410-120-2025 HRSN Person-Centered Service Plan (PCSP) (1) Upon authorization of HRSN Services, the MCE or, as applicable, the Authority, shall, together with the HRSN Authorized Member, update their Care Plan as outlined in OAR 410-141-3870 to include an HRSN PCSP for the authorized HRSN Service(s). (2) The HRSN PCSP shall be a written component of the Member’s Care Plan as outlined in OAR 410-141-3870 and developed with and agreed upon by the Member, the Member’s Representative, or both, as applicable. (3) If the HRSN Authorized Member does not have a Care Plan in place in accordance with OAR 410-141-3870, the HRSN PCSP shall serve as their Care Plan and must be included in the Member’s Care Profile as outlined in OAR 410-141-3865. (4) MCEs and the Authority shall ensure the HRSN PCSP is documented and includes all of the following elements: (a) The Authorized HRSN Service(s); (b) The Authorized HRSN Service duration; (c) If applicable, that the Member has declined the Authorized HRSN Service(s); (d) The HRSN Service Provider, as applicable, to which the Member is referred, which must reflect the Member choice, or a mutually agreeable option if choices are limited; (e) The determination that the Authorized HRSN Service, unit(s) of service, and service duration are Clinically Appropriate based on HRSN Clinical and Social Risk Factors for the Authorized HRSN Service; (f) The goals of the HRSN Service(s) for which the Member has been authorized, or provided (in the case of HRSN O&E), including the identification of other HRSN Services or other OHP or other benefit programs or services the Member may need (if not already included in the Member’s Care Plan). (g) The follow-up and transition plan, including conducting rescreening for new HRSN Services or, in accordance with OAR 410-120-2020, previously approved but undelivered HRSN Services prior to the conclusion of the then-current Authorized HRSN Service; and (h) The designated person or team within the MCE or the Authority that is responsible for managing the HRSN Authorized Member’s HRSN Services. (5) The MCE or, as applicable, the Authority, is responsible for managing the HRSN Authorized Member’s HRSN Services and HRSN PCSP. The HRSN PCSP must, in accordance with OAR 410-141-3870, include relevant information from providers involved in the HRSN Authorized Member’s care. (6) The MCE or, the Authority, as applicable must ensure and document the Member’s HRSN Service needs are being met and/or have been met by the HRSN Service Provider in compliance with the Member’s HRSN PCSP. (7) When it is convenient for the HRSN Authorized Member, either before or after the HRSN Service delivery, depending upon the urgency of receipt of the HRSN Service, the MCE or, as applicable, the Authority, shall have no less than one meeting with the HRSN-Authorized Member, their Representative, or both, as applicable, either in person or by telephone or videoconference, during development of the HRSN PCSP, unless such Member declines participation. (8) If efforts to have a meeting with the HRSN Authorized Member are unsuccessful, or if the HRSN Authorized Member expressly declines to participate in the development of the HRSN PCSP, the HRSN Authorized Member is still entitled to receive the HRSN Services for which they have been authorized. Neither the MCE nor the Authority has the right to deny the provision of HRSN Services due to the Member’s desire to not participate in the development of the HRSN PCSP. In all such circumstances, the MCE or the Authority must document: (a) The efforts made to have one or more meetings with the Member, including identifying the specific attempts and barriers to having the meetings; and (b) The Member’s reasons for not participating in the HRSN PCSP to the maximum extent feasible; and (c) If the HRSN Authorized Member declines participation in the HRSN PCSP or attempts to schedule meetings are unsuccessful, the HRSN Eligibility Screening shall serve as justification for provision of HRSN Services and shall be documented to the Member’s Care Plan in lieu of an HRSN PCSP as required in OAR 410-141-3870. (9) A Representative may receive an HRSN Service on behalf of a child who has been Authorized to receive an HRSN Service if it is developmentally appropriate, as determined through the development of the HRSN PCSP. (10) For Members receiving the HRSN Pantry Stocking Benefit, the PCSP may serve as, and meet the requirement for, the Nutrition Care Plan as outlined in OAR 410-120-0000. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.572, 414.605, 414.665, 414.719 & 414.632 History: DMAP 97-2025, amend filed 12/29/2025, effective 01/01/2026 DMAP 42-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 130-2024, adopt filed 10/24/2024, effective 11/01/2024