Or. Admin. Code § 410-172-0600

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

Section 410-172-0600 - Acronyms and Definitions

(1) "Activity of Daily Living (ADLs)" means those personal and functional activities required by an individual for continued well-being, that are essential for health and safety. ADLs include eating, bathing, dressing, toileting, transferring (including mobility and ambulation) and maintaining continence.

(2) "Adult" means an individual 18 years of age or older or an emancipated minor. An individual with Medicaid eligibility who needs services specific to children, adolescents, or young adults in transition shall be considered a child until age 21 for the purposes of these rules. Adults who are between the ages of 18 and 21 who are considered children for purposes of these rules shall have all rights afforded to adults as specified in these rules.

(3) "ASAM PPC" means the most current publication of the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-related Disorders, which is a clinical guide used in matching individuals to appropriate levels of care.

(4) "Authority" means the Oregon Health Authority, the agency established in ORS 413 that administers the funds for Titles XIX and XXI of the Social Security Act, or its designee. It is the single state agency for the administration of the medical assistance program under ORS 414. For purposes of these rules, the agencies under the authority of the Oregon Health Authority are the Public Health Division, Health Systems Division, External Relations, Health Policy and Analytics, Fiscal and Operations, Office of Equity and Inclusion, and the Oregon State Hospital.

(5) "Authorized Representative" means any adult with longstanding involvement in assuring the individual's health and safety, appointed to participate in the service planning process, and is:

(a) Chosen and appointed by the individual or their legal representative, if applicable;

(b) Not a paid provider of Home and Community Based Services (HCBS) and supports or personal care services;

(c) Authorized, in writing or other method that clearly indicates consenting choice, by the individual or legal representative, if applicable, to serve as the individuals representative in connection with the provision of funded supports; and

(d) Responsible to act as the authorized representative until the individual or legal representative, if applicable, modifies the authorization or notifies the agency that the authorized representative is no longer authorized to act on their behalf.

(6) "Behavioral Health" means mental health, mental illness, addiction disorders and substance use disorders.

(7) "Behavioral Health Services" means medically appropriate services rendered or made available to a recipient for treatment of a behavioral health diagnosis.

(8) "Child" means an individual under the age of 18. An individual with Medicaid eligibility who needs services specific to children, adolescents, or young adults in transition shall be considered a child until age 21 for purposes of these rules.

(9) "Community Mental Health Program (CMHP)" means an entity that is responsible for planning and delivery of services for persons with substance use disorders or a mental health diagnosis, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division as defined in OAR 309-019-0105.

(10) "Cueing" means giving verbal direction or visual clues and encouragement during the activity to help the individual complete activities without hands-on assistance and may include redirection.

(11) "Delegated Nursing Task" means a registered nurse (RN) authorizes a person as described in OAR 851-047-0000 who is not licensed to provide or perform a nursing task. In accordance to OAR chapter 851 division 047, the RN shall, prior to issuing written authorization of a delegated nursing task, assess a specific eligible individuals care needs, evaluate the person's ability to perform the specific nursing task, provide the person with education and training to perform the nursing task, and supervise and re-evaluate the individual and the person performing the task.

(12) "Department" means the Oregon Department of Human Services (ODHS).

(13) "Designee" means an organization with which the Authority contracts or has an interagency agreement.

(14) "Disability" means a physical, cognitive, or emotional impairment which, for an individual, constitutes or results in a functional limitation in one or more of the activities of daily living described in OAR 410-172-0780.

(15) "Division" means the Health Systems Division of the Oregon Health Authority, or its designee.

(16) "Face to Face" means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if medically appropriate.

(17) "Guardian" means an individual appointed by a court of law to act as guardian of a minor or a legally incapacitated individual. Guardian may also mean legal representative.

(18) "Hands-on" means a provider physically performs all or part of an activity because the individual is unable to do so.

(19) "Immediate Family" means spouses of recipients and parents of minor recipients, including stepparents who are legally responsible for minor children.

(20) "Individual" means any person being considered for or receiving services and supports regulated by these rules.

(21) "In-Person" means meeting with someone rather than talking on the phone, e-mailing, or writing to the person.

(22) "Instrumental Activities of Daily Living (IADLs)" means those self-management activities performed by an individual on a day-to-day basis that are not essential to basic self-care and independent living. IADLs individual include, but are not limited to, housekeeping, including laundry, shopping, transportation, medication management, and meal preparation.

(23) "Independent and Qualified Agent (IQA)" means an entity meeting the provider qualification requirements identified in 42 CFR § 441.730 and under contract with the Division.

