reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 5 - PRIVACY OF PROTECTED INFORMATION › Section 411-005-0010 - Disclosure of Information to the Client or Third Party

Current through Register Vol. 63, No. 7, July 1, 2024
This rule applies to programs covered by chapter 411 of the
				Oregon Administrative Rules.
(1)
			 Except as provided in section (2) of this rule and OAR
			 410-014-0030:
(a) The Department must make information in a
			 client case record or record of service as defined in
			 411-320-0070 available to the
			 client or anyone authorized by the client.
(b) Information that was obtained from a
			 third party, becomes part of the case record of the client and is available to
			 the client.
(c) Case record
			 information may be requested by the client and released to the client or third
			 party by telephone. The client must satisfy the local office as to their
			 identity. A verbal authorization from the client is permitted to allow verbal
			 release of case record information specified by the client to third parties.
			 Each authorization is valid for a period of 30 days from the date the
			 authorization is given verbally, unless a shorter time period is
			 given.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 5 - PRIVACY OF PROTECTED INFORMATION › Section 411-005-0015 - Release of Information to a Law Enforcement Officer

Current through Register Vol. 63, No. 7, July 1, 2024
For any program covered by chapter 411 of the Oregon
				Administrative Rules:
(1) The
			 Department may provide client information only to a law enforcement officer in
			 any of the following situations:
(a) The law
			 enforcement officer is involved in carrying out public assistance laws, or any
			 investigation, criminal or civil proceedings connected with administering the
			 Department's benefit programs.
(b)
			 The disclosure is required or authorized by statute or administrative
			 rule.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 5 - PRIVACY OF PROTECTED INFORMATION › Section 411-005-0020 - Release of Information to a State or Federal Legislative Body or Committee

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department may not disclose any information identifying any client by name or
			 address to any committee, advisory board, legislative body, or individual
			 member of such committee, board, or body without written consent of the
			 client.
(2) The Department may
			 disclose the minimum necessary information about a client to a public official
			 who has been asked by the client to review an action taken by the
			 Department.
Stat. Auth.: ORS
				  410.140 &
				  411.300
Stats. Implemented: ORS
				  410.140 &
				  410.150
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 5 - PRIVACY OF PROTECTED INFORMATION › Section 411-005-0035 - Release of Information in Judicial Proceedings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Client specific information must not be
			 divulged in any judicial proceeding unless:
(a) The proceeding is directly connected with
			 administration of public assistance or service under chapter 411 of the Oregon
			 Administrative Rules; or
(b) The
			 client has given written authorization for release of specific information at
			 the judicial proceeding; or
(c) A
			 judge orders the release of the information.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 5 - PRIVACY OF PROTECTED INFORMATION › Section 411-005-0045 - Release of Alcohol and Drug and Mental Health Reports

