OAR 411-318-0005
Definitions

In addition to the following definitions, OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services) includes general definitions for words and terms frequently used in OAR chapter 411, division 318. If a word or term is defined differently in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services), the definition in this rules applies.
(1) “CDDP” means Community Developmental Disabilities Program.
(2) “Claimant” means the person directly impacted by an action that is the subject of a hearing request.
(3) “Complaint” means an oral or written expression of dissatisfaction with a developmental disabilities service or provider.
(4) “Complaint Investigation” means the investigation of a non-abuse related complaint that has been made to a proper authority.
(5) “Complaint Log” means a list of complaint-related information.
(6) “Continuing Services” means the continuation of a developmental disabilities service following the request for a hearing. Services continue until a Final Order is issued.
(7) “DD Administrative Hearing Request” means form 0443DD.
(8) “Denial” means any rejection of a request for a developmental disabilities service or for an increase in a developmental disabilities service. A denial of a Medicaid service requires a Notification of Planned Action.
(9) “Department Hearing Representative” means a person authorized by the Department to represent the Department in a hearing as described in OAR 411-001-0500 (Contested Case Hearings).
(10) “Department Staff” means a person employed by the Department who is knowledgeable in a particular subject matter. For the purposes of the complaint process, Department staff may not be involved in a specific complaint prior to the receipt of the complaint or the request for a review of the complaint.
(11) “Exit” means termination or discontinuance of a Department-funded developmental disabilities service.
(12) “Good Cause” means an excusable mistake, surprise, excusable neglect (which may include neglect due to a significant cognitive or health issue), circumstances beyond the control of a claimant, reasonable reliance on the statement of Department staff or an adverse provider relating to procedural requirements, [or due to] fraud, misrepresentation, or other misconduct of the Department or a party adverse to a claimant.
(13) “Hearing” means a contested case hearing subject to OAR 137-003-0501 (Rules for Office of Administrative Hearings) to 137-003-0700 (Stay Proceeding and Order), which results in a Final Order.
(14) “Informal Conference” means the discussion between a claimant, the representative of the claimant, Department staff, and a Department representative that is held prior to a hearing to address any matters pertaining to the hearing, as described in OAR 411-318-0025 (Contested Case Hearings for Reductions, Suspensions, Terminations, or Denials). An administrative law judge does not participate in an informal conference. The informal conference may result in resolution of the issue.
(15) “Informal Discussion” means the conversation between an individual making a complaint, or as applicable the representative of the individual, and the designee of the Department or local program who received the complaint to address the content of the complaint. The informal discussion may result in resolution of the issue.
(16) “Involuntary Reduction” means a provider has made the decision to reduce services provided to an individual without prior approval from the individual.
(17) “Involuntary Transfer” means a provider has made the decision to transfer an individual to another setting operated by the same provider without prior approval from the individual.
(18) “Local Program” means the case management entity, provider organization, or other certified, licensed, or endorsed provider or agency with which the Department contracts to provide developmental disabilities services and is providing services to the individual with whom a complaint is associated.
(19) “Notice of Involuntary Reduction, Transfer, or Exit” means form 0719DD. This form is part of the AFH/DD Mandatory Written Notice of Exit or Transfer.
(20) “Notification of Planned Action” means form 0947. The Notification of Planned Action is the written decision notice issued to an individual in the event that a developmental disabilities service is denied, reduced, suspended, or terminated.
(21) “OAH” means the Office of Administrative Hearings.
(22) “OHA” means the Oregon Health Authority.
(23) “Program Director” means the Director of a local program or the designee of the Director.
(24) “Program Staff” means a person employed by the local program who is knowledgeable in a particular subject matter. For the purposes of the complaint process, program staff may not be involved in a specific complaint prior to the receipt of the complaint or the request for a review of the complaint.
(25) “Representative” means any adult, such as a parent, family member, guardian, legal representative, advocate, or other person, who is chosen by an individual or the legal representative of the individual to represent the individual in connection with the provision of developmental disabilities services or during the complaint or hearing process. The representative may not be an employee of the Department, CDDP, or Brokerage acting in official capacity. An individual or the legal representative for the individual is not required to choose a representative.
(26) “Request for Service” means:
(a) Submission of a completed application for developmental disabilities services as described in OAR 411-320-0080 (Application and Eligibility Determination);
(b) A written request for a new developmental disabilities service or provider; or
(c) A written request for a change in a developmental disabilities service currently provided.
(27) “Service” means the developmental disabilities services and service settings described in OAR chapter 411, divisions 004 and 300 to 455.
(28) “Service Funds” mean state public funds or Medicaid funds used to purchase developmental disabilities services.
(29) “These Rules” mean the rules in OAR chapter 411, division 318.
(30) “Transfer” means an exit immediately followed by an entry at another location administered or operated by the same provider. A transfer is subject to the same standards as an entry and exit.
(31) “Written Outcome” means the written response from the Department or the local program to a complaint following a review of the complaint.

Source: Rule 411-318-0005 — Definitions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-318-0005.

Last Updated

Jun. 8, 2021

Rule 411-318-0005’s source at or​.us