justicedao/ipfs_state_laws huggingface dataset:
411-034-0040 Employer-Employee Relationship (1) EMPLOYER RESPONSIBILITIES. An individual or the individual's representative must demonstrate the ability to: (a) Locate, screen, and hire a qualified HCW or employ an IHCA; (b) Supervise and train a HCW; (c) Schedule work, leave, and coverage; (d) Track the hours worked and verify the authorized hours completed by a provider; (e) Recognize, discuss, and attempt to correct any performance deficiencies with the HCW or IHCA and provide appropriate, progressive, disciplinary action as needed; and (f) Discharge an unsatisfactory provider. (g) Abide by federal and state laws related to employer responsibilities, including ensuring the employee is not harassed. (2) An eligible individual exercises control as the employer and directs the provider in the provision of the services. An individual who is unable or unwilling to act as an employer may select a licensed In-Home Care Agency (IHCA) who is enrolled as a Medicaid provider. (3) The Department makes payment for State Plan personal care services to the provider on an individual's behalf. Payment for services is not guaranteed until the Department has verified that an individual's provider meets the qualifications in OAR chapter 418, division 020 or for an in-home care agency in chapter 411, division 033. (4) ENDING CONSUMER-EMPLOYER RELATIONSHIP. Termination and the grounds for termination of employment are determined by an individual or the individual's representative. An individual has the right to terminate an employment relationship with a provider at any time and for any reason. An individual or the individual's representative must establish an employment agreement at the time of hire. The employment agreement may include grounds for dismissal, notice of resignation, work scheduling, and absence reporting. (5) REPRESENTATIVE. (a) The Department may require that an individual obtain a representative to act as the consumer-employer for service planning purposes. (b) The Department, or the Department’s designee, may deny an individual’s request for any representative if the representative has a history of a substantiated adult protective service complaint as described in OAR chapter 411, division 020. (c) The individual may select another representative. (d) An individual with a guardian must have a representative to act as the consumer-employer and for service planning purposes. A guardian may designate themselves as the representative. (e) A representative may not be a paid caregiver for the individual they are representing. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 410.020, 410.070, 410.608, 410.710 & 411.159 History: APD 57-2022, amend filed 12/22/2022, effective 12/23/2022 APD 28-2022, temporary amend filed 06/22/2022, effective 07/01/2022 through 12/27/2022 APD 8-2018, amend filed 03/28/2018, effective 03/29/2018 APD 22-2017, temporary amend filed 09/29/2017, effective 10/01/2017 through 03/29/2018 SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13 SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04
411-034-0050 Provider Qualifications (1) To provide personal care services to an individual who qualifies for SPPC the provider must meet the qualifications of chapter 411, division 031 or be an employee of an IHCA meeting the criteria in chapter 411, division 033. (2) To be in alignment with the provision of services, Money Management Services (MMS) providers must have an existing Oregon Money Management Program (OMMP) contract with the Department. (a) The provider must be in compliance with SSA representative payee requirements. (b) All staff and volunteers must pass a background check as defined in OAR chapter 407, division 007. (c) Providers must not solicit payment income or voluntary donations from Medicaid eligible participants. (d) Providers who fail to meet any of the above criteria will be denied or terminated at the Department’s discretion. (3) Meals on Wheels (MOW) provider must meet qualifications in OAR chapter 411, division 040 (https://www.oregon.gov/DHS/SENIORS-DISABILITIES/SPPD/APDRules/411-040.pdf). (4) Long Term Care Community Nursing must meet criteria defined in OAR chapter 411, division 048. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.010, 410.020, 410.070 & 410.608 History: APD 57-2022, amend filed 12/22/2022, effective 12/23/2022 APD 28-2022, temporary amend filed 06/22/2022, effective 07/01/2022 through 12/27/2022 SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13 SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04 SSD 2-1996, f. 3-13-96, cert. ef. 3-15-96
