333-071-0200
Purpose and Applicability

(1) The purpose of these rules is to establish standards for the licensure of special inpatient care facilities (SICF) to ensure the health and safety of individuals who receive services from these facilities.

(2) An SICF classified as a religious institution is exempt from these rules except for:

(a) OAR 333-071-0200 through 0290;

(b) OAR 333-071-0310 through 0320;

(c) OAR 333-071-0345;

(d) OAR 333-071-0350;

(e) OAR 333-071-0380;

(f) OAR 333-071-0410;

(g) OAR 333-071-0420(1)(a) through (f);

(h) OAR 333-071-0440;

(i) OAR 333-071-0450;

(j) OAR 333-071-0510; and

(k) OAR 333-071-0550 though OAR 333-071-0580.

Statutory/Other Authority: ORS 441.025, 441.056, 441.057, 441.060, 441.062, 441.173, 441.175 & 441.223
Statutes/Other Implemented: ORS 441.015 - 441.087
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0205
Definitions

As used in OAR chapter 333, division 71, unless the context requires otherwise, the following definitions apply:

(1) "Assessment" means a complete nursing assessment, including:

(a) The systematic and ongoing collection of information to determine an individual's health status and need for intervention;

(b) A comparison with past information; and

(c) Judgement, evaluation or a conclusion that occurs as a result of subsections (a) and (b) of this definition.

(2) "Authentication" means verification that an entry in the patient medical record is genuine.

(3) "Authority" means the Oregon Health Authority, Public Health Division.

(4) "CMS" means the Centers for Medicare and Medicaid Services.

(5) "Certified nursing assistant" (CNA) means a person who is certified by the Oregon State Board of Nursing to assist licensed nursing personnel in the provision of nursing care.

(6) "Conditions of participation" or "conditions for coverage" mean the applicable federal regulations that health care facilities are required to comply with in order to participate in the federal Medicare and Medicaid programs.

(7) "Deemed status" means an SICF that has been inspected by a CMS-approved national accrediting organization, has been found to meet or exceed all applicable Medicare conditions, and CMS finds the SICF to be in compliance.

(8) "Direct ownership" has the meaning given the term 'ownership interest' in 42 CFR 420.201.

(9) "Discharge" means the release of a person who was an inpatient of an SICF including, but not limited to:

(a) The release of a person from the SICF to another facility;

(b) A patient who has died; and

(c) An inpatient who leaves the SICF for purposes of utilizing non-SICF owned or operated diagnostic or treatment equipment, if the person does not return as an inpatient of the same SICF with a 24-hour period.

(10) "Financial interest" means a five percent or greater direct or indirect ownership interest.

(11) "Freestanding hospice facility" (FHF) means an SICF which:

(a) Only admits patients who have been certified by the hospice medical director or physician designee, in collaboration with the patient's attending physician, to be terminally ill, to have a life expectancy not to exceed 6 months, and have given up active treatment aimed at cure; and

(b) Complies with ORS 443.850 and 443.860.

(c) For purposes of freestanding hospice facilities, "attending physician" means a physician, physician assistant, or nurse practitioner that has been identified by a patient, at the time the patient elects to receive hospice care, as having the most significant role in the determination and delivery of the patient's medical care.

(12) "Full compliance survey" means a survey conducted by the Authority following a complaint investigation to determine an SICF's compliance with the CMS conditions of participation or conditions for coverage.

(13) "Governing body" means the body or person legally responsible for the direction and control of the operation of the facility.

(14) "Governmental unit" means the state, or any county, municipality, or other political subdivision, or any related department, division, board or other agency.

(15) "Health care practitioner" has the meaning given that term in ORS 441.224.

(16) "Indirect ownership" has the meaning given the term 'indirect ownership interest' in 42 CFR 420.201.

(17) "Inpatient beds" means a bed in an SICF available for occupancy by a patient who will or may be cared for and treated on an overnight basis.

(18) "Intensive rehabilitative services" means therapy and training to restore an individual to health or to participate in activities of daily living that includes but is not limited to occupational therapy, physical therapy, speech therapy or respiratory therapy.

(19) "Licensed" means that the person to whom the term applies is currently licensed, certified or registered by the proper authority to follow his or her profession or vocation within the State of Oregon, and when applied to an SICF means that the facility is currently licensed by the Authority.

(20) "Licensed practical nurse" (LPN) means a person licensed under ORS chapter 678 to practice practical nursing.

(21) "NFPA" means National Fire Protection Association.

(22) "Nonmedical care and services" means assistance or services, other than medical health care and services, provided by attendants for the physical, mental, emotional or spiritual comfort and well-being of residents or patients.

(23) "Nurse practitioner" (NP) has the meaning given that term in ORS 678.010.

(24) "Nursing assistant" means a person who assists licensed nursing personnel in the provision of nursing care.

(25) "Nursing staff" means a registered nurse, a licensed practical nurse, or other assistive nursing personnel.

(26) "Patient audit" means review of the medical record or patient observation including the care provided to a patient from admission to discharge.

(27) "Person" has the meaning given that term in ORS 442.015.

(28) "Physician" means a person licensed as a doctor of medicine or osteopathy under ORS chapter 677.

(29) "Physician designee" means a physician designated by the hospice who assumes the responsibilities and obligations as the medical director when the medical director is not available.

(30) "Physician's assistant" has the meaning given that term in ORS 677.495.

(31) "Plan of correction" means a document executed by a hospital in response to a statement of deficiency issued by the Authority that describes with specificity how and when deficiencies of SICF licensing laws, conditions of participation or conditions for coverage shall be corrected.

(32) "Registered nurse" (RN) means a person licensed under ORS chapter 678 to practice registered nursing.

(33) "Rehabilitation hospital" means a hospital licensed in accordance with these rules that provides intensive rehabilitative services for patients with complex nursing, medical management and rehabilitative needs.

(34) "Religious institution" is a facility that meets the qualifications specified in ORS 441.065 and provides nonmedical care and services.

(35) "Special inpatient care facility" (SICF) means a facility with inpatient beds that are designed and utilized for special health care purposes, including but not limited to a rehabilitation hospital, substance use disorder treatment facility, freestanding hospice facility, or a religious institution.

(36) "SICF licensing law" means ORS 441.005 through 441.990 and its implementing rules.

(37) "Statement of deficiencies" means a document issued by the Authority that describes an SICF’s deficiencies in complying with SICF licensing laws, conditions of participation or conditions for coverage.

(38) "Survey" means an inspection of an SICF to determine the extent to which an SICF is in compliance with SICF licensing laws, conditions of participation or conditions for coverage.

(39) "These rules" means OAR 333-071-0200 through OAR 333-071-0580.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.015 - 441.087
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0000, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 13-1987, f. 9-1-87, ef. 9-15-87

333-071-0210
License Application and Fees

(1) An applicant wishing to apply for a new or renewal license to operate an SICF shall submit an application on a form prescribed by the Authority and pay the applicable nonrefundable hospital fee as specified in ORS 441.020.

(2) If an applicant is proposing a new SICF, the applicant shall also submit evidence of plans review approval as required by OAR chapter 333, division 675.

(3) An SICF must inform the Authority in writing of any changes in ownership, organizational structure, or other information required on the application form, within 30 days of the change. Failure to notify the Authority may result in denial or revocation of the license.

(4) An applicant that has a certificate of accreditation and deemed status for Medicare certification from an accrediting organization approved by the Authority shall provide the certificate to the Authority with its license application, and shall include:

(a) All survey and inspection reports; and

(b) Written evidence of all corrective actions underway, or completed, in response to recommendations, including all progress reports.

(5) No license shall be issued for any SICF for which a certificate of need is required, unless a certificate of need has first been issued under ORS 442.315.

(6) The Authority may charge a reduced SICF fee if the Authority determines that charging the standard fee constitutes a significant financial burden.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.020, 441.025 & 442.315
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0215
Application Review

(1) In reviewing an application for a new SICF the Authority shall:

(a) Verify compliance with the applicable sections of ORS chapters 441, 442 and 476, these rules and OAR chapter 333, division 675;

(b) Determine whether a certificate of need is required and was obtained for a new SICF;

(c) Conduct an on-site licensing survey in coordination with the State Fire Marshal's Office; and

(d) Verify compliance with conditions of participation or conditions for coverage if the applicant has requested Medicare or Medicaid certification.

(2) In determining whether to license an SICF, the Authority shall consider factors relating to the health and safety of individuals to be cared for at the SICF and the ability of the operator of the SICF to safely operate the facility, and may not consider whether the SICF is or shall be a governmental, charitable or other nonprofit institution or whether it is or shall be an institution for profit.

(3) An SICF classified as a religious institution shall:

(a) Provide only non-medical care and services to a patient who relies solely upon a religious method of healing; and

(b) Comply with the CMS, Religious Nonmedical Health Care Institutions, conditions for coverage - 42 CFR 403.720, 403.724, 403.730 and conditions of participation – 42 CFR 403.732, 403.734, 403.736, 403.738, 403.740, 403.742, 403.744 and 403.746.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.022 & 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0220
Approval of License Application

(1) The Authority shall notify an applicant in writing if a license application is approved and shall include the license with the appropriate classification.

(2) A license shall be issued only for the premises or governmental units named in the application and it is not transferable or assignable.

(3) The license shall be conspicuously posted in the area where patients are admitted.

(4) No SICF licensed pursuant to the provisions of ORS chapter 441 and these rules, shall in any manner or by any means assert, represent, offer, provide or imply that such person or SICF is or may render care or services other than that which is permitted by or which is within the scope of the license issued to the SICF by the Authority, nor shall any service be offered or provided which is not authorized within the scope of the license issued to the SICF.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.015 & 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0005, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0225
Fees for Complaint Investigations and Compliance Surveys

In accordance with ORS 441.021, the Authority may charge an additional fee for complaint investigations, full compliance surveys, on-site follow-up surveys, or off-site follow-up surveys.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.020 & 441.021
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0010, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0230
Expiration and Renewal of License

(1) Each license to operate an SICF shall expire on December 31 following the date of issue, and if a renewal is desired, the licensee shall make application and pay the appropriate fee at least 30 days prior to the expiration date upon a form prescribed by the Authority.

(2) For emergency preparedness planning and licensing purposes, a licensee shall provide, in its application for license renewal:

(a) The number of beds currently in use or capable of being used;

(b) The total number of beds that could be used with only minor alterations, taking into consideration existing equipment, the ancillary service capability of the facility, and the physical environment required by these rules, as applicable; and

(c) The number of beds to be licensed.

(3) An applicant that has a certificate of accreditation and deemed status for Medicare certification from an accrediting organization approved by the Authority shall provide the certificate to the Authority with its renewal application, and shall include:

(a) All approved accrediting organization survey and inspection reports; and

(b) Written evidence of all corrective actions underway, or completed, in response to the approved accrediting organization recommendations, including all progress reports.

(4) If an applicant wishes to renew its license and increase the number of beds licensed from the previous licensing year, the applicant shall include:

(a) Evidence of plans review approval as required by these rules and OAR chapter 333, division 675 as applicable; and

(b) Evidence that a certificate of need was obtained or is not required.

(5) The Authority may not renew a license for any SICF if a certificate of need is required and has not been obtained pursuant to ORS 442.315.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025 & 441.030
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0015, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0235
Denial of License Application

If the Authority intends to deny a license application, it shall issue a Notice of Proposed Denial of License Application in accordance with ORS 183.411 through 183.470.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.030
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0020, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0240
Return of SICF License and SICF Closure

(1) If an SICF license is suspended, revoked, or if a facility decides to permanently close, the license certificate in the licensee's possession shall be returned to the Authority immediately.