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Unauthorized use, disclosure and
			 redisclosure of alcohol and drug treatment information and mental health
			 information is prohibited.
(2) A
			 client has the right to restrict to what entity or person and for what purpose
			 treatment information may be disclosed.
(3) The client's right to limit use and
			 disclosure of alcohol and drug and mental health information must be
			 communicated to the client.
Stat. Auth.: ORS
				  410.140 &
				  411.300
Stats. Implemented: ORS
				  410.140 &
				  410.150,
				  179.505
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 11 - PROVISION OF SERVICES BY AREA AGENCIES ON AGING AND COMPETITIVE PROCUREMENT › Section 411-011-0000 - Provision of Services by Area Agencies on Aging (AAAs)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "No supportive or nutrition services will
			 be directly provided by the State agency or an Area Agency on Aging, except
			 where, in the judgment of the State agency, provision of such services by the
			 state agency or an Area Agency on Aging is necessary to assure an adequate
			 supply of such services, or where such services are directly related to such
			 State or Area Agency on Aging's administrative functions, or where such
			 services of comparable quality can be provided more economically by such State
			 or Area Agency on Aging." (Older Americans Act, as amended through 1984,
			 Section 307(a)(10)).
(2) In
			 districts where the county has been designated the Area Agency on Aging and
			 where the county has multiple responsibilities for health and social service
			 delivery, services may be provided through an interagency agreement between the
			 Area Agency on Aging and the pertinent health or social services components of
			 the county.
(3) Decision of the
			 Seniors and People with Disabilities Division on provision of services shall be
			 based on the following criteria:
(a) Adequacy
			 of supply;
(b) Administrative
			 functions:
(A) Program Development,
			 Coordination, Advocacy, Title XIX Case Management, and Oregon Project
			 Independence Case Management at the option of the Area Agency on Aging are
			 considered integral to AAA administration;
(B) The AAA may also provide service(s)
			 directly when it can demonstrate, on the basis of documentation in the area
			 plan, that it would not be practical to separate the service(s) from the AAA's
			 overall administrative functions. The services which may be directly related to
			 administrative functions are: non-Title XIX Case Management, Information and
			 Referral and Meal Site Supervision;
(c) Quality and Economy -- This will be based
			 upon the competitive process as specified under OAR
			 411-011-0005(2).
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 11 - PROVISION OF SERVICES BY AREA AGENCIES ON AGING AND COMPETITIVE PROCUREMENT › Section 411-011-0005 - Competitive Procurement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General
			 Requirements:
(a) The Competition in
			 Contracting Act of 1984 requires that, in the procurement of services, there be
			 a solicitation, and that it be designed to achieve full and open competition
			 for the procurement;
(b) A
			 competitive process requires use of performance based contracts. The contract
			 type will be a firm, fixed unit rate; fixed rate with economic adjustment; or
			 fixed ceiling price contract. The contract will state the conditions under
			 which economic adjustment will occur, and/or under what conditions cost will be
			 allowed within a fixed ceiling price contract;
(c) Contract principles described in
45 CFR Part 74 ; Title 41 Code of Federal Regulations
; and the
Federal Acquisition Regulation (FAR), Part 6
, outlines the
			 principal processes for contracting and are to be followed in procuring
			 services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 11 - PROVISION OF SERVICES BY AREA AGENCIES ON AGING AND COMPETITIVE PROCUREMENT › Section 411-011-0010 - Competitive Procurement for Nutrition Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In accordance with the Older Americans
			 Act, as amended through 1984:
"No contract awarded after September 30,
			 1982, shall be entered into for the provision of nutrition services unless such
			 contract has been awarded through a competitive process. Such process shall
			 include evaluation of each bidder's experience in providing services to older
			 individuals. Whenever there is no evidence of improved quality of service and
			 cost effectiveness on the part of another bidder, a provider of services, who
			 received funds under Title VII of the Older Americans Act of 1965 as in effect
			 on September 29, 1978, shall be given preference"
. (Section
			 501(b))
(2) Those elements of
			 nutrition services relevant to competitive contracting are meal preparation and
			 meal service delivery and management.
(3) The Area Agency on Aging (AAA) may apply
			 the criteria under OAR
			 411-011-0005(2)
			 to meal preparation and meal service delivery management combined or separately
			 and in any combination of geographic locations. Additionally, these criteria
			 may be applied to management of a local site of which nutrition services are
			 but one component.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.250,
				  410.270 &
				  410.280
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 11 - PROVISION OF SERVICES BY AREA AGENCIES ON AGING AND COMPETITIVE PROCUREMENT › Section 411-011-0015 - Response by Area Agency on Aging to Requests for Proposal

