OAR 309-033 establishes the standards and procedures governing Oregon's involuntary civil commitment process for persons with mental illness under ORS Chapter 426. It prescribes requirements for custody, detention, placement, and treatment of persons alleged to have or found to have a mental illness, including roles and responsibilities of Community Mental Health Programs (CMHPs), hospitals, nonhospital facilities, peace officers, and licensed independent practitioners. Facility operators and CMHP directors must comply with reporting, data collection, and procedural requirements throughout the commitment process, including diversion, prehearing detention, and community-based civil commitment.
View official sourceOregon Health Authority Health Systems Division: Behavioral Health Services - Chapter 309 Division 33 CIVIL COMMITMENT PROCEEDINGS 309-033-0200 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe general standards and procedures relating to the involuntary civil commitment of persons with mental illness as defined in ORS 426.005. (2) Statutory authority. These rules are authorized by ORS 426.005 through 426.395 and carry out the provisions of 426.005 through 426.395. These rules replace OAR 309-033-0100 through 309-033-0170, which were in effect from September 2, 1992 through August 31, 1994. Statutory/Other Authority: ORS 413.042 & ORS 426.005 - 426.395 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0000 309-033-0210 Definitions (1) “Administrator” means the director or chief executive over behavioral health services in a community hospital or the person in charge of treatment and rehabilitation programs at nonhospital facilities. Whenever “administrator” appears it means the administrator or designee. (2) “Assignment” means “placement” as defined in OAR 309-033-0210. (3) “Attorney-in-fact” means a person, as appointed in a valid declaration for mental health treatment (DMHT), authorized to make mental health treatment decisions for the person who is subject of the DMHT. (4) “Authority” or “OHA” means the Oregon Health Authority. (5) “Capacity evaluator” means, in relation to a Declaration for Mental Health Treatment, a licensed independent practitioner (LIP) or a licensed psychologist who, with one other LIP or licensed psychologist, determines if a person is incapable or not incapable. (6) “Caregiver” means the person who is appointed by the court under ORS 426.125 to be allowed to care for a person who has a mental illness and is in need of treatment on conditional release. (7) “Certificate” means the document or documents issued by the Division, which identifies and declares certification of a provider pursuant to OAR 309-008-0100 to 309-008-1600. A letter accompanying issuance of the certificate will detail the scope and approved service delivery locations of the certificate. (8) “Clinical record” means the record required by OAR 309-014-0035 documenting the mental health services delivered to clients by a CMHP or subcontractor. (9) “Community-based civil commitment” means conditional releases pursuant to ORS 426.125, outpatient commitments pursuant to ORS 426.127, and trial visits pursuant to ORS 426.273. (10) “Community Mental Health Program (CMHP)” means the entity responsible for organization of various services for persons with a mental health diagnosis or addictive disorders, operated by, or contractually affiliated with, a local mental health authority and operated in a specific geographic area of the state under an agreement with the Division pursuant to OAR 309-014-0000. (11) “Community hospital” means any hospital that is not Oregon State Hospital. (12) “Conditions of placement” means the set of expectations and guidelines that a person shall adhere to, as described in OAR 309-033-0280 and 309-033-0282, in order to be placed and remain on a community-based civil commitment and avoid revocation. (13) “Council” means a regional acute care psychiatric facility organization with a mission statement and bylaws, comprised of facility representatives, consumers, and family members. The council is advisory to the facility. (14) “County governing body” means the county court or the board of county commissioners of one or more counties who operate a CMHP, or in the case of a Native American Reservation, the Tribal Council, or if the county declines to operate or contract for all or part of a CMHP, the board of directors of a public or private corporation selected by the county. (15) “County of commitment” means the county in which the person was initially placed under civil commitment, or the county to which the county of commitment was transferred as appropriate. (16) “County of custody” means the county in which the person was initially detained by either a peace officer pursuant to ORS 426.228 or a CMHP director pursuant to ORS 426.233. (17) “County of placement” means the county in which the person under civil commitment is residing for the purpose of treatment, care, and custody. (18) “County of residence” means the county where the person currently maintains a mailing address or, if the person has no current mailing address within the state, the county where the person was taken into custody or the county in which a person under civil commitment has been conditionally released as defined by ORS 426.241 to 426.255. (19) “Court” means the circuit court acting pursuant to ORS Chapter 426. (20) “Custody” means the physical detention of a person pursuant to ORS 426.070, 426.228, 426.231, 426.232, and 426.233. (21) “Declaration for Mental Health Treatment” or “DMHT” means the legal document as described in ORS 127.700 through 127.737 that describes a person’s preferences regarding mental health treatment and provides instructions to providers to meet the person’s care needs. (22) "Director" means the director of the community mental health program and includes the director's designee, who must be a QMHP, or peace officer authorized by the director to act on their behalf for purposes of this rule. (23) “Diversion from commitment” means the initial 14-day period of intensive treatment and, if offered and accepted, the 14-day extension of the initial diversion period, not exceeding 28 consecutive calendar days combined. (24) “Division” means the Behavioral Health Division of the Oregon Health Authority. (25) “Emergency” means, in the opinion of the treating licensed independent practitioner, immediate action is required to preserve the life or physical health of a person, or because the behavior(s) of that person creates a substantial likelihood of immediate physical harm to self or to others in the facility. The fact that a person is in custody under the provisions or ORS 426.072, 426.232 or 426.233 must not be the sole justification that an emergency exists. (26) “Fresh air” means the inflow of air from outside the facility where the person under civil commitment is receiving services. “Fresh air” may be accessed through an open window or similar method as well as through access to the outdoors. (27) “ Health care facility” means, in relation to the Declaration for Mental Health Treatment, an inpatient setting, a residential facility, an adult foster home or a hospice program. (28) “Healthcare supervisor” means the appointed licensed independent practitioner, master’s level registered nurse or registered nurse certified by the American Nursing Association who reviews and approves policies and procedures related to reporting medical concerns to a LIP and staff training on the administrative rules in OAR Chapter 33, Division 207. (29) “Hospital” or “hospital facility” means the community hospital, or regional acute care psychiatric facility certified for the use of seclusion or restraints to committed persons and persons in custody or on diversion. (30) “Hospital hold” means the notice of mental illness submitted to the court pursuant to ORS 426.232(1)(a) by one licensed independent practitioner at a hospital licensed by the Authority under ORS Chapter 441, and by which a person is physically detained in the community hospital. (31) “Incapable” means, for the purpose of the DMHT and as determined by two capacity evaluators or a court, unable to make informed mental health treatment decisions. (32) “Judicial day” means any day the court is open for business excluding Saturday, Sunday, and a legal holiday as described in ORS 187.010 and 187.020. (33) “Legally incapacitated person” means a person who has been found by the court to be unable to give informed consent to medical treatment, and the court has appointed a guardian to make such decisions on the person’s behalf pursuant to ORS 126.127. (34) “Licensed Independent Practitioner” or “LIP” means a physician, nurse practitioner, or naturopathic physician as defined in ORS 426.005. (35) “Material risk” means the risk may have a substantial adverse effect on the patient’s psychological and/or physical health. (36) “Mechanical restraint” means any device or equipment used to restrict a person’s freedom of movement. (37) “Monitoring” as used in OAR 309-033-0280 and 309-033-0282 means the set of activities and tasks completed by a CMHP employee who is designated to support an individual successfully adhere to the conditions of placement or to a treatment plan related to assisted outpatient treatment, a diversion from commitment, an outpatient commitment, or a trial visit. (38) “Next of kin” means one of the following people: a person’s spouse or domestic partner, adult child, parent, siblings, or any person related to the person. (39) “Notice of Mental Illness (NMI)” is the notification required, pursuant to ORS 426.070, to be submitted to the director by any two persons, a county health officer, or a magistrate, and thereafter submitted by the director to the court or, pursuant to ORS 426.234, to be submitted by the LIP or the director to the court. Pursuant to ORS 426.070 and 426.234, the court commences proceedings pursuant to ORS 426.070 to 426.130 upon receipt of the NMI. (40) “Nonhospital facility” means any facility, other than a hospital, that is certified by the Authority to provide adequate security, psychiatric, nursing, and other services to persons under ORS 426.232 or 426.233. (41) “Nonhospital hold” means the emergency detention of a person at a nonhospital facility, and the approval for emergency care and treatment, pursuant to the provisions of ORS 426.232. (42) “Nurse” means a registered nurse, or a psychiatric nurse practitioner licensed by the Oregon State Board of Nursing but does not include a licensed practical nurse or a certified nurse assistant. (43) “Outdoors” means an area with fresh air that is not completely enclosed overhead. “Outdoors” may include a courtyard or similar area. (44) “PAMI” means a person alleged to have a mental illness and who is in need of treatment, and refers to a person who is subject to a mental health investigation and pending a civil commitment hearing. (45) “PRN” (pro re nata) means that a medication or medical treatment has been ordered to be given as needed. (46) “Patient day” means the day of admission plus each additional day of stay, but not the day of discharge, unless it is also the day of admission. (47) “Peace officer” means a sheriff, constable, marshal, municipal police officer, member of the Oregon State Police or investigator of the Criminal Justice Division of the Department of Justice and such other persons as may be designated by law. (48) “Person with mental illness” means a person who has been found to have a mental disorder and, due to this mental disorder, is in need of treatment because the person is a danger to self, danger to others, unable to provide for basic personal needs, or has a chronic mental disorder. (49) “Physical harm” means physical injury, physical pain or other physiological impairment, other than an injury, pain or impairment that is trivial in terms of pain or bodily impact. (50) “Physician” means a person who holds a degree of Doctor of Medicine, Doctor of Osteopathy, or Doctor of Podiatric Medicine, if the context in which the term “physician” is used does not authorize or require the person to practice outside the scope of a license issued under ORS 677.805 through 677.840. (51) “Physician Associate” means a person who is licensed by the Oregon Medical Board per ORS 677.495 through ORS 677.755. (52) “Placement” means the assignment of persons alleged to have a mental illness and persons with mental illness to a facility, program, or provider, including the transfer of a person from one location where the person was in care, custody, or treatment to another location for the same purpose. Once placed, placement means the facility, program, or provider that provides care, custody, and treatment to a person alleged to have mental illness or a person with mental illness. (53) “Post-Acute Intermediate Treatment Services” or “PAITS” means a level of care that is a mix of rehabilitation services designed for adults who have received acute psychiatric care services in a community hospital or Oregon State Hospital, who may or may not have been approved for long term psychiatric care, whose symptoms have improved, sufficiently, such that they no longer require hospital level of care, yet still require intensive treatment services to continue psychiatric stabilization, prior to lower level placement, in another community setting. (54) “Prehearing period of detention” means the timeframe beginning when a person is taken into custody by a peace officer or director per ORS Chapter 426, or is detained by a LIP at a hospital or nonhospital facility who has held a person for up to 12 hours or who has filed a NMI with the court. The five judicial day period of time a person may be detained as referenced in ORS 426.095(2), 426.210, 426.232, 426.237(4)(a), and 426.275(2) encompasses the prehearing period of detention. (55) “Psychiatrist” means a physician licensed as provided pursuant to ORS 677.010 to 677.450 by the Board of Medical Examiners for the State of Oregon and who has completed an approved residency training program in psychiatry. (56) “Psychologist” means a psychologist licensed by the Oregon Board of Psychology. (57) “Qualified Mental Health Associate” (QMHA) means, as defined in OAR 309-019-0125, a mental health professional who works under the supervision of a qualified mental health professional and who is certified by an appropriate board. (58) “Qualified Mental Health Professional” (QMHP) means, as defined in OAR 309-019-0125, a mental health professional with a qualifying graduate degree or a bachelor’s degree in nursing, or is an occupational therapist, or is certified or licensed by an appropriate board. (59) “Recertification” means the certification of continued civil commitment provided for under ORS 426.301. Recertification does not always result in a recommitment, though it is required to initiate the process. (60) “Regional Acute Care Psychiatric Facility” means a facility certified by the Division to provide services for adults as described in OAR 309-032-0850 through 309-032-0890 and is operated in cooperation with a regional or local council. A regional acute care psychiatric facility must include 24 hour per day psychiatric, multi-disciplinary, inpatient, or residential stabilization, care and treatment, for adults aged 18 or older with severe psychiatric disabilities in a designated region of the state. For the purpose of these rules, a state hospital is not a regional acute care psychiatric facility. . (61) "Restraint" means any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. Restraint may be used only for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others. (62) “Seclusion” is the involuntary confinement of a person alone in a room or area, from which the person is physically prevented from leaving. Seclusion may be used only for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the person, patients, a staff member, or others. (63) “Secure transport provider” means a secure transport provider approved according to OAR 309-033-0432. (64) “Serious physical harm” means physical injury, physical pain or other physiological impairment that places a person at risk of or causes death, serious and irreversible deterioration of health, or serious and irreversible deterioration of any bodily organ. (65) “Significant procedure” means a diagnostic or treatment modality which poses a material risk of substantial pain or harm to the patient or resident such as, but not limited to, electro-convulsive therapy. (66) “State hospital” means any campus of the Oregon State Hospital system. (67) “Superintendent” means the chief executive officer of the state hospital or their designee. (68) “Warrant of detention” means a court ordering that a person be held in custody pending court proceedings or an investigation. Statutory/Other Authority: ORS 413.042, 426.005, 426.060, 426.110(2), 426.232, 426.236 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 20-2026, minor correction filed 07/09/2026, effective 07/09/2026 BHS 17-2026, amend filed 06/26/2026, effective 06/26/2026 BHS 30-2025, temporary amend filed 12/29/2025, effective 01/01/2026 through 06/29/2026 BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 17-2022, temporary amend filed 10/14/2022, effective 10/14/2022 through 04/11/2023 MHS 28-2016, f. & cert. ef. 12-29-16 MHD 9-2000, f. & cert. ef. 7-21-00 MHD 2-2000(Temp), f. & cert. ef. 1-25-00 thru 7-22-00 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0010 309-033-0220 General Standards (1) Goals. The goals of the Division in implementing these civil commitment standards are: (a) To promote the well-being of persons alleged to have a mental illness and those who are a person with mental illness during involuntary care, custody and treatment of mental illness pursuant to ORS Chapter 426; (b) To promote the protection of the civil rights of each person who is a person alleged to have amental illness and who is a person with mental illness; (c) To encourage consistent application of ORS Chapter 426 as it specifically pertains to each of the following groups: (A) Persons alleged to have a mental illness; and (B) Persons with mental illness. (d) To encourage voluntary enrollment of persons in available mental health services in lieu of pursuing involuntary treatment through civil commitment, whenever possible; (e) To encourage the provision of care, custody, and treatment of persons in the least restrictive environment that currently is available within existing resources. A director or designee responsible for investigations of persons alleged to have a mental illness and for placement of persons with mental illness shall be expected to offer and encourage diversions whenever possible and feasible. (f) To encourage that the director monitors the commitment process in their county, is knowledgeable of the statutes and administrative rules pertaining to civil commitment, provides leadership so that persons being held are afforded their civil rights and are treated with dignity in the implementation of ORS Chapter 426; (g) To provide for the safety of the community when symptoms and behaviors of mental illness may present as a risk of danger to others; (h) Support the de-stigmatization of mental illness and people living with mental illness(es). (2) State’s interest. The state’s interest is to establish sufficient facts for the court to make a decision that is consistent with the intent of ORS Chapter 426. (3) Declaration for mental health treatment (DMHT). The director shall establish procedure and written policy which assures that every person who has been investigated to be a person with mental illness as defined by ORS 426.005 is educated about the Declaration for Mental Health Treatment and is offered the opportunity to complete one by the end of the investigation period or end of the civil commitment, as applicable. The director shall make available to the Authority upon request a copy of the written policy and associated procedures. (4) Data. The Authority aims to maintain consistent and reliable data collection methods from which the results can be utilized to monitor outcomes, inform program evaluation, guide program development, and promote program efficacy. (a) Hospital and nonhospital facility administrators and CMHP directors shall ensure that all reporting requirements related to civil commitment proceedings as described in OAR Chapter 309 Division 33 and in statute in ORS Chapter 426 are met according to agreement, certification, contract, and licensing. (b) CMHP directors shall comply with all reporting requirements for all provided civil commitment services via the Measures and Outcomes Tracking System (MOTS) and any of its successors. (c) Hospital and nonhospital facilities operating as regional acute care psychiatric facilities shall comply with all reporting requirements for all provided civil commitment services in the online portal for the Acute Care Reporting (ACR) system or another preferred data collection program selected by the Oregon Health Authority. Data must be entered into ACR for each individual within 12 hours of the day of admission and updated within 12 hours of the day of discharge. (5) Service of Citation and Return of Service. The Community Mental Health Program (CMHP) investigating the person alleged to have a mental illness will complete service of the citation issued by the judge, unless the judge orders personal service through different means, under ORS 426.090 and filing of the completed return of service of the citation under ORS 426.080, whether accomplished directly or through authorized third parties. Statutory/Other Authority: ORS 413.042, 426.060 & ORS 426.080 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, amend filed 06/26/2026, effective 06/26/2026 BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0030 309-033-0222 Need for Treatment Considerations (1) When a certified mental health investigator is making a hearing recommendation, or a certified mental health examiner is making a commitment recommendation, they must consider whether the person is a person with mental illness and is in need of treatment because the person: (a) Is a danger to self; (b) Is a danger to others; (c) Is unable to provide for basic personal needs; or (d) Has a chronic mental disorder. (2) A danger to self, danger to others, or risk of serious physical harm due to inability to provide for basic personal needs must be reasonably foreseeable in the near future but need not be imminent. (3) When a certified mental health investigator or examiner are preparing a report or testifying at a civil commitment hearing regarding the issue of whether the person is a person with mental illness and in need of treatment because they are a danger to themselves, they should consider: (a) The person’s recent overt acts causing or attempting to cause serious physical harm to self; (b) Recent acts placing the person in circumstances that resulted in or were likely to result in serious physical harm to self; (A) The person’s recent threats to cause serious physical harm to self and the severity of the harm threatened; (B) Absent treatment, the likelihood of such threats being carried out; and (C) Absent treatment, the likelihood of such threats reoccurring. (c) Any past behavior and patterns of deterioration resulting from a mental disorder that contributed to prior involuntary hospitalizations for being a danger to self, how recently the past behavior occurred and the frequency and severity of the past behavior. (4) When a certified mental health investigator or examiner are preparing a report or testifying at a civil commitment hearing regarding the issue of whether the person is a person with mental illness and in need of treatment because they are a danger to others, they should consider: (a) Recent overt acts causing or attempting to cause physical harm to another person and (A) The frequency and severity of such acts. (B) Recent destructive acts against property that were reasonably likely to place others at risk of physical harm. (b) Recent threats to cause physical harm to another person; (A) The severity of the harm threatened; (B) Absent treatment, the likelihood of such threats being carried out; and (C) Absent treatment, the likelihood of such threats reoccurring. (c) Any past behavior and patterns of deterioration resulting from a mental disorder that contributed to prior involuntary hospitalizations for being a danger to others; (A) How recently the past behavior occurred; and (B) The frequency and severity of the past behavior. (5) An inability to meet basic personal needs is demonstrated when a person, because of a mental disorder: (a) Is unable to provide for basic personal needs that are necessary to avoid reasonably foreseeable serious physical harm in the near future; and (b) Is not receiving such care that would be necessary to avoid serious physical harm, or for persons under a court commitment or other involuntary program for mental health treatment, it is reasonably foreseeable that the person will not, upon release, receive such care that would be necessary to avoid serious physical harm. (6) A chronic mental disorder is demonstrated when: (a) A person has a chronic mental illness as defined in ORS 426.495; (b) Within the previous three years the person has been placed, at least twice, in a hospital or an approved inpatient unit as directed by the Authority or a CMHP director under ORS 426.060. (c) The person is exhibiting symptoms or behaviors substantially similar to those that preceded and led to one or more of the placements; and (d) To a reasonable medical probability, the person will, without treatment, continue to deteriorate physically or mentally so that the person will become a danger to self, a danger to others, or be unable to provide for the person’s basic personal needs. (7) Certified mental health investigators and certified mental health examiners, when determining whether a person is in need of treatment because the person is a danger to self or a danger to others, are to consider: (a) The person’s insight into their psychiatric needs and current circumstances; (b) The person’s ability to, with their level of insight, follow a treatment plan; and (c) How likely the person may become a danger to self, danger to others, or unable to provide for basic personal needs without sufficient and available mental health treatment. (8) A need for assisted outpatient treatment (AOT) is demonstrated when: (a) A person is at least 18 years old (b) Has a mental disorder (c) Cannot provide informed consent for mental health treatment, and (d) Will not access mental health treatment on a voluntary basis and as a result: (A) Is unable to safely live in the community without mental health treatment; and (B) Must receive mental health treatment to prevent further deterioration or becoming a person who