OAR 411-450-0080: Minimum Standards for Provider Agencies Delivering Community Living Supports

(1) CERTIFICATION, ENDORSEMENT, AND ENROLLMENT. To be endorsed to operate a community living support program, a provider agency must have all of the following: (a) A certificate and an endorsement, in accordance with OAR chapter 411, division 323, to deliver community living supports as a community living supports agency or a standard model agency. (b) An Agency Identification Number assigned by the Department in accordance with OAR chapter 411, division 370. (2) INSPECTIONS AND INVESTIGATIONS. A provider agency must allow inspections and investigations in accordance with OAR 411-323-0040. (3) MANAGEMENT AND PERSONNEL PRACTICES. A provider agency must comply with the management and personnel practices in OAR 411-323-0050. (4) PRE-SERVICE TRAINING. A provider agency must maintain written documentation of six hours of pre-service training prior to staff supporting individuals that includes mandatory abuse reporting, ISPs, and Service Agreements. (5) PARENT PROVIDER TRAINING. A provider agency must ensure a parent provider completes the training required in OAR 411-440-0060(1), prior to delivering services to their child. (6) CONFIDENTIALITY OF RECORDS. A provider agency must ensure the confidentiality of individuals' records in accordance with OAR 411-323-0060. (7) DOCUMENTATION REQUIREMENTS. Unless stated otherwise, all entries required by these rules must comply with the agency documentation requirements in OAR 411-323-0060. (8) DAY SUPPORT ACTIVITIES (DSA). For DSA, a provider agency must develop and share the following information with an individual and the individual's case manager: (a) A written plan or implementation strategies. The written strategies for service implementation must be given to an individual and the individual’s case manager within 60 calendar days of providing services for the ISP year. (b) A risk mitigation strategy or protocol that addresses each identified relevant risk. The risk mitigation strategy or protocol must be given to an individual and the individual’s case manager before services begin for the ISP year. (c) Other documents requested by the ISP team. (9) PROGRESS NOTES AND RECORDS. (a) A provider agency must maintain progress notes regarding the delivery of community living supports. A progress note must include, at minimum, all of the following information regarding the supports rendered to an individual: (A) The date and time the support was delivered. (B) The staff delivering the support. (C) A description of the attendant care provided and how the support met an identified ADL or IADL support need or a health-related task included in the individual’s ISP or Service Agreement. (b) Progress notes must be made available monthly and upon request by a case management entity. (c) Failure to furnish written documentation upon the written request from the Department, the Oregon Department of Justice Medicaid Fraud Unit, Centers for Medicare and Medicaid Services, or their authorized representatives, immediately or within timeframes specified in the written request, may be deemed reason to recover payment. (d) Records must be retained in accordance with OAR chapter 166, division 150, Secretary of State, Archives Division. (A) Financial records, supporting documents, statistical records, and all other records (except individual records) must be retained for at least three years after the close of a contract period. (B) Individual records must be kept for at least seven years. (10) ABUSE AND INCIDENT HANDLING AND REPORTING. Complaints of abuse and the occurrence of serious incidents must be treated in accordance with OAR 411-323-0063. (11) POLICIES AND PROCEDURES. A provider agency must develop and implement policies and procedures required for administration and operation in compliance with these rules including, but not limited to, all of the following: (a) A provider agency must have, and implement, written policies and procedures protecting the individual rights in OAR 411-318-0010 and that: (A) Provide for individual participation in selection, training, and evaluation of staff assigned to provide services to the individuals; (B) Protect individuals during hours of service from financial exploitation that may include, but is not limited to, any of the following: (i) Staff borrowing from, or loaning money to, an individual. (ii) Witnessing wills in which staff or the provider agency may benefit directly or indirectly. (iii) Adding the name of a staff member or provider agency to the bank account or other personal property of an individual without the approval of the individual or their legal representative (as applicable). (b) Policies and procedures appropriate to the scope of service including, but not limited to, those required to meet the minimum standards in sections (15) through (28) of this rule and consistent with the ISPs or written Service Agreements for individuals currently receiving services. (c) A provider agency delivering community living supports, not including DSA, must adopt policies to reduce the impact of the loss of supports to an individual when an agency employee is unavailable to deliver a scheduled support including, but not limited to: (A) A list of employees assigned to work with the individual must be made available upon request from an individual, guardian, designated representative, case management entity, or the Department. (B) The provider agency and the individual, or the individual’s legal or designated representative, must develop a plan for the continuity of services during a planned absence or emergency circumstances when the assigned employee is unavailable. (C) The provider agency must ensure the individual, or the individual’s legal or designated representative, is notified of any unforeseen changes in the delivery of services, as applicable, such as a change in an agency employee who provides a service, the frequency of a service, and the days and times when services will be provided. Documentation of the notification must be maintained in the individual’s record. (12) SERVICE DELIVERY. A provider agency must deliver services