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An Area Agency
			 on Aging may respond to its own Request for Proposal (RFP). In doing so, it
			 shall process the evaluation of responses to such a Request for Proposal in the
			 following manner:
(a) The Area Agency on
			 Aging shall place its pricing (only unit cost) proposal, along with the notice
			 of intent to propose, in the RFP so that all other agencies or organizations
			 wishing to submit proposals may determine whether or not they are able to
			 submit proposals in competition to the one published by the Area Agency on
			 Aging;
(b) When another agency or
			 organization submits a proposal, in addition to the Area Agency, evaluation of
			 all RFPs shall be accomplished by a fair and impartial evaluation team.
			 Membership on the panel by Area Agency Board and Advisory Council membership on
			 the evaluation team shall constitute less than 50 percent. The evaluation team
			 shall be chaired by a disinterested party not affiliated with the Area Agency
			 or any of the proposers;
(c)
			 Technical and price proposals must not identify the organization submitting the
			 proposal in any way in the proposal or on the envelope. Proposals which do
			 identify the organization submitting the proposal in the technical or price
			 proposals shall be deemed unresponsive and shall not be considered for possible
			 contract award. The management proposal will be the only part of the proposal
			 that identifies the organization submitting the proposal. The evaluation team
			 shall not be aware of the organization submitting the proposal until after the
			 technical and price proposals have been evaluated and scored;
(d) If the Area Agency on Aging is the
			 recipient of the award, it must meet the same contractual provisions,
			 standards, and price that any non-Area Agency on Aging provider would be
			 required to meet.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of these rules is to define the eligibility
				requirements for the Oregon Project Independence-Medicaid (OPI-M)
				Program.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0005 - 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 014:
(1) "Activities of Daily Living (ADL)" mean
			 those personal functional activities required by an individual for continued
			 well-being, which are essential for health and safety and defined in OAR
			 411-015-0006. Activities include
			 bathing and personal hygiene, cognition, dressing and grooming, eating,
			 elimination, and mobility.
(2)
			 "Adult" means any person at least 18 years of age.
(3) "Alternative Service Resources" means
			 other possible resources for the provision of services to meet an individual's
			 needs. Alternative service resources include, but are not limited to, natural
			 supports, risk intervention services, Veterans programs or other community
			 supports. Alternative service resources are not paid by Medicaid.
(4) "Area Agency on Aging (AAA)" means the
			 Department designated agency charged with the responsibility to provide a
			 comprehensive and coordinated system of services to older adults and adults
			 with disabilities in a planning and service area. The term Area Agency on Aging
			 (AAA) is inclusive of both Type A and Type B AAAs as defined in ORS
			 410.040 to
			 410.300.
(a) "Type A Area Agency on Aging" means an
			 Area Agency on Aging for which either the local government or the area agency
			 board does not agree to accept local administrative responsibility for Title
			 XIX Medicaid except OPI-M; and that provides a service to adults.
(b) "Type B Area Agency on Aging" means an
			 Area Agency on Aging:
(A) For which the local
			 government agrees to accept local administrative responsibility for Title XIX
			 Medicaid;
(B) That provides a
			 service to older adults or to older adults and persons with disabilities who
			 require services similar to those required by older adults; and
(C) Are one of two models of Type B AAAs -
			 Type B Contract or Type B Transfer:
(i) Type B
			 Contract- Staff are employed by the AAA and only administer Older Americans
			 Act, Oregon Project Independence and Oregon Project Independence Medicaid
			 services case management services.
(ii) Type B Transfer- Staff are employed by
			 the AAA and administer all of the following programs: Medicaid, financial
			 services, Supplemental Nutrition Assistance Program, adult protective services,
			 regulatory programs, Older Americans Act, Oregon Project Independence and all
			 Oregon Project Independence-Medicaid services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0020 - Eligibility and Limitations for Oregon Project Independence-Medicaid

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible
			 for Oregon Project Independence- Medicaid services, an individual must:
(a) Be age 18 or older;
(b) If aged 18-59, meet the criteria for
			 disability in OAR 461-125-0370 used for the
			 OSIPM;
(c) Meet financial
			 eligibility criteria in OAR chapter 411, division 014 and the OSIPM
			 requirements for individuals in non-standard living arrangements in OAR chapter
			 461, all divisions unless otherwise covered in OAR
			 411-014-0025;
(d) Meet the functional impairment level
			 within the service priority levels (1) to (18) as defined in OAR
			 411-015-0010; and
(e) Reside in an In-home setting as defined
			 in OAR 411-030-0033 and not reside in
			 any of the settings in OAR
			 411-030-0040(7).
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0025 - Financial Eligibility for OPI-M

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The income and
			 resource methodology for OSIPM outlined in OAR chapter 461 is used to determine
			 financial eligibility for the OPI-M except as follows:
(a) In OPI-M an individual must have adjusted
			 income (see OAR 461-001-0000) that is equal to
			 or less than 400 percent of the federal poverty level for a family of one and
			 may not be exceeded through qualifying trusts as specified in OAR
			 461-145-0540(9)(c).
(b) For an individual, the resource limit is
			 calculated using the basic statutory daily nursing facility rate as described
			 in OAR 411-070-0075(1)
			 multiplied by 30.4 (average days per month) multiplied by six (6)
			 months.
(c) At initial eligibility,
			 the resources of the spouse (see OAR
			 461-001-0000) are considered and
			 the provisions of OAR
			 461-160-0580(2)(f)(A)
			 apply, except that the individual's resource limit is calculated in accordance
			 with subsection (b) of this section.
(d) Individuals are subject to the rules
			 regarding both of the following:
(A) The
			 transfer of assets as set forth in OAR
			 461-140-0210 to
			 461-140-0300.
(B) The home equity value limits as set forth
			 in OAR 461-145-0220.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0030 - Scope of OPI-M Eligibility Case Management

