justicedao/ipfs_state_laws huggingface dataset:
411-011-0005 Competitive Procurement (1) General Requirements: (a) The Competition in Contracting Act of 1984 requires that, in the procurement of services, there be a solicitation, and that it be designed to achieve full and open competition for the procurement; (b) A competitive process requires use of performance based contracts. The contract type will be a firm, fixed unit rate; fixed rate with economic adjustment; or fixed ceiling price contract. The contract will state the conditions under which economic adjustment will occur, and/or under what conditions cost will be allowed within a fixed ceiling price contract; (c) Contract principles described in 45 CFR Part 74; Title 41 Code of Federal Regulations; and the Federal Acquisition Regulation (FAR), Part 6, outlines the principal processes for contracting and are to be followed in procuring services. (2) Criteria to Assure Competitive Process: (a) At least annually, the Division shall solicit potential providers by advertising in the Daily Journal of Commerce (DJC) and a newspaper having statewide circulation and appropriate minority media. Additionally, the Area Agency on Aging (AAA) shall advertise in the geographic area in which services will be impacted; (b) At the option of the AAA, make available to potential providers (contractors) identified through subsection (2)(a) of this rule, the cost (i.e., unit cost) at which the Area Agency on Aging has provided and will provide services, including enough data from the cost analysis for potential providers to determine whether they will commit to a letter of intent to submit a proposal if a Request for Proposal (RFP) is issued; (c) If two or more potential providers are identified as a result of subsection (2)(a) of this rule and OAR 411-011-0000(3) does not apply, the AAA shall follow the provisions of subsection (1)(c) of this rule; (d) If the AAA has determined through subsection (2)(a) of this section that there is only one potential provider of the service and OAR 411-011-0000(3) does not apply, then the AAA shall proceed with a negotiated procurement as sole source; (e) If the AAA has determined through subsection (a) of this section that there are no potential providers, other than the AAA itself, the AAA may provide the service directly, as provided for under OAR 411-011-0000(3)(a); (f) The AAA may respond to its own RFP in accordance with OAR 411-011-0015. [Publications: Publications referenced are available from the agency.] Statutory/Other Authority: ORS 411.070 Statutes/Other Implemented: ORS 410.250, 410.270 & 410.280 History: SSD 4-1986, f. & ef. 2-20-86
411-011-0010 Competitive Procurement for Nutrition Services (1) In accordance with the Older Americans Act, as amended through 1984: “No contract awarded after September 30, 1982, shall be entered into for the provision of nutrition services unless such contract has been awarded through a competitive process. Such process shall include evaluation of each bidder’s experience in providing services to older individuals. Whenever there is no evidence of improved quality of service and cost effectiveness on the part of another bidder, a provider of services, who received funds under Title VII of the Older Americans Act of 1965 as in effect on September 29, 1978, shall be given preference.” (Section 501(b)) (2) Those elements of nutrition services relevant to competitive contracting are meal preparation and meal service delivery and management. (3) The Area Agency on Aging (AAA) may apply the criteria under OAR 411-011-0005(2) to meal preparation and meal service delivery management combined or separately and in any combination of geographic locations. Additionally, these criteria may be applied to management of a local site of which nutrition services are but one component. Statutory/Other Authority: ORS 411.070 Statutes/Other Implemented: ORS 410.250, 410.270 & 410.280 History: SSD 4-1986, f. & ef. 2-20-86
