reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0190 - Entry, Transfer, Exit, Closure, and Community Living Supports

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 NON-DISCRIMINATION. An individual may not be denied services in an AFH-DD or
			 otherwise discriminated against on the basis of race, color, religion, sex,
			 gender identity, sexual orientation, national origin, marital status, age,
			 disability, source of income, duration of Oregon residence, or other protected
			 classes under federal and Oregon Civil Rights laws.
(2) ELIGIBILITY. An individual who enters an
			 AFH-DD is subject to eligibility as described in this section.
(a) To be eligible for services in an AFH-DD,
			 an individual must meet the following requirements:
(A) Be an Oregon resident who meets the
			 residency requirements in OAR
			 461-120-0010.
(B) Be receiving:
(i) A Medicaid Title XIX benefit package
			 through OSIPM or HSD medical programs; or
(ii) A benefit package through the Healthier
			 Oregon medical program.
(C) Be determined eligible for:
(i) Developmental disabilities services by
			 the CDDP of the county of origin as described in OAR
			 411-320-0080; or
(ii) Services for Aging and People with
			 Disabilities as described in OAR chapter 411, division 015.
(D) Meet the level of care as
			 defined in OAR 411-317-0000.
(E) Not receive other Department-funded
			 in-home, community living support, or other services in another residential
			 setting.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0200 - Adjustment, Suspension, or Termination of Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department may adjust, suspend, or
			 terminate payment to a provider when any of the following conditions occur:
(a) The license for the AFH-DD is revoked,
			 suspended, or terminated.
(b) Upon
			 finding that the provider is failing to deliver any care or service as agreed
			 to in an ISP or Service Agreement.
(c) When funding, laws, regulations, or the
			 priorities of the Department change such that funding is no longer available,
			 redirected to other purposes, or reduced.
(d) The care and service needs of an
			 individual change.
(e) An
			 individual is determined to be ineligible for services.
(f) An individual moves, with or without
			 notice, from the AFH-DD. The provider is paid only through the last night the
			 individual slept in the AFH-DD.
(g)
			 An individual is away from the licensed AFH-DD, accompanied by the provider or
			 staff paid by the provider, for 30 consecutive days or 45 days in an ISP year.
(A) The provider is not paid for the 31st and
			 following consecutive days an individual is not at the AFH-DD.
(B) The provider is not paid for the 46th and
			 following non-consecutive days an individual is not at the AFH-DD.
(C) Days not paid do not count in the 45-day
			 total.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0210 - Inspections and Abuse Investigations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department conducts an inspection of
			 an AFH-DD:
(a) Prior to the issuance of an
			 AFH-DD license;
(b) Prior to the
			 annual renewal of an AFH-DD license;
(c) Upon receipt of an oral or written
			 complaint of violations that threaten the health, safety, or welfare of
			 individuals; or
(d) Anytime the
			 Department has probable cause to believe that an AFH-DD violated a regulation
			 or provision of these rules or is operating without an AFH-DD license.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0220 - Complaints

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department
			 furnishes each AFH-DD with a Complaint Notice. The Complaint Notice must be
			 posted in a conspicuous location in the AFH-DD, stating the telephone number of
			 the Department and the CDDP, and the procedure for making complaints.
(2) Any person who believes these
			 rules have been violated may file a complaint with the Department or CDDP.
(3) The Department investigates
			 any complaint regarding the AFH-DD.
(4) Copies of all AFH-DD complaints are
			 maintained by the Department. All complaints and action taken on the complaint,
			 indexed by the name of the provider, must:
(a) Be placed into the public file at the
			 Department. (Information regarding the investigation of the complaint may not
			 be filed in the public file until the investigation has been completed);
(b) Protect the privacy of the
			 complainant and the individual; and
(c) Treat the names of the witnesses as
			 confidential information.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0230 - Procedures for Correction of Violations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If an inspection or investigation results
			 in a violation of these rules other than abuse, the Department notifies the
			 provider in writing of violations of these rules.
(2) The notice of violation includes the
			 following:
(a) A description of each conduct
			 or condition that constitutes a violation;
(b) Each rule that has been violated; and
(c) A specific timeframe for
			 correction, not to exceed 30 calendar days after receipt of the notice of
			 violations.
(A) The Department may approve a
			 reasonable timeframe in excess of 30 calendar days if correction of the
			 violation within that timeframe is not practical.
(B) If the licensee requests more than 30
			 calendar days to correct the violation, such time must be specified in the
			 licensee's plan of correction and must be found acceptable by the Department.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0240 - Administrative Sanction