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility
			 Case Managers are responsible for:
(a) Service
			 eligibility assessments and service eligibility determinations as described OAR
			 411-014-0040;
(A) Initial eligibility determinations must
			 be conducted within 45 days of the date of request;
(B) Redeterminations must be completed every
			 two years.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0035 - Qualified Case Manager

Current through Register Vol. 63, No. 7, July 1, 2024
Eligibility case managers must meet the qualifications in OAR
				411-028-0040.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.060,
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY › Section 411-014-0040 - Assessments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Assessments
			 must be conducted by eligibility case managers and in accordance with OAR
			 411-015-0008.
(2) The Services Case Manager may attend the
			 assessment conducted by the Eligibility Case Manager if the individual
			 approves.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.060,
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of establishing priorities for persons to be served
				is to assist the Department in addressing the following goals:
(1) To enable persons eligible for and
			 receiving services to remain in the least restrictive and least costly setting
			 consistent with their service needs; and
(2) To serve those persons who are the most
			 functionally impaired and who have no or inadequate alternative service
			 resources; and
(3) To assure access
			 to services paid by the Department to eligible persons; and
(4) To assure that services paid by the
			 Department, and the setting in which they are provided are safe and adequate;
			 and
(5) To manage limited resources
			 to enable the greatest possible number of persons to receive needed services
			 through a priority system based on the Department's assessment of the
			 individual's functional impairment and alternative service resources.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0005 - 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 015:
(1) "AAA" means "Area Agency on Aging" as
			 defined in this rule.
(2)
			 "Activities of Daily Living (ADL)" mean those personal functional activities
			 required by an individual for continued well-being, which are essential for
			 health and safety. Activities include eating, dressing and grooming, bathing
			 and personal hygiene, mobility, elimination, and cognition.
(3) "Adult" means any person at least 18
			 years of age.
(4) "Alternative
			 Service Resources" means other possible resources for the provision of services
			 to meet an individual's needs. Alternative service resources include, but are
			 not limited to, natural supports, risk intervention services, Older Americans
			 Act programs, or other community supports. Alternative service resources are
			 not paid by Medicaid.
(5)
			 "Architectural Modifications" means any service leading to the alteration of
			 the structure of a dwelling to meet the specific service needs of an eligible
			 individual.
(6) "Area Agency on
			 Aging (AAA)" means the Department designated agency charged with the
			 responsibility to provide a comprehensive and coordinated system of services to
			 older adults and adults with disabilities in a planning and service area. The
			 term Area Agency on Aging (AAA) is inclusive of both Type A and Type B AAAs as
			 defined in ORS 410.040 to
			 410.300.
(7) "Assistance Types" needed for activities
			 of daily living and instrumental activities of daily living include the
			 following:
(a) "Cueing" means giving verbal or
			 visual clues during an activity to help an individual complete the activity
			 without hands-on assistance.
(b)
			 "Hands-on" means a provider physically performs all or parts of an activity
			 because an individual is unable to do so.
(c) "Monitoring" means a provider must
			 observe an individual to determine if intervention is needed.
(d) "Reassurance" means to offer an
			 individual encouragement and support.
(e) "Redirection" means to divert an
			 individual to another more appropriate activity.
(f) "Set-up" means getting personal effects,
			 supplies, or equipment ready so that an individual may perform an
			 activity.
(g) "Stand-by" means a
			 provider is at the side of an individual ready to step in and take over the
			 task if the individual is unable to complete the task independently.
(h) "Support" means to enhance the
			 environment to enable an individual to be as independent as possible.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0006 - Activities of Daily Living (ADL)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Evaluation of the individual's need for
			 assistance in activities of daily living is based on:
(a) The individual's ability to complete
			 activities, components, and tasks rather than the services provided;
(b) How the individual functioned during the
			 30 days prior to the assessment date, with consideration of how the person is
			 likely to function in the 30 days following the assessment date; and
(c) Evidence of the actual or predicted need
			 for assistance of another person within the assessment time frame, and it must
			 not be based on possible or preventive needs.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0007 - Instrumental Activities of Daily Living