is a danger to self, is a danger to others, is unable to provide for basic personal needs, or has a chronic mental disorder. (e) When determining whether a person has a need for AOT, a certified civil commitment investigator or a certified mental health examiner may consider: (A) The person’s ability to access finances in order to get food or medicine. (B) The person’s ability to obtain treatment for the person’s medical condition. (C) The person’s ability to access necessary resources in the community without assistance. (D) The degree to which there are risks to the person’s safety. (E) The likelihood that the person will decompensate without immediate care or treatment. (F) The person’s previous attempts to inflict physical injury on self or others. (G) The person’s history of mental health treatment in the community. (H) The person’s patterns of decompensation in the past. (I) The person’s risk of being victimized or harmed by others. (J) The person’s access to the means to inflict harm on self or others. (f) The person’s history of accessing and engagement in mental health treatment in the community, including previous patterns of decompensation and the likelihood that the person will decompensate without immediate care or treatment. Statutory/Other Authority: ORS 413.042, 426.005, 426.060, 426.110(2), 426.232, 426.236 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, adopt filed 06/26/2026, effective 06/26/2026 BHS 31-2025, temporary adopt filed 12/29/2025, effective 01/01/2026 through 06/29/2026 BHS 30-2025, temporary adopt filed 12/29/2025, effective 01/01/2026 through 06/29/2026 309-033-0225 Variances (1) Criteria for a variance. Variances to rules in Oregon Administrative Rules Chapter 309, Division 33 may be granted to a Community Mental Health Program (CMHP), provider, or facility if there is a lack of resources to implement the standards required in this rule or if implementation of the proposed alternative services, methods, concepts, or procedures would result in services or systems that meet or exceed the standards in these rules and is pursuant to relevant Oregon Revised Statutes. (2) Variance application. The CMHP, provider, or facility requesting a variance shall submit, in writing, an application to the Division which contains the following: (a) The section of the rule from which the variance is sought; (b) The reason for the proposed variance; (c) The alternative practice, service, method, concept or procedure proposed; (d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and (e) Signed documentation from the council indicating its position on the proposed variance. (3) Division review. The Division or designee of the Division shall approve or deny the request for a variance. (4) Notification. The Division shall notify the CMHP, provider, or facility of the decision. This notice shall be given to the CMHP, provider, or facility, with a copy to the council, within 30 days of the receipt of the request by the Division. (5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Division, whose decision shall be final. (6) Written approval. The CMHP, provider, or facility may implement a variance only after written approval from the Division. The Intergovernmental Agreement shall be amended to the extent that the variance changes a term in that agreement. (7) Duration of variance. A variance shall be initially approved, at maximum, for a period not to exceed two years, though may be shorter depending on the Division’s decision. Variances shall be reviewed by the Division at least every two years for continued need. Statutory/Other Authority: ORS 413.042 & 426.060-426.500 Statutes/Other Implemented: ORS 426.005-426.395 History: BHS 9-2023, adopt filed 04/04/2023, effective 04/07/2023 309-033-0230 Custody (1) Custody by a Licensed Independent Practitioner (LIP) pursuant to ORS 426.231. A LIP taking a person into custody pursuant to ORS 426.231 at a hospital approved under OAR 309-033-0550 shall detain the person for no more than 12 hours. During the initial 12 hours, the LIP shall do one of the following: (a) Authorize the person for transportation to an approved hospital or nonhospital facility and provide transportation according to the agreement required under OAR 309-033-0550; (b) Release the person if the LIP no longer believes that the person is dangerous to self or others; or (c) If, after the 12-hour period of detention, the LIP believes the person remains a danger to self or others and is in need of emergency care or treatment for mental illness, the LIP may proceed with an emergency hold pursuant to ORS 426.232. (2) Custody by a peace officer or secure transport provider. A peace officer taking a person into custody shall remove the person to an approved hospital as directed by the director in the county where the person was taken into custody. The peace officer or approved secure transport provider shall only take a person into custody under the provisions of one of the following: (a) Custody on peace officer’s own initiative. A peace officer may take a person into custody pursuant to the provisions of ORS 426.228 when the peace officer has probable cause to believe that the person is dangerous to self or others, and is in need of immediate care, custody or treatment for a mental illness; (b) Custody on the director’s authority. The director may direct, pursuant to the provisions of ORS 426.233, a peace officer or an approved secure transport provider to take into custody a person who is dangerous to self or others and in need of immediate care, custody or treatment for mental illness; (c) Custody of a person under civil commitment on the director’s authority. The director may direct a peace officer or an approved secure transport provider to take into custody, pursuant to the provisions of ORS 426.233, a person under civil commitment who is on trial visit, outpatient commitment or conditional release in the community, who is dangerous to self or others or who is unable to provide for basic personal needs, who is not receiving the care that is necessary for health and safety, and who is in need of immediate care, custody or treatment for mental illness; (d) A peace officer may transfer a person in custody under this section to the custody of an approved secure transport provider. The peace officer may meet the approved secure transport provider at any location that is in accordance with ORS 426.140 to effect the transfer. When transferring a person in custody to an authorized person, the peace officer shall deliver the report required under subsection (3) of this section to the authorized person. (3) Peace officer’s written report. When taking a person into custody pursuant to ORS Chapter 426.228, by a peace officer’s own initiative, a peace officer shall prepare a written report which states: (a) The reason for custody; (b) The date, time and place the person was taken into custody; and (c) The name of the director in the county where the person is taken into custody and a telephone number where the director may be reached at all times. (4) Director’s written report. When a peace officer or approved secure transport provider takes a person into custody pursuant to ORS Chapter 426.228 at the direction of the director, a director shall prepare a written report which states: (a) The reason for custody; (b) The date, time and place the person was taken into custody; and (c) The name of the director in the county where the person is taken into custody and a telephone number where the director may be reached at all times. (5) Transportation to a hospital or nonhospital facility more than one hour away. If the peace officer determines that more than one hour is required to transport the person to a hospital or nonhospital facility approved by the Division, the peace officer or approved secure transport provider shall obtain a certificate, if possible, from a LIP prior to transporting the person. A LIP authorizing transport shall sign a certificate, on a form approved by the Division, only if the person’s condition, in the opinion of the LIP, meets all of the following requirements: (a) The travel will not be detrimental to the person’s physical health; (b) The person is dangerous to self or others; and (c) The person is in need of immediate care or treatment for mental illness. (6) The director directs peace officers or approved secure transport providers to appropriate facility. The director shall adopt written procedures for directing peace officers or approved secure transport providers to transport persons taken into custody, pursuant to ORS 426.228, to an approved hospital or nonhospital facility: (a) The written procedures shall include one of the following, whichever, in the opinion of the director, serves the best interests of persons with mental illness and the community: (A) A list of approved hospitals or nonhospital facilities where peace officers or approved secure transport providers are to transport persons; (B) A procedure for contacting the director 24 hours-a-day, seven days-a-week. (b) The director shall distribute copies of the written procedures to the sheriff and the chief of police of each municipality in the county and approved secure transport providers. The procedures shall be distributed as often as the procedure is amended; (c) The director may develop a written agreement with the law enforcement agencies in the county which designates a site or sites where the director can safely evaluate the person and determine which facility, in the director’s opinion, can best serve the person’s needs within the resources available. If such an agreement exists in a county, the director may direct a peace officer to transport a person in custody under ORS 426.228 to a site designated in the agreement. Once the director makes a determination, the peace officer shall transport and deliver the person to a hospital or nonhospital facility as directed by the director. The agreement shall: (A) Designate the site or sites where the director can safely evaluate the person’s needs for treatment; (B) Define the minimum response time for the director meeting the peace officer at the site; and (C) Be signed by all parties to the agreement. Statutory/Other Authority: ORS 413.042, 426.228, 426.231 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-2000, f. & cert. ef. 7-21-00 MHD 2-2000(Temp), f. & cert. ef. 1-25-00 thru 7-22-00 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0040 309-033-0240 Initiation of the Civil Commitment Process (1) Initiation. The civil commitment process is initiated when a Notice of Mental Illness (NMI) is filed with the circuit court. The NMI shall be filed with the circuit court as directed below: (a) Public petition. When an NMI is given to the director of the county where the person alleged to have a mental illness resides pursuant to ORS 426.070, the director shall immediately file the NMI with the court in the county where the person alleged to have a mental illness resides. If the person has no residence, then the NMI shall be given to the director in the county where the person is currently located. The director shall file the original NMI with the court on the day the NMI is received or, if the NMI is received outside the court’s routine business hours, the next day the court is open for business. The director shall retain a copy of the NMI in the clinical record as required by OAR 309-033-0930. The following persons may give an NMI to the director: (A) Any two persons; (B) A county health officer; or (C) Any magistrate or judge. (b) Hospital hold. When a Licensed Independent Practitioner (LIP) admits or retains a person in a hospital pursuant to ORS 426.232, the LIP shall: (A) Immediately notify the director in the county in which the hospital is located unless the person resides in a county other than the county where the hospital is located, in which case the LIP shall immediately notify the director in the person’s county of residence and offer that director the first right of refusal; and (B) File the NMI with the appropriate circuit court as follows: (i) If the director of the person’s county of residence requests it, the LIP shall file the NMI with the circuit court in the person’s county of residence; or (ii) If the director of the person’s county of residence does not request it, or the person does not maintain a residence in Oregon, the LIP shall file the NMI with: (I) The circuit court in the county in which the hospital is located if the person did not arrive at the hospital under custody pursuant to ORS 426.228 or ORS 426.233; or (II) The circuit court in the county of custody if the director of the county in which the hospital is located does not request that the NMI be filed in its circuit court. (c) Nonhospital hold. When a director admits or retains a person in a nonhospital facility pursuant to ORS 426.233, the director shall file the NMI as follows: (A) If the director of the person’s county of residence requests it, the NMI shall be filed with the circuit court in the county of residence; or (B) If the director of the person’s county of residence does not request it, the NMI shall be filed with the circuit court in the county of custody. (d) How a director requests where the NMI is filed. A director may request that the LIP, in the case of a hospital hold, or the director of the county of custody, in the case of a nonhospital hold, file the NMI according to the provisions of ORS 426.234 by either: (A) Making the request immediately upon receipt of the notice required by ORS 426.234; or (B) Sending a written general request to a hospital or a director. (2) Initiation for a Person under the Jurisdiction of a Federally Recognized Tribe in Oregon. The civil commitment process may be initiated for a person under the jurisdiction of a federally recognized tribe located in Oregon by a tribal court pursuant to ORS 426.180, by a tribal court or other statutory grounds pursuant to ORS 426.070, or by a licensed independent practitioner (LIP) pursuant to ORS 426.232. (a) Initiation by a Tribal Court in Oregon. When a person is received at a hospital or nonhospital facility pursuant to ORS 426.180, the LIP at the hospital or nonhospital facility shall immediately review the accompanying medical records and court documents. (i) After reviewing the documentation, the receiving LIP may decline to hold the person if the LIP: (I) Does not believe that an emergency exists; or (II) Finds that the person is not a danger to self or others and is not in need of immediate care, custody, and treatment for mental illness. (ii) If the LIP determines that an emergency exists or that the person is a danger to self or others and is in need of emergency care or treatment for mental illness, the LIP shall: (I) Admit the person to the hospital or nonhospital facility by detaining the person pursuant to ORS 426.231 or placing an emergency hold pursuant to ORS 426.232; (II) Provide the person with the warning in accordance with ORS 426.123; and (III) Immediately file a NMI with the circuit court in the county in which the hospital is located and immediately notify the CMHP director in that county. (iii) The director of the hospital or nonhospital facility or LIP shall notify the tribal court that found the person to be a danger to self or others of any action taken in accordance with ORS 426.180 through ORS 426.210 no later than 24 hours after the action is taken, except for information protected from disclosure by state or federal laws. (b) Initiation Pursuant to ORS 426.070. If a NMI is filed under ORS 426.070(1) for a person under the jurisdiction of a federally recognized tribe located in Oregon, the NMI shall be provided to the CMHP director in the county where the person alleged to have a mental illness resides, unless the person is eligible for services provided by a tribal CMHP in which case the NMI shall be provided to the CMHP director in the county where the person is located. When the CMHP director receives a NMI pursuant to this rule, the director shall immediately notify the judge in the circuit court where the CMHP is located. The following persons may provide a NMI to the director: (A) Any two persons; (B) A county health officer; or (C) Any magistrate or judge. (c) Initiation Pursuant to ORS 426.232. When a person under the jurisdiction of a federally recognized tribe located in Oregon is received at a hospital or nonhospital facility pursuant to ORS 426.232, after an LIP has evaluated the person, the following shall occur: (A) If the LIP determines that there likely is probable cause to believe the person is a danger to self or others and is in need of emergency care or treatment for mental illness, the LIP shall: (i) Admit the person to a hospital where the LIP has admitting privileges or is on staff; or approve the person for emergency care or treatment at a nonhospital facility approved by the Authority; (ii) Inform the person of their right to counsel and provide the warning in accordance with ORS 426.100 and 426.123; (iii) Notify the CMHP director in the county where the person alleged to have a mental illness resides, unless the person lives on an Indian reservation located within Oregon in which case the NMI shall be provided to the CMHP director in the county where the person is located. (iv) When the CMHP director receives the LIP’s notification as described in subsection (1)(e)(C)(3) of this rule, the director shall immediately notify the judge in the circuit court where the CMHP is located; (B) If the LIP determines there likely is not probable cause to believe the person is a danger to self or others and that the person is in need of emergency care or treatment for mental illness, the LIP shall release the person unless otherwise directed by a state or federal court order or the person agrees to remain in the hospital voluntarily. Statutory/Other Authority: ORS 413.042, 426.070, 426.180, 426.228, 426.231 & 426.232 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 42-2023, temporary amend filed 12/14/2023, effective 12/15/2023 through 06/11/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-2000, f. & cert. ef. 7-21-00 MHD 2-2000(Temp), f. & cert. ef. 1-25-00 thru 7-22-00 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0050 309-033-0250 Standards for Custody, Hospital and Nonhospital Holds, Emergency Commitment and Emergency Hospitalization of Persons Under Warrant of Detention (1) Criteria for placement into custody. (a) Persons who are a danger to self or others, whether prior to being placed under civil commitment or during a period of civil commitment, and who are in need of mental health treatment shall be placed in custody at a facility approved by the Division. (b) A person who has been placed on conditional release, outpatient commitment, or trial visit, in addition to the criteria in Section 1(a) of this rule number, may also be taken into custody if the person is unable to provide for basic personal needs that are necessary to avoid serious physical harm in the near future and is not receiving such care as is necessary to avoid such harm. (2) Warrant of detention. (a) If the court issues a warrant of detention to the director for the prehearing detention of a person alleged to have a mental illness, the director shall make arrangements to take the person into custody and arrange to transport the person to an OHA-approved community hospital or nonhospital facility that is licensed under ORS Chapter 441, other than an institution listed in ORS 426.010. (A) The director is required to inform the person of their rights with regard to representation by or appointment of counsel as described in ORS 426.100 and be given the warning described under in ORS 426.070(5)(b)(B) and OAR 309-033-0540. (B) The director shall make arrangements as applicable to transport the person to the civil commitment hearing, as directed in the warrant of detention or a subsequent court order. (C) Unless otherwise directed by a court order or as provided for in these rules, the director shall place the person in an OHA-approved community hospital or nonhospital facility until the date indicated in the warrant of detention or any subsequent court order. The director shall seek to place the person in the least restrictive placement possible that will meet the person’s immediate health and safety needs. (i) If the person represents an immediate and serious danger to the staff or physical facilities of an OHA-approved community hospital or nonhospital facility, the director, after providing written notice to OHA of the alternative placement, may confine the person in a non-OHA approved correctional setting that can meet the health and safety needs of the person pursuant to ORS 426.140(1). The notice must include contact information for the CMHP director authorizing the transfer to a correctional setting, the physical address and contact information for the placement site, and a description of the person’s behavior(s) that represent an immediate and serious danger to facility staff or property. The person may be placed in this alternative placement until the date indicated in the warrant of detention or subsequent court order, or until the person is transferred to an OHA-approved community hospital or nonhospital facility. (ii) If no OHA-approved community hospital or nonhospital facility will admit the person, the director may place the person in a non-OHA approved setting that can meet the health and safety needs of the person pursuant to ORS 426.140(2). If the person is not placed in a community hospital, the director shall ensure that a care attendant is in direct charge of the person at all times while they are onsite at the alternative placement, that the placement is suitable for the comfortable, safe, and humane confinement of the person, and that the Authority is immediately notified in writing of the alternative placement. The person may be placed in this alternative placement until the date indicated in the warrant of detention or a subsequent court order, or until the person is transferred to an OHA-approved community hospital or nonhospital facility. (b) If the court has issued the warrant of detention to the sheriff of the county to provide for the custody and transportation of the person alleged to have a mental illness, the director is not responsible for taking the person into custody, providing transportation to the treatment facility, or transportation to the civil commitment hearing. The director shall coordinate with the sheriff on the person’s placement and the ongoing civil commitment process. (c) If the court has issued the warrant of detention to a hospital or nonhospital facility to provide for the custody of the person alleged to have a mental illness, the director is not responsible for taking the person into custody. The director shall coordinate with the hospital or nonhospital facility the transportation of the person to the indicated treatment setting, unless otherwise authorized under ORS 426.150(2), including notifying a peace officer or another authorized individual, pursuant to ORS 426.233(1)(b), to take custody of and transport the person to the hospital or nonhospital facility. (d) In cases where the state hospital initiated the civil commitment proceeding and the person is already at the state hospital, the person shall remain at the state hospital upon receipt of the warrant of detention, unless otherwise indicated by the presiding judge. (3) Hospital hold. Only a LIP with admitting privileges or on staff at a hospital approved by the Authority and who has completed a face-to-face examination of the person may retain the person in custody in the hospital as provided by ORS 426.232. When implementing a hospital hold, the LIP shall document the following information on the Notice of Mental Illness (NMI), retaining a copy of the NMI in the clinical record: (a) Examples of indicators that support the LIP’s belief that the person is a danger to self or others due to symptoms and behaviors related to a mental disorder; (b) Examples of thoughts, plans, actions, access to means, history of dangerousness, and other indicators that support the LIP’s belief that the person is imminently dangerous. (4) Peace officer custody requested by director. A director may direct a peace officer to take into custody a person who the director has probable cause to believe is dangerous to self or any other person and who the director has probable cause to believe is in need of immediate care, custody or treatment for mental illness: (a) A county governing body may authorize the director, or a person named and recommended by the director, to direct a peace officer or approved secure transport provider to take persons alleged to have a mental illness into custody. Such an authorization shall be made formally and in writing by the county governing body of the director. The director shall keep a copy of each authorization in each person’s personnel file; (b) Prior to directing a peace officer or approved secure transport provider to take a person into custody, a director shall have face-to-face contact with the person and document on forms approved by the Division, the evidence for probable cause to believe that the person is: (A) Dangerous to self or others; and (B) In need of immediate care, custody or treatment for a mental illness. (5) When a person in custody can be released. A person who is detained, in custody, or on a hold shall be released as described: (a) LIP’s release of a person on peace officer custody. When a person is brought to a hospital by a peace officer or approved secure transport provider pursuant to ORS 426.228 the treating LIP shall release the person if, upon initial examination prior to admission, the LIP makes the determination that the person is not dangerous to self or others. It is not necessary to notify the court of the release; (b) LIP’s release of a person on transport custody. At any time during the 12-hour detention period, the treating LIP shall release a person detained pursuant to ORS 426.231 if the LIP makes the determination that the person is not dangerous to self or others. It is not necessary to notify the court of the release; (c) LIP’s release of a person on a hospital hold. The treating LIP shall release a person retained or admitted to a hospital pursuant to ORS 426.232 whenever the LIP makes the determination that the person is not dangerous to self or others. The treating LIP shall immediately notify the director and the circuit court where the NMI was filed. See OAR 309-033-0240; or (d) Director’s release of a person on a nonhospital hold. The director shall release a person detained in a nonhospital facility, approved under OAR 309-033-0530, pursuant to ORS 426.233, whenever the director, in consultation with a LIP, makes the determination that the person is not dangerous to self or