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1 Underlined text is being added. Strikethrough text is being deleted Purpose OREGON ADMINISTRATIVE RULES OREGON HEALTH AUTHORITY, PUBLIC HEALTH DIVISION CHAPTER 333 DIVISION 27 HOME HEALTH AGENCIES The purpose of these rules is to establish the standards for licensure of home health agencies. Stat. Auth.: ORS & Stats. Implemented: ORS Definitions The following definitions shall apply in OAR through : (1) "Admission" means acceptance of a patient for the provision of services by an agency. (2) Authority means the Oregon Health Authority. (32) Agency means Home Health Agency. (433) "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 generally, not to exceed 60 miles one hour's travel time from the parent agency. (544) "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. (655) "Clinical Record" means all information and documentation pertaining to the care of a patient. (6) "Critical/fluctuating condition" means a situation where the patient's clinical and/or behavioral state is of a serious nature, expected to rapidly change, and in need of continuous reassessment and evaluation. (7) "Division" means the Public Health Division of the Oregon Health Authority. (87) "Governing Body" means the designated person(s) having ultimate responsibility for the home health agency. (98) "Home Health Agency" ("Agency") means a public or private entity providing coordinated home health services on a home visiting basis. (109) "Home Health Aide" means a person who is certified as a nursing assistant as such 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. (110) "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. Page 1 of 28

2 (11) "Licensed Physical Therapist Assistant"means a person licensed as such by the Oregon Physical Therapist Licensing Board. (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 means a registered nurse who has been certified by the Oregon State Board of Nursing as qualified to practice in an expanded specialty role within the practice of nursing. (14) "Occupational Therapist" has the meaning given that term in ORS means a person who is licensed as such by the Oregon Occupational Therapy Licensing Board. (15) "Occupational Therapy Assistant" has the meaning given that term in ORS means a person licensed as such by the Oregon Occupational Therapy Licensing Board. (16) "Parent Home Health Agency" ("Parent Agency") means an agency that has branches and/or subunits. (17) Physical Therapist Assistant" has the meaning given that term in ORS and is licensed in accordance with ORS (187) "Physical Therapist" has the meaning given that term in ORS means a person licensed as such by the Oregon Physical Therapist Licensing Board. (198) "Physician" means a person who is licensed by the Oregon Medical Board and that meets the definition in has the meaning given that term in ORS (13) and (14).means a person who holds a degree of Doctor of Medicine or Doctor of Osteopathy and who is authorized to practice medicine or surgery by the state in which such function or action is performed. (19) "Podiatrist" means a podiatric physician and surgeon whose practice is limited to treating the ailments of the human foot and is authorized to practice by the state in which such function or action is performed. (2019) 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. (210) "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. (221) "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. (232) "Progress Note" means a documented written summary of a patient's response to care provided during a specific period of time. (243) "Registered Nurse" means a person licensed as such by the Oregon State Board of Nursing in accordance with ORS chapter 678. (254) "Skilled Nursing" means the patient care services pertaining to the curative, rehabilitative, and/or preventive aspects of nursing performed by, or under the supervision of, a registered nurse pursuant to the plan of treatment. (265) "Social Worker" means a person who has a master's degree from a school of social work accredited by the Council onf Social Work Education and has one year of social work experience in a health care setting. Page 2 of 28