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Instrumental Activities of Daily Living
			 (IADL)" or "Self-Management tasks" consists of housekeeping including laundry,
			 shopping, transportation, medication management and meal preparation.
(2) Evaluation of the individual's needs for
			 assistance in Instrumental Activities of Daily Living is based on:
(a) The individual's abilities rather than
			 the services provided; and
(b) How
			 the individual functioned during the thirty days prior to the assessment date,
			 with consideration of how the person is likely to function in the thirty days
			 following the assessment date; and
(c) Evidence of the actual or predicted need
			 for assistance of another person within the assessment time frame and can not
			 be based on potential or preventative needs.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0008 - Assessments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) ASSESSMENT.
(a) The assessment process:
(A) Identifies an individual's ability to
			 fully perform in a safe and dignified manner, comparable with how tasks would
			 be performed by an individual not receiving Long Term Care Services and
			 Supports (LTSS), the tasks described within activities of daily living in OAR
			 411-015-0006 and instrumental
			 activities of daily living in OAR
			 411-015-0007;
(B) Determines an individual's ability to
			 address health and safety concerns; and
(C) Includes an individual's preferences to
			 meet service needs.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0010 - Priority of Paid Services

Current through Register Vol. 63, No. 7, July 1, 2024
To determine the service priority level, an individual must be
				determined eligible, using the Department's standardized assessment tool, by
				meeting at least the requirements for Assist or Full Assist in activities of
				daily living as defined in OAR
				411-015-0006, in the following
				order and as designated in OAR
				411-015-0015.
(1) Requires Full Assistance in Mobility,
			 Eating, Elimination, and Cognition.
(2) Requires Full Assistance in Mobility,
			 Eating, and Cognition.
(3) Requires
			 Full Assistance in Mobility, or Cognition, or Eating.
(4) Requires Full Assistance in
			 Elimination.
(5) Requires
			 Substantial Assistance with Mobility, Assistance with Elimination and
			 Assistance with Eating.
(6)
			 Requires Substantial Assistance with Mobility and Assistance with
			 Eating.
(7) Requires Substantial
			 Assistance with Mobility and Assistance with Elimination.
(8) Requires Minimal Assistance with Mobility
			 and Assistance with Eating and Elimination.
(9) Requires Assistance with Eating and
			 Elimination.
(10) Requires
			 Substantial Assistance with Mobility.
(11) Requires Minimal Assistance with
			 Mobility and Assistance with Elimination.
(12) Requires Minimal Assistance with
			 Mobility and Assistance with Eating.
(13) Requires Assistance with
			 Elimination.
(14) Requires
			 Assistance with Eating.
(15)
			 Requires Minimal Assistance with Mobility.
(16) Requires Full Assistance in Bathing or
			 Dressing.
(17) Requires Assistance
			 in Bathing or Dressing.
(18)
			 Individuals assessed with ADL needs not included in S PL 1-17 or those with
			 medical or medication management needs.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0015 - Current Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department has the authority to establish, by administrative rule, service
			 eligibility within which to manage the Department's limited resources. The
			 Department is currently able to serve:
(a)
			 Individuals determined eligible for the Medicaid OHP Plus benefit package who
			 are assessed as meeting at least one of the service priority levels (1) through
			 (13) as described in OAR
			 411-015-0010.
(b) Individuals eligible for Oregon Project
			 Independence funded services, if the individual meets at least one of the
			 service priority levels (1) through (18) of OAR
			 411-015-0010.
(c) Individuals needing risk intervention
			 services in areas designated to provide such services. Individuals with the
			 lowest service priority level number under OAR
			 411-015-0010 are served
			 first.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0030 - Extended Waiver Eligibility (EWE)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual determined to no longer
			 meet the criteria in 411-015-0100 and assessed as
			 Service Priority Level (SPL) 14 - 18 through the assessment process outlined in
			 411-015-0008 may be eligible to
			 continue receiving Long-Term Support Services (LTSS) when one of the following
			 circumstances causes unmet needs or health and safety risks, which would result
			 in the individual being institutionalized or hospitalized within 30 days:
(a) Lack of access to shelter and support
			 would cause the individual to deteriorate or decompensate;
(b) Without supports, the individual would
			 lack access to safe housing or has a documented history of eviction or threats
			 of eviction that would lead the individual to deteriorate or decompensate;
			 or
