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Oregon Bulletin

September 1, 2013

Oregon Health Authority, Division of Medical Assistance Programs, Chapter 410

Rule Caption: Align with Department of Human Services OAR chapter 461, medical eligibility rules

Adm. Order No.: DMAP 39-2013(Temp)

Filed with Sec. of State: 7-26-2013

Certified to be Effective: 8-1-13 thru 1-28-14

Notice Publication Date:

Rules Amended: 410-120-0006

Subject: The General Rules Program administrative rules govern the Division’s payments for services provided to clients, and medical assistance eligibility determinations made by the Oregon Health Authority. In coordination with the Department of Human Services’ (Department) revision of medical eligibility rules in chapter 461, the Division is amending OAR 410-120-0006 to assure that the Division’s medical eligibility rule aligns with and reflects information found in the Department’s medical eligibility rules. In OAR

   410-120-0006, the Division adopts in rule by reference Department eligibility rules and must update OAR 410-120-0006 in conjunction.

Rules Coordinator: Cheryl Peters—(503) 945-6527

410-120-0006

Medical Eligibility Standards

As the state Medicaid and CHIP agency, the Oregon Health Authority (Authority) is responsible for establishing and implementing eligibility policies and procedure consistent with applicable law. As outlined in 943-001-0020; the Authority, and the Department of Human Services (Department) work together to adopt rules to assure that medical assistance eligibility procedures and determinations are consistent across both agencies.

(1) The Authority adopts and incorporates by reference the rules established in OAR Chapter 461 and in effect August 1, 2013, for all medical eligibility requirements for medical assistance when the Authority conducts eligibility determinations.

(2) Any reference to OAR Chapter 461 in Oregon Administrative Rules or contracts of the Authority are deemed to be references to the requirements of this rule and shall be construed to apply to all eligibility policies, procedures and determinations by or through the Authority.

(3) For purposes of this rule, references in OAR chapter 461 to the Department or to the Authority shall be construed to be references to both agencies.

(4) Effective on or after July 1, 2011 the Authority shall conduct medical eligibility determinations using the OAR chapter 461 rules which are in effect on the date the Authority makes the medical eligibility determination.

(5) A request for a hearing resulting from a determination under this rule, made by the Authority shall be handled pursuant to the hearing procedures set out in division 25 of OAR Chapter 461. References to “the Administrator” in division 25 of chapter 461 or “the Department” are hereby incorporated as references to the” Authority.”

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 413.042 & 414.065

Hist.: DMAP 10-2011, f. 6-29-11, cert. ef. 7-1-11; DMAP 18-2011(Temp), f. & cert. ef. 7-15-11 thru 1-11-12; DMAP 21-2011(Temp), f. 7-29-11, cert. ef. 8-1-11 thru 1-11-12; DMAP 25-2011(Temp), f. 9-28-11, cert. ef. 10-1-11 thru 1-11-12; DMAP 36-2011, f. 12-13-11, cert. ef. 1-1-12; DMAP 1-2012(Temp), f. & cert. e.f 1-13-12 thru 7-10-12; DMAP 2-2012(Temp), f. & cert. ef. 1-26-12 thru 7-10-12; DMAP 3-2012(Temp), f. & cert. ef. 1-31-12 thru 2-1-12; DMAP 4-2012(Temp), f. 1-31-12, cert. ef. 2-1-12 thru 7-10-12; DMAP 9-2012(Temp), f. & cert. ef. 3-1-12 thru 7-10-12; DMAP 21-2012(Temp), f. 3-30-12, cert. ef. 4-1-12 thru 7-10-12; DMAP 25-2012(Temp), f. & cert. ef. 5-1-12 thru 7-10-12; Administrative correction 8-1-12; DMAP 35-2012(Temp), f. & cert. ef. 7-20-12 thru 1-15-13; DMAP 45-2012(Temp), f. & cert. ef. 10-5-12 thru 1-19-13; DMAP 50-2012, f. 10-31-12, cert. ef. 11-1-12; DMAP 53-2012(Temp), f. & cert. ef. 11-1-12 thru 4-29-13; DMAP 56-2012(Temp), f. 11-30-12, cert. ef. 12-1-12 thru 4-1-13; DMAP 60-2012, f. 12-27-12, cert. ef. 1-1-13; DMAP 65-2012(Temp), f. 12-28-12, cert. ef. 1-1-13 thru 6-29-13; DMAP 2-2013(Temp), f. & cert. ef. 1-8-13 thru 6-29-13; DMAP 3-2013(Temp), f. & cert. ef. 1-30-13 thru 6-29-13; DMAP 5-2013(Temp), f. & cert. ef. 2-20-13 thru 6-29-13; DMAP 7-2013(Temp), f. & cert. ef. 3-1-13 thru 6-29-13; DMAP 12-2013, f. 3-27-13, cert. ef. 4-1-13; DMAP 17-2013, f. & cert. ef. 4-10-13; DMAP 24-2013, f. & cert. ef. 5-29-13; DMAP 32-2013, f. & cert. ef. 6-27-13; DMAP 39-2013(Temp), f. 7-26-13, cert. ef. 8-1-13 thru 1-28-14


Rule Caption: Amend Pharmacy & Therapeutics Committee rule to remove expiration date and clarity given to safety

Adm. Order No.: DMAP 40-2013(Temp)

Filed with Sec. of State: 8-1-2013

Certified to be Effective: 8-1-13 thru 1-28-14

Notice Publication Date:

Rules Amended: 410-121-0111

Subject: Rule changes include the removal of expiration date and addition of clarification regarding responsibility of committee to recipient safety.

