l'ieti L?nrrerl L?npy ttl't Jrigi uni 1! it. EEFDRE THE ADMNISTRATIVE HEARINGS STATE fur the HEALTH rauressn arts FINAL ennsn IN THE MATTER. DF ?eemet and 3' HEALTH artasrun HISTORY 0F THE CASE [la June 14, the ?regnn Health Authur'ity's Health Systems Divisien {Audrerity} Want that it had denied a request tn antheriae payment fer eentinued heusirrg at . a seeured residential treatment faeility (SRTF) fur the period May 30, 2013 tlneugh August 23, 2013. ?n June 23. 2913, Autherily a request fer hearing elairnant ehallenging the denial. Dn July 3, 21313, the Authority referred elainrarrt?s hearing request tn the Dt?ee at" Administrative Hearings (BAH). A telephene hearing was seheduled for August 27, 2013. The Auther'ity eendueted a review ef the request and an July 12, 2013, neti?ed elainrant that it was denial. {in July renters. Health SysteIns'Etivtsien issued an amended denial netiee, further clarifying its reasan fer uphelding the denial. Dn August 24. 2013, the Autherity again issued an amended denial nntiee. amending the denial e?'eetive date tn August 3, 2013. {in August LIT, Administrative Law Judge (ALJ) Alelt A. Wipperrnan granted elaimant?s request far a due tn late er" the Authority?s amended denial nntiee that same day. ALI Wipperman eenvened a hearing an September 5, father, re resented elaitrtant. Claimant appeared and testi?ed QMHP, administrater tutti. testi?ed as a. witness for elairnant. appeared but did net testify. _represented the Au?terity and testi?ed. LPG, ef Keystene Peer Review ?rganizatiun testi?ed as a witness fer the Autheri . KEPRU appeared but did nut testify. at" the Authurity appeared but did net testr . By agreement a was enntinned tn September ll, 2013. On Seprtemher 11. 201 s, eld a eentinued hearing. represented elaimant and tesWesti?ed as a witness for claimant. Claimant appeared but did nut te5tify. represented the Autharity. and ef KEPRD appeared but did net testify. The elased at the eenelusinn nf the euntinued hearing on September 1 l, 2013. epartrea,? eating ?t-"critietl {Torre-r1 ?flirt-Hind ZEUS evaluation that claimant requires prompting and supervision to deal with mental health that posed a risk to his safety. Claimant is often able to deal with stress created by his paranoid delusions and audial hallucinations, but that ability is diminished during periods of increased The record shows these situations arise at least Claimant has a history of attempting suicide by taking overdoses of over-the-counter medication, which would he readily available in the if claimant did not have supervision or prompting. More likely than not, claimant has a documented clinical need for a setting that restricts his ability to come and go for purposes of?mncr UAR at the-time of the request at issue in this matter. Consequently, claimant would also more likely than not be a risk to himself outside the SRTF setting (subsection {El} based on his history and presentation. This places claimant at significant risk of hospitalization due to his mental illness, satisfying subsection Because subsection (F) is presented as an alternative to subsection (E), claimant need not satisfyr the requirements'of subsection (F). Claimant has not failed placement at a lower level of care for purposes of subsection but he did have a failed placement at the same level oi?carc at Telecare. The reason for the failed placement was claimant?s ability to leave the facility and return without inspection, which led to a suicide attempt when claimant procured a large amount of over-the-counter pain medication. This tends to show that claimant mayr fail a placement in an unsecured setting. Subsection (L) is presented as an alternative to subsection (K). Because claimant satisfies subsection (K), he need not satisfy subsection 011 the balance of the evidence, claimant more likely than not satis?es the criteria of farmer DAR for placement in an SRTF because he requires less than acute hospital-level care, has a documented need for a setting that restricts his egress, clinical evidence shows he would be a rial: to'himselt? outside the SRTF setting, is under a permanent guardianship, and requires highly stnictured supports and close monitoring due to suicidal idealion in the 31] days prior to the prior authorization request. Consequently, standards of evidence based practice support euntinued care at the SRTF level based on the May it], 2018 request. Continuing claimant's behavioral care at the SRT level is medically appropriate for purposes of The Authority must pay for the requested care for the period August 3, E?l? through August 23, E?l? pursuant to ?nger DAR. DRDER The June 14, 2013 and July 12, 2013 decisions, as amended by the decisions dated July 19, 2018 and August 24, denying authorization of payment for continued housing in an SRTF for the period August 3, EDIE through August 23, 21113 are REVERSED. Alek A. Wippennan Administra?ve Law Judge Of?ce of Administrative Hearings APPEAL This is the Administrative Law Judge?s Proposed Drder. 1f the Proposed Dtder is adverse to you, you may: Teril'ied L'urrecl {Jetty Hi If lngi net 254 FILE EXCEPTIONS. Yen have the right te ?le written exceptions er present argument te he censldered by the hdrninistrater in issuing the Final Order, Year exceptinns must he received by the ltlih werkday freer the date ef mailing ef this erder. OAR Send them te: - Administrater Oregen Health Audrerity Health Systems Divisien 3rd Fleur, Suite E49 Summer Street NE Salem, OR STSUI Ifyeu de net ?le any timely written exceedens te this Prepesed Order, it will become the Final Order at the clese cf business en the t?ih werltday ?ner the date ef mailing. dc ?le timely written eaeeptiens tn the Prepesed Order, the Antherity may censider year written caceptiens in issuing a Final Order, The Autherity'may alse disagree with the Prepesed Order and ?le its can w?tten esceptiens, in which case, the Audrerity will issne an Amended Prepesed Order. If the Autherity issues a Final Order, it will preyide yeu with an explanatien ef the Appeal Precedure in the Final Order. If the Prepesed Order hecemes a Final Order try eperatien ef law at the clese ef business an the 10"? day after mailing ef the Prepesed Order and yea are net satis?ed with the Final Order, yen may: I ASK FOR REHEARING OR Yen may ask the te rehear the hearing at reconsider the inal Order. A request fer rehearing er recensideratiurl must he received by the Antherity er pestrnarked as later than sisgr (dd) days here the date the Order hecemes ?nal. 1ii?a'l'ren 'yeu ask fer rehearing er eecensideratierr, .yeu must identify and re?r te any evidence in the hearing recnrd that yeu think the Administrative Law Judge shenid have used and explain the reasens yen are asking fer rehearing er recensideratien. Yen must send this infennatieu and year written request in: Oregerr Health Authetity Health Systems Divisien 3rd Finer, Suite E49 500 Sunmrer Street NE Salem, OR STSSI The Aulh?rity will censider a request fer rehearing er recensideratien as either and decide whether in grant yeur request. If yen dc net explain why the sheuld rehear er recensider year ease, the Antherity will deny yeur request fer rehearing er recensideratien.