(c) Without supports, the
			 individual is at significant risk of abuse or exploitation.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 15 - LONG-TERM CARE SERVICE PRIORITIES FOR INDIVIDUALS SERVED › Section 411-015-0100 - Eligibility for Nursing Facility or Home and Community-Based Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible
			 for nursing facility services or home and community-based services, a person
			 must:
(a) Be age 18 or older.
(b) Be eligible for the Medicaid OHP Plus
			 benefit package.
(A) Individuals receiving
			 Medicaid OHP Plus under OAR 410-200 coverage for services in a nonstandard
			 living arrangement as defined in OAR
			 461-001-0000 are subject to the
			 requirements in the same manner as if they were requesting these services under
			 OSIPM, including the rules regarding:
(i) The
			 transfer of assets as set forth in OAR
			 461-140-0210 to
			 461-140-0300; and
(ii) The equity value of a home which exceeds
			 the limits as set forth in OAR
			 461-145-0220.
(B) When an individual is
			 disqualified for a transfer of assets, a notice for transfer of assets is
			 required in accordance with OAR
			 461-175-0310.
(C) When an individual is determined
			 ineligible for the equity value of a home, a notice for being over resources is
			 required in accordance with
			 461-175-0200.
(c) Meet the functional impairment
			 level within the service priority levels currently served by the Department as
			 outlined in OAR 411-015-0010 and the
			 requirements in OAR 411-015-0015.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of the Oregon Project Independence-Medicaid program
				is to:
(1) Provide limited,
			 non-medical assistance to delay or prevent the need for full Medicaid long term
			 services and supports under Oregon's 1915(c) waiver authority or any other
			 state plan authorities;
(2)
			 Optimize and maintain an eligible individual's personal resources and natural
			 supports;
(3) Provide access to
			 limited, preventive in-home services to older adults and adults with
			 disabilities who require assistance with activities of daily living;
			 and
(4) Develop and maintain the
			 ability of individual, using natural supports, to meet their personal needs and
			 support the health and well-being of unpaid caregivers to sustain caregiving
			 relationships.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0005 - 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 016:
(1) "Activities of Daily Living (ADL)" mean
			 those personal functional activities required by an individual for continued
			 well-being, which are essential for health and safety and defined in OAR
			 411-015-0006. Activities include
			 bathing and personal hygiene, cognition, dressing and grooming, eating,
			 elimination, and mobility
(2)
			 "Adult" means any person at least 18 years of age.
(3) "Adult Day Services (ADS) Program" means
			 a community-based group program designed to meet the needs of adults needing
			 assistance with ADLs described in OAR chapter 411, division 066.
(4) "Alternative Service Resources" means
			 other possible resources for the provision of services to meet an individual's
			 needs. Alternative service resources include, but are not limited to, natural
			 supports, risk intervention services, or other community supports. Alternative
			 service resources are not paid by Medicaid.
(5) "Area Agency on Aging (AAA)" means the
			 Department designated agency charged with the responsibility to provide a
			 comprehensive and coordinated system of services to older adults and adults
			 with disabilities in a planning and service area. The term Area Agency on Aging
			 (AAA) is inclusive of both Type A and Type B AAAs as defined in ORS
			 410.040 to
			 410.300.
(a) "Type A Area Agency on Aging" means an
			 Area Agency on Aging for which either the local government or the area agency
			 board does not agree to accept local administrative responsibility for Title
			 XIX Medicaid, except OPI-M; and that provides a service to adults.
(b) "Type B Area Agency on Aging" means an
			 Area Agency on Aging:
(A) For which the local
			 government agrees to accept local administrative responsibility for Title XIX
			 Medicaid;
(B) That provides a
			 service to older adults or to older adults and persons with disabilities who
			 require services similar to those required by older adults; and
(C) Are one of two models of Type B
			 AAA's-Type B Contract or Type B Transfer:
(i)
			 Type B Contract- Staff are employed by the AAA and only administer Older
			 Americans Act, Oregon Project Independence and Oregon Project
			 Independence-Medicaid services case management services.
(ii) Type B Transfer- Staff are employed by
			 the AAA and administer all of the following programs: Medicaid, financial
			 services, Supplemental Nutrition Assistance Program, adult protective services,
			 regulatory programs, Older Americans Act, Oregon Project Independence and all
			 Oregon Project Independence-Medicaid services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0010 - Scope of OPI-M Services Case Management

