justicedao/ipfs_state_laws huggingface dataset:
411-035-0065 Environmental Modification Provider Qualifications and Requirements (1) Providers of the environmental modification must have a distinct Medicaid provider number before the work begins. (2) Modifications over $500 must be completed by a state licensed contractor. (3) Modifications requiring a permit must be inspected and certified, by an inspector, to ensure compliance with local codes. (4) No material upgrades or supplemental payments to the provider are allowed by landlords or informal supports. (5) No monetary funds may be released to the provider until the work is finished and meets the specifications of the modification agreement. Providers must provide documentation, such as pictures of the completed work and signed releases from the consumer, prior to receiving payment from the Department. (6) Providers must include drawings or pictures when possible with all bids of proposed Environmental Modifications. (7) Providers must supply a revised bid when requested by designated Central Office staff. (8) Providers must submit the final invoice for payment within one year of the date of service. Statutory/Other Authority: 410.070 & ORS 409.050 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: APD 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 16-2014, f. & cert. ef. 6-4-14
411-035-0070 Eligibility for Consumer Transition Services (1) Eligibility for transition services covered through the K-State Plan are restricted to consumers transitioning from a nursing facility or the Oregon State Hospital, as defined in OAR 309-091-0005(16), into a community-based or in-home program. (2) Consumers transitioning from an acute care hospital directly to a community-based or in-home program are not eligible for transition services under this rule. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: 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 16-2014, f. & cert. ef. 6-4-14
411-035-0080 Transition Services Provider Qualifications and Requirements (1) Providers of cleaning or moving services must have a distinct Medicaid provider number before providing services. (2) Movers must have a certificate of authority or a permit from the Oregon Department of Transportation. (3) No monetary funds shall be released to the provider until the work has been completed. (4) Providers must supply a revised bid when requested by designated Central Office staff. (5) Providers must submit the final invoice for payment within one year of the date of service. Statutory/Other Authority: ORS 410.070 & ORS 409.050 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: APD 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 16-2014, f. & cert. ef. 6-4-14
411-035-0085 Consumer Eligibility Criteria for Voluntary Consumer Training Services (1) To be eligible for K-State Plan Voluntary Consumer Training Services, consumers must be or be expected to, receive services in a setting described in OAR 411-030-0033, In-Home Service Living Arrangement. (2) Services are voluntary in nature. (3) Services may be provided to designated representatives performing the duties of a consumer-employer on behalf of the consumer. (4) Natural supports and designated representatives may receive services in addition to the eligible consumer. (5) All in-home consumers participating in the Consumer-Employed Provider Program must be offered the voluntary training during the in-home service planning process. Case managers must make a referral to an approved training provider. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: 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 16-2014, f. & cert. ef. 6-4-14
411-035-0095 Provider Qualifications and Requirements for Voluntary Consumer Training Services (1) To ensure services are consistent with the provision of the state’s comprehensive voluntary consumer training services, providers must be approved by, or have a contract with, the Oregon Home Care Commission. (2) Services must be provided by providers who have experience providing direct or educational services to seniors and people with physical disabilities and who: (a) Demonstrate knowledge of DHS rules pertaining to in-home services; (b) Demonstrate skills in communication, person-centered planning, and in providing individual supports, which are needed to provide the services described in this rule; (c) Have fulfilled background check requirements for the programs in which the provider is providing services; and (d) Participate in ongoing technical assistance and conferences provided by the Oregon Home Care Commission. (3) Providers must supply a revised bid when requested by designated Central Office staff. (4) Providers must submit the final invoice for payment within one year of the date of service. Statutory/Other Authority: ORS 410.070 & ORS 409.050 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: APD 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 16-2014, f. & cert. ef. 6-4-14
411-037-0010 Purpose and Scope Community Transition Services are non-recurring set-up expenses for individuals who are transitioning from licensed community based care settings or acute care hospitals to an in-home service setting defined in OAR 411-030-0033 where the person would be directly responsible for his or her own living expenses. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.050 & 410.070 History: APD 7-2018, adopt filed 03/28/2018, effective 03/29/2018 APD 23-2017, temporary adopt filed 09/29/2017, effective 10/01/2017 through 03/29/2018