others. The director shall immediately notify the circuit court. (6) When a person in custody cannot be released. If a person is taken into custody by order of a warrant of detention pursuant to ORS 426.070(5)(b)(A) and ORS 426.070(5)(b)(C) , the person may only be released by the court. However, a person may be discharged from a hospital or nonhospital facility when the person is transferred to another approved facility. (7) Commencement of the five judicial days. No person who is detained, in custody, or on a hold pursuant to ORS 426.070, ORS 426.228, ORS 426.232, or ORS 426.233 shall be involuntarily held for more than five judicial days without a hearing before a judge unless otherwise determined pursuant to ORS 426.237 or ORS 426.307. (a) The first day of the prehearing period of detention is determined to be the judicial day immediately following the day: (A) The person was placed in custody by the director or a peace officer pursuant to ORS 426.228 or ORS 426.233, if the person was not initially held pursuant to ORS 426.231; or (B) A Notice of Mental Illness (NMI) was completed and submitted to a court pursuant to ORS 426.232, if the person was not detained or placed in custody prior to the NMI. (b) The time limit is counted by the 24-hour day, regardless of the precise time a custody or NMI is completed. It is not counted by hour, minute, or second. Statutory/Other Authority: ORS 413.042, 426.070, 426.231, 426.232, 426.233 & 426.234 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 23-2021, amend filed 12/13/2021, effective 12/13/2021 BHS 16-2021, temporary amend filed 07/30/2021, effective 07/30/2021 through 01/25/2022 MHD 9-2000, f. & cert. ef. 7-21-00 MHD 2-2000(Temp), f. & cert. ef. 1-25-00 thru 7-22-00 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0060 309-033-0265 The Authority’s Denial of Payment for Services to Persons in Custody or on Diversion (1) The Authority denial. The Authority shall deny part or all payment for services for a person in custody or on a diversion only when the Authority determines that there is insufficient evidence to reasonably support the belief that the person in custody demonstrated: (a) Living with a mental disorder; and (b) Dangerousness to self or others as evidenced by thoughts, plans, means, actions, history of dangerousness or other indicators of imminent dangerousness which Division believes are within accepted community standards of professional knowledge. (2) The Authority consultation with Licensed Independent Practitioner (LIP). When making a determination under this rule which is primarily based on accepted community standards of professional knowledge, the Authority shall consult with a LIP. (3) Information payer must submit. When making a request for denial of payment, the payer responsible for the services provided to the person in custody or on diversion under ORS 426.241 shall submit the following to the Authority: (a) A statement requesting the Authority review the appropriateness of the hold or diversion for the purpose of approving denial of part or all payment for services rendered; (b) An explanation of why the payer believes the services provided to the person in custody or on diversion do not meet criteria described in ORS 426.232, 426.233 or 426.237; (c) Any documentation which supports the payer’s belief that the services provided to the person in custody or on diversion were inappropriate. (4) Clinical records to be submitted. At the request of the Authority, as provided by ORS 426.241(5)(b), the following shall submit clinical records and other documents requested relating to the services in question to the Division: (a) A hospital or a nonhospital facility approved under OAR 309-033-0530; (b) A LIP or person providing services to the person in custody or on diversion. Statutory/Other Authority: 413.042, 426.005, 426.060, 426.110(2), 426.232 & 426.236 Statutes/Other Implemented: 426.241 History: BHS 7-2024, adopt filed 04/30/2024, effective 05/28/2024 309-033-0270 Provision of Care, Custody and Treatment of Persons under Civil Commitment (1) Persons under civil commitment have the rights provided under ORS 426.385, ORS 430.205 through 430.210, and this rule, including: (a) A person under civil commitment’s right to fresh air. (b) If a person under civil commitment requests access to fresh air and the outdoors or the person under civil commitment’s treating health care provider determines that fresh air or the outdoors would be beneficial to the person under civil commitment, the facility in which the person under civil commitment is receiving services shall provide daily access to fresh air and the outdoors unless this access would create a significant risk of harm to the person under civil commitment or others; (c) The determination whether a significant risk of harm to the person under civil commitment or others exists shall be made by the person under civil commitment’s treating health care provider. The treating health care provider may find that a significant risk of harm to the person under civil commitment or others exists if: (A) The person under civil commitment’s circumstances and conditions indicate an unreasonable risk of harm to the person under civil commitment or others which cannot be reasonably accommodated within existing programming should the person under civil commitment be allowed access to fresh air and the outdoors; or (B) The facility’s existing physical plant or existing staffing prevent the provision of access to fresh air and the outdoors in a manner than maintains the safety of the person under civil commitment or others. (d) If a facility determines that its existing physical plant prevents the provision of access to fresh air and the outdoors in a safe manner, the facility shall make a good faith effort at the time of any significant renovation to the physical plant that involves renovation of the unit or relocation of where persons under civil commitment are treated to include changes to the physical plan or location that allow access to fresh air and the outdoors, so long as such changes do not add an unreasonable amount to the cost of the renovation. (2) Provision of care at a state hospital. The superintendent of the state hospital shall be responsible for all admissions to the state hospital pursuant to OAR 309-091-0015. The superintendent shall implement policies and procedures which afford a person under civil commitment placed in a state hospital the rights provided by ORS 426.385, 430.205 through 430.210 and this rule. (3) Provision of care at a community hospital. The director shall place a person under civil commitment at a community hospital only if it is approved under OAR 309-033-0530: (a) The Licensed Independent Practitioner (LIP), in consultation with the director, shall determine whether the best interests of a person under civil commitment are served by an admission to a community hospital; (b) The administrator shall implement policies and procedures which afford a person under civil commitment placed in a community hospital the rights provided by ORS 426.385, 430.205 through 430.210 and this rule. (4) Provision of care at a nonhospital facility or an outpatient program. The director shall only place a person under civil commitment in a nonhospital facility that is licensed or certified by the Division: (a) The administrator, in consultation with the director, shall determine whether the best interests of a person under civil commitment are served by an admission to a nonhospital facility or an outpatient program; (b) The administrator shall implement policies and procedures which afford a person under civil commitment placed in a nonhospital facility or an outpatient program the rights provided by ORS 426.385, 430.205 through 430.210 and this rule; (c) The director may place the person under civil commitment on a trial visit when the person is discharged from Oregon State Hospital, a community hospital, or a level one facility to a lower level of care in accordance with OAR 309-033-0290 and 309-033-0300 . A lower level of care may include treatment in another facility, outpatient care, or case management services; (d) The director may place a person under civil commitment on outpatient commitment, who , at the time of the civil commitment hearing and immediately following it, is not initially placed in a level one facility or hospital setting . This may include treatment or services whereby the person resides in a residential behavioral health facility or their personal residence with outpatient or medication management services (5) Provision of medical services for a person under civil commitment. The superintendent of the state hospital, the treating LIP at a community hospital or the director may transfer a person under civil commitment to a community hospital, or transfer a person under civil commitment from a psychiatric unit to a medical unit for medical care: (a) The treating LIP shall only provide medical care with the consent of the person under civil commitment in accordance with OAR 309-033-0600 through 309-033-0650; (b) The superintendent or treating LIP shall transfer a person under civil commitment to a community hospital for medical services on a pass or discharge the person from the state hospital when it is determined that the person will not return to the state hospital within a reasonable length of time, or that discharge is clinically appropriate and is required for the person to have access to third-party insurance benefits; (c) The treating LIP shall immediately notify the director that a person was transferred to another hospital for medical care under this subsection. Statutory/Other Authority: ORS 413.042, 426.060, 426.385 & 430.205 - 430.210 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 17-2022, temporary amend filed 10/14/2022, effective 10/14/2022 through 04/11/2023 MHS 5-2009, f. & cert. ef. 12-17-09 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0080 309-033-0280 Procedures for Persons under Civil Commitment and on Outpatient Commitment or Trial Visit (1) Outpatient commitment. At the time of the civil commitment hearing the director may place a person under civil commitment on an outpatient commitment if adequate treatment services are available. (a) A director may place a person on outpatient commitment who also has professional or natural supports in the community that are willing and available to assist the person in adhering to the conditions of placement. (b) The director of the county of commitment shall establish the initial conditions of placement for a person on outpatient commitment in accordance with OAR 309-033-0282, including enrolling the person in services. Thereafter, the director of the county of placement may modify the conditions without a hearing in accordance with OAR 309-033-0280(4)(a). (c) The director of the county of commitment shall be responsible for monitoring the provision of care for a person on outpatient commitment, including documenting in the person’s clinical record the person’s progress toward discharge of the outpatient commitment. (2) Trial visit. A director may, upon approval of the director of the county of placement, grant a trial visit to any person under civil commitment and placed at the state hospital, a community hospital, or level one facility approved by the Division. While it may be clinically advisable, the director is not required to obtain the consent or signature of the person under civil commitment. (a) A trial visit shall not exceed the time remaining in the period of civil commitment, unless otherwise recommitted in accordance with ORS 426.307; (b) The director of the county of placement, unless otherwise determined in accordance with ORS 426.278, shall be responsible for monitoring the provision of care for persons on trial visit, including documenting in the person’s clinical record progress toward successful discharge of the civil commitment. (3) Nonadherence to conditions of placement. The director shall evaluate any complaints or concerns received from any person regarding the behavior or treatment of a person on a community-based civil commitment. A director may petition the court for a revocation hearing if the person who is placed on outpatient commitment or trial visit is unable to meet the conditions as set. (4) Modifications to the conditions of placement. In accordance with ORS 426.127 and 426.273, the director of the county of placement shall be responsible for documenting in the person’s clinical record any modifications to the conditions, and reasons for such changes, and the distribution of revised conditions of placement as described in ORS 426.278. Modifications to the conditions of placement that are more restrictive require a revocation hearing before a judge prior to being adopted. The court maintaining jurisdiction shall be notified of the request for revocation hearing by: (a) For outpatient commitments, the director of the county of residence. (b) For trial visits, the director of the county of placement. (c) The notice shall include the reason for revocation and include a copy of the conditions of placement if the person is placed on outpatient commitment or trial visit. (5) Distribution of the conditions of placement. When a person under civil commitment is placed on outpatient commitment or trial visit, the following persons shall receive a copy of the initial conditions of placement and any subsequent modified conditions of placement: (a) The person under civil commitment; (b) The director of the county of placement where the person is to receive nonhospital or outpatient care; (c) The director of any facility, program, service, or other provider who is designated to provide treatment; (d) The court in the county of commitment; and (e) The court in the county of placement, if different than the county of commitment. (6) Transfer of trial visit or outpatient commitment to another county. The director may transfer a person on trial visit or outpatient commitment to another county only if the director for the county where the person will reside agrees to accept and provide for monitoring of the trial visit or outpatient commitment: (a) The director of the county where the person currently resides shall provide the director of the county where the person will reside a copy of the current conditions of placement for the person on trial visit or outpatient commitment; (b) The director of the transferring county of placement shall make every reasonable effort to enroll the person in available services prior to the transfer. The director of the transferring county of placement shall modify the conditions of placement to accommodate any necessary changes, except those that are more restrictive requiring a hearing, and distribute the modified conditions as required in Section 5 of this rule. Statutory/Other Authority: ORS 413.042, 426.127, 426.273 & 426.278 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0090 309-033-0282 Establishing and Monitoring Conditions of Placement (1) The conditions of placement serve as the objective and legal civil commitment service goals documented as part of an electronic medical or health record.The conditions of placement shall be established prior to the person’s release from the more restrictive setting. (a) The initial conditions of placement shall be established by the director of the county of commitment. Any subsequent changes to the conditions of placement shall be managed by the director of the county of placement. (b) The conditions of placement shall include at minimum: (A) Where the person is to physically reside. This may be a physical location description or physical address. (B) The identified person responsible for ensuring monitoring tasks are completed including the person’s name, credential(s), and contact information, including email address and phone number. (C) For outpatient commitment, the designation of a facility, program, or service where the person is to receive care, including contact information. Facilities, programs, and services providing mental health treatment shall be designated in accordance with OAR 309-033-0270(4). At least one of the following professional supports shall be identified in the conditions of placement: (i) The identified provider for treatment or medication management, including contact information; or (ii) The identified care coordinator, case manager, or outreach worker who maintains a therapeutic or supportive relationship with the person and assists the person with the following tasks, but not exclusively the following tasks: benefits coordination, ensuring housing needs are met, securing support in meeting instrumental activities of daily living (I/ADLs), money management, and meeting other identified needs. (D) For trial visits pursuant to ORS 426.273(2), should outpatient care be a condition of placement Section (C) of this rule shall apply to the trial visit conditions of placement. (E) A list of activities, behaviors, and tasks that the person on community-based placement shall be expected to adhere to, which may include but are not limited to: (i) Mental health treatment and counseling services; (ii) Co-occurring disorder or substance use disorder services or supports; (iii) Residential treatment services; (iv) Medication management; (v) Case management and care coordination; and (vi) Skills training. (c) The director establishing the conditions of placement shall make reasonable efforts to obtain a release of information signed by the person under civil commitment that authorizes the sharing and exchange of the person’s protected health information (PHI), including mental health and substance use authorizations, between all parties associated with the conditions of placement. Any sharing or exchange of the person’s PHI shall be for care coordination purposes. (d) Conditions of placement shall be distributed to individuals or entities in accordance with ORS 426.278: (A) The committed person; (B) The community mental health program director or designee of the county of placement; (C) The director of any facility, service or other provider designated to provide care or treatment; (D) The court of the county of commitment; (E) The court of the county of placement if the person is living in a different county than the county of commitment. (2) The Community Mental Health Program (CMHP) director shall identify in the conditions of placement a qualified CMHP employee to ensure monitoring services are sufficiently provided for individuals placed on outpatient commitment or trial visit. The identified person is responsible for notifying the court of nonadherence to the conditions of the placement and any request for revocation. (a) Qualifications. A CMHP director shall only identify qualified persons to oversee monitoring services. A qualified person is a person who: (A) Is certified at minimum as a Qualified Mental Health Associate (QMHA), unless otherwise provided for by OAR 309-033-0225, or be actively working toward the QMHA credential as verified by the CMHP director. (B) Has completed the mental health investigator training as provided by the Division or is working toward completing the training. (b) Monitoring services are intended to support the person under civil commitment in fulfilling the legal components of civil commitment by adhering to the conditions of placement and reduce barriers to success. (c) Monitoring services shall be provided by direct contacts on a regular basis. A direct contact is considered a phone call or in-person visit with the person under civil commitment. Direct contacts do not include those with legal guardians, authorized representatives, or other surrogate decision makers. The aim of direct contacts is to obtain primary information regarding the person’s progress toward stabilization or in maintaining stabilization. (d) Monitoring services shall also include indirect contacts. An indirect contact is considered any communication with a person other than the person placed under civil commitment and that is related to the person’s progress. Indirect contacts may include but not be limited to medical and behavioral health providers, prescribers, counselors, case managers, family members, friends, law enforcement, peers, and advocates. (e) Direct and indirect contacts, including unsuccessful attempts, shall be documented in the person’s clinical record. Documentation must include but not be limited to changes to circumstance such as housing or health, observations of mood and behavior, successes or challenges adhering to the conditions of placement, descriptions of supportive services provided, and any recommendations or actions taken pertaining to need for revocation or early discharge of the civil commitment. Statutory/Other Authority: 426.125, 426.127, 426.275 & 426.267 Statutes/Other Implemented: ORS 422.005 - 426.395 History: BHS 17-2024, minor correction filed 06/27/2024, effective 06/27/2024 BHS 7-2024, adopt filed 04/30/2024, effective 05/28/2024 309-033-0290 Placement of Persons under Civil Commitment (1) Placement authority. The Authority, pursuant to ORS 426.060, delegates the responsibility for the placement of a person under civil commitment to the director of the county of commitment: (a) The director, in consultation with the appropriate administrator, may place or transfer placement of a person under civil commitment to any facility or program approved by the Authority which, in the opinion of the director, will appropriately meet the mental health needs of the person under civil commitment and is consistent with applicable rules and statutes; (b) Pursuant to ORS 426.300, the director of the county of placement may discharge a person from civil commitment by notifying, in writing, the court having jurisdiction, when voluntary status is in the best interest of the person, or if the director determines the person is no longer a person with mental illness as defined by ORS 426.005; (c) Placement outside the county of residence. The director of the county of commitment may place the person under civil commitment at a facility in a county other than the county of residence or county of commitment if the director determines that such placement is in the best interest of the person under civil commitment; (d) Placement at the state hospital. The director of the county of commitment shall only place a person under civil commitment in the state hospital with the consent of the superintendent. (2) Placement procedure. The director of the county of commitment shall make the initial placement in writing immediately upon the civil commitment of a person by the court or at the time the person under civil commitment is transferred to another placement during the civil commitment period. The director shall: (a) Retain an original placement order, as provided by the Division, on file in paper or electronic format, in safe keeping for seven years; (b) Deliver a signed original copy, paper or electronic, of the placement order to the person under civil commitment prior to placement; (c) Enter into the Division’s current electronic data systems a copy of the director’s written placement order, and information about the person under civil commitment including: (A) Name and any known aliases; (B) Date of birth; (C) The physical location where the person can be found while under civil commitment. The physical location may be an address or description for those without an address; (D) Address of the facility, hospital, or program where the person is placed for treatment, if different from physical location; (E) Name and telephone number of the administrator of the hospital, facility, or program providing the person’s treatment; and (F) Any other data as requested by the Division. (d) Should the Division’s current electronic data system(s) be unavailable to upload and communicate the written placement order, within three business days the director shall submit a copy of the placement order to the Division by email at civil.commitment@odhsoha.oregon.gov; (e) Petition for transfer of jurisdiction when placement is outside the county of commitment. The director of the transferring county of commitment shall petition its court to transfer jurisdiction to the court in the county where the person is to reside, pursuant to ORS 426.275. (3) Appeal of placement procedure. At any time during the period of civil commitment, a person under civil commitment may appeal to the Authority for a change in placement made by a director. The Division shall, in addition to the person under civil commitment, accept completed and submitted appeals from advocates; a person’s legal representation, authorized healthcare representatives; a person’s social worker or caseworker; and others who submit the appeal on behalf of the person under civil commitment and with the person’s documented consent. (a) How to make an appeal. The person under civil commitment shall make the appeal in writing and shall include the following information in the appeal: (A) A statement that the person under civil commitment appeals the current placement; (B) The reason(s) the person under civil commitment believes the current placement is inappropriate; and (C) The proposed alternate placement and the reasons the person under civil commitment is requesting the alternate placement. (b) Appeal of a placement. When an appeal to a placement has been made, the Authority shall determine the placement for the person under civil commitment and notify the person under civil commitment of the placement decision, in writing or verbally, within five judicial days of the receipt of the written appeal. The Authority’s determination shall be final: (A) In determining an appealed placement, the Authority: (i) Shall review the written appeal; (ii) Shall contact the director making the placement, and consider the director’s reason(s) for making the placement; (iii) Shall consider the opinion of the person’s treating licensed independent practitioner (LIP); (iv) May require the director to submit a written statement which gives the reason(s) for the placement; (v) May consider the consultation or opinion of any person that the Authority believes has knowledge relevant to the case; and (vi) Shall consider whether the person has been accepted at the person’s preferred placement. (B) The Authority shall consider the following criteria in making a determination of an appealed placement: (i) The best interests of the person under civil commitment; (ii) The safety of the person and the community; and (iii) The availability of the least restrictive, most integrated setting depending on available resources. Statutory/Other Authority: ORS 413.042 & 426.060 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 17-2022, temporary amend filed 10/14/2022, effective 10/14/2022 through 04/11/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0100 