309-045-0380 Temporary rule language in effect until 04/06/2026. Operational Standards (1) An Agency with Choice's licensee assumes full legal, financial, and overall responsibility for the Agency with Choice's operation and contractual obligations. Any violations by Agency with Choice licensees, owners, staff, or representatives are attributable to the Agency with Choice and against the Agency with Choice’s license. (2) An Agency with Choice must comply with all applicable federal, state, and local laws and the rules adopted thereunder. (3) An Agency with Choice must not assign or contract administrative or supervisory functions to another entity or organization. (4) When Medicaid is the source of payment for the services provided by the Agency with Choice, the Medicaid service payment is considered payment in full for all services provided by the Agency with Choice. (5) All Agency with Choice records must be kept separate and distinct from other business entities. (6) An Agency with Choice must ensure services are made available to any Individual who chooses this service option, in alignment with the Medicaid statewide operations requirement outlined in Section 1902 (a)(1) of the Social Security Act and 42 CFR Part 431 . Agency with Choice must have the capacity to meet the needs of individuals through responsive communication, proactive recruitment, staffing, and retention of Direct Support Workers and must be able to serve individuals statewide. (7) An Agency with Choice is responsible for ensuring that all services are provided based on the individual’s needs and preferences, while prioritizing their choices and active participation in service delivery, provided appropriately, delivered timely and properly supervised. (8) An Agency with Choice must assist the individual with administrative and professional oversight to ensure that the services are delivered with a focus on self-direction, quality and meeting the needs of each individual. (9) Agency with Choice employees, direct support workers, and administrators, must carry identification indicating their name and the Agency with Choice employer. (10) An Agency with Choice direct support worker may accompany an individual outside the state if all the following conditions are met: (a) An individual has requested an Agency with Choice direct support worker to accompany the individual; and (b) The travel plans are described and documented in an individual’s person-centered service plan (A) An Agency with Choice must require a direct support worker who accompanies an individual outside the state to: (i) Document all services and care provided to the individual on a daily basis; (ii) Report to the Agency with Choice administrator or administrator's designee either by phone or electronic mail the status of the individual before leaving the state and immediately upon return; and (iii) Check-in with the Agency with Choice administrator or administrator's designee no less than once per week if the travel results in the individual and direct support worker being gone for more than one week. (B) If the individual experiences a change in condition while traveling, the direct support worker must contact the Agency with Choice administrator or administrator's designee immediately. (11) Travel out of the United States or its territories is not permitted and payment to direct support workers is prohibited as defined in ORS 410-120-1180 and 42 CFR § 431.52 . (12) An Agency with Choice must : (a) Maintain a drug-free workplace that prohibits direct support workers from being under the influence of alcohol, inhalants, or drugs, including prescription and over-the-counter medications that prevents duties from being performed, and prohibits the manufacture, possession, selling or trading of illegal drugs when providing services to an individual or while in the individual’s home; (b) Immediately report all allegations of abuse, neglect, or fiscal improprieties involving an individual or a direct support worker to the local CMHP and taking immediate action in response to the allegation(s); (c) Immediately report of all critical incidents, alleged critical incidents or any violations of individual’s rights to the Division; (d) Conduct internal investigations of any complaint, grievance, incident, critical incident, provision of personal care, medication or treatment and allegation of abuse upon receiving prior authorization from the Authority; (e) Notify the individual’s service coordinator of any change in the individual’s health, behavior, environment and related incidents or allegations of abuse; (f) Provide equitable and non-discriminatory services to all individuals, regardless of race, color, religion, national origin, age, sex, sexual orientation, gender identity, disability, or any other protected status under state and federal law. (g) Ensure direct support workers are provided personal care services in accordance with an individual’s person-centered service plan; (h) Provide standardized training to direct support workers and ensure that direct support workers complete and are current with all training prescribed by these rules; (i) Involve direct support workers employed by the Agency with Choice and individuals served by the Agency with Choice in the development of and decision-making about work processes, performance standards, quality improvement strategies, training, technology use, and workplace safety; (j) Minimize the impact of the loss of pay and work hours for direct support workers resulting from the hospitalization or death of an individual or the dismissal of the direct support worker by the individual; (k) Provide other administrative and employment-related supports; (l) Engage and work closely with individuals to design and implement Agency with Choice services by appointing individuals to an advisory board, using focus groups of individuals or employing other methods, approved by the Authority, for working with individuals effectively; (m) Enhance the role of direct support workers as members of the individual’s service team, as desired and approved by the individual, or their authorized representative; and (n) Meet with individuals at least every three months, with at least one in-home visit with the individual every 12 months; and (o) Comply with other requirements as prescribed by the Authority, and by rule. (13) An Agency with Choice is responsible for hiring and terminating direct support workers who are employed by the Agency with Choice. (14) The Agency with Choice must submit their training plan and curriculum for approval by the Division including who will be providing the training. (a) The training plan must substantially meet the training required by the Oregon Home Care Commission in both content and length of training as defined OAR 418-020-0035 ; and (b) The training plan must include how direct support workers