411-034-0090 Payment Limitations (1) The maximum allowed hours for State Plan personal care services are limited to 270 hours per calendar year for individuals served by APD or a AAA. (a) Individuals whose assessed service needs exceed the maximum allowed hours for State Plan personal care services in a service period may request additional hours through the exception process described in this rule. The Department Central Office may approve or deny the requests based on analysis of the individual’s need and criteria for an exception. (b) State Plan personal care service hours are authorized in accordance with an individual's service plan and may be scheduled throughout the service period to meet the service needs of the individual. (2) Authorized LTC community nurse assessment and monitoring services are not included in the maximum hours per service period for State Plan personal care services described in section (1) of this rule. (3) The Department does not guarantee payment for State Plan personal care services until all acceptable provider enrollment standards have been verified and both the employer and provider have been formally notified in writing that payment by the Department is authorized. (4) In accordance with OAR 410-120-1300, all provider claims for payment must be submitted within 12 months of the date of service. (5) Payment may not be claimed by a provider until the hours authorized for the payment period have been completed, as directed by an eligible individual or the individual's representative. (6) Claims for Money Management may only be made by qualified money management service providers and are not included in the 270-hour limitation. (7) Claims for Home Delivered Meals may only be made by qualified HDM providers and are not included in the 270-hour limitation. (8) Nursing Services may only be made by licensed and enrolled long term care community nurses and the hours authorized for this service are not included in the 270 hour limitation. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 410.020, 410.070, 410.710, 411.159 & 411.675 History: APD 57-2022, amend filed 12/22/2022, effective 12/23/2022 APD 28-2022, temporary amend filed 06/22/2022, effective 07/01/2022 through 12/27/2022 APD 8-2018, amend filed 03/28/2018, effective 03/29/2018 APD 22-2017, temporary amend filed 09/29/2017, effective 10/01/2017 through 03/29/2018 SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13 SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07 SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04 SSD 2-1996, f. 3-13-96, cert. ef. 3-15-96
411-035-0000 Purpose (1) These rules ensure individuals served by the Department of Human Services, Aging and People with Disabilities program have equal access to required and optional K-State Plan services that are not defined in other rules in OAR chapter 411. The services in these rules are intended to assist and empower an eligible individual to maximize their independence, dignity, and human potential through the provision of flexible, efficient, and suitable services. (2) Services described in these rules include: (a) Backup Systems and Assistive Technology. (b) Chore Services. (c) Environmental Modification Services. (d) Transition Services. (e) Voluntary Consumer Training. (3) Payments for the services in these rules are limited to the lowest possible cost which will adequately meet the individual's minimum necessary needs. 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 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 39-2016, f. 9-27-16, cert. ef. 10-1-16 APD 16-2014, f. & cert. ef. 6-4-14
411-035-0015 Eligibility for Supplemental K State Plan Services To be eligible for any Medicaid Supplemental K State Plan services defined in this division, consumers must: (1) Be eligible for Medicaid long term care services and supports as described in OAR 411-015-0010 through 411-015-0100. (2) Not have natural supports or other services available in the community that would meet the identified need. (3) Not be eligible for the item through Medicare, other Medicaid programs, or other medical coverage. (4) Have an identified need in their person-centered service plan that: (a) Supports the desires and goals of the consumer receiving services and increases a consumer's independence; (b) Reduces a consumer's need for assistance from another person; or (c) Maintains a consumer's health and safety. (5) Be provided the choice to accept or deny the service being offered. (6) Have a completed service assessment that reflects the current needs of the consumer. (7) To be considered an eligible request, when possible, three bids are required from providers. Consumers should work with their case manager to obtain bids. Bids may not include comparative pricing done through the internet. Bids are required for: (a) Assistive Technology; (b) Chore Services; (c) Environmental Modifications; and (d) Transition Services - Moving Costs. 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 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
411-035-0020 (Reserved) Text available via filing PDF that is stored in ORMS 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 16-2014, f. & cert. ef. 6-4-14
