reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0040 - Employer-Employee Relationship

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0050 - Provider Qualifications

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0055

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  409.050 &
				  410.070
Stats. Implemented: ORS
				  409.010,
				  410.020,
				  410.070, &
				  411.675
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0070 - State Plan Personal Care Service Assessment, Authorization, and Monitoring

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PERSONAL CARE
			 ASSESSMENT. The assessment process identifies an individual's ability to
			 perform ADLs, IADLs, and determines an individual's ability to address health
			 and safety concerns.
(a) A case manager must
			 meet in person with an individual to assess the individual's ability to perform
			 the personal care tasks listed in OAR
			 411-034-0020 at least once every
			 calendar year (365 days).
(b) The
			 individual may request that others participate in the assessment
			 process.
(c) A case manager must
			 consider an individual's service needs, identify the resources meeting any of
			 the individual's needs, and determine if the individual is eligible for State
			 Plan personal care services or other services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0090 - Payment Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0091 - Exceptions to Maximum Hours of Service

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility for SPPC Exceptions to
			 Maximum Hours of Service.
(a) If the
			 Department determines the individual's assessed service needs will not be met
			 within the maximum 270 annual hours as set forth in Oregon's Medicaid State
			 Plan the individual may receive an exception to the maximum annual
			 hours.
(b) The Department may deny
			 an exception if the request is:
(A) Based on a
			 request for services outside of assessed service needs.
(B) Not medically appropriate.
(C) For assistance types not allowed by OAR
			 411-034-0010(6)
			 for a particular ADL or IADL.
(D)
			 For services not covered in the Medicaid State Plan, OAR
			 411-034-0020(2).
(E) For tasks not identified in OAR
			 411-034-0020(2).
(c) An exception is valid for the
			 period determined by the case manager and communicated to the individual in the
			 notice, not to exceed one calendar year.
(d) If an individual has an existing approved
			 SPPC exception, a new request must be submitted after the annual assessment is
			 completed and will be reviewed prior to the exception end date. If the
			 individual requests the same or fewer exception hours, a decision to renew the
			 exception may be made if section (3)(d) of this rule is not met. The case
			 manager may supply the required documentation as outlined in section (4) of
			 this rule.
(e) Exceptions may be
			 reviewed at reassessments, change of care setting or living situations, or
			 change of conditions.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0015 - Eligibility for Supplemental K State Plan Services

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0020 - Reserved

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  409.050,
				  410.040,
				  410.090,
				  410.210 to
				  410.300,
				  441.520
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0025 - Eligibility for Consumer Electronic Back-up Systems and Assistive Technology

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0030 - Eligible Electronic Back-up Systems and Assistive Technology Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0035 - Provider Qualifications and Requirements for Electronic Back-up Systems and Assistive Technology

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0040 - Eligibility Criteria for Chore Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0045 - Eligible Chore Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0050 - Chore Service Provider Qualifications and Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(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
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0055 - Eligibility for Consumer Environmental Modifications

