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The Oregon Administrative Rules contain OARs filed through November 15, 2014
 
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OREGON HEALTH AUTHORITY,
PUBLIC HEALTH DIVISION

 

DIVISION 27

HOME HEALTH AGENCIES

333-027-0000

Purpose

The purpose of these rules is to establish the standards for licensure of home health agencies.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.005 - 443.090
Hist.: HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 22-1988, f. & cert. ef. 9-16-88; OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0005

Definitions

The following definitions shall apply in OAR 333-027-0000 through 333-027-0190:

(1) "Admission" means acceptance of a patient for the provision of services by an agency.

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

(3) “Agency” means Home Health Agency.

(4) "Branch Office" means a location or site from which a home health agency provides services to patients within a portion of the total geographic area served by the parent agency and does not exceed 60 miles from the parent agency.

(5) "Clinical Note" means a dated, written, and signed notation by a member of the home health agency team of a contact with the patient that describes care rendered, signs and symptoms, treatment and/or drugs given, patient's reaction, and any changes in patient's physical or mental condition.

(6) "Clinical Record" means all information and documentation pertaining to the care of a patient.

(7) "Division" means the Public Health Division of the Oregon Health Authority.

(8) "Governing Body" means the designated person(s) having ultimate responsibility for the home health agency.

(9) "Home Health Agency" means a public or private entity providing coordinated home health services on a home visiting basis.

(10) "Home Health Aide" means a person who is certified as a nursing assistant by the Oregon State Board of Nursing in accordance with OAR chapter 851, division 062 and who assists licensed nursing personnel in providing home health services.

(11) "Home Health Service" means items and services furnished to an individual by a home health agency, or by others under arrangement with such agency, on a visiting basis in a place of temporary or permanent residence used as the individual's home for the purpose of maintaining that individual at home.

(12) "Licensed Practical Nurse" means a person licensed as such by the Oregon State Board of Nursing in accordance with ORS chapter 678.

(13) "Nurse Practitioner" has the meaning given that term in ORS 678.010.

(14) "Occupational Therapist" has the meaning given that term in ORS 675.210.

(15) "Occupational Therapy Assistant" has the meaning given that term in ORS 675.210.

(16) "Parent Home Health Agency" ("Parent Agency") means an agency that has branches or subunits.

(17) “Physical Therapist Assistant" has the meaning given that term in ORS 688.010 and is licensed in accordance with 688.020

(18) "Physical Therapist" has the meaning given that term in ORS 688.010.

(19) "Physician" means a person who is licensed by the Oregon Medical Board and that meets the definition in ORS 677.010(13) and (14).

(20) “Plan of treatment” means a document developed by the treating physician or nurse practitioner in consultation with agency staff after a patient assessment that identifies the patient’s medical status and needs, and outlines the services that will be provided to the patient to meet identified needs. The plan of treatment may also be referred to as the plan of care.

(21) "Primary Agency" means the agency that admits the patient for the provision of curative, rehabilitative, and/or preventive services in the patient's home by home health professionals.

(22) "Professional Policy-Making Committee" (Committee) means a group of individuals who are appointed by the governing body of an agency, and who has authority and responsibility for the development and monitoring of all professional policies pertaining to the home health agency.

(23) "Progress Note" means a documented summary of a patient's response to care provided during a specific period of time.

(24) "Registered Nurse" means a person licensed as such by the Oregon State Board of Nursing in accordance with ORS chapter 678.

(25) "Skilled Nursing" means the patient care services pertaining to the curative, rehabilitative, or preventive aspects of nursing performed by, or under the supervision of, a registered nurse pursuant to the plan of treatment.

(26) "Social Worker" means a person who has a master's degree from a school of social work accredited by the Council on Social Work Education and has one year of social work experience in a health care setting.

(27) "Social Work Assistant" means a person who has a baccalaureate degree in social work, psychology, or another field related to social work and has at least one year of social work experience in a health care setting.

(28) "Speech Pathologist" means a person who is licensed in accordance with ORS 681.250 and has a Certificate of Clinical Competence in speech pathology or audiology from the American-Speech-Language-Hearing Association.

(29) "Stable and predictable condition" means a situation where the patient's clinical or behavioral state is known, not characterized by rapid changes, and does not require continuous reassessment and evaluation.

(30) "Subunit" means an agency that provides services for a parent agency in a geographic area different from that of the parent agency and at a distance that exceeds 60 miles from the parent agency.

(31) “Survey” means an inspection of an applicant for a home health agency license or licensed home health agency to determine the extent to which the applicant or agency is in compliance with ORS chapter 443 and these rules.

(32) "Therapeutic services" means services provided for curative, rehabilitative, or preventive purposes.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.005 & 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 22-1988, f. & cert. ef. 9-16-88; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11; PH 11-2011, f. & cert. ef. 10-27-11; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

Services and Administration

333-027-0010

Application for Licensure

(1) An agency that establishes, purports to manage or operate as a home health agency must be licensed by the Division and comply with ORS 443.005–443.095 and OAR chapter 333, division 027.

(2) An applicant wishing to apply for a license to operate a home health agency shall submit an application on a form prescribed by the Division and pay the applicable fee as specified in OAR 333-027-0025.

(3) If an owner or administrator will have direct contact with a patient, the owner or administrator must submit background information to the Division, in accordance with OAR 333-027-0064 for the purposes of conducting a criminal records check.

(4) If any of the information delineated in the agency's most recent application changes at a time other than the annual renewal date, the agency shall notify the Division in writing within 30 days.

(5) A subunit must independently comply with all licensure requirements.

(6) A branch office is part of the parent agency and therefore need not independently comply with these licensure requirements. The Division shall determine on a case-by-case basis exceptions to the 60 mile travel distance from the parent agency requirement for a branch office and subunits as defined in OAR 333-027-0005.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.015 & 443.065
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0015

Review of License Application

(1) In reviewing an application for a home health agency license, the Division shall verify that the agency:

(a) Is primarily engaged in providing skilled nursing and at least one of the following other services: physical therapy, occupational therapy, speech therapy, medical social services, home health aide, or other therapeutic services;

(b) Has a governing body established pursuant to ORS 443.055 and OAR 333-027-0060;

(c) Has policies established by professional personnel associated with the entity, including one or more physicians and one or more registered nurses, at least two of whom are neither owners or employees of the agency, and two consumers, to govern the services that it provides;

(d) Has a physician, a nurse practitioner or registered nurse supervise all services provided by the agency as described under subsection (1)(a) of this rule;

(e) Maintains clinical and financial records on all patients; and

(f) Has an overall plan and budget in effect.

(2) The Division shall conduct a survey in accordance with OAR 333-027-0035 of the agency, and may include subunits or branch locations, to determine if the agency is in compliance with ORS chapter 443 and OAR chapter 333, division 027 and has the intent to provide home health services. If an agency is in compliance and has the intent to provide home health services to patients, a license may be issued for the operation of the agency.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.015
Hist.: HD 151, f. & ef. 12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 3-1989, f. & cert. ef. 5-24-89; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0017

Approval of License Application

(1) The Division shall notify an applicant in writing if a license application is approved.

