411-032-0000 Definitions (1) "AAA" means "Area Agency on Aging". (2) "Activities of Daily Living (ADL)" mean those personal care functional activities required by an individual for continued well being, health, and safety. For the purposes of these rules, ADLs consist of eating, dressing/grooming, bathing/personal hygiene, mobility (ambulation and transfer), elimination (toileting, bowel, and bladder management), and cognition/behavior as described in OAR 411-015-0006. (3) "Adjusted Income" means the income for all household members after deductions for household medical expenses as described in OAR 411-032-0044. (4) "ADL" means "Activities of Daily Living". (5) "Administrative Costs" mean those expenses associated with the overall operation of OPI that are not directly attributed to an authorized service. Administrative costs include, but are not limited to, costs associated with accounting services, indirect costs, facility expenses, etc. (6) "Adult Day Service" means a community-based group program designed to meet the needs of adults with functional impairments through service plans. These structured, comprehensive, non-residential programs provide health, social and related support services in a protective setting during part of a day, but for less than 24 hours per day. (7) "Advisory Council" means an advisory council of the authorized AAA. (8) "Alzheimer's Disease or a Related Disorder" means a progressive and degenerative neurological disease that is characterized by dementia including the insidious onset of symptoms of short-term memory loss, confusion, behavior changes, and personality changes. It includes dementia caused from any one of the following disorders: (a) Multi-Infarct Dementia (MID); (b) Normal Pressure Hydrocephalus (NPH); (c) Inoperable Tumors of the Brain; (d) Parkinson's Disease; (e) Creutzfeldt-Jakob Disease; (f) Huntington's Disease; (g) Multiple Sclerosis; (h) Uncommon Dementia such as Pick's Disease, Wilson's Disease, and Progressive Supranuclear Palsy; or (i) All other related disorders recognized by the Alzheimer's Association. (9) "Area Agency on Aging (AAA)" means the agency designated by the Department as an AAA that is charged with the responsibility to provide a comprehensive and coordinated system of services to older adults and individuals with physical disabilities in a planning and service area. For purposes of these rules, the term "Area Agency on Aging" is inclusive of both Type A and B AAAs as defined in ORS 410.040 to 410.350. (10) "Area Plan" means the approved plan for providing authorized services under OPI. (11) "Assisted Transportation" means escort services that provide assistance to an individual who has difficulties (physical or cognitive) using regular vehicular transportation. (12) "Assistive Technology Device" means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of an individual. (13) "Authorized Service" means any service designated by the Department and these rules to be eligible for OPI funding. (14) "Chore" means assistance such as heavy housework, yard work, or sidewalk maintenance provided on an intermittent or one-time basis to assure health and safety. (15) "Consumer-Employed Provider Program" refers to the program wherein the provider is directly employed by the eligible individual to provide either hourly or live-in services. In some aspects of the employer and employee relationship, the Department acts as an agent for the consumer-employer. These functions are clearly described in OAR chapter 411, division 031. (16) "DAS" means the Department of Administrative Services for the State of Oregon. (17) "Department" means the Department of Human Services. (18) "Diagnosed" means, for purposes of these rules, that an individual's physician has reason to believe and indicates that the individual has Alzheimer's Disease or a related disorder. (19) "Director" means the Director of the Department of Human Services, or that person's designee. (20) "Direct Service Costs" mean those expenses for direct labor that are attributable to the authorized services specified in OAR 411-032-0010(1)(a)(A) and (1)(c). For example, the direct service cost of home care is the cost of time actually spent providing home care supportive services in the home. Other direct service costs are those that are directly attributable to an individual-related function. (21) "Eligibility Determination" means the process of deciding if a prospective individual meets the requirements necessary to receive authorized services under OPI. (22) "Evidence-Based Health Promotion" means individual or group programs that have been tested through randomized control trials and have been shown to be effective at helping participants adopt healthy behaviors, improve their health status, and reduce their use of health services. (23) "Exception" means that an agency or individual contractor or subcontractor is not required to meet one or more specific requirements of these rules. (24) "Fiscal Records and Data" means all information pertaining to the financial operation of an agency or program. (25) "Gross Income" means household income from salaries, interest and dividends, pensions, Social Security, railroad retirement benefits, and any other income prior to any deductions. (26) "Health Care Costs" mean health-related expenses paid out-of-pocket that include but are not limited to medical, dental, health insurance, prescription drugs, over-the-counter drugs, hearing aids, and eyeglasses. (27) "Home Care" means assistance with IADLs such as housekeeping, laundry, shopping, transportation, medication management, and meal preparation. (28) "Home Care Supportive Services" means in-home or community-based services that assist an individual in achieving the greatest degree of independent functioning in the individual’s place of residence. (29) "Homecare Worker" means a provider, as defined in OAR 411-030-0020 and described in 411-031-0040, who is directly employed by an eligible individual via the Consumer-Employed Provider Program to provide hourly services to eligible individuals. (30) "Home Delivered Meal" means a service that includes a meal provided to an eligible individual in the individual's place of residence. Home Delivered Meals: (a) Are prepared and delivered in compliance with