reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0438 - Specific Requirements: OHP Bridge - Basic Health Program

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the general requirements applicable to OHP
				Bridge - Basic Health Program set forth in this Division 200, this rule
				describes specific eligibility requirements for OHP Bridge - Basic Health
				Program.
(1) OHP Bridge - Basic Health
			 Program is effective on July 1, 2024.
(2) To be eligible for OHP Bridge - Basic
			 Health Program an individual must:
(a) Be age
			 19 or older and under age 65;
(b)
			 Have, as required under OAR 410-200-0315, monthly MAGI-based income which
			 exceeds 133 percent of the federal poverty level (FPL) for the applicable
			 family size; have annual household income for the applicable family size up to
			 and including 200 percent FPL for the coverage year being requested;
			 and
(c) Meet citizenship status
			 requirements outlined in OAR 410-200-0215(1), or non-citizen status
			 requirements outlined in OAR 410-200-0215(5).
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0440 - Specific Requirements; Extended Medical Assistance

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Individuals who lose eligibility for MAGI
			 PCR due to the receipt or increase of earned income are eligible for a period
			 of up to 12 months of Extended Medical Assistance if:
(a) They were eligible for and receiving MAGI
			 PCR benefits for any one of the six months preceding the receipt or increase in
			 earned income that resulted in loss of MAGI PCR eligibility;
(b) Eligibility is redetermined and the
			 individual is found ineligible for any Medicaid program except BCCTP or
			 Substitute Care; and
(c) They are
			 the parent or caretaker relative of a dependent child living in their
			 home.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0445 - Specific Requirements - Compact Of Free Association (COFA) Dental Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Compact
			 of Free Association (COFA) Dental Program is effective January 1,
			 2023.
(2) To be eligible for the
			 COFA Dental Program, an individual must:
(a)
			 Be lawfully residing in the United States in accordance with the Compacts of
			 Free Association (I.e., the governments of the Federated States of Micronesia,
			 the Republic of the Marshall Islands, and the Republic of Palau);
(b) Be a resident of Oregon; and
(c) Have MAGI-based income (see OAR
			 410-200-0015  General Definitions (55)) within 138% FPL;
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0450 - Specific Requirements - Veteran Dental Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Veteran Dental Program is effective
			 January 1, 2023.
(2) To be eligible
			 for the Veteran Dental Program, an individual must:
(a) Be a resident of Oregon;
(b) Be a veteran as described in ORS
			 408.225, except the individual
			 may be discharged or released under honorable conditions or other conditions;
			 and
(c) Have MAGI-based income (see
			 OAR 410-200-0015  General Definitions (55)) within 400% FPL.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0500 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  411.402,
				  411.404 &
				  413.042
Stats. Implemented: ORS
				  411.400,
				  411.402,
				  411.404,
				  411.406,
				  411.439,
				  411.443,
				  413.032,, 414.025,
				  414.231,
				  414.440 &
				  414.706;
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0505

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  411.402,
				  411.404,
				  413.042 &
				  413.038
Stats. Implemented: ORS
				  411.400,
				  411.402,
				  411.404,
				  411.406,
				  413.032,
				  413.038,
				  414.025,
				  414.231 &
				  414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0510

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  411.402,
				  411.404,, 413.042 &
				  414.534
Stats. Implemented: ORS
				  411.400,
				  411.402,
				  411.404,
				  411.406,
				  411.439,
				  411.443,
				  413.032,
				  413.038,
				  414.025,
				  414.231, 414.447,
				  414.534,
				  414.536&
				  414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0520 - COVID-19 Emergency Policies