(2) A license shall be issued only for the agency and person(s) named in the application and may not be transferred or assigned.

(3) The license shall be conspicuously posted in an office that is viewable by the public.

(4) A licensed home health agency that provides personal care services that are necessary to assist an individual’s daily needs, but do not include curative or rehabilitative services is not required to be licensed as an in-home care agency. Such agencies shall comply with ORS 443.305 through 443.355 and OAR 333-536-0000 through 333-536-0125 with the exception of the licensing requirements.

Stat. Auth.: ORS 443.085
Stat. Implemented: ORS 443.015, 443.085 & 443.090
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0018

Denial of License Application

If the Division intends to deny a license application, it shall issue a Notice of Proposed Denial of License Application in accordance with ORS 183.411 through 183.470.

Stat. Auth: ORS 443.085
Stat. Implemented: ORS 443.045
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0020

Expiration and Renewal of License

(1) Each license shall expire on the 31st day of December of each calendar year.

(2) An agency shall submit a completed application for renewal on a form prescribed by the Division, accompanied by the required fee, to the Division not less than 30 days prior to the license expiration date.

(3) The Division may issue a renewal license contingent upon evidence of the agency's compliance with ORS chapter 443 and OAR chapter 333, division 027; attestation to the delivery of agency services to patient(s) during the last calendar year; and, if requested, receipt of an annual statistical report containing such information as may be prescribed by the Division.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.015
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98, Renumbered from 333-027-0095; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

Organization and Quality of Patient Care

333-027-0025

Fees

(1) The fee for an initial agency license shall be $1,600 plus an additional $1,600 for each subunit of a parent agency.

(2) If the ownership of an agency changes, other than at the time of the annual renewal, the agency's licensure fee shall be $500, plus an additional $500 for each subunit. If the change of ownership of the agency does not involve the majority owner or partner, or the administrator operating the agency, the license fee shall be $100.

(3) The annual license renewal fee for an agency shall be $850 plus an additional $850 for each subunit.

(4) A hospital exempted under ORS 443.025 may provide home health services without maintaining a separate governing body and administrative services so long as the services provided meet the requirements of 443.005 through 443.095 and the hospital pays the home health licensing fee under 443.035.

(5) License fees will not be prorated and are non-refundable.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.015 & 443.035
Hist.: HD 151, f. & ef. 12-30-77; HD 20-1981, f. & ef. 10-9-81; HD 21-1986(Temp), f. & ef. 12-24-86; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98, Renumbered from 333-027-0075; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0029

Denial, Suspension, or Revocation of License

(1) The Division may deny an agency's initial or renewal application, and may suspend or revoke an agency's license for failure to comply with ORS 443.004, 443.005 through 443.105 or OAR chapter 333, division 027.

(2) If the Division intends to suspend or revoke an agency license, it shall do so in accordance with ORS Chapter 183.411 through 183.470.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.045
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0033

Return of Agency License

Each license certificate in the licensee’s possession shall be returned to the Division immediately upon the suspension or revocation of the license, failure to renew the license by the date of expiration, or if operation is discontinued by the voluntary action of the licensee.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0036

Surveys

(1) The Division shall, in addition to any investigations conducted pursuant to OAR 333-027-0038, conduct at least one on-site inspection of each agency prior to licensure and once every three years thereafter as requirement of licensing and at such other times as the Division deems necessary.

(2) In lieu of the on-site inspection required by section (1) of this rule, the Division may accept a certification or accreditation from a federal agency or an accrediting body approved by the Division that the state licensing standards have been met if the agency:

(a) Notifies the Division to participate in any exit interview conducted by the federal agency or accrediting body; and

(b) Provides copies of all documentation concerning the certification or accreditation requested by the Division.

(3) An agency shall permit Division staff access to any location from which it is operating its agency or providing services during a survey.

(4) A survey may include but is not limited to:

(a) Interviews of patients, patient family members, agency management and staff;

(b) On-site observations of patients and staff performance;

(c) Review of documents and records;

(d) Patient audits.

(5) An agency shall make all requested documents and records available to the surveyor for review and copying.

(6) Following a survey, Division staff may conduct an exit conference with the agency owner or his or her designee. During the exit conference, Division staff shall:

(a) Inform the agency representative of the preliminary findings of the inspection; and

(b) Give the person a reasonable opportunity to submit additional facts or other information to the surveyor in response to those findings.

(7) Following the survey, Division staff shall prepare and provide the agency owner or his or her designee specific and timely written notice of the findings.

(8) If the findings result in a referral to another regulator agency, Division staff shall submit the applicable information to that referral agency for its review and determination of appropriate action.

(9) If no deficiencies are found during a survey, the Division shall issue written findings to the agency owner indicating that fact.

(10) If deficiencies are found, the Division shall take informal or formal enforcement action in compliance with OAR 333-027-0180 or 333-027-0185.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.019 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0037

Complaints

(1) Any person may make a complaint verbally or in writing to the Division regarding an allegation as to the care or services provided by a home health agency or violations of home health agency laws or regulations.

(2) The identity of a person making a complaint will be kept confidential.

(3) Information obtained by the Division during an investigation of a complaint or reported violation under this section is confidential and not subject to public disclosure under ORS 192.410 through 192.505.

(4) Upon the conclusion of the investigation, the Division may publicly release a report of its findings but may not include information in the report that could be used to identify the complainant or any patient of a home health agency. The Division may use any information obtained during an investigation in an administrative or judicial proceeding concerning the licensing of a home health agency.

(5) An employee or contract provider with knowledge of a violation of ORS Chapter 443 or OAR chapter 333, division 027, shall use the reporting procedures established by the home health agency before notifying the Division or other state agency of the inappropriate care or violation, unless the employee or contract provider:

(a) Believes a patient’s health or safety is in immediate jeopardy; or

(b) Files a complaint in accordance with section (1) of this rule.

(6) If the complaint involves an allegation of criminal conduct or an allegation that is within the jurisdiction of another local, state, or federal agency, the Division will refer the matter to that agency.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.355
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0038

Investigations

(1) An unannounced complaint investigation will be carried out within 45 calendar days of the receipt of the complaint and may include, but is not limited to:

(a) Interviews of the complainant, caregivers, patients, a patient’s representative, a patient’s family members, witnesses, and agency management and staff;

(b) On-site observations of the patient(s), staff performance, patient environment; and

(c) Review of documents and records.

(2) Should the complaint allegation represent an immediate threat to the health or safety of a patient, the Division will notify appropriate authorities to ensure a patient's safety, and an investigation will be commenced within two working days.

(3) An agency shall permit Division staff access to the agency during an investigation.

