Or. Admin. Code § 309-019-0155

Current through Register Vol. 63, No. 12, December 1, 2024

Section 309-019-0155 - Enhanced Care Services (ECS) and Enhanced Care Outreach Services (ECOS)

(1) To be eligible for Enhanced care Services (ECS) an individual shall:

(a) Be Medicaid eligible;

(b) Meet the diagnostic criteria of severe mental illness with complex behaviors and be approved by the enhanced care services team;

(c) Require intensive community mental health services to be in the most integrated setting available;

(d) Have a history of unsuccessful placements due to complex behaviors; and

(e) be at risk of psychiatric hospitalization; and

(f) have a history of or be currently exhibiting two or more of the following: self-endangering behavior, aggressive behavior, intrusive behavior, refractory psychiatric symptoms, complex medication needs, sexually inappropriate behavior, and elopement behavior.

(2) ECS providers shall:

(a) provide staffing to support the behavioral health needs of the clients within Enhanced Care Unit as outlined in the MOU, with no fewer than four hours a day for programs with 8 or less beds and no fewer than six hours per day for programs with 9-16 beds. ECS mental health staffing shall be available seven days per week provided by or arranged for by the contracted mental health provider;

(b) ECS programs who are not able to meet staff hour requirements must submit in writing to the State Enhanced Care Providers a plan of how services are going to delivered and a plan of how they are going to correct the issue.

(c) Coordinate weekly interdisciplinary team meetings (IDT) to develop the service plan, and to coordinate care planning with the Department of Human Services (Department) licensed provider staff, APD case manager, QMHP, prescriber, individual consumer, or their representative and related professionals such as the Department licensed facility or program direct care staff, the Department licensed facility RN, and facility administrator.

(d) Coordinate quarterly behavioral health trainings as agreed upon in the MOU for Department-licensed providers and related program staff providing services to ECS; and

(e) Ensure the availability of consultation and crisis services staffed by a QMHP/QMHA or the local CMHP, with an accessible written plan on how to access these services available to the ECS provider and the Department licensed facility direct care staff 24-hours per day

(f) provide reports of critical incidences to the Enhanced Care State Coordinators within 72 business hours. A critical incident can be defined as an actual or alleged event or behavior that can or does result in a negative outcome for a consumer including- Death from unknown causes; Emergency Medical Care; Missing Person; Unplanned Hospitalization; Neglect/Abuse/Exploitation/Mistreatment; Damage or theft of property; medication management issues; criminal justice involvement. ; and

(g) submit monthly census reports to the Enhanced Care State Coordinators no later than the 10th day of every calendar month; and

(h) submit referral outcome forms within 7 calendar days of date sent referral to the Enhanced Care State Coordinators; and

(i) submit Database I forms within 15 calendar days of an individual's admission to the program; and

(j) submit Database II forms within 15 calendar days of an individual's discharge from the program; and

(k) Provide collaboration and support to ODHS Department-licensed providers on their development of behavior support plans.

(3) ECS program staffing requirements include:

(a) Each ECS program may have services provided by a QMHPs, QMHA's, CADCs, Peer Delivered Services, and LMP's. ECS programs staff are responsible for coordinating program entries, transitions, and required IDT's; assuring the completion of individual assessments and mental health service; ECS programs are responsible for providing supervision of QMHP's and QMHA's; and coordinating services and trainings with facility staff;

(b) Each CMHP ECS program shall have a QMHA or QMHP available during CMHP ECS provider program hours as outlined in the MOU;

(c) Each ECS program shall have LMP consultation available. For ECS programs serving more than ten individuals, the LMP shall participate.

(d) ECS programs who are not able to meet staffing requirements must submit in writing to the State Enhanced Care Providers a plan of how services are going to delivered and a plan of how they are going to correct the problem.

(4) In ECS programs, the CMHP and the Department licensed provider shall develop a written collaborative agreement that addresses at a minimum: risk management, census management, staff levels, training, treatment and activity programs, entry and transition procedures, a process for reporting and evaluating critical incidents, record keeping, policy and procedure manuals, dispute resolution, and service coordination. This should be reviewed on an annual basis.

Or. Admin. Code § 309-019-0155

MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14; MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17; MHS 6-2017, f. & cert. ef. 6/23/2017; MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18; MHS 4-2018, amend filed 02/27/2018, effective 3/1/2018; BHS 23-2024, amend filed 10/14/2024, effective 10/15/2024

Statutory/Other Authority: ORS 161.390, 413.042, 430.640 & 443.450

Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168