Oregon Administrative Code

309-013-0160 Expenses (1) A service provider subject to audit under these rules shall keep its accounting records consistent with Generally Accepted Accounting Principles. Accounting records shall be retained for three years from the date of the expiration of the Division’s agree…

309-013-0170 Audit Process and Reports (1) Any person, organization, or agency, including the Division, may request an audit of a community mental health program or any service provider offering a service thereunder or any direct contractor by submitting an audit request in writi…

309-013-0180 Disposition of Audit Findings (1) To the extent an audit documents non-allowable expenditures in non-capitated programs, the Division shall recover such funds. (2) To the extent an audit report evidences non-compliance with applicable program and/or licensing rules, …

309-013-0190 Provider Appeals (1) A provider may appeal certain decisions affecting the provider by making a written request to the Division Assistant Administrator for the Office of Finance. The request must state whether the provider wants an administrative review, and/or a con…

309-013-0200 Basic Accounting Records A service provider subject to audit under these rules shall maintain a chart of accounts that defines all items included in determining the cost for each service element. The chart of accounts shall list all revenues and expense accounts. The…

309-013-0210 Internal Controls Establishing and maintaining an internal control structure is the responsibility of the service provider. Effective internal controls are considered essential to achieving the proper conduct of business with full accountability for the resources mad…

309-013-0220 Independent Audit Reports The Division may, in its discretion, accept an independent audit, in lieu of a Division audit, if it determines the workpapers and procedures of the independent auditor meet Government Auditing Standards (where applicable), Generally Accepte…

309-014-0000 Purpose and Statutory Authority (1) Purpose. These rules prescribe general administrative standards for Division community mental health programs. (2) Certificate Required: To receive a certificate for the provision of behavioral health treatment services a Community…

309-014-0005 Definitions As used in these rules: (1) “Certificate” means the document or documents issued by the Division, which identifies and declares certification of a provider pursuant to OAR 309-008-0100 to 309-008-1600. A letter accompanying issuance of the certificate wil…

309-014-0010 Purpose of a Community Mental Health Program The purpose of a CMHP is to provide a system of appropriate, accessible, coordinated, effective, efficient safety net services to meet the mental health needs of the citizens of the community. Statutory/Other Authority: OR…

309-014-0015 Division Responsibility for Community Addictions and Mental Health The Division shall assist the local mental health authority in establishing and operating community mental health services and shall integrate such services with other mental health system components …

309-014-0020 Program Director Qualifications (1) The CMHP Director shall be a full time employee of the local mental health authority or the public or private corporation operating the community mental health program; (2) The CMHP Director shall meet the following requirements: (…

309-014-0021 Management Functions (1) In addition to other duties as may be assigned in the area of developmental disability services, the CMHP shall, at a minimum, assure the following duties are performed: (a) Develop plans as may be needed to provide a coordinated and efficien…

309-014-0022 Contracts (1) In keeping with the principles of family support expressed in ORS 417.342, and notwithstanding 430.670(2) or 291.047(3), an entity operating a CMHP may purchase services for an individual from a service provider without first providing an opportunity fo…

309-014-0023 The Appeal Process (1) Notice of Appeal. (a) If a service provider believes that the contract offered by the CMHP contains terms or conditions that are not substantially similar to those established by the Division in the model contract, the service provider may appe…

309-014-0025 Management of Community Mental Health Program Areas Each CMHP contractor providing a community mental health program area under a contract with the Division is required to meet the following standards for management: (1) Organizations: (a) Each CMHP area contractor s…

309-014-0030 Management of All Service Elements All contractors providing community mental health service elements under a contract with the Division are required to meet the following standards for management: (1) Fee Policy. For all community mental health service elements, exc…

309-014-0035 Delivery of CMHP Service Elements All community mental health contractors providing community mental health service elements under a contract with the Division are required to meet the following general standards for delivery of community mental health service elemen…

309-014-0036 Records (1) Service Records. A record shall be maintained for each client who receives direct treatment training and/or care services. The record shall contain client identification, problem assessment, treatment, training and/or care plan, medical information when a…

309-014-0037 Dispute Resolution (1) The CMHP shall adopt a dispute resolution policy that pertains to disputes that may arise from contracts with service providers that deliver services funded by the Division for the CMHP. Procedures implementing this policy shall be included in …

309-014-0040 Variances (1) Requirements and standards for requesting and granting variances or exceptions are found in OAR 309-008-1600. (2) Division Review and Notification: The Division must approve or deny the request for a variance to these rules within the scope and authorit…

309-014-0300 Purpose and Scope These rules relate to the implementation of Chapter 418, Oregon Laws 2011 sections 13 through 20. The scope is limited to the creation of the Central Health Council and the implementation of the Central Oregon Health Improvement Plan. Statutory/Othe…

309-014-0310 Definitions (1) “Authority” means the Oregon Health Authority (OHA). (2) “Central Oregon Health Council” (COHC) means a council which shall, as a minimum, conduct a regional health assessment and adopt a regional health improvement plan to serve as a strategic popula…

309-014-0320 Regional Health Improvement Plan (1) The Regional Health Improvement Plan (RHIP) submitted by the Central Oregon Health Council, defined in OAR 309-014-0300, must include, but need not be limited to the following: (a) Federally required components; (b) Health policy;…

309-014-0330 Central Oregon Health Council (1) The council may not convene until the governing body of each county adopts a resolution signifying the body’s intention to do so. (2) Subsequent to the formation of the council, a county that is adjacent to Crook, Deschutes or Jeffer…

309-014-0340 Central Oregon Health Improvement Plan (COHIP) (1) The COHC shall develop a health improvement plan as detailed in OAR 309-017-0030. (2) The COHIP will replace all prior plans required by the Authority in ORS 430.630, 430.640, 431.385 and 624.510 and plans required b…

