Or. Admin. Code § 411-048-0160

Current through Register Vol. 63, No. 12, December 1, 2024

Section 411-048-0160 - Definitions

Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 048:

(1) "AAA" means the Area Agency on Aging designated by the Department that is responsible for providing a comprehensive and coordinated system of services to older adults and adults with disabilities in a designated planning and service area.

(2) "Abuse" means:

(a) "Abuse" as it applies to a "child" as those terms are defined in ORS 419B.005.

(b) "Abuse" as it applies to a "child in care" as those terms are defined in ORS 418.257.

(c) "Abuse" as it applies to an "adult" as those terms are defined in ORS 430.735.

(d) "Abuse" as defined in ORS 124.005 and OAR 411-020-0002 for older adults and adults with a physical disability who are 18 years of age or older.

(3) "Business Day" means the day that the "Local Office" is open for business.

(4) "Care Coordination" means the email, faxes, phone calls, meetings and other types of information exchange, consultation, and advocacy provided by an RN on behalf of an individual that is necessary for the RN's assessments, complete medication reviews, provide for individual safety needs, and implement an individual's Nursing Service Plan.

(5) "Caregiver" means any person responsible for providing services to an eligible individual in a Medicaid-funded home and community-based setting. A caregiver may include an unlicensed person as a designated caregiver as described in OAR chapter 851, division 048.

(6) "Case Manager" means a person employed by the Department, CDDP, Support Services Brokerage, or AAA who assesses the service needs of an applicant, determines eligibility, and offers service choices to the eligible individual. The case manager authorizes and implements an individual's plan for services and monitors the services delivered.

(7) "CDDP" means "Community Developmental Disability Program" as defined in OAR 411-317-0000.

(8) "Day Support Activities" as defined in OAR 411-317-0000.

(9) "Delegation Process" means the standards and processes described in OAR chapter 851, divisions 006, 045, and 047.

(10) "Department" means the Oregon Department of Human Services or the Department's designee.

(11) "Department Approved Form" means the forms used by an RN and case manager to support these rules. The Department maintains these documents on the Department's website https://www.oregon.gov/odhs/providers-partners/ltccn/Pages/resources.aspx#forms

(12) "Direct Hands-on Nursing" means an RN providing treatment or therapies directly to an individual instead of teaching or delegating the tasks of nursing to the individual's caregiver. Payment for direct hands-on nursing services is not reimbursed unless an exception has been granted by the Department as described in OAR 411-048-0170.

(13) "Documentation" means a written record of all services provided to, and for, an individual and an individual's caregiver that is maintained by an RN as described in OAR 411-048-0200.

(14) "Employment Services" through the Office of Developmental Disabilities Services as defined in OAR 411-317-0000 or through Vocational Rehabilitation as described in OAR chapter 582.

(15) "Enrolled Medicaid Provider" means an entity or individual that meets and completes all the requirements in these rules, OAR 407-120-0300 to 0400, and OAR chapter 410, division 120, as applicable.

(16) "Healthcare Provider" means a licensed provider delivering services to an eligible individual such as, but not limited to, home health, hospice, mental health, primary care, specialty care, durable medical equipment, pharmacy, or hospitalization.

(17) "Home" means a non-licensed setting where an individual is receiving Medicaid-funded home and community-based services.

(18) "Home and Community-Based Services" as defined in OAR 411-004-0010.

(19) "Home Health Agency" as defined in ORS 443.443.014.

(20) "Individual" means a person eligible for long term care community nursing services under these rules.

(21) "In-Home Care Agency" as defined in ORS 443.305.

(22) "Local Office" means the Department office, AAA, CDDP, or Support Services Brokerage, responsible for Medicaid services including case management, referral, authorization, and oversight of long term care community nursing services in the region where the individual lives and where the long term care community nursing services are delivered.

(23) "Long Term Care Community Nursing Services" mean a distinct set of services that focus on an individual's chronic and ongoing health and activity of daily living needs. Long term care community nursing services includes assessments, monitoring, delegation, teaching, and coordination of services that addresses an individual's health and safety needs in a Nursing Service Plan that supports individual choice and autonomy. The requirements in these rules are provided in addition to any nursing related requirements stipulated in the licensing rules governing the individual's place of residence.

(24) "Medication Review" means a review focused on an individual's medication regime that includes examination of the prescriber's orders and related administration records, consultation with a pharmacist or the prescriber, clarification of PRN (as needed) parameters, and the development of a teaching plan based upon the needs of the individual or the individual's caregiver. In an unlicensed setting, the medication review may include observation and teaching related to administration methods and storage systems.

(25) "Nursing Assessment" for the purpose of payment under this program means an assessment defined in OAR chapter 851, division 006 and codified in OAR chapter 851, division 045 as a legal requirement of the RN practice and within the scope of the nurse's license.

(26) "Nursing Service Plan" also referred to as Plan of Care, means the plan that is developed by an RN based on an RN's initial nursing assessment of the individual, reassessment, or updates made to a nursing assessment as a result of monitoring visits.

(27) "OSBN" means the Oregon State Board of Nursing. OSBN is the agency responsible for regulating nursing education, licensing, and practice for the purpose of protecting the public's health, safety, and well-being.

(28) "Rate Schedule" means the rate schedule maintained by the Department in OAR 411-027-0170 and posted at http://www.dhs.state.or.us/spd/tools/program/osip/rateschedule.pdf.

(29) "RN" means a registered nurse licensed by the OSBN. An RN providing long term care community nursing services under these rules is either an independent contractor who is an enrolled Medicaid provider or an employee of an organization that is an enrolled Medicaid provider. A Licensed Practical Nurse (LPN) or Certified Nursing Assistant (CNA) are not an RN under these rules.

(30) "Support Services Brokerage" means "Brokerage" as defined in OAR 411-317-0000.

(31) "These Rules" mean the rules in OAR chapter 411, division 048.

(32) "Unregulated Assistive Person" or "UAP" is the same as caregiver as defined in (5) of these rules. CNAs and Certified Medication Aides (CMAs) are certified and not licensed.

Or. Admin. Code § 411-048-0160

SPD 8-2013, f. & cert. ef. 4-15-13; SPD 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 44-2013, f. 12-13-13, cert. ef. 12-15-13; APD 12-2014(Temp), f. & cert. ef. 5-1-14 thru 10-28-14; APD 34-2014, f. & cert. ef. 10-1-14; APD 10-2021, temporary amend filed 02/24/2021, effective 03/01/2021 through 08/27/2021; APD 30-2021, amend filed 08/25/2021, effective 8/25/2021; APD 18-2023, amend filed 10/13/2023, effective 11/1/2023

Statutory/Other Authority: ORS 409.050 & 410.070

Statutes/Other Implemented: ORS 409.010 & 410.070