Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 173 - 1915(i) HOME AND COMMUNITY BASED SERVICES STATE PLAN OPTION › Section 410-173-0025 - Person-Centered Service Planning Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A person-centered service plan shall be
			 developed through a person-centered service planning process that includes the
			 following:
(a) Be completed face-to-face with
			 the Individual to ensure the individual's involvement and direction in the
			 development of their PCSP;
(b) Be
			 directed by the Individual accessing 1915(i) services and supports;
(c) Include the Individual and those people
			 chosen by the Individual to participate in the planning process;
(d) Reflect the services, supports, and
			 delivery of those services and supports in a way that is important to the
			 Individual;
(e) Provide necessary
			 information and support to ensure the Individual directs their PCSP process to
			 the maximum extent possible and is enabled to make informed choices and
			 decisions. This information and support shall include:
(A) Notification to the individual accessing
			 1915(i) HCBS services informing them of their right to invite others they want
			 to attend their PCSP meeting;
(B)
			 Notification to the Individual's legal representative and/or authorized
			 representative, if applicable, informing them of the right to be included in
			 the person-centered service planning process; and
(f) Processes that are timely, responsive to
			 changing needs, occurs at times and locations chosen by and convenient to the
			 Individual;
(g) A review of the
			 PCSP with the individual, and legal or authorized representative, every ninety
			 (90) days or more often as determined by the Individual;
(h) Practices must reflect cultural
			 considerations and values of the Individual;
(i) Use language, format, and presentation
			 methods appropriate for effective communication according to the needs and
			 abilities of the Individual and, as applicable, the legal representative or
			 authorized representative of the Individual;
(j) Include strategies for resolving
			 disagreement within the process, including clear conflict of interest
			 guidelines for all planning participants that include:
(A) Discussing concerns of each
			 person-centered service planning team member and determining acceptable
			 solutions;
(B) Supporting the
			 Individual in arranging and conducting a person-centered service planning
			 meeting;
(C) Utilizing any
			 available greater community conflict resolution resources;
(D) For Individuals living in a residential
			 facility refer concerns to the Oregon Residential Facilities ,Ombudsperson;
			 and
(E) For those living
			 independently refer concerns to the Oregon Health Plan Ombuds person;
			 and
(F) Following existing,
			 program-specific grievance or complaint processes;
(k) Offer choices to the Individual regarding
			 the services and supports the Individual receives and from whom and record the
			 alternative HCBS settings that were considered by the Individual;
(l) Provide a method for the Individual or,
			 as applicable, the legal representative or authorized representative of the
			 Individual to request updates to the person-centered service plan for the
			 Individual;
(m) Be conducted to
			 reflect what is important to the Individual to ensure delivery of services in a
			 manner reflecting personal preferences and ensuring health and
			 welfare;
(n) Identify the strengths
			 and preferences, service and support needs, goals, and desired outcomes of the
			 Individual;
(o) Include
			 individually identified goals and preferences related to relationships, greater
			 community participation, employment, income and savings, healthcare and
			 wellness, and education;
(p)
			 Include risk factors and plans to minimize any identified risk factors,
			 including:
(A) Identification of back-up
			 plans, as needed; and
(B)
			 Identification of procedures to follow when the primary provider is unable to
			 deliver approved services.
(q) Results in a person-centered service plan
			 conducted by the IQA and implemented by the provider of HCBS in the home and
			 community settings.