(4) The agency shall cooperate with investigations of allegations of client abuse and neglect conducted by the Department of Human Services, Oregon Health Authority, Adult Protective Services, and other agencies such as law enforcement.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.355
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0040

Services and Supplies

If services or supplies are required by law to be prescribed by a physician or a nurse practitioner, the agency shall offer or provide such services and supplies only under an order for treatment and plan of treatment. Services and supplies offered or provided by an agency shall include only the following:

(1) Nursing care provided by or under the supervision of a registered nurse;

(2) Physical, occupational, or speech therapy, or medical social services;

(3) Other therapeutic services conforming to generally accepted and established standards;

(4) Home health aide services; and

(5) Medical supplies, other than drugs and biologicals, and medical appliances. When patient care supplies are stored in the agency, the agency shall store such supplies in a manner that prevents their contamination and ensures that the supplies do not exceed the manufacturer’s expiration date.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.075
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1986, f. & ef. 12-9-86; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-23-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0050

Changes in Services Provided

(1) An agency must obtain written approval from the Division prior to the implementation of the provision of additional services. When an agency applies for approval of additional services, the agency must provide evidence of:

(a) Governing body approval of addition of the services and all revisions in agency policies pertaining to the new services;

(b) The agency's professional policy-making committee development and approval of all policies and procedures pertaining to the new services; and

(c) Adherence to agency personnel policies and ORS Chapter 443 and OAR chapter 333, division 027 by all individuals providing services through the agency. If a new service is provided under the designation of "other therapeutic services" and is not in a category of licensure/certification covered by Oregon law, the governing body must designate and approve standards of educational or technical qualifications of personnel providing the services.

(2) An agency must notify the Division if it no longer provides a service listed on its current license.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0060

Administration of Home Health Agency

An agency shall clearly set forth in writing the organization, services provided, administrative control, and lines of authority for the delegation of responsibility to the patient care level. An agency shall not delegate administrative and supervisory functions to another agency, individual, or organization.

(1) The primary agency shall monitor and control all services provided through contractual agreements between the primary agency and any patient service provider.

(2) An agency shall maintain appropriate administrative records for each of its offices. If an agency has any branch offices, it shall ensure that each branch office is part of the agency and shares administration, supervision, and services on a daily basis.

(3) If an agency chooses to provide professional students with a practicum in home health, the governing body must ensure that:

(a) A contract between the agency and the accredited educational institution is in effect and it includes at a minimum, a description of:

(A) Program objectives;

(B) Program coordination;

(C) Student supervision;

(D) Adherence to agency policy; and

(E) Conformance with applicable professional practice laws, rules, and regulations.

(b) The agency maintains documentation of each practicum and the student's activities, supervision and the evaluation of these activities.

(c) The agency maintains documentation of patient care services provided by the student.

(4) An agency's governing body, or its designee, shall assume full legal and fiscal responsibility for the agency's operation. The agency's governing body shall provide for effective communication with administration of the agency and the owner of the agency.

(5) An agency's governing body shall:

(a) Employ a qualified administrator, unless exempted under ORS 443.025, who may also serve as Director of Professional Services;

(b) Regularly monitor the performance of the administrator;

(c) Appoint a professional policy-making committee;

(d) Adopt and annually review its written by-laws or acceptable equivalent; and

(e) Document all decisions affecting home health services.

(6) The Administrator shall have the following qualifications:

(a) A physician or registered nurse, currently licensed in Oregon, who has education, experience, and knowledge in community health service systems appropriate to the fulfillment of his/her responsibilities; or

(b) An individual who has education, experience, and knowledge in a related community health service systems and at least one year overall administrative experience in home health care or related community health program appropriate to the fulfillment of his/her responsibilities.

(7) The Administrator shall:

(a) Have authority and responsibility for the agency's overall management and operation;

(b) Organize and direct the agency's ongoing functions;

(c) Maintain ongoing communication between agency's governing body, professional policy-making committee, and staff;

(d) Employ qualified personnel and ensure the provision of adequate staff education and the completion of performance evaluations;

(e) Involve the Director of Professional Services in health care decisions;

(f) Ensure the accuracy of information provided to the public regarding the agency and its services;

(g) Implement an effective budgeting and accounting system;

(h) Designate, in writing, an individual qualified to serve as acting administrator in the administrator's absence; and

(i) Ensure that adequate and appropriate staff resources are available and used to meet the care needs of the agency's patients as identified in the plans of treatment.

(8) The agency shall employ a Director of Professional Services who must be a physician or registered nurse. The agency shall ensure that the Director of Professional Services or a similarly qualified alternate, designated in writing, is available for consultation at all times during operating hours of the agency. The Director of Professional Services or designee shall have written authority, responsibility, and accountability for:

(a) Functions, activities, and evaluations of all health care personnel;

(b) The quality of home health services;

(c) Orientation and in-service education for all agency health care personnel;

(d) Coordination of home health services;

(e) Development and documentation of all written material related to agency services, including policies, procedures, and standards;

(f) Participation and involvement in employment decisions affecting home health care personnel;

(g) Assignment of adequate and appropriate staff resources to meet the home health care needs of the agency's patients; and

(h) Designating, in writing, a person qualified to serve as acting Director of Professional Services in the Director's absence.

(9)(a) The agency shall develop personnel policies which must be appropriate to the agency, be documented, and include:

(A) Hours of work;

(B) Orientation that is appropriate to the classification of the employee. The following portions of the orientation shall be completed within two weeks of employment; and shall include at a minimum: policies and procedures of the agency; job description and responsibility; role as team member providing services in the home setting; and information regarding other community agencies, infection control, ethics and confidentiality.

(C) An inservice program that provides ongoing education to ensure that staff skills are maintained for the responsibilities assigned and ensures that staff are educated in their responsibility in infection control;

(D) Work performance evaluations;

(E) Employee health program;

(F) Provisions for tuberculosis screening in accordance with OAR 333-019-0041; and

(G) Provisions for the completion of criminal records checks in accordance with ORS 443.004 and OAR 333-027-0064.

(b) Personnel records shall include job descriptions, personnel qualifications, evidence of any required licensure or certification, evidence of orientation and performance evaluations, evidence of a completed criminal records check and fitness determination.

(c) An agency may provide services by agency personnel working out of their individual homes within a portion of the geographic area served by an agency. The individual homes are not construed to be a branch. These services must be controlled, supervised, and evaluated by the agency, in accordance with all written agency policies. Such policies shall, at a minimum require documentation of:

(A) A meeting at least every two weeks of the supervisor and the individual to review the plan(s) of treatment;

(B) A telephone conference on at least a weekly basis between meetings;

(C) Supervisor participation in the development of each plan of treatment; and

(D) Procedures for submitting clinical and progress notes, summary reports, schedule of visits and periodic evaluations.