411-011-0015 Response by Area Agency on Aging to Requests for Proposal (1) An Area Agency on Aging may respond to its own Request for Proposal (RFP). In doing so, it shall process the evaluation of responses to such a Request for Proposal in the following manner: (a) The Area Agency on Aging shall place its pricing (only unit cost) proposal, along with the notice of intent to propose, in the RFP so that all other agencies or organizations wishing to submit proposals may determine whether or not they are able to submit proposals in competition to the one published by the Area Agency on Aging; (b) When another agency or organization submits a proposal, in addition to the Area Agency, evaluation of all RFPs shall be accomplished by a fair and impartial evaluation team. Membership on the panel by Area Agency Board and Advisory Council membership on the evaluation team shall constitute less than 50 percent. The evaluation team shall be chaired by a disinterested party not affiliated with the Area Agency or any of the proposers; (c) Technical and price proposals must not identify the organization submitting the proposal in any way in the proposal or on the envelope. Proposals which do identify the organization submitting the proposal in the technical or price proposals shall be deemed unresponsive and shall not be considered for possible contract award. The management proposal will be the only part of the proposal that identifies the organization submitting the proposal. The evaluation team shall not be aware of the organization submitting the proposal until after the technical and price proposals have been evaluated and scored; (d) If the Area Agency on Aging is the recipient of the award, it must meet the same contractual provisions, standards, and price that any non-Area Agency on Aging provider would be required to meet. (2) In the event the Area Agency on Aging Board selects the Area Agency as the provider over the recommendation of the evaluation team, the Area Agency must provide its justification in a public meeting held locally, and, in writing, document to the Senior Services Division Administrator the rationale for making its selection. The Administrator of the Senior Services Division or his/her designee, shall have the discretion to either uphold or override the decision of the Area Agency Board or cause the RFP to be reissued. Statutory/Other Authority: ORS 411.070 Statutes/Other Implemented: ORS 410.250, 410.270 & 410.280 History: SSD 4-1986, f. & ef. 2-20-86
411-014-0000 Purpose The purpose of these rules is to define the eligibility requirements for the Oregon Project Independence-Medicaid (OPI-M) Program. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 23-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-014-0025 Financial Eligibility for OPI-M (1) The income and resource methodology for OSIPM outlined in OAR chapter 461 is used to determine financial eligibility for the OPI-M except as follows: (a) In OPI-M an individual must have adjusted income (see OAR 461-001-0000) that is equal to or less than 400 percent of the federal poverty level for a family of one and may not be exceeded through qualifying trusts as specified in OAR 461-145-0540(9)(c). (b) For an individual, the resource limit is calculated using the basic statutory daily nursing facility rate as described in OAR 411-070-0075(1) multiplied by 30.4 (average days per month) multiplied by six (6) months. (c) At initial eligibility, the resources of the spouse (see OAR 461-001-0000) are considered and the provisions of OAR 461-160-0580(2)(f)(A) apply, except that the individual’s resource limit is calculated in accordance with subsection (b) of this section. (d) Individuals are subject to the rules regarding both of the following: (A) The transfer of assets as set forth in OAR 461-140-0210 to 461-140-0300 except in OAR 461-140-0250 (2)(a)(A)(ii) the resource limit is the current OPI-M resource limit in OAR 411-014-0025(1)(b), not the OSIPM resource limit. (B) The home equity value limits as set forth in OAR 461-145-0220. (2) No payments or benefits paid under OPI-M shall be subject to the estate recovery program, including, without limitation, under OARs 461-135-0835, 461-135-0837, and 461-135-0845. Trustees of Medicaid-qualifying trusts (OARs 461-145-0540(10)(a), 461-145-0540(10)(c), or 461-145-0540(11)) need not repay these benefits under those trusts’ required payback clauses. Notwithstanding the exclusion of OPI-M services from estate recovery, an individual must still comply with OAR 461-145-0022 Annuities: OSIPM. (3) OPI-M recipients are not subject to a liability as described in OAR 461-160-0620. (4) Periodic redeterminations of eligibility required in OAR 461-115-0430 are required every 24 months for people receiving OPI-M services. (5) Notwithstanding OAR 411-014-0025(4) if one of the following circumstances occur during an individual’s period of continuous OPI-M eligibility, OPI-M eligibility may be redetermined or terminated: (a) The individual becomes pregnant or otherwise eligible for