Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1403 - Definitions of Coordinated Care and Case Management for Behavioral Health Care Services

Universal Citation: OR Admin Rules 836-053-1403

Current through Register Vol. 63, No. 9, September 1, 2024

(1) The definitions set forth in ORS 743A.168 apply to the use of those terms in these rules.

(2) "Caring contacts" mean brief communications with a patient that start during care transition such as discharge or release from treatment, or when a patient misses an appointment or drops out of treatment, and continues as long as a qualified mental health professional deems necessary.

(3) "Case management" means the management of services that are provided to assist an individual in accessing medical and behavioral health care, social and educational services, public assistance and medical assistance and other needed community services identified in the individual's patient-centered care plan.

(4) "Coordination of care" means the process of coordinating patient care activities as well as the facilitation of ongoing communication and collaboration with lay caregivers by community resource providers, health care providers, and agencies to meet the multiple needs of a patient by:

(a) Organizing and participating in team meetings; and

(b) Ensuring continuity of care during each transition of care.

(5) "Crisis stabilization plan" means an individually tailored plan provided to a patient and the patient's lay caregiver that:

(a) Is based on the patient's behavioral health assessment and physical health assessment; and

(b) Describes the patient's specific short-term rehabilitation objectives and proposed crisis interventions.

(6) "Lay caregiver" means:

(a) For a patient who is younger than 14 years of age, a parent or legal guardian of the patient.

(b) For a patient who is at least 14 years of age or older, an individual designated by the patient or a parent or legal guardian of the patient to the extent permitted under ORS 109.640 and 109.675.

(c) For a patient who is at least 14 years of age or older, and who has not designated a caregiver, an individual to whom a health care provider may disclose protected health information without a signed authorization under ORS 192.567.

(7) "Lethal means counseling" means counseling strategies designed to reduce the access by a patient who is at risk for suicide to lethal means, including but not limited to firearms.

(8) "Medically appropriate treatment" means the services and supports necessary to diagnose, stabilize, care for and treat a behavioral health condition.

(9) "Patient centered care" means care provided in a manner that:

(a) Is respectful of and responsive to a patient's preferences, needs and values; and

(b) Ensures that all clinical decisions are guided by the patient's values.

(10) "Peer delivered services" means an array of support services provided by agencies or community-based organizations to patients or family members of patients:

(a) Using peer support specialists; and

(b) That are designed to support the needs of patients and their families.

(11) "Peer support specialist" means a Peer Wellness Specialist or a Peer Support Specialist, including Family Support Specialist and Youth Support Specialist, as defined in ORS 414.025 and 414.665 and certified under OAR 410-180-0310 to 410-180-0312.

(12) "Qualified mental health professional" means an individual meeting the minimum qualification criteria adopted by the Oregon Health Authority by rule for a qualified mental health professional.

(13) "Safety plan" means a written plan developed by a patient in collaboration with the patient's lay caregiver, if any, as facilitated by a health care provider that identifies strategies for the patient or lay caregiver to use when the patient's risk for suicide is elevated or following a suicide attempt.

(14) "Transition of care" means the process of transferring a patient from one provider or care setting to another provider or care setting.

(15) Coordination of Care and Case Management processes shall ensure coordination and management of services when indicated by a behavioral health assessment conducted by a behavioral health clinician, including, but not limited to:

(a) A best practices risk assessment and, if indicated, a safety plan and lethal means counseling;

(b) A determination of the patient's clinical needs and recommendations, if within the scope of the provider's practice, for medically appropriate treatment including but not limited to one or more of the following:
(A) Adjusting or prescribing medication;

(B) Therapeutic services;

(C) Other medically appropriate treatment; or

(D) Peer delivered services.

(c) Caring contacts.

(d) Recommendations as required or permitted under ORS 192.567, 441.054 and 441.051 to the patient, lay caregiver and health care provider.

(e) Informing the patient, lay caregiver and health care provider of the practitioners who can provide the recommended services and how to access the practitioners and other community-based resources.

(f) Explaining to the patient and the lay caregiver crisis stabilization planning and patient centered care and establishing a goal of convening a care team.

(g) Identifying a person to provide coordination of care who:
(A) Is part of a behavioral health home, as defined in ORS 414.025, a patient centered primary care home, as defined in ORS 414.025, or a patient centered medical home recognized by the National Committee for Quality Assurance;

(B) Is appropriately licensed or certified;

(C) Will communicate directly with the patient and the lay caregiver; and

(D) When possible or requested, will meet personally with the patient and the lay caregiver.

(h) Creating with the patient and the lay caregiver a plan for the transition of care and sharing the plan with the patient's health care providers and care team.

Statutory/Other Authority: ORS 731.244 & ORS 743A.168

Statutes/Other Implemented: ORS 743A.168

Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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