(10) An agency contracting with individual personnel or public or private entities for home health care services shall maintain written contracts and shall clearly designate:

(a) That patients are accepted for care only by the primary agency;

(b) The services to be provided;

(c) The rights and responsibilities of the contracting individual or entity in the coordination, supervision, and evaluation of the care or service provided;

(d) The obligation to comply with all applicable agency policies;

(e) The party with responsibility for development and revisions of the plan of treatment, patient assessment, progress reports, and patient care conferences, scheduling of visits or hours, and discharge planning;

(f) Appropriate documentation of services provided on record forms provided by the agency; and

(g) The terms of the agreement and basis for renewal or termination.

(11) An agency, under the direction of the governing body, shall prepare and document an overall program plan and annual operating budget. The agency's operating budget shall include all anticipated income and expenses related to items that would, under generally accepted accounting principles, be considered income and expense items. The agency's overall program plan and budget shall be reviewed and updated at least annually by a committee consisting of representatives of the governing body, the administrative staff, and the professional staff of the agency.

(12) An agency's governing body shall appoint a professional policy-making committee composed of professional personnel associated with the agency.

(a) The committee shall include one or more physicians and one or more registered nurses, at least two of whom are neither owners nor employees of the agency, and two consumers.

(b) The committee shall establish in writing and review annually, the agency's policies governing scope of services, admission and discharge policies, medical supervision, plans of treatment, emergency care, clinical records, personnel qualifications, and program evaluation.

(c) The committee shall meet as needed to advise the agency on other professional issues.

(d) The committee members shall participate with the agency staff in the annual evaluation of the agency's program.

(e) The agency shall document the committee's systematic involvement and effective communication with the governing body and the management of the agency.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.004, 443.055, 443.065 & 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 22-1988, f. & cert. ef. 9-16-88; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0064

Criminal Records Check

(1) For the purposes of this rule, the following definitions apply:

(a) “Direct contact with” means to provide home health services and includes meeting in person with a potential or current patient to discuss services offered by an agency or other matters relating to the business relationship between an agency and client;

(b) “Disqualifying condition” means a non-criminal personal history issue that makes an individual unsuitable for employment, contracting or volunteering for an agency, including but not limited to discipline by a licensing or certifying agency, or drug or alcohol dependency;

(c) “Subject Individual” (SI) means an individual on whom an agency may conduct a criminal records check and from whom an agency may require fingerprints for the purpose of conducting a national criminal records check, including:

(A) An employee or prospective employee;

(B) A contractor, temporary worker, volunteer or owner of an agency who has direct contact with an agency client or potential client; and

(C) A prospective contractor, temporary worker, or volunteer or owner who may have direct contact with an agency client.

(d) “Vendor” means a researcher or company hired to provide a criminal records check on a subject individual.

(2) An agency shall conduct a criminal records check before hiring or contracting with an SI and before allowing an SI to volunteer to provide services on behalf of the agency, if the SI will have direct contact with a patient of the agency.

(3) An SI who has or will have direct contact with a recipient of home health services may not be employed, contract with, or volunteer with an agency in any capacity if the criminal records check conducted reveals the SI has been convicted of a crime as described in ORS 443.004(3).

(4) An agency shall have a policy on criminal records check requirements which shall include weighing test actions should the background check screening indicate that an SI has been convicted for crimes against an individual or property other than those identified in ORS 443.004(3). The policy must include the following provisions for performing a weighing test:

(a) The agency shall consider circumstances regarding the nature of potentially disqualifying convictions and conditions including but not limited to:

(A) The details of incidents leading to the charges of potentially disqualifying convictions or resulting in potentially disqualifying conditions;

(B) Age of the SI at time of the potentially disqualifying convictions or conditions;

(C) Facts that support the convictions or potentially disqualifying conditions; and

(D) Passage of time since commission of the potentially disqualifying convictions or conditions.

(b) Other factors which should be considered when available include but are not limited to:

(A) Other information related to criminal activity including charges, arrests, pending indictments and convictions. Other behavior involving contact with law enforcement may also be reviewed if information is relevant to other criminal records or shows a pattern relevant to criminal history;

(B) Periods of incarceration;

(C) Status of and compliance with parole, post-prison supervision or probation;

(D) Evidence of alcohol or drug issues directly related to criminal activity or potentially disqualifying conditions;

(E) Evidence of other treatment or rehabilitation related to criminal activity or potentially disqualifying conditions;

(F) Likelihood of repetition of criminal behavior or behaviors leading to potentially disqualifying conditions, including but not limited to patterns of criminal activity or behavior;

(G) Changes in circumstances subsequent to the criminal activity or disqualifying conditions including but not limited to:

(i) History of high school, college or other education related accomplishments;

(ii) Work history (employee or volunteer);

(iii) History regarding licensure, certification or training for licensure or certification; or

(iv) Written recommendations from current or past employers;

(H) Indication of the SI’s cooperation, honesty or the making of a false statement during the criminal records check process, including acknowledgment and acceptance of responsibility of criminal activity and potentially disqualifying conditions.

(c) An agency shall consider the relevancy of the SI’s criminal activity or potentially disqualifying conditions to the paid or volunteer position, or to the environment in which the SI will work, especially, but not exclusively:

(A) Access to medication;

(B) Access to clients’ personal information;

(C) Access to vulnerable populations.

(5) An agency shall document the weighing test and place in the employee’s file.

(6) A background check shall be performed by:

(a) The Department of Human Services Background Check Unit; or

(b) A vendor that:

(A) Is accredited by the National Association of Professional Background Screeners (NAPBS); or

(B) Meets the following criteria:

(i) Has been in business for at least two years;

(ii) Has a current business license and private investigator license, if required in the company’s home state; and

(iii) Maintains an errors and omissions insurance policy in an amount not less than $1 million.

(7) An agency may use the Oregon State Police, Open Records Unit in order to fulfill the state records requirement for a criminal records check, however, an agency would still need to complete a nationwide check through a qualified vendor.

(8) The criminal records check must include the following:

(a) Name and address history trace;

(b) Verification that the SI’s records have been correctly identified, via date of birth check and Social Security number trace;

(c) A local criminal records check, including city and county records for SI’s places of residence for the last seven years;

(d) A nationwide multijurisdictional criminal database search, including state and federal records;

(e) A nationwide sex offender registry search;

(f) The name and contact information of the vendor who completed the background check;

(g) Arrest, warrant and conviction data, including but not limited to:

(A) Charge(s);

(B) Jurisdiction; and

(C) Date.

(h) Source(s) for data included in the report.

(9) An agency shall perform and document a query of an SI with the National Practitioner Data Bank (NPDB) and the List of Excluded Individuals and Entities (LEIE).

(10) All criminal records checks conducted under this rule shall be documented in writing and made part of the agency’s personnel files.

(11) An agency that has a contract with the Department of Human Services (Department) or Oregon Health Authority for the provision of home health services on or after April 1, 2012 and who is subject to the Department’s criminal records check rules does not have to comply with section (12) of this rule.

(12) For an SI working or volunteering for an agency on or after July 6, 2011, an agency shall have until July 1, 2012 to ensure that the agency is in compliance with section (3) of this rule.