309-033-0300 Transfers Between Classes of Facilities (1) Transfers between classes of facilities. The director may transfer a person under civil commitment from one class of facility to another in the same class or in a less restrictive class as provided by ORS 426.060. However, the director shall transfer a person under civil commitment who has voluntarily agreed to placement at the facility only with the written consent of the person. The director shall transfer persons under civil commitment as provided by OAR 309-033-0400 through 309-033-0440 and OAR 309-033-0290. The director shall modify the conditions of trial visit to reflect the change of placement and shall notify the following persons of the transfer: (a) The person under civil commitment; (b) The court in the county where the person was civilly committed; (c) The court in the county where the person is to be placed; (d) The director in the county where the person is to reside; (e) The administrator of the facility designated to provide care or treatment; and (f) Any other provider designated to provide care or treatment. (2) Transfers restricted by rule. The director may transfer a person under civil commitment from a facility of one class to another facility of a same class or lower class by: (a) Placing the person under civil commitment at the new facility; and (b) Modifying the person’s civil commitment status as follows: (A) Persons transferred to a Class 2 or Class 3 facility. When the director transfers a person under civil commitment to a Class 2 or Class 3 facility, the director shall place the person on trial visit (see OAR 309-033-0290); (B) Transfers between Class 1 hospitals or facilities. The director shall transfer a person between Class 1 hospitals or facilities without placing the person on trial visit; or (C) Transfer to any facility and discharged from civil commitment. When the director determines a person under civil commitment is no longer a person with mental illness as defined by ORS 426.005, or the person agrees to voluntary treatment and does so in good faith, the director of the county of placement shall discharge the person from civil commitment pursuant to OAR 309-033-0330 and enroll the person in services voluntarily at the receiving facility. (3) Transfers from a facility of one class to a facility of a more restrictive class: (a) Involuntary transfers of persons under civil commitment. The director shall transfer a person who is on trial visit to a facility of a more restrictive class only: (A) By revocation as ordered by the court after a hearing, pursuant to ORS 426.275; or (B) Initiate involuntary procedures as provided in OAR 309-033-0300(3)(c) and as provided by ORS 426.233. (b) Voluntary transfers of persons on trial visit. The director may transfer a person who is on trial visit to a facility of a more restrictive class with the person’s consent. However, if the person revokes his/her consent to the current more restrictive placement and requests to be placed at another facility of a less restrictive class, as soon as reasonably possible the director shall: (A) Transfer the person to a facility where the person consents to receive services; or (B) Initiate involuntary procedures as provided in this paragraph and by ORS 426.233. (c) Emergency transfers of persons on trial visit and outpatient commitment. As provided by ORS 426.233, the director may transfer a person who is on a community-based civil commitment to a hospital or nonhospital facility approved by the Division when the director has probable cause to believe the person is dangerous to self or others, or is unable to provide for basic personal needs that are necessary for health and safety and is in need of immediate care, custody, and treatment. Should the director or designee recommend revocation, the director or designee shall proceed as described in OAR 309-033-0320(3). (4) Authority to retake persons. A Class 1 or Class 2 facility shall immediately notify a peace officer and the Division of any person who has left the facility without lawful authority and shall immediately request the assistance of a peace officer(s) in retaking and returning the person to a Division-approved hospital or facility. The director shall show the peace officer a copy of the order of civil commitment. Statutory/Other Authority: ORS 413.042, 426.060, 426.223, 426.233, 426.273, 426.275 & 426.278 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0110 309-033-0310 Recertification for Continued Civil Commitment. (1) Recertification for continued civil commitment of persons placed in a state hospital: (a) After consulting with the director of the person’s county of residence, the superintendent shall issue a recertification to: (A) The person whose 180-day period of civil commitment is due to expire, if the person is still a person with mental illness as defined by ORS 426.005 and is in need of further treatment; and (B) The director. (C) The recertification shall inform the person of their right to an attorney and that the state will provide one if indicated, that a request for additional time under civil commitment will be given to the court, that the person may contest the recertification within 14 days of receiving the recertification otherwise, if not contested, the person may be recommitted for an additional period of up to 180 days. (b) The superintendent shall notify the court concerning: (A) The date the recertification was issued to the person; and (B) Whether the person, within 14 days of the issuance of the recertification, protests to continued civil commitment. (2) Recertification for continued civil commitment of persons placed in a community hospital or nonhospital facility: (a) After consulting with the director of the person’s county of residence, the director shall issue a recertification to: (A) The person whose 180-day period of civil commitment is due to expire, if the person is still a person with mental illness and in need of further treatment; and (B) The director of the person’s county of residence. (C) The recertification shall inform the person of their right to an attorney and that the state will provide one if indicated, that a request for additional time under civil commitment will be given to the court, that the person may contest the recertification within 14 days of receiving the recertification otherwise, if not contested, the person may be recommitted for an additional period of up to 180 days. (b) The director shall notify the court concerning: (A) The date recertification was issued to the person; and (B) Whether the person, within 14 days of the issuance of the recertification, protests continued civil commitment. (3) Documentation of recertification for continued civil commitment in the clinical record. The director or the superintendent making the recertification shall include in the clinical record: (a) The date and time the director’s approval of continued civil commitment was obtained prior to the recertification being issued to the person; (b) The date and time the recertification was issued to the person; (c) A copy of the recertification issued to the person; (d) Concerning the notification to the court of the date the recertification was issued to the person: (A) The date and time that the court was notified of the issuance of the recertification to the person; and (B) A copy of the notification. (e) Concerning the notification to the court of whether the person, within 14 days of the issuance of the recertification, protests continued civil commitment: (A) The date and time that the court was notified of whether the person protests; and (B) A copy of the notification to the court whether the person protests. (f) If an examination is requested by the person: (A) The name of the psychiatrist or the certified mental health examiner ordered by the court to conduct the examination; (B) The date that the examination was conducted; and (C) A copy of the examination report sent to the court. (g) If the court orders continued civil commitment, a copy of the order continuing the civil commitment; and (h) If the court orders the release of the person: (A) A copy of the order requiring release; (B) If the person consents to services upon discharge, a copy of an aftercare plan signed by the person and the name of the case manager responsible for arranging outpatient services; or (C) If the person refuses services upon discharge, a statement signed by the person indicating the person’s refusal of outpatient services; and (D) The date and time the person was released from the facility. Statutory/Other Authority: ORS 413.042, 426.301 & 426.307 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0120 309-033-0320 Revocation of Conditional Release, Outpatient Commitment or Trial Visit (1) Conditional release. A caregiver appointed by the court to care for a person under civil commitment while on conditional release is responsible for reporting to the court any violation of the conditions of placement. If a person on conditional release, whose conditions of placement include any service agreed to be provided by a Community Mental Health Program (CMHP), violates the conditions of conditional release, the director shall include in the clinical record a revocation report which documents the following: (a) The person’s nonadherence to those conditions of placement that include services provided by the CMHP; (b) Efforts by the CMHP to inform the caregiver of the nonadherence and the caregiver’s response to these efforts; (c) Requests by the caregiver for the CMHP to assist in obtaining compliance from the person on conditional release, or in notifying the court of the person’s nonadherence to the conditions of placement, and the CMHP response to the requests for assistance; (d) Documentation of the disposition made by the court, if the caregiver submits notification to the court; and (e) The date the person was transported to a more restrictive facility, and the name of the facility, if appropriate. (2) Outpatient commitment and trial visit. A monitor may request that a person’s community-based civil commitment be revoked due to nonadherence to the conditions of placement. Nonadherence occurs when a person: (a) does not complete any one or more condition as agreed upon at the onset of the community-based placement; and/or (b) is not receptive to one or more attempts at improvement plans to remedy conditions not met; and/or (c) manifests a decompensated mental status and the monitor has good cause to believe the person will quickly become a danger to self or others or be unable to provide for basic needs without more intensive clinical intervention; and/or (d) is, in good faith, determined to be better served by a placement that is in a more restrictive setting. (3) Intent to revoke due to nonadherence. For persons on outpatient commitment or trial visit, the director or designee is responsible for reporting to the court any nonadherence to the conditions of placement. For persons on outpatient commitment or trial visit and for whom revocation will be requested , the director or designee shall: (a) Provide notice to the court in the county with jurisdiction of intent to revoke by submitting a request for revocation hearing. Upon receipt of the request, the judge may issue a warrant of detention for the person under civil commitment to remain at a designated facility following the LIP evaluation; and (b) Provide the person with written and verbal notice of intent to revoke in accordance with OAR 309-033-0300. The notice shall include: (i) A statement of the person’s right to legal representation for the revocation hearing; (ii) The name and email address of the director or designee who determined it was in the person’s best interest to seek revocation; (iii) The individual condition(s) of placement to which the person is alleged to have been nonadherent and is serving as grounds to seek revocation; and (iv) A summary of any effort(s) to resolve the concern in the community and the person’s response(s) to the intervention(s). (c) Submit to the court: (A) A request for revocation hearing; and (B) A copy of the conditions of placement. (d) Include in the clinical record a revocation report which includes the following: (A) Documentation of the person’s nonadherence with the conditions of placement; (B) Documentation of efforts from all parties attempting to obtain adherence from the person under civil commitment and the response of the person to these efforts; (C) A copy of the request for revocation hearing as submitted to the court as notification of the person’s nonadherence to the conditions of placement; (D) Documentation of the disposition made by the court; (E) Documentation of the distribution of any modified conditions of placement or disposition placing the person in a higher level of care to all parties originally receiving copies of the conditions of placement; and (F) Date the person was transported to a higher level of care, and the name of the facility, if appropriate. Statutory/Other Authority: ORS 413.042 & 426.275 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0130 309-033-0330 Discharge of Civil Commitment for Persons under Civil Commitment and Placed in the Community (1) Only the director of county of placement may discharge. Only the director of the county of placement may change the civil commitment status of a person under civil commitment who is placed in a community hospital or other community facility: (a) The director shall discharge a person from civil commitment when: (A) Release from treating facility. The director believes the person under civil commitment is no longer a person with mental illness as defined in ORS 426.005, and the person is to be released from the treating facility. (B) Transfer to voluntary status. The director believes it is in the best interest of the person to transfer to voluntary status, but the person is to remain at the treating facility. (b) The director shall discharge a person from civil commitment by notifying the last committing court and the court of residence, pursuant to the provisions of ORS 426.300. (2) Persons required to notify director prior to discharge. The following persons shall notify the director of the county of commitment 48 hours before discharging a person from a hospital, nonhospital or residential facility, or outpatient treatment: (a) If the person under civil commitment is in a state hospital, the superintendent or designee shall notify the director; (b) If the person under civil commitment is in a hospital serving as a regional acute care hospital or a private hospital, the treating Licensed Independent Practitioner shall notify the director; (c) If the person under civil commitment is placed in a nonhospital or residential facility, the administrator of the facility shall notify the director; (d) If the person is placed with an outpatient treatment provider or program, the administrator of the program where the person is receiving outpatient treatment shall notify the director. (3) Procedures for discharge. The director shall give written notice to the person under civil commitment within thirty days after the civil commitment was discharged. The notice shall state the date the civil commitment expired or was discharged. A copy of the notice shall be kept in the person’s clinical record. Statutory/Other Authority: ORS 413.042 & 426.300 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 17-2022, temporary amend filed 10/14/2022, effective 10/14/2022 through 04/11/2023 MHD 6-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-200-0140 309-033-0400 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe standards and procedures relating to the care, custody, and treatment of persons under civil commitment and persons alleged to have a mental illness. (2) Statutory authority. These rules are authorized by ORS 426.005 through 426.395 and carry out the provisions of ORS 426.005 through 426.395. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 7-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-205-0000 309-033-0420 Transportation and Transfer of Persons in Custody or On Diversion (1) Notification of court. The director shall immediately inform the court of a transfer and the location of the person and of the time the person is admitted to a new hospital or nonhospital facility. (2) Transfer of persons in custody or on diversion. The director may transfer a person who is in custody or on diversion only when: (a) The director believes there is a facility approved in accordance with OAR 309-033-0530available that can provide necessary care or treatment which is sufficient to meet the emergency psychiatric needs of the person; (b) The director has obtained the consent required by OAR 309-033-0420(3) and 309-033-0420(4). (3) Consent by treating Licensed Independent Practitioner (LIP) and receiving LIP or director for transfer between hospitals. If the transfer is from a hospital to another hospital or to a nonhospital facility, the director shall obtain the consent of the treating LIP and of the receiving LIP or the director of the nonhospital facility prior to transferring the person: (a) The treating LIP shall give consent by documenting in the person’s clinical record an order over the LIP’s signature within 24 hours of giving verbal or written consent; (b) The receiving LIP at a hospital or the administrator of a nonhospital facility shall accept the transfer verbally and shall document the acceptance in the clinical record of the person. (4) Consent by treating LIP for transfer from nonhospital facility to hospital. If the transfer is from a nonhospital facility to a hospital, the director shall obtain the consent of the receiving LIP prior to transferring the person: (a) The receiving LIP shall give consent by documenting in the person’s clinical record an order over the LIP’s signature within 24 hours of giving consent to the director to admit the person to the hospital; (b) The director shall provide the nonhospital facility written approval of the transfer within 24 hours of giving verbal or written approval of the transfer; (c) The administrator of the nonhospital facility shall document the director’s verbal approval and retain written approval of the transfer in the person’s clinical record. (5) Consent by administrator for transfer between nonhospital facilities. If the transfer is from one nonhospital facility to another nonhospital facility, the director shall obtain the verbal or written consent of the administrator of the receiving nonhospital facility prior to transferring the person: (a) The administrator of the receiving nonhospital facility shall consent to the transfer by documenting in the person’s clinical record the consent within 24 hours of giving verbal or written consent; (b) The director shall provide the sending nonhospital facility written approval of the transfer within 24 hours of giving verbal or written approval of the transfer; (c) The administrator of the sending nonhospital facility shall document the director’s verbal or written approval and retain written approval of the transfer in the person’s clinical record. (6) Notice to person to be transferred. Except in cases of emergency, 24 hours before the transfer is to take place, the director shall provide a notice to the person to be transferred which includes: (a) Transfer date and time; (b) A statement that the person may use the grievance procedure and a brief description of how to initiate a grievance; and (c) Justification for the transfer. Statutory/Other Authority: ORS 413.042, 426.060 & 426.235 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 7-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-205-0030 309-033-0425 Provider Requirements for the Transportation and Transfer of Minors in Custody or by Consent of Legal Guardian (1) Providers must be contracted to provide secure non-emergent medical transport (NEMT) services. (2) Transportation of minor individuals (under the age 18) must be consistent with the requirement of 419-480-0010 through 419-480-0120 and must include disclosure in a noticeable location in any advertisements or promotional materials for its secure transportation services that the provider is authorized by the Oregon Health Authority to provide secure transportation services; (a) The disclosure must also indicate that the secure transportation services provider is not licensed by the Department under ORS 418.215 or 418.240 to provide secure transportation services and, if applicable, the reason for the provider’s licensing exemption under 419-480-0020(2); (b) Secure NEMT service providers can obtain an exemption from Oregon Department of Human Services (ODHS) to conduct secure transports within the parameters set forth in the legislation such as secure transport to/from Oregon when it originates or ends at a Child Care Agency (CCA), Oregon Developmental Disabilities Services (ODDS) residential facility or a Child Welfare certified foster home. (3) When transporting minors, the provider must have a documented service agreement that describes: (a) The services to be provided; (b) The fee for the services; (c) Any physical limitations, allergies, medications (prescribed or over the counter that are to be administered during transport); (d) Any special needs of the child, any instructions from the child, parent or guardian, including but not limited to guidance on what would help the child feel comfortable, safe and secure while being transported ; (e) The route to be taken when requested; (f) An inventory of personal belongings transported with the child; and (g) A plan for how the provider will meet the child’s needs during transport. (4) The provider must have clear policies and procedures addressing the following: (a) Employee conduct; (b) How protected health information will be kept secure and confidential; (c) How medication, lodging, food, bathroom and personal needs will be met during transport; (d) How the provider will coordinate with the parents/guardian if emergency conditions require any deviations from the planned itinerary; and (e) Accessing roadside assistance 24/7 for emergency support or roadside assistance. (5) The provider must have a policy describing the process by which referrals for the secure transport of children are received, reviewed, and approved. The policy must include: (a) Information that is required to be submitted to ensure the safety of the child while being transported; and (b) The identification of the individual responsible to take custody of the child after transport. (6) The provider must maintain a record of each secure transport service provided to include the name and date of birth for the child being transported. The date(s) of transportation, the name, address and contact information for the parents/guardian, a copy of authorization (consent) to transport the child and a copy of the release of information (ROI) signed by the parent/guardian for health care information relating to the transport needs of the child. (7) Incident Reporting. A written description of any injury involving a child in care must be placed in the individual child in care's record and a copy provided to the parent/legal guardian or identified caregiver responsible for the child’s care. Any critical incident, elopement or possible abuse must also be reported to the appropriate protective services agency, the Health Systems Division, the receiving agency, the parent/legal guardian and other partnering agencies as appropriate based on the reported information. (8) The secure transportation services provider must ensure a child in care is properly secured in an age-appropriate safety seat when transported in a motorized vehicle and that all seatbelts in use not requiring an age-appropriate safety seat are designed to be operated by the passenger without the assistance of a third party. The provider will encourage the continued use of all seatbelts and safety seat mechanisms while in transport and will provide any assistance to properly adjust or release seatbelts or safety seat mechanisms when needed. (9) The provider must prohibit any smoking, aerosolizing, or vaporizing of an inhalant in the presence of a child in care. Statutory/Other Authority: ORS 413.042, 426.005, 426.060, 426.110(2), 426.232, 426.236, 409.050, 418.005, 418.240 & 418.255 Statutes/Other Implemented: ORS 426.005-426.395 & 418.205-418.327 History: BHS 28-2022, minor correction filed 12/21/2022, effective 12/21/2022 BHS 24-2022, adopt filed 12/20/2022, effective 12/20/2022 309-033-0430 Transportation of a Person under Civil Commitment to a State Hospital, Community Hospital or Nonhospital Facility (1) Transportation of a person under civil commitment to a state hospital, community hospital or nonhospital facility. The director of the county of commitment shall arrange for the transportation of persons under civil commitment to the hospital or nonhospital facility: (a) Only persons under civil commitment who have received prior approval for admission by the superintendent may be transported to a state hospital; (b) A guardian, friend or relative may transport the person under civil commitment to the designated facility if all of the following are met: (A) The guardian, friend, or relative requests to transport the person to the designated facility prior to or at the time of the civil commitment hearing; (B) The committing judge at the civil commitment hearing determines that the means of transportation would not be detrimental to the welfare of the person with mental illness or to the public. (2) Medically unstable persons under civil commitment. The costs of providing care, custody, and treatment for a person under civil commitment who is unable to be transported or cannot be admitted to a state hospital because of medical necessity shall be paid by the county of residence from funds provided to it by the Division for the provision of mental health services. The hospital or other facility shall charge to and collect from the county of residence only after the hospital or other facility has charged to and collected from the person, third party payers or agencies otherwise legally responsible for the costs of emergency care, custody, and treatment, as it would for any other patient. (3) Transfer of a person under civil commitment to another hospital. The administrator of a facility providing care, custody, and treatment to a person under civil commitment may transfer the person only with the recommendation of the director of the county of residence and the approval of the administrator of the receiving facility. (4) Transfer of a person under civil commitment to voluntary status or discharge for civil commitment. The superintendent of a state hospital, on his/her own initiative or on the request of the person under civil commitment, shall transfer the person to