Current through Register Vol. 63, No. 7, July 1, 2024
The provisions in this rule apply to all Health Systems
				Division (HSD) Medical Program eligibility determinations made as of March 18,
				2020 through March 31, 2023.
(1) In
			 accordance with the Families First Coronavirus Response Act (FFCRA) and OAR
			 410-120-0011, following the declaration of a national public health emergency
			 (PHE), the Authority adopts temporary measures related to HSD Medical program
			 eligibility.
(2) In accordance with
			 the Consolidated Appropriations Act, 2023, the continuous enrollment provisions
			 established as part of the FFCRA are no longer coupled with the national public
			 health emergency effective March 31, 2023. See OAR 410-200-0521  for Agency
			 policies effective April 1, 2023.
(3) Notwithstanding any other rule to the
			 contrary in these Chapter 410, division 200 rules, during the COVID-19 PHE, HSD
			 Medical program eligibility shall be determined as set forth in this
			 rule.
(4) Except for individuals
			 receiving coverage during a period of presumptive eligibility (see section 5 of
			 this rule), individuals who were receiving HSD Medical Program benefits on
			 March 18, 2020, or who begin receiving coverage following that date via full
			 eligibility determination shall not have benefits terminated prior to April 1,
			 2023, with the following exceptions:
(a)
			 Terminations of coverage shall be limited to the following reasons:
(A) Eligibility was approved for an HSD
			 medical program at either initial application or during a redetermination, and
			 it is later determined the decision was incorrect due to one of the following:
(i) Administrative error; or
(ii) When a court determines the individual
			 made a false or misleading statement, or misrepresented, concealed, or withheld
			 a fact for the purpose of establishing or maintaining eligibility.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0521 - Unwinding Period - HSD Medical Programs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The provisions in this rule apply to all
			 Health Systems Division (HSD) Medical Program determinations effective April 1,
			 2023, and later. Notwithstanding any other rule to the contrary in these
			 chapter 410 division 200 rules, during the unwinding period, HSD Medical
			 Program eligibility shall be determined as set forth in this rule.
(2) For the purposes of this rule, the term
			 "unwinding period" refers to the period of 15 calendar months beginning April
			 1, 2023, in which the agency will initiate a full eligibility renewal for all
			 HSD Medical Program beneficiaries.
(3) In accordance with the Consolidated
			 Appropriations Act, 2023, the continuous enrollment conditions established via
			 the Families First Coronavirus Response Act end effective March 31,
			 2023.
(4) Except for individuals
			 receiving coverage during a period of presumptive eligibility (see OAR
			 410-200-0105), individuals who were receiving HSD Medical Program benefits
			 prior to April 1, 2023, shall maintain coverage as described in OAR
			 410-200-0520  until their unwinding period renewal activity is
			 initiated.
(5) Individuals
			 receiving coverage during a period of presumptive eligibility shall maintain
			 presumptive eligibility coverage until:
(a) A
			 full eligibility determination is completed; or
(b) The individual's benefits are terminated
			 due to failure to complete the full application process.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0000

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0010

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0020

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0030

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0040

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0050

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 500 - RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM › Section 410-500-0060

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  676.550-556
Stats. Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0100 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The purpose of
			 the rules in OAR chapter 411, division 001 is to establish procedures for the
			 operation of the Medicaid Long Term Care Quality and Reimbursement Advisory
			 Council (Council).
(2) The Council
			 was established by the 1995 Legislative Assembly and consists of 12
			 stakeholders including the Long Term Care Ombudsman, consumers, advocates, and
			 providers. Council appointments are made by the Governor, the President of the
			 Senate, the Speaker of the House, the Governor's Commission on Senior Services,
			 and the Oregon Disabilities Commission as described in ORS
			 410.550.
(3) The Council is directed to advise the
			 Department of Human Services or the Oregon Health Authority on changes or
			 modifications to the Medicaid reimbursement system and the adverse and positive
			 effects of the changes or modifications on the quality of long term care and
			 community-based services and reimbursement for long term care and
			 community-based services.
Stat. Auth.: ORS
				  410.070,
				  410.555
Stats. Implemented: ORS
				  410.550 -
				  410.555
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0110 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Authority"
			 means the Oregon Health Authority.
(2) "Council" means the Medicaid Long Term
			 Care Quality and Reimbursement Advisory Council.
(3) "Department" means the Department of
			 Human Services.
(4) "Medicaid
			 Reimbursement System" means the method or methodology associated with
			 reimbursing providers of long term care and community-based services under the
			 Department. The Medicaid reimbursement system does not include rates
			 established by collective bargaining, rates established by actuarial
			 calculations, or rate increases that have been approved and funded by the
			 Legislature.
(5) "Quality" means
			 the degree to which long term care systems, services, and supplies for
			 individuals and populations increase the likelihood of positive outcomes.
(6) "These Rules" mean the rules
			 in OAR chapter 411, division 001.
Stat. Auth.: ORS
				  410.070 &
				  410.555
Stats. Implemented: ORS
				  410.550-410.555
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0115 - Council Administration