(13) On or after April 1, 2012 an agency shall ensure that a criminal records check is performed on an SI every three years from the date of the SIs last criminal records check in accordance with these rules.

(14) Notwithstanding sections (12) and (13) of this rule, the Division and not the agency shall conduct a criminal records check on an owner of any agency who is subject to a criminal records check under subsection (1)(c) of this rule. The Division shall conduct a criminal records check:

(a) At the time of application for a person who applies for a license on or after April 1, 2012 and every three years thereafter.

(b) By April 1, 2013 for an agency that is licensed on or before April 1, 2012, and every three years thereafter.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.004 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0070

Acceptance of Patients

An agency shall accept patients for treatment on the basis of a reasonable expectation that the patient's needs can adequately be met by the agency in the patient's residence. The agency shall consider the following in relation to acceptance of its patients:

(1) Adequacy and suitability of the agency's staff and resources to provide needed services;

(2) Assessment of the patients' medical, nursing, and social needs as they relate to the benefits of home care;

(3) The services provided by the agency;

(4) Assurance that services can be effectively coordinated with care provided by other organizations and individuals;

(5) Degree of patient and family awareness of their rights and responsibilities;

(6) A plan to meet medical emergencies;

(7) Availability, ability, and willingness of others to participate in the care;

(8) Adequacy of physical facilities and equipment; and

(9) Attitudes of the patient and family.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98

333-027-0080

Patients' Rights

(1) Bill of Rights: An agency must provide each patient with a written notice of the patient's rights prior to furnishing care to the patient or during the initial evaluation visit prior to the initiation of treatment. This notice shall state that a patient of the agency has the following rights:

(a) The right to have personal property treated with respect;

(b) The right to voice grievances regarding treatment or care, a lack of respect for property by anyone furnishing services on behalf of the agency, or any other issue, without discrimination or reprisal for exercising such rights. The agency must investigate all complaints made by the patient or the patient's family or guardian regarding the above and must document the investigation and the resolution of the complaint;

(c) The right to be informed, in advance, about the care to be furnished, any changes in the care to be furnished, the disciplines that will furnish care, and the frequency of visits proposed to be furnished;

(d) The right to participate in the planning of care;

(e) The right to have clinical records confidentially maintained by the agency;

(f) The right to be advised, before care is initiated, of the extent that payment for the agency services may be expected from Medicare or other sources, and the extent that payment may be required from the patient. The agency must provide this information orally and in writing before care is initiated; and

(g) The right to be advised orally and in writing of any changes in the information provided in accordance with subsection (1)(f) as soon as possible, but no later than 30 working days from the date that the agency becomes aware of a change.

(2) Health Care Directives: An agency shall maintain written policies and procedures, applicable to any person 18 years of age or older, or to any adult as defined under ORS 127.505, who is receiving health care by, or through, the agency, that provide for:

(a) Delivery to the patient or the patient's legal representative of the following information and materials, in written form, without recommendation:

(A) Information on the rights of the individual under Oregon law to make health care decisions;

(B) Information on the policies of the agency with respect to the implementation of the rights of the individual under Oregon law to make health care decisions;

(C) A copy of the advance directive set forth in ORS 127.531 along with a disclaimer attached to each form in at least 16-point bold type stating "You do not have to fill out and sign this form"; and

(D) The name of a resource that can provide additional information concerning the forms for advance directives.

(b) Documentation placed prominently in the patient's record and reflecting whether the patient has executed an advance directive.

(c) Compliance by the agency with Oregon law relating to advance directives; and

(d) Education of agency personnel and the community on issues relating to advance directives.

(3) An agency shall provide the written information described in section (2) to the patient not later than 15 days after the initial provision of care by the agency, but in any event before discharge of the patient;

(4) An agency need not furnish a copy of an advance directive to a patient or the patient's legal representative if it has reason to believe that the patient has received a copy of an advance directive in the form set forth in ORS 127.531 within the preceding 12-month period or has previously executed an advance directive.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87. ef. 12-1-87; OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0090

Plan of Treatment

The primary agency is responsible for the patient's plan of treatment signed by the physician or nurse practitioner, including home health services provided to the patient through contractual arrangements with other organizations or individuals. A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient. When rehabilitation therapy service (speech therapy, physical therapy or occupational therapy) is the only service ordered by the physician, and if the need for that service establishes program eligibility, the initial assessment visit may be made by the appropriate rehabilitation skilled professional.

(1) The agency shall ensure that the plan of treatment is developed in consultation with the agency personnel and established at the time of, or prior to, acceptance of the patient.

(2) The agency shall ensure that the plan of treatment is transmitted to the patient's physician or nurse practitioner for signature within 10 calendar days of admission to service.

(3) The plan of treatment shall cover the following:

(a) All pertinent diagnoses, mental status, types of services and equipment required;

(b) Frequency of visits;

(c) Prognosis;

(d) Rehabilitation potential;

(e) Functional limitations;

(f) Activities permitted;

(g) Nutritional requirements;

(h) Medications and treatments;

(i) Safety measures to protect against injury;

(j) Instructions for timely discharge or referral; and

(k) Any other appropriate items.

(4) If a patient is accepted under a plan of treatment that cannot be completed until after an evaluation visit, the physician or nurse practitioner shall be consulted to approve revisions to the original plan.

(5) Orders for therapy services shall include the specific procedures and modalities to be used and, as appropriate, the amount, frequency, and duration.

(6) The therapist and other agency personnel shall participate in developing the plan of treatment.

(7) The plan of treatment shall be signed by the physician or nurse practitioner and included in the patient's clinical record within the time period specified in the agency's policy but no longer than 30 calendar days after admission.

(8) The agency shall submit all plans of treatment to the primary physician or nurse practitioner and shall send copies to other physicians or nurse practitioners involved in the patient's care.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.075 & 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0100

Periodic Review of Plan of Treatment

An agency shall ensure that:

(1) The plan of treatment shall be reviewed by the attending physician or nurse practitioner and agency personnel as often as the patient's condition requires, but at least once every two months;

(2) Agency professional personnel promptly alert the physician or nurse practitioner to any changes that suggest a need to alter the plan of treatment;

(3) Information provided to the physician or nurse practitioner is documented in the clinical record; and

(4) The updated plan of treatment is included in the patient's clinical record within 30 calendar days of the revision.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.075 & 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0110

Conformance with Physician's or Nurse Practitioner's Orders

(1) Agency personnel shall administer drugs and treatments only as ordered by the patient's physician in accordance with 42 CFR 484.18 or by other providers as authorized by Oregon law.

(2) The nurse or therapist who receives a verbal order shall immediately record the order and transmit it to the physician or nurse practitioner within 72 hours.

(3) The physician's or nurse practitioner's countersignature shall be obtained within 30 calendar days of the verbal order.

(4) Agency professional personnel shall check all medicines that a patient may be taking to identify possible ineffective drug therapy, adverse reactions, significant side effects, drug allergies, and contraindicated medication.