according to an individual's ISP or written Service Agreement. (13) SERVICE RATES. Service rates, as authorized in the Department's electronic payment and reporting system for individuals authorized to receive community living supports and paid to a provider agency for delivering services as described in these rules, shall be reimbursed at the rate for an employer model agency identified in the Expenditure Guidelines unless the provider agency is endorsed to operate a standard model agency in accordance with OAR 411-450-0090. (14) BILLING. For a provider agency offering services to the general public, billings for Medicaid funds may not exceed the customary charges to private individuals for any like item or services charged by the provider agency. (15) SERVICE RECORD. A provider agency must maintain a current service record for each individual receiving services. The individual's service record must include all of the following: (a) The individual's name, current home address, and home phone number. (b) The individual's current ISP or written Service Agreement. (c) Contact information for the individual's legal or designated representative (as applicable) and any other people designated by the individual to be contacted in case of incident or emergency. (d) Contact information for the case management entity assisting the individual to obtain services. (e) Records of service provided, including type of services, dates, hours, and staff involved. (f) For skills training, relief care services, and attendant care that does not meet the definition of DSA, an electronic system must record all of the following for a service provided at the time of service: (A) Type of service provided. (B) Individual receiving service. (C) Date of service provided. (D) Location of service. (E) Staff member providing the service. (F) Start time of the service. (G) End time of the service. (16) TRAINING. A provider agency must ensure staff, contractors, and volunteers receive appropriate and necessary training. (17) DRUG-FREE WORKPLACE. A provider agency regulated by these rules must be a drug-free workplace. (18) SAFETY AND EMERGENCY PLANNING. A provider agency that owns or leases a site, delivers services to individuals at the site, and regularly has individuals present and receiving services at the site, must meet all of the following minimum requirements: (a) A written emergency plan must be developed and implemented and must include instructions for staff and volunteers in the event of fire, explosion, accident, or other emergency, including evacuation of individuals receiving services. (b) Posting of emergency information including, but not limited to, posting the following telephone numbers by designated telephones: (A) Local fire, police department, and ambulance service, or "911". (B) The executive director of the provider agency and other people to be contacted in case of emergency. (c) A documented safety review must be conducted quarterly to ensure the service site is free of hazards. Safety review reports must be kept in a central location by a provider agency for three years. (d) When an individual begins receiving services at a service site, a provider agency must deliver training to the individual to leave the site in response to an alarm or other emergency signal and to cooperate with assistance to exit the site. (e) EVACUATION DRILLS. A provider agency must conduct an unannounced evacuation drill each month when individuals are present. (A) Exit routes must vary based on the location of a simulated fire. (B) Any individual failing to evacuate the service site unassisted within the established time limits set by the local fire authority for the site must be provided with specialized training or support in evacuation procedures. (C) Written documentation must be made at the time of the drill and kept by the provider agency for at least two years following the drill. The written documentation must include all of the following: (i) Date and time of the drill. (ii) Location of the simulated fire. (iii) Last names of all individuals and staff present at the time of the drill. (iv) Amount of time required by each individual to evacuate if the individual needs more than the established time limit. (v) Signature of the staff conducting the drill. (D) In sites delivering services to an individual who is medically fragile or has severe physical limitations, requirements of evacuation drill conduct may be modified. The modified plan must: (i) Be developed with the local fire authority, the individual or the individual's legal or designated representative (as applicable), and the provider agency's executive director; and (ii) Be submitted as a variance request according to OAR 411-450-0100. (f) A provider agency must provide necessary adaptations to ensure fire safety for sensory and physically impaired individuals. (g) HEALTH AND SAFETY INSPECTIONS. At least once every five years, a provider agency must conduct a health and safety inspection. (A) The inspection must cover all areas and buildings where services are delivered to individuals, including administrative offices and storage areas. (B) The inspection must be performed by: (i) The Oregon Occupational Safety and Health Division; (ii) The provider agency's worker's compensation insurance carrier; (iii) An appropriate expert, such as a licensed safety engineer or consultant as approved by the Department; or (iv) The Oregon Health Authority, Public Health Division, when necessary. (C) The inspection must cover all of the following: (i) Hazardous material handling and storage. (ii) Machinery and equipment used at the service site. (iii) Safety equipment. (iv) Physical environment. (v) Food handling, when necessary. (D) The documented results of the inspection, including recommended modifications or changes and documentation of any resulting action taken, must be kept by the provider agency for five years. (h) FIRE AND LIFE SAFETY INSPECTIONS. A provider agency must ensure each service site has received initial fire and life safety inspections performed by the local fire authority or a Deputy State Fire Marshal. The documented results of the inspection, including