Current through Register Vol. 63, No. 7, July 1, 2024
Council By-Laws supplement ORS
				410.550 to
				410.555 and these
				rules.
Stat. Auth.: ORS
				  410.070,
				  410.555
Stats. Implemented: ORS
				  410.550 -
				  410.555
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0118 - Council Scope

Current through Register Vol. 63, No. 7, July 1, 2024
(1) At the
			 beginning of each legislative session, the Council shall review the Governor's
			 Recommended Budget for the Department. The Council may submit a recommendation
			 in support or opposition of the Governor's Recommended Budget.
(2) The Department or Authority shall submit
			 any proposed change or modification to the Medicaid reimbursement system to the
			 Council for the Council's review and recommendation.
(3) Upon review of any proposed change or
			 modification under section (2) of this rule, the Council shall issue a written
			 advisory recommendation to the Department or Authority as described in OAR
			 411-001-0120.
(4) Prior to implementing any change or
			 modification to the Medicaid reimbursement system, the Department or Authority
			 shall submit the Council's written recommendation to the Legislative Assembly
			 or to the Emergency Board if the Legislative Assembly is not in session.
(5) If the Council has a
			 disagreement with any change or modification to the Medicaid reimbursement
			 system, the Department or Authority shall obtain the approval of the
			 Legislative Assembly or the Emergency Board if the Legislative Assembly is not
			 in session, before instituting the proposed change or modification. A proposed
			 change or modification with an estimated fiscal impact of $100,000 or less is
			 exempt from this provision.
(6)
			 The Department shall inform the Council of all rate changes within the
			 Department's Aging and People with Disabilities Programs, including rates
			 established by collective bargaining, rates established by actuarial
			 calculations, and rate increases that have been approved and funded by the
			 Legislature.
(7) The Council may
			 review the Department's strategic initiatives in order to assess the likelihood
			 of increased quality for individuals served by the Department.
Stat. Auth.: ORS
				  410.070 &
				  410.555
Stats. Implemented: ORS
				  410.550-410.555
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0120 - Council Operation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Within
			 60 calendar days after receipt from the Department or Authority of any proposed
			 change or modification to the Medicaid reimbursement system, the Council shall
			 issue a written advisory recommendation to the Department or Authority. The
			 60-day period begins the day following delivery to the chairperson of the
			 Council if a proposed change or modification is faxed, hand-delivered, or
			 e-mailed. Otherwise, the 60-day period begins the third day after the date of
			 mailing first class.
(2) A written
			 advisory recommendation issued by the Council must state:
(a) Whether the Council supports or opposes
			 the proposed change or modification;
(b) Whether the Council concludes that the
			 proposed change or modification shall have an adverse or positive effect on the
			 quality of long term care and community-based services provided under the
			 Oregon Medicaid program; and
(c)
			 The basis for the Council's recommendation, which must include:
(A) The reason for the Council's position;
(B) A list of the principal
			 documents, reports, or studies, if any, relied upon in considering the proposed
			 change or modification; and
(C)
			 Other information deemed appropriate by the Council.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0500 - Contested Case Hearings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR
			 411-001-0500,
			 411-001-0510, and
			 411-001-0520 apply to all
			 contested case hearing requests authorized under OAR chapter 411, except to the
			 extent that:
(a) There is another conflicting
			 rule in OAR chapter 411 that applies to the hearing request; or
(b) There is a rule in OAR chapter 411 that
			 applies a conflicting rule in OAR chapter 461, division 025 to the hearing
			 request.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0510 - Lay Representation in Contested Case Hearings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Subject to the approval of the Attorney
			 General, an officer or employee of the Department of Human Services
			 (Department) is authorized to appear on behalf of the Department in the
			 following types of hearings conducted by the Office of Administrative Hearings:
(a) Eligibility for public assistance
			 services or other benefits available through a waiver or state plan
			 administered by the Department's Aging and People with Disabilities (APD) or
			 Office of Developmental Disability Services (ODDS), including but not limited
			 to the level or amount of benefits, and effective date;
(b) Eligibility for medical benefits, the
			 level and amount of benefits, and effective date;
(c) Eligibility for Supplemental Nutrition
			 Assistance Program (SNAP), the level and amount of benefits, and effective
			 date, and the termination, suspension, reduction, or denial of benefits.
(d) Client overpayments and
			 intentional program violations related to public assistance or medical
			 assistance, SNAP, waivered or state plan service benefits or medical benefits;
(e) Medical assistance, including
			 but not limited to eligibility for services available through a waiver or state
			 plan for medical assistance, the level and amount of services or benefits, and
			 the termination, suspension, reduction, or denial of medical assistance
			 services, prior authorizations, or medical management decisions; and
(f) Consumer-employed provider matters,
			 including but not limited to provider enrollment or denial of enrollment,
			 overpayment determinations, audits, and sanctions; and
(g) Provider enrollment or denial of
			 enrollment, provider overpayments, audits, and audit sanctions.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 1 - ADMINISTRATIVE RULEMAKING AND MEDICAID AND LONG TERM CARE (MLTCQRAC) NOTICE REQUIREMENTS › Section 411-001-0520 - Late Contested Case Hearing Requests