Rules Coordinator: Cheryl Peters—(503) 945-6527

410-121-0111

Drug Use Review/Pharmacy and Therapeutics Committee

(1) Pursuant to Oregon Laws 2011, chapter 720 (HB 2100), the Drug Use Review Board (DUR Board) is abolished and the tenure of office for the members of the DUR Board expires. The legislature transferred the duties, functions and powers previously vested in the DUR Board to the Pharmacy and Therapeutics (P&T) Committee. This rule is retroactively effective on September 5, 2011, the date the P&T Committee was created and the DUR Board was abolished by HB 2100, and expires whenever the Oregon Health Authority (Authority) suspends the rule.

(2) Unless otherwise inconsistent with these administrative rules or other laws, any administrative rule or agency policy with reference to the DUR Board or a DUR Board volunteer, staff or contractor shall be considered to be a reference to the P&T Committee or a P&T Committee volunteer, staff or contractor. The current preferred drug list (PDL), prior authorization process and utilization review process developed by the DUR Board remains in effect until such time as the Authority, after recommendations and advice from the P&T Committee, modifies them through the adoption of new administrative rules or policies and procedures.

(3) The P&T Committee shall advise the Oregon Health Authority (Authority) on the:

(a) Implementation of the medical assistance program retrospective and prospective programs, including the type of software programs to be used by the pharmacist for prospective drug use review and the provisions of the contractual agreement between the state and any entity involved in the retrospective program;

(b) Implementation of the Practitioner Managed Prescription Drug Plan (PMPDP);

(c) Adoption of administrative rules pertaining to the P&T Committee;

(d) Development of and application of the criteria and standards to be used in retrospective and prospective drug use review, and safety edit programs in a manner that ensures that such criteria and standards are based on compendia, relevant guidelines obtained from professional groups through consensus-driven processes, the experience of practitioners with expertise in drug therapy, data and experience obtained from drug utilization review program operations. The P&T Committee must have an open professional consensus process, establish an explicit ongoing process for soliciting and considering input from interested parties, and make timely revisions to the criteria and standards based on this input and scheduled reviews;

(e) Development, selection and application of and assessment for interventions being educational and not punitive in nature for medical assistance program prescribers, dispensers and patients.

(4) The P&T Committee shall make recommendations to the Authority, subject to approval by the Director or the Director’s designee, for drugs to be included on any PDL adopted by the Authority and on the PMPDP. The P&T Committee shall also recommend all utilization controls, prior authorization requirements or other conditions for the inclusion of a drug on the PDL.

(5) The P&T Committee shall, with the approval of the Director or designee, do the following:

(a) Publish an annual report;

(b) Publish and disseminate educational information to prescribers and pharmacists regarding the P&T Committee and the drug use review programs, including information on the following:

(A) Identifying and reducing the frequency of patterns of fraud, abuse or inappropriate or medically unnecessary care among prescribers, pharmacists and recipients;

(B) Potential or actual severe or adverse reactions to drugs;

(C) Therapeutic appropriateness;

(D) Overutilization or underutilization;

(E) Appropriate use of generic products;

(F) Therapeutic duplication;

(G) Drug-disease contraindications;

(H) Drug-drug interactions;

(I) Drug allergy interactions;

(J) Clinical abuse and misuse.

(K) Patient safety

(6) Adopt and implement procedures designed to ensure the confidentiality of any information that identifies individual prescribers, pharmacists or recipients and that is collected, stored, retrieved, assessed or analyzed by the P&T Committee, staff of the P&T Committee, contractors to the P&T Committee or the Authority.

Stat. Auth.: ORS 413.042, 414.065, 414.355, 414.360, 414.365, 414.370, 414.380, Or Law 2011, chap. 720 (HB 2100)

Stats. Implemented: ORS 414.065, Or Law 2011, chap. 720 (HB 2100)

Hist.: SPD 12-2012(Temp) , f. 8-31-12, cert. ef. 9-1-12 thru 2-28-13; DMAP 42-2012(Temp), f. & cert. ef. 9-12-12 thru 3-10-13; DMAP 61-2012, f. 12-27-12, cert. ef. 1-1-13; DMAP 40-2013(Temp), f. & cert. ef. 8-1-13 thru 1-28-14


Rule Caption: Hospital Assessment Rate Increase

Adm. Order No.: DMAP 41-2013

Filed with Sec. of State: 8-1-2013

Certified to be Effective: 8-1-13

Notice Publication Date: 7-1-2013

Rules Amended: 410-050-0861

Rules Repealed: 410-050-0861(T)

Subject: This hospital assessment rule amendment increases the hospital assessment rate from 4.32% to 5.30% effective April 1, 2013. Upon adoption of this rule, the temporary rule, effective April 1, 2013, will be repealed.

