OAR 411-325-0390
Entry, Exit, Transfer, and Closure
(1)
NON-DISCRIMINATION. An individual considered for Department-funded services may not be denied services 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)
QUALIFICATIONS FOR DEPARTMENT-FUNDED SERVICES. An individual who enters a 24-hour residential setting is subject to eligibility as described in this section.(a)
To be eligible for services in a 24-hour residential setting, an individual must meet the following requirements:(A)
Be an Oregon resident.(B)
Be receiving a Medicaid Title XIX (OHP) benefit package through OSIPM or the OCCS 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 (Application and Eligibility Determination); 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 (General Definitions and Acronyms for Developmental Disabilities Services).(E)
Not receive other Department-funded in-home, community living support, or other services in another residential setting.(b)
Individuals receiving Medicaid Title XIX (OHP) under OCCS medical coverage for services in a nonstandard living arrangement as defined in OAR 461-001-0000 (Definitions for Chapter 461) 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 (Asset Transfer; General Information and Timelines) through 461-140-0300 (Adjustments to the Disqualification for Asset Transfer); and(B)
The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220 (Home).(3)
ENTRY.(a)
A provider considering an individual for entry into the home must:(A)
Provide notification to the local CDDP of the intended entry prior to the individual moving into the home.(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 a home with individuals age 18 or older;(ii)
An individual 18 or older moving into a home with individuals under the age of 18; or(iii)
An individual who turns 18 and continues to reside in a home 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 home.(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 other 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 less than 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 Plan (if available).(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.(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 home.(b)
A provider must notify an individual’s case manager prior to the voluntary transfer or exit of an individual from the home or services, even when the individual enters into another home 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 home when the exit is a voluntary exit from the home.(5)
INVOLUNTARY REDUCTIONS, TRANSFERS, AND EXITS.(a)
A provider must only reduce, 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 another third-party reimbursement.(E)
The provider’s license for the home is suspended, revoked, not renewed, or voluntarily surrendered.(F)
The provider’s Medicaid provider enrollment agreement or contract has been terminated.(G)
The provider’s certification or endorsement described in OAR chapter 411, division 323 is suspended, revoked, not renewed, or voluntarily surrendered.(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, transfer, or exit. 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 imminent danger to self or others in the home 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 home 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 (Contested Case Hearings for Provider Notices of Involuntary Reductions, Transfers, or Exits) 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 avail services in accordance with the individual’s needs until receipt of the Final Order.(d)
An individual or their legal or designated representative may request an expedited hearing in accordance with OAR 411-318-0030 (Contested Case Hearings for Provider Notices of Involuntary Reductions, Transfers, or Exits).(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 (Accessing Developmental Disabilities Services).(8)
CLOSURE. A provider must notify the Department and case management entity in writing prior to announcing a voluntary closure of a home to individuals and the legal representatives of the individual (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, the provider, or caregivers.(b)
If the provider has more than one home, the individuals may not be transferred from one home to another home 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 welfare of individuals, the provider, or caregivers.(c)
A provider must return the license for a home to the Department if the home closes prior to the expiration of the license.
Source:
Rule 411-325-0390 — Entry, Exit, Transfer, and Closure, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-325-0390.