(2) If an SICF decides to voluntarily permanently close, it shall issue a multimedia press release at least 24 hours prior to closure, notifying the public of the closure. The press release must include information about how an individual may obtain their medical records.

(3) An SICF that decides to voluntarily permanently close shall notify the Authority at least 14 days prior to the closure and submit a plan for the storage and disposal of medical records. Medical records not claimed that are more than seven years old from the last date of discharge may be destroyed. Medical records not claimed that are less than seven years old from the last date of discharge shall be stored until they are more than seven years old from the last date of discharge. Medical records may be thinned to include only the admission and discharge sheet (face sheet), discharge summary, history and physical, operative report(s), pathology report(s), and X-ray report(s).

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0025, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0245
Discontinuance and Recommencement of Operations

(1) If an SICF wishes to temporarily discontinue operation but retain its license to operate, the SICF shall notify the Authority of the fact at least 14 days prior to the temporary discontinuance.

(2) An SICF shall issue a multimedia press release in accordance with OAR 333-071-0240(2).

(3) Before any patient is admitted to an SICF that has temporarily discontinued operation, the SICF shall request that the Authority conduct an on-site survey to determine whether the SICF is in compliance with SICF licensing laws, conditions of participation or conditions for coverage if applicable.

(4) An SICF may not renew operation until it receives approval, in writing, from the Authority.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0250
Classification

(1) An SICF shall be classified as follows:

(a) Freestanding hospice facility;

(b) Rehabilitation hospital;

(c) Religious institution; or

(d) Substance use disorder treatment facility.

(2) The classification of each SICF shall be so designated on the license.

(3) An SICF licensed by the Authority shall neither assume a descriptive title or be held out under any descriptive title other than the classification title established by the Authority and under which the facility is licensed. This not only applies to the name on the facility but where stationery, advertising and other representations are involved.

(4) No change in the licensed classification of any SICF, as set out in this rule, shall be allowed by the Authority unless the SICF files a new application, accompanied by the required license fee, with the Authority. If the Authority finds that the applicant complies with SICF licensing laws and the regulations of the Authority relating to the new classification for which application for licensure is made, the Authority shall issue a license for such classification.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0030, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 13-1987, f. 9-1-87, ef. 9-15-87

333-071-0260
Waivers

(1) While all SICFs are required to maintain continuous compliance with the Authority's rules, these requirements do not prohibit the use of alternative concepts, methods, procedures, techniques, equipment, facilities, personnel qualifications or the conducting of pilot projects or research. A request for a waiver from a rule must be:

(a) Submitted to the Authority in writing;

(b) Identify the specific rule for which a waiver is requested;

(c) The special circumstances relied upon to justify the waiver;

(d) What alternatives were considered, if any, and why alternatives (including compliance) were not selected;

(e) Demonstrate that the proposed waiver is desirable to maintain or improve the health and safety of the patients, and will not jeopardize patient health and safety; and

(f) The proposed duration of the exception.

(2) Upon finding that the SICF has satisfied the conditions of this rule, the Authority may grant a waiver.

(3) An SICF may not implement a waiver until it has received written approval from the Authority.

(4) During an emergency, the Authority may waive a rule that an SICF is unable to meet, for reasons beyond the SICF's control. If the Authority waives a rule under this section it shall issue an order, in writing, specifying which rules are waived, which SICFs are subject to the order, and how long the order will remain in effect.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0145, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0270
Complaints

(1) Any person may make a complaint verbally or in writing to the Authority regarding an allegation against an SICF of a violation of any SICF licensing law or condition of participation.

(2) The identity of a person making a complaint and any personal identifiable information, as that is defined in ORS 432.005, is confidential and not subject to disclosure under ORS 192.311 to 192.478.

(3) An investigation will be carried out as soon as practicable after receipt of a complaint in accordance with OAR 333-071-0280.

(4) 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 Authority will refer the matter to that agency.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.057
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0045, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 29-1988, f. & cert. ef. 5-27-88

333-071-0280
Investigations

(1) As soon as practicable after receiving a complaint, taking into consideration the nature of the complaint, Authority staff will begin an investigation.

(2) An SICF shall permit Authority staff access to the facility during an investigation.

(3) An investigation may include but is not limited to:

(a) Interviews of the complainant, patients of the SICF, patient family members, witnesses, SICF management and staff;

(b) On-site observations of patients, staff performance, and the physical environment of the SICF; and

(c) Review of documents and records.

(4) Information obtained by the Authority during an investigation of a complaint or reported violation under this rule is confidential and not subject to public disclosure under ORS 192.410 to 192.505, except as otherwise specified in 42 CFR § 401, Subpart B, if applicable. Upon the conclusion of the investigation, the Authority 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 at the SICF. The Authority may use any information obtained during an investigation in an administrative or judicial proceeding concerning the licensing of an SICF, and may report information obtained during an investigation to a health professional regulatory board as defined in ORS 676.160 as that information pertains to a licensee of the board.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.057
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0290
Surveys

(1) The Authority shall, in addition to any investigations conducted under OAR 333-071-0280, conduct at least one on-site licensing survey of each SICF every three years to determine compliance with SICF licensing laws and at such other times as the Authority deems necessary.

(2) In lieu of an on-site inspection required under section (1) of this rule, the Authority may accept:

(a) CMS certification by a federal agency or an approved accrediting organization; or

(b) A survey conducted within the previous three years by an accrediting organization approved by the Authority, if:

(A) The certification or accreditation is recognized by the Authority as addressing the standards and condition of participation requirements of the CMS and other standards set by the Authority. An SICF must provide the Authority with the letter from CMS indicating its deemed status;

(B) The SIFC notifies the Authority to participate in any exit interview conducted by the federal agency or accrediting body; and

(C) The SIFC provides copies of all documentation concerning the certification or accreditation requested by the Authority.

(3) An SICF shall permit Authority staff access to the facility during a survey.

(4) A survey may include but is not limited to:

(a) Interviews of patients, patient family members, SICF management and staff;

(b) On-site observations of patients, staff performance, and the physical environment of the SICF;

(c) Review of documents and records; and

(d) Patient audits.

(5) An SICF shall make all requested documents and records available to the surveyor for review and copying.

(6) Following a survey, Authority staff may conduct an exit conference with the SICF administrator or the administrator's designee. During the exit conference Authority staff shall:

(a) Inform the SICF 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 a survey, Authority staff shall prepare and provide the SICF administrator or the administrator's designee specific and timely written notice of the findings.

(8) If the findings result in a referral to another regulatory agency, Authority 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 Authority shall issue written findings to the SICF administrator indicating that fact.

(10) If deficiencies are found, the Authority shall take informal or formal enforcement action in compliance with OAR 333-071-0315 or 333-071-0320.

Statutory/Other Authority: ORS 441.025 & 441.062
Statutes/Other Implemented: ORS 441.025, 441.057, 441.060 & 441.062
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0300
Nurse Staffing Audit and Complaint Investigation Procedures

An SICF is subject to and shall comply with hospital nurse staffing audit procedures and hospital nurse staffing complaint investigation procedures specified in OAR chapter 333, division 501.

Statutory/Other Authority: ORS 441.025, 441.057, 441.171 & 441.175
Statutes/Other Implemented: ORS 441.057 & 441.171
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0310
Violations

In addition to non-compliance with any SICF licensing law, condition of participation or condition for coverage, it is a violation to:

(1) Refuse to cooperate with an investigation or survey, including but not limited to failure to permit Authority staff access to the SICF, its documents or records;

(2) Fail to implement an approved plan of correction;

(3) Fail to comply with all applicable laws, lawful ordinances and rules relating to safety from fire;

(4) Refuse or fail to comply with an order issued by the Authority;

(5) Refuse or fail to pay a civil penalty; or

(6) Fail to comply with rules governing the storage of medical records following the closure of a facility.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.015, 441.025, 441.030 & 441.175
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0315
Informal Enforcement

(1) If, during an investigation or survey Authority staff document violations of SICF licensing laws, conditions of participation or conditions for coverage, the Authority may issue a statement of deficiencies that cites the law alleged to have been violated and the facts supporting the allegation.

(2) A signed plan of correction must be received by the Authority within 10 business days from the date the statement of deficiencies was mailed to the SICF. A signed plan of correction will not be used by the Authority as an admission of the violations alleged in the statement of deficiencies.

(3) An SICF shall correct all deficiencies within 60 days from the date of the exit conference, unless an extension of time is requested from the Authority. A request for such an extension shall be submitted in writing and must accompany the plan of correction.

(4) The Authority shall determine if a written plan of correction is acceptable. If the plan of correction is not acceptable to the Authority, the Authority shall notify the SICF administrator in writing and request that the plan of correction be modified and resubmitted no later than 10 working days from the date the letter of non-acceptance was mailed to the administrator.

(5) If the SICF does not come into compliance by the date of correction reflected on the plan of correction or 60 days from the date of the exit conference, whichever is sooner, the Authority may propose to deny, suspend, or revoke the SICF license, or impose civil penalties.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.015 & 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0320
Formal Enforcement

(1) If, during an investigation or survey, Authority staff document substantial failure to comply with SICF licensing laws, conditions of participation or conditions for coverage or if an SICF fails to pay a civil penalty imposed under ORS 441.170, the Authority may issue a Notice of Proposed Suspension or Notice of Proposed Revocation in accordance with ORS 183.411 through 183.470.

(2) The Authority may issue a Notice of Imposition of Civil Penalty for violations of SICF licensing laws.

(3) At any time, the Authority may issue a Notice of Emergency License Suspension under ORS 183.430(2).

(4) If the Authority revokes an SICF license, the order shall specify when, if ever, the SICF may reapply for a license.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.015 & 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0330
Approval of Accrediting Organization

An accrediting organization may request approval by the Authority in accordance with OAR 333-501-0060.

Statutory/Other Authority: ORS 441.062
Statutes/Other Implemented: ORS 441.062
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0340
Civil Penalties for Violations of Nurse Staffing Laws

(1) For the purposes of this rule, "safe patient care" has the meaning given to the term in OAR 333-510-0002.

(2) The Authority may impose civil penalties for a violation of any provision of ORS 441.152 to 441.177 and 441.185 if there is a reasonable belief that safe patient care has been or may be negatively impacted.

(3) Each violation of the written SICF staffing plan shall be considered a separate violation.

(4) If imposed, the Authority will issue civil penalties in accordance with Table 1 of OAR 333-501-0045.

(5) In determining whether to issue a civil penalty, the Authority will consider all relevant evidence including, but not limited to, witness testimony, written documents and observations.

(6) A civil penalty imposed under this rule shall comply with ORS 183.745.

(7) The Authority shall maintain for public inspection records of any civil penalties imposed on SICFs penalized under this rule.

Statutory/Other Authority: ORS 413.042, 441.175 & 441.185
Statutes/Other Implemented: ORS 441.175 & 441.185
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0345
Civil Penalties for Violation of Smoking Prohibition

(1) If the Authority determines that an administrator or person in charge of an SICF permits a person to smoke tobacco in an SICF or within 10 feet of a doorway, open window or ventilation intake of an SICF, the Authority may assess a civil penalty of not more than $500 per day against the administrator or the person in charge of an SICF.

(2) In determining whether an administrator or person in charge of an SICF has permitted a person to smoke tobacco in violation of ORS 441.815, the Authority shall consider whether:

(a) An SICF administrator or person in charge of an SICF has taken steps to enforce the smoking prohibitions, including calling law enforcement to report a violation;

(b) The SICF administrator or person in charge of an SICF took affirmative action to address any complaints about smoking in an SICF or within 10 feet of a doorway, open window or ventilation intake of an SICF; and

(c) An SICF administrator or person in charge of an SICF has taken steps to educate the public and staff about the smoking ban.