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 administrative sanction may be imposed for non-compliance with these rules. An
			 administrative sanction may include one or more of the following actions:
(a) Attachment of conditions to an AFH-DD
			 license;
(b) Civil penalties;
(c) Denial, suspension,
			 revocation, or non-renewal of the AFH-DD license; or
(d) Reclassification of the AFH-DD license.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0250 - License Conditions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department may attach conditions to a license that limit, restrict, or specify
			 other criteria for operation of an AFH-DD. The type of condition attached to an
			 AFH-DD license must directly relate to the risk of harm or potential risk of
			 harm to individuals.
(2) The
			 Department may attach a condition to a license upon any of the following
			 findings:
(a) Information on the application
			 or initial inspection requires a condition to protect the health, safety, or
			 welfare of individuals.
(b) A
			 threat to the health, safety, or welfare of an individual exists.
(c) There is evidence of abuse, neglect, or
			 exploitation.
(d) The AFH-DD is not
			 being operated in compliance with these rules or the rules in OAR chapter 411,
			 division 004.
(e) A licensee is
			 licensed to provide services for a specific individual only and further
			 placements may not be made into the AFH-DD.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0260 - Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A civil
			 penalty of not less than $100 and not more than $250 per violation, except as
			 otherwise provided in this rule, is imposed on a licensee for a general
			 violation of these rules.
(2) A
			 civil penalty of up to $500, unless otherwise required by law, is imposed for
			 falsifying individual or AFH-DD records or causing another to falsify
			 individual or AFH-DD records.
(3) A
			 civil penalty of $250 is imposed on a licensee for failure to have either the
			 provider, resident manager, or other qualified caregiver on duty 24 hours per
			 day in the AFH-DD per ORS
			 443.725(3),
			 unless permitted under OAR
			 411-360-0180(5).
(4) A civil penalty of $250 is imposed for
			 dismantling or removing the battery from any required smoke alarm or failing to
			 install any required smoke alarm.
(5) A civil penalty of not less than $250 and
			 not more than $500, unless otherwise required by law, is imposed on a licensee
			 who admits knowing that the care or service needs of an individual exceed the
			 license classification of the AFH-DD if the admission places the individual or
			 other individuals at grave risk of harm.
(6) Civil penalties of up to $1,000 per
			 occurrence may be assessed for substantiated abuse.
(7) If the Department conducts an abuse
			 investigation and the substantiated abuse resulted in the death, serious
			 injury, rape, or sexual abuse of an individual, a civil penalty of not less
			 than $2,500 is imposed for each violation.
(a) To impose the civil penalty in section
			 (7) of this rule, the Department must establish that:
(A) The abuse arose from deliberate or other
			 than accidental action or inaction;
(B) The conduct resulting in the abuse was
			 likely to cause death, serious injury, rape, or sexual abuse of an individual;
			 and
(C) The person with the
			 substantiated finding of abuse had a duty of care and services toward the
			 individual.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0275 - Suspension

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department
			 may suspend a license for reasons of abuse, neglect, or exploitation of an
			 individual if:
(a) An immediate threat to the
			 health, safety, or welfare of any individual exists;
(b) There is evidence of abuse, neglect, or
			 exploitation of any individual;
(c) The AFH-DD is not operated in compliance
			 with ORS 443.705 to
			 443.825 or the rules adopted
			 there under; or
(d) The provider
			 has been found to have been convicted of a crime that would have resulted in a
			 denied fitness determination of a background check.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0280 - Criminal Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Operating an AFH-DD without a license is punishable as a Class C misdemeanor
			 pursuant to ORS 443.991(5).
(2) Refusing to allow the
			 Department access and inspection to the AFH-DD or access to the AFH-DD
			 regarding fire safety by state and local fire inspector, is punishable as a
			 Class B misdemeanor pursuant ORS
			 443.991(6).
Stat. Auth.: ORS
				  409.050,
				  410.070,
				  443.725,
				  443.730,
				  443.735,
				  443.738,
				  443.742,
				  443.760,
				  443.765,
				  443.767,
				  443.775, &
				  443.790
Stats. Implemented: ORS
				  443.705 -
				  443.825
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0290 - Enjoinment of Operation

Current through Register Vol. 63, No. 7, July 1, 2024
The Department may commence an action to enjoin operation of an
				AFH pursuant to ORS 443.775(8):
(1) When an AFH-DD is operated
			 without a valid license; or
(2)
			 After notice of revocation or suspension has been given, a reasonable time for
			 placement of individuals in other homes has been allowed, and such placement
			 has not been accomplished.
Stat. Auth.: ORS
				  409.050,
				  410.070,
				  443.725,
				  443.730,
				  443.735,
				  443.738,
				  443.742,
				  443.760,
				  443.765,
				  443.767,
				  443.775, &
				  443.790
Stats. Implemented: ORS
				  443.705 -
				  443.825
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0300 - Zoning