Medicaid or CHIP; (b) The individual is no longer an Oregon resident; (c) The individual requests termination of eligibility; (d) The individual dies; or (e) The agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual. Statutory/Other Authority: ORS 409.050, 410.060, 410.070, 411.070, 411.404, 411.816, 412.049, 413.085 & 414.685 Statutes/Other Implemented: ORS 409.010, 410.060, 410.070, 411.070, 411.404, 411.816, 412.049, 413.085 & 414.685 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 23-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-014-0030 Scope of OPI-M Eligibility Case Management (1) Eligibility Case Managers are responsible for: (a) Eligibility related, consultation, and referral tasks including: (A) Service eligibility assessments and service eligibility determinations as described OAR 411-014-0040; (i) Initial eligibility determinations must be conducted within 45 days of the date of request; (ii) Redeterminations must be completed every two years. (B) Initial financial eligibility determinations and re-determinations as required by OAR 461-135-0010(3) including income and asset verifications and notice of eligibility. (C) Verifying all other eligibility requirements in OAR 411-014-0020 for OPI-M are met; (D) Program consultation, presenting options, resources, and alternatives to an individual to assist the individual in making informed choices about program selection; and (E) Referrals for program coordination and communication with the Services Case Manager when OPI-M is chosen by the individual. (b) Assisting individuals to make informed decisions by providing complete and unbiased information. (c) Person-centered planning processes and ensuring the processes: (A) Are driven by the individual; (B) Include people chosen by the individual; (C) Consider the program options that best meet the identified needs; (D) Reflect the cultural considerations of the individual; and (E) Use the language, format, and presentation methods appropriate for effective communication according to the needs and abilities of the individual and, as applicable, representative of the individual . (d) Informing individuals of grievance and hearing rights and follow grievance and hearing processes. (2) Type B transfer AAA staff serving as OPI-M Eligibility Case Managers may also serve as Services Case Managers. (3) ODHS Eligibility case managers must respond to OPI-M communication from AAAs within five business days. Responses to communication from eligible individuals and their representatives must also occur within five business days. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 23-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-014-0035 Qualified Case Manager Eligibility case managers must meet the qualifications in OAR 411-028-0040. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 23-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-014-0040 Assessments (1) Assessments must be conducted by eligibility case managers and in accordance with OAR 411-015-0008 except that the service eligibility assessment and determination is made every 24-months in accordance with the continuous eligibility standard in OPI-M. (2) The Services Case Manager may attend the assessment conducted by the Eligibility Case Manager if the individual approves . Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 23-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-015-0000 Purpose The purpose of establishing priorities for persons to be served is to assist the Department in addressing the following goals: (1) To enable persons eligible for and receiving services to remain in the least restrictive and least costly setting consistent with their service needs; and (2) To serve those persons who are the most functionally impaired and who have no or inadequate alternative service resources; and (3) To assure access to services paid by the Department to eligible persons; and (4) To assure that services paid by the Department, and the setting in which they are provided are safe and adequate; and (5) To manage limited resources to enable the greatest possible number of persons to receive needed services through a priority system based on the Department's assessment of the individual’s functional impairment and alternative service resources. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 19-2006, f. 5-26-06, cert. ef. 6-1-06 SPD 12-2003, f. 5-30-03, cert. ef. 6-4-03 SDSD 11-2002(Temp), f. 12-5-02, cert. ef. 12-6-02 thru 6-3-03 SSD 21-1991, f. 12-31-91, cert. ef. 1-1-92, Former (2)(a) - (l) Renumbered to 411-015-0005; Former (3) renumbered to 411-015-0010; Former (4) Renumbered to 411-015-0015 SSD 12-1991(Temp), f. 6-28-91, cert. ef. 7-1-91 SSD 12-1987, f. 12-31-87, cert. ef. 1-1-88 SSD 9-1986, f. & cert. ef. 7-1-86 SSD 5-1986, f. & cert. ef. 4-14-86 SSD 3-1985, f. & cert. ef. 4-1-85