(5) Agency professional personnel shall promptly report any problems to the patient's physician or nurse practitioner.

(6) Only medications and treatments that must be administered to the patient by agency personnel need to be on a written order form from the physician or nurse practitioner.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.075 & 443.085
Hist.: OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0120

Coordination of Patient Services

(1) All personnel furnishing services shall ensure that their efforts are coordinated effectively and support the objectives outlined in the patient's plan of care.

(2) The clinical record or minutes of case conferences shall reflect that effective communication and coordination of patient care occurs.

(3) A written summary report for each patient shall be sent to the attending physician or nurse practitioner at least every 62 days.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0130

Nursing Services

The agency shall provide skilled nursing service by or under the supervision of a registered nurse in accordance with agency policies and the plan of treatment. Such services shall comply with applicable laws. For the purposes of this rule, “critical and fluctuating” means a situation where the patient's clinical or behavioral state is of a serious nature, expected to rapidly change, and in need of continuous reassessment and evaluation.

(1) Registered Nurse's Duties: The registered nurse shall make the initial visit, regularly reevaluate the patient's nursing needs, initiate appropriate preventive and rehabilitative nursing procedures, provide those services requiring substantial specialized nursing skills, prepare clinical and progress notes, coordinate services, inform the physician or nurse practitioner and other personnel (including paid caregivers) of changes in the patient's condition and needs, counsel the patient, family or other caregivers (as applicable) in meeting nursing and related needs, participate in inservice programs, and supervise, teach, and assign care tasks to other nursing personnel. The registered nurse may delegate aspects of patient care to unlicensed individuals in accordance with OAR chapter 851, division 047.

(a) Supervision of the licensed practical nurse shall include:

(A) Initial evaluation of the patient to identify appropriate tasks to be performed by the licensed practical nurse. These tasks shall be documented in the patient's clinical record; and

(B) A supervisory visit every 60 days when the patient's condition is stable and predictable, and at least every two weeks when the patient's condition is critical and fluctuating. This visit shall be made either when the licensed practical nurse is present to observe and assist or when the licensed practical nurse is absent, to assess relationships and determine that goals are being met. Documentation of these activities shall be maintained in the patient's clinical record.

(b) Home Health Aide Supervision: The registered nurse is responsible for supervising for quality and appropriateness of care provided by the home health aide service. The registered nurse shall be readily available to the home health aide by telephone at all hours services are provided. Supervisory visits by the registered nurse or therapist shall be documented in the patient's clinical record.

(A) When skilled nursing services and home health aide services are being furnished to the patient, the registered nurse shall make a supervisory visit to the patient's residence at least every two weeks, either when the home health aide is present to observe and assist, or when the home health aide is absent to assess relationships and determine if goals are being met.

(B) If a patient is receiving only skilled therapy services and home health aide services, a skilled therapist may make the supervisory visits at least every two weeks, in lieu of a registered nurse. The therapist must convey information about the performance of the home health aide to the aide's registered nurse supervisor.

(C) When only home health aide services are being furnished to a patient, a registered nurse must make a supervisory visit to the patient's residence at least once every 60 days. Each supervisory visit must occur when the aide is furnishing patient care.

(2) Licensed Practical Nurse:

(a) Duties: The licensed practical nurse shall provide services in accordance with agency policies, prepare clinical and progress notes, assist the physician or nurse practitioner or registered nurse in performing specialized procedures, prepare equipment and materials for treatments, observe aseptic techniques as required, and assist the patient in learning designated self-care techniques.

(b) Supervision of Licensed Practical Nurse: A licensed practical nurse shall provide services only under the supervision of a registered nurse.

(3) Home Health Aide: When an agency provides or arranges for home health aide service, an aide shall be assigned if the plan of treatment, as described in OAR 333-027-0090, specifies that the patient needs personal care. Home health aide services shall be provided under the supervision of the registered nurse and in accordance with the registered nurse's assignment and agency policies.

(a) The duties of a home health aide shall include:

(A) Performance of simple procedures as assigned by the registered nurse;

(B) Personal care;

(C) Ambulation and exercise;

(D) Household services essential to health care at home;

(E) Assistance with medications that are ordinarily self-administered;

(F) Reporting changes in the patient's condition and needs; and

(G) Completing appropriate records.

(b) A home health aide must have the following qualifications:

(A) Oregon Certified Nursing Assistant (CNA) certification and inclusion on the Oregon State Board of Nursing Nurse Aide Registry.

(B) Prior to providing care to a patient, the home health aide must be evaluated by a registered nurse for competency in each of the following areas:

(i) Communication skills;

(ii) Observation of, reporting of, and documentation about the patient and care provided;

(iii) Maintenance of a clean, safe and healthy environment;

(iv) Basic infection control procedures;

(v) Basic nutrition and fluid intake, including food preparation techniques as appropriate;

(vi) Reading and recording temperature, pulse, and respiration;

(vii) Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor;

(viii) Recognizing emergencies and knowledge of emergency procedures;

(ix) The physical, emotional, and developmental needs of, and ways to work with, the populations served by the agency, including the need for respect for the patient, the patient's privacy, and the patient's property;

(x) Appropriate and safe techniques in personal hygiene and grooming that include:

(I) Bed bath;

(II) Sponge, tub, or shower bath;

(III) Shampoo: sink, tub, or bed;

(IV) Nail and skin care;

(V) Oral hygiene; and

(VI) Toileting and elimination.

(xi) Safe transfer techniques and ambulation;

(xii) Normal range of motion and positioning; and

(xiii) Any other task the agency may choose to have the home health aide perform.

(c) Home health aide competency evaluation:

(A) An individual may furnish home health aide services on behalf of an agency only after that individual has successfully completed a competency evaluation program that meets the following requirements:

(i) The competency evaluation program must address each of the subjects listed in subparagraphs (3)(b)(B)(i) through (xiii) of this rule;

(ii) The subject areas listed at subparagraphs (3)(b)(B)(vi), (x), (xi), and (xii) of this rule must be evaluated through observation of the aide's performance of the tasks with a patient; and

(iii) All other subject areas listed in paragraph (3)(b)(B) of this rule may be evaluated through written examination, oral examination, or observation of the aide with a patient.

(B) A home health aide is not considered competent in any task for which the aide's performance is evaluated as unsatisfactory. The aide must not perform that task without direct supervision by a licensed nurse until the aide receives training in the tasks for which the aide's performance was evaluated as unsatisfactory and passes a subsequent evaluation with a satisfactory rating.

(C) A home health aide has not successfully passed a competency evaluation if the aide's performance is unsatisfactory in more than one of the areas delineated in paragraph (3)(b)(B) of this rule.

(D) The agency must maintain documentation that demonstrates that the home health aide has met competency evaluation requirements.

(d) Home Health Aide Orientation: The agency shall complete orientation of the home health aide to the agency's program and document the completion within two weeks of employment. This orientation must include information about:

(A) Policies and objectives of the agency;

(B) The duties of a home health aide;

(C) The functions of other agency personnel and how they relate to each other in caring for the patient;

(D) Other community agencies; and

(E) Ethics and confidentiality.