documentation of recommended modifications or changes and documentation of any resulting action taken, must be kept by the provider agency for five years. (i) STAFFING. Direct service staff must be present in sufficient number to meet health, safety, and service needs specified in the individual ISP or Service Agreement for each individual present. When individuals are present, at least one staff member on duty must have the following minimum skills and training: (A) CPR certification. (B) Current First Aid certification. (C) Training to meet other specific medical needs identified in individual ISPs or Service Agreements. (D) Training to meet other specific behavior support needs identified in individual ISPs or Service Agreements. (19) MEDICATIONS AND HEALTH AND MEDICAL NEEDS. A provider agency delivering services to individuals that involve assistance with meeting health and medical needs must: (a) Develop and implement written policies and procedures addressing all of the following: (A) Emergency medical intervention. (B) Treatment and documentation of illness and health care concerns. (C) Administering, storing, and disposing of prescription and non-prescription drugs, including self-administration. (D) Emergency medical procedures, including the handling of bodily fluids. (E) Confidentiality of medical records. (b) Maintain a current written record for each individual receiving assistance with meeting health and medical needs that includes all of the following: (A) Health status as known. (B) Changes in health status observed during hours of service. (C) Any remedial and corrective action required and when such actions were taken if occurring during hours of service. (D) A description of any known restrictions on activities due to medical limitations. (c) If providing support with medication management when an individual is unable to self-administer medications the provider agency must: (A) Have an individualized written protocol describing the supports with medication management to be provided by the agency including a record of staff trained on the protocol. (B) Have a written order or copy of the written order, signed by a physician or physician designee, before any support is provided with prescription medication. (d) Administer medications per written orders. (e) Administer medications from containers labeled as specified per physician written order. (f) Keep medications secure and unavailable to any other individual and stored as prescribed. (g) Record administration on an individualized Medication Administration Record (MAR), including treatments and PRN, or "as needed", orders. (h) Not administer unused, discontinued, outdated, or recalled medication. (i) Not administer PRN psychotropic medication. PRN orders may not be accepted for psychotropic medication. (j) When medication is administered by an agency, the agency must maintain a MAR. The MAR must include all of the following: (A) The name of the individual. (B) The brand name or generic name of the medication, including the prescribed dosage and frequency of administration as contained on the physician order and medication. (C) Times and dates the administration of the medication occurs. (D) The signature of the staff administering the medication. (E) Method of administration. (F) Documentation of any known allergies or adverse reactions to a medication. (G) Documentation and an explanation of why a PRN, or "as needed", medication was administered and the results of such administration. (H) An explanation of any medication administration irregularity with documentation of a review by the provider agency's executive director or their designee. (k) When supports for medication management, other than administration of medication, are provided the agency must maintain documentation of support provided for every occurrence of support including the following: (A) The name of the individual. (B) The brand name or generic name of the medication, including the prescribed dosage and frequency physician order and medication. (C) Times and dates the support of the medication management occurs. (D) Nature of the medication support provided. (E) An explanation of why a PRN, or “as needed” medication was needed and the results of the medication utilization. (l) Provide safeguards to prevent adverse medication reactions including, but not limited to, all of the following: (A) Maintaining information about the effects and side-effects of medications the provider agency has agreed to administer. (B) Communicating any concerns regarding any medication usage, effectiveness, or effects to an individual or the individual's legal or designated representative (as applicable). (C) Prohibiting the use of one individual's medications by another individual or person. (m) Maintain a record of visits to medical professionals, consultants, or therapists if facilitated or delivered by the provider agency. (20) TRANSPORTATION. A provider agency that owns or operates vehicles that transport individuals must: (a) Maintain the vehicles in safe operating condition. (b) Comply with the laws of the Oregon Driver and Motor Vehicles Division (DMV). (c) Maintain insurance coverage on the vehicles and all authorized drivers. (d) Carry a first aid kit in each vehicle. (e) Assign drivers who meet the applicable DMV requirements to operate vehicles that transport individuals. (21) MANAGEMENT OF FUNDS. If assisting with management of funds, a provider agency must have and implement written policies and procedures related to the oversight of an individual's financial resources that includes the following: (a) Procedures that prohibit inappropriately expending an individual's personal funds, theft of an individual's personal funds, using an individual's funds for the benefit of staff, commingling an individual's personal funds with the provider agency's or another individual's funds, or the provider agency becoming an individual's legal or designated representative. (b) The provider agency's reimbursement to an individual of any funds that are missing due to theft or mismanagement on the part of any staff of the provider agency, or of any funds within the custody of