Loading
The Oregon Administrative Rules contain OARs filed through August 15, 2014
 
QUESTIONS ABOUT THE CONTENT OR MEANING OF THIS AGENCY'S RULES?
CLICK HERE TO ACCESS RULES COORDINATOR CONTACT INFORMATION

 

OREGON HEALTH AUTHORITY,
ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 91

STATE HOSPITAL ADMISSIONS AND DISCHARGES

309-091-0000

Purpose and Scope

(1) These rules establish and define the criteria which support the proper management and utilization of services provided by the Oregon state hospital system, by limiting admissions to those most severely symptomatic individuals whose treatment and recovery needs cannot be met in a community treatment setting.

(2) These rules apply to all individuals admitted into any state hospital setting, and address differences which occur due to each individual’s legal status.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0005

Definitions

(1) “AMH” means the Addictions and Mental Health Division of the Oregon Health Authority.

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

(3) “Chief Medical Officer” (CMO) means the physician designated by the superintendent of each state institution who is responsible for the administration of medical treatment, or his or her designee.

(4) “Civil Commitment” means the individual has been committed to the Authority for emergency psychiatric care and treatment pursuant to ORS 426.070, 426.228 to 426.235 or 426.237.

(5) “Clinical Reviewer” means the Division employee designated to the role of determining eligibility for state hospital admissions.

(6) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(7) “DSM” means the most recent edition of the Diagnostic and Statistical Manual of Psychiatric Disorders, published by the American Psychiatric Association.

(8) “Forensic” means related to the law, and references individuals committed to treatment and supervision by the courts pursuant to Oregon Revised Statutes (ORS) 161.290 – 161.400.

(9) “Legal Guardian” in this rule means an individual appointed by a court of law to act as guardian of an adult having been determined to be legally incapacitated.

(10) “Licensed Residential Facility or Licensed Residential Home” means those residences defined in OAR 309, Chapter 035.

(11) “Local Mental Health Authority” (LMHA) means one of the following entities:

(a) The Board of County Commissioners of one or more counties that establishes or operates a CMHP;

(b) The tribal council of a federally recognized tribe of Native Americans that elects to enter into an agreement to provide mental health services or

(c) A regional LMHA comprised of two or more boards of county commissioners.

(12) “Primary Diagnosis” means the diagnosis which identified the condition considered the most severe for which the individual receives treatment.

(13) “Psychiatric Security Review Board” (PSRB) means board appointed by the Governor and authorized in ORS 161.385.

(14) “Responsible Party” means the LMHA, community mental health program, the Medicaid managed care organization, when applicable the individual’s legal guardian, and other parties identified by AMH.

(15) “Severe Mental Illness” (SMI) means an individual’s symptoms meet the criteria in OAR 309-091-0010.

(16) “State Hospital” means any campus of the Oregon State Hospital (OSH) system, and the Blue Mountain Recovery Center (BMRC).

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

Civil Commitment and Guardian Admissions and Discharges

309-091-0010

Civilly Committed and Guardian Authorized Admission Criteria

Each non-forensic individual admitted to a state hospital must meet the following criteria:

(1) The individual must be age 18 or older;

(2) The individual must be named in a current civil commitment order, or the individual’s legal guardian must have signed consent for admission;

(3) There must be recent documentation by a qualified professional that the individual is experiencing an Axis I diagnosis of a mental disorder with severe psychotic symptoms, such as schizophrenia, delusional disorder, affective disorder, mood disorder or other disorders which manifest psychotic symptoms as defined in the most recent version of the DSM; and

(4) The current symptoms must be of such severity that the resulting symptoms require extended placement in a 24-hour medically supervised psychiatric hospital. Severity is established by a determination of:

(a) The degree of dangerousness to self;

(b) The degree of dangerousness to others; and

(c) The degree of the individual’s inability to meet his or her basic health and safety needs.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0015

Determining Need for State Hospital Care

(1) State hospital level of care is determined appropriate when the individual’s condition or symptoms have not improved in an acute care setting despite having received comprehensive psychiatric and medical assessment, treatment and/or community services typical for a psychiatric illness or psychiatric emergency.

(2) Prior to referral for admission to a state hospital, the individual should have received:

(a) A comprehensive medical assessment to identify conditions that may be causing, contributing to, or exacerbating the mental illness;

(b) Services from an appropriate medical professional for the treatment and stabilization of any medical or surgical conditions that may be contributing to or exacerbating the mental illness and

(c) Treatment in an acute setting within the parameters of the most recent version of the American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders.