(3) A civil penalty issued under this rule shall not exceed $2,000 in any 30-day period.

(4) A civil penalty imposed under this rule shall comply with ORS 183.745.

Statutory/Other Authority: ORS 441.815
Statutes/Other Implemented: ORS 441.815
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0350
Civil Penalties, Generally

(1) This rule does not apply to civil penalties for violations of ORS 441.162, 441.166, 441.815, or 435.254 or rules adopted to implement these statutes.

(2) A licensee that violates an SICF licensing law, including OAR 333-071-0310 (Violations), is subject to the imposition of a civil penalty not to exceed $500 per day per violation.

(3) In addition to the penalties under section (2) of this rule, civil penalties may be imposed for violations of ORS 441.030 or 441.015(1).

(4) In determining the amount of a civil penalty, the Authority shall consider whether:

(a) The Authority made repeated attempts to obtain compliance;

(b) The licensee has a history of noncompliance with SICF licensing laws;

(c) The violation poses a serious risk to the public's health;

(d) The licensee gained financially from the noncompliance; and

(e) There are mitigating factors, such as a licensee's cooperation with an investigation or actions to come into compliance.

(5) The Authority shall document its consideration of the factors in section (4) of this rule.

(6) Each day a violation continues is an additional violation.

(7) A civil penalty imposed under this rule shall comply with ORS 183.745.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.990
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0360
Governing Body Responsibility

(1) If an SICF is part of a multi-hospital system, one governing body may oversee multiple licensed hospitals within the system.

(2) The governing body of each SICF shall be responsible for the operation of the facility, the selection of the medical staff and the quality of care rendered in the facility. The governing body shall ensure that:

(a) All health care personnel for whom state licenses or registrations are required are currently licensed or registered;

(b) Qualified individuals allowed to practice in the SICF are credentialed and granted privileges consistent with their individual training, experience and other qualifications;

(c) Procedures for granting, restricting and terminating privileges exist and that such procedures are regularly reviewed to assure their conformity to applicable law;

(d) It has an organized medical staff responsible for reviewing the professional practices of the SICF for the purposes of improving patient safety and patient care;

(e) A physician is not denied medical staff privileges at the facility solely on the basis that the physician holds medical staff membership or privileges at another health care facility;

(f) All SICF employees and health care practitioners granted privileges have been tested for tuberculosis in accordance with OAR 333-071-0450; and

(g) A notice, in a form specified by the Authority, summarizing the provisions of ORS 441.152 through 441.177 is clearly visible to the public that includes a phone number for purposes of reporting a violation of nurse staffing laws.

(3) An SICF may grant privileges to nurse practitioners or physician assistants in accordance with ORS 441.064 and subject to SICF rules governing credentialing and staff privileges.

(a) An SICF may refuse to grant privileges to nurse practitioners only upon the same basis that privileges are refused to other licensed health care practitioners.

(b) An SICF may refuse to grant privileges to a physician assistant based on the refusal of privileges to the physician assistant's supervising physician.

(4) An SICF shall require that every patient admitted shall be and remain under the care of a member of the medical staff as specified under the medical staff by-laws.

(5) Nothing in these rules shall preclude an attending physician, identified by a patient, from providing care to the patient in a freestanding hospice facility.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.055, 441.056, 441.063, 441.064 & 441.169
History:
PH 47-2020, minor correction filed 05/08/2020, effective 05/08/2020
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0050, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0370
Health Care Practitioner Credentialing

Each SICF shall comply with the health care practitioner and telemedicine provider credentialing requirements in accordance with OAR chapter 409, division 45.

Statutory/Other Authority: ORS 441.025, 441.056 & 441.223
Statutes/Other Implemented: ORS 441.025, 441.056 & 441.223
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0380
Administrator

(1) Each SICF shall employ or contract with a chief executive officer (CEO) or administrator who is responsible for the operation of the SICF and SICF based services in a manner commensurate with the authority conferred by the governing body, supports the delivery of high quality care and services and ensures compliance with all SICF policies and applicable state and federal laws and regulations. In determining the appropriate number of facilities for which a CEO or administrator is responsible, the governing body of the SICF or health system should consider distance between hospitals and the size and complexity of each facility.

(2) The SICF shall notify the Authority, in writing, of the voluntary or involuntary termination of the CEO or administrator as well as the appointment of a new CEO or administrator within 30 days of the termination and appointment.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0390
Medical Staff

(1) The medical staff is responsible for reviewing the professional practices of the SICF for the purposes of improving patient safety and patient care, and is accountable to the governing body.

(2) The SICF's medical staff organized pursuant to OAR 333-071-0360 shall include physicians and may include other licensed health care practitioners as permitted by the governing body.

(3) The medical staff shall adopt and enforce by-laws, medical staff policies, and medical staff rules and regulations to carry out its responsibilities. The by-laws, medical staff policies, and medical staff rules and regulations must be approved by the governing body.

(4) By-laws, medical staff policies and medical staff rules and regulations shall include, but are not limited to:

(a) The organization of the medical staff, including qualifications for serving on the medical staff, nominations, election, appointment or removal of officers, and periodic review of its members;

(b) Criteria for credentialing health care practitioners and the process for applying for credentials;

(c) Criteria for restricting or terminating facility privileges and the process for restricting or terminating facility privileges;

(d) A process for periodically reviewing the procedures for granting, restricting and terminating facility privileges to ensure that procedures are being followed; and

(e) Procedures for ensuring that licensed health care practitioners with facility privileges i are acting within their scope of practice and acting consistent with the privileges granted by the governing body;

(f) Procedures for the acceptance of verbal orders by those individuals authorized by law or their scope of practice to accept verbal orders;

(g) Procedures for responding to medical emergencies, including contacting at least one physician in the event of a medical emergency; and

(h) Procedures for notifying patients orally and in writing of any financial interest as required by ORS 441.098.

(5) Amendments to medical staff by-laws shall be accomplished through a cooperative process involving both the medical staff and the governing body. Medical staff by-laws shall be adopted, repealed or amended when approved by the medical staff and the governing body. Approval shall not be unreasonably withheld by either. Neither the medical staff nor the governing body shall withhold approval if such repeal, amendment, or adoption is mandated by law, statute or regulation or is necessary to obtain or maintain accreditation or to comply with fiduciary responsibilities or if the failure to approve would subvert the stated moral or ethical purposes of the facility.

(6) All health care practitioners with individual admitting privileges are subject to applicable provisions of the medical staff by-laws and rules governing admission and staff privileges.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0055, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0400
Organization Policies

(1) An SICF's internal organization shall be structured to include appropriate departments and services consistent with the needs of its defined community.

(2) An SICF shall adopt and maintain clearly written definitions of its organization, authority, responsibility, relationships and scope of services offered.

(3) An SICF shall adopt, maintain and follow written patient care policies that include but are not limited to:

(a) Admission and transfer policies that address:

(A) Types of clinical conditions not acceptable for admission;

(B) Constraints imposed by limitations of services, staff coverage or physical facilities. No patient shall be admitted to a bed in any room, other than one regularly designated as a bedroom or ward;

(C) Emergency admissions;

(D) Requirements for informed consent signed by the patient or legal representative of the patient for diagnostic and treatment procedures; such policies and procedures shall address informed consent of minors in accordance with provisions in ORS 109.640, 109.670, and 109.675;

(E) Requirements for identifying persons responsible for obtaining informed consent and other appropriate disclosures and ensuring that the information provided is accurate and documented appropriately in accordance with these rules and ORS 441.098; and

(F) A process for the internal transfer of patients from one level or type of care to another, if applicable;

(b) Discharge planning and termination of services in accordance with OAR 333-505-0055;

(c) Patient rights;

(d) Housekeeping;

(e) All patient care services provided by the facility;

(f) Preventive maintenance program for all aspects of the facility's physical plant, operations, and equipment used in patient care and patient environment;

(g) Treatment or referral of acute sexual assault patients in accordance with ORS 147.403;

(h) Identification of patients who could benefit from palliative care in order to provide information and facilitate access to appropriate palliative care in accordance with ORS 413.273; and

(i) Procedures for ensuring that an ASC provides health care interpreter services to a patient who prefers to communicate in a language other than English in accordance with ORS 413.559 and OAR 950-050-0160.

(4) In addition to the policies described in section (3) of this rule, an SICF shall, in accordance with the Patient Self-Determination Act, 42 CFR 489.102, adopt policies and procedures that require (applicable to all capable individuals 18 years of age or older who are receiving health care in the facility):

(a) Providing to each adult patient, including emancipated minors, not later than five days after an individual is admitted as an inpatient, but in any event before discharge, the following in written form, without recommendation:

(A) Information on the rights of the individual under Oregon law to make health care decisions, including the right to accept or refuse medical treatment and the right to execute directives and powers of attorney for health care;

(B) Information on the policies of the facility 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 form set forth in ORS 127.529; and

(D) The name of a person who can provide additional information concerning the forms for directives.

(b) Documenting in a prominent place in the individual's medical record whether the individual has executed a directive.

(c) Compliance with ORS chapter 127 relating to directives for health care.

(d) Educating the staff and the community on issues relating to directives.

(5) An SICF's transfer agreements or contracts shall clearly delineate the responsibilities of parties involved.

(6) Patient care policies shall be evaluated triennially and rewritten as needed, and presented to the governing body or a designated administrative body for approval triennially. Documentation of the evaluation is required.

(7) An SICF shall have a system, described in writing, for the periodic evaluation of programs and services, including contracted services.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 147.401, 413.273, 441.025, 441.196, 441.198, 413.559 & 413.561
History:
PH 36-2023, minor correction filed 09/08/2023, effective 09/08/2023
PH 21-2023, minor correction filed 04/18/2023, effective 04/18/2023
PH 20-2023, minor correction filed 04/18/2023, effective 04/18/2023
PH 197-2022, amend filed 09/07/2022, effective 09/21/2022
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0410
Patient Rights

(1) An SICF shall ensure that the facility recognizes and protects the following rights of each patient. Each patient has a right to:

(a) Be treated with dignity and respect;

(b) Receive care in a safe setting;

(c) Participate in the development and implementation of care and services to be furnished, including any changes or cessation of care and services;

(d) Make informed decisions about requesting or refusing care and services;

(e) Verbalize advance directives and to have the SICF and staff who provide care to comply the directives;

(f) Have a family member, lay caregiver or other representative notified when admitted and discharged from the SICF;

(g) Be free from neglect of care, and all forms of abuse or harassment;

(h) Personal privacy;

(i) The confidentiality of his or her medical records;

(j) Access information contained in his or her medical record within a reasonable time frame;

(k) Be free from physical or chemical restraint or seclusion; and

(L) Voice grievances or complaints regarding care, services or any other issue without discrimination or reprisal for exercising such rights.

(2) An SICF shall inform each patient, or the patient's representative, in writing of the patient's rights in advance of receiving or discontinuing care or services when possible. The information provided must include:

(a) Procedures for filing a grievance or complaint with the SICF; and

(b) Procedures for filing a grievance or complaint with the Authority.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0420
Personnel

(1) An SICF shall:

(a) Maintain a sufficient number of qualified personnel and equipment to provide effective patient care and all other related services;

(b) Have written personnel policies and procedures that are available to personnel;

(c) Provide orientation for new employees;

(d) Have an annual continuing education plan;

(e) Have a job description for each position which delineates the qualifications, duties, authority and responsibilities inherent in each position;

(f) Provide an annual work performance evaluation for each employee with appropriate records maintained;

(g) Have an employee health screening program for the purpose of protecting patients and employees from communicable diseases, including but not limited to requiring tuberculosis testing for employees in accordance with OAR 333-071-0450.