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0060 - Eligible Environmental Modification Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0065 - Environmental Modification Provider Qualifications and Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers of
			 the environmental modification must have a distinct Medicaid provider number
			 before the work begins.
(2)
			 Modifications over $500 must be completed by a state licensed
			 contractor.
(3) Modifications
			 requiring a permit must be inspected and certified, by an inspector, to ensure
			 compliance with local codes.
(4) No
			 material upgrades or supplemental payments to the provider are allowed by
			 landlords or informal supports.
(5)
			 No monetary funds may be released to the provider until the work is finished
			 and meets the specifications of the modification agreement. Providers must
			 provide documentation, such as pictures of the completed work and signed
			 releases from the consumer, prior to receiving payment from the
			 Department.
(6) Providers must
			 include drawings or pictures when possible with all bids of proposed
			 Environmental Modifications.
(7)
			 Providers must supply a revised bid when requested by designated Central Office
			 staff.
(8) Providers must submit
			 the final invoice for payment within one year of the date of service.
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
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0070 - Eligibility for Consumer Transition Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility for transition services
			 covered through the K-State Plan are restricted to consumers transitioning from
			 a nursing facility or the Oregon State Hospital, as defined in OAR
			 309-091-0005(16),
			 into a community-based or in-home program.
(2) Consumers transitioning from an acute
			 care hospital directly to a community-based or in-home program are not eligible
			 for transition services under this rule.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  409.050,
				  410.040,
				  410.090,
				  410.210 to
				  410.300,
				  441.520
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0075 - Eligible Transition Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Approval for services and supports must:
(a)
			 Be based on an assessed need determined during the person-centered service
			 planning process.
(b) Support the
			 desires and goals of the consumer receiving services and supports.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0080 - Transition Services Provider Qualifications and Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers of
			 cleaning or moving services must have a distinct Medicaid provider number
			 before providing services.
(2)
			 Movers must have a certificate of authority or a permit from the Oregon
			 Department of Transportation.
(3)
			 No monetary funds shall be released to the provider until the work has been
			 completed.
(4) Providers must
			 supply a revised bid when requested by designated Central Office
			 staff.
(5) 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
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0085 - Consumer Eligibility Criteria for Voluntary Consumer Training Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible
			 for K-State Plan Voluntary Consumer Training Services, consumers must be or be
			 expected to, receive services in a setting described in OAR
			 411-030-0033, In-Home Service
			 Living Arrangement.
(2) Services
			 are voluntary in nature.
(3)
			 Services may be provided to designated representatives performing the duties of
			 a consumer-employer on behalf of the consumer.
(4) Natural supports and designated
			 representatives may receive services in addition to the eligible consumer.
(5) All in-home consumers
			 participating in the Consumer-Employed Provider Program must be offered the
			 voluntary training during the in-home service planning process. Case managers
			 must make a referral to an approved training provider.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  409.050,
				  410.040,
				  410.090,
				  410.210 to
				  410.300,
				  441.520
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0090 - Voluntary Consumer Training Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) GENERAL GUIDELINES.
(a) State K-Plan voluntary training services
			 are offered on how to select; manage; and dismiss homecare workers.
(b) The training must meet the needs of
			 consumers in regards to selecting, managing, and dismissing attendants.
(c) The training must be provided
			 in a culturally competent manner.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 35 - K-STATE PLAN ANCILLARY SERVICES › Section 411-035-0095 - Provider Qualifications and Requirements for Voluntary Consumer Training Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To
			 ensure services are consistent with the provision of the state's comprehensive
			 voluntary consumer training services, providers must be approved by, or have a
			 contract with, the Oregon Home Care Commission.
(2) Services must be provided by providers
			 who have experience providing direct or educational services to seniors and
			 people with physical disabilities and who:
(a) Demonstrate knowledge of DHS rules
			 pertaining to in-home services;
(b)
			 Demonstrate skills in communication, person-centered planning, and in providing
			 individual supports, which are needed to provide the services described in this
			 rule;
(c) Have fulfilled background
			 check requirements for the programs in which the provider is providing
			 services; and
(d) Participate in
			 ongoing technical assistance and conferences provided by the Oregon Home Care
			 Commission.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 37 - COMMUNITY-BASED CARE TRANSITION SERVICES › Section 411-037-0010 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
Community Transition Services are non-recurring set-up expenses
				for individuals who are transitioning from licensed community based care
				settings or acute care hospitals to an in-home service setting defined in OAR
				411-030-0033 where the person
				would be directly responsible for his or her own living
				expenses.
Statutory/Other Authority: ORS
				  409.050 &
				  410.070
Statutes/Other Implemented: ORS
				  409.050 &
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 37 - COMMUNITY-BASED CARE TRANSITION SERVICES › Section 411-037-0020 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Central
			 Office" means the Program office of the Department.
(2) "Consumer" means the person applying for
			 or eligible for Medicaid home or community-based services.
(3) "Department" means the Department of
			 Human Services (DHS).
(4)
			 "Transition Services and Supports" means services that are non-recurring set-up
			 expenses for individuals who are transitioning from a licensed community based
			 care setting or an acute care hospital to a living arrangement in a private
			 residence where the person is directly responsible for his or her own living
			 expenses.
Statutory/Other Authority: ORS
				  409.050 &
				  410.070
Statutes/Other Implemented: ORS
				  409.050 &
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 37 - COMMUNITY-BASED CARE TRANSITION SERVICES › Section 411-037-0030 - Eligibility for Community Transition Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility for community transition
			 services are restricted to consumers transitioning from a community-based care
			 facility or an acute care hospital to an in-home setting, described in
			 411-030-0033.
(2) Consumers transitioning between
			 community-based care facilities or from other institutions are not eligible for
			 Community Transition Services defined in this rule. Consumers not eligible
			 under these rules may be eligible for transition services defined in OAR
			 chapter 411, division 035.
Statutory/Other Authority: ORS
				  409.050 &
				  410.070
Statutes/Other Implemented: ORS
				  409.050 &
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 37 - COMMUNITY-BASED CARE TRANSITION SERVICES › Section 411-037-0040 - Community Transition Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Approval for services and supports must:
(a)
			 Be based on an assessed need determined during the person-centered service
			 planning process.
(b) Support the
			 desires and goals of the consumer receiving services and supports.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 37 - COMMUNITY-BASED CARE TRANSITION SERVICES › Section 411-037-0050 - Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
Community Transition Services:
(1) Are furnished only to the extent that
			 they are reasonable and necessary as determined through the service plan
			 development process, clearly identified in the service plan and the person is
			 unable to meet such expense or when the services cannot be obtained from other
			 sources.
(2) Do not include any of
			 the following:
(a) Monthly rental or mortgage
			 expense.
(b) Food.
(c) Regular utility charges.
(d) Household appliances or items that are
			 intended for purely diversional or recreational purposes.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0000 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Home
			 delivered meals, exclusive of those funded through the Older Americans Act or
			 Oregon Project Independence, constitute a service that can be provided as part
			 of a waivered services care plan to assist a client to remain in his/her own
			 home.
(2) Payment for meals
			 delivered to the client at his/her home may be provided when other plans do not
			 appear feasible and home delivered meals are determined by the Department's
			 local unit to be more appropriate for the client's needs than nursing facility
			 care. The cost for these meals shall be calculated into the service plan in
			 conjunction with in-home services provided by a client-employed provider or a
			 home care agency.
(3) All requests
			 for home delivered meals will be referred to the Department's local
			 unit.
(4) The Department's unit
			 staff are responsible for establishing, authorizing, purchasing and monitoring
			 a plan for home-delivered meals.
(5) Clients who are required to make a
			 monthly payment under OAR
			 461-185-0050 in order to remain
			 eligible for Medicaid waiver services must have their home-delivered meal costs
			 calculated in conjunction with their in-home service provider costs.
(a) To remain eligible for waiver services,
			 pay-in clients are responsible for payment of authorized home-delivered meals
			 received up to their specified monthly pay-in amount. Client payments due for
			 meal services are to be included as part of the monthly sum sent to the
			 Department's pay-in unit rather than making any direct payments to the meal
			 provider.
(b) The Department is
			 responsible for direct payments made to providers for all authorized
			 home-delivered meals to waiver service eligible clients. Direct payment from
			 the Department includes meals paid through the client's monthly pay-in and for
			 meals that exceed the client's total monthly liability.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0010 - 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 040:
(1) "Approved Carrier" means the United
			 States Postal Service, or other carrier, who can ensure providers have passed
			 criminal background checks to protect the well-being of the Medicaid eligible
			 participant. Use of an Approved Carrier must be approved by the Department,
			 Aging and People with Disabilities or the Area Agency on Aging (AAA).
(2) "Client Liability" means the
			 dollar amount participants with excess income must contribute to the cost of
			 service pursuant to OAR
			 461-160-0610 and
			 461-160-0620.
(3) "Department" means the Department of
			 Human Services (DHS).
(4)
			 "Homebound" means that leaving home is a significant effort to the point that
			 leaving home unassisted is not normally possible.
(5) "Home Delivered Meals" means meals that
			 are delivered to a Medicaid eligible participant in their own home or apartment
			 per 411-040-0035 of this rule.
(6) "Meal preparation" means
			 safely preparing food as defined in
			 411-015-0007(6).
(7) "Medicaid eligible individual"
			 means a participant who meets the eligibility criteria defined in OAR
			 411-015-0000 through
			 411-015-0100.
(8) "Medicaid Home Delivered Meal Provider"
			 means an approved home delivered meal provider that meets the qualifications in
			 these rules and has an active Medicaid provider number.
(9) "Natural Supports" means resources and
			 supports (e.g. relatives, friends, significant others, neighbors, roommates, or
			 the community) who are willing to voluntarily provide services to an individual
			 without the expectation of compensation. Natural supports are identified in
			 collaboration with the individual and the potential "natural support". The
			 natural support is required to have the skills, knowledge and ability to
			 provide the needed services and supports.
(10) "Nutrition education" means a program to
			 promote better health by providing accurate and culturally sensitive nutrition,
			 physical fitness, or health (as it relates to nutrition) information and
			 instruction to participants, caregivers, or participants and caregivers in a
			 group or individual setting overseen by a dietitian or individual of comparable
			 expertise.
(11) "Nutrition
			 screening survey" means the act of screening a participant's nutrition risk.
(12) "Participant" means a
			 Medicaid eligible individual receiving Medicaid home delivered meals.
(13) "Provider" means Medicaid
			 home delivered meal provider.
Stat. Auth.: ORS
				  410.070,
				  411.060, &
				  411.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0020 - Client Eligibility and Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible for Medicaid home
			 delivered meals a participant must:
(a) Be
			 Medicaid eligible per
			 411-015-0100, and be receiving
			 Medicaid long term services and supports in their own home;
(b) Be home-bound;
(c) Be unable to do meal preparation on a
			 regular basis without assistance; and
(d) Not have natural supports available that
			 are willing and able to provide meal preparation services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0030 - Medicaid Home Delivered Meal Provider Qualifications and Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 To be in alignment with the provision of services, home delivered meal
			 providers must have contracts with, or be, an AAA as defined in
			 411-002-0100(1).
(2) The provider must be in
			 compliance, during all stages of food service operation, with applicable
			 federal, state and local regulations, codes, and licensor requirements relating
			 to fire; health; sanitation; safety; building and other provisions relating to
			 the public health, safety, and welfare of meal patrons.
(3) The provider must demonstrate that menu
			 standards are developed to sustain and improve a participant's health through
			 the provision of safe and nutritious meals that are approved by a dietician.
(4) Each provider must be an
			 enrolled Medicaid provider approved to provide Medicaid home delivered meals.
(5) The provider must ensure that
			 all requirements in OAR
			 411-040-0035 through
			 411-040-0037 are met.
(6) Providers must ensure that anyone who
			 delivers meals:
(a) Have passed a background
			 check as defined in OAR
			 407-007-0275; or
(b) Uses an approved carrier.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0035 - Meal Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each
			 meal served must meet the current United States Department of Agriculture and
			 Health and Human Services Dietary Guidelines and contain at least 33-1/3
			 percent of the current Dietary Reference Intakes as established by the Food and
			 Nutrition Board of the National Academy of Science-National Research Council.
(2) Foods must be prepared,
			 served, and transported:
(a) With the least
			 possible manual contact;
(b) With
			 suitable utensils; and
(c) On
			 surfaces that have been cleaned, rinsed, and sanitized to prevent cross
			 contamination prior to use.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0036 - Service Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Except
			 as provided in subsection (2), providers must provide:
(a) In-person delivery whereby a paid staff
			 or volunteer delivers the meal to the participant's home. To the extent
			 possible, the staff or volunteers must report any changes in participant's
			 condition or concerns to the participant's case manager.
(b) Nutrition screening survey.
(A)The nutrition screening survey must be
			 designed to indicate signs of poor nutritional health. In situations in which
			 the screening shows that the individual has poor nutritional health, the
			 provider will contact the participant's Medicaid case manager.
(B) Nutrition screening surveys will be
			 completed at intake and at annual updates.
(c) Nutrition education.
(A) Nutrition education will be provided a
			 minimum of one time per year.
(B)
			 Nutrition education is required to be offered at the first nutrition risk
			 assessment.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0037 - Staff and Volunteer Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Prior to having direct contact with
			 participants, staff and volunteers must successfully pass a criminal background
			 check.
(2) All staff and
			 volunteers involved in food preparation will have training in:
(a) Portion control;
(b) FDA Food Code practices for sanitary
			 handling of food;
(c) Oregon food
			 safety requirements; and
(d)
			 Agency safety policies and procedures.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0040 - Provider Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers
			 will be reimbursed on a per meal basis, no more than 1 meal per day within the
			 month.
(2) Provider rates will be
			 published on the Department's rate table.
Stat. Auth.: ORS
				  410.070,
				  411.060, &
				  411.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0050 - Local Office Responsibility and Oversight

