(G) Copies of protocols, the risk tracking record, and any support documentation (if available).

(H) Copies of documents relating to the guardianship, conservatorship, health care representation, power of attorney, court orders, probation and parole information, or any legal restrictions on the rights of the individual (if applicable).

(I) Copies of medical decision-making documents, such as an Advance Directive and Portable Order for Life-Sustaining Treatment (POLST), if applicable.

(J) Written documentation that the individual is participating in out of residence activities, including public school enrollment for individuals under 21 years of age.

(K) Written documentation to explain why preferences of the individual may not be implemented.

(L) A copy of the most recent Functional Behavior Assessment, Positive Behavior Support Plan, ISP or Service Agreement, Nursing Service Plan, and Individualized Education Program (if applicable).

(d) If an individual is being admitted from the family home of the individual and the information required in subsection (c) of this section is not available, the provider must assess the individual upon entry for issues of immediate health or safety and document a plan to secure the remaining information no later than 30 calendar days after entry. The plan must include a written justification as to why the information is not available.

(e) A provider retains the right to deny entry of any individual if the provider determines the support needs of the individual may not be met by the provider or for any other reason not specifically prohibited by these rules.

(f) An AFH-DD may not be used as a site for foster care for children, adults from other agencies, or any other type of shelter or day care without the written approval of the Department.

(4) VOLUNTARY TRANSFERS AND EXITS.

(a) A provider must promptly notify an individual's case manager if the individual gives notice of the intent to exit or abruptly exits services. An individual is not required to give notice to a provider if the individual chooses to exit the AFH-DD.

(b) A provider must notify an individual's case manager prior to the voluntary transfer or exit of an individual from the AFH-DD or services, even when the individual enters into another AFH-DD operated by the same provider.

(c) Notification and authorization of the voluntary transfer or exit of the individual must be documented in the record for the individual.

(d) A provider is responsible for the provision of services until an individual exits the AFH-DD when the exit is a voluntary exit from the home.

(5) INVOLUNTARY REDUCTIONS, TRANSFERS, AND EXITS.

(a) A provider must only reduce services, transfer, or exit an individual involuntarily for one or more of the following reasons:

(A) The behavior of the individual poses an imminent risk of danger to self or others.

(B) The individual experiences a medical emergency that results in the individual requiring substantially increased ongoing support that the provider is unable to meet.

(C) The service needs of the individual exceed the ability of the provider.

(D) The individual fails to pay for services or room and board, and payment is not available from Medicaid or other third-party reimbursement.

(E) The provider's license for the AFH-DD is suspended, revoked, not renewed, or voluntarily surrendered.

(F) The provider's Medicaid provider enrollment agreement or contract has been terminated.

(G) The conditions are met for an immediate exit as described in section (9) of this rule.

(b) NOTICE OF INVOLUNTARY REDUCTION, TRANSFER, OR EXIT. A provider must not reduce services, transfer, or exit an individual involuntarily without giving advance written notice 30 calendar days prior to the reduction, exit or transfer. The notice of involuntary reduction, transfer or exit must be provided to the individual and the individual's legal or designated representative (as applicable) and case manager, except in the case of a medical emergency or when an individual is engaging in behavior that poses an immediate danger to self and others as described in subsection (c) of this section.

(A) The written notice must be provided on the applicable Department form and include:

(i) The reason for the reduction, transfer, or exit; and

(ii) The right of the individual to a hearing as described in section (6) of this rule.

(B) A notice is not required when an individual requests the reduction, transfer, or exit.

(c) A provider may give advance written notice less than 30 calendar days prior to an exit or transfer only in a medical emergency or when an individual is engaging in behavior that poses an imminent danger to self or others in the AFH-DD and undue delay in moving the individual increases the risk of harm. The notice must be provided to the individual and the individual's legal or designated representative (as applicable) and case manager immediately upon the provider's determination of the need for a reduction, transfer, or exit.

(d) A provider must demonstrate through documentation, attempts to resolve the reason for the involuntary reduction, transfer, or exit, including consideration of alternatives to the reduction, transfer, or exit and engagement of the case manager in this process.

(e) A provider is responsible for the provision of services until the date of reduction, transfer, or exit identified in the notice, or when an individual requests a hearing, until the hearing is resolved.

(6) HEARING RIGHTS.

(a) An individual must be given the opportunity for a hearing under ORS chapter 183 and OAR 411-318-0030 to dispute an involuntary reduction, transfer, or exit, except when a provider's license is revoked, not renewed, voluntarily surrendered, or the provider's Medicaid contract is terminated.

(b) If an individual requests a hearing within 15 calendar days after the date of the notice and requests continuation of services, the individual must receive the same services until the hearing is resolved.

(c) When an individual has been given written notice less than 30 calendar days in advance of a reduction, transfer, or exit as described in section (5)(c) of this rule and the individual has requested a hearing, the provider must reserve the room of the individual and deliver services according to the individual's needs until receipt of the Final Order.

(d) An individual or their legal or designated representative may request an expedited hearing as described in OAR 411-318-0030.

(7) EXIT MEETING. A provider must participate in an exit meeting before any decision to exit an individual is made, unless the exit meeting is waived in accordance with OAR 411-415-0080.

(8) CLOSURE. A provider must notify the Department and case management entity in writing prior to announcing a voluntary closure of the AFH-DD to individuals and the legal representatives of the individuals (as applicable).