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Services Case
			 Managers are responsible for:
(a)
			 Person-centered service plan development including goals, preferences and plan
			 monitoring;
(b) Presenting program
			 options, service options, resources, and alternatives to an individual to
			 assist the individual and their representative in making informed choices and
			 decisions;
(c) Risk assessment and
			 monitoring, including:
(A) Identifying and
			 documenting risks;
(B) Working with
			 an individual to eliminate or reduce risks;
(C) Developing and implementing a Risk
			 Mitigation Plan;
(D) Monitoring
			 risks at least quarterly and more frequently if needed; and
(E) Adjusting an individual's person-centered
			 service plan as needed.
(d) Other program coordination such as
			 helping an individual navigate or coordinate with other social, health, and
			 assistance programs;
(e) Assisting
			 with crisis response and intervention such as participating in problem
			 resolution with an individual or the individual's representative;
(f) Authorizing services to meet the service
			 choices, assessed need and preferences of the individual, considering natural
			 supports and other alternative service resources and service plan related
			 notifications;
(g) Service
			 provision issues such as assisting an individual with problem solving to
			 resolve providers, services or hours issues that do not meet the individual's
			 needs;
(h) Documentation of changes
			 in condition, service plan adjustments and reasons for adjustments, service
			 alternatives, completion of required forms and other service plan case
			 management requirements including narration; and,
(i) Completing an Unpaid Caregiver assessment
			 if Community Caregiver Supportive Services or Caregiver Education and Training
			 is requested.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0020 - Qualified Services Case Manager

Current through Register Vol. 63, No. 7, July 1, 2024
Services Case Managers must meet the following criteria:
(1) Be employed by an Area Agency on Aging or
			 the Department;
(2) Have completed
			 the Department required training for case managers; and
(3) The AAA or the Department has determined
			 that the Services Case Manager has the skills, knowledge and ability for the
			 Services Case Manager position and responsibilities.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.060,
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0025 - OPI-M Service Eligibility and Responsibilities of the Individual

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For ongoing
			 eligibility of OPI-M services, the individual or their representative must meet
			 all of the following criteria:
(a) Participate
			 in the person-centered service planning process with the Services Case
			 Manager;
(b) Participate in risk
			 assessments and risk monitoring activities;
(c) Participate in an Unpaid Caregiver
			 assessment, if required;
(d) Agree
			 to and work with a fiscal intermediary if required; and
(e) Be receiving at least one service benefit
			 as defined in OAR 411-016-0030(5)
			 or
(f) If not receiving at least
			 one service benefit as defined in OAR
			 411-016-0030(5)
			 must participate, at a minimum, in quarterly Case Management and Service
			 Coordination with their Services Case Manager.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0030 - Person-Centered Service Planning

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Services Case
			 Managers must use a person-centered service planning process to develop
			 person-centered service plans. The process must:
(a) Be directed by the individual and include
			 people chosen by the individual;
(b) Provide necessary information and
			 supports so that the individual can make informed choices and
			 decisions;
(c) Offer all available
			 service options including assistive devices, home modifications and other
			 alternative service resources as defined in OAR
			 411-014-0005 to meet the
			 identified needs;
(d) Include
			 assessing the cost effectiveness and sustainability of the plan;
(e) Result in authorization of the minimum
			 level of services that the individual chooses and is eligible for, that are
			 required to adequately meet the individual's assessed needs or support the
			 unpaid caregiver and caregiving relationship;
(f) Be documented in Oregon Access, CA/PS and
			 other approved forms and systems.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0040 - Service Plan Hours