3 (276) "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. (287) "Speech Pathologist" means a person who is licensed in accordance with ORS as such by the Oregon Board of Examiners for Speech Pathology and Audiology and has a Certificate of Clinical Competence in speech pathology or audiology from the American- Speech-Language- and Hearing Association. (298) "Stable and/ predictable condition" means a situation where the patient's clinical and/or behavioral state is known, not characterized by rapid changes, and does not require continuous reassessment and evaluation. (3029) "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 generally exceedsing 60 milesone hour's travel time from the parent agency. (3129) 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. (320) "Therapeutic services" means services provided for curative, rehabilitative, and/or preventive purposes. Stats. Implemented: ORS & Services and Administration Application for Licensure (1) An agency that establishes, purports to manage or operate conducts, or represents itself to the public as a home health agency must be licensed by the DivisionAuthority and comply with ORS and OAR chapter 333, division 027. To be eligible for licensure, an agency must: (a) Be 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) Have 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; (c) Require supervision by a physician, a nurse practitioner or registered nurse of all services provided by the agency. Such services are described under subsection (a) of this section; (d) Maintain clinical, financial and professional records on all patients; and (e) Have an overall plan and budget in effect. (2) An agency that applies for an initial or renewal license must submit to the Authority a completed Home Health Agency Licensure Application form provided by the Authority. 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 Page 3 of 28

4 . (43) An agency that submits a completed application for licensure must demonstrate to the Authority substantial compliance with Oregon Revised Statute through and these administrative rules through the survey process. 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 DivisionAuthority in writing within 30 days. (54) A subunit must independently comply with all licensure requirements. (65) A branch office is part of the parent agency and therefore need not independently comply with these licensure requirements. The DivisionAuthority shall determine on a case-by-case basis exceptions to the 60 mile one hour's travel distancetime from the parent agency requirement for a branch office and subunits as defined in OAR Stats. Implemented: ORS &and Initial LicensureReview 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 and OAR ; (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. (21) The Division shall conduct Upon receipt of a completed application and the required fee, the Authority may make a survey in accordance with OAR of the agency, and may includeing subunits and/or branch locations, to determine if the agency is in compliance with ORS cchapter 443 and OAR chapter 333, division 027 and has the intent to provide home health services. If an agency is in substantial compliance and has the intent to provide home health services to patients, a license may be issued for the operation of the agency. (2) Each agency license shall expire on the 31st day of December of each calendar year. (3) Each license shall be issued only for the agency named in the application and shall not be transferable or assignable. If the ownership of the agency changes, the new owner shall apply for a license. (4) An agency's license shall be prominently posted on the premises of the agency. Page 4 of 28

5 Stats. Implemented: ORS 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 through and OAR through with the exception of the licensing requirements. Stat. Implemented: ORS , , & 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 through Stat. Auth: ORS Stat. Implemented: ORS Expiration and Renewal of Licenses (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 DivisionAuthority not less than thirty (30) days prior to the license's expiration date. (3) The DivisionAuthority may issue a renewal licenses contingent upon evidence of the agency's substantial compliance with ORS cchapter 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 DivisionAuthority. Stats. Implemented: ORS Organization and Quality of Patient Care Page 5 of 28

6 Fees (1) The fee for an initial agency license shall be $1, plus an additional $1, for each subunit of a parent agency. The fee for renewal of a license shall be $ plus an additional $ for each subunit. (2) If the ownership of an agency changes, other than at the time of the annual renewal, the agency's licensure fee shall be $500.00, plus an additional $ 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 $ (3) The annual license renewal fee for an agency shall be $ plus an additional $ for each subunit. (4) Any hospital exempted under ORS may provide home health services without paying a separate license fee and without maintaining a separate governing body and administrative services so long as the services provided meet the requirements of ORS througho and the hospital pays the home health licensing fee under ORS (5) License fees will not be prorated and are non-refundable. Stats. Implemented: ORS & 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 , to 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 through Stats. Implemented: ORS Surveys The Authority may survey each agency and each subunit of an agency at least annually to determine compliance with ORS 443 and OAR chapter 333, division 027. Each agency and subunit shall open all of its records for inspection during its business hours to a representative of the Authority for the purpose of determining compliance with ORS 443 and OAR chapter 333, division 027. If the Authority notifies an agency in writing of any deficiencies, the agency must submit a plan of correction and correct the deficiencies within the time limit set by the Authority. Stats. Implemented: ORS Page 6 of 28