411-035-0025 Eligibility for Consumer Electronic Back-up Systems and Assistive Technology (1) To be eligible for electronic back-up systems or mechanisms, a consumer must not be receiving community-based care in a licensed care setting. (2) Electronic back-up systems and assistive technologies must be appropriate and cost effective to meet the service needs of the consumer and: (a) For new equipment: (A) Are limited to a maximum of $5000 for purchasing of a device. (B) All requests over $500 must be approved by designated Central Office staff. (C) Monthly rentals or lease fee limits are posted on the APD rate table. (b) For repairs: (A) Repair of purchased devices may be done if the repair is more cost effective than purchasing a new device. (B) This may include electric wheelchair or scooter battery replacement if denied by Medicare or the Medicaid State Plan. (C) Repairs of rented or leased equipment are the responsibility of the provider. (c) Monthly maintenance, fees, or service charges are not included in the maximums described in (a) or (b). (d) For Personal Emergency Response Systems (ERS): (A) ERS services may include either basic ERS or enhanced ERS services and must be appropriate for the individual’s needs. (B) Monthly rentals or lease fee limits are posted on the APD rate table. (e) For Assistive Technology: Expenditures over $500 must be approved by designated Central Office staff. Statutory/Other Authority: ORS 410.070 & ORS 409.050 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 - 410.300 & 441.520 History: APD 34-2019, amend filed 09/27/2019, effective 10/01/2019 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
411-035-0030 Eligible Electronic Back-up Systems and Assistive Technology Services (1) Electronic Back-up Systems and Assistive Technology services must: (a) Ensure continuity of services and support the health, welfare, and safety of the consumer; (b) Enable the consumer to function with greater independence; or (c) Substitute for human assistance. (2) Electronic Back-up systems and supports may be allowed as long as the system sufficiently meets the need of the consumer being served. (3) Consumers with an assessed need qualify for electronic back-up systems, including but not limited to: (a) Personal Emergency Response Systems; (b) Medication reminders; (c) Alert systems for ADL and IADL supports that increase a consumer’s independence; and (d) Mechanisms, and any specialized or durable medical equipment, necessary to support the consumer’s health or well-being. (4) Consumers with an assessed need qualify for Assistive Technology including, but not limited to: (a) Motion sensors; (b) Sound sensors; (c) Two-way communication systems; (d) Automatic faucets; (e) Soap dispensers; (f) Toilet flushing sensors; (g) Incontinent sensors; (h) Fall sensors; (i) Lift chairs; (j) Transfer poles; (k) Wandering alerts; and (l) Other technology, which may be approved on a case-by-case basis with Central Office approval. 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
411-035-0035 Provider Qualifications and Requirements for Electronic Back-up Systems and Assistive Technology (1) Companies providing back-up support or back-up systems must have a Medicaid provider number before providing services. (2) No monetary funds shall be released for installation of electronic back-up systems or assistive technology to the provider until the work is finished and is functioning as expected. (3) Payment for on-going electronic back-up systems or assistive technology must be paid to providers after the consumer receives the service each month. (4) Upon delivery, providers must ensure: (a) The product is functioning correctly; (b) The product properly fits the consumer; and (c) If applicable, the individual is given adequate instruction on the product's use. (5) Providers must supply a revised bid when requested by designated Central Office staff. (6) 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
411-035-0040 Eligibility Criteria for Chore Services (1) To be eligible for chore services, a consumer must not be receiving community-based care in a licensed care setting and must meet the requirements in OAR 411-030-0033. (2) An eligible consumer may receive chore services if any of the following are true: (a) The consumer needs garbage pick-up and removal, or payment of previous garbage bills, to continue or resume receiving garbage services and to ensure the home is safe for the consumer and their service providers. (b) The consumer’s premises requires heavy cleaning to remove hazardous debris or dirt in the home to ensure the consumer’s home is safe and allows for independent living. (c) The consumer's premises requires the removal of outside debris (for example, trees, leaves, clutter) that endangers the structure of the home, the consumer's ability to traverse within the home, or to safely enter or exit the home. (d) The services must be completed to enable the consumer to move from one residence to another and to establish services in the new home. (3) If the service is done in a rental location, the service must be a service that is not required of the landlord under applicable landlord-tenant law. (4) Chore services are not part of the consumer’s on-going service plan. Once the chore service is complete, homecare workers may begin or continue ongoing housekeeping. (5) Chore services must be appropriate and cost effective to meet the service need of the consumer. (a) If feasible, three bids are required from companies or vendors who provide chore services. A bid is not comparative pricing through the Internet. (b) Bids over $500 require a state licensed contractor. (6) The consumer must sign a written agreement to: (a) Have a vendor clean their home; (b) Remove hazardous debris; or (c) To haul off agreed upon items that may pose a health and safety risk to the consumer or others. 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 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