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department shall establish,
			 authorize, purchase, and monitor the standards for Medicaid paid home delivered
			 meals.
(2) Case managers must
			 authorize Medicaid home delivered meal services.
(3) Subsequent yearly nutrition education:
(a) May be determined by local Medicaid home
			 delivered meal providers; and
(b)
			 Will be monitored by the Medicaid case manager at least annually.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 40 - MEDICAID FUNDED HOME DELIVERED MEALS › Section 411-040-0060 - Impact on Client Liability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 cost for home delivered meals shall be calculated into the service plan, in
			 addition to in-home services provided by a client-employed provider or a home
			 care agency.
(2) Participants
			 required to make a client contribution, under OAR
			 461-185-0050, must have their
			 home-delivered meal costs added to cost of care calculations.
Stat. Auth.: ORS
				  410.070,
				  411.060, &
				  411.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 44 - OREGON LIFESPAN RESPITE CARE PROGRAM › Section 411-044-0000 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
Lifespan respite care is a community-based system of accessible
				respite care services for any individual and/or family regardless of age,
				income, ethnicity, race, special need or situation. Lifespan respite care
				services can include providing respite-related information to the community,
				recruitment and training of paid and volunteer respite providers, connecting
				individuals and/or families with respite care providers and linking individuals
				and/or families with respite care payment resources.
Stat. Auth.: ORS
				  409.050 &
				  409.474
Stats. Implemented: ORS
				  409.450 -
				  409.478
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 44 - OREGON LIFESPAN RESPITE CARE PROGRAM › Section 411-044-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Department"
			 means the Department of Human Services of the State of Oregon.
(2) "Special Needs" may encompass physical,
			 emotional, and/or mental illnesses and/or conditions an individual may
			 experience which result in the need for ongoing care and supervision, such as:
(a) Developmental disabilities;
(b) Physical disabilities;
(c) Mental illnesses;
(d) Emotional and behavioral
			 disorders;
(e) Alzheimer's disease
			 and related disorders;
(f) Chronic
			 illness; and
(g) Medical
			 fragility.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 44 - OREGON LIFESPAN RESPITE CARE PROGRAM › Section 411-044-0020 - Application Procedures

