Oregon Administrative Rules › Chapter 582 - DEPARTMENT OF HUMAN SERVICES, VOCATIONAL REHABILITATION SERVICES › Division 70 - STANDARDS FOR PROVISION OF SERVICES AND RATES OF PAYMENT › Section 582-070-0030 - Limitations of Payments

Current through Register Vol. 63, No. 7, July 1, 2024
NOTE:
For medical and related services refer also
				to OAR 582-075 and 582-080; and, for providers of community rehabilitation
				services refer also to OAR 582-010.
(1) Payment in Full: Vendors providing any
			 services authorized by the Program shall not make any charge to or accept any
			 payment from the individual or their family for such services unless the amount
			 of the service charge or payment to be borne by the individual is previously
			 agreed to by the individual or their family, known to and, where applicable,
			 approved by the Program.
(2) Client
			 financial participation and the financial needs test: Except as expressly
			 exempted, services funded by the Program are subject to client financial
			 participation. Individuals shall be required to contribute financially as set
			 forth in OAR 582-070-0030. The contribution requirements apply for individuals
			 submitting applications for services and for annual individualized plan for
			 employment (IPE) reviews.
(a) Individual
			 participation in service costs encourages commitment to and investment in a
			 successful vocational rehabilitation process. Service equity is advanced and
			 limited Program resources are expanded when the financial contribution is
			 individualized.
(b) Except as
			 provided in OAR 582-070-0030(2)(j) and (k), the following individuals are
			 exempt from any mandatory client financial participation:
(A) Any individual who has been determined
			 eligible for and is currently receives Social Security Benefits under Title II
			 (Social Security Disability Insurance, SSDI) or Title XVI (Supplemental
			 Security Income, SSI) of the Social Security Act;
(B) Recipients of qualifying needs-based
			 governmental public assistance programs, including Self Sufficiency Cash
			 Benefits, Oregon Health Plan (OHP), Temporary Assistance for Needy Families
			 (TANF), and Supplemental Nutrition Assistance Program (SNAP), but excluding
			 financial aid for post-secondary education;
(C) Unhoused or transient
			 individuals.
(c) Except
			 as provided in OAR 582-070-0030(2)(j) and (k), the following services are
			 exempt from client financial participation:
(A) Assessment to determine eligibility,
			 vocational rehabilitation needs, or priority for services, including assessment
			 by personnel skilled in rehabilitation technology;
(B) Vocational rehabilitation counseling and
			 guidance, including information and support services to assist an individual in
			 exercising informed choice;
(C)
			 Referral and other services necessary to assist applicants and eligible
			 individuals to secure needed services from other agencies, including other
			 components of the statewide workforce investment system and to advise those
			 individuals about client assistance programs;
(D) Job related services, including job
			 search and placement assistance, job retention services, follow-up services,
			 and follow-along services;
(E)
			 Auxiliary aids or services, required to participate in the vocational
			 rehabilitation program, such as interpreter services, including sign language
			 and oral interpreter services, for individuals who are deaf or hard of hearing,
			 and tactile interpreting services for individuals who are deaf-blind provided
			 by qualified personnel. Note: Hearing aids are not considered auxiliary aids.
			 See OAR 582-001-0010(9).
(d) Under the financial needs test,
			 individuals with annual family income of less than 300 percent of the federal
			 poverty guidelines are not subject to client financial participation.
(A) The Program will publish the client
			 financial participation rates annually.
(B) This transmittal shall determine the
			 mandatory contribution to document in the individualized plan for employment
			 (IPE).
(e) Client
			 financial participation shall be determined at the time that the IPE is
			 written, and annually thereafter. Client financial participation shall not
			 exceed the annual cost of non-exempt services as described in the
			 IPE.
(f) The Program shall use the
			 following definitions to calculate client financial participation:
(A) "Income" means the adjusted gross income
			 from the most recent federal tax return.