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the Department of Human Services
			 (Department) receives a completed hearing request that is not filed within the
			 timeframe required by the applicable rule in OAR chapter 411 but is filed no
			 later than the deadlines set out in section (2) of this rule:
(a) The Department shall refer the hearing
			 request to the Office of Administrative Hearings for a contested case hearing
			 on the merits of the Department's action described in the notice when:
(A) The Department finds that the claimant
			 and claimant's representative did not receive the notice and did not have
			 actual knowledge of the notice; or
(B) The Department finds good cause that the
			 claimant did not meet the timeframe required due to excusable mistake,
			 surprise, excusable neglect (which may include neglect due to significant
			 cognitive or health issues), circumstances beyond the claimant's control,
			 reasonable reliance on the statement of a Department employee or an adverse
			 provider relating to procedural requirements, or due to fraud,
			 misrepresentation, or other misconduct of the Department or a party adverse to
			 the claimant.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0100 - Definitions Relating to the Designation of Planning and Service Areas

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Area Agency on
			 Aging" means the designated entity with which the Division contracts to meet
			 the requirements of the Older Americans Act and ORS Chapter 410 in planning and
			 providing services to the elderly or elderly and disabled population for a
			 designated Planning and Service Area.
(2) "Division" means the Seniors and People
			 with Disabilities Division of the Department of Human Services.
(3) "Planning and Service Area" means the
			 geographical area, consisting of one or more counties, for which one Area
			 Agency on Aging is designated by the Division to plan for and provide services
			 under the Older Americans Act and Oregon Revised Statute (ORS) Chapter
			 410.
(4)
(a) "Type A Area Agency on Aging" means a
			 designated entity that administers the Older Americans Act and Oregon Project
			 Independence programs for a Planning and Service Area. A Type A Area Agency on
			 Aging may be:
(A) An office or agency of a
			 unit of general purpose local government which is selected by the chief elected
			 official of the unit to serve as an Area Agency on Aging; or
(B) Any office or agency designated by the
			 appropriate chief elected officials of any combination of units of general or
			 general and special purpose local government formed in accordance with ORS
			 Chapter 190; or
(C) A private
			 non-profit organization.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0105 - Basis for Planning and Service Area Designation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Boundaries for Planning and Service Areas
			 will be designated by the Division Administrator and indicated in the current
			 State Plan on Aging.
(2)
			 Designation of additional Planning and Service Areas shall be in compliance
			 with the Older Americans Act, appropriate federal regulations, and Division
			 administrative rules.
(3) The
			 official decision-making body for any unit of general purpose local government,
			 a region recognized for area-wide planning, metropolitan area or Indian
			 reservation may make application to the Division to be designated as a Planning
			 and Service Area. The Division will notify the applicant of its approval or
			 disapproval within 60 days of either the date the application is received by
			 the Division, or any closing date for applications, whichever is
			 later.
(4) An Indian reservation
			 must have at least 250 residents age 60 or over to be designated as a Planning
			 and Service Area. Services on Indian reservations so designated shall be
			 available to all persons 60 years of age or older who reside on the
			 reservation.
(5) During its review
			 of any application for Planning and Service Area designation, the Division will
			 consider:
(a) The distribution in the state
			 of persons age 60 and older, including those who have greatest economic and
			 social need, particularly low-income minority elderly;
(b) The views of public officials of the
			 units of general purpose local governments;
(c) The incidence of need for services
			 provided under the Older Americans Act and ORS Chapter 410 and the resources to
			 meet these needs;
(d) The
			 boundaries of existing areas within the State which were drawn for the planning
			 or administration of Older Americans Act programs;
(e) The location of units of general purpose
			 local government within the State; and
(f) Any other relevant factors, including
			 those listed in sections (8), (9) and (10) of this rule.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0110 - Designation of Area Agencies on Aging