309-015-0000 Purpose and Statutory Authority (1) Purpose. These rules prescribe the eligibility criteria, methods, and standards for payments to psychiatric hospitals through the Division of Medical Assistance Programs, Oregon Health Authority. The rules apply to provision of psy…

309-015-0005 Definitions (1) “Active Treatment” means implementation of a professionally developed and supervised plan of care that is in effect within 14 days of admission and designed to achieve the patient’s discharge at the earliest possible time. Custodial care is not active…

309-015-0007 General Conditions of Eligibility and Treatment In order for payment to be made by the Division, the following conditions must be met: (1) Medicaid-eligible age. The patient must be eligible for Medicaid benefits, be aged 65 or over, aged 20 or under, or aged 21 and …

309-015-0010 Conditions of Service Provider Participation (1) Medicaid certification. A service provider must be certified by the responsible state or federal authority as meeting federal Medicaid certification requirements for psychiatric hospital inpatient services. (2) Written…

309-015-0020 Establishing the Base Year and the Initial Maximum Allowable Rate (1) Base year. In order to establish a base year rate, the Medicaid Intermediary used cost statements which overlapped the base period (July 1, 1981 through June 30, 1982) for all Oregon hospitals who …

309-015-0021 Establishing the Maximum Allowable Rate for Years Following the Base Period (1) Base rate usage. The statewide average per diem cost for the base period has been used as the fixed base for determining the maximum allowable reimbursement rate for all fiscal periods fo…

309-015-0023 Interim Rate Setting Rate establishment process. At least annually, the Medicaid intermediary will establish an interim Medicaid per diem rate for each participating psychiatric hospital, separate cost entity or distinct program within a hospital: (1) A hospital may …

309-015-0025 Retrospective Settlement Rate Setting (Year End and Final) (1) Year-end settlement process. The year-end settlement process will be as follows: (a) Upon receipt of an audited Medicaid cost report from the Supervisor of the Division Audit Section, the Revenue and Rate…

309-015-0030 Billing Requirements (1) Bill submission time limits. Bills shall be submitted to the Division through the Division of Medical Assistance Programs, on forms designated by the Medicaid Intermediary, as soon as possible after the date service is rendered. Payment shall…

309-015-0035 Payments (1) Timing. Payments to providers will be made following the month of service, based on the invoice submitted by the provider to the Division of Medical Assistance Programs. (2) Eligible services. Payments will be made for the provision of active psychiatric…

309-015-0040 Accounting and Record Keeping (1) Records retention. The provider shall maintain, for a period of not less than three years following the date of submission of the annual Medicaid cost report to the Medicaid Intermediary, financial and statistical records of the peri…

309-015-0045 Filing of Annual Medicaid Cost Report (1) Timing of report. The provider shall file annually with the Medicaid Intermediary, an annual Medicaid cost report covering actual costs based on the latest fiscal period of operation of the facility. If the provider has separ…

309-015-0050 Auditing (1) Desk review of annual Medicaid cost report. The Medicaid intermediary will analyze by desk review each annual Medicaid cost report after it has been properly completed and filed. (2) Scope of desk review. The scope of the desk review will verify, to the …

309-015-0052 Provider Sanctions (1) Basis for sanctioning. The Division will follow the Division of Medical Assistance Program rules OAR 410-120-0000 through 410-120-1980 and Section 1902 of the Social Security Act for provider sanctions. The basis for sanctioning will include: (…

309-015-0055 Appeals (1) Rate appeals. A letter will be sent notifying the provider of the interim per diem rate, the year-end settlement rate, or the final settlement rate. A provider shall notify the Division in writing within 15 days of receipt of the letter if the provider wi…

309-015-0060 Emergency Services in Non-Participating Hospitals Reimbursable services. Emergency services provided in licensed psychiatric hospitals not participating in Medicaid will be reimbursed if the Division determines they meet federal requirements for Medicare reimbursemen…

309-018-0100 Purpose and Scope (1) Purpose: These rules prescribe minimum standards for services and supports provided by addictions and mental health providers approved by the Health Systems Division of the Oregon Health Authority. (2) Scope: In addition to applicable requiremen…

309-018-0105 Definitions (1) “Abuse of an Adult” means the circumstances defined in ORS 430.735 and OAR Chapter 407, Division 45 for abuse of an adult with mental illness or who is receiving residential substance use disorder treatment or withdrawal management services. (2) “Abus…

309-018-0107 Certification Required Entities providing or seeking to provide residential treatment services under these rules shall also hold or successfully obtain from the Division a certificate to provide behavioral health treatment services under OAR 309-008-0100 to 309-008-1…

309-018-0108 Licensing Standards (1) Residential Substance Use Disorders Treatment and Recovery Services Programs shall be licensed by the Division in accordance with OAR 415-012 in order to render residential substance use disorder treatment and recovery services. A License issu…

309-018-0110 Provider Policies (1) All providers shall develop and implement written policies and procedures compliant with these rules. (2) Policies shall be available to individuals, guardians, and family members upon request. (3) Providers shall develop and implement written p…

309-018-0115 Individual Rights (1) In addition to all applicable statutory and constitutional rights, every individual receiving services has the right to: (a) Choose from available services and supports, those that are consistent with the Service Plan, culturally competent, prov…

309-018-0125 Specific Staff Qualifications and Competencies Provider must assure that staff in the following positions meet applicable qualifications, credentialing or licensing standards and competencies, including those set forth in these rules: (1) Program staff providing trea…

309-018-0130 Documentation, Training, and Supervision (1) Providers shall maintain personnel records for each program and milieu staff that contain all of the following documentation: (a) The results of a criminal records check applicable to the current position or title, and: (A…