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department may solicit applications for the development and implementation of
			 community-based lifespan respite care services systems.
(2) Applicants shall be:
(a) Private non-profit;
(b) For profit;
(c) Public agency; or
(d) A coalition that has a designated fiscal
			 agent.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 44 - OREGON LIFESPAN RESPITE CARE PROGRAM › Section 411-044-0030 - Application Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department shall review all applications and may request any additional
			 information needed to assure applications are complete.
(2) After an application is determined to be
			 complete and concordant with the intended goals and outcomes of the program, it
			 shall be forwarded to the Lifespan Advisory Review Committee, a sub-committee
			 of the Oregon Family Support Council, for review and possible recommendation
			 for selection approval.
(3) In
			 reviewing applications, the Committee shall consider the following elements:
(a) The amount of available funds for the
			 Oregon Lifespan Respite Care Program;
(b) The existence of a strong community
			 coalition representing children, adults and seniors with special needs and
			 situations. The coalition should include, but not be limited to, members from
			 the following areas:
(A) Families and/or
			 consumers;
(B) Respite
			 providers;
(C) Medical and/or
			 health related fields;
(D) State,
			 federal and/or county agencies;
(E)
			 Private businesses;
(F) Civic,
			 social and community organizations;
(G) Faith communities; and
(H) Community volunteers.
(c) The willingness and ability to
			 contract with the Department and participate in all required Oregon Lifespan
			 Respite Care Program activities;
(d) The ability to articulate program
			 outcomes and strategies, which include Family Support principles, as described
			 in ORS 417.342;
(e) The amount of in-kind services;
(f) The stability of other funding sources;
			 and
(g) Additional departmental
			 administrative costs or responsibilities associated with the individual
			 application.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 44 - OREGON LIFESPAN RESPITE CARE PROGRAM › Section 411-044-0040 - Selection