(B) "Family income" means the income from the
			 individual, the spouse of the individual if residing with the individual and
			 includes parental income if the individual is under 26 and living with a
			 parent.
(C) "Federal poverty
			 guidelines" means the current poverty guidelines of the United States
			 Department of Health and Human Services.
(D) "Size of the family unit" means, for the
			 purpose of selecting the appropriate federal poverty guideline, those family
			 members residing with the individual or claimed on federal taxes as
			 dependents.
(E) "Disability-related
			 expenses" means non-reimbursed deductions excluded from individual's income for
			 the purpose of determining the client financial participation. These include,
			 but are not be limited to:
(i) Medical
			 expenses (including co-payments)
(ii) Therapeutic treatments
(iii) Specialized equipment
(iv) Specialized care
(v) In-home care
(vi) Loss of work time
(vii) Access to resources that impact where
			 they live and work
(F)
			 "Participant contribution rate" means the payment rate that Program
			 participants shall contribute, if a contribution is required.
(i) Disability related deductions and the
			 annual federal poverty guideline allowance shall be subtracted from the
			 individual's adjusted gross annual income. This resulting amount shall be
			 multiplied by one percent to provide the client contribution for the
			 individualized plan for employment. The contribution shall not exceed the
			 annual cost of non-exempt services to the Program.
(ii) Formula: (Income - (non-reimbursed
			 disability related deductions + annual federal poverty guideline allowance)) *
			 1.0% if greater than zero and less than the annual cost of non-exempt services
			 to the Program.
(g) If the individual or their family choose
			 not to share information about their income as part of the calculation of the
			 client financial participation, an annual, mandatory individual contribution of
			 $3,500 shall be established, not to exceed the annual cost of non-exempt
			 services to the Program.
(h) The
			 maximum contribution is the lesser of the amount determined by the contribution
			 formula (OAR 582-070-0030(f)(F)) or $3,500 annually.
(i) Subsequent financial needs tests shall be
			 conducted:
(A) During the annual review of the
			 individualized plan for employment (IPE), and,
(B) May also be conducted if there is a
			 change in the financial situation of either the individual or the family unit
			 that impact the client financial participation rate.
(j) A hardship waiver shall be considered:
(A) When the counselor identifies other
			 information related to the individual's financial situation that negatively
			 affects the individual's ability to participate in the cost of the
			 rehabilitation program; or,
(B) If
			 requiring the expected financial contribution will result in undue delay in the
			 rehabilitation program.
(C) In
			 determining whether to make an adjustment for hardship, the Program may
			 consider the individual's current income and the reasons for the request. If
			 the hardship justifies an exception, the Program may delay or waive all or part
			 of the individual's financial contribution.
(D) Examples of hardship would include:
(i) A change in the individual's household
			 income from the previous year, such as job loss, injury or illness that results
			 in the individual's ability to maintain prior income level.
(ii) If the individual's income has remained
			 stable but there have been significant financial hardships within the last 12
			 months that are involuntary or out of the individual's control. In this case,
			 extenuating circumstances may be considered.
(E) To request a hardship waiver the
			 counselor shall:
(i) Provide individual's
			 documentation of the reasons for the hardship waiver to their supervisor;
			 and,
(ii) Obtain written approval
			 of their supervisor;
(iii) Maintain
			 both the documentation of circumstances and written approval in the case
			 service record.
(k) All authorizations for services must meet
			 the rehabilitation needs of the individual and shall be of the most reasonable
			 and satisfactory quality at the lowest available cost.
(A) In the circumstance when an individual
			 prefers an upgrade, enhancement, or optional feature that results in a higher
			 cost but is not required to satisfy the rehabilitation needs that justify the
			 expenditure, the Program may agree to allow the individual to pay the
			 difference in cost of the item or service.
(B) In this situation, payment is required
			 regardless of any exempt status that might apply to the individual or item;
			 and,
(C) Any payments by the
			 individual in this situation do not count toward any applicable mandated client
			 financial participation.
(l) An IPE may include voluntary client
			 contributions.