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Through a
			 person-centered planning process with the individual, the Services Case Manager
			 authorizes hours to address the individual's unmet needs or to support the
			 unpaid caregiver relationship.
(2)
			 A service plan may have no more than a maximum total of 40 hours of in-home
			 services including both ADL and IADL hours, per pay period.
(3) Hours are authorized to meet assessed
			 ADL/IADL needs as defined in OAR
			 411-015-0006 and OAR
			 411-015-0007.
(4) Hours should reflect only the minimum
			 necessary for health and safety that supplement supports provided by natural
			 supports and alternative service resources. The hours authorized must be
			 documented in the service plan form.
(5) For households with two or more eligible
			 individuals receiving any combination of Medicaid funded or Oregon Project
			 Independence in-home services, the service plan for each individual must avoid
			 duplication of services.
(6) Hours
			 authorized for assessed needs are paid at the rates in accordance with OAR
			 411-027-0170 for In-Home Care
			 Agencies and for Homecare Workers at rates published on the current rate
			 schedule or the current collective bargaining agreement between the Department
			 of Administrative Services on behalf of the State of Oregon and the Oregon
			 Homecare Commission and Service Employees International Union, Local 503,
			 Oregon Public Employees Union.
(7)
			 A provider may not receive payment from the Department for more than the total
			 amount of in-home services hours authorized by the AAA or the Department on the
			 service plan authorization form under any circumstances. All service payments
			 must be prior authorized by a Services Case Manager or AAA or Department
			 designated staff.
(8) Payment by
			 the Department for In-Home services hours are only made for the tasks described
			 in OAR 411-015-0006 and OAR
			 411-015-0007 as ADL or IADL
			 tasks. Services must be authorized to meet the needs of an eligible individual
			 and may not be provided to benefit an entire household.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.060,
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0050 - Limitations on In-Home Services Plans

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The AAA or
			 Department must take necessary safeguards to protect an individual's health,
			 safety, and welfare when implementing an individual's service plan in
			 accordance with 42 CFR
			 441.302 and
			 42 CFR
			 441.570. When an individual with the ability
			 to make an informed decision selects a service choice that jeopardizes health
			 and safety, AAA or Department staff shall offer or recommend options to the
			 individual to minimize those risks. For this rule, an "informed decision" means
			 the individual understands the benefits, risks, and consequences of the service
			 choice selected. Minimizing risks may include offering or recommending one or
			 more of the following:
(a) Natural supports to
			 help with safety or health emergencies;
(b) An emergency response system;
(c) A back-up plan for assistance with
			 service needs;
(d) Resources for
			 emergency disaster planning;
(e) A
			 referral for long term care community nursing services;
(f) Resources for provider and consumer
			 training;
(g) Assistive devices;
			 or
(h) Home
			 modifications.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0075 - Consumer-Employer Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 CONSUMER-EMPLOYER RESPONSIBILITIES. To be eligible for OPI-M in-home services
			 provided by a homecare worker, an individual or the individual's representative
			 must be able to:
(a) Locate, screen, and hire
			 a qualified homecare worker;
(b)
			 Supervise and train the homecare worker;
(c) Schedule the homecare worker's work,
			 leave, and coverage;
(d) Track the
			 hours worked and verify the authorized hours completed by the homecare
			 worker;
(e) Recognize, discuss, and
			 attempt to correct any performance deficiencies with the homecare
			 worker;
(f) Discharge an
			 unsatisfactory homecare worker; and
(g) Follow all employer responsibilities
			 required by law to ensure the workplace is safe from harassment.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0080 - Homecare Workers and Provider Qualifications

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the purpose
			 of this rule, case manager as used in OAR chapter 411, division 031 means the
			 OPI-M Services Case Manager.
(2)
			 Homecare workers must be enrolled in and follow the rules in the
			 Consumer-Employed Provider Program described in chapter 411, division 031 to
			 provide in-home services as part of an OPI-M service plan.
(3) A single homecare worker is limited to
			 providing 16 hours of awake care during a 24-hour work period.
(4) All homecare workers are limited to no
			 more than 60 hours per week.
(5)
			 Homecare workers must use Electronic Visit Verification (EVV) as required in
			 OAR 411-031-0040(10)(a).
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.060,
				  410.070 &
				  414.065