justicedao/ipfs_state_laws huggingface dataset:
411-028-0040 Qualified Case Manager Staff working for the Department or the Department's designee must meet the following requirements to provide case management services: (1) A bachelor’s degree in a behavioral science, social science, or a closely related field; or (2) A bachelor’s degree in any field and one year of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing; or (3) An associate’s degree in a behavioral science, social science, or a closely related field and two years of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing; or (4) Three years of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 46-2013, f. 12-13-13, cert. ef. 12-15-13 SPD 15-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13
411-028-0050 Frequency of Case Management Services A case manager who meets the requirements in OAR 411-028-0040 must provide the following case management services to an eligible individual receiving Medicaid home and community-based services: (1) A direct case management service as described in OAR 411-028-0020 must be provided to an eligible individual no less than once in each calendar quarter. (2) An indirect case management service must be provided in every calendar month a direct case management service was not provided. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 46-2013, f. 12-13-13, cert. ef. 12-15-13 SPD 15-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13
411-029-0000 Purpose The purpose of this division is to establish requirements for the application, approval, distribution, and oversight of the Community-Based Care (CBC) Distressed Provider Relief Fund (Fund). This Fund provides a financial assistance grant to CBCs who are experiencing financial hardships and contemplating closure. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0005 Definitions (1) “Community-Based Care (CBC)” means: (a) An Assisted Living Facility licensed under rules contained in Oregon Administrative Rule chapter 411, division 054; or (b) A Residential Care Facility licensed under rules contained in Oregon Administrative Rule chapter 411, division 054; or (c) A Memory Care Facility (Endorsed Units only) licensed under rules contained in Oregon Administrative Rule chapter 411, division 057. (2) "Department" means the Oregon Department of Human Services (ODHS). (3) “Essential Facility” means a facility that serves: (a) Predominantly rural or frontier communities as designated by the Oregon Office of Rural Health; or (b) Serves low-income communities; or (c) Has a high Medicaid Occupancy. (4) “Financial Hardship” means a facility needs substantially all current and anticipated income and liquid assets to meet current and anticipated ordinary and necessary facility expenses. This means the facility is experiencing or facing insolvency or significant cash flow problems and may be at risk of closure in the next six months. (5) “Medicaid Occupancy” means the number of Medicaid individuals divided by the number of total individuals residing in the facility. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0010 Community-Based Care Distressed Provider Relief Fund (1) ESTABLISHMENT. The Oregon Department of Human Services (Department) establishes the CBC Distressed Provider Relief Fund. The Fund will prioritize financial assistance grants to CBC facilities who meet the criteria described in OAR 411-029-0020. (2) TIMELINESS. Initial applications for the CBC Distressed Provider Relief Fund must be submitted to the Department during the open application submission timeframe as announced by the Department. The Department may announce subsequent application periods through policy guidance or provider alert if funding remains after the initial application. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0020 Criteria The Department will accept completed applications from CBCs that are able to confirm a Financial Hardship and whom have a valid Medicaid provider number. Prioritization will be given to facilities as described in OAR 411-029-0025. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0025 Prioritization of Applications The Department will prioritize funding based on following criteria: (1) Facilities who meet the definition of Essential Facility; (2) Facilities with high Medicaid Occupancy on a date specified by the Department; (3) Facilities who are actively in the process of closing or are at a significant risk of closing their facility due to a Financial Hardship; (4) Facilities that can demonstrate the potential for viability with a cash assistance grant; and (5) Facilities with demonstrated regulatory record of ensuring patient safety. (6) The Department retains the right to approve or deny any application within available funding based on the Department’s determination of the most at risk facilities. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0030 Facility Statement of Need Sufficient information and financial records shall be submitted to the Department, in addition to the application form referenced in OAR 411-029-0040, and shall include each of the following: (1) A written Facility Statement of Need that includes each of the following: (a) Written statement of how a potential closure of the facility would create a lack of access to care, particularly for low income and Medicaid beneficiaries in the area; (b) Written statement of steps taken to address current financial hardships, such as accessing reserve funds, being approved for the Enhanced Wage Add-on Program (OAR 411-027-0160), employed strategies to increase facility census, and recruiting and retaining permanent staff; (c) Written statement demonstrating how the facility plans to be financially sustainable in the future; and (d) Written statement of an amount that the facility is requesting to assist the facility out of financial hardship. This amount may not reflect the approved amount by the Department. (2) A copy of the following records from the facility and the parent corporation, if applicable: (a) Federal income tax return for the previous two years; (b) A current Working Trial Balance; (c) A current Income Statement; and (d) A current Cash Flow Statement. (3) Any other information or records that the Department may request to support a Facility’s Statement of Need. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0040 Application (1) Interested Community-Based Care Facilities must submit a completed application form designated by the Department, in addition to the information and records supporting the Facility’s Statement of Need, described in OAR 411-029-0030. (2) These documents can be combined in the application form or submitted as separate documents, at the time of submission. (3) Complete applications will be accepted by the due date set by the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0050 Approval and Payment (1) The Department will notify all facilities, in writing, whether approved or not approved. (2) Once approved, the Department will process the payment within ten (10) business days of written approval. (3) The Department will only authorize funds to the extent of the appropriation authorized by the Oregon legislature. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-029-0060 Oversight All payments authorized for this Program are subject to audit at the discretion of the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022, temporary adopt filed 08/19/2022, effective 08/19/2022 through 11/10/2022 APD 21-2022, temporary adopt filed 05/09/2022, effective 05/15/2022 through 11/10/2022
411-030-0002 Purpose and Scope (1) The rules in OAR chapter 411, division 30 ensure that in-home services maximize independence, empowerment, dignity, and human potential through the provision of flexible, efficient, and suitable services. In-home services fill the role of complementing and supplementing an individual's own personal abilities to continue to live in his or her own home or the home of a relative. (2) Medicaid in-home services are provided through the Consumer-Employed Provider Program, Spousal Pay Program, Independent Choices Program, and other approved service providers. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 43-2013, f. 10-31-13, cert. ef. 11-1-13 SPD 10-2013(Temp), f. & cert. ef. 5-23-13 thru 11-19-13 SPD 15-2008, f. 12-26-08, cert. ef. 1-1-09 SPD 15-2004, f. 5-28-04, cert. ef. 6-7-04 SSD 4-1993, f. 4-30-93, cert. ef. 6-1-93
411-031-0030 Purpose The rules in OAR chapter 411, division 031 establish the standards and procedures governing homecare workers and the fiscal services provided on behalf of the Department or AAA consumer-employers to homecare workers enrolled in the Consumer-Employed Provider Program. Homecare workers provide Medicaid, Oregon Project Independence and Healthier Oregon funded in-home services to the Department or AAA consumers. In-home services support the ability of the consumer-employers to continue to live in their own homes. Statutory/Other Authority: ORS 409.050, 410.070 & 410.090 Statutes/Other Implemented: ORS 410.010, 410.020 & 410.070 History: APD 3-2023, amend filed 03/01/2023, effective 03/01/2023 APD 31-2016, f. 8-24-16, cert. ef. 8-28-16 SPD 4-2013, f. 3-25-13, cert. ef. 3-26-13 SPD 3-2010, f. 5-26-10, cert. ef. 5-30-10 SPD 17-2004, f. 5-28-04, cert.ef. 6-1-04