(2) In addition to the requirements specified in section (1) of this rule, an SICF classified as a rehabilitation hospital shall have:

(a) A medical director with training or experience in rehabilitation who provides services in the facility for a minimum of 20 hours per week;

(b) A sufficient number of qualified physical therapists, occupational therapists, speech-language pathologists or audiologists based on the rehabilitative services offered;

(c) An adequate number of qualified staff available when needed to evaluate each patient, initiate a plan of treatment and supervise supportive personnel when furnishing rehabilitation services. The number of qualified staff is based on the type of patients treated and the frequency, duration and complexity of the treatment ordered; and

(d) An individual that directs the rehabilitation services offered that has the necessary knowledge, experience and capabilities to properly supervise and administer the services.

(3) An SICF shall restrict the work of employees with restrictable diseases in accordance with OAR 333-019-0010.

(4) The actions taken by an SICF under this rule shall be fully documented for each employee.

Statutory/Other Authority: ORS 441.025, ORS 431.110, 433.004 & 433.332
Statutes/Other Implemented: ORS 441.025, ORS 433.004 & 433.329
History:
PH 48-2020, minor correction filed 05/08/2020, effective 05/08/2020
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0057, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89

333-071-0430
Medical Records

(1) A medical record shall be maintained for every patient admitted for care in an SICF.

(2) A legible reproducible medical record shall include, but is not limited to the following (if applicable):

(a) Admitting identification data including date of admission.

(b) Chief complaint.

(c) Pertinent family and personal history.

(d) Medical history, physical examination report and provisional diagnosis as required by OAR 333-071-0470.

(e) Admission notes outlining information crucial to patient care.

(f) All patient admission, treatment, and discharge orders.

(A) All patient orders shall be initiated, dated, timed and authenticated by a licensed health care practitioner in accordance with section (4) of this rule.

(B) Documentation of verbal orders shall include:

(i) The date and time the order was received;

(ii) The name and title of the health care practitioner who gave the order; and

(iii) Authentication by the authorized individual who accepted the order, including the individual’s title.

(C) Verbal orders shall be dated, timed, and authenticated promptly by the ordering health care practitioner or another health care practitioner who is responsible for the care of the patient.

(D) For purposes of this rule, a verbal order includes but is not limited to an order given over the telephone.

(g) Clinical laboratory reports as well as reports on any special examinations. (The original report shall be authenticated and recorded in the patient's medical record.)

(h) X-ray reports bearing the identification of the originator of the interpretation.

(i) Consultation reports when such services have been obtained.

(j) Records of assessment and intervention, including graphic charts and medication records and appropriate personnel notes.

(k) Discharge summary including final diagnosis.

(L) Discharge order.

(m) Autopsy report if applicable.

(n) Such signed documents as may be required by law.

(o) Informed consent forms that document:

(A) The name of the SICF where the procedure or treatment was undertaken;

(B) The specific procedure or treatment for which consent was given;

(C) The name of the health care practitioner performing the procedure or administering the treatment;

(D) That the procedure or treatment, including the anticipated benefits, material risks, and alternatives was explained to the patient or the patient’s representative or why it would have been materially detrimental to the patient to do so, giving due consideration to the appropriate standards of practice of reasonable health care practitioners in the same or a similar community under the same or similar circumstances;

(E) The manner in which care will be provided in the event that complications occur that require health services beyond what the SICF has the capability to provide;

(F) The signature of the patient or the patient’s legal representative; and

(G) The date and time the informed consent was signed by the patient or the patient’s legal representative.

(p) Documentation of the disclosures required in ORS 441.098.

(3) In addition to the requirements specified in section (2) of this rule, the following information shall be transferred to and made part of the SICF patient medical record, if applicable:

(a) Surgical records:

(A) Preoperative history, physical examination and diagnosis documented prior to operation.

(B) Anesthesia record including preanesthesia assessment and plan for anesthesia, records of anesthesia, analgesia and medications given in the course of the operation and postanesthetic condition.

(C) A record of operation dictated or written immediately following surgery and including a complete description of the operation procedures and findings, postoperative diagnostic impression, and a description of the tissues and appliances, if any, removed. When the dictated operative report is not placed in the medical record immediately after surgery, an operative progress note shall be entered in the medical record after surgery to provide pertinent information for any individual required to provide care to the patient.

(D) Postanesthesia recovery progress notes.

(E) Pathology report on tissues and appliances, if any, removed at the operation.

(b) Obstetrical records:

(A) The patient's prenatal care including at least a serologic test result for syphilis, Rh factor determination, and past obstetrical history and physical examination.

(B) The labor and delivery record, including reasons for induction and operative procedures, if any.

(C) Records of anesthesia, analgesia, and medications given in the course of delivery.

(c) Emergency room, outpatient and clinic records:

(A) Patient identification.

(B) Admitting diagnosis, chief complaint and brief history of the disease or injury.

(C) Physical findings.

(D) Laboratory and X-ray reports (if performed), as well as reports on any special examinations. The original report shall be authenticated and recorded in the patient's medical record.

(E) Diagnosis.

(F) Record of treatment, including medications.

(G) Disposition of case with instructions to the patient.

(H) Signature or authentication of attending physician.

(I) A record of the pre-hospital report form (when patient is brought in by ambulance) shall be attached to the emergency room record.

(4) All entries in a patient's medical record shall be dated, timed and authenticated.

(a) Authentication of an entry requires the use of a unique identifier, including but not limited to a written signature or initials, code, password, or by other computer or electronic means that allows identification of the individual responsible for the entry.

(b) Systems for authentication of dictated, computer, or electronically generated documents must ensure that the author of the entry has verified the accuracy of the document after it has been transcribed or generated.

(5) The following records shall be maintained and kept permanently in written or computerized form:

(a) Patient's register, containing admissions and discharges;

(b) Patient's master index;

(c) Register of all deliveries, including live births and stillbirths;

(d) Register of all deaths; and

(e) Register of outpatients (seven years).

(6) The completion of the medical record shall be the responsibility of the attending qualified member of the medical staff. Any licensed health care practitioner responsible for providing or evaluating the services provided shall complete and authenticate those portions of the record that pertain to their portion of the patient's care. The appropriate individual shall authenticate the history and physical examination, operative report, progress notes, orders and the summary. In a facility using interns, such orders must be according to policies and protocols established and approved by the medical staff. An authentication of a licensed health care practitioner on the face sheet of the medical record does not suffice to cover the entire content of the record:

(a) Medical records shall be completed by a licensed health care practitioner and closed within four weeks following the patient's discharge.

(b) If a patient is transferred to another health care facility, transfer information shall accompany the patient. Transfer information includes but is not limited to:

(A) The name of the facility from which the patient was transferred;

(B) The name of physician or other health care practitioner to assume care at the receiving facility;

(C) The date and time of discharge;

(D) The current medical findings;

(E) The current nursing assessment;

(F) Current medical history and physical information;

(G) Current diagnosis;

(H) Orders from a physician or other licensed health care practitioner for immediate care of the patient;

(I) Operative report, if applicable;

(J) TB test, if applicable;

(K) Other information germane to patient's condition.

(c) If the discharge summary is not available at time of transfer, it shall be transmitted to the new facility as soon as available.

(7) Diagnoses and operations shall be expressed in standard terminology. Only abbreviations approved by the medical staff may be used in the medical records.

(8) Medical records shall be filed and indexed. Filing shall consist of an alphabetical master file with a number cross-file. Indexing is to be done according to diagnosis, operation, and qualified member of the medical staff, using a system such as the International or Standard nomenclature systems.

(9) Medical records are the property of the SICF. An SICF shall comply with the use, disclosure, protection and security requirements of the federal Health Insurance Portability and Accountability Act of 1996 (P.L.104-191) and regulations adopted under that law, including 45 CFR parts 160 and 164, federal alcohol and drug treatment confidentiality laws and regulations adopted under those laws, including 42 CFR part 2, and state health and mental health confidentiality laws, including ORS 179.505, 192.517 and 192.553 to 192.581.

(10) Authorized personnel of the Authority shall be permitted to review medical records and patient registers as necessary to determine compliance with SICF licensing laws.

(11) Medical records shall be kept for a period of at least 10 years after the date of last discharge. Original medical records may be retained on paper, electronic or other media.

(12) If an SICF changes ownership, all medical records in original or electronic form shall remain in the facility or related institution, and it shall be the responsibility of the new owner to protect and maintain these records.

(13) If an SICF closes, its medical records and the registers required under section (5) of this rule may be delivered and turned over to any other facility in the vicinity willing to accept and retain the same as provided in section (11) of this rule. An SICF which closes permanently shall follow the procedure for Authority and public notice regarding disposal of medical records under OAR 333-071-0240.

(14) All original clinical records or photographic or electronic facsimile thereof, not otherwise incorporated in the medical record, such as X-rays, electrocardiograms, electroencephalograms, and radiological isotope scans shall be retained for seven years after a patient's last visit if professional interpretations of such graphics are included in the medical records.

(15) If a qualified medical record practitioner, RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator) is not the Director of the Medical Records Department, periodic and at least annual consultation must be provided by a qualified medical records consultant, RHIT/RHIA. The visits of the medical records consultant shall be of sufficient duration and frequency to review medical record systems and assure quality records of the patients. The contract for such services shall be made available to the Authority.

(16) A current written policy on the release of medical record information including a patient’s access to his or her medical record shall be maintained in the medical records department.

(17) Pursuant to ORS 441.059, the rules of an SICF that govern patient access to previously performed X-rays or diagnostic laboratory reports shall not discriminate between patients of chiropractic physicians and patients of other licensed health care practitioners permitted access to such X-rays and diagnostic laboratory reports.

(18) Nothing in this rule is meant to prohibit or discourage an SICF from maintaining its records in electronic form.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0060, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0440
Quality Assessment and Performance Improvement

The governing body of an SICF must ensure that there is an effective, written, facility-wide quality assessment and performance improvement program to evaluate and monitor the quality and appropriateness of patient care.

(1) All organized services related to patient care, including services furnished by a contractor must be evaluated.

(2) Written documentation of quality assurance activities shall be recorded at least quarterly.

(3) Health care acquired infections, medication therapy, and blood and blood product transfusions must be evaluated.

(4) All medical services performed in the facility must be evaluated as they relate to appropriateness of diagnosis and treatment.

(5) The facility must have an ongoing plan, consistent with available community and facility resources, to provide and make available social work, psychological, and educational services to meet the medically-related needs of its patients.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0065, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0450
Infection Control

(1) Each SICF shall establish and maintain an active facility-wide infection control program. This program shall, at a minimum, include the following:

(a) Identification of existing or potential infections in patients and employees, medical staff, and health care practitioners with SICF privileges;

(b) Control of factors affecting the transmission of infections and communicable disease;

(c) Provisions for orienting and educating all medical staff, health care practitioners with SICF privileges and employees on the cause, transmission, and prevention of infections; and

(d) Collection, analysis, and use of data relating to infections in the SICF.

(2) Each SICF shall be responsible for the development, implementation and periodic review of policies under section (1) of this rule.

(3) The infection control program shall be managed by a qualified individual and overseen by a multidisciplinary committee with the responsibility for investigating, controlling and preventing infections in the facility. The composition of the committee may vary but shall include at least representation from major departments and services and shall provide for consultation both from other departments and services and to them.

(4)(a) An SICF shall comply with all rules of the Authority for the control of communicable diseases as specified in OAR chapter 333, divisions 17, 18 and 19.

(b) An SICF shall have a tuberculosis infection control plan that includes provisions for employee assessment and screening for protecting patients and employees from tuberculosis in accordance with OAR 333-019-0041.