voluntary status if the superintendent believes with reasonable medical certainty that the person will pursue voluntary treatment. The superintendent of a state hospital may discharge the person from civil commitment when the person is no longer a person with mental illness as defined in ORS 426.005. (a) The administrator of a community hospital or nonhospital facility, other than a state hospital, providing care, custody, and treatment for the person under civil commitment, in consultation with the director, may transfer the person to voluntary status or discharge the person from civil commitment; (b) When a person is transferred to voluntary status, the superintendent or administrator shall notify the director and the court of the county of current commitment of such action within 72 hours; (c) Any person under civil commitment transferred to voluntary status shall be discharged from the treating facility, at the request of the person or the person’s legal guardian, within 72 hours of the request unless the person meets the criteria for prehearing custody and is placed in custody, thus initiating the civil commitment process. (5) Grievance of transfer. The director and the superintendent shall have written procedures for resolving grievances about the transfer of persons under civil commitment from one facility to another. The director or the superintendent shall suspend the transfer of the person until the grievance procedure is completed, unless immediate transfer is necessary for health or safety, upon the written or verbal protest of one of the following persons: (a) The person being transferred; (b) The legal guardian of the person being transferred. Statutory/Other Authority: ORS 413.042 & 426.150 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 7-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-205-0040 309-033-0432 Standards for the Approval of a Secure Transport Provider to Transport a Person in Custody or On Diversion to an Approved Holding Hospital or Nonhospital Facility (1) A secure transport provider must be approved by the Division under this rule in order to transport a person pursuant to the provisions of ORS 426.228, 426.231, and 426.233. A Secure transport provider approved under this rule may transport the person only to a hospital or nonhospital facility approved under OAR 309-033-0530 (Approval of Hospitals and Nonhospital Facilities to Provide Services to Committed Persons and to Persons in Custody and on Diversion). (2) A secure transport provider shall submit a letter of application to the Division. If approved, the Division shall issue a certificate of approval to provide transportation services. This approval shall be renewed every two years subject to the application of the secure transport provider and review by the Division. (3) Requirements for approval include all of the following: (a) Secure transport providers must comply with the requirements in OAR 309-033-0435 (Client Rights with Regards to a Secure Transport Provider) and OAR 309-033-0437 (Mechanical Restraint by a Secure Transport Provider); (b) The director of the county in which the secure transport provider is located will submit to the governing body of the county a letter formally identifying the secure transport provider as authorized to provide secure transport services for the county throughout the state as needed to transport persons in custody or on diversion; (c) The director in the county in which the secure transport is to be used shall submit a letter of recommendation for approval to the Division on behalf of the secure transport provider with a copy of the letter submitted to the governing body identifying that the secure transport provider is authorized to provide secure transportation services for persons in custody or on diversion; and (d) The secure transport provider’s vehicles must: (A) Have a secured rear seat in an area separated from the driver; (B) Have a safety shield that prohibits physical contact with the driver; (C) Have plexiglass or secured window guards covering any windows in the secured area; (D) Be washable and non-breakable in the secured area; (E) Be absent of inside locks or door handles in the secured area; (F) Have wrist and ankle restraints (preferably soft non-metal) for use when necessary to control violent or overt behavior; (G) Be absent of any foreign items or instruments in the secured area that may be used by the client to inflict harm to self, attendant or person accompanying the client; (H) Have an operating cellular phone or other communication device for use in transit; (I) Have an operable flashlight; (J) Have a First Aid kit with disposable gloves (universal precautions); (K) Have tire traction devices when appropriate; (L) Have an operable horn, windshield wipers, working turn signals, back-up lights, break lights, headlights, taillights, and safety mirrors; (M) Have adequate ventilation and heating appropriate to the secured seating; (N) Be licensed as an ambulance service in accordance with OAR 333-250-0040, if providing transportation to a Psychiatric Emergency Services (PES) facility. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 24-2022, amend filed 12/20/2022, effective 12/20/2022 MHS 28-2016, f. & cert. ef. 12-29-16 MHD 10-2000, f. & cert. ef. 7-21-00 MHD 3-2000(Temp), f. 1-25-00, cert. ef. 1-25-00 thru 7-22-00 309-033-0435 Client Rights with Regards to a Secure Transport Provider (1) A secure transport provider shall maintain written policies and procedures with regard to client rights. The policies and procedures must assure that a client has the right to be treated with consideration, respect, and full recognition of human dignity and individuality. These rights are in addition to any other rights provided for in law. (2) The client care policies and procedures must include but are not limited to: (a) Considerate and respectful care; (b) Reasonable privacy concerning a client's transportation and care; (c) Confidentiality of all communications and records relating to client transportation and care except to the extent otherwise required by law; (d) An environment in the secure transport that is free from recognized hazards. (3) A secure transport provider shall keep a record of any formal complaint or report of misconduct made against an employee. The record must contain a copy of the complaint or report or a detailed written summary of the allegation. A provider shall investigate the accuracy of the complaint, report, or allegation and shall include a summary of the investigation and resulting action taken, if any, in the record. These records must be included in the driver's file with a copy provided to the Division. (4) A secure transport provider shall report any client abuse in accordance with: (a) ORS 419B.005 to 419B.050 for child abuse; (b) ORS 435.735 to 430.765 for abuse of an adult with mental illness or developmental disabilities; and (c) ORS 124.050 to 124.095 for elderly or persons with disabilities . (5) When alleged abuse or death of an individual has occurred, and a law enforcement agency, the Authority, the Department of Human Services or their designee in community mental health or developmental disabilities programs has determined to initiate an investigation, the secure transport provider may not conduct an internal investigation without prior authorization from the Division. For the purposes of this section, an "internal investigation" is defined as: (a) Conducting interviews of the alleged victim, witness, accused person, or any other person who may have knowledge of the facts of the abuse allegation or related circumstances; (b) Reviewing evidence relevant to the abuse allegation, other than the initial report; or (c) Any other actions beyond the initial actions of determining: (A) If there is reasonable cause to believe that abuse has occurred; (B) If the alleged victim is in danger or in need of immediate protective services; (C) If there is reason to believe that a crime has been committed; or (D) What, if any, immediate personnel actions must be taken to assure individual safety. (6) Upon completion of the abuse investigation, the secure transport provider may conduct an investigation without further Division approval to determine if any personnel actions are necessary. (7) A secure transport provider shall obtain criminal offender information on all employees who are Transporting a Person in Custody or on Diversion in accordance with OAR chapter 407, division 007. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 426.005 - 426.395, 430.205 & 430.210 History: BHS 24-2022, amend filed 12/20/2022, effective 12/20/2022 MHS 5-2007, f. & cert. ef. 5-25-07 MHD 10-2000, f. & cert. ef. 7-21-00 MHD 3-2000(Temp), f. 1-25-00, cert. ef. 1-25-00 thru 7-22-00 309-033-0437 Mechanical Restraint by a Secure Transport Provider (1) A mechanical restraint may be used by secure transport providers in emergency situations to prevent a person from inflicting immediate and serious harm to self or others, or property. A mechanical restraint shall only be used for health and safety reasons. Mechanical restraint that results in injury to the person requires immediate written notification to the Division. (2) Checking a person in a mechanical restraint: (a) The provider shall monitor the client’s need for adequate circulation; (b) Staff shall document that the client was checked and appropriate attention paid to the person’s needs. (3) A Secure transport provider shall have adequately trained employees who are transporting a person in custody or on diversion; (a) The employee shall participate in four hours of training annually, in supportive interaction, redirection, de-escalation and the management of aggressive behavior, and the proper application of mechanical restraint and standards for the proper use of mechanical restraint; (b) The employee shall not use threats, intimidation, coercion, or the display of defensive tools such as batons, mace, or weapons as behavioral interventions or to compel compliance; (c) Annual training curriculum shall include: Job duties and responsibilities, a review of provider’s policies and procedures, universal precautions and infection control guidelines, and mandatory abuse reporting for children and adults; (d) The employee shall maintain current certification in first aid and cardiopulmonary resuscitation; (e) Within 90 days of the date of hire, the employee shall complete certification in a nationally recognized safe driving course and complete all activities required to maintain certification. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 24-2022, amend filed 12/20/2022, effective 12/20/2022 MHD 10-2000, f. & cert. ef. 7-21-00 MHD 3-2000(Temp), f. 1-25-00, cert. ef. 1-25-00 thru 7-22-00 309-033-0500 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe standards for the approval of facilities that provide involuntary care, custody and treatment to persons in protective custody, in custody and on diversion. (2) Statutory authority. These rules are authorized by ORS 426.395, and 426.005 through 426.395 and carry out the provisions of ORS 426.005 through 426.395. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 Statutes/Other Implemented: ORS 426.005 - 426.395 History: MHD 8-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-210-0000 309-033-0520 Classes of Facility that Provide Care, Custody or Treatment to Persons under Civil Commitment or to Persons in Custody or on Diversion. (1) Division to assign classification. The Division shall assign a classification to a facility approved to serve a person under civil commitment pursuant to ORS 426.130, or a person in custody pursuant to ORS 426.232, 426.233, or on diversion pursuant to 426.237. (2) Class 1. A Class 1 facility is: (a) A facility that is approved under applicable administrative rules to be locked to prevent a person from leaving the facility, to use seclusion and restraint, and to involuntarily administer psychiatric medication, including a hospital, regional acute psychiatric care facility or other nonhospital facility approved under OAR 309-033-0530; (b) A state hospital or a residential facility operated by a state hospital on a state hospital campus; or (c) A facility which, in the opinion of the Division, restricts the liberty of a person to substantially the same degree as other facilities in this class. (3) Class 2. A Class 2 facility is a facility that is approved under applicable administrative rules to be locked to prevent a person from leaving the facility. This class of facility includes: (a) A secure residential facility that is approved under OAR 309-035-0100 through 309-035-0190 and that is approved by the Division to be locked to prevent a person from leaving the facility; (b) A facility which, in the opinion of the Division, restricts the liberty of a person to substantially the same degree as other facilities in this class. (4) Class 3. A Class 3 facility is a residential facility that is approved under OAR 309-035-0100 through 0309-035-0190 that is not otherwise included in another class of facility. A Class 3 facility shall not lock its doors to prevent a person from leaving the facility. Statutory/Other Authority: ORS 413.042 & 426.238 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 BHS 12-2021, amend filed 06/16/2021, effective 06/16/2021 BHS 13-2020, temporary amend filed 10/21/2020, effective 10/21/2020 through 04/18/2021 MHD 8-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-210-0030 309-033-0530 Approval of Hospitals and Nonhospital Facilities to Provide Services to Persons under Civil Commitment and to Person in Custody and on Diversion This section establishes rules for approval of hospital and nonhospital facilities which provide service to a person under civil commitment or to a person in custody or on diversion. (1) Approved hospitals and other facilities. Only hospitals and nonhospital facilities, approved by the Division under this rule, shall provide care and treatment services for persons under civil commitment or for persons in custody or on diversion. (2) Application for approval. Approval of hospitals or nonhospital facilities shall be accomplished by submission of a letter of application pursuant to OAR 309-008-0400. If approved, a certificate pursuant to OAR 309-008-0500 will be issued to the hospital or nonhospital facility to provide such services. This approval shall be reviewed on a biennial basis subject to application of the hospital or other facility and/or review by the Division. (3) Requirements for approval. In undertaking review of the hospital or nonhospital facility for approval, the Division shall be satisfied that the hospital or nonhospital facility meets one of the following requirements: (a) Approval to provide seclusion and restraint to persons under civil commitment and to persons in custody and on diversion. The Division shall approve, without further requirement, hospitals and nonhospital facilities currently approved under OAR 309-033-0700 through 309-033-0740; (b) Requirements for facilities not approved to provide seclusion and restraint. The Division shall approve a nonhospital facility to serve persons under civil commitment and persons in custody and on diversion if the nonhospital facility is certified as a secure residential facility under Division rules and the nonhospital facility has the following: (A) Written policies and procedures in place which assure that: (i) The facility shall not admit a person who may require seclusion or physical restraint. (ii) A person who develops the need for seclusion and restraint is immediately removed to a hospital or nonhospital facility approved under OAR 309-033-0700 through 309-033-0740. (iii) Each person admitted to the facility has a Licensed Independent Practitioner (LIP) who is responsible for treating the person during the person’s stay at the facility and who examines the person within 24 hours of the person’s admission to the facility. (iv) A staff person shall provide direct care for consumers only when that staff person is trained in the curriculum approved by the LIP. The staff shall receive the training within the last six months prior to providing direct consumer care. (v) A staff person shall participate in the training approved by the LIP quarterly. (B) A LIP, who is employed by the facility or has a contract with the facility, to provide medical oversight of admission policies and procedures, and staff training; (C) A staff training curriculum which is approved by the LIP and includes: (i) Criteria for the admission of a person who can safely be served by the nonhospital facility; (ii) Recognition of indicators of violence or assault and criteria for the transfer of person to a more secure facility; (iii) Indicators of medical problems, identification of medication side effects, and indicators of medical problems and medical crisis; and (iv) Management of aggressive behavior and de-escalation techniques. (D) At least two qualified mental health associates who are available on-site 24 hours-a-day, seven days-a-week; (E) Alarmed doors and windows which have been approved by the Division; (F) A written agreement with a law enforcement agency to respond to emergencies that provides: (i) Emergency response time within 15 minutes of the nonhospital facility’s request; (ii) Agreement by the law enforcement agency to retake a person who elopes and to return the person to the nonhospital facility or remove the person to a hospital or nonhospital facility approved under OAR 309-033-0700 through 309-033-0740, as directed by the administrator of the nonhospital facility. (G) Documentation of fire marshal approval to operate as a secure facility. (3) Data reporting. Hospital and nonhospital facilities, including CMHPs and facilities operating as regional acute care psychiatric facilities, approved to provide services to individuals placed under civil commitment for care, custody, and treatment shall complete, within 24 hours of hospital admission or discharge, the appropriate reporting requirements related to the care, custody, and treatment for persons under civil commitment as indicated in: (a) The County Financial Assistance Agreement (CFAA): (b) OAR 309-032-0870; and (c) Any additional contract, agreement, or licensing requirement(s) necessary to maintain in order to continue providing for the care, custody, and treatment of persons under civil commitment. Statutory/Other Authority: ORS 413.042, 426.228, 426.232, 426.233 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 28-2016, f. & cert. ef. 12-29-16 MHD 8-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-210-0040 309-033-0540 Administrative Requirements for Hospitals and Nonhospital Facilities Approved to Provide Services to Persons in Custody. (1) Written policies. Each hospital or nonhospital facility shall have written policies concerning the care, custody, and treatment of persons in custody or on diversion. These policies shall be written to provide for the comfort and safety of the person being provided care and for the safety of the facility staff providing care to that person. These policies shall detail staff responsibilities, person’s rights, and emergency procedures. All staff involved in the care of these persons shall be fully familiar with these policies and procedures. These policies shall be reviewed as part of the Division’s approval process. (2) Warning. Each hospital or nonhospital facility shall: (a) Have a Licensed Independent Practitioner (LIP), nurse, or a Qualified Mental Health Professional (QMHP) give the person the following warning: “You are being held in this hospital because someone is concerned that you may hurt yourself or other people. Anything the staff of this hospital observes you do or say while you are in custody here may be used as evidence in a court of law to determine whether you should be under civil commitment as a person with mental illness. You have a right to legal counsel. If you cannot afford an attorney one will be provided for you by the court.” (b) Have the warning given at the time of admission and at times when it is determined that the person will reasonably understand the notice, and as often as it is determined necessary to assure that the person has been given an opportunity to be aware of the notice; (c) Have the warning given to the person in writing, as required by ORS 426.123. An attempt shall be made to have the person sign the written warning. A copy of the signed written warning shall be given to the person and the original shall be kept in the clinical record. The person’s inability to sign the written warning or refusal to sign the written warning shall be documented on the written warning below the place where the person’s signature would be normally found, clearly stating the reasons the signature was not obtained. The written warning shall include a place where the person, by making a mark, may request legal counsel. (3) Notification of next of kin. If the person consents, a LIP or QMHP at a hospital shall make every effort to notify the person’s next of kin of the location and condition of the person as required under ORS 426.234. (4) Notification of the court of hospital hold. The admitting LIP, if the person is at a hospital, shall immediately notify the circuit court in writing. The admitting LIP shall also immediately notify the director in the county where the hospital is located so that an investigation can be conducted. (5) Notification of the court of nonhospital hold. The director, if the person is at a nonhospital facility, shall notify, in writing, the circuit court in the county where the person was taken into custody. (6) Log. Each hospital or nonhospital facility shall maintain a log of persons in custody that includes: name, date of birth, date of admission, type of admission, and a notation of the use of restraints. (7) Posted warning and rights. Each hospital or nonhospital facility shall post a copy of the person’s rights in the holding room behind protective unbreakable plastic or in another location clearly visible from the holding room which, at a minimum, states: (a) The warning described in OAR 309-033-0540; (b) The person’s right to be free from electro-shock therapy or unduly hazardous procedures. (8) Clinical records. Each hospital or nonhospital facility shall maintain a clinical record which accurately documents the care, custody, and treatment of a person in custody. These records shall include: (a) A copy of the hold form which documents the reasons for the hold, including specific behaviors which indicate the person: (A) Is dangerous to self or another person; and (B) Is in need of immediate care, custody or treatment for mental illness. (b) Documentation that the warning described in OAR 309-033-0540 has been given to the person; (c) Documentation of the potential effects and the observed effects of any medication administered which may substantially affect the person to prepare for or function effectively at the commitment hearing, signed by the treating LIP; (d) A report of physical examination and relevant laboratory tests (e) Daily medical progress notes; (f) 24 hour nursing notes; (g) Documentation, signed by the treating LIP, of each use of any mechanical restraints and the specific reasons which justify the use; (h) Documentation of the psychiatric history which, whenever possible, shall include: (A) History of present illness, including specific prodromal symptoms; (B) Medical history; (C) Family history; (D) Past psychiatric history; (E) Substance use and abuse history; (F) History of legal difficulties; and (G) Social history including current support system. (i) A report of mental status; (j) A diagnostic impression; (k) A treatment plan. (9) Access to clothing before release of persons in custody. Each hospital or nonhospital facility shall allow the person in custody to have access to his/her clothing before being released to attend the commitment hearing. Statutory/Other Authority: ORS 413.042, 426.123, 426.232, 426.233, 426.234 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 8-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-210-0050 309-033-0550 Standards for the Approval of Hospitals Detaining Persons in Custody Pending Transport to an Approved Holding Hospital or Nonhospital Facility. (1) Approved hospitals. Only hospitals approved by the Division under this rule may detain a person pending transport pursuant to the provisions of ORS 426.231. A hospital approved under this rule may transport the person only to a hospital or nonhospital facility approved under OAR 309-033-0530. Hospitals approved under OAR 309-033-0530 are also approved under this rule to detain a person pending transport and may transport a person to another hospital or nonhospital facility approved under OAR 309-033-0530. (2) Application for approval. Approval of hospitals shall be accomplished by submission of a letter of application in accordance with administrative rules on letters of approval. If approved, a certificate of approval will be issued to the hospital to provide such services. This approval shall be renewed on a biennial basis subject to the application of the hospital or review by the Division. (3) Requirements for approval. The director in the county in which the hospital is located shall submit a letter of recommendation for approval on behalf of the hospital. The letter of recommendation shall clearly state that the director and the hospital have a written agreement which includes the following: (a) The procedures to be followed when a person is detained or transported to another hospital or nonhospital facility, with the parties responsible for performing the procedures clearly identified. The procedures shall state whether the hospital is required to give notice to the director prior to the release of the person; (b) The party or parties responsible for transporting the person to another hospital or nonhospital facility and the means through which such transportation is initiated and authorized; (c) The services to be provided by the hospital when a person is detained and transported to another hospital or nonhospital facility, and the payment the hospital is to receive for these services; (d) The hospital shall have a room which meets OAR 309-033-0720 or shall provide an attendant to provide continuous face-to-face oversight of the person. (4) Responsibilities of the Licensed Independent Practitioner (LIP). The LIP shall complete a face-to-face examination of the person. Once the LIP determines that the person is dangerous to self or any other person and in need of emergency care or treatment for mental illness, the LIP shall: (a) Assure the detention of the person in safe and humane quarters for no longer than 12 hours; (b) Assure that the person is monitored face-to-face every 15 minutes; (c) Consult with a LIP who has