the provider agency that are missing. Such reimbursement must be made within 10 business days of the verification that funds are missing. (22) PROFESSIONAL BEHAVIOR SERVICES. A provider agency must have and implement written policies and procedures to assure professional behavior services are delivered by a qualified behavior professional in accordance with OAR chapter 411, division 304. (23) BEHAVIOR SUPPORTS. A provider agency must have and implement written policies and procedures for the delivery of behavior supports that prohibits abusive practices and assures behavior supports are included in a Positive Behavior Support Plan. (a) A provider agency must inform each individual, and as applicable their legal or designated representative, of the behavior support policies and procedures at the time of entry and as changes occur. (b) A decision to alter an individual's behavior must be made by the individual or their legal or designated representative. (c) Psychotropic medications and medications for behavior must be: (A) Prescribed by a physician through a written order; and (B) Monitored by the prescribing physician for desired responses and adverse consequences. (d) Behavior supports must not include any of the following characteristics: (A) Abusive. (B) Aversive. (C) Coercive. (D) For convenience. (E) Disciplinary. (F) Demeaning. (G) Mechanical. (H) Prone or supine restraint. (I) Pain compliance. (J) Punishment. (K) Retaliatory. (24) ADDITIONAL STANDARDS FOR BEHAVIOR SUPPORTS. For the purpose of this section, a designated person is the person implementing the behavior supports identified in an individual's Positive Behavior Support Plan. (a) SAFEGUARDING INTERVENTIONS AND SAFEGUARDING EQUIPMENT. (A) A designated person must only utilize a safeguarding intervention or safeguarding equipment when: (i) BEHAVIOR. Used to address an individual's challenging behavior, the safeguarding intervention or safeguarding equipment is included in the individual's Positive Behavior Support Plan written by a qualified behavior professional as described in OAR 411-304-0150 and implemented consistent with the individual's Positive Behavior Support Plan. (ii) MEDICAL. Used to address an individual's medical condition or medical support need, the safeguarding intervention or safeguarding equipment is included in a medical order written by the individual's licensed health care provider and implemented consistent with the medical order. (B) An individual, or as applicable their legal representative, must provide consent for a safeguarding intervention or safeguarding equipment through an individually-based limitation in accordance with OAR 411-004-0040. (C) Prior to utilizing a safeguarding intervention or safeguarding equipment, a designated person must be trained. (i) For a safeguarding intervention, the designated person must be trained in intervention techniques using an ODDS-approved behavior intervention curriculum and trained to an individual's specific needs. Training must be conducted by a person who is appropriately certified in an ODDS-approved behavior intervention curriculum. (ii) For safeguarding equipment, the designated person must be trained on the use of the identified safeguarding equipment. (D) A designated person must not utilize any safeguarding intervention or safeguarding equipment not meeting the standards set forth in this rule even when the use is directed by an individual or their legal or designated representative, regardless of the individual's age. (b) EMERGENCY PHYSICAL RESTRAINTS. The use of an emergency physical restraint when not written into a Positive Behavior Support Plan, not authorized in an individual’s ISP, and not consented to by the individual in an individually-based limitation, must only be used when all of the following conditions are met: (A) In situations when there is imminent risk of harm to the individual or others. (B) Only as a measure of last resort. (C) Only for as long as the situation presents imminent danger to the health or safety of the individual or others. (25) AGENCY EMPLOYEES. (a) A provider agency may not knowingly allow an agency employee to provide community living supports skills training or attendant care services, other than DSA or employment services, to an individual that also engages the agency employee's services as a personal support worker. (b) A provider agency may not allow: (A) The spouse of an individual receiving services to provide services as an employee of the agency to the employee’s spouse. (B) The parent of a minor child to provide services as an employee of the agency to the employee’s own child unless: (i) The child is enrolled in the Children’s Extraordinary Needs Program; and (ii) The parent provider and no other family member of the parent provider has an administrative role, leadership role, or ownership interest, in the provider agency. (c) No later than January 1, 2023, a provider agency must only deliver community living supports through employees of the agency. Contracted direct support professionals are prohibited. (26) PARENT PROVIDERS FOR THE CHILDRENS EXTRAORDINARY NEEDS PROGRAM. (a) A provider agency must assure that a parent provider is in compliance with OAR chapter 411, division 440. (b) A provider agency may not allow a child enrolled in the Children's Extraordinary Needs Program to receive more than a total of 20 hours of attendant care from one or more parent providers in a workweek, not to exceed the child’s total monthly hour allocation as described in OAR 411-450-0060. (c) A parent provider is not eligible to be paid using Department funds for attendant care delivered when any of the conditions in OAR 411-440-0050(2) are present. (27) WAGES. A provider agency must maintain an average wage for direct support professionals who deliver hourly attendant care, not including DSA, that is equal to or greater than the hourly rate stated in the Department’s approved published rate model. (28) ANNUAL REPORTING. A provider agency must submit annual data to the nationally standardized reporting survey organization specified by the Department using the instructions provided by the organization and the Department.