(5) An SICF shall have a system of isolation that prevents the transmission of infections in an SICF.

(a) A system of isolation shall:

(A) Follow the principles of epidemiology and disease transmission;

(B) Include precautions to interrupt the spread of infection by all routes that are likely to be encountered in the SICF; and

(C) Be reviewed and approved by a committee responsible for the oversight of the infection control program.

(b) Guidelines for isolation precautions are published periodically by the Centers for Disease Control and Prevention, Hospital Infection Control Practices Advisory Committee (HICPAC) and may be used by an SICF as a reference in order to maintain up-to-date isolation practices.

(6) The SICF multidisciplinary committee shall oversee all aspects of the infection control program, and will ensure that the system of isolation implemented addresses the following fundamentals of infection control:

(a) Handwashing and gloving;

(b) Patient placement;

(c) Transport of infected patients;

(d) Protective apparel;

(e) Patient care equipment and articles;

(f) Linen and laundry;

(g) Dishes, glasses, cups, and eating utensils; and

(h) Routine and terminal cleaning.

(7)(a) An SICF shall develop and enforce policies and procedures related to cleaning, disinfection, sterilization, or disposal of:

(A) Patient care items;

(B) Patient care equipment;

(C) Furnishings; and

(D) The health care environment.

(b) Policies and procedures shall be developed in accordance with the 2008, Centers for Disease Control and Prevention, Guideline for Disinfection and Sterilization in Healthcare Facilities.

(8) Single patient use items and equipment must be labeled with patient name and room number when the items or equipment are used in a multi-bed room.

Statutory/Other Authority: ORS 441.025, ORS 433.004, 433.332 & 442.855
Statutes/Other Implemented: ORS 441.025, ORS 433.004, 433.329, 442.405, 442.853 & 442.855
History:
PH 14-2020, amend filed 03/24/2020, effective 03/24/2020
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0115, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0470
Patient Admission and Treatment Orders

(1) No patient shall be admitted to an SICF except on the order of an individual who has admitting privileges. The admitting medical staff member for the facility shall provide sufficient information at the time of admission to establish that care can be provided to meet the needs of the patient. Admission medical information shall include a statement concerning the admitting diagnosis and general condition of the patient. Other pertinent medical information, orders for medication, diet, and treatments shall also be provided, as well as a medical history and physical.

(2) Within 24 hours of a patient’s admission, an SICF shall ensure that:

(a) The patient’s medical history is taken and a physical examination performed, unless:

(A) A medical history and physical examination has been completed within 30 days prior to admission, as provided in the medical staff rules and regulations; or

(B) The patient is readmitted within a month’s time for the same or related condition, as long as an interval note is completed; and

(b) The patient is given a provisional diagnosis.

(3) Even if a medical history or physical examination at the time of admission is not required under section (2) of this rule, an SICF shall ensure that any changes crucial to patient care are noted in an admission note.

(4) Visits from licensed health care providers shall be according to patient's needs. Initial and ongoing assessments shall be performed for each patient and the results and observations recorded in the medical record.

(5) A physician, physician assistant or nurse practitioner with admitting privileges shall be responsible, as permitted by the individual's scope of practice for the care of any medical problem that may be present on admission or that may arise during an inpatient stay.

(6) No medication or treatment shall be given except on the order of one duly authorized to give such orders within the State of Oregon.

(7) Notwithstanding the requirements specified in sections (1) through (6) of this rule:

(a) An SICF classified as a rehabilitation hospital shall ensure that:

(A) Rehabilitation services are provided to patients under the orders of a qualified and licensed health care practitioner who is responsible for the care of the patient, acting within his or her scope of practice and who is authorized by the medical staff to order the services in accordance with SICF licensing laws;

(B) All orders shall be documented in the patient's medical record in accordance with OAR 333-071-0430;

(C) Patient assessments are conducted on a regular basis in accordance with 42 CFR 412.606. Each patient shall be evaluated by a rehabilitation physician at time of admission and shall be supervised by a rehabilitation physician, as reflected in at least three face-to-face visits each week; and

(D) Respiratory services comply with 42 CFR 582.57.

(b) An SICF classified as a freestanding hospice facility shall comply with CMS conditions of participation, 42 CFR 418.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0073, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89

333-071-0480
Nursing Care Management

(1) The nursing care of each patient in a health care facility shall be the responsibility of a registered nurse (RN).

(2) The RN will only provide services to the patients for which she or he is educationally and experientially prepared and for which competency has been maintained.

(3) The RN shall be responsible and accountable for managing the nursing care of her or his assigned patients. She or he shall only assign the nursing care of each patient to other nursing personnel in accordance with the patient’s needs and the specialized qualifications and competence of the nursing staff available. The responsible RN shall ensure that the following activities are completed:

(a) Document the admission assessment of the patient within four hours following admission and initiate a written plan of care. This shall be reviewed and updated whenever the patient’s status changes.

(b) Develop and document, within eight hours following admission, a plan of care for nursing services for the patient, based on the patient assessment and realistic, understandable, achievable patient goals consistent with the applicable rules in OAR chapter 851, division 45.

(c) Observe and report to the nurse manager and the patient's physician or other health care provider authorized by law, when appropriate, any significant changes in the patient's condition that warrant interventions that have not been previously prescribed or planned for.

(d) When the RN questions the efficacy, need or safety of continuation of medications being administered to a patient, the RN shall report that question to the physician or other responsible health care provider authorized by law authorizing the medication and shall seek further instructions concerning the continuation of the medication.

(4)(a) An SICF shall maintain documentation of certification of certified nursing assistants (CNA's), which shall be available on request to Authority personnel.

(b) A nursing assistant who works in an SICF must be certified prior to assuming nursing assistant duties in accordance with OAR chapter 851, division 62.

(c) An SICF shall maintain documentation that CNAs, whose function includes administration of non-injectable medications, are qualified.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0075, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88

333-071-0485
Nursing Services

(1) An SICF shall provide a nursing service department which provides 24-hour onsite registered nursing care, seven days per week.

(2) The nursing services department shall be under the direction of a nurse executive who is a registered nurse, licensed to practice in Oregon.

(3) All nursing personnel shall maintain current certification in cardiopulmonary resuscitation.

(4) An SICF shall comply with hospital nurse staffing regulations in accordance with OAR chapter 333, division 510 and ORS 441.151 through 441.192.

Statutory/Other Authority: ORS 441.025 & ORS 413.042
Statutes/Other Implemented: ORS 441.025 & 441.151 - 441.192
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0080, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0490
Nurse Executive

(1) The nurse executive position shall be full-time (40 hours per week). Time spent in professional association workshops, seminars and continuing education may be counted as his or her duties in considering whether or not he or she is full-time.

(2) The nurse executive shall:

(a) Have had progressive responsibility in managing in a health care setting. The nurse executive shall be a registered nurse licensed in Oregon. In addition, the nurse executive must have a baccalaureate degree or other advanced degree, or appropriate equivalent experience, with emphasis in management preferred.

(b) Have written administrative authority, responsibility and accountability for assuring functions and activities of the nursing services department and shall participate in the development of any policies that affect the nursing services department. This includes budget formation, implementation and evaluation. The nurse executive shall ensure the:

(A) Development and maintenance of a nursing service philosophy, objective, standards of practice, policy and procedure manuals and job descriptions for each level of nursing service personnel;

(B) Development and maintenance of personnel policies of recruitment, orientation, in-service education, supervision, evaluation and termination of nursing service staff or ensure it is done by another department;

(C) Development and maintenance of policies and procedures for determination of nursing staff's capacity for providing nursing care for any patient seeking admission to the facility;

(D) Development and maintenance of a quality assurance program for nursing service;

(E) Coordination of nursing service departmental function and activities with the function and activities of other departments; and

(F) Ensure participation with the administrator and other department directors in development and maintenance of practices and procedures that promote infection control, fire safety and hazard reduction.

(3) Whenever the nurse executive is not available in person or by phone, she or he shall designate in writing a specific registered nurse or nurses, licensed to practice in Oregon, to be available in person or by phone to direct the functions and activities of the nursing services department.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0077, filed 12/19/2018, effective 12/19/2018
OHD 6-1999, f. & cert. ef. 10-22-99
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89

333-071-0510
Dietary Services

(1) An SICF, regardless of classification, shall:

(a) Have an organized dietary department, directed by qualified personnel that conforms to the requirements in the Oregon Food Sanitation Rules, OAR 333-150-0000;

(b) Employ supportive personnel competent to carry out the functions of the dietary service;

(c) Provide dietetic services to patients in accordance with a written order by the responsible physician, or other health care practitioner authorized within the scope of his or her professional license, and record appropriate dietetic information in the patient's medical record including the following:

(A) Timely and periodic assessments of the patient's nutrient intake and tolerance to the prescribed diet modification, including the effect of the patient's appetite and food habits on food intake;

(B) A description of the diet instructions given to the patient or family and assessment of their diet knowledge;

(C) A description or copy of the diet information forwarded to another institution upon patient discharge; and

(D) Nutritional care follow-up with the patient’s health care practitioner or a health care agency.

(d) Regularly review and evaluate the quality and appropriateness of nutritional care provided by the dietetic service including the nutritional adequacy of all menus.

(e) Serve food that has an appetizing appearance, is palatable, is served at proper temperature and is cooked and served in such a way as to retain the nutrient value of food.

(f) Restrict admittance to the kitchen area to those who must enter to perform assigned duties.

(g) Develop written procedures for cleaning equipment and work areas and enforce those procedures.

(2) Services of a consulting dietician shall be obtained.

(3) Arrangements may be made for outside services. All food services shall meet the requirements of OAR 333-150-0000, the Oregon Food Sanitation Rules.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0085, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0520
Laboratory Services

The facility shall provide or shall have a written contract with a licensed clinical laboratory under ORS chapter 438 and OAR chapter 333, division 24, or its equivalent. A list of available tests and procedures shall be maintained.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0090, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0530
Pharmacy Services

(1) An SICF is subject to ORS chapter 689 and all the rules thereunder as applicable.

(2) Pharmacy services shall be in accordance with ORS chapter 689 and OAR 855-041-5005 through 855-041-6840.

(3) Provision shall be made for convenient and prompt 24-hour distribution of drugs to patients. This may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system meeting the rules of the Oregon Board of Pharmacy.

(a) If used, a medicine preparation room or unit shall be under the nursing staff's visual control and contain a work counter, refrigerator and locked storage for biologicals and drugs.

(b) A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of nursing or pharmacy staff.

(4) An SICF shall dispose of old medications, including special prescriptions for patients who have left the facility, by incineration or other equally effective method, except narcotics and other drugs under the drug abuse law, which shall be handled in the manner prescribed by the Drug Enforcement Administration of the United State Department of Justice.

(5) Drugs shall not be supplied or given to either inpatients or outpatients, unless ordered by a physician or individual authorized within the scope of his or her professional license to prescribe drugs. Such order shall be in writing over the physician's or other authorized individual's signature or authentication.

(6) If an SICF having a drug room and no pharmacy, the drug room must be supervised by a licensed pharmacist who provides his or her services with sufficient professionalism, quality and availability to adequately protect the safety of the patients and to properly serve the needs of the facility, pursuant to OAR 855-041-6800.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0110, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0535
Radiology Services

An SICF, regardless of classification shall have on-site or contract radiology services that:

(1) Comply with ORS chapter 453 and rules adopted thereunder;

(2) Support the SICF’s medical and other services; and

(3) Are available on a timely basis.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0550
Sanitary Precautions

(1) Provisions shall be made for the proper cleaning of linen and other washable goods and proper disposal of all refuse.