Rules Coordinator: Cheryl Peters—(503) 945-6527

410-050-0861

Tax Rate

(1) The tax rate for the period beginning January 1, 2005 and ending June 30, 2006 is .68 percent.

(2) The tax rate for the period beginning July 1, 2006 and ending December 31, 2007 is .82 percent.

(3) The tax rate for the period beginning January 1, 2008 and ending June 30, 2009 is .63 percent.

(4) The tax rate for the period of January 1, 2008 through June 30, 2009 does not apply to the period beginning July 1, 2009.

(5) The tax rate for the period beginning July 1, 2009 and ending September 30, 2009 is .15 percent.

(6) The tax rate for the period beginning October 1, 2009 and ending June 30, 2010 is 2.8 percent.

(7) The tax rate for the period beginning July 1, 2010 and ending June 30, 2011 is 2.32 percent.

(8) The tax rate for the period beginning July 1, 2011 and ending September 30, 2011 is 5.25 percent.

(9) The tax rate for the period beginning October 1, 2011 and ending December 31, 2011 is 5.08 percent.

(10) The tax rate for the period beginning January 1, 2012 and ending March 31, 2013 is 4.32 percent.

(11) The tax rate for the period beginning April 1, 2013 is 5.30 percent.

Stat. Auth.: ORS 413.042

Stats. Implemented: 2009 OL Ch. 867 ¦ 17, 2007 OL Ch. 780 ¦ 1 & 2003 OL Ch. 736 ¦ 2 & 3

Hist.: OMAP 28-2005(Temp), f. & cert. ef. 5-10-05 thru 11-5-05; OMAP 34-2005, f. 7-8-05, cert. ef. 7-11-05; OMAP 14-2006, f. 6-1-06, cert. ef. 7-1-06; DMAP 29-2007, f. 12-31-07, cert. ef. 1-1-08; DMAP 3-2008, f. & cert. ef. 1-25-08; DMAP 24-2009, f. & cert. ef. 7-1-09; DMAP 25-2009(Temp), f. & cert. ef. 7-15-09 thru 1-10-10; DMAP 27-2009, f. & cert. ef. 9-1-09; DMAP 33-2009, f. & cert. ef. 10-1-09; DMAP 21-2010, f. 6-30-10, cert. ef. 7-1-10; DMAP 16-2011(Temp), f. & cert. ef. 7-1-11 thru 11-1-11; DMAP 26- 2011(Temp), f. 9-29-11, cert. ef. 10-1-11 thru 11-1-11; DMAP 31-2011, f. 10-28-11, cert. ef. 11-1-11; DMAP 50-2011(Temp), f. 12-30-11, cert. ef. 1-1-12 thru 4-30-12; DMAP 8-2012, f. 2-27-12, cert. ef. 3-1-12; DMAP 15-2013(Temp), f. & cert. ef. 4-1-13 thru 9-27-13; DMAP 41-2013, f. & cert. ef. 8-1-13


Rule Caption: Process for Non-Traditional Health Worker Training, Certification, Registry Enrollment and Training Program Criteria

Adm. Order No.: DMAP 42-2013(Temp)

Filed with Sec. of State: 8-2-2013

Certified to be Effective: 8-2-13 thru 1-29-14

Notice Publication Date:

Rules Adopted: 410-180-0300, 410-180-0305, 410-180-0310, 410-180-0312, 410-180-0315, 410-180-0320, 410-180-0325, 410-180-0327, 410-180-0340, 410-180-0345, 410-180-0350, 410-180-0355, 410-180-0360, 410-180-0370, 410-180-0375, 410-180-0380

Subject: The Oregon Health Authority, Office of Equity and Inclusion is temporarily adopting administrative rules in chapter 410, division 180 pertaining to Non-Traditional Health Workers. House Bill 3650, passed during the 2011 legislative session, mandates that members enrolled in Oregon’s coordinated care organizations (CCOs) have access to Non-Traditional Health Workers (NTHW) to facilitate culturally and linguistically appropriate care. The purpose of these rules is to develop standard guidelines for a state-wide NTHW Program to train, certify, and provisionally certify NTHWs, including Community Health Workers, Peer Wellness Specialists, Personal Health Navigators, Peer Support Specialists, and Doulas. These rules establish competency requirements for each NTHW type; a NTHW registry and background check requirements for placement on the registry; eligibility requirements and procedures for NTHW certification and provisional certification. These rules also establish curriculum guidelines and procedures for training programs to be approved by the Authority. OAR 410-180-0310 through 0345 shall become effective October 1, 2013.

Rules Coordinator: Cheryl Peters—(503) 945-6527

410-180-0300

Purpose and Effective Dates

The purpose of these rules is to establish criteria, description, and training requirements for Non-Traditional Health Workers (NTHW) which include community health workers, personal health navigators, peer wellness specialists and other health care workers not regulated or certified by the state of Oregon. These rules set forth the procedures for NTHW certification and enrollment in a registry maintained by the Authority. These rules also establish curriculum guidelines for training programs seeking to train NTHWs and the procedures for Authority approval of training programs. OAR 410-180-0310 through 0345 shall become effective October 1, 2013.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0305

Definitions

The following definitions apply to OAR 410-180-0300 through 410-180-0380:

(1) “Authority” means the Oregon Health Authority.