(e) Training on the Job: In addition to orientation, an agency shall provide the home health aide patient-specific, on-the-job instruction for carrying out procedures that are not transferable to another patient. Such training shall be in accordance with OAR chapter 851, division 061, and shall be documented in the patient's clinical record.

(f) Inservice Training: The agency shall arrange for and document at least 12 hours of inservice training annually. These training sessions shall pertain to the role and responsibilities of the home health aide.

(g) Home Health Aide Assignment: The agency shall provide teaching and supervision of the home health aide in accordance with OAR chapter 851, division 061. All assignments for patient care shall be written, prepared by a registered nurse, and updated on a monthly basis, or more often if the patient's condition requires. Special tasks of nursing care may be delegated by a registered nurse to a home health aide according to the provisions of OAR chapter 851, division 047.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.065 & 443.085
Hist.: OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0140

Therapy Services

(1) Physical Therapy Services: If an agency provides physical therapy services, either directly or under contract, these services shall be provided only by a physical therapist or by a physical therapist assistant. The physical therapist and the physical therapist assistant shall provide physical therapy services in accordance with applicable laws, rules, agency policies and the patient's plan of treatment. Services provided by a physical therapist assistant shall be supervised by a physical therapist.

(a) Duties of a physical therapist include: assisting a physician in evaluating levels of function, helping to develop and revise the plan of treatment, preparing clinical and progress notes, advising and consulting with the family and other agency personnel, participating in inservice programs, and providing services.

(b) Duties of the physical therapist assistant include: performing services that are planned, assigned, delegated, and supervised by the physical therapist; assisting in preparation of clinical notes and progress reports; participating in the education of the patient and family; and participating in inservice programs.

(c) Supervision of the physical therapist assistant shall include at a minimum:

(A) Initial evaluation of the patient by the physical therapist to identify appropriate tasks to be performed by the physical therapist assistant. These tasks shall be documented in each patient's clinical records; and

(B) A visit to the patient's residence by the physical therapist at least once a month when the patient's condition is no longer stable and predictable, or at 60-day intervals when the patient's condition is stable, either when the assistant is present to observe and assist or when the assistant is absent, to assess relationships and determine that goals are being met. Documentation of these visits by the physical therapist shall be maintained in the patient's clinical record.

(2) Occupational Therapy Services: If an agency provides occupational therapy services, either directly or under contract these services shall be provided only by an occupational therapist or by an occupational therapy assistant under the supervision of an occupational therapist. The occupational therapist and occupational therapy assistant shall provide occupational therapy services in accordance with applicable statutes, rules, agency policies and the patient's plan of treatment. The agency shall assure that services provided by an occupational therapy assistant shall be supervised by an occupational therapist.

(a) Duties of the occupational therapist include: assisting the physician in evaluating levels of function, helping to develop and revise the plan of treatment, preparing clinical and progress notes, advising and consulting with the family and other agency personnel, participating in inservice programs, and providing services.

(b) Duties of the occupational therapy assistant include: performing services planned, assigned, delegated, and supervised by the occupational therapist; assisting in the preparation of clinical notes and progress reports; participating in the education of the patient and family; and participating in inservice programs.

(c) Supervision of the occupational therapy assistant shall include at a minimum:

(A) Initial evaluation of the patient by the occupational therapist to identify appropriate tasks to be performed by the occupational therapy assistant. These tasks shall be documented in each patient's clinical record; and

(B) A visit to the patient's residence by the occupational therapist at least once a month when the patient's condition is no longer stable and predictable, or at 60-day intervals when the patient's condition is stable, either when the assistant is present to observe and assist or when the assistant is absent, to assess relationships and determine that goals are being met. The occupational therapist shall document these visits in each patient's clinical record.

(3)(a) Speech Therapy Services: If an agency provides speech therapy services, either directly or under contract, these services shall be provided only by a speech pathologist. The speech pathologist shall provide speech therapy services in accordance with applicable statutes, rules, agency policies and the patient's plan of treatment.

(b) Duties of the speech pathologist include: assisting the physician in evaluating the patient's level of function; helping to develop and revise the plan of treatment; preparing clinical and progress notes; advising and consulting with the family and other agency personnel; participating in inservice programs; and providing services.

(4) Medical Social Services: If an agency provides medical social services, either directly or under contract these services shall be provided only by a social worker, or by a social work assistant. The social worker or the social work assistant shall provide social work services in accordance with applicable statutes, rules, agency policies and the patient's plan of treatment.

(a) Duties of the social worker include: assisting the physician, other team members, and the family in understanding the significant social and emotional factors related to health problems of the patient; participating in the development of the plan of treatment; preparing clinical and progress notes; working with the family; utilizing appropriate community resources; participating in discharge planning and inservice programs; and acting as a consultant to other agency personnel.

(b) Duties of the social work assistant include: performing services planned, assigned, delegated, and supervised by the qualified social worker, preparing clinical notes and progress reports; and participating in inservice programs.

(c) Supervision of the social work assistant shall include at a minimum:

(A) Initial evaluation of the patient by the social worker to identify appropriate tasks to be performed by the social work assistant. These tasks shall be documented in the individual patient's clinical records; and

(B) After the initial evaluation by the social worker and development of the plan of treatment, documented supervisory conferences with the social work assistant shall be held at least two times monthly to assess adherence to the goals and quality of relationships. In the event the patient's situation changes and requires a change in the treatment plan and goals, the social worker will make a joint visit with the social work assistant to revise the plan of treatment.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.065 & 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; Renumbered from 333-027-0055, OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0150

Clinical Records

General Requirements for Clinical Records:

(1) An agency shall maintain, for each patient, a clinical record that covers the service(s) the agency provides directly, or through contract with another agency. All entries in the patient's clinical record must be dated and authenticated. Authentication of an entry requires the use of a unique identifier such as a signature, code thumbprint, voice print, or other means, that provides identification and the title of the individual responsible for the entry. Clinical notes shall be written the day services are rendered and shall be incorporated into the clinical record at least weekly. The agency shall maintain an approved list of standard abbreviations, signs and symbols for use in the clinical record.

(a) The record of each patient receiving home health services shall contain pertinent past and current findings. The findings shall include, but not be limited to, history and physical examination, and hospital discharge summary. The record shall contain other appropriate information such as: patient identifying information; name of physician; signed and dated clinical and progress notes; copies of summary reports that have been sent to the physician; and a discharge summary.

(b) The record shall contain the patient's plan of treatment.

(c) Clinical records shall contain all original or facsimile physician orders and agency caregiver documentation.

(2) Retention and Protection of Records:

(a) The administrator of the agency shall be responsible for proper preparation, adequate content, and preservation of the clinical records. The agency shall permit authorized personnel of the Division to review clinical records as necessary to determine compliance with these rules.