applicable state and local laws; (b) Meet a minimum of 33 1/3 percent of Dietary Reference Intakes and Dietary Guidelines; (c) Include meal menus approved by a registered dietitian; (d) Require an in-person initial assessment and a minimum annual assessment; and (e) Provide nutrition education to the individual one time per year. (31) "Hourly Services" mean the in-home services, including ADLs and IADLs, provided at regularly scheduled times. Hourly services are not exempt from federal or state minimum wage or overtime laws. (32) "Household" means the individual, spouse, and any dependents as defined by the Internal Revenue Service. (33) "IADL" means "Instrumental Activities of Daily Living". (34) "Indirect Cost" means: (a) Incurred for a common or joint purpose benefiting more than one cost objective; and (b) Not readily assignable to the cost objectives specifically benefited, without effort disproportionate to the results achieved. The term "indirect cost," as used herein, applies to costs of this type originating in the grantee department, as well as those incurred by other departments in supplying goods, services, and facilities. To facilitate equitable distribution of indirect expenses, to the cost objectives served, it may be necessary to establish a number of pools of indirect costs. Indirect cost pools are distributed to benefited cost objectives on bases that produce an equitable result in consideration of relative benefits derived. (35) "In-Home Care Agency" means an incorporated entity or equivalent licensed in accordance with OAR chapter 333, division 536 to provide hourly contracted in-home service to individuals in that individual's place of residence. (36) "Institution" means any state, community, or private hospital and any nursing facility. (37) "Instrumental Activities of Daily Living (IADL)" mean the self-management tasks that consist of housekeeping including laundry, shopping, transportation, medication management, and meal preparation as described in OAR 411-015-0007. (38) "Natural Support" means the resources available to an individual from their relatives, friends, significant others, neighbors, roommates, and the community. Services provided by natural supports are resources not paid for by the Department or AAA. (39) "OPI" means Oregon Project Independence. (40) "Options Counseling" means counseling that supports informed long term care decision making through assistance provided to individuals and families to help them understand their strengths, needs, preferences, and unique situations and translate this knowledge into possible support strategies, plans, and tactics based on the choices available in the community. (41) "Personal Care" means in-home services provided to maintain, strengthen, or restore an individual's functioning in their own home when an individual is dependent in one or more ADLs, or when an individual requires assistance for ADL needs. Assistance is provided either by an in-home care agency or by a homecare worker. (42) "Place of Residence" means the physical location of an individual’s legal residence. For purposes of these rules "place of residence" does not include an adult foster home, assisted living facility, residential care facility, or nursing facility licensed by the Department. (43) "Priority" means the order in which the AAA determines individuals to be eligible for OPI. (44) "Program Records and Data" means any information of a non-fiscal nature. (45) "Program Support Costs" mean those expenses associated with managing the services provided either through contract or directly by the AAA, that are attributable to a specific service. (46) "Provider" means the individual who actually renders the service. (47) "Registered Nurse Services" mean services provided by a registered nurse on a short-term or intermittent basis that include but are not limited to: (a) Interviewing the individual and, when appropriate, other relevant parties; (b) Assessing the individual's ability to perform tasks; (c) Preparing a service plan that includes treatment needed by the individual; (d) Monitoring medication; and (e) Training and educating providers around the provisions of the service plan. (48) "Respite" means paid temporary services to provide relief for families or other caregivers who are unpaid. In-home and out-of-home respite may be provided on an hourly or daily basis, including 24-hour respite service for several consecutive days. The range of tasks provided may include supervision, companionship, and personal care services usually provided by the primary caregiver. (49) "Service Coordination" means a service designed to individualize and integrate social and health care options with an individual being served. The goal of service coordination is to provide access to an array of service options to assure appropriate levels of service and to maximize coordination in the service delivery system. (50) "Service Coordination Costs" mean those expenses associated with individualizing and integrating social and health care options with an individual receiving a service. Cost elements include time spent with the individual, travel to and from an individual's place of residence, mandated training time, case recording, reporting, time spent arranging for and coordinating services for an individual, and supervision and staffing time related to an individual. Service coordination costs also include the time spent on the initial assessment of an individual who does not become eligible for OPI. (51) "Service Determination" means the process of determining the proper authorized service for each eligible individual. (52) "Service Need" means those functions or activities for which an individual requires the support of the Department or AAA. (53) "Service Provider" means any agency or program that provides one or more authorized services under OPI. (54) "These Rules" mean the rules in OAR chapter 411, division 032. Statutory/Other Authority: ORS 410.070 & ORS 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 Reverted to SDSD 7-1999, f. 6-30-99, cert. ef. 7-1-99 SDSD 9-2002(Temp), f. & cert. ef. 11-1-02 thru 4-29-03 SDSD 7-1999, f. 6-30-99, cert. ef. 7-1-99 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. & ef. 7-1-87 SSD 11-1984, f. 11-30-84, ef. 12-1-84