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each Planning and Service Area shall have
			 only one designated Area Agency on Aging.
(2) The Administrator of the Division shall
			 designate Area Agencies on Aging.
(3) The designation shall comply with the
			 Older Americans Act by giving right of first refusal in designating new Area
			 Agencies on Aging to a unit of general purpose local government, of which the
			 boundaries, and the boundaries of the proposed Planning and Service Area, are
			 reasonably contiguous. If a unit of local government does not exercise this
			 right, the Division shall give preference to an established office on
			 aging.
(4) A designated Area Agency
			 on Aging shall be:
(a) An office or agency of
			 a unit of general purpose local government, which is selected by the chief
			 elected official of the unit to serve as an Area Agency; or
(b) Any office or agency designated by the
			 appropriate chief elected officials of any combination of units of general or
			 general and special purpose local government formed in accordance with ORS
			 Chapter 190; or
(c) A private
			 nonprofit organization.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0120 - Area Agency on Aging Applicant Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An applicant requesting to replace an
			 existing Area Agency on Aging must clearly establish the need for such a
			 change.
(2) It is the
			 responsibility of the applicant to submit sufficient information and supporting
			 documentation which will allow the Division to make a decision on
			 designation.
(3) Mandatory
			 Functions -- All information submitted by the applicant must specifically
			 address mandatory functions required of an Area Agency on Aging. These
			 functions are outlined as follows:
(a)
			 Staffing Functions -- An Area Agency on Aging must have a qualified director
			 and an adequate number of qualified staff (including full or part-time
			 bookkeeper and clerical support) to operate the program. The applicant shall
			 submit the following:
(A) Staff plan
			 identifying number and types of positions, position descriptions with minimum
			 qualifications and pay scales;
(B)
			 Draft personnel policy establishing organizational rules, standards, and
			 compliance actions with civil rights laws, affirmative action, and hiring
			 preference policy, and fringe benefit package, if any; and
(C) Organizational chart depicting lines of
			 authority and internal functions and responsibilities.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0130 - Designation of a Type B1 Area Agency on Aging

