413-070-0949 Guardianship Assistance Agreement Requirements (1) Before a guardian may receive guardianship assistance, there must be a negotiated written guardianship assistance agreement between the Department and the potential guardian or guardian signed by all parties prior to the court order establishing the legal guardianship. (2) The guardianship assistance agreement must include each of the following: (a) A statement indicating that a guardianship assistance agreement remains in effect without regard to the state of residency of the guardian. (b) The effective date of the guardianship assistance agreement. (c) That the Department will pay the nonrecurring guardianship expenses associated with obtaining legal guardianship of the child, to the extent the nonrecurring guardianship expenses do not exceed $2,000 per child. (d) That the child or young adult for whom the Department is providing a guardianship assistance payment remains eligible for medical assistance provided: (A) The guardianship remains in effect; (B) A payment is being made; and (C) The child or young adult is placed in the United States or possession thereof. (e) Information regarding garnishment of guardianship assistance payments as set forth in OAR 413-070-0939(8). (f) That the guardian agrees to comply with the reporting requirements under OAR 413-070-0964. (g) That the guardian understands that a guardianship assistance agreement may be reviewed and the guardianship assistance may be adjusted, suspended, or terminated under OAR 413-070-0974. (h) A statement indicating that the guardian understands that the provisions of ORS 192.558 allow the Oregon Health Plan (OHP) and the OHP managed care plans without the authorization of the guardian or child or young adult to exchange the following protected health information for the purpose of treatment activities related to the behavioral or physical health of the child or young adult when the child or young adult is the recipient of OHP services: (A) The name and Medicaid recipient number of the child or young adult; (B) The name of the hospital or medical provider of the child or young adult; (C) The Medicaid number of the hospital or medical provider; (D) Each diagnosis for the child or young adult; (E) Each treatment activity's date of service; (F) Each treatment activity's procedure or revenue code; (G) The quantity of units or services provided; and (H) Information about medication prescription and monitoring. (i) The amount of the guardianship assistance and the manner in which it is to be provided. (j) The basis and requirements for periodic changes in the guardianship assistance payment, in consultation with the guardian, based on the circumstances of the guardian and the needs of the child or young adult. (k) The additional services and assistance for which the child or young adult and guardian are eligible under the agreement and the procedure by which the guardian may apply for such services. (L) When the Department has agreed to include such language, that the Department may continue to provide guardianship assistance for a child or young adult when the child or young adult moves out of the home of the guardian to attend college or live independently. (3) The potential guardian or guardian may name a successor legal guardian in the guardianship assistance agreement, to replace the guardian in the event of the death or incapacity of the guardian. (4) The Department must provide the guardian with a copy of the guardianship assistance agreement. Statutory/Other Authority: ORS 411.141 & 418.005 Statutes/Other Implemented: ORS 409.010, 411.141 & 418.005 History: CWP 17-2015, f. 9-28-15, cert. ef. 10-1-15 CWP 12-2015, f. & cert. ef. 7-17-15 CWP 4-2015(Temp), f. & cert. ef. 1-21-15 thru 7-19-15 CWP 8-2004, f. & cert. ef. 4-1-04 CWP 1-2014, f. 1-31-14, cert. ef. 2-1-14 CWP 30-2011, f. 12-27-11, cert. ef. 12-28-11 CWP 24-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 12-27-11 CWP 11-2011(Temp), f. & cert. ef. 6-30-11 thru 12-27-11 CWP 6-2010, f. & cert. ef. 6-15-10 CWP 1-2010(Temp), f. & cert. ef. 2-1-10 thru 6-14-10 Renumbered from 413-070-0935, CWP 18-2009(Temp), f. & cert. ef. 12-16-09 thru 6-14-10 CWP 12-2009, f. & cert. ef. 9-28-09 CWP 7-2009(Temp), f. & cert. ef. 7-1-09 thru 9-27-09 CWP 5-2009(Temp), f. & cert. ef. 3-31-09 thru 9-27-09 Reverted to CWP 26-2003, f. & cert. ef. 7-31-03 CWP 49-2003(Temp), f. 12-31-03, cert. ef. 1-1-04 thru 4-28-04 CWP 26-2003, f. & cert. ef. 7-31-03 SOSCF 43-2001, f. 12-31-01, cert. ef. 1-1-02 SOSCF 7-2000, f. & cert. ef. 2-10-00 SOSCF 18-1999(Temp), f. & cert. ef. 9-14-99 thru 3-12-00