411-015-0010 Priority of Paid Services To determine the service priority level, an individual must be determined eligible, using the Department's standardized assessment tool, by meeting at least the requirements for Assist or Full Assist in activities of daily living as defined in OAR 411-015-0006, in the following order and as designated in OAR 411-015-0015. (1) Requires Full Assistance in Mobility, Eating, Elimination, and Cognition. (2) Requires Full Assistance in Mobility, Eating, and Cognition. (3) Requires Full Assistance in Mobility, or Cognition, or Eating. (4) Requires Full Assistance in Elimination. (5) Requires Substantial Assistance with Mobility, Assistance with Elimination and Assistance with Eating. (6) Requires Substantial Assistance with Mobility and Assistance with Eating. (7) Requires Substantial Assistance with Mobility and Assistance with Elimination. (8) Requires Minimal Assistance with Mobility and Assistance with Eating and Elimination. (9) Requires Assistance with Eating and Elimination. (10) Requires Substantial Assistance with Mobility. (11) Requires Minimal Assistance with Mobility and Assistance with Elimination. (12) Requires Minimal Assistance with Mobility and Assistance with Eating. (13) Requires Assistance with Elimination. (14) Requires Assistance with Eating. (15) Requires Minimal Assistance with Mobility. (16) Requires Full Assistance in Bathing or Dressing. (17) Requires Assistance in Bathing or Dressing. (18) Individuals assessed with ADL needs not included in SPL 1-17 or those with medical or medication management needs. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 58-2022, amend filed 12/22/2022, effective 12/23/2022 APD 25-2022, temporary amend filed 06/14/2022, effective 07/01/2022 through 12/27/2022 SPD 19-2006, f. 5-26-06, cert. ef. 6-1-06 SPD 8-2004, f. & cert. ef. 4-27-04 SPD 16-2003(Temp), f. & cert. ef. 10-27-03 thru 4-23-04 SPD 12-2003, f. 5-30-03, cert. ef. 6-4-03 SDSD 11-2002(Temp), f. 12-5-02, cert. ef. 12-6-02 thru 6-3-03 SSD 21-1991, f. 12-31-91, cert. ef. 1-1-92, Renumbered from 411-015-0000(3) SSD 12-1991(Temp), f. 6-28-91, cert. ef. 7-1-91 SSD 12-1987, f. 12-31-87, cert. ef. 1-1-88 SSD 9-1986, f. & cert. ef. 7-1-86 SSD 5-1986, f. & cert. ef. 4-14-86 SSD 3-1985, f. & cert. ef. 4-1-85
411-015-0100 Eligibility for Nursing Facility or Home and Community-Based Services (1) To be eligible for nursing facility services or home and community-based services, a person must: (a) Be age 18 or older. (b) Be eligible for the Medicaid OHP Plus benefit package. (A) Individuals receiving Medicaid OHP Plus under OAR 410-200 coverage for services in a nonstandard living arrangement as defined in OAR 461-001-0000 are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding: (i) The transfer of assets as set forth in OAR 461-140-0210 to 461-140-0300; and (ii) The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220. (B) When an individual is disqualified for a transfer of assets, a notice for transfer of assets is required in accordance with OAR 461-175-0310. (C) When an individual is determined ineligible for the equity value of a home, a notice for being over resources is required in accordance with 461-175-0200. (c) Meet the functional impairment level within the service priority levels currently served by the Department as outlined in OAR 411-015-0010 and the requirements in OAR 411-015-0015. (2) To be eligible for services paid through the Spousal Pay Program, an individual must meet the requirements listed above in section (1) of this rule in addition to the requirements in OAR 411-030-0080. (3) Individuals who are age 17 or younger and reside in a nursing facility, are eligible for nursing facility services only and are not eligible to receive home and community-based services administered by the Department's Aging and People with Disabilities. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 58-2022, amend filed 12/22/2022, effective 12/23/2022 APD 25-2022, temporary amend filed 06/14/2022, effective 07/01/2022 through 12/27/2022 APD 9-2015, f. 3-30-15, cert. ef. 4-3-15 APD 49-2014(Temp), f. 12-30-14, cert. ef. 1-1-15 thru 6-29-15 APD 35-2014, f. & cert. ef. 10-1-14 APD 9-2014(Temp), f. 4-17-14, cert. ef. 4-21-14 thru 10-18-14 SPD 45-2013, f. 12-13-13, cert. ef. 12-15-13 SPD 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 19-2006, f. 5-26-06, cert. ef. 6-1-06 SPD 19-2005, f. & cert. ef. 12-29-05 SPD 1-2005, f. & cert. ef. 1-4-05 SPD 29-2004(Temp), f. & cert. ef. 8-6-04 thru 1-3-05 SPD 8-2004, f. & cert. ef. 4-27-04 SPD 17-2003(Temp), f. 10-31-03, cert. ef. 11-1-03 thru 4-28-04 SPD 12-2003, f. 5-30-03, cert. ef. 6-4-03 SPD 1-2003(Temp), f. 1-7-03, cert. ef. 2-1-03 thru 6-3-03 SDSD 11-2002(Temp), f. 12-5-02, cert. ef. 12-6-02 thru 6-3-03 SSD 13-1991, f. 6-28-91, cert. ef. 7-1-91 SSD 7-1991(Temp), f. & cert. ef. 4-1-91
411-016-0000 Purpose The purpose of the Oregon Project Independence-Medicaid program is to: (1) Provide limited, non-medical assistance to delay or prevent the need for full Medicaid long term services and supports under Oregon’s 1915(c) waiver authority or any other state plan authorities; (2) Optimize and maintain an eligible individual’s personal resources and natural supports; (3) Provide access to limited, preventive in-home services to older adults and adults with disabilities who require assistance with activities of daily living; and (4) Develop and maintain the ability of individual, using natural supports, to meet their personal needs and support the health and well-being of unpaid caregivers to sustain caregiving relationships. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 22-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024
411-016-0010 Scope of OPI-M Services Case Management (1) Services Case Managers (SCMs) are responsible for: (a) Person-centered service plan development including goals, preferences and plan monitoring; (b) Presenting program options, service options, resources, and alternatives to an individual to assist the individual and their representative in making informed choices and decisions; (c) Risk assessment and monitoring, including: (A) Identifying and documenting risks; (B) Working with an individual to eliminate or reduce risks; (C) Developing and implementing a Risk Mitigation Plan; (D) Monitoring risks at least quarterly and more frequently if needed; and (E) Adjusting an individual's person-centered service plan as needed. (d) Other program coordination such as helping an individual navigate or coordinate with other social, health, and assistance programs; (e) Assisting with crisis response and intervention such as participating in problem resolution with an individual or the individual’s representative; (f) Authorizing services to meet the service choices, assessed need and preferences of the individual, considering natural supports and other alternative service resources and service plan related notifications; (g) Service provision issues such as assisting an individual with problem solving to resolve providers, services or hours issues that do not meet the individual's needs; (h) Informing individuals of grievance and hearing rights and following grievance and hearing processes. (i) Documentation of changes in condition, service plan adjustments and reasons for adjustments, service alternatives, completion of required forms and other service plan case management requirements including narration; and, (j) Completing an Unpaid Caregiver assessment if Community Caregiver Supportive Services or Caregiver Education and Training is requested. (2) Fiscal Intermediary Responsibilities: SCMs are responsible for the following tasks if fiscal intermediary services are available: (a) Enrolling the individual into fiscal intermediary services; (b) Coordinating and reviewing benefit expenditures; (c) Resolving payment issues with fiscal intermediary; and (d) Problem solving and monitoring fiscal intermediary services defined in provider contracts. (3) Case management services must meet the conflict-free case management expectations. When the only willing and qualified provider organization provides both case management and direct services, Department approved firewalls must be in place and followed to ensure a separation of functions within the organization. Conflict-free case management protects against conflicts of interest, fraud and misuse of funding to benefit a provider. (4) Type B transfer AAA staff serving as OPI-M SCMs may also serve as Eligibility Case Managers as defined OAR 411-014-0005. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024 APD 22-2024, temporary adopt filed 05/20/2024, effective 05/31/2024 through 11/26/2024