Or. Admin. Code § 411-318-0005

Current through Register Vol. 63, No. 8, August 1, 2024

Section 411-318-0005 - Definitions and Acronyms

In addition to the following definitions and acronyms, OAR 411-317-0000 includes general definitions for words and terms frequently used in OAR chapter 411, division 318. If a word or term is defined differently in OAR 411-317-0000, the definition in this rule applies.

(1) "CDDP" means "Community Developmental Disabilities Program" as defined in OAR 411-317-0000.

(2) "Claimant" means the person directly impacted by an action that is the subject of a hearing request.

(3) "Complainant" means an individual, as defined in OAR 411-317-0000, or an individual's representative.

(4) "Complaint" means a complainant expresses dissatisfaction with a case management entity or provider, in their preferred language, and requests a formal response.

(5) "Complaint Form" means the form used to file a complaint (form 0946).

(6) "Complaint Investigation" means the investigation of a non-abuse related complaint that has been made to the Department or a local program.

(7) "Complaint Log" means a list of complaint-related information.

(8) "Continuing Services" means the continuation of a developmental disabilities service following the request for a hearing. Services continue until a Final Order is issued.

(9) "DD Administrative Hearing Request" means the form used to request an administrative hearing to contest an action related to developmental disabilities services (form 0443DD).

(10) "Denial" means a rejection of a request for a developmental disabilities service or for an increase in a developmental disabilities service. A denial of a Medicaid service requires a Notification of Planned Action.

(11) "Department" means the Oregon Department of Human Services, including the Office of Developmental Disabilities Services.

(12) "Department Hearing Representative" means a person authorized by the Department to represent the Department in a hearing as described in OAR 411-001-0510.

(13) "Department Staff" means a person employed by the Department who is knowledgeable in a particular subject matter.

(14) "Exit" means termination or discontinuance of a Department-funded developmental disabilities service.

(15) "eXPRS" means the Department's electronic payment and reporting system.

(16) "Good Cause" means an excusable mistake, surprise, excusable neglect (which may include neglect due to a significant cognitive or health issue), circumstances beyond the control of a claimant, reasonable reliance on the statement of Department staff or an adverse provider relating to procedural requirements, [or due to] fraud, misrepresentation, or other misconduct of the Department or a party adverse to a claimant.

(17) "Hearing" means a contested case hearing subject to OAR 137-003-0501 through 137-003-0700, which results in a Final Order.

(18) "Informal Conference" means the discussion between a claimant, the claimant's representative, Department staff, and a Department hearing representative that is held prior to a hearing to address any matters pertaining to the hearing, as described in OAR 411-318-0025. An administrative law judge does not participate in an informal conference. An informal conference may result in resolution of the issue.

(19) "Involuntary Reduction" means a provider has made the decision to reduce services provided to an individual without prior approval from the individual.

(20) "Involuntary Transfer" means a provider has made the decision to transfer an individual to another setting operated by the same provider without prior approval from the individual.

(21) "Local Program" means the case management entity, provider organization, or other certified, licensed, or endorsed provider or agency that contracts with the Department to provide developmental disabilities services, including services to an individual associated with a complaint.

(22) "Notice of Involuntary Reduction, Transfer, or Exit" means:

(a) Notice of Exit or Transfer for Residential Settings (form 0719R).

(b) Notice of Exit, Suspension, or Reduction for Community Living and Supported Living Services (form 0719C).

(c) Notice of Exit, Suspension, Transfer, or Reduction for Day Support Activities and Employment Services (form 0719E).

(23) "Notification of Planned Action" means the written decision notice issued to an individual in the event that a developmental disabilities service is denied, reduced, suspended, or terminated (form 0947).

(24) "OAH" means the Office of Administrative Hearings.

(25) "Personnel Complaint" means a complaint involving the conduct of a person receiving funds to deliver developmental disabilities services.

(26) "Program Director" means the Director of a local program, or the Director's designee.

(27) "Program Staff" means a person employed by the local program who is knowledgeable in a particular subject matter.

(28) "Representative" means an adult, such as a parent, family member, guardian, legal representative, advocate, or any other person, who is chosen by an individual or the individual's legal representative to represent the individual in connection with the provision of developmental disabilities services or during the complaint or hearing process. A representative may not be an employee of the Department, CDDP, or Brokerage acting in official capacity. An individual or the individual's legal representative is not required to choose a representative.

(29) "Request for Service" means:

(a) Submission of a completed application for developmental disabilities services as described in OAR 411-320-0080;

(b) A written request for a new developmental disabilities service or provider; or

(c) A written request for a change in a developmental disabilities service currently provided.

(30) "Service" means the developmental disabilities services and service settings described in OAR chapter 411, divisions 004 and 300 to 455.

(31) "These Rules" mean the rules in OAR chapter 411, division 318.

(32) "Transfer" means an exit immediately followed by an entry at another location administered or operated by the same provider. A transfer is subject to the same standards as an entry and exit.

(33) "Written Outcome" means the written response from the Department or the local program to a complaint following a review of the complaint.

Or. Admin. Code § 411-318-0005

APD 22-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 40-2014, f. 12-26-14, cert. ef. 12/28/2014; APD 37-2015(Temp), f. 12-31-15, cert. ef. 1-1-16 thru 6-28-16; APD 17-2016, f. 6-28-16, cert. ef. 6/29/2016; APD 46-2019, amend filed 10/29/2019, effective 11/1/2019; APD 26-2024, amend filed 06/05/2024, effective 6/10/2024

Statutory/Other Authority: ORS 409.050, 427.104, 427.107 & 430.662

Statutes/Other Implemented: ORS 183.411-183.471, 409.010, 427.007, 427.101, 427.104, 427.107, 427.109, 430.215, 430.610 & 430.662