411-032-0001 Goals The goals of Oregon Project Independence are to: (1) Promote quality of life and independent living among older adults and people with physical disabilities; (2) Provide preventive and long-term care services to eligible individuals to reduce the risk for institutionalization and promote self-determination; (3) Provide services to frail and vulnerable adults who are lacking or have limited access to other long-term care services; and (4) Optimize eligible individuals' personal resources and natural supports. Statutory/Other Authority: ORS 410.070 & 410.435 Statutes/Other Implemented: ORS410.410 - 410.480 History: SPD 11-2013, f. 5-31-13, cert. ef. 7-1-13 SPD 21-2010(Temp), f. & cert. ef. 7-30-10 thru 12-28-10 SPD 16-2010(Temp), f. & cert. ef. 7-1-10 thru 12-28-10 SPD 14-2010(Temp), f. & cert. ef. 6-30-10 thru 12-27-10 SPD 29-2006, f. 10-23-06, cert. ef. 11-1-06 SPD 18-2004, f. & cert. ef. 5-28-04 SPD 11-2003, f. & cert. ef. 5-2-03 SDSD 9-2002(Temp), f. & cert. ef. 11-1-02 thru 4-29-03 SSD 12-1988, f. & cert. ef. 12-2-89
411-032-0010 Authorized Services and Allowable Costs (1) AUTHORIZED SERVICES. (a) Authorized services for which OPI funds may be expended include: (A) Home care supportive services limited to the following: (i) Home care; (ii) Chore; (iii) Assistive technology device; (iv) Personal care; (v) Adult day services; (vi) Registered nurse services; and (vii) Home delivered meals. (B) Service coordination. (b) Other authorized services for which OPI funds may be expended are authorized on a case by case basis by the Director of the Department. Other authorized services may include: (A) Services to support community caregivers and strengthen the natural support system of individuals; (B) Evidence-based health promotion services; (C) Options counseling; or (D) Assisted transportation options that allow individuals to live at home and access the full range of community resources. (c) Authorized services provided by an in-home care agency must meet the standards and requirements of in-home care agencies under ORS 443.305 to 443.350 and OAR chapter 333, division 536, and may only be offered through an in-home care agency licensed by the Oregon Health Authority. (d) Authorized services provided by a homecare worker must meet the standards and requirements of the Home Care Commission under ORS 410.600 to 410.614 and OAR chapter 411, divisions 030 and 031. (e) Authorized services provided using the Consumer-Employed Provider Program must meet the standards and requirements of OAR chapter 411, divisions 030 and 031. (2) COMPUTATION OF ALLOWABLE COSTS. Allowable costs by AAAs are costs associated with the direct provision of authorized services to individuals and such administrative costs as may be required to assure adequate services and to provide information to the Department. (3) ADMINISTRATIVE COSTS. Administrative costs cannot exceed ten percent of OPI funds. Statutory/Other Authority: ORS 410.070 & 410.435 Statutes/Other Implemented: ORS 410.410 - 410.480 History: SPD 11-2013, f. 5-31-13, cert. ef. 7-1-13 SPD 29-2006, f. 10-23-06, cert. ef. 11-1-06 SPD 18-2004, f. & cert. ef. 5-28-04 SPD 11-2003, f. & cert. ef. 5-2-03 SDSD 9-2002(Temp), f. & cert. ef. 11-1-02 thru 4-29-03 SSD 3-1997, f. 11-28-97, cert. ef. 12-1-97 SSD 11-1993, f. 12-30-93, cert. ef. 1-1-94 SSD 5-1990, f. & cert. ef. 2-1-90 SSD 19-1989(Temp), f. 12-29-89, cert. ef. 1-1-90 SSD 12-1988, f. & cert. ef. 12-2-89 SSD 6-1987, f. & cert. ef. 7-1-87 SSD 11-1984, f. 11-30-84, cert. ef. 12-1-84
411-032-0050 Pilot for Adults with Disabilities This rule applies from July 1, 2021 through June 30, 2023. (1) The purpose of this rule is to set out the policies that apply to the expansion of Oregon Project Independence services to adults with physical disabilities. The pilot allows the Department to study the potential to transition Oregon Project Independence to a statewide, age neutral, program that assesses and serves seniors and persons with physical disabilities based on their functional needs. (2) "Disability" means, for the purposes of this rule, a physical, cognitive, or emotional impairment which, for an individual, constitutes or results in a functional limitation in one or more of the activities of daily living defined in OAR 411-015-0006, or in one or more of the instrumental activities of daily living defined in OAR 411-015-0007. (3) "Adult" means, for purposes of this rule, any person 19 to 59 years of age. (4) OAR 411-032-0000 to 411-032-0044 apply to this pilot program, except as noted below: (a) Authorized Services and Allowable Costs. Authorized services may not be available in all service areas. Authorized services for the pilot funds include home care supportive services, service coordination, and other services, including the following: (A) Home care. (B) Chore services. (C) Assistive Technology. (D) Personal care services. (E) Adult day services. (F) Registered nurse services. (G) Home delivered meals. (H) Services to support community caregivers and strengthen the natural support system of individuals. (I) Evidence-based health promotion services. (J) Options counseling. (K) Assisted transportation options that allow individuals to live at home and access the full range of community resources. (b) Eligibility. (A) In order to qualify for authorized services under this