(2) “Authority Approved Training Program” (Training program) means an organization that has a training program with curriculum that meets Authority standards and has been approved by the Authority to train NTHWs.

(3) “Certified Non-Traditional Health Worker” means an individual who has successfully completed a training program or doula training as required by these rules, has applied for and been certified by the Authority for one of the NTHW types; or a grandfathered NTHW who has been certified by the Authority.

(4) “Community Based Organization” (CBO) means a public or private nonprofit organization of demonstrated effectiveness that is representative of a community or significant segments of a community, which may be located within or in close proximity to the community it serves; and is engaged in meeting that community’s needs in the areas of social, human, or health services.

(5) “Community Health Worker” has the meaning given that term in ORS 414.025.

(6) “Contact Hour” means a training hour, which includes classroom, group or distance learning. Contact hour does not include homework time, preparatory reading, or clinical practicum.

(7) “Competencies” mean key skills and applied knowledge necessary for NTHWs to be effective in the work field and carry out their roles.

(8) “Doula” means a birth companion who provides personal, nonmedical support to women and families throughout a woman’s pregnancy, childbirth, and post-partum experience.

(9) “Equivalency” means an individual has fulfilled the requirements of a course or combination of courses, by completing a relatively equivalent course.

(10) “Grandfathered NTHW” means an individual who has been issued a certificate by the Authority as an NTHW as a result of their prior NTHW work experience and fulfillment of all additional requirements for grandfathering as set forth in these rules.

(11) “Incumbent Worker Training” means training offered by an Authority approved training program for individuals eligible for grandfathering that that assesses for and addresses any gaps in NTHW competencies

(12) “NTHW Applicant” means an individual who has applied for certification as an NTHW.

(13) “Non-Traditional Health Worker” (NTHW) means a community health worker, peer wellness specialist, personal health navigator, peer support specialist or doula.

(14) “Peer” means any individual who has similar life experience, either as a current or former recipient of addictions or mental health services, or as a family member of an individual who is a current or former recipient of addictions or mental health services.

(15) “Peer Support Specialist” means a person providing peer delivered services to an individual or family member with similar life experience. A Peer Support Specialist must be:

(a) A self-identified person currently or formerly receiving mental health services; or

(b) A self-identified person in recovery from an addiction disorder, who meets the abstinence requirements for recovering staff in alcohol and other drug treatment programs;

(c) A self-identified person in recovery from problem gambling; or

(d) A family member of an individual who is a current or former recipient of addictions or mental health services.

(16) “Peer Wellness Specialist” has the meaning given that term in ORS 414.025.

(17) “Personal Health Navigator” has the meaning given that term in ORS 414.025.

(18) “Provisionally Certified NTHW” means an individual who has temporary certified status, pursuant to OAR 410-180-0327.

(19) “Registry” means a list of certified NTHWs maintained by the Authority.

(20) “Training Program Applicant” means an organization that has applied for Authority approval of its training program and curricula for any of the NTHW types.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0310

Community Health Worker, Peer Wellness Specialist, Personal Health Navigator Certification Requirements

(1) To be certified as a community health worker, peer wellness specialist, or personal health navigator, an individual must successfully complete all required training offered by a training program for that individual’s NTHW type.

(2) Individuals who have worked or volunteered in the capacity of a community health worker, peer wellness specialist or personal health navigator in the state of Oregon at least 3000 hours from January 1, 2004 to June 30, 2014 but have not completed a training program are eligible for certification if they successfully complete incumbent worker training offered by a training program.

(3) Community health workers, peer wellness specialists or personal health navigators who have completed some or all of the certification training requirements may receive equivalency for previously completed training. The training program shall determine equivalency requirements.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0312

Peer Support Specialist Certification Requirements

(1) To be certified as a peer support specialist, an individual must:

(a) Successfully complete all required training offered by an Authority approved training program for peer support specialist; or

(b) Be certified by an entity whose qualifications for the certificate must have included at least: completion of an Authority approved training program for peer support specialists and that requires a minimum of 20 hours of continuing education every three years.

(2) Individuals who have worked or volunteered in the capacity of a peer support specialist in the state of Oregon at least 2000 hours from January 1, 2004 to June 30, 2014 but have not completed an approved training program are eligible for certification if they successfully complete incumbent worker training offered by a training program.

(3) Individuals who have successfully completed a training program for peer support specialists may receive equivalency for previously completed training. The Authority shall grant credit for approved hours to an applicant who has completed an Authority-Addictions and Mental Health Division (AMH) approved training curriculum.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0315

Doula Certification Requirements

To be certified in Oregon as a doula, an individual must:

(1) Successfully complete an approved doula training program; or

(2) Successfully complete all doula training requirements as described in OAR 410-180-0375 through one or a combination of doula training programs.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0320

NTHW Continuing Education Requirements

(1) To maintain certification status, all NTHWs must complete at least 20 hours of continuing education during every three year renewal period.

(2) Continuing education hours taken in excess of the total number required may not be carried over to the next renewal period.

(3) The Authority shall award continuing education hours for:

(a) NTHW training offered by a training program; and

(b) Any other training or event that has been approved by the Authority.