(d) In addition there must be evidence of additional treatment and services having been attempted, including:

(A) Use of evidence-based or promising psychosocial interventions which were delivered in relevant culturally-competent, strength-based, person-centered and trauma-informed manners and which adequately treated the assessed and/or expressed needs of the individual. When requested by the individual, treatments should include members of the individual’s family, support network and /or peers;

(B) Documentation of ongoing review and discussion of options for discharge to non-hospital levels of care; and

(C) Documentation of services and supports attempted by the responsible party to divert admission and establish treatment and recovery in a non-hospital setting.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0020

Neuropsychiatric and Geropsychiatric Admissions

Admissions due primarily to symptoms resulting from a traumatic or acquired brain injury, dementia or other cognitive disorders, or an organic brain syndrome due to a medical condition may occur on a case-by-case basis when, as determined by the designated clinical reviewer, the individual’s condition or symptoms would likely improve if treated in a state hospital, and at least one of the following:

(1) Denial of admission will result in a serious health or safety issue for the individual; or

(2) Denial of admission will cause a specifically described community safety issue; or

(3) Denial of admission will result in the significant worsening of the individual’s condition.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0025

Exclusion Criteria and Exceptions

(1) State hospitals are intended to provide recovery-oriented intervention for individuals experiencing symptoms related to a severe, persistent and disabling mental illness.

(2) Admissions must not be based upon a primary diagnosis of the following related conditions:

(a) An acute or existing medical or surgical condition which requires primary placement in a medical setting and which cannot be safely or adequately treated within a state hospital facility;

(b) Delirium;

(c) Pervasive Developmental Disorder;

(d) Intellectual Developmental Disorder;

(e) Substance Use or Substance Abuse Disorder or

(f) Personality Disorder.

(3) Administrative transfers from the Oregon Department of Correction of individuals for the purpose of treatment may occur in accordance with OAR 291-047-0021. Individuals civilly committed upon discharge from the Oregon Department of Correction must meet the admission criteria and the process defined in this rule.

(4) Administrative transfers from the Oregon Youth Authority of individuals over the age of 18 for the purpose of stabilization and evaluation not exceeding 30 days may occur in accordance with OAR 416-425-020.

(a) Individuals transferred for the purpose of stabilization and evaluation for a period of time exceeding 30 days may occur in accordance with OAR 416-425-020.

(b) Individuals over the age of 18 who are civilly committed upon discharge from the Oregon Youth Authority must meet the admission criteria and the process defined in this rule.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0030

Discharge Planning

(1) The state hospital will notify the responsible parties of each admission, unit or campus transfer, and each hospital treatment team determination related to assessing discharge readiness.

(2) The responsible party must arrange housing, treatment and other services assessed as needed to support the continuity of care necessary to maintain the individual’s stability in the community.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0035

Discharge Criteria and Procedures for Civil Commit or Guardian

(1) The state hospital will periodically assess the individual’s continued need for state hospital level of care based upon the admission criteria established in these rules.

(2) The state hospital retains the authority to solely determine when someone no longer needs state hospital level of care based on standardized criteria adopted by the hospital. Whenever possible, the decision should be made in collaboration with the responsible party and legal guardian, when applicable.

(3) An individual determined ready for discharge may later be determined not ready for discharge and removed from the discharge ready list.

(4) Individuals with an active discharge and community placement plan who no longer meet the state hospital criteria as defined in these rules shall not remain in an Oregon state hospital.

(5) Prior to an individual no longer needing state hospital level of care, the hospital will collaborate with the responsible party and with the patient’s legal guardian if assigned by the courts, to identify appropriate services and supports for the patient.

(6) When an individual no longer needs state hospital level of care, and an appropriate community transition plan and additional necessary supports are in place, the patient will be discharged.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

Forensic Admissions and Discharges

309-091-0040

Forensic Admission Criteria and Procedures

Forensic admissions will occur as prescribed ORS 161.327, 161.328, 161.365, 161.370.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0045

Discharge Criteria and Procedures

(1) Individuals admitted by court order after a finding of guilty except for insanity of a felony will be discharged when approved by the PSRB and in accordance with the state hospital policies and procedures.

(2) Individuals whose jurisdiction under the PSRB has ended as identified by the state hospital Legal Department shall be allowed to discharge on midnight of the final day of PSRB jurisdiction unless the hospital determines the need for civil commitment or some other legal hold.

(3) The responsible party will assess individuals ending jurisdiction and when determined appropriate, arrange housing, treatment and other services assessed as needed to support the continuity of care necessary to maintain the individual’s stability in the community.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0050

Other Forensic Discharges and Roles of Responsible Parties

(1) Individuals committed to the state hospital pursuant to ORS 161.328 and 161.370 will be discharged upon determination by the superintendent that the individual no longer presents a substantial danger to others.

(2) The responsible party must provide assistance to individuals determined through assessment as needing treatment, services or supports upon discharge.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

The official copy of an Oregon Administrative Rule is contained in the Administrative Order filed at the Archives Division, 800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the published version are satisfied in favor of the Administrative Order. The Oregon Administrative Rules and the Oregon Bulletin are copyrighted by the Oregon Secretary of State. Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

© 2013 State of Oregon All Rights Reserved​