(b) An agency shall have written policies governing access to, and maintenance, retention, utilization, storage, and disposition of all clinical records.

(c) An agency shall complete all clinical records of discharged patients within 30 calendar days of the patient's discharge.

(d) Clinical records are the property of the agency.

(e) Upon a patient's request, the agency shall provide information from the patient's clinical record related to the patient's condition and the care provided.

(f) An agency shall ensure that original clinical records are readily retrievable. Clinical records may be retained on paper, microfilm, electronic, or other media.

(g) An agency shall keep all clinical records for a period of 10 years after the date of the patient's last discharge from the agency.

(h) An agency shall keep clinical records in a safe and secure environment that will protect them from damage and harm.

(i) If an agency changes ownership, the agency shall retain all clinical records in original or microfilmed form and it shall be the responsibility of the successor agency to protect and maintain these records.

(j) In the event of dissolution of an agency, the agency administrator shall notify the Division where the clinical records will be stored.

(k) The agency shall retain non-medical records according to the policy of the individual agency.

(l) An agency shall comply with ORS 192.518 through 192.529, which governs the use and disclosure of patient’s protected health information.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.065 & 443.085
Hist.: OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0160

Program Evaluation

An agency shall conduct an overall evaluation of its program at least annually. The Committee and the agency shall conduct the review. The evaluation shall consist of reviews of overall policies, administrative practices, and quality assurance activities. The evaluation shall assess the extent to which the agency’s program is appropriate, adequate, effective, and efficient. The Committee shall provide a written report of the evaluation to the governing body of the agency. Evaluation reports shall be maintained in its admini?strative records. The agency shall take corrective action, if appro?priate, on negative findings identified as a result of the pro?g?ram evaluation.

(1) Policy and Administrative Review: As part of the evalua?tion process, the agency shall review its policies and adminis?trative practices to determine the extent to which they promote patient care that is appropriate, adequate, effective, and efficient.

(2) Quality assurance: The agency shall implement an on?go?ing quality assurance program designed to objectively and system?a?tically monitor the quality and appropriateness of patient care. The agency shall perform this review at least quarterly. The agen?cy’s quality assurance program must include a review of clinical records.

(a) The quality assurance program shall consist of problem identification, implementation of a corrective action plan, and re-monitoring of identified problems.

(b) Quality assurance activities shall be performed by a multi?disciplinary team consisting of health professionals from each of the services the agency provides.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; Renumbered from 333-027-0065, OHD 13-1998, f. & cert. ef. 11-6-98

333-027-0170

Waivers

(1) Each agency must comply with ORS chapter 443 and OAR chapter 333, division 027. However, an agency may request that the Division grant an exception to these rules for the use of alternative concepts, methods, procedures, techniques, equipment, facilities, personnel qualifications or the conducting of pilot projects or research. If an agency seeks an exception to the Division's rules, it must:

(a) Submit the request in writing to the Division;

(b) Identify the specific rule for which an exception is requested;

(c) Explain the special circumstances relied upon to justify the exception;

(d) List any alternatives that were considered and the reasons those alternatives were not selected;

(e) Demonstrate that the proposed exception is desirable to maintain or improve the health and safety of the patients and will not jeopardize patient health and safety; and

(f) State the proposed duration of the exception.

(2) After reviewing the written request, the Division may grant the exception. If the Division grants an exception, it shall issue its decision in writing.

(3) An agency may not implement any exception until it has received the Division's written approval of the exception.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.085
Hist.: HD 20-1993, f. & cert. ef. 10-28-93; Renumbered from 333-027-0067, OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0175

Violations

In addition to non-compliance with any law that governs a home health agency, it is a violation to:

(1) Refuse to cooperate with an investigation or survey, including but not limited to failure to permit Division staff access to the agency, its documents or records;

(2) Fail to implement an approved plan of correction;

(3) Refuse or fail to comply with an order issued by the Division;

(4) Refuse or fail to pay a civil penalty;

(5) Fail to comply with rules governing the storage of records following the closure of an agency;

(6) Fail to report suspected abuse of elderly persons as defined in ORS 124.050;

(7) Fail to return a license as provided in OAR 333-027-0033; or

(8) Operate without a license.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.045 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0180

Informal Enforcement

(1) If during an investigation or survey Division staff document violations of home health licensing rules or laws, the Division may issue a statement of deficiencies that cites the law alleged to have been violated and the facts supporting the allegation.

(2) A signed plan of correction must be mailed to the Division within 10 business days from the date the statement of deficiencies was received by the agency. A signed plan of correction will not be used by the Division as an admission of the violations alleged in the statement of deficiencies.

(3) An agency shall correct all deficiencies within 60 days from the date of the exit conference, unless an extension of time is requested from the Division. A request for such an extension shall be submitted in writing and must accompany the plan of correction.

(4) The Division shall determine if a written plan of correction is acceptable. If the plan of correction is not acceptable to the Division, the Division shall notify the agency owner in writing or by telephone:

(a) Identifying which provisions in the plan the Division finds unacceptable;

(b) Citing the reasons the Division finds them unacceptable; and

(c) Requesting that the plan of correction be modified and resubmitted no later than 10 working days from the date the letter of non-acceptance was received by the owner.

(5) If the agency does not come into compliance by the date of correction reflected on the plan of correction or 60 days from date of the exit conference, whichever is sooner, the Division may propose to deny, suspend, or revoke the agency license, or impose civil penalties.

Stat Auth.: ORS 443.085
Stats. Implemented: ORS 443.045 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0185

Formal Enforcement

(1) If during an investigation or survey Division staff document a substantial failure to comply with home health licensing laws or rules, or if an agency fails to pay a civil penalty imposed under ORS 443.045, the Division may issue a Notice of Proposed Suspension or Notice of Proposed Revocation in accordance with 183.411 through 183.470.

(2) The Division may issue a Notice of Imposition of Civil Penalty for violations of home health licensing laws.

(3) At any time the Division may issue a Notice of Emergency License Suspension under ORS 183.430(2).

(4) If the Division revokes an agency license, the order shall specify when, if ever, the agency may reapply for a license.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.045 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

333-027-0190

Civil Penalties

(1) An agency that violates home health licensing laws or rules, an administrative order, or settlement agreement is subject to the imposition of a civil penalty not to exceed $1,000 per violation and may not total more than $2,000.

(2) In determining the amount of a civil penalty, the Division shall consider whether:

(a) The Division made repeated attempts to obtain compliance;

(b) The licensee has a history of non-compliance with home health licensing laws and rules;

(c) The violation poses a serious risk to the public’s health; and

(d) There are mitigating factors, such as a licensee’s cooperation with an investigation or actions to come into compliance.

(3) The Division shall document its consideration of the factors in section (2) of this rule.

(4) Each day a violation continues is an additional violation.

(5) A civil penalty imposed under this rule shall comply with ORS 183.746.

Stat. Auth.: ORS 443.085
Stats. Implemented: ORS 443.045 & 443.085
Hist.: PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

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