(2) All garbage and refuse shall be stored and disposed of in a manner that will not create a nuisance or a public health hazard. Infectious waste shall be stored and disposed of in accordance with OAR chapter 333, division 56.

(3) Measures shall be taken to prevent the entry of rodents, flies, mosquitoes, and other insects. Adequate measures shall include but are not limited to preventing their entry through doors, windows, or other outside opening.

(4) The walls and floors shall be of a durable and cleanable composition necessary to maintain a sanitary environment appropriate to the use of the area. The building shall be kept clean and in good repair.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0120, filed 12/19/2018, effective 12/19/2018
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0560
Safety and Emergency Preparedness

(1) An SICF shall:

(a) Have a physical plant and overall facility environment that is developed and maintained in such a manner that the safety and well-being of patients are provided for.

(b) Have telephone or another communication method to summon help in case of fire or other emergency.

(c) Comply with ORS chapter 479, its implementing rules, and all other requirements of the State Fire Marshal.

(d) Have emergency power facilities that are tested monthly and are in readiness at all times for use in all areas required in the 2012 NFPA 99 and the Oregon Electrical Specialty Code.

(2) An SICF shall develop and maintain a comprehensive emergency preparedness program based on classification:

(a) A freestanding hospice facility shall comply with 42 CFR 418.113;

(b) A rehabilitation hospital shall comply with 42 CFR 482.15;

(c) A religious institution shall comply with 42 CFR 403.748;

(d) A substance use disorder treatment facility shall comply with 42 CFR 482.15.

Statutory/Other Authority: ORS 441.025
Statutes/Other Implemented: ORS 441.025
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0125, filed 12/19/2018, effective 12/19/2018
PH 13-2008, f. & cert. ef. 8-15-08
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88

333-071-0570
Smoking Prohibition

(1) The administrator or person in charge of the SICF may not permit a person to smoke tobacco in the facility or within 10 feet of a doorway, open window or ventilation intake of the SICF.

(2) An SICF shall comply with ORS 433.835 through 433.875 and its implementing rules, OAR chapter 333, division 15.

Statutory/Other Authority: ORS 441.815
Statutes/Other Implemented: ORS 441.815
History:
PH 4-2019, adopt filed 02/21/2019, effective 02/21/2019

333-071-0580
Physical Environment Requirements

(1) Any person proposing to construct a new SICF or proposing to make certain alterations or additions to an existing SICF, must, before commencing new construction, alterations, or additions, comply with OAR chapter 333, division 675 and these rules.

(2) Only the portion of an existing SICF that is being altered or renovated and any impacted ancillary areas required to ensure full functionality of the SICF must meet the requirements in sections (4) through (7) of this rule.

(3) The following guidelines are adopted by reference as specified in sections (4) through (6) of this rule. Each SICF must also meet the requirements of state building and specialty codes in affect at the time of initial licensure.

(a) 2018, Facility Guidelines Institute (FGI), Guidelines for the Design and Construction of Hospitals; and

(b) 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities.

(4)(a) An applicant or a licensed SICF classified as a freestanding hospice facility shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (4)(b) and (c) of this rule. References in FGI to "and/or" mean "or".

(A) 1.1 – Introduction;

(B) 1.2 – Planning/Predesign Process;

(C) 1.3 – Site Selection;

(D) 1.4 – Design, Construction, and Commissioning Considerations and Requirements;

(E) 1.5 – Equipment;

(F) 2.1 – Site Elements;

(G) 2.2 – Design Criteria;

(H) 2.3 – Design Elements;

(I) 2.4 – Design and Construction Requirements;

(J) 2.5 – Building Systems; and

(K) 3.2 – Specific Requirements for Hospice Facilities.

(b) Section 2.3-4.2.2.4 of the 2018, FGI, Design and Construction of Residential Health, Care and Support Facilities, is not adopted by reference and does not apply under subsection (4)(a) of this rule.

(c) The following amendments or additions are made to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities, as adopted and incorporated by reference under subsection (4)(a) of this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities.

(A) Amend subsection 1.1-2.2.2 to read: "Standards set forth in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities shall be considered minimum and do not prohibit designing facilities and systems that exceed these requirements where desired by the governing body of the health, care, or support facility. Project submittal criteria shall comply with OAR 333-675-0000."

(B) Amend subsection 1.1-3.1.2.1 to read: "Where major structural elements make total compliance impractical or impossible, exceptions shall be considered in accordance with OAR 333-071-0260."

(C) Delete paragraphs (3) through (7) and amend subsection 1.1-3.1.2.2 to read: "The following exceptions to the requirements in Section 1.1-3.1.1 (Compliance Requirements) shall be permitted provided they meet the criteria specified in OAR 333-675-0000(2) or (3) and do not reduce the level of health and safety in an existing facility. (1) Routine repairs and maintenance to buildings, systems, or equipment shall not require improvements to building features or systems. (2) Replacement of building furnishings and movable or fixed equipment shall only require improvements to building systems that serve that equipment and only to the extent necessary to provide sufficient capacity for the replacement."

(D) Amend subsection 1.1-3.1.4 to read: "Temporary Waivers. When parts of an existing facility essential to continued overall facility operation cannot comply with particular standards during a renovation project, a temporary waiver of those standards shall be permitted as determined by the authority having jurisdiction if resident, participant, or outpatient health and safety will not be jeopardized as a result. Reference OAR 333-071-0260 for requirements."

(E) Amend subsection 1.1-5.2.1 to read: "In the absence of state or local requirements, the project shall comply with approved nationally recognized building codes except as modified in the latest CMS adopted edition of NFPA 101: Life Safety Code and/or herein."

(F) Amend subsection 1.2-2.1.2.1 to read: "The care provider shall be responsible for providing a functional program for each facility project to the project architect/engineer and the authority having jurisdiction (AHJ). (1) Findings and recommendations from the resident safety risk assessment (see Section 1.2-3) shall be addressed in the functional program."

(G) Amend subsection 1.2-2.1.2.2 to read: "The functional program shall include an executive summary as well as detailed information about each operation conducted in the facility that will affect the physical setting design. Refer to OAR 333-675-0000(6) for additional requirements to be included in the functional program."

(H) Amend subsection 1.2-3.1.1.2 to read: "To support this goal, a resident safety risk assessment (RSRA) shall be developed and completed by an interdisciplinary team. A copy of the RSRA shall accompany construction documents submitted to the Oregon Health Authority, Facility Planning and Safety Program."

(I) Delete subparagraph (e) in subsection A1.2-3.5.3.4(3).

(J) Amend subparagraph (b) in subsection A1.2-4.5.1 to read: "b. Window sill height should not exceed 3 feet (.91 meter) above the floor and should be above grade. Operable windows shall be designed to prevent accidental falls when sill heights are lower than 36 inches and above the first floor."

(K) Amend subparagraph (i) in subsection A1.2-4.5.2.2 to read: "i. Water features. Where provided and where allowed per the RSRA, open water features should be equipped to safely manage water quality to protect occupants from infectious or irritating aerosols. See Section 2.1-3.6.3 (Outdoor Water Features) and appendix section A2.4-2.2.13 (Decorative water features) for additional information and requirements."

(L) Amend subsection 2.1-3.6.3.2 to read: "Where provided and allowed by the resident safety risk assessment (RSRA) for facilities that serve special care populations, outdoor water features shall be designed with the care population in mind to provide safe and accessible environments."

(M) Delete subparagraph (i) in subsection A2.2-4.2.1.

(N) Amend subparagraph (2)(a) in subsection 2.3-2.3.3.2 to read: "(a) Space for dining in accordance with the needs of the care population, including residents and participants who use resident-operated mobility devices. Provide a minimum of 28 square feet (2.60 square meters) for each resident or participant at one seating."

(O) Amend subsection A2.3-2.3.3.2(2) to read: "Adult day care programs may require additional participant space based on the care population being served."

(P) Amend paragraph (2) in subsection 2.3-4.2.2.1 to read: "(2) A medication room, a self-contained medication distribution unit, or other approaches acceptable to the authority having jurisdiction (AHJ) shall be permitted to be used for preparing, dispensing, and administering medications."

(Q) Amend subsection 2.3-4.2.2.3 to read: "Self-contained medication distribution units, automated medication-dispensing stations, or mobile medication-dispensing carts. Where these or other systems approved by the AHJ are used, the following shall apply: (1) Location of such units shall be permitted at the staff work area, in the clean utility room, in an alcove. (2) Areas used for medication preparation and distribution by mobile cart shall include task-specific lighting."

(R) Delete paragraphs (4) and (5) and amend subsection 2.3-4.5.3.4 to read: "Ice-making equipment and drinking water source. (1) Location of ice-making equipment in the food preparation area or in a separate room shall be permitted as long as the equipment is directly accessible to the food preparation area. (2) Ice-making equipment shall be cleanable. (3) Ice-making equipment shall be self-dispensing. (4) A filtered self-dispensing drinking water source shall be provided."

(S) Amend subsection 2.4-2.2.4 to read: "Doors and Door Hardware. See the facility chapters in Parts 3 through 5 for requirements in addition to those in this section. Door type for residing patient bathing/toilet facilities and other single-user toilets subject to patient use. Rooms that contain bathtubs, sitz baths, showers, or toilets for patient use shall have one of the following: (1) Two separate doors (2) A door that swings outward (3) A door equipped with emergency rescue hardware (4) A sliding door".

(T) Amend subsection 2.4-2.2.6.2 to read: "Sill height. Windows in resident rooms, suites, and dwelling units shall have sills located no higher than 36 inches (91.44 centimeters) above the finished floor. Operable windows shall be designed to prevent accidental falls when sill heights are lower than 36 inches and above the first floor."

(U) Amend paragraphs (1) and (2) in subsection 2.4-2.2.8.1 to read: "(1) The number and placement of hand-washing stations shall be determined as indicated in other sections and by the infection control risk assessment (ICRA). (2) If not required by other sections, hand sanitation dispensers shall be permitted to be used in lieu of hand-washing stations as determined by the ICRA."

(V) Amend subsection 2.4-2.2.13 to read: "Decorative Water Features Provision of decorative water features shall be permitted in residential health, care, and support facilities where allowed by the RSRA."

(W) In subsection A3.2-2.2.1.2(2):

(i) Amend subparagraph (b) to read: "b. Home-based hospice services. This hospice care model is ineligible for review within these guidelines as the hospice care either takes place in individual homes or in facilities under the regulation of State of Oregon, Department of Human Services (DHS). This model includes services that are brought to a resident living in an assisted living facility or independent living setting. Home-based hospice services are provided for residents who live in an independent or assisted living setting. Hospice services to be provided by a care and support facility, if any, should be identified during the functional programming process."

(ii) Amend subparagraph (g) to read: "g. Nursing home-based hospice facilities. This hospice care model is ineligible for review within these guidelines as these facilities are regulated by the State of Oregon, Department of Human Services (DHS). This model follows hospice regulations and includes any number of beds housed in a nursing home setting. Nursing home-based hospice facilities provide end-of-life services and should be provided in a private room that includes adequate family space. Nursing homes should provide hospice services and related accommodations for residents and family."

(X) Amend paragraph (3) in subsection 3.2-2.2.2.2 to read: "(3) Room size shall be 80 square feet for each residing patient in a double room and at least 100 square feet for each patient residing in a single room. Room size shall also be based on the care model and in-room furniture and clothing storage requirements."

(Y) Amend subsection 3.2-2.3.3.3 to read: "Recreation, lounge, and activity areas. Lounge areas shall be provided for resident and visitor use at a minimum of 15 square feet per resident being served."