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A designated Type B1 Area Agency on Aging
			 shall meet the requirements of OAR
			 411-002-0110.
(2) Notwithstanding OAR
			 411-002-0110(4),
			 a designated Type B1 Area Agency on Aging shall be:
(a) An office or agency of a unit of general
			 purpose local government which is designated by the Chief elected official of
			 the unit to serve as an Area Agency; or
(b) Any office or agency designated by the
			 appropriate chief elected officials of any combination of units of general or
			 general and special purpose local government formed in accordance with ORS
			 Chapter 190.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0140 - Type B1 Area Agency on Aging Applicant Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) It is the responsibility of the applicant
			 to submit sufficient information and supporting documentation to allow the
			 Division to make a decision on a type B1 designation.
(2) A Type B1 Area Agency on Aging applicant
			 shall meet the requirements of OAR
			 411-002-0120 and the following
			 additional requirements: Mandatory Functions-- An applicant must submit
			 information that specifically addresses the mandatory functions required of a
			 Type B1 Area Agency on Aging. These functions are outlined as follows:
(a) Staffing Functions -- A Type B1 area
			 agency on aging must have an adequate number of qualified staff, including case
			 management capability, to operate the Medicaid program for the elderly.
			 Staffing patterns must be clearly identified for personnel who are assigned
			 Medicaid program responsibility. Staffing must adhere to standards established
			 by the Division.
(b) Planning
			 Functions -- Type B1 Area Agencies on Aging are required to provide a plan
			 describing how the agency intends to:
(A)
			 Administer the Medicaid programs for the elderly in the PSA and how the
			 Medicaid programs will be integrated into the overall service delivery system;
			 and
(B) Assure that elderly
			 Medicaid recipients in the area have reasonable access to information and
			 services; and
(C) Include any
			 necessary interagency agreements that affect the operation of the B1 Area
			 Agency on Aging. The Type B1 Area Agency on Aging will coordinate with the
			 local Disability Services Office(s) in its area to insure services that affect
			 both the elderly and disabled occur in a timely and effective manner.
(D) Basic Service Delivery Requirements - B1
			 area agencies on aging are required to meet basic Medicaid service delivery
			 requirements as required by the Division.
(E) Management Control Functions - B1 area
			 agencies on aging must establish policies and procedures to accomplish Medicaid
			 program goals as required by the Division.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0150 - Designation and Requirements of Type B2 Area Agencies on Aging

Current through Register Vol. 63, No. 7, July 1, 2024
A Type B2 Area Agency on Aging must meet the requirements of
				OAR 411-002-0110,
				411-002-0120,
				411-002-0130 and the following
				additional requirements: Mandatory Functions - All information submitted by the
				applicant must specifically address mandatory functions required of a B2 Area
				Agency on Aging. These functions are outlined as follows:
(1) Staffing Functions -- B2 Area Agencies on
			 Aging must have an adequate number of qualified staff, including case
			 management, to operate the program for disabled Medicaid recipients.
(2) Planning Functions -- B2 Area Agencies on
			 Aging are required to develop and administer an Area Plan for a comprehensive
			 and coordinated service delivery system in the Planning and Service Area. The
			 applicant shall submit the following documentation:
(a) A plan describing how the new agency
			 intends to:
(A) Assure the kinds and levels of
			 services needed by disabled Medicaid recipients in the area, and how these
			 findings will be integrated into the planning process; and
(B) Assure that disabled Medicaid recipients
			 in the area have reasonable access to information and services; and
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0155 - State Employee Supervision in a Type B1 or Type B2 Contract AAA

Current through Register Vol. 63, No. 7, July 1, 2024
General Requirements:
(1) The Department of Human Services (the
			 Department) and the AAA Contracted local government entities, in the best
			 interest of the affected State employees, must collaborate and cooperate in the
			 administration of state human resource policies. Communication regarding
			 changes in the Department of Administrative Services (DAS) and the Department's
			 human resource policies and procedures relating to State employee supervision
			 as well as communication regarding the day-to-day supervision and management of
			 State employees will be encouraged.
(2) Both parties must comply with externally
			 imposed Employment Relations Board (ERB) decisions, arbitration decisions,
			 Equal Employment Opportunity Commission (EEOC), Workers' Compensation (WC),
			 Americans with Disabilities Act (ADA), and other settlement decisions or
			 agreements.
(3) The Department will
			 be the sole negotiator for employment related settlements for State employees.
(a) Type B1 or Type B2 Contract AAAs, which
			 contract with the Department of Human Services for services of State employers,
			 are required to manage employees in accordance with the Collective Bargaining
			 Agreement between the SEIU, Local 503, Oregon Public Employees Union and
			 Department of Administrative Services, and the Department.
(A) The Collective Bargaining Agreement,
			 State and Federal laws, the Department of Administrative Services, and
			 Department rules and policies relating to supervision of State employees must
			 take precedent over Type B1 and Type B2 Contract AAA rules, policies or
			 procedures.
(B) The Department must
			 review any county or local government policies that will be applied to State
			 employees to ensure compliances with State, Federal, DAS, and DHS policies for
			 regulations.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0160 - Changing from a Type A or Type B1 AAA to a Type B2 AAA