(4) Requests for approval of continuing education may come from the hosting organization or from a certified NTHW attending the training or event.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0325

Application and Renewal Process for NTHW Certification and Registry Enrollment

(1) Individuals seeking NTHW certification and registry enrollment must:

(a) Be at least 18 years of age;

(b) Have successfully completed all training requirements for certification pursuant to these rules; and

(c) Submit to the Authority all required documentation and a completed application on an Authority prescribed form. All application materials submitted in a language other than English must be accompanied by:

(A) An accurate translation of those documents into English; and

(B) A translator’s certification that the translated documents are accurate.

(2) Individuals seeking NTHW certification and registry enrollment as a grandfathered community health worker, peer wellness specialists, personal health navigator, or peer support specialist must comply with the requirements in section (1) and must also submit:

(a) A minimum of one letter of recommendation and competency evaluation on an Authority prescribed form from any previous employer for whom NTHW services have been provided from January 1, 2004 to June 30, 2014; and

(b) Except for peer support specialists, all NTHW’s must submit verifiable evidence of working or volunteering in the capacity of a community health worker, peer wellness specialist or personal health navigator for at least 3000 hours from January 1, 2004 to June 30, 2014;

(c) Peer support specialists must submit verifiable evidence of working or volunteering in the capacity of a peer support specialist for at least 2000 hours from January 1, 2004 to June 30, 2014;

(d) Verifiable evidence may include but is not limited to pay statement, services contract, student practicum, or intern time log.

(3) Applications are available on the NTHW program webpage or a paper copy may be obtained upon request to the Oregon Health Authority Office of Equity and Inclusion.

(4) Applicants may withdraw from the process at any time by submitting written notification to the Authority.

(5) Applicants must apply for certification within three years of completing a training program.

(6) Applicants who have completed a training program more than three years prior to application for certification shall be denied certification. If the Authority denies certification, the applicant may file an appeal with the Authority for an exemption.

(7) If the Authority determines that an applicant has met all certification requirements, the Authority shall notify the applicant in writing granting the individual certification as a NTHW and add the individual to the registry.

(8) Certification is valid for 36 months from the date of certification.

(9) A NTHW seeking certification renewal must:

(a) Submit a completed renewal application on an Authority prescribed form; and

(b) Provide written verification indicating the certificate holder has met the applicable requirements for continuing education set forth in OAR 410-180-0320.

(10) Renewal applications must be submitted to the Authority no less than 30 days prior to the expiration of the current certification period.

(11) The Authority shall remove a NTHW from the registry if the NTHW fails to renew certification within the renewal period.

(12) NTHWs who have been removed from the registry following certification expiration shall be denied renewal unless they file an appeal with the Authority and are granted an exemption.

(13) NTHWs are subject to a background check in accordance with OAR 943-007-0010 through 0501 specifically incorporating and limited to OAR 407-007-0200 to 407-007-0250, and 407-007-0280 to 407-007-0325, and 407-007-0340 to 407-007-0370 and expressly not incorporating OAR 407-007-0275(Disqualifying Convictions Under ORS 443.004 for Aging and People with Disabilities Programs) and 407-007-0277(Disqualifying Convictions under ORS 443.004 for Mental Health or Alcohol and Drug Programs) to determine whether the applicant is excluded from participation in the medical assistance program. A new or renewal applicant may be denied certification based on a fitness determination applying a weighing test for potentially disqualifying convictions or conditions, or if otherwise excluded from participation in the medical assistance program.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 181.537, 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0327

Provisional NTHW Certification

(1) Individuals may qualify for provisional certification by the Authority if:

(a) They are eligible for grandfathering as described in OAR 410-180-0310 and OAR 410-180-0312 but have not yet completed incumbent worker training; or

(b) They have completed or matriculated in a non-approved NTHW training program between February 4, 2010 and August 2, 2013 provided:

(A) The individual successfully completes the training program; and

(B) The training program includes a minimum of 40 contact hours of training.

(2) Individuals seeking provisional certification must:

(a) Be at least 18 years of age;

(b) Submit a completed application on an Authority prescribed form; and

(c) Submit one of the following:

(A) Verifiable evidence of working or volunteering in the capacity of a community health worker, peer wellness specialist, or personal health navigator for at least 3000 hours from January 1, 2004 to June 30, 2014; or

(B) Verifiable evidence of working or volunteering in the capacity of a peer support specialist for at least 2000 hours from January 1, 2004 to June 30, 2014; or

(C) Written documentation of successful completion of a NTHW training program that includes at minimum 40 contact hours of training.

(3) Applications are available on the NTHW program webpage or a paper copy may be obtained upon request to the Oregon Health Authority Office of Equity and Inclusion.

(4) If the Authority determines that an applicant has met all provisional certification requirements, the Authority shall notify the applicant in writing granting provisional certification.

(5) Provisionally certified NTHWs may become certified if:

(a) The individual successfully completes remaining training requirements or incumbent worker training from a training program within one year from the provisional certification date; or

(b) The non-approved training program completed by the provisionally certified NTHW becomes Authority approved.

(6) Provisionally certified NTHWs seeking certification must comply with OAR 410-180-0325.

