Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 435 - DEVELOPMENTAL DISABILITIES ANCILLARY SERVICES › Section 411-435-0030 - General Eligibility for Ancillary Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual
			 may not be denied ancillary services 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
			 ancillary services, an individual must meet the following requirements:
(a) Be an Oregon resident who meets the
			 residency requirements in OAR
			 461-120-0010.
(b) Be enrolled with a case management
			 entity.
(c) Be determined eligible
			 for developmental disabilities services by the Community Developmental
			 Disabilities Program 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).
(d) Be receiving one of the
			 following:
(A) Family support services as
			 described in OAR chapter 411, division 305. A child who is eligible for family
			 support funds may access ancillary services according to the conditions
			 described in OAR 411-305-0230.
(B) A Medicaid Title XIX benefit package
			 through OSIPM or HSD medical programs. 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.
(C) A benefit package through the
			 Healthier Oregon medical program.
(e) Be determined to meet the level of care
			 as defined in OAR 411-317-0000, except for
			 individuals receiving family support services as described in OAR chapter 411,
			 division 305.
(f) Demonstrate a
			 need for an ancillary service as documented in an ISP or Annual Plan.
(g) For individuals with excess income,
			 contribute to the cost of service in accordance with OAR
			 461-160-0610 and OAR
			 461-160-0620, except for
			 individuals receiving family support services as described in OAR chapter 411,
			 division 305.
(h) For services
			 funded through the Community First Choice state plan or a 1915(c) waiver,
			 participate in a functional needs assessment and provide information necessary
			 to complete the functional needs assessment and reassessment within the time
			 frame required by the Department.
(A) Failure
			 to participate in the functional needs assessment or to provide information
			 necessary to complete the functional needs assessment or reassessment within
			 the applicable 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 or legal representative
			 prevent timely participation in the functional needs assessment or timely
			 submission of information necessary to complete the functional needs assessment
			 or reassessment.