pilot, an individual must: (i) Be an adult with a disability; (ii) Be a resident of a designated pilot area and seek services at that location; (iii) Not be receiving Medicaid; and (iv) Meet the requirements of the long-term care services priority rules in OAR chapter 411, division 015. (B) The Area Agencies on Aging must determine eligibility prior to an individual receiving authorized services. Statutory/Other Authority: ORS 409.050, 410.070 & 410.435 Statutes/Other Implemented: ORS 409.010 & 410.410 - 410.480 History: APD 9-2022, amend filed 03/10/2022, effective 03/11/2022 APD 35-2021, temporary amend filed 09/17/2021, effective 09/17/2021 through 03/15/2022 APD 48-2019, amend filed 11/13/2019, effective 12/01/2019 APD 32-2019, temporary amend filed 09/03/2019, effective 09/03/2019 through 02/24/2020 APD 31-2019, temporary amend filed 08/30/2019, effective 08/30/2019 through 02/24/2020 APD 26-2017, amend filed 11/16/2017, effective 12/15/2017 APD 16-2017(Temp), f. 6-27-17, cert. ef. 7-1-17 thru 12-27-17 APD 21-2015, f. 12-1-15, cert. ef. 12-27-15 APD 11-2015(Temp), f. 6-24-15, cert. ef. 7-1-15 thru 12-27-15 APD 38-2014, f. 12-16-14, cert. ef. 12-28-14 APD 19-2014(Temp), f. 6-26-14, cert. ef. 7-1-14 thru 12-28-14
411-033-0000 Purpose and Scope The rules in OAR chapter 411, division 033 ensure in-home care agencies, as one of the Medicaid in-home service provider options, provide services to maximize independence, empowerment, dignity, and human potential through the provision of flexible, efficient, and suitable services. In-home services fill the role of complementing and supplementing an individual's personal abilities, so the individual is able to continue to live in their own home. Statutory/Other Authority: ORS 409.050, 410.070, 410.090 & 413.085 Statutes/Other Implemented: ORS 410.010, 410.020, 410.070 & 413.085 History: APD 12-2017, f. & cert. ef. 5-30-17
411-034-0000 Purpose The rules in OAR chapter 411, division 034 ensure State Plan personal care services support and augment independence, empowerment, dignity, and human potential through the provision of flexible, efficient, and suitable services to individuals eligible for State Plan personal care services served through Aging and People with Disabilities. State Plan personal care services are intended to supplement an individual's own personal abilities and resources. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 410.020, 410.070 & 410.710 History: APD 57-2022, amend filed 12/22/2022, effective 12/23/2022 APD 28-2022, temporary amend filed 06/22/2022, effective 07/01/2022 through 12/27/2022 SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13 SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 Reverted to SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 18-2010(Temp), f. & cert. ef. 7-29-10 thru 12-27-10 SPD 15-2010(Temp), f. & cert. ef. 6-30-10 thru 12-27-10 SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04 SSD 2-1996, f. 3-13-96, cert. ef. 3-15-96
411-034-0035 Applying for State Plan Personal Care Services (1) Individuals eligible for state plan personal care services as described in OAR 410-172-0790(1) must apply through the local community mental health program or agency contracted with Health Systems Division (HSD). An individual applying for State Plan personal care services that is not eligible for or receiving services through ODDS or APD is referred to the appropriate HSD office. (2) An individual with an intellectual or developmental disability eligible for or receiving services through the Department's Office of Developmental Disabilities Services (ODDS), a Community Developmental Disability Program (CDDP), or Support Services Brokerage must apply for State Plan personal care services through the local CDDP or the local support services brokerage. (3) An older adult or an adult with a disability eligible for or receiving case management services from the Department's Aging and People with Disabilities (APD) or Area Agency on Aging (AAA) must apply for State Plan personal care services through the local APD or AAA office. (4) Individuals receiving benefits through the Department's Self-Sufficiency Programs (SSP) must apply for State Plan personal care services through the local APD or AAA office. APD/AAA is responsible for service assessment and for any planning and payment authorization for State Plan personal care services, if the applicant is determined eligible. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 410.020, 410.070, 410.608, 410.710 & 411.116 History: APD 57-2022, amend filed 12/22/2022, effective 12/23/2022 APD 28-2022, temporary amend filed 06/22/2022, effective 07/01/2022 through 12/27/2022 SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13 SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 31-2010, f. 12-29-10, cert. ef. 1-1-11 SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04