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Director of
			 the Department of Human Services or his/her designee shall make the final
			 decision regarding selection of community-based lifespan respite
			 programs.
(2) The Department shall
			 notify applicants in writing of the approval or rejection of the
			 applications.
(3) Selected
			 applicants shall:
(a) Develop and maintain a
			 point of contact for access to lifespan respite care services within a
			 designated geographical area;
(b)
			 Develop and maintain a mechanism to recruit and screen potential respite
			 providers and volunteers;
(c)
			 Identify local training resources and coordinate respite training opportunities
			 for caregivers, respite providers, and families;
(d) Publicize the lifespan respite care
			 program phone number and address; and
(e) Comply with all program policies and
			 guidelines established by the Oregon Lifespan Respite Care Program.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 45 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 411-045-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Program of
			 All-inclusive Care for the Elderly (PACE) is a permanent provider type under
			 Medicare that allows states the option to pay for PACE services under Medicaid.
			 The PACE program is capitated by both Medicare and Medicaid to provide all
			 medical and long-term care services.
(2) The intent of these rules is to implement
			 the PACE program as administered by the Department of Human Services and to
			 address the responsibilities of the Department as the state administering
			 agency under 42 CFR 460, that includes additional obligations of coordination
			 with CMS in the administration of the Medicare aspects of the PACE program. The
			 Department will regularly consult with CMS in conducting related
			 responsibilities and in the implementation of the PACE program through the
			 submission of appropriate state plan amendments and the PACE program
			 agreement.
Stat. Auth.: ORS
				  410.090
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 45 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 411-045-0020 - Program Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 PACE program must be, or be a distinct part of, one of the following:
(a) An entity of a city, county, state, or
			 tribal government;
(b) A private,
			 not-for-profit entity organized for charitable purposes under section
			 501(c)(3) of the
			 Internal Revenue Code or 1986; or
(c) A PACE for-profit demonstration program
			 that has been approved by CMS.