Current through Register Vol. 63, No. 9, September 1, 2024
All contractors providing community mental health service
elements under a contract with the Division are required to meet the following
standards for management:
(1) Fee
Policy. For all community mental health service elements, except local
administration and those provided by a public education district, the agency
providing the service element shall:
(a)
Determine the cost of each type of service element provided;
(b) Establish a schedule of fees for service
elements based on the costs of the service elements, adjusted on the basis of
the client's ability to pay;
(c)
At the time the service elements is initiated, inform the client of the agency
fee policy, the agency fee schedules, and the fee rate to be collected from the
client in the event that third party payments do not cover the cost of the
client's service elements;
(d)
Billings for Title XIX funds shall in no case exceed the customary charges to
private clients for any like item or service charged by the service element;
and
(e) Charge fees for service
elements as follows:
(A) Except where
expressly prohibited by federal law or regulation, when third party payments do
not cover the full fee for the service elements provided, charge the client or
those legally responsible for the cost of the client's care, in an amount which
is the lesser of:
(i) The balance of the fee
charged to but not paid by the third party payor(s); or
(ii) A fee adjusted on the basis of the
client's ability to pay.
(B) Charge any third party payor in the
amount of the full fees for the service elements provided. Should the sum of
any third party payments and client payments exceed the fee, a refund of the
excess payment shall be given to the client.
(2) Quality Assurance. Each provider of
community mental health and developmental disability service elements shall
implement and maintain a quality assurance program.
(3) Internal Management. Each provider of
CMHP service elements funded by the Division shall meet the following internal
management standards:
(a) There shall be an
up-to-date organization chart showing lines of authority and responsibility for
the services within the agency;
(b) There shall be up-to-date, written
position descriptions for all staff providing community mental health and
developmental disability services;
(c) If four or more staff provide CMHP
services, there shall be written personnel policies and procedures concerning:
(A) Recruitment and termination of employees;
(B) Compensation plan;
(C) Performance appraisals, promotions and
merit increases, and staff development;
(D) Employee benefits; and
(E) Grievance procedures.
(d) Each employee providing CMHP
services shall have the opportunity for in-service training with pay;
(e) There shall be up-to-date
accounting records for each mental health service element accurately reflecting
all revenue by source, all expenses by object of expense, and all assets,
liabilities, and equities, consistent with generally accepted accounting
principles and conforming to the requirements of OAR
309-013-0120 to
309-013-0220;
(f) There shall be written statements of
policy and procedure as are necessary and useful to assure compliance with any
administrative rule pertaining to fraud and embezzlement and abuse of patients,
residents, and clients; and
(g)
There shall be such other written statements of policy and procedure as are
necessary and useful to enable the agency to accomplish its mental health
service objectives and to meet the requirements of these rules and other
applicable standards and rules.
Stat. Auth.: ORS
413.042 &
430.640
Stats. Implemented: ORS
430.610 -
430.640