(7) The Authority shall revoke provisional certification if the individual does not successfully complete the remaining training requirements within one year from the date of provisional certification.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0340

Standards of Professional Conduct

(1) A certified or provisionally certified NTHW must comply with Standards of Professional Conduct set forth in this rule. The violation of the standards may result in the denial of an application for certification or suspension or revocation of certification.

(2) NTHWs must:

(a) Acquire, maintain and improve professional knowledge and competence using scientific, clinical, technical, psychosocial, and governmental sources of information;

(b) Represent all aspects of professional capabilities and services honestly and accurately;

(c) Ensure that all actions with a client are based on understanding and implementing the core values of caring, respect, compassion, appropriate boundaries, and appropriate use of personal power;

(d) Develop alliances with the client, colleagues, other health care providers, and the community to provide care and services that are safe, effective, and appropriate to the client’s needs;

(e) Develop and incorporate respect for diverse client backgrounds including a client’s clinical diagnosis, lifestyle, sexual orientation, race, gender, ethnicity, religion, age, and socioeconomic background when planning and providing services;

(f) Act as an advocate for client and client’s needs;

(g) Respect the client’s right and responsibility for self-determination in making health care choices;

(h) Base decisions and actions on behalf of a client on sound ethical reasoning and current principles of practice;

(i) Maintain client confidentiality; and

(j) Recognize and protect a client’s rights as described in section (3) of this rule.

(3) Clients have the right to:

(a) Be treated with dignity and respect;

(b) Be free from theft, damage, or misuse of personal property;

(c) Be free from neglect of care, verbal, mental, emotional, physical, and sexual abuse;

(d) Be free from financial exploitation;

(e) Be free from physical restraints;

(f) Voice grievances or complaints regarding services or any other issue without discrimination or reprisal for exercising their rights;

(g) Be free from discrimination in regard to race, color, national origin, gender, sexual orientation, or religion; and

(h) Have client information and records confidentially maintained.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0345

Denial, Suspension or Revocation of Certification

(1) The Authority may deny, suspend, or revoke certification when an applicant or certificate holder fails to comply with ORS 414.665 or these rules.

(2) The Authority shall deny, suspend, or revoke certification pursuant to ORS 183.411 through 183.470 and the applicant or certificate holder may request a contested case hearing.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0350

Training Program Requirements

(1) All training programs must:

(a) Meet the curriculum requirements for the NTHW type being trained;

(b) Demonstrate active efforts to establish equivalency for students who have previously completed training that meets one or more training requirements for their NTHW type;

(c) Demonstrate active efforts to involve experienced NTHWs in developing and teaching the core curriculum;

(d) Demonstrate active efforts to collaborate with at least one culturally diverse CBO;

(e) Demonstrate the use of various teaching methodologies including but not limited to popular education and adult learning;

(f) Demonstrate the use of various training delivery formats including but not limited to classroom instruction, group and distance learning;

(g) Demonstrate efforts to make training inclusive and accessible to individuals with different learning styles, education backgrounds, and student needs;

(h) Demonstrate efforts to remove barriers to enrollment for students;

(i) Demonstrate inclusion of cognitive and practical examinations to evaluate and document the acquisition of knowledge and mastery of skills by the individual trained. This examination:

(A) May be any combination of written, oral, or practical competency tests; and

(B) Must assess NTHW competencies covered in the curriculum.

(j) Demonstrate the inclusion of a method or process for the individual trained to evaluate and give feedback on the training experience;

(k) Maintain an accurate record of each individual’s attendance and participation in training for at least five years after course completion;

(l) Agree to verify and provide the Authority with names of individuals who successfully completed the training program when those individuals apply for certification and registry enrollment; and

(m) Agree to issue a written letter of completion to all successful training program graduates.

(2) All training programs that provide incumbent worker training for individuals eligible to grandfather into the NTHW program must also:

(a) Require students to submit an Authority prescribed competency evaluation form from any previous employer for whom NTHW services have been provided in the five years prior to the date of application

(b) Include a pre-course assessment to evaluate student’s current level of knowledge and skill; and

(c) Provide training that addresses gaps in competencies identified in the employer competency evaluation and pre-course assessment.

(3) Training program applicants must submit an application to the Authority. At a minimum, the training program application must include:

(a) Contact information for the individual or entity, including director name and contact information;

(b) Syllabus and course materials that demonstrate curriculum requirements are met;

(c) Indication of the training type to be offered:

(A) Curriculum for community health workers, peer wellness specialists, peer support specialists, personal health navigators, and doulas; and

(B) Additional curriculum for:

(i) Community health workers;

(ii) Peer wellness specialists

(iii) Peer support specialists; and

(iv) Incumbent worker training

(d) An overview of the teaching philosophy and methodology;

(e) A description of the method of final examination as described in section (1)(h);

(f) A list of instructors, including experienced NTHWs if available;

(g) A geographic description of the training site;

(h) If the applicant is not a CBO, a signed agreement with a partnering CBO;

(i) A description of the approach for recruiting and enrolling a diverse student population to meet the needs of the community, including any strategies for reducing barriers to enrollment; and

(j) An indication of whether academic credit may be given for successful completion of training program.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0355

Application and Renewal Process for Authority Training Program Approval

(1) Training program applications are available on the NTHW program webpage or by requesting a paper copy from the Oregon Health Authority Office of Equity and Inclusion.