(Z) Amend subsection 3.2-2.3.6.2 to read: "Inclusion of a gas fireplace or other comparable heating elements shall be permitted in a family room where non-operable glass doors are used. These heating element surfaces may not exceed 120 degrees Fahrenheit when they are installed in locations that are subject to incidental contact by people or with combustible material."

(AA) Amend subsection 3.2-4.5.3.1 to read: "Where an outside vendor is used to provide meals for a facility of 16 or more beds, the facility shall include dedicated space and equipment for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies."

(BB) Amend subsection 3.2-4.5.4 to read: "Decentralized Kitchen Where food preparation is conducted on-site for 16 or more beds, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies."

(CC) Amend paragraph (2) in subsection 3.2-4.6.2.2 to read: "(2) Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/Extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant."

(DD) Amend paragraph (3) in subsection 3.2-4.6.3.2 to read: "(3) Room(s) used for processing shall have a flushing-rim sink and a handwash sink."

(5)(a) An applicant or a licensed SICF classified as a rehabilitation hospital shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Hospitals, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (5)(b) and (c) of this rule. References in FGI to "and/or" mean "or".

(A) 1.1 – Introduction;

(B) 1.2 – Planning, Design, Construction, and Commissioning;

(C) 1.3 – Site;

(D) 1.4 – Equipment;

(E) 2.1 – Common Elements for Hospitals;

(F) 2.2 – Specific Requirements for General Hospitals;

(G) 2.6 – Specific Requirements for Rehabilitation Hospitals; and

(H) Part 3 – Ventilation of Hospitals.

(b) The following sections, paragraphs, subparagraphs or appendices of the 2018, FGI, Guidelines for Design and Construction of Hospitals are not adopted by reference and do not apply under subsection (5)(a) of this rule:

(A) A1.2-2.1.2.1;

(B) 1.2-2.1.2.3;

(C) 1.2-8.3 through 1.2-8.3.3;

(D) 2.1-2.8.10.2; and

(E) A2.1-8.3.3.1(2).

(c) The following amendments or additions are made to the 2018, FGI, Guidelines for Design and Construction of Hospitals, as adopted and incorporated by reference under subsection (5)(a) of this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Hospitals.

(A) Amend section 1.1-2 to read: "New Construction Project submittal criteria shall comply with OAR 333-675-0000. Projects with any of the following scopes of work shall be considered new construction and shall comply with the requirements in the Guidelines for Design and Construction of Hospitals:"

(B) Amend subsection 1.1-3.1.1.2 to read: "Major renovation projects. Project submittal criteria shall comply with OAR 333-675-0000. Projects with either of the following scopes of work shall be considered a major renovation and shall comply with the requirements for new construction in the Guidelines for Design and Construction of Hospitals to the extent possible as determined by the authority having jurisdiction: (1) A series of planned changes and updates to the physical plant of an existing facility (2) A renovation project that includes modification of an entire building or an entire area in a building to accommodate a new use or occupancy."

(C) Amend subsection 1.1-3.1.2.1 to read: "Where major structural elements make total compliance impractical or impossible, exceptions shall be considered in accordance with the Oregon Administrative Rules specific to the physical environment of the type of hospital under consideration."

(D) Amend subsection 1.1-3.1.2.2 to read: "Minor renovation or replacement work shall be permitted to be exempted from the requirements in Section 1.1-3.1.1 (Compliance Requirements) provided they meet the criteria specified in OAR 333-675-0000(2) or (3) and do not reduce the level of health and safety in an existing facility."

(E) Amend subsection 1.1-3.1.4 to read: "Temporary Waivers When parts of an existing facility essential to continued overall facility operation cannot comply with particular standards during a renovation project, a temporary waiver of those standards shall be permitted as determined by the authority having jurisdiction if patient care and safety will not be jeopardized as a result. Reference Oregon Administrative Rules specific to the physical environment of the type of hospital under consideration."

(F) Amend subsection A1.2-2.1.1 to read: "Functional program purpose. a. All projects, large and small, require a functional program to guide the design. The length and complexity of the functional program will vary greatly depending on project scope. b. The functional program can be used as a supplement to the construction documents; it is not intended to be approved by the authority having jurisdiction (AHJ)."

(G) Amend subsection 1.2-2.1.2.1 to read: "The governing body shall be responsible for having a functional program developed, documented, and updated. The governing body may delegate documentation of the functional program to consultants with subject matter expertise. The governing body shall review and approve the functional program."

(H) Add subsection 1.2-2.2.7.4 and specify: "A description of the following: (a) Special design feature(s); (b) Occupant load, numbers of staff, patients, visitors and vendors; (c) Issue of privacy/confidentiality for patient; (d) In treatment areas, describe: (A) Types of procedures; (B) Design considerations for equipment; (C) Requirements where the circulation patterns are a function of asepsis control; and (D) Highest level of sedation, if applicable."

(I) Amend subsection 1.2-4.1.1.2 to read: "To support this goal, an interdisciplinary team shall develop a safety risk assessment (SRA). A copy of the SRA shall accompany construction documents submitted to the Oregon Health Authority, Facility Planning and Safety Program."

(J) Amend subsection 1.2-4.6.1 to read: "Behavioral and Mental Health Elements of the Safety Risk Assessment. The SRA report shall identify areas where patients at risk of mental health injury and suicide will be served. Elements of the assessment shall include but not be limited to: (1) A statement explaining the psychiatric population groups served; (2) A discussion of the capability for staff visual supervision of patient ancillary areas and corridors; (3) A discussion of the risks to patients, including self-injury, and the project solutions employed to minimize such risks; and (4) A discussion of building features and equipment, including items which may be used as weapons, that is intended to minimize risks to patients, staff and visitors."

(K) Amend subparagraph (d) in subsection A1.2-5.4.5 to read: "d. In facilities with multi-bed rooms, family consultation rooms or grieving rooms, in addition to family lounges, should be provided to permit patients and families to communicate privately."

(L) Amend subsection 2.1-2.8.2.1 to read: "This area shall include the following: (1) Space for counters (2) Hand-washing station(s) (a) At least one hand-washing station shall be provided within twenty feet and not through a door. See section 2.1-7.2.2.8 (Handwashing stations) for requirement."

(M) Amend paragraph (1) in subsection 2.1-2.8.7.3 to read: "(1) At least one hand-washing station shall be provided for every four patient care stations or fewer."

(N) Amend subsection 2.1-2.8.10.1 to read: "Ice-making equipment shall be of the self-dispensing type."

(O) Amend subsection 2.1-4.2.8.7 to read: "Handwashing station. A hand-washing station(s) shall be provided within each separate room where open medication is prepared for administration except where prohibited. Placement shall be determined by OAR chapter 845, division 45; USP 797 and USP 800."

(P) Amend subsection 2.1-4.3.1.3 to read: "Regulations. Construction, equipment, and installation of food and nutrition service facilities in a hospital shall comply with the requirements of: (1) U.S. Food and Drug Administration (FDA) (2) U.S. Department of Agriculture (USDA) (3) Underwriters Laboratories, Inc. (UL) (4) NSF International (5) All offered dietary services shall comply with Oregon Health Authority, Food Sanitation Rules, OAR 333-150-0000 and other authorities having jurisdiction."

(Q) Amend paragraph (2) in subsection 2.1-5.2.2.2 to read: "(2) Laundry processing room. This room shall have space for commercial or industrial washing and drying equipment that can process at least a seven-day supply of laundry during the regularly scheduled work week. (a) Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/Extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant. (b) Dryers (c) Supply storage. Storage shall be provided for laundry supplies."

(R) Amend subsection 2.1-5.4.1.3 to read: "Regulated waste holding spaces (1) Secured space shall be provided for regulated medical waste and other regulated waste types. (a) Where provided as interior spaces, regulated medical waste or infectious waste holding spaces shall have cleanable floor and wall surfaces. (i) Wall base shall be integral and coved with the floor, tightly sealed to the wall, and constructed without voids that can harbor insects. (ii) Shall have hand sanitation dispenser in or adjacent to interior regulated waste storage spaces. (b) Where an exterior holding space is provided, it shall have the following: (i) Cleanable floor (and wall, where provided) surfaces (ii) Protection from weather (iii) Protection from animals (iv) Protection from vermin infestation (2) Such holding spaces shall provide: (a) Illumination per Illuminating Engineering Society of North America (IES) standards (b) Protection from unauthorized entry (3) Refrigeration requirements for such holding facilities shall comply with local and/or state regulations (4) Regulated waste management shall be in accordance with the requirements of OAR chapter 333, division 56."

(S) Amend subsection 2.1-6.2.7.1 to read: "Storage. A designated area located out of the required corridor width and directly accessible to the entrance shall be provided for storage of at least one wheelchair."

(T) Add paragraph (4) to subsection 2.1-7.2.2.11 to read: "(4) All imaging facilities and radiation producing equipment installations must comply with OAR chapter 333, divisions 100 through 123, and be licensed by the Oregon Health Authority, Radiation Protection Services program."

(U) Amend subparagraph (7)(a) in subsection 2.1-7.2.3.1 to read: "(a) The room types listed in this section shall have floor and wall base assemblies that are monolithic and have an integral coved wall base that is carried up the wall a minimum of 6 inches (150 mm) and is tightly sealed to the wall. (i) Operating room (ii) Class 2 and Class 3 imaging rooms (iii) Cesarean delivery room (iv) Procedure rooms where cystoscopy, urology, and endoscopy procedures are performed (v) Endoscope processing room (vi) IV and chemotherapy preparation room (vii) Airborne infection isolation (AII) room (viii) Protective environment (PE) room (ix) Anteroom to AII and PE rooms, where provided (x) Sterile processing facility (xi) Bathing and toilet rooms (xii) Soiled workrooms and soiled hold rooms (xiii) Environmental services rooms".

(V) Amend paragraph (2) in subsection 2.1-8.3.3.1 to read: "Stored fuel is required and storage capacity shall permit continuous operation for at least 96 hours."

(6)(a) An applicant or a licensed SICF classified as a substance use disorder treatment facility shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (6)(b) and (d) of this rule. References in FGI to "and/or" mean "or".

(A) 1.1 – Introduction;

(B) 1.2 – Planning/Predesign Process;

(C) 1.3 – Site Selection;

(D) 1.4 – Design, Construction, and Commissioning Considerations and Requirements;

(E) 1.5 – Equipment;

(F) 2.1 – Site Elements;

(G) 2.2 – Design Criteria;

(H) 2.3 – Design Elements;

(I) 2.4 – Design and Construction Requirements;

(J) 2.5 – Building Systems; and

(K) 4.3 – Specific Requirements for Long-Term Residential Substance Abuse Treatment Facilities.

(b) The amendments specified in paragraphs (4)(c)(A) through (V) of this rule shall also apply to an SICF classified as a substance use disorder treatment facility.

(c) Section 2.3-4.2.2.4 of the 2018, FGI, Design and Construction of Residential Health, Care and Support Facilities, is not adopted by reference and does not apply under subsection (6)(a) of this rule.

(d) The following amendments or additions are made to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities, as adopted and incorporated by reference under subsection (6)(a) of this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities.