admitting privileges at a receiving hospital or nonhospital facility approved by the Division to determine that the receiving LIP: (A) Agrees that the person appears to be dangerous to self or any other person; and (B) Consents to receive the person for further evaluation for involuntary emergency care and treatment for mental illness. (d) If the person is to be sent to the receiving hospital or nonhospital facility, complete a written statement that states: (A) The LIP has examined the person within the preceding 12 hours; (B) The reasons the LIP has found the person to be dangerous to self or any other person and is in need of emergency care or treatment for mental illness; and (C) The name of the admitting LIP at the receiving hospital or nonhospital facility who has agreed to transporting the person for further evaluation and possible admission. (e) Retain a copy of the written statement in the person’s clinical record. The original written statement shall accompany the person to the receiving hospital and shall serve as authorization for transport. (5) Release of detained person awaiting transport. If the LIP at the hospital where the person is detained and is awaiting transport believes the person is no longer dangerous to self or any other person, then the LIP shall release the person as soon as possible. If the LIP cannot locate a receiving hospital where a LIP agrees to receive the person for evaluation, and if the LIP no longer believes the person is dangerous to self or others, then the person shall be released within twelve hours of the time the person was originally detained. Statutory/Other Authority: ORS 413.042 & 426.231 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 8-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-210-0060 309-033-0600 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe standards and procedures for community hospitals, nonhospital facilities and residential facilities relating to obtaining informed consent to treatment from a person under civil commitment, and for the administration of significant procedures without obtaining the informed consent of a person under civil commitment. (2) Statutory authority. These rules are authorized by ORS 426.385 and carry out the provisions of 426.005 through 426.395. Statutory/Other Authority: ORS 413.042 & 426.385 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 30-2025, temporary amend filed 12/29/2025, effective 01/01/2026 through 06/29/2026 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-215-0000 309-033-0620 Obtaining Informed Consent to Treatment from a Person and the Administration of Significant Procedures Without the Informed Consent of a Person under Civil Commitment. (1) Basic rule for obtaining informed consent to treatment from a person. A person or a guardian, on behalf of a legally incapacitated person, may refuse any significant procedure and may withdraw at any time consent previously given to any significant procedure. (2) Documentation of withdrawal of consent. Any refusal or withdrawal or withholding of consent shall be documented in the person’s record. (3) Exceptions to obtaining informed consent from a person. Personnel of a facility shall not administer a significant procedure to a person under civil commitment unless informed consent is obtained from or on behalf of the person in the manner prescribed in OAR 309-033-0620, except as described in OAR 309-033-0630 and OAR 309-033-0630. (4) Capacity of the person under civil commitment. Unless adjudicated legally incapacitated for all purposes or for the specific purpose of making treatment decisions, a person shall be presumed competent to consent to, or refuse, withhold, or withdraw consent to significant procedures. (a) A Licensed Independent Practitioner (LIP) shall deem a person unable to consent to or refuse, withhold, or withdraw consent to a significant procedure only if the person currently demonstrates an inability to comprehend and weigh the risks and benefits of the proposed procedure, alternative procedures, or no treatment at all or other information disclosed pursuant to OAR 309-032-0620. Such inability is to be documented in the person’s record and supported by documented statement or behavior of the person. (b) A person under civil commitment and court ordered to the custody of the Division shall not be deemed unable to consent to or refuse, withhold, or withdraw consent to a significant procedure merely by reason of one or more of the following facts: (A) That the person has been involuntarily placed under civil commitment to the Division; (B) That the person has been diagnosed with a mental disorder; (C) That the person has disagreed or now disagrees with the treating LIP’s diagnosis; and (D) That the person has disagreed or now disagrees with the treating LIP’s recommendation regarding treatment. (c) If a court has determined that a person under civil commitment is legally incapacitated with regard to medical treatment decisions, then consent shall be sought from the legal guardian or healthcare representative as defined by ORS 127.505. (5) Procedures for obtaining informed consent and information to be given. (a) The person from whom informed consent to a significant procedure is sought, as required by ORS 677.097, shall be given information regarding: (A) The nature and seriousness of the person under civil commitment’s mental illness or condition; (B) The purpose and method of the significant procedure, its intended outcome and the risks and benefits of the procedure and when neuroleptic medication is prescribed, that tardive dyskinesia is a risk; (C) Any alternatives that are reasonably available and reasonably comparable in effectiveness; and (D) Any additional information concerning the proposed significant procedure requested by the person. (b) The LIP intending to administer a significant procedure shall document in the person’s chart that the information required in OAR 309-033-0620 was explained and that the person or guardian of a legally incapacitated person or resident explicitly consented, refused, withheld, or withdrew consent. (6) Voluntary consent. Consent to a proposed significant procedure must be given voluntarily, free of any duress or coercion. Subject to the provisions of OAR 309-033-0640 and 309-033-0260 the decision to refuse, withhold or withdraw consent previously given shall not result in the denial of any other benefit, privilege, or service solely on the basis of refusing withholding to or withdrawing consent. A voluntary person may be discharged from the facility if offered procedures are refused. (7) Obtaining consent with respect to legally incapacitated persons. A facility may not administer a significant procedure to a person determined legally incapacitated and who is under civil commitment without the consent of the guardian, except in the case of an emergency. (8) Reports of progress. The person or the guardian of a person determined legally incapacitated shall, upon request, be informed of the progress of the person during administration of the significant procedure. (9) Right to appeal. A person has the right to appeal the application of any provision of these rules as provided in the grievance policies and procedures of the facility. If the person under civil commitment is also determined to be legally incapacitated, the guardian has the right to appeal the application of any provision of these rules by using the grievance procedures. Statutory/Other Authority: ORS 413.042 & 426.385 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-215-0030 309-033-0625 Administration of Medication and Treatment without the Informed Consent of a Person in Custody (1) Hospitals or Nonhospital Facilities Authorized. Only a Licensed Independent Practitioner (LIP) at a hospital or nonhospital facility approved under OAR 309-033-0500 through 309-033-0560 may administer medication and treatment without the informed consent of a person in custody. (2) Grounds for the administration of medication and treatment without informed consent. As provided by ORS 426.072(2)(c), a LIP shall administer medication and treatment to a person in custody without obtaining prior informed consent, only in the following circumstances: (a) If an emergency exists as described in OAR 309-033-0210; or (b) If the LIP, in consultation with another LIP or qualified mental health professional, the person is unable to give informed consent as described in OAR 309-033-0620. (3) Procedures and limitations for the administration of medication or treatment without consent. When administering medication or treatment without the informed consent of a person in custody, the LIP shall: (a) Administer medication and treatment in accordance with medical standards in the community; (b) Not administer electro-shock therapy or unduly hazardous treatment as set forth in ORS 426.072; (c) Document in the person’s clinical record the specific nature of each emergency and the procedure that was used to deal with the emergency, or if the person is unable to give consent, document that fact in the person’s clinical record; (d) If the person is a minor or has a guardian, make a reasonable effort to contact the legal guardian prior to the administration of medication or treatment, but if efforts to contact the guardian are not successful, the LIP may only administer medication or treatment in an emergency and shall notify the legal guardian as soon as possible, otherwise the LIP shall not administer medication until consent is obtained from the guardian; (e) Review the medication and treatment with the treatment team within a reasonable period of time after the medicine or treatment is administered without consent and, if applicable, administer medication or treatment designed to correct the behavior creating the emergency; (f) Not continue to administer medication or treatment after the emergency has subsided or the person has regained the ability to consent to treatment, without obtaining the person’s informed consent; and (g) Immediately proceed as provided in OAR 309-033-0600 through 309-033-0650 if the person who was in custody is under civil commitment and the LIP believes the person remains unable to give consent and it is necessary to continue involuntary administration of medication or treatment; the LIP may only continue the administration of medication or treatment under the provisions of 309-033-0625 for seven days pending a decision under 309-033-0640. Statutory/Other Authority: ORS 413.042, 426.072, 426.231 & 426.236 Statutes/Other Implemented: ORS 426.005 – 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 5-2007, f. & cert. ef. 5-25-07 309-033-0630 Administration of Significant Procedures in Emergencies Without the Informed Consent of a Person under Civil Commitment (1) Hospitals or nonhospital facilities authorized. The following facilities that serve persons under civil commitment and which administer significant procedures in emergencies, without obtaining informed consent, shall be subject to the provisions of 309-033-0630: (a) A hospital or nonhospital facility approved under OAR 309-033-0700 through 309-033-0740. (b) A hospital or nonhospital facility approved under OAR 309-033-0530. (c) Secure residential facilities licensed by the Division or licensed by Aging and People with Disabilities (APD). (d) Intermediate care facilities or enhanced care facilities licensed by the APD. (2) Administering a significant procedure. If an emergency exists, the responsible physician or nurse may administer a significant procedure to a person under civil commitment without obtaining prior informed consent in the manner otherwise required by these rules, provided: (a) The physician or designee shall document in the person’s clinical record the specific nature of each emergency and the procedure which was used to deal with the emerge; (b) If the person is determined to be legally incapacitated or has a court-appointed guardian the physician or designee shall make reasonable effort to contact the legal guardian prior to the administration of the significant procedure. If contact is not possible, the physician or designee shall notify the legal guardian as soon as possible; (c) Within a reasonable period of time after an emergency procedure is administered, the treatment team shall review the treatment and, if practicable, implement treatment designed to correct the behavior creating the emergency; (d) The responsible physician or nurse shall not administer a significant procedure after the emergency situation has subsided, without obtaining informed consent. Statutory/Other Authority: ORS 413.042 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-215-0040 309-033-0640 Involuntary Administration of Significant Procedures to a Person under Civil Commitment with Good Cause (1) Hospitals or nonhospital facilities authorized. Only the following facilities that serve persons under civil commitment shall involuntarily administer significant procedures with good cause under the provisions of 309-033-0640: (a) A hospital or nonhospital facility approved under OAR 309-033-0700 through 309-033-0740; (b) A hospital or nonhospital facility approved under OAR 309-033-0530; (c) Secure residential facilities licensed by the Division or licensed by Aging and People with Disabilities (APD). (d) Intermediate care facilities or enhanced care facilities licensed by APD which have a variance from APD to provide involuntary medication. (2) Good cause. Good cause exists to administer a significant procedure to a person under civil commitment without said person’s informed consent if, in the opinion of the treating Licensed Independent Practitioner (LIP), after consultation with the treatment team: (a) The person is deemed unable pursuant to OAR 309-033-0620 to consent to, refuse, withhold or withdraw consent to the significant procedure; (b) The proposed significant procedure will likely restore, or prevent deterioration of, the person’s mental or physical health, alleviate extreme suffering, or save or extend the person’s life; (c) The proposed significant procedure is the most appropriate treatment for the person’s condition according to current clinical practice, and all other less intrusive procedures have been considered and all criteria and information set forth in OAR 309-033-0620 are considered; (d) The treating LIP has made a conscientious effort to obtain informed consent to the significant procedure from the person under civil commitment. (3) Independent review. Prior to granting approval for the administration of a significant procedure for good cause to a person under civil commitment, the administrator shall obtain consultation and approval from an independent examining LIP. (a) The administrator shall maintain a list of independent examining LIPs and shall seek consultation and approval from independent examining LIPs selected on a rotating basis from the list. The independent examining LIP shall: (A) Be a psychiatrist; (B) Not be in a position to provide primary or on-call care or treatment to the person who is subject of the independent review; (C) Not be an employee of the facility; (D) Have been subjected to review by medical staff executive committee as to qualifications to make such an examination; and (E) Have read and received training from the medical staff regarding the meaning and the application of these rules. (b) Prior to seeking consultation and approval of an examining LIP, the administrator shall provide written notice to the person under civil commitment who is subject to the proposed significant procedure without the person’s consent. (4) Independent LIP activities. The LIP selected to conduct the independent consultation shall: (a) Review the person’s clinical record, including the records of efforts made to obtain the person’s informed consent; (b) Personally examine the person; (c) Interview the person to determine the extent of the need for the procedure and the nature of the person’s refusal, withholding, or withdrawal or inability to consent to the significant procedure; (d) Consider additional information, if any, presented prior to or at the time of examination or interview as may be requested by the person; and (e) Make a determination whether the factors required under these rules exist for the particular person or that one or more factors are not present. If the LIP determines that the person does not have capacity to give consent to treatment, the LIP shall review the proposed significant procedure. The LIP shall make his/her determination of capacity, approval or disapproval of the proposed significant procedure to: (A) The administrator; and (B) The person to whom a significant procedure is proposed to be administered, with a copy being made part of the person’s record. (5) Administrator determination. The administrator shall approve or disapprove of the administration of the significant procedure to a person under civil commitment based on good cause, provided: (a) The administrator shall not approve the significant procedure and it shall not be performed when the independent examining LIP found that one or more of the factors required by OAR 309-033-0640 were not present or otherwise disapproved of the procedure; (b) Approval of the significant procedure shall terminate if there is a substantial increase in risk, as determined by a LIP, of administering the significant procedure or at any time the person regains capacity to give informed consent/refusal. Approval of the significant procedure shall terminate at the end of the person’s civil commitment but in no case longer than 180 days. Disapproval shall be only so long as no substantial change occurs in the person’s condition; (c) Written notice of the administrator’s determination shall be provided to the person and made part of the person under civil commitment’s clinical records; (d) A copy of the independent examining LIP’s report shall be made part of the person under civil commitment’s clinical record. (6) Ninety-day right to review. The administrator shall adopt procedures which assure that the person under civil commitment may request independent review of the approval once every ninety days after the initial approval. Within 14 days of a verbal or written request from the person under civil commitment, the administrator shall initiate an independent review of the approval, as in OAR 309-033-0640. (7) Transfer of approval. The administrator, or the superintendent of a State hospital, shall transfer the approval of the administration of a significant procedure when a person under civil commitment is transferred to another hospital or nonhospital facility described in OAR 309-033-0640. (a) The administrator, or the superintendent, of the sending hospital or nonhospital facility shall transfer the approval by sending copies of all approval documents to the administrator of the receiving facility. (b) The administrator, or the superintendent, of the receiving hospital or nonhospital facility shall assure that the treating physician at that facility reexamines the person under civil commitment and verifies that the need for the approval continues to exist as described in OAR 309-033-0620and 309-033-0640. The receiving hospital or nonhospital facility may administer the significant procedure if the need for the procedure continues in accordance with OAR 309-033-0640. (c) In no event shall the approval of a significant procedure continue beyond 180 days from the date of the original approval without reestablishing the need for the approval by following the procedures prescribed in OAR 309-033-0640. (8) Administrative procedures. (a) Utilization summary. Every four months the administrator shall make a summary of the use of OAR 309-033-0630 and 309-033-0640 that includes: (A) Each type of proposed significant procedure for which consultation with an independent examining LIP was sought; (B) The number of times consultation was sought from a particular independent examining LIP or disposition board for each type of proposed significant procedure; (C) The number of times each independent examining LIP approved and disapproved each type of proposed significant procedure; and (D) The number of times the approved and disapproved each type of proposed significant procedure. (b) Outside reviewer’s access to summaries. The administrator shall provide a copy of a utilization summary to the federally-mandated advocacy and protection agency for Oregon, which is appointed by the Governor and which currently is the Oregon Advocacy Center, and the Division. The Division may only distribute the report to any other person or organization authorized by the Division which in the opinion of the Authority: (A) Has substantial interest in the advocacy and protection of the rights of persons with mental illness; and (B) Whose access to the summaries will provide a substantial and material benefit to the citizens of Oregon. Statutory/Other Authority: ORS 413.042 & 426.385 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 9-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-215-0050 309-033-0700 Purpose and Scope (1) This section establishes rules pursuant to ORS 426.072, 426.236, 426.228, 426.232, 426.233 and 426.234, 426.385 for certification of hospitals and facilities which provide care, custody, and treatment to persons under civil commitment and to persons in custody or on diversion. (2) Seclusion or restraint may be used only for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or other individuals. Statutory/Other Authority: ORS 413.042, 426.236, 426.385 & 430.021 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 MHD 10-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-220-0000 309-033-0720 Application, Training and Minimum Staffing Requirements (1) Only the following facilities shall be certified pursuant to this rule and the procedures found OAR 309-008-0100 to 309-008-1600 to use seclusion or restraint: (a) Community hospitals licensed by the Public Health Division; (b) Regional acute care facilities for adults certified by the Division pursuant to OAR 309-032-0850 through 309-032-0890; and (c) Nonhospital facilities certified by the Division pursuant to OAR 309-033-0500 through 309-033-0550. (2) Applications. Certification for the use of seclusion and restraints must be accomplished by submission of an application, and by the application process described in OAR 309-008-0100 to 309-008-1600. Continued certification is subject to hospital or facility reviews at frequencies determined by the Division. (3) Requirements for Certification. In order to be certified for the use of seclusion and restraint, the Division must be satisfied that the hospital or facility meets the following requirements: (a) Medical staffing. An adequate number of nurses, direct care staff, Licensed Independent Practitioners (LIP) or physician assistants shall be available at the hospital or facility, to provide emergency medical services which may be required. For hospitals, a letter from the chief of the medical staff or medical director of the hospital or facility, ensuring such availability, shall constitute satisfaction of this requirement. For nonhospital facilities, a written agreement with a local hospital, to provide such medical services may fulfill this requirement. When such an agreement is not possible, a written agreement with a local physician to provide such medical services may fulfill this requirement. (b) Direct Care Staff Training. A staff person must be trained and able to demonstrate competency in the application of restraints and implementation of seclusion during the following intervals: (A) A new staff person must be trained within the six months prior to providing direct patient care or as part of orientation; and (B) Subsequently on a periodic basis consistent with the hospital or facility policy. (c) Documentation in the staff personnel records must indicate the training and demonstration of competency were successfully completed. (d) Trainer Qualifications. Individuals providing staff training must be qualified as evidenced by education, training, and experience in techniques used to address a person’s behaviors. (e) Training Curriculum. The training required for direct care staff must include: (A) Standards for the proper use of seclusion and restraints as described in OAR 309-033-0730; (B) Identification of medication side effects; (C) Indicators of medical problems and medical crisis; (D) Techniques to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of a restraint or seclusion; (E) The use of non-physical intervention skills; (F) Choosing the least restrictive intervention based on an individualized assessment of the person’s medical, or behavioral status or condition; (G) The safe application and use of all types of restraint or seclusion used in the hospital or facility, including training in how to recognize and respond to sign of physical or psychological distress; (H) Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary; (I) Monitoring the physical and psychological well-being of the patient who is restrained or secluded, including but not limited to respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by the hospital or facility policies and procedures; and (J) The use of first aid techniques and certification in the use of cardio-pulmonary resuscitation, including periodic recertification. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 28-2016, f. & cert. ef. 12-29-16 MHS 13-2014, f. & cert. ef. 9-29-14 MHD 10-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-220-0030 309-033-0725 Medical Services (1) A Licensed Independent Practitioner (LIP) must be available 24 hours per day, seven days per week to provide medical supervision of the services provided. (a) In accordance with state law, those LIPs authorized to order seclusion or restraint pursuant to the facility policy must at minimum have a working knowledge of the hospital policy regarding the use of seclusion and restraint; (b) A LIP must examine a person admitted to the facility within 24 hours of the person’s admission. (2) At least one registered nurse must be on duty at all times. (3) The facility must maintain a personnel file for each patient care staff which includes a written job description; the minimum level of education or training required for the position; copies of applicable licenses, certifications, or degrees granted; annual performance appraisals; a biennial, individualized staff development plan signed by the staff; documentation of CPR training; documentation of annual training and certification in managing aggressive behavior, including seclusion and restraint; and other staff development and/or skill training received. (4) Healthcare supervisor. The facility must appoint a Healthcare supervisor who shall review and approve policies and procedures relating to: (a) The reporting of indicators of medical problems to a LIP; and (b) Curriculum for the staff training, as identified in these rules; and (c) The Restraint/Seclusion Review Committee as described in OAR 309-033-0733, including review of its findings. The healthcare supervisor shall make these reviews available to the Authority upon request. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232, 426.236 & 430.041 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 309-033-0727 Structural and Physical Requirements (1) The hospital or other facility which provides care, custody, and treatment for persons with mental illness or persons alleged to have a mental illness have available at least one room which meets the following requirements: (a) The room must be of adequate size, not isolated from regular staff of the facility, and provided with an adequate locking device on all doors and windows; (b) The door must open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside and before entering; (c) The room shall contain no protruding objects, such as doorknobs, towel or clothes bars, hooks, or racks. There shall be no exposed curtains, drapes, rods, or furniture, except a portable bed which can be removed, if necessary. In case of the removal of the bed frame, a fireproof mattress shall be placed on the floor. Beds which are securely fastened to the floor must have no protrusions such as bed posts or sharp corners; (d) Any windows shall be made of unbreakable or shatterproof glass, or plastic. Non-shatterproof glass shall be protected by adequate detention type screening, such as Chamberlain Detention Screen; (e) There shall be no exposed pipes or electrical wiring in the room. Electric outlets shall be permanently capped or covered with a metal shield which opens with a key. Ceiling and wall lights shall be recessed and covered with safety-type glass or unbreakable plastic. Any cover, cap or shield shall be secured by tamper-proof screws or other means approved by the Division; (f) The room shall contain no combustible material, such as matches, lighters, cigarettes, etc. Smoking shall not be allowed in the room, except under direct supervision of staff; (g) The room shall meet fire, safety, and health standards. If sprinklers are installed, they shall be recessed and covered with a fine mesh metal screening. If pop-down type, sprinklers must have breakaway strength of under 80 pounds. In lieu of sprinklers, a combined smoke and heat detector shall be used. Documentation of the breakaway strength of sprinklers must be on file at the facility. (2) Bathroom requirements include: (a) Adequate toilet and sanitary facilities; (b) The bathroom shall contain no shower rods, shower curtains, window curtain rods, curtains, or towel rods, unless used only with direct staff supervision; (c) The bathroom shall not lock from the inside and, if connected to the room, shall be locked when not in use. (3) No sharp objects, such as razor blades, scissors, knives, nail files, etc., shall be available to the patient, except under direct staff supervision. No poisons or cleaning materials shall be kept in the room or in the bathroom available for the room. Statutory/Other Authority: ORS 426.236, 426.385 & 430.041 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 309-033-0730 Seclusion and Restraint Procedures (1) Certified facilities shall not use seclusion and restraint except in an emergency and only then subject to the conditions and limitations of these rules. (2) General procedures: (a) Only a Licensed Independent Practitioner (LIP), physician assistant, or registered nurse may initiate seclusion or restraint procedures; (b) Each use of seclusion or restraint shall be monitored and supervised by a LIP or a registered nurse; (c) A LIP responsible for the patient’s care must order the use of seclusion or restraint within one hour of the administration of the procedure. This approval must be documented in the person's medical record. The LIP's order may occur by the following methods: (A) Verbally, in person or via telephone; (B) By Electronic Medical Record; or (C) By a written order. (d) Within one hour after the initiation of the seclusion or restraint intervention, the patient must be seen face-to-face by a LIP, a registered nurse or physician assistant who has been trained in accordance with these rules; (e) If the face-to-face evaluation is performed by a registered nurse or physician assistant, the evaluator must consult with the attending LIP as soon as possible following the face-to-face evaluation; (f) The face-to-face evaluation must include the following: (A) An evaluation of the patient's immediate situation; (B) The patient's reaction to the intervention; (C) The patient's medical and behavioral condition; and (D) The need to continue or terminate the restraint or seclusion. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232 & 426.236 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 MHD 10-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-220-0040 309-033-0732 Time Limits (1) The maximum time limit for each restraint or seclusion order — before consideration of a renewal, and up to a maximum of 24 hours — is as follows: (a) 4 hours for adults 18 years of age or older; (b) 2 hours for children and adolescents 9 to 17 years of age; or (c) 1 hour for children under 9 years of age. (2) Orders may be renewed according to time limits for a maximum 24 hours verbally or in writing, or through an electronic medical record. After each 24 hours of continuous restraint or seclusion, and prior to further extension of the restraint or seclusion, an examination and second opinion must occur by a second Licensed Independent Practitioner (LIP). (3) The LIP responsible for the care of the patient shall examine a person within 24 hours of the administration of seclusion or restraint and the person must be examined by a registered nurse every two hours until such time as the LIP examines the person and either makes new orders for seclusion nor restraint or for releasing the patient from seclusion or restraint. The LIP must document reasons for the use of the seclusion or restraint over the LIP’s signature. (4) A LIP shall not order physical restraint on an as required basis, i.e. a LIP shall not make "P.R.N." orders for physical restraint. (5) No form of restraint shall be used as punishment, for the convenience of staff, or as a substitute for activities, treatment, or training. (6) Medication will not be used as a restraint but will be prescribed and administered according to acceptable medical, nursing, and pharmaceutical practices. (7) Patients shall not be permitted to use restraint on other patients. (8) Physical restraint must be used in accordance with sound medical practice to assure the least risk of physical injury and discomfort. Any patient placed in physical restraint shall be protected from self-injury and from injury by others. (9) 15 Minute Checks: (a) A patient in restraint or seclusion must be checked at least every 15 minutes; (b) Include circulation checks, during waking hours adequate range of motion, and partial release of restraint to permit motion and exercise without endangering the patient or staff; (c) Attention must be paid to the patient's basic personal needs (such as regular meals, personal hygiene, and sleep) as well as the person's need for good body alignment and circulation; (d) Staff must document that the patient was checked, and appropriate attention paid to the person's needs; (e) The patient must be released as soon as the patient is assessed by a registered nurse or LIP to not present imminent dangerousness to themselves or others. Statutory/Other Authority: ORS 426.005, 426.060, 426.110(2), 426.232, 426.236 & 430.041 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 309-033-0733 Documentation (1) No later than the end of their work shifts, the persons who obtained authorization and carried out the use of restraint shall document in the person's chart including but not necessarily limited to the following: (a) The specific behavior(s) which required the intervention of seclusion or restraint; (b) Less restrictive alternatives used before deciding seclusion or restraint was necessary; (c) The methods of intervention used and the patient's responses to the interventions; and (d) Findings and recommendations from the face-to-face evaluation discussed in OAR 309-033-0730(d) through (f) above. (2) Within 24 hours after the incident resulting in the use of restraint, the treating Licensed Independent Practitioner (LIP) who ordered the intervention must review and sign the order. (3) Each use of restraint must be reported daily to the health care supervisor. (4) Any death that occurs while a patient is in seclusion or restraint must be reported to the Division within 24 hours of the death. (5) Restraint/Seclusion Review Committee. Each facility must have a Restraint/Seclusion Review Committee. The committee may be one formed specifically for the purposes set forth in this rule, or the duties prescribed in this rule may be assigned to an existing committee. The purpose and duty of the Restraint/Seclusion Review Committee is to review and evaluate, at least quarterly, the appropriateness of all such interventions and provide its findings to the healthcare supervisor in a written report: (a) The committee shall evaluate incidents of seclusion and restraint for alternative approaches and interventions where a resident required seclusion or restraint. (b) In Class 1 facilities, the committee shall evaluate all incidents wherein a resident requiring restraint or seclusion was transferred to another facility for the administration of seclusion and restraint. Statutory/Other Authority: ORS 426.236, 426.385 & 430.021 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHS 13-2014, f. & cert. ef. 9-29-14 309-033-0735 Quarterly Reports (1) Every facility certified under these rules must report to the Division and to the Council within 30 days of each quarter’s end, the following information: (a) The number of seclusion and the number of restraint incidents; and (b) The number of patient days in the quarter. (2) The Division must compile the information from all facilities approved under this rule and make available to the public statewide aggregate data. The information may be divided according to facility types. Statutory/Other Authority: ORS 426.236, 426.385 & 430.021 Statutes/Other Implemented: ORS 426.005 - 426.309 History: MHS 13-2014, f. & cert. ef. 9-29-14 MHS 5-2008, f. & cert. ef. 6-27-08 MHS 17-2007(Temp), f. 12-28-07, cert. ef. 1-1-08 thru 6-29-08 309-033-0811 Declaration for Mental Health Treatment (DMHT) Standards and Processes (1) A DMHT communicates a person’s preferred mental health treatments, services, and supports so that, in the event a court or two capacity evaluators determine the person is incapable to make informed mental health treatment decisions: (a) A provider is informed of the person’s wishes about treatment; or (b) A provider can consult with an attorney-in-fact, if appointed, concerning the person’s wishes about mental health treatment. (2) An LIP at a hospital or nonhospital facility approved under OAR 309-033-0500 to OAR 309-033-0570 must review a person’s DMHT if a DMHT is in the person’s clinical record or if presented with a copy of a DMHT. (3) An LIP must follow the instructions for care provided in a DMHT when a person is determined to be incapable to make mental health treatment decisions by two capacity evaluators or a court unless: (a) The person is under a civil commitment order pursuant to ORS 426.005 to 426.390, and 426.701; (b) The treating provider does not believe that the preferred treatments are sufficient and available; (c) The person is court committed to the Oregon State Hospital or a secure residential treatment facility pursuant to ORS 161.295, ORS 161.365, ORS 161.370, or ORS 419C.411; (d) State law and administrative rule authorizes intervention due to an emergency that risks the life or health of the person; or (e) As otherwise provided in ORS 127.720. (4) When a CMHP director in a person’s county of residence receives a DMHT on behalf of the person, the CMHP director must: ensure that a copy: (a) Be entered into the person’s clinical record maintained by the CMHP; (b) If the person consents, submit a copy to submitted to, if the person chooses, the voluntary mental health database contained within the Law Enforcement Data System (LEDS) or its successor; (c) If provided, give a copy to local hospital and nonhospital facilities, including those the person has identified in their declaration, with instructions to retain it. (5) If a LIP suspects that a person may be incapable to make informed mental health treatment decisions, the LIP must: ensure that an incapable determination is made by: (a) Petition The court to make a determination; or (b) With one other capacity evaluator, make the determination in accordance with Two capacity evaluators under Subsection 6 of this rule, where one may be the treating LIP. (6) An incapable determination by two capacity evaluators must be documented by each capacity evaluator in the person’s medical record within 24 hours of the determination being made. An incapable or not incapable determination must consider, and the documentation must attest to, the person’s: (a) Knowledge of available mental health treatment options and their ability to understand the risks and benefits associated with each and in comparison, to each other; (b) Understanding of factors other than mental health treatment that may be harmful or beneficial to the person’s mental health, including behavioral factors; (c) Ability to communicate preferred outcomes related to treatment, and the person’s ability to consider new information and formulate new desired outcomes as appropriate; and (d) Understanding of preferred outcomes on the person’s ability to create and maintain positive relationships, find and maintain adequate housing, secure and maintain employment; or avoid episodes of involuntary treatment or criminal-legal involvement including incarceration. (7) If an incapable determination cannot be made under Subsections 5 and Subsection 6 of this rule, a LIP or treating provider must request an incapable determination be made by the court by submitting a petition to the court in which the Notice of Mental Illness was filed. (8) When a person has been determined to be incapable and treatment is then provided in accordance with the DMHT, a LIP or CMHP director must provide care and treatment to the person as a voluntary admission to care. (9) If a person declines to participate in the plan of care described in the person’s DMHT following an incapable determination, made by two capacity evaluators, either directly or following the attorney-in-fact’s decision to implement the DMHT: (a) The LIP may petition the court for an incapable determination to be made; or (b) If the LIP believes the person is a danger to self or a danger to others, the LIP must assess the person and determine whether to detain the person under ORS 426.232. (10) If a PAMI disagrees with the incapable determination made by two capacity evaluators and the PAMI does not wish for the instructions in the DMHT to be followed or for the attorney-in-fact to make decisions, the PAMI may independently petition the court in the county in which the Notice of Mental Illness was filed to make a determination. (11) If a person is determined to be incapable to make mental health treatment decisions through this process, the determination is only applicable to the validity of the DMHT and may not be used as evidence in the course of civil commitment proceedings. Statutory/Other Authority: ORS 413.042, 426.385 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, adopt filed 06/26/2026, effective 06/26/2026 BHS 30-2025, temporary adopt filed 12/29/2025, effective 01/01/2026 through 06/29/2026 309-033-0815 Diversion from Commitment (1) 14-Day Diversion from Commitment. The CMHP director may offer a person a diversion at any time prior to the conclusion of a civil commitment hearing for an initial period of up to 14 calendar days. (a) If the CMHP director and a LIP have probable cause to believe the person has a mental illness and is in need of treatment and they both agree that there is a hospital or nonhospital facility available to meet the person’s needs, then notice must be provided as follows: (A) The CMHP director must provide notice of the diversion to the person alleged to have a mental illness and be in need of treatment, in writing and orally; (B) The CMHP director must notify the court having jurisdiction of the investigation that the diversion from commitment will begin. (b) A proper notice must include: (A) An attestation of probable cause signed by the director and the LIP. An attestation may be: “I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court. (B) A diversion treatment plan. (C) Notice of the person’s right to request and be provided a hearing at any time during the diversion treatment plan. (D) Notice of the person’s right to counsel. (E) Date and time the notice was given to the person alleged to have a mental illness and be in need of treatment. (F) The notice nor attestation is required to be notarized. (2) Diversion treatment plan. The director and the treating LIP shall prepare a diversion treatment plan that describes, in general terms, the types of treatment and medication to be provided during the diversion. The treatment plan must include, at a minimum: (a) Mental health interventions, therapies or diagnostic procedures to be employed; (b) The person’s preferences about medications and therapies and any limitations on the specific use of medications or therapies. (c) Location where treatment is to be initiated and the type of hospital or nonhospital facilities where the person may be transferred during the diversion; or (d) Other conditions or limitations agreed to by the person and the director concerning the care or treatment that is to be provided. (3) If, following consultation with legal counsel and reviewing the proposed diversion treatment plan, the person: (a) Does not accept the offer of diversion, a hearing as required by ORS 426.070 must be held no later than five judicial days following the person’s initial detention. (b) Does accept the offer of diversion, the court must be immediately notified so that the hearing may be postponed for no more than 14 calendar days from the day the person accepted the offer of diversion. (c) Should the CMHP director or designee and the LIP determine the person still fulfills the criteria in subsection (1)(a), the CMHP director may offer to extend the diversion from commitment by up to another period of 14 calendar days. (A) If the person agrees to the extension, the CMHP director must immediately notify the court and the hearing will be postponed for an additional 14 calendar days. (B) A person who agrees to the extension shall not be held for more than 28 days from the date of agreement to the initial period of diversion without a civil commitment hearing per ORS 426.130. (4) Consent for non-psychiatric care. A treating LIP shall obtain the person’s consent for non-psychiatric medical care and treatments which may be prescribed during the diversion. The diversion treatment plan for psychiatric intervention shall not include plans for non-psychiatric medical care or treatment. (5) LIP to provide information. The LIP shall provide the information described in OAR 309-033-0620 when administering a specific medication. (6) Nonadherence to treatment plan or demand for discharge. The person on diversion may decline the psychiatric treatment described in the diversion treatment plan or demand discharge at any time during the initial or extended diversion by signing the form described in this paragraph or, if the person does not sign the form, by verbally declining treatment or demanding discharge to two known staff of the facility. In accepting the person’s disengagement with treatment or demand for discharge the staff of the facility shall: (a) Provide the person a warning, both verbally and in writing, at the person’s first indication that they wish to decline treatment or demand discharge, which states: "If you decline psychiatric treatment described in the diversion treatment plan or demand to be discharged you may be required to appear at an involuntary civil commitment hearing. It is your right to request an involuntary civil commitment hearing at this time. If a judge finds that you have a mental disorder, are a danger to yourself or others, are unable to meet your basic personal needs, or otherwise meet civil commitment criteria, you may be civilly committed for up to 180 days. However, if a judge finds you do not meet those criteria, you may be released. The treatment in which you were to participate as a condition of avoiding a civil commitment hearing is described in your diversion treatment plan. You were given a copy of your diversion treatment plan when you accepted the diversion. You may see the copy of your diversion treatment plan on file with this facility at any time. You may talk with your attorney before you decline this treatment, demand discharge, or request a hearing." (b) If, after receiving the warning regarding ending the diversion, the person still declines treatment, demands discharge, or requests a hearing, offer the person a form to sign with the following elements: (A) Notice: (B) If you decline psychiatric treatment described in your diversion treatment plan or demand discharge you may be required to appear at an involuntary civil commitment hearing. You have a right to request an involuntary civil commitment hearing at this time. If a judge finds that you have a mental disorder, are a danger to yourself or others, are unable to meet your basic personal needs, or otherwise meet civil commitment criteria, you may be civilly committed for up to 180 days. The psychiatric treatment in which you were to participate as a condition of avoiding a civil commitment hearing is described in your diversion treatment plan. You were given a copy of your diversion treatment plan when you accepted the diversion. You may see the copy of your diversion treatment plan on file with this facility at any time. You may talk with your attorney before you decline this treatment, demand discharge, or request a hearing. (C) I decline the treatment described in my diversion treatment plan. (D) I request a hearing before the circuit court. (E) Signature of Person Alleged to Have a Mental Illness and be in need of treatment. (c) If the person does not sign the form described in this section and verbally or nonverbally declines treatment, the staff of the facility shall document on the form and in the person’s clinical record, that the person did not sign the form; (d) Immediately upon the person declining treatment, demanding discharge or requesting a hearing, the treating LIP shall treat the person as a person in custody, as provided under ORS 426.072, and shall immediately notify the director. The director shall immediately: (A) Notify the person and the person’s legal counsel that refusal of treatment may result in a civil commitment hearing; and (B) If, after providing the person one judicial day to re-engage the diversion treatment plan, the CMHP director determines that the person is not likely to re-engage meaningfully, the CMHP director may request a hearing. (7) A person shall only be offered a diversion from commitment if payment for the care, custody and treatment is approved verbally by the director of the county of residence as provided under ORS 426.237. The director of the county of residence’s approval shall be documented by a written statement, signed by the director, and distributed by the end of the diversion period as follows: (a) The original shall be filed in the clinical record at the Community Mental Health Program; and (b) A copy shall be delivered to each facility serving the person during the diversion period. Statutory/Other Authority: ORS 413.042, 426.236, 426.237 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, adopt filed 06/26/2026, effective 06/26/2026 BHS 30-2025, temporary adopt filed 12/29/2025, effective 01/01/2026 through 06/29/2026 309-033-0900 Statement of Purpose and Statutory Authority (1) Purpose. These rules prescribe standards and procedures relating to the investigation and examination of a person alleged to be a person with mental illness during the involuntary civil commitment process, including training, education, and certification of mental health investigators and examiners. (2) Statutory authority. These rules are authorized by ORS 426.005–426.395 and carry out the provisions of 426.005–426.395. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0000 309-033-0920 Certification of Mental Health Investigators (1) Investigation only by a certified investigator. Only a person certified by the Division shall conduct an investigation of a person alleged to be a person with mental illness as required by ORS 426.070(3)(c) and 426.074. (2) Certification of a mental health investigator. The Division shall certify as a qualified mental health investigator, for three years or until such time as the Division terminates the certificate, any person who meets the following: (a) Is recommended by a director for certification as a mental health investigator; and (b) Is a Qualified Mental Health Provider (QMHP), or on January 1, 1988, has been employed by a Community Mental Health Program (CMHP) as an investigator for a minimum of two years; and (c) Has established individual competence through training provided by the Division and within 6 months of the training has passed an examination conducted by the Division in the following areas: (A) The role and duties of an investigator and the process of investigation; (B) Oregon statutes and administrative rules relating to the civil commitment of persons with mental illness; (C) Establishing probable cause for mental disorder; (D) The mental status examination; and (E) The assessment of suicidality, self-harm, dangerousness to self and others, and ability to care for basic needs. (3) Certification of a senior mental health investigator. The Division shall certify as a senior mental health investigator, for five years or until such time as the Division terminates the certificate, a person who meets the following: (a) Is recommended by a director for certification as a senior mental health investigator; (b) Is a QMHP; (c) Has been certified as a mental health investigator for three years; and (d) Has completed the training required under OAR 309-033-0920 during the six months prior to application for certification. (4) Certification of a mental health investigator resident. The Division shall certify as a mental health investigator resident for a non-renewable period of six months, or until such time as the Division terminates the certificate, a person who meets the following: (a) Is recommended by a director for certification as a mental health investigator; (b) Is a QMHP; (c) Has passed an examination conducted by the Division regarding Oregon statutes and administrative rules relating to the civil commitment of persons with mental illness; and (d) Is supervised by a certified senior mental health investigator. The senior mental health investigator shall review each investigation conducted by the mental health investigator resident and co-sign each investigation report as evidence that the senior mental health investigator believes the report meets OAR 309-033-0940, The Investigation Report. (5) Qualifications for recertification. The Division may recertify a mental health investigator or a senior mental health investigator who is currently employed by a CMHP, is recommended by the director for recertification and who, during the period of certification, has maintained the QMHP certification or other equivalent licensure and completed eight hours of training provided by the Division covering civil commitment statutes, administrative rules, and procedures. (6) Residents cannot be recertified. The Division shall not recertify a mental health investigator resident. (7) Termination of certification. The Division may terminate the certification of a mental health investigator, senior mental health investigator, or a mental health investigator resident when, in the opinion of the Authority: (a) The person no longer can competently perform the duties required by this rule, or (b) The person has exhibited a behavior or a pattern of behavior which violates the rights, afforded by statute, of persons being investigated. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0030 309-033-0930 Investigation of Persons Alleged to Have a Mental Illness (1) Upon receipt of a Notice of Mental Illness (NMI) the Community Mental Health Program (CMHP) must conduct an investigation of the person to determine probable cause for mental disorder. The person conducting the investigation must not be the same as the person filing the NMI. (a) At a minimum, if the person can be located, the investigator must contact the person by telephone within three judicial days of the receipt of the NMI by the director. (A) The investigator must complete an investigation and submit an investigation report to the circuit court within 15 calendar days of the director’s receipt of the NMI; (B) The investigator may request an extension from the court if a treatment option less-restrictive than involuntary inpatient commitment is actively being pursued or if the person cannot be located. (b) The investigator must investigate persons in a hospital or nonhospital facility and in custody under ORS 426.070, 426.232, or 426.233 as soon as reasonably possible but no later than one judicial day after the initiation of the detention and 24-hours prior to the hearing. Whenever feasible, the investigator must: (A) Make face-to-face contact with the person within one judicial day of admission to a hospital or nonhospital facility; and (B) Meet with the person one additional time prior to making a recommendation for the court to hold a commitment hearing. (C) Ask whether the person has made a DMHT. (2) Only certified mental health investigators, senior mental health investigators or mental health investigator residents are permitted to conduct an investigation of a PAMI. (a) While conducting an investigation, the investigator must: (A) Present photo identification, authorized and provided by the county mental health authority, to the person; and (B) Verbally explain the reason for the investigation and, if doing so would not endanger the investigator, in writing. (b) The investigator must seek information about the PAMI in electronic records or from next of kin and other people familiar with the PAMI, whenever feasible, including but not limited to: (A) Information frm the Nine Federally Recognized Tribes of Oregon. When the person is identified as an enrolled member of a federally recognized tribe in Oregon, the investigator shall solicit information from that tribe, whenever feasible; and (B) Whether the person has a made a DMHT. (c) Disclosure of names. The investigator must disclose the names of the persons filing the NMI to the PAMI except when, in the opinion of the investigator, disclosure will jeopardize the safety of the persons filing the NMI. The investigator may withhold any information that is used in the investigation report, only until the investigation report is delivered to the court and others as required under ORS 426.074. The investigator may withhold any information that is not included in the investigation report if the investigator determines that release of the information would constitute a clear and immediate danger to any person. (d) The director must maintain a clinical record for every person investigated under this rule. The clinical record must document to the extent possible the following: (A) A brief summary of the events leading to the filing of an NMI, the circumstances and events surrounding the interview of the person and the investigator’s attempts to engage the person in voluntary mental health services; (B) Identifying information about the person; (C) A copy of the NMI; (D) A copy of the investigation report submitted to the court; (E) Names, addresses and telephone numbers of family, friends, relatives, or other persons who the investigator interviewed for pertinent information. This list must include the names of the persons filing the NMI with the director; and (F) Summary of the disposition of the case. (e) When appropriate, the investigator will attempt to voluntarily enroll a PAMI in the least restrictive community mental health services that can meet the person’s treatment needs, including: (A) Diversion from civil commitment; (B) Assisted outpatient treatment; or (C) As declared in a person’s DMHT. (f) If the investigator discovers a DMHT or otherwise has reason to believe the PAMI has a DMHT, the investigator must immediately disclose such information in a notice that also includes information about the incapable determination process to: (A) The PAMI and to their legal counsel, if any; and (B) The attorney-in-fact, if one has been appointed, and the investigator can locate the attorney-in-fact. The notice to the attorney-in-fact must also: (i) Inform the attorney-in-fact that the PAMI is the subject of a mental health investigation; and (ii) Provide notice of the PAMI’s right to counsel and right to appointment of counsel as provided in ORS 426.100. (C) The court. The notice to the court must also include a copy of the DMHT and all information available to the investigator pertaining to the factors relevant to an incapable determination as described in OAR 309-033-0810(6). The investigator must give a copy of the court’s notice to: (i) The state’s legal counsel; (ii) The PAMI; (iii) The PAMI’s legal counsel, if any; and (iv) The attorney-in-fact appointed in the person’s DMHT, if any. (g) When the investigator receives a judgment from the court that the PAMI has: (A) Not been determined to be incapable, the investigator will continue with the investigation; or (B) Been determined to be incapable, the investigator must immediately consult with the treating LIP and determine if the treatment options authorized in the DMHT are sufficient and available to meet the person’s needs: (i) If an agreement that the DMHT authorizes treatment that is sufficient and available is not reached, the investigator must continue the investigation. (ii) If the investigator, the LIP, and the court agree that the DMHT authorizes treatment that is sufficient and available, the investigator will stop the investigation and submit a report to the court per ORS 426.074. (C) An investigator may request additional time under ORS 426.074(1)(c)(A) to complete the investigation. Statutory/Other Authority: ORS 413.042, 426.060 - 426.500 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, amend filed 06/26/2026, effective 06/26/2026 BHS 30-2025, temporary amend filed 12/29/2025, effective 01/01/2026 through 06/29/2026 BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0040 309-033-0940 The Investigation Report (1) The investigator shall include in a report to the court, if relevant or available, evidence and the source of that evidence in the following areas: (a) Evidence which describes the present illness and the course of events which led to the filing of the Notice of Mental Illness (NMI) and which occurred during the investigation of the person; (b) Evidence to support or contradict the allegation that the person has a mental disorder; (c) Evidence to support or contradict the need for treatment allegation(s). (d) Any medical records that the investigator relied on to determine the presence of a mental disorder or if the PAMI has a need for treatment must be submitted with the investigation report when the investigation report is provided to the court. (2) The evidence which describes the present illness shall include: (a) The situation in which the person was found and the most recent behaviors displayed by the person which lead to and support the filing of an NMI; (b) The sequence of events affecting the person during the investigation period including dates of admission, transfer or discharge from a hospital or nonhospital facility; (c) Any change in the mental status of the person during the course of the investigation; and (d) Attempts by the investigator to engage the person in voluntary treatment in lieu of civil commitment and their outcome. (3) Documentation of mental disorder. Evidence to support or contradict the allegation that the person has a mental disorder shall include the results of a mental status examination and a psychosocial history. (a) Mental status examination. A mental status examination shall review the presence of indicators of mental disorder in the following areas: (A) Appearance. Features of the person’s dress, physical condition which may indicate the presence of a mental disorder. (B) Behavior. Features of the person’s behavior, movement or rate of speech which may indicate the presence of mental disorder. (C) Thought content. Features of the content of the person’s speech such as delusions and hallucinations which may indicate the presence of a mental disorder. (D) Thought process. Features of the person’s expressed thoughts which may indicate that the person is unable to think in a clear logical fashion and which may indicate the presence of a mental disorder. (E) Insight. Features of the person’s understanding and appreciation of his/her current mental state which may indicate the presence of a mental disorder. (F) Judgment. Features of the person’s ability to make objectively safe decisions about social situations and dangerous situations which may indicate the presence of a mental disorder. (G) Cognition. Features of the person’s ability to concentrate, ability to remember recent and historical events, ability to use abstract thinking, and ability to use or remember generally known information which may indicate the presence of a mental disorder. (H) Emotions. Features of the person’s emotions, such as being inappropriate to the situation, which may indicate the presence of a mental disorder. (b) Psychosocial History. A psychosocial history shall discuss the presence of indicators of mental disorder in the following areas: (A) Psychiatric history: (i) History of psychiatric or mental health treatment; (ii) History of commitments for mental disorder including verification from the Division if available; and (iii) Current participation in mental health treatment. (B) Family history: (i) Members of the person’s family who have a history of psychiatric or mental health treatment; (ii) Members of the person’s family who have a history of commitment for mental disorder; or (iii) Reports of family members who appear to have had an untreated mental disorder. (C) Substance use history: (i) History of alcohol or substance misuse; (ii) Behaviors which the person may have displayed during the course of the investigation, which are substantially similar to behaviors that indicate the presence of a mental disorder, that may be attributable to the use of alcohol or drugs; or (iii) If the person appears to have a mental disorder, the effect of the person’s current use of alcohol or drugs on behaviors that may indicate the presence of a mental disorder. (D) History of a loss of function. (E) Social function. (F) Personal finances: (i) Availability of financial resources to provide for basic personal needs such as food and shelter; (ii) Use of financial resources to meet needs for food and shelter; or (iii) Other features of the manner in which the person uses money which would indicate the presence of a mental disorder. (G) Medical issues: (i) Medical conditions that may produce behaviors which are substantially similar to behaviors that indicate the presence of a mental disorder; or (ii) Medical conditions which contribute to the seriousness of a mental disorder which appears to be present. (4) Documentation of one or more need for treatment. Evidence to support or contradict the need for treatment allegation(s) that the person is a danger to self, danger to others, is unable to provide for basic personal needs, or has a chronic mental illness, including, in addition to the considerations of OAR 309-033-0222: (a) A danger to self-assessment including: (A) Past and present self-harm behavior(s), and the potential and intended outcome, including death, of such behavior(s); (B) History of thoughts, plans or attempts at suicide; (C) Presence of thoughts, plans or attempts at suicide; (D) Means and ability to carry out the plans for suicide; (E) The potential lethality of the plan; (F) The probable imminence of an attempt at suicide; and (G) Available support systems which may prevent the person from acting on the plan. (b) A danger to others assessment including: (A) History of thoughts, plans, attempts or acts of assault or violence; (B) Presence of thoughts, plans, attempts or acts of assault or violence; (C) Means and ability to carry out the plans for assault or violence; (D) The potential lethality of the plan; (E) The probable imminence of an attempt at assault or violence; and (F) Available support systems which may prevent the person from attempting an assault or an act of violence. (c) An assessment of the person’s ability to provide for basic personal needs including: (A) History of the person’s ability to provide for basic personal needs; (B) The person’s current use of resources to obtain food, shelter, and health care necessary for health and safety; (C) Behaviors which may result in the person being vulnerable to danger or making others vulnerable to danger; (D) Available support systems which may provide the person care necessary for health and safety; and (E) If the person appears to be unable to care for self, the availability of a guardian or other decision-maker who can assure the provision of such care. (5) Additional report requirements. The investigation report shall also include the following: (a) The person’s consent or objection to contact with specific third parties; (b) If appropriate and if available from the Division, or as gathered by other sources in the course of the investigation, verification of the person having a chronic mental disorder; and (c) Should a hearing be recommended, the investigator’s clinical opinion on whether inpatient civil commitment or outpatient civil commitment could meet the person’s treatment needs. (6) Report availability. The investigation report shall be made available to: (a) The facility with custody of the person if the person is under civil commitment; and (b) The Authority upon request. (7) The investigation report is the record of a CMHP completing its responsibilities as outlined in its local plan and pursuant to ORS 430.630(9)(e)(M). At the conclusion of an investigation, an investigator must submit an investigation report to the court having jurisdiction of the investigation. (a) If an investigation is started, an investigation report is required. (b) If the investigator recommends a hearing in the investigation report, the investigator must file the investigation report with the circuit court at least twenty-four hours before the hearing. The investigator must appear at the civil commitment hearing for the investigation report to be entered into evidence per ORS 426.095. (c) If the investigator does not recommend a hearing in the investigation report, the investigator must file an investigation report with the circuit court within 14 calendar days of the investigated person being released from detention or the investigator having concluded the investigation, whichever is later. (d) If an investigation is ended because a valid DMHT was discovered and implemented because the person was determined to be incapable, an investigation report is still required. (e) If the PAMI agrees to and successfully completes an initial or extended diversion from commitment, an investigation report is still required to be submitted. Statutory/Other Authority: ORS 413.042, 426.060 - 426.500 & HB 2005 (2025) Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, amend filed 06/26/2026, effective 06/26/2026 BHS 30-2025, temporary amend filed 12/29/2025, effective 01/01/2026 through 06/29/2026 BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0050 309-033-0950 Certification of Mental Health Examiners (1) Psychiatrists exempt from certification. A psychiatrist may serve as an examiner as provided by ORS 426.110. Division certification is not necessary for psychiatrists serving as mental health examiners. (2) Qualifications for certification of persons other than psychiatrists. The Division shall certify, as a qualified mental health examiner for three years or until such time as the Division terminates the certificate, a person who meets all of the following: (a) Has at least three years clinical experience in the diagnosis and treatment of adults with severe and persistent mental illness who primarily live with a psychotic disorder; (b) Presents acceptable written references from two people who have the above qualifications and can demonstrate direct knowledge of the person’s qualifications; (c) Is recommended by the CMHP director to be an examiner in the county; and (d) Has established individual competence through training provided by the Division in the following areas: (A) The role and duties of an examiner and the process of examination; (B) Oregon statutes and administrative rules relating to the civil commitment of persons with mental illness; (C) Establishing clear and convincing evidence for mental disorder; (D) The mental status examination; and (E) The assessment of suicidality, self-harm, risk of harm to self or others, and ability to care for basic needs. (e) Is a Qualified Mental Health Provider (QMHP). (3) Qualifications for recertification. The Division may recertify for three years, or until such time as the Division terminates the certificate of, any mental health examiner who meets the following: (a) The examiner has been certified by the Division after July 1, 1988; (b) The examiner has successfully maintained certification or licensure in accordance with credentials described in subsections (1) and (2) of this rule, and completed eight hours of training provided by the Division relating to the assessment and diagnosis of mental disorder and, changes in statutes and administrative rules relating to civil commitment; and (c) The director recommends the person to be an examiner in the county. (4) Examination. The examiner shall conduct an examination in a manner that elicits the data necessary for establishing a diagnosis and a plan for treatment. Only certified examiners shall conduct an examination of an alleged person with a mental illness. (5) Termination of certification. The Division may terminate the certification of any mental health examiner when, in the opinion of the Division: (a) The person no longer can competently perform the duties required by this rule; or (b) The person has exhibited a behavior or a pattern of behavior which violates the rights, afforded by statute, of persons being investigated. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 17-2026, amend filed 06/26/2026, effective 06/26/2026 BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0060 309-033-0960 Mental Health Examiner’s Report to the Court (1) Examiner assessment of evidence. The examiner shall provide in a report to the court the examiner’s opinion whether the evidence supports or contradicts: (a) The allegation that the person has a mental disorder; (b) The allegation that the person is a danger to self or others, or is unable to provide for basic personal needs and is not receiving such care as is necessary for health and safety; and (c) That the person would cooperate with and benefit from voluntary treatment. (2) Mental status examination and psychosocial history. In addition to considering other evidence presented at the hearing, the examiner shall conduct a mental status examination and a psychosocial history to determine whether the person alleged to have mental illness has a mental disorder: (a) Mental status examination. A mental status examination shall include review of the presence of indicators of mental disorder in the following areas: (A) Appearance. Features of the person’s dress, physical condition which may indicate the presence of a mental disorder. (B) Behavior. Features of the person’s behavior, movement or rate of speech which may indicate the presence of mental disorder. (C) Thought content. Features of the content of the person’s speech such as delusions and hallucinations which may indicate the presence of a mental disorder. (D) Thought process. Features of the person’s expressed thoughts which may indicate that the person is unable to think in a clear logical fashion and which may indicate the presence of a mental disorder. (E) Insight. Features of the person’s understanding of his/her current mental state which may indicate the presence of a mental disorder. (F) Judgment. Features of the person’s ability to make objectively safe decisions about social situations and dangerous situations which may indicate the presence of a mental disorder. (G) Cognitive testing. Features of the person’s ability to concentrate, ability to remember recent and historical events, ability to use abstract thinking, and ability to use or remember generally known information which may indicate the presence of a mental disorder. (H) Emotions. Features of the person’s emotions, such as being inappropriate to the situation, which may indicate the presence of a mental disorder. (b) Psychosocial history. A psychosocial history shall consider the presence of indicators of mental disorder in the following areas: (A) Psychiatric history: (i) History of psychiatric or mental health treatment; (ii) History of commitments for mental disorder including verification from the Division if available; and (iii) Current participation in mental health treatment. (B) Family history: (i) Members of the person’s family who have a history of psychiatric or mental health treatment; (ii) Members of the person’s family who have a history of commitment for mental disorder; or (iii) Reports of family members who appear to have had an untreated mental disorder. (C) Substance use history: (i) History of alcohol or drug misuse; (ii) Behaviors the person may have displayed during the course of the investigation which are substantially similar to behaviors that indicate the presence of a mental disorder that may be attributable to the use of alcohol or drugs; or (iii) If the person appears to have a mental disorder, the effect of the person’s current use of alcohol or drugs on behaviors that may indicate the presence of a mental disorder. (D) History of a loss of function: (E) Social function. (F) Personal finances: (i) Availability of financial resources to provide for basic needs such as food and shelter; (ii) Use of financial resources to meet needs for food and shelter; and (iii) Other features of the manner in which the person uses money which would indicate the presence of a mental disorder. (G) Medical issues: (i) Medical conditions that may produce behaviors which are substantially similar to behaviors that indicate the presence of a mental disorder; or (ii) Medical conditions which contribute to the seriousness of a mental disorder which appears to be present. (3) Assessment of dangerousness and ability to provide basic needs. In addition to considering other evidence presented at the hearing, the examiner shall conduct an assessment of the danger the person represents to self or others and an assessment of the person’s ability to provide for basic personal needs: (a) An assessment of dangerousness to self shall consider the following areas: (A) History of thoughts, plans or attempts at suicide; (B) Presence of thoughts, plans or attempts at suicide; (C) Means and ability to carry out the plans for suicide; (D) The potential lethality of the plan; (E) The probable imminence of an attempt at suicide; and (F) Available support systems which may prevent the person from acting on the plan. (b) An assessment of dangerousness to others shall consider the following areas: (A) History of thoughts, plans, attempts or acts of assaultiveness or violence; (B) Presence of thoughts, plans, attempts or acts of assaultiveness or violence; (C) Means and ability to carry out the plans for assaultiveness or violence; (D) The potential lethality of the plan; (E) The probable imminence of an attempt at assault or violence; and (F) Available support systems which may prevent the person from attempting an assault or an act of violence. (c) An assessment of the person’s ability to provide for basic personal needs shall consider the following areas: (A) History of the person’s ability to provide for basic personal needs; (B) The person’s current use of resources to obtain food, shelter, and health care necessary for health and safety; (C) Behaviors which result in exposure to danger to self or other; (D) Available support systems which may provide the person care necessary for health and safety; and (E) If the person appears to lack capacity to care for self, the availability of a guardian who can assure the provision of such care. Statutory/Other Authority: ORS 413.042 & 426.060 - 426.500 Statutes/Other Implemented: ORS 426.005 - 426.395 History: BHS 7-2024, amend filed 04/30/2024, effective 05/28/2024 BHS 9-2023, amend filed 04/04/2023, effective 04/07/2023 MHD 12-1998, f. 6-26-98, cert. ef. 7-1-98, Renumbered from 309-230-0070