(a) The provider must give each individual, the legal representative of the individual (as applicable), and the case management entity written notice 30 calendar days in advance of the planned closure, except in circumstances where undue delay might jeopardize the health, safety, or welfare of the individuals, provider, or caregivers.

(b) If a provider has more than one AFH-DD, the individuals may not be transferred from one AFH-DD to another AFH-DD without providing each individual, the legal representative of the individual (as applicable), and the case management entity written notice 30 calendar days in advance of the planned closure, unless prior approval is given and agreement obtained from the individuals, the legal representative of the individuals (as applicable), and the case management entity, or when undue delay might jeopardize the health, safety, or well-being of the individuals, provider, or caregivers.

(c) A provider must return the AFH-DD license to the Department if the AFH-DD closes prior to the expiration of the license.

(9) IMMEDIATE EXIT.

(a) An individual who was admitted on or after July 1, 2014 may be moved without advance notice if all of the following are met:

(A) The provider was not notified prior to the entry of the individual to the AFH-DD that the individual is on probation, parole, or post-prison supervision after being convicted of a sex crime;

(B) The provider learns that the individual is on probation, parole, or post-prison supervision after being convicted of a sex crime; and

(C) The individual presents a current risk of harm to another individual, staff, or visitor in the AFH-DD as evidenced by:

(i) Current or recent sexual inappropriateness, aggressive behavior of a sexual nature, or verbal threats of a sexual nature; or

(ii) Current communication from the State Board of Parole and Post-Prison Supervision, Department of Corrections, or community corrections agency parole or probation officer that the Static 99 score for the individual or other assessment indicates a probable sexual re-offense risk to others in the AFH-DD.

(b) Prior to the move, the provider must contact the Central Office of the Department by telephone to review the criteria in subsection (a) of this section. The Department shall respond within one business day of contact by the AFH-DD. The parole or probation officer of the Department of Corrections must be included in the review, if available. The Department shall advise the AFH-DD provider if rule criteria for immediate exit are not met. The Department shall assist in locating placement options.

(c) A written move-out notice must be completed on form 0719DD. The form must be filled out in its entirety and a copy of the notice must be delivered in person to the individual or if applicable the legal representative of the individual. Where an individual lacks capacity and there is no legal representative, a copy of the notice to move-out must be immediately faxed to the State Long Term Care Ombudsman.

(d) Prior to the move, the AFH-DD licensee must orally review the notice and the right to object with the individual, or as applicable the legal representative of the individual, and determine if a hearing is requested. A request for hearing does not delay the exit. The AFH-DD must immediately telephone the Central Office of the Department when a hearing is requested. The hearing must be held within five business days of the exit of the individual. An informal conference may not be held prior to the hearing.

(10) COMMUNITY LIVING SUPPORTS.

(a) Community living supports may be provided to one or more individuals if the addition of the individual receiving community living supports in the AFH-DD does not cause the capacity of the AFH-DD as determined by OAR 411-360-0060 to exceed five. Relief care may not be provided for more than 14 consecutive days to a single individual without prior approval from the Department.

(b) The provider must have information sufficient to provide for the health and safety of an individual receiving community living supports that includes the following:

(A) Medications provided in a container labeled from a pharmacy or in the original container labeled from the manufacturer;

(B) A list of medications, administration times, and self-administration information as needed. Administration of medication must be documented on a MAR;

(C) Basic summary sheet for the individual that includes the following:

(i) The name of the physician or health care provider of the individual and the phone number for the physician or health care provider;

(ii) The name of the emergency contact person of the individual and the phone number for the emergency contact;

(iii) List of supports related to food and drink (textures, special diets, allergies, preferences);

(iv) List of supports related to health supports;

(v) List of supports related to safety, including ability to adjust water temperature; and

(vi) List of supports related to challenging behaviors.

(c) On the first relief care visit of an individual, the provider must practice and document a fire drill immediately upon the arrival of the individual. For subsequent relief care visits, the provider must review the fire evacuation procedures with the individual and document the review.

(d) No use of PRN (as needed) psychotropic medications is allowed.

Or. Admin. Code § 411-360-0190

SPD 3-2005, f. 1-10-05, cert. ef 2-1-05; SPD 13-2010, f. 6-30-10, cert. ef. 7-1-10; SPD 25-2011(Temp), f. & cert. ef. 12-1-11 thru 5-29-12; SPD 29-2011(Temp), f. & cert. ef. 12-30-11 thru 5-29-12; SPD 5-2012, f. & cert. ef. 5-29-12; SPD 34-2013, f. & cert. ef. 9-27-13; APD 29-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 47-2014, f. 12-26-14, cert. ef. 12/28/2014; APD 30-2015(Temp), f. 12-31-15, cert. ef. 1-1-16 thru 6-28-16; APD 21-2016, f. & cert. ef. 6/29/2016; APD 31-2018, minor correction filed 08/15/2018, effective 8/15/2018; APD 39-2019, amend filed 10/29/2019, effective 11/1/2019; APD 34-2022, temporary amend filed 07/01/2022, effective 7/1/2022 through 12/27/2022; APD 53-2022, amend filed 12/14/2022, effective 12/15/2022

Statutory/Other Authority: ORS 409.050, 427.104, 430.662, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.765, 443.767, 443.775 & 443.790

Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.610, 430.662, 443.001-443.004, 443.705-443.825, 443.875 & 443.991