(A) Amend subsection A4.3-1.1.1.1 to read: "Long-term residential substance abuse treatment facility typology. Long-term residential treatment facilities may be located in a wide variety of settings including, but not limited to, a large suburban house, larger freestanding residential setting, or part of a nursing home, assisted living facility, homeless shelter, or facility in a prison. Only a large suburban house or larger freestanding residential setting shall be eligible for review within these guidelines for Special Inpatient Care Facility. The Authority does not have jurisdiction over other settings specified. Care is provided 24 hours a day, generally in non-clinical/acute care settings. This therapeutic community (TC) is a common type of long-term residential treatment setting for substance use disorders, which typically require 18 to 24 months of treatment, although funding and insurance limitations may reduce an individual’s stay to three, six, or 12 months. The focus of a TC is resocialization of an individual using the program’s entire community as active components of treatment. Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is typically highly structured and can be modified for specific care populations (e.g., adolescents, homeless residents, individuals from the criminal justice system, those with mental/behavioral issues). In addition to long-term residential treatment, a therapeutic community may offer shorter-term residential or outpatient treatment. A TC acquires a medical partner has an opportunity to become a federally qualified health center or a patient-centered medical home. A specialized type of treatment setting called a 'modified therapeutic community' incorporates features of traditional therapeutic communities with a special focus on addressing co-occurring mental health conditions. Correctional institutions may incorporate in-prison TCs, and TCs are also available for people reentering society after being released from prison with the goal of reducing drug use and recidivism."

(B) Amend paragraph (2) in subsection 4.3-2.2.2.2 to read: "A minimum of 70 square feet of floor space per bed is required in semi-private rooms and wards. A minimum of 100 square feet of floor space shall be provided in private rooms."

(C) Amend subsection 4.3-2.2.2.7 to read: "Resident bathroom. Each resident shall have access to a bathroom. Bathroom doors shall comply with 2.4-2.2.4. (1) The bathroom shall contain the following: (a) Toilet (b) Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements. (c) Mirror. See Section 2.4-2.2.8.7 (Mirror) for requirements. (d) Private individual storage for the personal effects of each resident. See Section 2.4-2.4.2 (Casework, Millwork, and Built-Ins) for requirements. (e) Shower. See Section 2.5-2.3.3.2 (Accessible showers) for requirements. (2) Where the bathroom is shared, privacy locks shall be permitted with provisions for emergency access."

(D) Add subsection 4.3-2.2.3.4 to read: "Detoxification Room. The design and need for a detoxification room shall be described in the Resident Safety Risk Assessment and functional program. Where provided, a minimum of one residing patient room for detoxification, located to allow direct observation by nursing staff, shall be provided. Windows in detoxification rooms shall be of a security type that can only be opened by keys or tools that are under the control of the staff. An adjoining or closely available toilet and hand washing lavatory is also required serving detoxification residing patients only. This room shall be designed with special consideration that residing patient is incapable of self-preservation in an emergency."

(E) Amend subsection 4.3-2.3.8.1 to read: "Outdoor spaces shall be provided for residents, visitors, and staff. The design and use of outdoor activity spaces shall be described in the Resident Safety Risk Assessment."

(F) Amend subsection 4.3-4.5.3.1 to read: "Where an outside vendor is used to provide meals for a setting of 16 or more beds, dedicated space and equipment shall be provided for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies."

(G) Amend subsection 4.3-4.5.4 to read: "Decentralized Kitchen Where food preparation is conducted on-site for 16 or more beds, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies."

(H) In subsection 4.3-4.6.3.2:

(i) Amend subparagraph (2)(c) to read: "(c) Rooms used for processing shall have a flushing-rim sink and a handwash sink."

(ii) Add paragraph (6) to read: "(6) Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/Extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant."

(I) Amend subsection 4.3-5.2.2.4 to read: "Doors and door hardware See Section 2.4-2.2.4 (Doors and Door Hardware) for requirements in addition to those in this section."

(7) An SICF classified as a religious institution must be designed, constructed, and maintained to ensure the safety of the patients, staff, and the public and shall comply with the following:

(a) General Building. The overall environment must be maintained in a manner that ensures the safety and well-being of the patients. The institution must have the following:

(A) Procedures for the proper storage and disposal of trash;

(B) Proper ventilation and temperature control and appropriate lighting levels to ensure a safe and secure environment;

(C) An effective pest control program including that:

(i) Wall openings for pipes, ducts, and conduits as well as joints at structural elements shall be sealed; and

(ii) In dietary and food storage areas, wall construction, finish, and trim, including joints between walls and floors, shall be free of insect- and rodent-harboring spaces;

(D) A preventive maintenance program to maintain essential mechanical, electrical, and fire protection equipment operating in an efficient and safe manner; and

(E) A working call system for patients to summon aid or assistance.

(b) Patient rooms. Patient rooms must be designed and equipped for adequate care, comfort, and privacy of the patient and shall meet the following conditions:

(A) Accommodate no more than four patients;

(B) Measure at least 80 square feet per patient in multiple patient rooms and at least 100 square feet in single patient rooms;

(C) Have direct access to an exit corridor;

(D) Be designed or equipped to assure full visual privacy for each patient. Design for privacy shall not restrict patient access to the toilet, room entrance, window, or other shared common areas in the patient room;

(E) Have at least one operable window to the outside, provided with window coverings;

(F) Have a floor at or above grade level; and

(G) Be furnished with the following:

(i) A separate bed of proper size and height for the convenience of the patient;

(ii) A clean, comfortable mattress and pillow with protective coverings;

(iii) Bedding appropriate to the weather and climate; and

(iv) Functional furniture appropriate to the patient's needs and individual closet space with clothes racks and shelves accessible to the patient.

(c) Plumbing and Sanitary Environment.

(A) Each patient shall have access to a toilet room without entering the general corridor area. One toilet room shall serve no more than four beds and no more than two patient rooms.

(i) The toilet room shall contain a toilet and a handwash station.

(ii) Doors to all rooms containing bathtubs, showers, and toilets for patient use shall be hinged, sliding, or folding with door hardware that allows staff access. Where swinging doors are provided, the door shall swing outward or be provided with emergency rescue (dual-swing) hardware.

(B) Adequate handwashing stations shall be provided for the total facility population and include lavatories with hot and cold running water, soap, and single use sanitary towels.

(i) A hand-washing station shall be provided both in the patient room and the toilet room. This hand-washing station shall be located at or adjacent to the entrance to the patient room with unobstructed access for use by health care personnel and others entering and leaving the room. When multi-patient rooms are permitted, this station shall be located outside the patients' cubicle curtains.

(ii) At least one hand-washing station shall be provided for the administrative center or nurses’ station that is within 20 feet and not through a door.

(C) Bathing facilities for patients shall be provided to include at least one shower or tub for each eight beds, serving patient rooms not containing bathing facilities directly adjoining the room. Bathing facilities shall include space for drying, dressing, grooming, and a surface to temporarily place toiletries.

(D) An institution licensed for more than 16 patients must provide at least one separate toilet and hand wash lavatory for staff and visitor use. The staff and visitor toilet shall not be located where it would require a visitor to travel through any intervening staff support areas.

(E) There shall be an environmental services room with floor or service sink and space for temporary storage of refuse. An institution licensed for 16 or fewer patients may combine this room with other soiled rooms.

(F) Cart sanitizing facilities and cart storage area for both dietary and linen services shall be available.

(G) Areas subject to frequent wet cleaning methods or high amounts of moisture, including but not limited to, kitchens, soiled workrooms, soiled and clean utility rooms, environmental services rooms and toilet rooms, shall meet the following requirements:

(i) The floors and wall bases shall be constructed of slip-resistant materials that are not physically affected by germicidal or other types of cleaning solutions.

(ii) Floors shall be homogeneous and have sealed joints.

(iii) Wall bases shall be continuous, integral or sealed to the floor and the wall, and constructed without voids.

(iv) Wall surfaces in areas routinely subjected to wet spray or splatter (for example, kitchens, soiled linen processing, environmental services room) shall be smooth, scrubbable, and water-resistant.

(v) Ceiling surfaces in dietary and laundry areas, bathrooms, central bathing rooms or areas with showers, soiled utility rooms, and environmental services rooms shall be impervious and moisture-resistant.

(d) There shall be a clean storage room or enclosed cabinet spaces for supplies and equipment.

(e) Space for patient dining at a minimum of 28 square feet per patient shall be provided.

(f) A room or space for social activities which may include group therapy or other gatherings at a minimum of 15 square feet per patient shall be provided. This space may be omitted if the institution is licensed for a capacity of 16 or fewer and social space is accommodated within the shared patient dining.

(g) There shall be an administrative center or nurse station. This space shall include provisions for storage of administrative supplies, a worksurface with equipment for documentation, and secure storage of staff personal belongings.

(h) Patients shall have access to a telephone and accommodations shall be made to allow private conversations.

(i) Food and nutrition services. The facility may provide onsite or third party contracted dietary services. All offered dietary services shall comply with Oregon Health Authority, Food Sanitation Rules, chapter 333, division 150 and other authorities having jurisdiction.

(A) Onsite dietary service in an institution licensed for a capacity of 16 or fewer may be of residential type except as required by the building codes. Kitchen facilities and equipment in an institution licensed for a capacity of more than 16 must be commercial type equipment. The following must be provided:

(i) A dishwasher;

(ii) A pot wash sink (unless all pots are sanitized in the dishwasher);

(iii) A food prep sink;

(iv) A separate hand wash lavatory;

(v) Stove and oven equipment for cooking and baking needs;

(vi) Self-dispensing ice-making equipment;

(vii) Refrigerator(s) and freezer(s);

(viii) Storage for a mop and other cleaning tools and supplies used for dietary areas must be separate from those used in toilet rooms, patient rooms, and other support areas. In an institution with a capacity of more than 16, a separate janitor closet or alcove must be provided with a floor or service sink and storage for cleaning tools and supplies; and

(B) Third-party contracted dietary services:

(i) Provisions shall be made to prevent contamination, keep hot and cold foods at required temperature ranges in transit and on site prior to consumption.

(ii) If ware washing is provided on site, either a three-compartment sink or dishwasher (commercial grade if the institution is licensed for a capacity of more than 16) shall be provided.

(iii) Nourishment area: There shall be a handwash station, food prep sink (if required by the functional program), work counter, refrigerator, storage cabinets, and equipment for serving nourishment as required by the functional program.

(j) Linen services:

(A) On-Site Processing. If linen is to be processed on the site, the following shall be provided:

(i) Soiled linen utility room with adequate space for receiving and sorting. Room(s) shall have ventilation and exhaust, a clinical sink or equivalent flushing-rim fixture with a rinsing hose or bedpan washer, handwash station, and space for linen and containers;

(ii) Laundry processing room with commercial-type washing and drying equipment. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant;

(iii) Secure storage for laundry supplies;

(iv) Clean linen inspection and mending room or area; and

(v) Clean linen storage, issuing, and holding room or area.

(B) If linen is processed off-site, the following shall be provided:

(i) Soiled linen holding room with ventilation and exhaust; and

(ii) Clean linen receiving, holding, inspection, and storage room(s).

(8) The Authority may, upon written request, allow variations from these requirements (other than fire and life safety requirements) when conditions make certain changes to an SICF impractical to accomplish, as long as the intent of the requirement is met, and the care and safety of patients will not be jeopardized. An applicant or SICF must obtain written approval from the Authority in accordance with OAR 333-071-0260, for any minor variation.

(9) An SICF shall conform to the editions of the Oregon State Building Code, as defined in ORS 455.010(8), under which they were constructed. SICFs to be certified for Medicare reimbursement shall meet standards of the 2012, National Fire Protection Association (NFPA) #101 and #99 Codes.

Statutory/Other Authority: ORS 441.060
Statutes/Other Implemented: ORS 441.060
History:
PH 4-2019, amend filed 02/21/2019, effective 02/21/2019
PH 281-2018, renumbered from 333-071-0105, filed 12/19/2018, effective 12/19/2018
HD 5-1989, f. 7-14-89, cert. ef. 8-1-89
HD 11-1988, f. & cert. ef. 5-27-88
HD 17-1987(Temp), f. 10-13-87, ef. 10-15-87 thru 4-15-88