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Type A or Type B1 Area Agencies on Aging
			 may request to change their model of service delivery to a Type B2 Area Agency
			 on Aging. The process for requesting the change is as follows:
(a) The AAA notifies the Division in writing
			 of its interest in changing to a Type B2 AAA.
(b) The Division will inform the Governor's
			 Commission on Senior Services, the Oregon Disabilities Commission and the local
			 Disability Services Advisory Council and Senior Advisory Council and provide
			 opportunity for local input.
(c)
			 The AAA will provide notice to affected populations and constituencies at the
			 local level of its intent to pursue a Type B2 model of service
			 delivery.
(d) The AAA will involve
			 affected stakeholders in the development of a process that includes identifying
			 any issues of concern, a process to address these concerns, and the development
			 of a service delivery plan.
(e) The
			 AAA will hold public hearings within the local area during the planning process
			 to receive comments and recommendations on the issues of concern and the
			 service plan.
(f) The Senior
			 Advisory Council and Disability Services Advisory Council will certify in
			 writing that they have been involved in developing the plan.
(g) Once the plan has been approved by the
			 Division, the operating level (office, division, or department of local
			 jurisdiction) of the AAA will amend its name to reflect the inclusion of
			 services to people with disabilities.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0170 - Withdrawal of Area Agency on Aging Designation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In carrying out provisions of the Older
			 Americans Act and ORS
			 410.100, the Division must
			 withdraw the agency designation whenever it, after reasonable notice and
			 opportunity for an Administrative Review and efforts at problem resolution have
			 been exhausted, finds that:
(a) An area
			 agency does not meet the requirements of 45 CFR 1321 ; or
(b) There is evidence of non-compliance with
			 provisions of the Area Plan contract.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 2 - DESIGNATION OF PLANNING AND SERVICE AREAS › Section 411-002-0175 - Methodology To Determine Budget Levels for Type B Area Agencies on Aging That Have Elected To Have Employment Transfer