7 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. Stats. Implemented: ORS Denial, Suspension, or Revocation of License The Authority may deny an agency's initial or renewal application, may suspend or revoke an agency's license for failure to comply with ORS 443 and OAR chapter 333, division 027. Stats. Implemented: ORS Surveys (1) The Division shall, in addition to any investigations conducted pursuant to OAR , 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. Page 7 of 28

8 (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 or Stats. Implemented: ORS & ORS 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 through (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. Stats. Implemented: ORS 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: Page 8 of 28

9 (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 Services and Supplies If services and/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. Stats. Implemented: ORS Changes in Services Provided (1) An agency must obtain written approval from the DivisionAuthority 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 Page 9 of 28

10 (c) Adherence to agency personnel policies and ORS chapter 4433 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, and/or technical qualifications of personnel providing the services. (2) An agency must notify the DivisionAuthority if it no longer provides a service listed on its current license. Stats. Implemented: ORS 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 , 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: Page 10 of 28

11 (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 policymaking 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 (2) 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. Page 11 of 28

12 (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; and (F) Provisions for tuberculosis screening in accordance with OAR ; and. (G) Provisions for the completion of criminal records checks in accordance with ORS and OAR (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, ats 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. Page 12 of 28

13 (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. Stats. Implemented: ORS , , & 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 background check on a subject individual. (2) An agency shall conduct a criminal background 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 background check conducted reveals the SI has been convicted of a crime as described in ORS (3). Page 13 of 28

14 (4) An agency shall have a policy on criminal background 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 (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 Page 14 of 28

15 (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 $1,000,000. (7) An agency may use the Oregon State Police, Open Records Unit in order to fulfill the state records requirement for a criminal background check, however, an agency would still need to complete a nationwide check through a qualified vendor. (8) The criminal background 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; Page 15 of 28

16 (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 background checks conducted under this rule shall be documented in writing and made part of the agency s personnel files. (11) Notwithstanding section (12) of this rule, an agency that has a contract with the Department of Human Services (DHS), Seniors and People with Disabilities for the provision of home health services on or after [effective date of these rules] and has already completed a DHS criminal records check on an SI is exempt from the requirements in this rule. (12) These rules go into effect on [insert effective date of rule]. An agency must complete a criminal records check every three years for all SIs. For existing employees who have already undergone a criminal records check prior to these rules going into effect, a criminal records check shall be performed every three years from [insert effect date of the rule] or every three years from the last criminal history check, whichever is sooner. (13) An agency shall have until [insert 90 days from the effective date of the rule] to conduct a criminal background check in accordance with these rules for all SIs working for, contracting with, or volunteering for an agency on or after July 6, Stats. Implemented: ORS & ORS Page 16 of 28

17 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) above as soon as possible, but no later than thirty (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 , 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 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 an resourceindividual thatwho 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 subsection (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; Page 17 of 28

18 (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 within the preceding 12-month period or has previously executed an advance directive. Stats. Implemented: ORS 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.; and (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. Page 18 of 28

19 (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. Stats. Implemented: ORS & ORS Periodic Review of Plan of Treatment (1) An agency shall ensure that: (1a) Tthe 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; (2b) Aagency professional personnel promptly alert the physician or nurse practitioner to any changes that suggest a need to alter the plan of treatment; (3c) Iinformation provided to the physician or nurse practitioner is documented in the clinical record; and (4d) Tthe updated plan of treatment is included in the patient's clinical record within 30 calendar days of the revision. Stats. Implemented: ORS & 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 or nurse practitioner in accordance with 42 CFR 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. Stats. Implemented: ORS & ORS Coordination of Patient Services Page 19 of 28

20 (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 sixty-two (62) days. Stats. Implemented: ORS 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 sectionrule, critical and fluctuating means a situation where the patient's clinical and/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 and/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 sixty (60) days when the patient's condition is stable and predictable, and at least every two (2) 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 the 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 (2) 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. Page 20 of 28