(2) Training program applicants must submit an application at least 90 days in advance of the first expected class day.

(3) If an application is incomplete, the Authority shall send notice requesting the additional materials required. The notice shall specify the date by which additional materials must be submitted. Unless the Authority grants an extension, if the applicant does not respond within the specified time, the Authority shall return the application to the applicant and take no further action.

(4) If the Authority determines that an applicant has met all training program requirements, the Authority shall send written notice of program approval. The written notice of Authority approval shall be made available to any student or partnering organization that requests a copy and, to the extent possible, displayed at the main training center.

(5) The Authority shall maintain a list of training programs. The list shall be available to the public.

(6) The training program must apply to renew its approval status every three years.

(a) Renewal applications are available on the NTHW program webpage or by requesting a paper copy from the Oregon Health Authority Office of Equity and Inclusion.

(b) Training programs must complete and submit the renewal application no less than six months prior to the expiration of the current approval period.

(c) At a minimum, training programs seeking renewal shall report:

(A) Summary of any proposed changes to the curriculum;

(B) Number of students trained in the three year approval period

(7) Training programs that fail to submit a renewal application pursuant to section (6)(b) of this rule must submit a new application and may not apply for renewal of its current approval.

(8) The Authority may conduct site visits of training programs, either prior to approving or renewing a training program application, or at any time during the three year approval period.

(9) During the three year approval period, any change made to a training program shall be reported to the Authority within 30 days of the decision to make the change.

(a) Changes that must be reported include:

(A) Changes to the training program director or primary contact;

(B) Changes to the teaching methodology;

(C) Changes to the curriculum; and

(D) Any other change that is not consistent with or not represented in the initial application for approval.

(b) If the Authority determines that the reported changes meet the training program requirements described in OAR 410-180-0350, the Authority shall approve the change.

(c) The Authority may request additional information and justification for the reported change.

(d) If the Authority determines that the reported changes do not comply with the training program requirements described in OAR 410-180-0350, the Authority may deny the change or revoke training program approval.

(10) A training program applicant or approved training program may request a temporary waiver from a requirement in these rules. A request for a waiver must be:

(a) Submitted to the Authority in writing;

(b) Identify the specific rule for which a waiver is requested;

(c) Identify the special circumstances relied upon to justify the waiver;

(d) Describe alternatives that were considered, if any, and why alternatives, including compliance, were not selected;

(e) Demonstrate that the proposed waiver is desirable to maintain or improve the training of NTHWs; and

(f) Indicate the proposed duration of the waiver, not to exceed one year.

(11) If the Authority determines that the applicant or program has satisfied the conditions of this rule, the Authority may grant a waiver.

(12) An applicant or an approved training program may not act on or implement a waiver until it has received written approval from the Authority.

(13) AMH Peer support specialist training programs that provide a minimum of 40 hours of training and approved prior to August 2, 2013, may remain approved, or receive continued approval until August 1, 2014 if:

(a) The program submits to the Authority peer support specialist renewal application form, which is available on the NTHW program webpage or by requesting a paper copy from the Oregon Health Authority Office of Equity and Inclusion.

(b) The program renewal form must be submitted no later than 60 calendar days after August 2, 2013 or the program must apply as a new PSS training program.

(c) The training program must renew within the next three years pursuant to these rules to remain approved.

(14) AMH approved peer support specialist training programs providing less than 40 hours of training and approved prior to August 2, 2013 may apply for renewal if:

(a) The program submits to the Authority peer support specialist renewal application form, available on the NTHW program webpage or by requesting a paper copy from the Oregon Health Authority Office of Equity and Inclusion.

(b) The training program must increase the curriculum to a minimum of 40 hours.

(c) The program renewal form must be submitted no later than 60 calendar days after August 2, 2013 or the program must apply as a new PSS training program.

(d) The training program must renew within the next three years pursuant to these rules to remain approved.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0360

Denial, Suspension or Revocation of Training Program Approval

(1) The Authority may deny, suspend or revoke training program approval when an applicant or approved program has failed to comply with ORS 414.665 or these rules.

(2) If the Authority denies, suspends, or revokes approval it shall send written notice and explain the basis for its decision.

(3) An applicant or approved training program may request that the Authority reconsider its decision and may request a meeting with Authority staff. The request for reconsideration and a meeting, if requested, must be submitted in writing within 20 days of the date the Authority mailed the written decision of denial, suspension or revocation. The request must contain a detailed statement with supporting documentation explaining why the requestor believes the Authority’s decision is in error. The Authority shall issue a written decision on reconsideration following review of the materials submitted by the applicant or training program and a meeting with the applicant or training program, if applicable.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0370

Community Health Workers, Peer Wellness Specialists, Personal Health Navigators, and Peer Support Specialists Certification Curriculum Standards

(1) All Authority approved curricula used to train community health workers, peer wellness specialists and personal health navigators must:

(a) Include a minimum of 80 contact hours, which addresses the core curricula topics set forth in section (2) of this rule and any other additional curriculum topics specific to the type of worker being trained;