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Definitions:
(a) A "Type B Transfer AAA" means a Type B
			 Area Agency on Aging that has elected to have employees transferred to
			 employment by the Area Agency by transfer agreement.
(b) A "Title XIX funded position" means a
			 position that is funded, in part, by Federal funds through Title XIX of the
			 Social Security Act.
(c) "SPD
			 Allocated Positions" means the position categories allocated to SPD field
			 offices. These are the categories of positions to be included for the Equity
			 comparison.
(d) "Annual OPE" means
			 the benefit rate as calculated by DHS. The resulting rate is used to calculate
			 the amount of OPE per type of position.
(e) "Indirect Cost Rate" means the percentage
			 rate used to calculate costs allocated to Type B Transfer AAA offices for
			 indirect costs, including State Government Service Charges and Infrastructure
			 Charges. An established indirect cost rate will not be amended in the middle of
			 the biennium. The initial indirect cost rate is set at 17.78% of the sum of
			 Salary and OPE expenses. The indirect cost rate will be re-based to be
			 effective the first day of the first biennium after the Department of
			 Administrative Services (DAS) changes rates that it publishes in its Price
			 List.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 4 - HOME AND COMMUNITY-BASED SERVICES AND SETTINGS AND PERSON-CENTERED SERVICE PLANNING › Section 411-004-0000 - Statement of Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The rules in OAR chapter 411, division 4 provide a foundation
				of standards to support the network of Medicaid-funded and private pay
				residential and non-residential Home and Community-Based Services (HCBS), Home
				and Community-Based (HCB) settings, and person-centered service planning for
				individuals receiving HCBS in Oregon. Additional standards are set forth in OAR
				chapters 309 and 411.
(1) These rules
			 are consistent with the missions and goals of the Department of Human Services
			 (DHS) and the Oregon Health Authority (OHA) to help people achieve optimum
			 physical, mental, and social well-being and independence.
(2) These rules ensure that individuals
			 receive HCBS in settings that are integrated in and support the same degree of
			 access to the greater community as people not receiving HCBS, including
			 opportunities for individuals enrolled in or utilizing HCBS to:
(a) Seek employment and work in competitive
			 integrated employment settings;
(b)
			 Engage in greater community life;
(c) Control personal resources; and
(d) Receive services in the greater
			 community.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 4 - HOME AND COMMUNITY-BASED SERVICES AND SETTINGS AND PERSON-CENTERED SERVICE PLANNING › Section 411-004-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless the context indicates otherwise, the following
				definitions apply to the rules in OAR chapter 411, division 4:
(1) "CMS" means the U.S. Department of Health
			 and Human Services, Centers for Medicare and Medicaid Services.
(2) "Competitive Integrated Employment" means
			 work that is performed on a full-time or part-time basis (including
			 self-employment):
(a) For which an
			 individual:
(A) Is compensated at a rate
			 that:
(i) Is not less than the higher of the
			 rate specified in federal, state, or local minimum wage law, and also is not
			 less than the customary rate paid by the employer for the same or similar work
			 performed by other employees who are not individuals with disabilities, and who
			 are similarly situated in similar occupations by the same employer and who have
			 similar training, experience, and skills; or
(ii) In the case of an individual who is
			 self-employed, yields an income that is comparable to the income received by
			 other individuals who are not individuals with disabilities, and who are
			 self-employed in similar occupations or on similar tasks and who have similar
			 training, experience, and skills.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 4 - HOME AND COMMUNITY-BASED SERVICES AND SETTINGS AND PERSON-CENTERED SERVICE PLANNING › Section 411-004-0020 - Home and Community-Based Services and Settings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Residential and non-residential HCB
			 settings must have all of the following qualities:
(a) The setting is integrated in and supports
			 the same degree of access to the greater community as people not receiving
			 HCBS, including opportunities for individuals enrolled in or utilizing HCBS to:
(A) Seek employment and work in competitive
			 integrated employment settings;
(B)
			 Engage in greater community life;
(C) Control personal resources; and
(D) Receive services in the greater
			 community.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 4 - HOME AND COMMUNITY-BASED SERVICES AND SETTINGS AND PERSON-CENTERED SERVICE PLANNING › Section 411-004-0040 - Individually-Based Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
This rule will begin being implemented January 1, 2017. The
				requirements in this rule must be in place no later than June 30, 2020.
				Individual program rules may require compliance to this rule earlier than June
				30, 2020.
(1) When the condition under
			 OAR 411-004-0020(1)(d)
			 may not be met due to a threat to the health and safety of an individual or
			 others, an individually-based limitation process, as described in this rule,
			 must apply in any residential or non-residential setting.
(2) When a condition under OAR
			 411-004-0020(2)(d) to
			 (2)(j) may not be met due to a threat to the
			 health and safety of an individual or others in a provider owned, controlled,
			 or operated residential setting, an individually-based limitation process, as
			 described in this rule, must apply.
(3) An individually-based limitation must be
			 supported by a specific assessed need and documented in the person-centered
			 service plan by completing and signing a program approved form documenting the
			 consent to the appropriate individually-based limitation. The form identifies
			 and documents, at minimum, all of the following requirements:
(a) The specific and individualized assessed
			 need justifying the individually-based limitation.
(b) The positive interventions and supports
			 used prior to any individually-based limitation.
(c) Less intrusive methods that have been
			 tried but did not work.
(d) A clear
			 description of the limitation that is directly proportionate to the specific
			 assessed need.
(e) Regular
			 collection and review of data to measure the ongoing effectiveness of the
			 individually-based limitation.
(f)
			 Established time limits for periodic reviews of the individually-based
			 limitation to determine if the limitation should be terminated or remains
			 necessary. The individually-based limitation must be reviewed at least
			 annually.
(g) The informed consent
			 of the individual or, as applicable, the legal representative of the
			 individual, including any discrepancy between the wishes of the individual and
			 the consent of the legal representative.
(h) An assurance that the interventions and
			 support do not cause harm to the individual.
(i) For restraints, there is a physician or
			 other qualified practitioner order for the use of restraint. Individual
			 licensing authorities may adopt stricter criteria regarding the use of
			 restraints.