411-037-0020 Definitions (1) "Central Office" means the Program office of the Department. (2) "Consumer" means the person applying for or eligible for Medicaid home or community-based services. (3) "Department" means the Department of Human Services (DHS). (4) "Transition Services and Supports" means services that are non-recurring set-up expenses for individuals who are transitioning from a licensed community based care setting or an acute care hospital to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.050 & 410.070 History: APD 7-2018, adopt filed 03/28/2018, effective 03/29/2018 APD 23-2017, temporary adopt filed 09/29/2017, effective 10/01/2017 through 03/29/2018
411-037-0030 Eligibility for Community Transition Services (1) Eligibility for community transition services are restricted to consumers transitioning from a community-based care facility or an acute care hospital to an in-home setting, described in 411-030-0033. (2) Consumers transitioning between community-based care facilities or from other institutions are not eligible for Community Transition Services defined in this rule. Consumers not eligible under these rules may be eligible for transition services defined in OAR chapter 411, division 035. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.050 & 410.070 History: APD 7-2018, adopt filed 03/28/2018, effective 03/29/2018 APD 23-2017, temporary adopt filed 09/29/2017, effective 10/01/2017 through 03/29/2018
411-037-0050 Limitations Community Transition Services: (1) Are furnished only to the extent that they are reasonable and necessary as determined through the service plan development process, clearly identified in the service plan and the person is unable to meet such expense or when the services cannot be obtained from other sources. (2) Do not include any of the following: (a) Monthly rental or mortgage expense. (b) Food. (c) Regular utility charges. (d) Household appliances or items that are intended for purely diversional or recreational purposes. (3) May not overlap, supplant, or duplicate other services provided through the Medicaid State Plan, Medicaid State Plan Options, or other approved Medicaid waiver authorities. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.050 & 410.070 History: APD 7-2018, adopt filed 03/28/2018, effective 03/29/2018 APD 23-2017, temporary adopt filed 09/29/2017, effective 10/01/2017 through 03/29/2018
411-039-0000 Purpose The purpose of these rules is to establish minimum standards and procedures for an Agency with Choice to perform administrative employer functions and support Individuals in self-directed care and services in their home, including older adults and adults with physical disabilities. These rules ensure Agencies with Choice provide self-directed services to maximize independence, empowerment, dignity, and human potential through the provision of flexible, efficient, and person-centered services enabling the Individual to move into or continue to live in their own home. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0030 Standards for License Renewal (1) A full and complete application for license renewal must be submitted to the Department at least 60 days prior to the expiration date of the existing license. Filing an application for renewal before the date of expiration extends the effective date of expiration, until the Department acts upon such application. The application for renewal must meet all the requirements in OAR 411-039-0020. (2) If the renewal application is not submitted prior to the expiration date of a license, the Agency with Choice is unlicensed and subject to civil penalties defined in OAR 411-039-0240 and must immediately cease providing support to Individuals. (3) The Department will conduct a compliance review of an Agency with Choice 90 days prior to the renewal of a license and shall assess compliance with these rules. (4) The Department must not renew a license if the Agency with Choice is not in substantial compliance with these rules. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0040 Reporting and Billing Requirements (1) In order to receive public funds, an Agency with Choice must be licensed as an Agency with Choice and must be enrolled with the Department as a Medicaid provider. (2) An Agency with Choice must meet all requirements in OAR 411-033-0030 (Provider Enrollment Requirements) for the Department. (3) To receive payment for services, the Agency with Choice must utilize a Department-approved Electronic Visit Verification system (EVV), as specified in OAR 411-033-0010, to verify the following details at the time of service for visits: (a) Date of service; (b) Start and end time; (c) Type of service; (d) Location of service; (e) The name of the Direct Support Worker providing the service; and (f) The name of Individual receiving services. (4) Agency with Choice must submit claims for reimbursement to the Department and pay Direct Support Workers for Authorized hours worked and billed in accordance with the Electronic Visit Verification requirements. All claims must be submitted no later than 12 months from the date of service. Per 42 CFR 424.44, time limits for filing claims, any claims submitted after 12 months from the date of service will not be eligible for reimbursement. (5) The Agency with Choice must withhold, file, and pay income taxes and all employment-related taxes, including but not limited to, workers’ compensation