Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 450 - COMMUNITY LIVING SUPPORTS › Section 411-450-0030 - Eligibility for Community Living Supports

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual
			 may not be denied community living supports or otherwise discriminated against
			 on the basis of race, color, religion, sex, gender identity, sexual
			 orientation, national origin, marital status, age, disability, source of
			 income, duration of Oregon residence, or other protected classes under federal
			 and Oregon Civil Rights laws.
(2)
			 To be eligible for community living supports, an individual must meet the
			 following requirements:
(a) Be an Oregon
			 resident who meets the residency requirements in OAR
			 461-120-0010.
(b) Be determined eligible for developmental
			 disabilities services by the Community Developmental Disabilities Program
			 (CDDP) of the county of origin as described in OAR
			 411-320-0080, except for those
			 enrolled in the Medically Involved Children's Waiver or the Medically Fragile
			 Children's Program as described in OAR chapter 411, division 300.
(A) A child enrolled in the Medically
			 Involved Children's Waiver must be determined eligible for the waiver as
			 described in OAR 411-300-0120(7).
(B) A child enrolled in the Medically Fragile
			 Children's Program must meet the eligibility requirements described in OAR
			 411-300-0120(5).
(c) Choose to use a case
			 management entity for assistance with the design and management of
			 developmental disabilities services.
(d) Be receiving a Medicaid Title XIX benefit
			 package through Oregon Supplemental Income Program-Medical (OSIPM) or Health
			 Systems Division, Medical Assistance Programs (HSD) medical programs or a
			 benefit package through Healthier Oregon.
(A)
			 An adult is eligible for community living supports if the adult had been
			 receiving community living supports as a child up to their 18th birthday and
			 has not become ineligible due to section (2)(d)(B) of this rule.
(B) Eligibility for community living supports
			 based on section (2)(d)(A) of this rule ends if:
(i) The individual does not apply for a
			 disability determination and Medicaid within 10 business days of their 18th
			 birthday;
(ii) The Social Security
			 Administration or the Presumptive Medicaid Disability Determination Team of the
			 Department finds the individual does not have a qualifying disability;
			 or
(iii) The individual is
			 determined by the state of Oregon to be ineligible for a Medicaid Title XIX
			 benefit package through OSIPM or HSD medical programs or a benefit package
			 through Healthier Oregon.
(C) Individuals receiving Medicaid Title XIX
			 through HSD medical programs for services in a nonstandard living arrangement
			 as defined in OAR 461-001-0000 are subject to the
			 requirements in the same manner as if they were requesting these services under
			 OSIPM, including the rules regarding:
(i) The
			 transfer of assets as set forth in OAR
			 461-140-0210 through
			 461-140-0300.
(ii) The equity value of a home which exceeds
			 the limits as set forth in OAR
			 461-145-0220.
(e) Be determined to
			 meet the level of care as defined in OAR
			 411-317-0000.
(f) POST ELIGIBILITY TREATMENT OF INCOME
			 Individuals with excess income must contribute to the cost of services in
			 accordance with OAR 461-160-0610 and OAR
			 461-160-0620.
(g) Participate in an Oregon Needs Assessment
			 and provide information necessary to complete the Oregon Needs Assessment prior
			 to receiving community living supports, annually, and as required by the
			 Department.
(A) Failure to participate in the
			 Oregon Needs Assessment or to provide information necessary to complete the
			 Oregon Needs Assessment within the required time frame results in the denial or
			 termination of service eligibility. In the event service eligibility is denied
			 or terminated, a written Notification of Planned Action must be provided as
			 described in OAR 411-318-0020.
(B) The Department may allow additional time
			 if circumstances beyond the control of the individual prevents timely
			 participation in the Oregon Needs Assessment or timely submission of
			 information necessary to complete the Oregon Needs Assessment.