411-035-0045 Eligible Chore Services (1) Chore services are not housekeeping services and are not to be provided by homecare workers or in-home agencies. (2) Chore services are intended to ensure the consumer’s home is safe and allows for independent living. (3) In order to ensure the consumer’s home is safe, services may be authorized for, but not limited to: (a) Heavy housecleaning to ensure the consumer and care providers can safely navigate in the home. This may include removal of hazardous debris or dirt from the home. (b) Removal of yard hazards to ensure the outside of the home is safe for the consumer to enter and exit the home. (4) Chore Services do not include: (a) Removal of debris that does not impede the consumer from: (A) Safely traversing within the home; or (B) Entering or exiting the home safely. (b) Removing items that do not present a potential fire hazard that would endanger the consumer’s health and safety. 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 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 16-2014, f. & cert. ef. 6-4-14
411-035-0050 Chore Service Provider Qualifications and Requirements (1) Providers of chore services must have a distinct Medicaid provider number before the work begins. (2) No monetary funds shall be released to the provider until the work is finished and meets the specifications of the chore service agreement. (3) Providers must submit the final invoice for payment within one year of the date of service. (4) Providers must supply a revised bid when requested by designated Central Office staff. 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 34-2019, amend filed 09/27/2019, effective 10/01/2019 APD 16-2014, f. & cert. ef. 6-4-14
411-035-0055 Eligibility for Consumer Environmental Modifications (1) To be eligible for environmental modifications, a consumer may not be receiving community-based care in a licensed care setting and must meet the requirements in OAR 411-030-0033. (2) If the consumer lives in a rental location, the consumer must have a written and signed agreement between the consumer receiving services and the owner or landlord of the rental property. (a) The agreement must include: (A) The scope of work provided; (B) That the modification is permissible; and (C) That the Department shall not restore the rental unit to its former condition. (b) Environmental modifications in rental locations must not be for services that are required of the landlord under applicable landlord-tenant law. (3) Environmental modifications are not part of the consumer’s on-going service plan. Once the environmental modification is complete, those services shall cease. No reduction notice is required. (4) Environmental modifications must be appropriate, cost effective, and meet the service need of the consumer. (a) Environmental modifications are limited to $5000 per environmental modification unless an exception is required per section (5) of this rule. (b) If feasible, three bids are required from companies or vendors. A bid is not comparative pricing through the Internet. (5) Exceptions to the $5,000 limitation may be granted if the consumer has service needs that warrant an exception for payment and no alternative is available to meet the needs of the consumer. (6) Upon completion of the requested and approved environmental modification, the Department is not responsible for restoring the home to its previous condition. This includes the completion of environmental modifications when the consumer claims to not be satisfied with the work completed by the provider. 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 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
411-035-0060 Eligible Environmental Modification Services (1) Environmental modifications in the consumer’s home must be: (a) To ensure the health, welfare and safety of the consumer. (b) To enable the consumer to function with greater independence. (c) To substitute for human assistance. (2) Environmental modifications are not for home maintenance and home repairs that are otherwise considered the responsibility of the home owner or for the convenience of the care providers. Excluded environmental modifications include, but are not limited to: (a) Plumbing; (b) Roofs; (c) Appliances; (d) Electrical; (e) Heating and cooling; (f) Hot water tanks; or (g) Skylights and windows. (3) Environmental modifications must be within the existing square footage of the home and must not add to the square footage of the home, except for external ramps needed to enter or exit the home. (4) Consumers assessed with limitations in mobility, toileting, or bathing may qualify for installation or modification of items including, but not limited to: (a) Ramps to enhance their ability to traverse within the home or to enter or exit the exterior of their home; (b) Grab-bars; (c) Hand rails; (d) Electric door openers; (e) Widening of doorways when the door is too narrow for the consumer to enter or exit through the doorway with or without a wheelchair; (f) Door and cabinet handles for consumers having difficulty due to dexterity; (g) Bathroom facilities, such as a raised toilet; (h) Kitchen cabinets or sinks, such as lowering counters and sinks for wheelchair accessibility; (i) Non-skid surfaces; and (j) Overhead track systems to assist with lifting or transferring a consumer. 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