premiums and unemployment taxes. The Agency with Choice must also verify the qualifications of each Direct Support workers as required by Oregon and Federal Laws. (6) The Agency with Choice shall be reimbursed: (a) Only for approved and authorized hours and services delivered to an Individual based on the Individual’s Person-Centered Service Planning. (b) Only at the Department’s approved hourly rate for services. (c) Request for reimbursement of community transportation must not include mileage for an employee commuting to and from the Individual's home. (d) To provide community transportation services, the Direct Support Worker must maintain valid driver’s license, current vehicle registration and necessary auto insurance. Proof must be available upon the request of the Department. Mileage must be prior authorized in the Person-Centered Service Plan. (7) The Agency with Choice must comply with OAR 411-020-0100, OAR 411-020-0105, and OAR 410-120-1510 and the requirements therein for prompt reporting of fraud, waste, and Abuse in the Medicaid program. Information on how to report may always be found online: https://www.oregon.gov/oha/FOD/PIAU/Pages/Report-Fraud.aspx. (8) The Agency with Choice must provide a copy of all information and documents as requested by the Department. (9) The Agency with Choice must cooperate with all review activities required by the Department, including but not limited to providing access to records, staff, and service documentation related to the delivery of Agency with Choice Services. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0050 Services Provided (1) The Agency with Choice must ensure that the Individual is supported in ensuring their services are adequate and responsive to their needs with a focus on self-direction. (2) The services provided by an Agency with Choice must include the provision of or assistance with ADL, IADL and health-related tasks as directed by the Individual or the Authorized Representative and approved in the Individual’s Department approved Service Plan. The Agency with Choice is not responsible for Long Term Care Community Nursing Services. (3) An Agency with Choice must agree in writing to deliver the supports identified in an Individual's Department approved Service Plan which includes the limits and scope of the services to be provided. Agreement may be shown by the Agency with Choice signature on the Service Plan. (4) The Agency with Choice must assist the Individual with the following responsibilities: (a) Recruiting, selecting, and retaining Direct Support Workers to assist Individuals with activities of daily living (ADL), Instrumental Activities of Daily Living (IADL) and health related tasks, and changing Direct Support Workers from an Individual’s service team when necessary; (b) Coordinating the schedules of Direct Support Workers prioritizing the Individual’s choices, needs, and preferences, ensuring that support is person-centered and self-directed; (c) Proactively work with the Individual or their Authorized Representative to develop a Back Up Plan to ensure continuity of services, when the regularly scheduled Direct Support Worker is unavailable due to absence or emergent circumstances and ensure that the Individual’s service needs are met during these planned and unplanned absences; (d) Establishing the responsibilities of Direct Support Workers and ensuring Direct Support Workers do not work more than the hours authorized by the Department; (e) Training Direct Support Workers on best practices and basic requirements and at the request of the Individual, the Individual’s specific needs and preferences to ensure Services and Supports are delivered appropriately; (f) Ensuring a safe and healthy workplace environment as defined in OAR chapter 411, division 030, and in the roles and responsibilities of co-employer; and (g) Ensuring Direct Support Workers are compliant with Electronic Visit Verification (EVV). (5) If the Agency with Choice is concerned that the Individual can no longer self-direct or if there is a Change of Condition, the Agency with Choice must contact the Individual’s Case Manager within five business days. (6) All documentation required in sections (2) and (4) of this rule must be kept in the Individual’s record. (7) The Licensee is responsible for the supervision, training, and overall conduct of all Agency with Choice staff when acting within the scope of their employment or duties. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0070 Background Checks (1) An Agency with Choice must submit a Background Check request for each Subject Individual to the Background Check Unit (BCU), prior to allowing the Subject Individual to work. A Subject Individual must not begin work on a preliminary basis. Preliminary approval is not permitted under these rules. (2) The Agency with Choice must comply with OAR 407-007-0200 through 407-007-0370 for all Subject Individuals, as applicable. (3) The Agency with Choice must maintain documentation of the BCU Background Check approval in the Subject Individual's personnel record. (4) An Agency with Choice must perform and document a query of the List of Excluded Individuals and Entities (LEIE). (5) An Agency with Choice must ensure that a Background Check is performed on a Subject Individual every two years from the date of the Subject Individual‘s last Background Check in accordance with OAR 407-007-0200 to 407-007-0370 (6) Any cost for a Background Check shall be the responsibility of the Agency with Choice and must not exceed the cost charged to the Department. (7) The Agency with Choice must notify the BCU, and the Department within 24 hours if any Subject Individual is involved in a potentially disqualifying crime under OAR 407-007-0281 or potentially disqualifying condition under OAR 407-007-0290, ORS 409.025, and 409.027. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0080 Emergency and Continuity of Operations Planning (1) Each Agency with Choice must establish and maintain, as part of their application, an emergency and continuity of operations plan to ensure the stability of its administrative functions and continuity of essential business operations during emergent events or disasters. (2) The plan must prioritize: (a) Securing a location to perform business functions, if necessary; (b) Ensuring availability of personnel; (c) Preserving information technology (IT) systems, including EVV systems, essential for uninterrupted service delivery; and (d) Complements Individual safety planning, which is managed by Case Managers for each Individual. (3) The Agency with Choice is responsible for ensuring the continuity of its business and administrative functions. Safety planning specific to Individuals, including emergency preparedness and health-related needs, must be coordinated by the assigned Case Manager as part of the Individual’s Person-Centered Service Plan. (a) The Agency with Choice must ensure Case Managers have up-to-date contact information for Direct Support Workers and Agency with Choice management; and (b) Access to relevant emergency information for effective coordination with administrative staff during emergencies. (4) The Emergency and continuity of operations plan must be reviewed and updated when significant changes occur, such as updates in technology, staffing, or business location. All updates must be: (a) Documented in writing and available in an easily accessible location; and (b) Distributed to all staff to ensure awareness and familiarity with current protocols. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0090 Response to Grievances and Critical Incidents (1) The Agency with Choice must maintain in its records documentation of all internal investigations of any Grievance, Complaint or Formal Complaint, and any event described in 411-039-0060(10)(b). Documentation must be maintained in a separate file from the Individual and personnel records and must include: (a) Who was interviewed, and the information provided; (b) Results of the investigation; and (c) Actions taken, including ongoing monitoring if applicable. (2) The Licensee and employees are Mandatory Reporters and must immediately report known or suspected Abuse, including events overheard or witnessed by observation to the Investigative Authority. (3) The Licensee and employees must call the local law enforcement agency first when the suspected Abuse is believed to be a crime such as but not limited to rape, murder, assault, burglary, kidnapping, theft of controlled substances. (4) The Licensee must provide quarterly reports of Grievances, Complaints events listed in OAR 411-039-0060(9)(a) to the Department. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0100 Administrator Qualifications and Requirements (1) The Administrator must have the education and training sufficient to administer the Agency with Choice. At a minimum, the Administrator must have two years of Management, and Professional Experience. (2) The Administrator must assign, in writing, a designee to act as the Administrator when the Administrator is temporarily unavailable. (3) The Administrator or Administrator's designee must be accessible and available during all hours in which services are being provided to Individuals to support the Direct Support Worker and address concerns from the Individual. (4) The Administrator or Administrator's designee is responsible for ensuring the Agency with Choice meets all of the requirements in these rules. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025
411-039-0110 Direct Support Worker Qualifications and Requirements (1) The services provided by an Agency with Choice must be rendered by qualified and trained employees. (2) Direct support workers who have been substantiated for Abuse or Medicaid fraud as a provider from any care setting in the United States may not be hired, nor retained as an employee of the Agency with Choice as prescribed as Medicaid regulations. (3) Direct support workers must receive all required training and additional training necessary to ensure the Direct Support Worker can competently provide the level of services they will be assigned to provide. The services must be provided as requested by the Individual or Authorized Representatives in accordance with these rules and the Person-Centered Service Plan. (4) Direct support workers must: (a) Be at least 18 years of age; (b) Must have sufficient communication and language skills to enable them to perform their duties and interact effectively with the Individual for whom they provide Services and Supports and other Agency with Choice staff; and (c) Accurately document the services provided on a daily basis. (5) A Direct Support Worker cannot be a representative or Legal Representative for an Individual for whom they provide services. Statutory/Other Authority: Or Laws 2024, ch. 37 Statutes/Other Implemented: ORS 124.050 & Or Laws 2024, ch. 37 History: APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025