will receive orientation and competency-based training and how the Agency with Choice will engage with the Individual to determine what Individual Specific Training is necessary. (15) An Agency with Choice must support each individual’s self-direction and choice while maximizing their autonomy and control over the decisions related to their daily service needs, including, Using a person-centered approach so that the individual is at the center of the decision-making process regarding: (a) Which personal care services are needed to assist the individual in activities of daily living, instrumental activities of daily living and health-related tasks, as defined by the Authority by rule; (b) Which services are consistent with the individual’s personal and cultural values and preferences; (c) Where and how the services are delivered; (d) When the services are delivered; and (e) Who provides the services. (16) An Agency with Choice must develop and implement written policies and procedures to direct the operation of the program and the provision of services to individuals as specified within these rules. (17) An Agency with Choice must have a disclosure statement which must be signed by the individual or the individual’s authorized representative when the individual is accepted to receive services. The disclosure statement must include: (a) A description of the services to be provided and how they will be provided, including a discussion regarding staffing availability, coordination and a back-up plan. (b) A statement the Agency with Choice will not bill the individual for any additional services; (c) A description of the individual’s or the individual’s authorized representative regarding their role as co-employer; (d) A description of Agency with Choice and individual's rights and responsibilities; (e) A description of the qualifications and training requirements necessary for direct support workers providing services and supports; (f) Procedures for contacting the Agency with Choice administrator or administrator's designee during all of the hours during which services are provided; (g) A clear statement indicating the disclosure statement must be made available to the individual or the individual’s authorized representative in an alternate format at the individual's or the individual’s authorized representative’s request; and (h) A copy of the individual’s rights; (i) The policy for reimbursement for stolen, broken or misappropriated property or funds to the individual; (j) A description of billing methods, payment systems, and due dates, if applicable; (k) The criteria, circumstances, and conditions which may result in termination of services by the Agency with Choice and description of notification that will be provided to the individual or the individual’s authorized representative; and (l) The notice: "(Name of Agency with Choice) does not discriminate and does not permit discrimination, including, but not limited to, bullying, abuse or harassment, based on an individual’s actual or perceived sexual orientation, gender identity, gender expression or human immunodeficiency virus status, or based on an individual’s association with another individual on account of the other individual’s actual or perceived sexual orientation, gender identity, gender expression or human immunodeficiency virus status. If you believe you have experienced this kind of discrimination, you may file a complaint with the Oregon Health Authority at BHD.MH.ComplaintsTA@ohs.oregon.gov (18) An Agency with Choice’s disclosure statement must not include: (a) Any provision in the disclosure statement that affect individual's rights or the Agency with Choice's liability for negligence; and (b) Language referencing "buy outs" or "finder's fees” or language preventing individuals from full access to other Medicaid services; (19) An Agency with Choice must provide each individual and the individual’s authorized representative, if applicable, with a written notice of the individual's rights as a part of the disclosure statement, prior to furnishing care to an individual. The individual’s rights notice must also include: (a) Procedures for filing a grievance or complaint with the Agency with Choice; (b) Procedures for filing a grievance or complaint with the Authority, along with the telephone number and contact information of the Authority; and (c) Notice of the individual’s rights and responsibilities as co-employer of the direct support worker as outlined in these rules. (20) An Agency with Choice must provide each individual with copies of the current policies and procedures including, but not limited to: (a) Policy on individual or Agency with Choice cancellation of services (b) The policy for individual reimbursement for stolen, broken or misappropriated property or funds. (21) An Agency with Choice must assist an individual in planning for direct support worker planned and unplanned absences or similar situations which call for replacement workers, consistent with the individual’s choice of direct support workers to provide the services. (22) An Agency with Choice must have in place a process to access and respond to a grievance or complaint submitted by an individual about the services provided to the individual by a direct support worker. An internal investigation must start no later than five business days from the date of the grievance or complaint and must finalize the response within 30 days. (a) For allegations that could reasonably be expected to result in harm to the individual, investigations must start within 24 hours. Investigations must be completed no later than 15 days from the date the investigation started. Findings and mitigation strategies must be reported to the Division. (b) The Agency with Choice must notify the Division of all complaints within 45 days of receiving the complaint, regardless of the outcome of the internal investigation. (23) An Agency with Choice must have in place a quality assurance system and a performance improvement plan to evaluate and monitor the quality, safety and appropriateness of the services provided by direct support workers. (24) 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 . (25) The Agency with Choice must authorize all staff to permit access to the Agency with Choice and agency, personnel and individual records to the Authority, the investigative authority, and CMS staff, for the purpose of inspection, investigation, and other duties within the scope of the agency’s authority. (26) Agency with Choice employees, agents and the licensee must not permit, aid or engage in abuse of individuals served by the Agency with Choice. Statutory/Other Authority: ORS 413.042, Oregon Law 2024, Chapter 37 & HB 4129 (2024 Statutes/Other Implemented: Oregon Law 2024, Chapter 37 History: BHS 23-2025, temporary adopt filed 10/09/2025, effective 10/09/2025 through 04/06/2026