(b) Provide training that addresses all the major roles and core competencies of community health workers, peer wellness specialists and personal health navigators in Oregon as listed and defined in Oregon Health Policy Board’s Report “The Role of Non-Traditional Health Workers in Oregon’s Health Care System” incorporated by reference. (http://www.oregon.gov/oha/oei/docs/nthw-report-120106.pdf, January 2012)

(2) An Authority approved core curriculum for community health workers,peer wellness specialists and personal health navigators shall, at a minimum, introduce students to the key principles of the following topics:

(a) Community Engagement, Outreach Methods and Relationship Building;

(b) Communication Skills, including cross-cultural communication, active listening, and group and family dynamics;

(c) Empowerment Techniques;

(d) Knowledge of Community Resources;

(e) Cultural Competency and Cross Cultural Relationships, including bridging clinical and community cultures;

(f) Conflict Identification and Problem Solving;

(g) Conducting Individual Needs Assessments;

(h) Advocacy Skills;

(i) Ethical Responsibilities in a Multicultural Context;

(j) Legal Responsibilities;

(k) Crisis Identification, Intervention and Problem-Solving;

(l) Professional Conduct, including culturally-appropriate relationship boundaries and maintaining confidentiality;

(m) Navigating Public and Private Health and Human Service Systems, including state, regional, and local;

(n) Working with Caregivers, Families, and Support Systems, including paid care workers;

(o) Trauma-Informed Care, including screening and assessment, recovery from trauma, minimizing re-traumatization;

(p) Self-Care;

(q) Social Determinants of Health;

(r) Building Partnerships with Local Agencies and Groups;

(s) The Role and Scope of Practice of Non-Traditional Health Workers;

(t) Roles and Expectations for Working in Multidisciplinary Teams;

(u) Data Collection and Types of Data;

(v) Organization Skills and Documentation and use of HIT;

(w) Introduction to Disease Processes, including chronic diseases, mental health, and addictions (warning signs, basic symptoms, when to seek medical help);

(x) Health Across the Life Span;

(y) Adult Learning Principles - Teaching and Coaching;

(z) Stages of Change;

(aa) Health Promotion Best Practices; and

(bb) Health Literacy Issues.

(3) In addition to the core curriculum set forth in section (2), training programs for community health workers shall include the following topics:

(a) Self-Efficacy;

(b) Community Organizing;

(c) Group Facilitation Skills;

(d) Conducting Community Needs Assessments;

(e) Popular Education Methods; and

(f) Principles of Motivational interviewing.

(4) In addition to the core curriculum, set forth in section (2) training programs for peer wellness specialists shall include the following topics:

(a) Self-Efficacy;

(b) Group Facilitation Skills;

(c) Cultivating Individual Resilience;

(d) Recovery, Resilience and Wellness Models; and

(e) Principles of Motivational interviewing.

(5) An Authority approved curriculum for peer support specialists shall include a minimum of 40 contact hours that include:

(a)The core curriculum set forth in section (2) (a) through (p);

(b) The Role and Scope of Practice of Peer Support Specialists; and

(c) Recovery, Resilience and Wellness.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0375

Doula Certification Curriculum Standards

(1) All Authority approved curricula used to train doulas must include a minimum of the following:

(a) 16 contact hours in Labor training;

(b) 4 contact hours in Breastfeeding training;

(c) 12 contact hours in Childbirth Education; and

(d) 6 contact hours in Cultural Competency training.

(2) Authority approved doula training curricula must also incorporate the following components and students must:

(a) Be CPR-certified;

(b) Read five books from an Authority approved reading list;

(c) Write an essay on the value of labor support;

(d) Create a community resource list;

(e) Submit evaluations from work with three families;

(f) Attend at least three births and three home visits; and

(g) Have a valid food handler’s permit.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

410-180-0380

NTHW and Training Program Complaints and Investigations

(1) Any individual may make a complaint verbally or in writing to the Authority regarding an allegation as to the care or services provided by a certified or provisionally certified NTHW or that an approved training program has violated NTHW statutes or these rules.

(2) The identity of an individual making a complaint shall be kept confidential to the extent permitted by law but may be disclosed as necessary to conduct the investigation and may include but is not limited to disclosing the complainant’s identity to the NTHW’s employer.

(3) If a complaint involves an allegation of criminal conduct or that is within the jurisdiction of another local, state, or federal agency, the Authority shall refer the matter to the appropriate agency.

(4) The Authority shall investigate complaints and take any actions that are necessary for resolution. An investigation may include but is not limited to:

(a) Interviews of the complainant, program management or staff, and other students; or

(b) Interviews of the complainant, caregivers, clients, client’s representative, client’s family members, and witnesses, and employer management and staff;

(c) On-site observations of the training program, the client, NTHW performance and client environment; and

(d) Review of documents and records.

Stat. Auth.: ORS 413.042, 414.635 & 414.665

Stats. Implemented: ORS 414.635 & 414.665

Hist.: DMAP 42-2013(Temp), f. & cert. ef. 8-2-13 thru 1-29-14

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2012.

2.) Copyright 2013 Oregon Secretary of State: Terms and Conditions of Use

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