(24) "Home and Community Based Services (HCBS)" means services and supports that assist eligible individuals to remain in their home and community in accordance with the Code of Federal Regulations, approved Medicaid State Plan authorities, and Oregon Administrative Rules.

(25) "Legal Representative" means a person who has been legally designated by court order to make financial or health care decisions for another individual. The legal representative only has authority to act within the scope and limits of their authority as designated by the court or other agreement. Legal representatives acting outside of their authority or scope shall meet the definition of authorized representative. For a child, this includes the parent or step-parent unless a court appoints another person or agency to act as the guardian.

(26) "Medicaid OHP Plus Benefit Package" means:

(a) Modified Adjusted Gross Income (MAGI) Medicaid/CHIP as defined at OAR 410-200-0015(58);

(b) Oregon Supplemental Income Program Medical (OSIPM) as defined at OAR 410-200-0015(60).

(27) "Level of Care" means the type, frequency, and duration of medically appropriate services provided to a recipient of behavioral health services.

(28) "Level of Care Determination" means the standardized process implemented to establish the type, frequency, and duration of medically appropriate services required to treat a diagnosed behavioral health condition.

(29) "Licensed Medical Practitioner (LMP)" means program staff who meet the following minimum qualifications:

(a) Physician licensed to practice in the State of Oregon; or

(b) Nurse practitioner licensed to practice in the State of Oregon; or

(c) Physician's assistant licensed to practice in the State of Oregon; and

(d) Whose training, experience, and competence demonstrate the ability to conduct a mental health assessment and provide medication management.

(30) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to eligible individuals under Title XIX of the Social Security Act.

(31) "Natural Support" means resources and supports (e.g., relatives, friends, significant others, neighbors, roommates, or the community associates) who voluntarily provide services and supports to an individual without the expectation of compensation. Natural supports are identified in collaboration with the individual and the potential "natural support." The natural support is required to have the skills, knowledge, and ability to provide the needed services and supports and shall be identified within the individuals service plan.

(32) "Personal Care Services" means medically appropriate services provided to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility or institution that are:

(a) Authorized for the eligible individual by a physician in accordance with the individuals assessment and a plan of treatment or otherwise authorized for the individual in accordance with a service plan approved by the Authority or designee;

(b) Provided by an individual who is an enrolled provider and is qualified by to provide such services and who is not a member of the individuals immediate family;

(c) Provided in the home or other non-institutional community locations outside the home; and

(d) Include a range of assistance, as developmentally appropriate, provided to persons with disabilities and chronic conditions of all ages, which enables them to accomplish tasks, which they would normally do for themselves if they did not have a disability or chronic condition. Assistance may be in the form of hands-on assistance or cueing so that the person performs the task by themselves.

(33) "Recovery Assistant" means a provider who provides a flexible range of services. Recovery assistants provide face-to-face services in accordance with a service plan that enables a participant to maintain a home or apartment, encourages the use of existing natural supports, and fosters involvement in treatment, social, and community activities. A recovery assistant shall:

(a) Be at least 18 years old;

(b) Meet the background check requirements described in OAR 950-060-0070;

(c) Conform to the standards of conduct as described in OAR 950-060-0080.

(34) "Redirection" means to divert the individual from one activity to another activity.

(35) "Relative" means a person, excluding an individual's spouse, who is related to the individual by blood, marriage, or adoption.

(36) "Service Plan" means a comprehensive plan for services and supports provided to or coordinated for an individual and their family, as applicable, that is reflective of the assessment and the intended outcomes of service.

(37) "Spouse" means an individual who is legally married to another individual.

(38) "Sub-Acute Care Facility" means a care center or facility that provides short-term rehabilitation and complex medical services to an individual with a condition that does not require acute hospital care but prevents the individual from being discharged to their home.

(39) "Supervision" means a provider is physically present and observing the individual to determine if the task is being completed properly and providing intervention if needed.

Or. Admin. Code § 410-172-0600

DMAP 85-2014(Temp), f. 12-24-14, cert. ef. 1-1-15 thru 6-29-15; DMAP 32-2015, f. 6-24-15, cert. ef. 6/26/2015DMAP 36-2021, temporary amend filed 09/14/2021, effective 9/14/2021 through 3/12/2022; DMAP 38-2022, amend filed 03/23/2022, effective 3/23/2022; DMAP 103-2024, minor correction filed 06/11/2024, effective 6/11/2024; DMAP 107-2024, minor correction filed 06/12/2024, effective 6/12/2024

Statutory/Other Authority: ORS 413.042 & 430.640

Statutes/Other Implemented: ORS 413.042, 430.640, 414.025, 414.065, 430.705 & 430.715