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 411-045-0010 - 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 045:
(1) Administrative Hearing - A hearing
			 related to a denial, reduction, or termination of benefits that is held when
			 requested by the PACE participant or his or her representative. A hearing may
			 also be held when requested by a PACE participant who believes a claim for
			 services was not acted upon with reasonable promptness or believes the payor
			 took an action erroneously.
(2)
			 Advance Directive - A process that allows a person to have another person make
			 health care decisions when he or she is unable to make the decision and tell a
			 doctor what life sustaining measures to take if he or she is near death.
(3) Aging and People with
			 Disabilities Division (APD) - A division within the Department that is the
			 designated State Unit on Aging (SUA) that also administers Medicaid's long-term
			 care program. APD is responsible for nursing facility and Medicaid home and
			 community-based services for eligible older adults and individuals with
			 disabilities. APD includes local offices and the AAAs who have contracted to
			 perform specific functions of the licensing and enrollment processes.
(4) Alternate Service Settings -
			 Residential 24-hour care facilities that include, but are not limited to,
			 residential care facilities, assisted living facilities, adult foster homes,
			 and nursing facilities.
(5)
			 Americans with Disabilities Act (ADA) - Federal law defining the civil rights
			 of persons with disabilities. The ADA requires that reasonable accommodations
			 be made in employment, service delivery, and facility accessibility.
(6) Ancillary Services - Those medical
			 services that are medically appropriate to support a covered service under the
			 PACE benefit package. A list of ancillary services and limitations is specified
			 in DMAP's Ancillary Services Criteria Guide.
(7) Appeal - A PACE participant's action
			 taken with respect to any instance where the PACE program reduces, terminates,
			 or denies a covered service.
(8)
			 Area Agency on Aging (AAA) - An established public agency within a planning and
			 service area designated under Section 305 of the Older American's Act that has
			 responsibility for local administration of Department programs. AAAs contract
			 with the Department to perform specific activities in relation to PACE programs
			 including processing of applications for Medicaid and determining the level of
			 care required under Oregon's State Medicaid Plan for coverage of nursing
			 facility services.
(9) Assessment
			 - The determination of a participant's need for covered services. An assessment
			 involves the collection and evaluation of data by each of the members of the
			 Interdisciplinary Team pertinent to the participant's health history and
			 current problems obtained through interview, observation, and record review.
			 The Assessment concludes with one of the following:
(a) Documentation of a diagnosis providing
			 the clinical basis for a written care plan; or
(b) A written statement that the participant
			 is not in need of covered services for a particular condition.