Current through Register Vol. 63, No. 7, July 1, 2024
An AFH-DD is a residential use of property for zoning purposes.
				An AFH-DD is a permitted use in any residential zone, including a residential
				zone that allows a single family dwelling, and in any commercial zone that
				allows a single-family dwelling. No city or county may impose any zoning
				requirement on the establishment and maintenance of an AFH-DD in these zones
				that is more restrictive than a single-family dwelling in the same zone.
Stat. Auth.: ORS
				  409.050,
				  410.070,
				  443.725,
				  443.730,
				  443.735,
				  443.738,
				  443.742,
				  443.760,
				  443.765,
				  443.767,
				  443.775, &
				  443.790
Stats. Implemented: ORS
				  443.705 -
				  443.825
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0310 - Public Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department maintains current information on all licensed AFH-DD's and makes
			 that information available to prospective individuals, the individuals'
			 families, and other interested members of the public.
(2) The information includes:
(a) The location of the AFH-DD;
(b) A brief description of the physical
			 characteristics of the AFH-DD;
(c)
			 The name and mailing address of the provider;
(d) The license classification of the AFH-DD
			 and the date the provider was first licensed to operate the AFH-DD;
(e) The date of the last inspection of the
			 AFH-DD, the name and telephone number of the office that performed the
			 inspection, and a summary of the findings of the inspection;
(f) Copies of all complaint investigations
			 involving the AFH-DD, together with the findings of and actions taken by the
			 Department;
(g) Any license
			 conditions, suspensions, denials, revocations, civil penalties, exceptions, or
			 other actions taken by the Department involving the AFH-DD; and
(h) Whether care and services are provided
			 primarily by the provider, a resident manager, or other arrangement.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0100

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0120

Current through Register Vol. 63, No. 7, July 1, 2024
Publications: Publications referenced are available from the
				  agency.
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0140

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0160

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0180

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0200

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0220

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0240

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0260

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0280

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0300

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 365 - [Repealed] › Section 411-365-0320

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  127.505 -
				  127.660,
				  409.050, &
				  443.450
Stats. Implemented: ORS
				  127.505 -
				  127.660, &
				  443.450
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 370 - PROVIDER ENROLLMENT, SERVICE BILLING, AND SERVICE PAYMENT FOR DEVELOPMENTAL DISABILITIES SERVICES › Section 411-370-0010 - Definitions and Acronyms

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the following definitions, OAR
				411-317-0000 includes general
				definitions for words and terms frequently used in OAR chapter 411, division
				370. If a word or term is defined differently in OAR
				411-317-0000, the definition in
				this rule applies.
(1) "Administrator"
			 means the Director of the Oregon Department of Human Services, Office of
			 Developmental Disabilities Services, or their designee.
(2) "Appropriate Service" means services that
			 are required by a recipient's approved individual service or support plan that
			 are:
(a) Consistent with the recipient's
			 identified needs, goals, and desired outcomes.
(b) Appropriate with regard to standards of
			 generally recognized practice, evidence based practice, and professional
			 standards of service as effective.
(c) Not solely for the convenience of a
			 provider of the service.
(d) The
			 most cost effective of the alternative services that may be effectively
			 provided to a recipient.
(e)
			 Coordinated with the recipient's local case management entity.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 370 - PROVIDER ENROLLMENT, SERVICE BILLING, AND SERVICE PAYMENT FOR DEVELOPMENTAL DISABILITIES SERVICES › Section 411-370-0020 - Provider Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These
			 rules cover all programs and services of the Department's community services
			 programs for recipients with developmental disabilities (hereinafter referred
			 to as community services programs). All providers seeking payment from the
			 Department for the provision of covered services to eligible service recipients
			 of community services programs must comply with these rules and the applicable
			 rules, standards, and procedures of the specific programs or services defined
			 as community services programs in OAR
			 411-370-0010.
(2) COVERED PROVIDER AGREEMENTS. Agreements
			 with providers for community services programs may include:
(a) Direct contracts with the Department;
(b) Contracts with Department
			 designees, including CDDPs; or
(c)
			 Provider enrollment agreements with the Department.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 370 - PROVIDER ENROLLMENT, SERVICE BILLING, AND SERVICE PAYMENT FOR DEVELOPMENTAL DISABILITIES SERVICES › Section 411-370-0030 - Provider Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the
			 purpose of this rule, all providers of community services programs, authorized
			 to utilize the eXPRS, SFMA, or MMIS, and licensed or certified by Department
			 rules, or otherwise qualified by program-specific rules, prior to July 1, 2011
			 shall be deemed to be an enrolled provider as of July 1, 2011, subject to all
			 provisions of these rules.
(2)
			 Being an enrolled provider is a condition of eligibility for a Department
			 payment for claims in community services programs. The Department requires
			 billing providers to be enrolled as providers consistent with the provider
			 enrollment processes set forth in this rule. If payment for community services
			 program services shall be made under a contract with the Department or the
			 Department's designees, including CDDPs, the provider must also meet the
			 contract requirements. Contract requirements are separate from the requirements
			 of these provider enrollment rules.
(3) Enrollment as a provider with the
			 Department is not a promise that the enrolled provider shall receive any
			 minimum amount of work from the Department, or the Department's designees,
			 including CDDPs.
(4) RELATION TO
			 SERVICE ELEMENT STANDARDS AND PROCEDURES, PROGRAM-SPECIFIC RULES, PROVIDER
			 ENROLLMENT AGREEMENT, OR CONTRACT REQUIREMENTS. Provider enrollment establishes
			 essential provider participation requirements for becoming an enrolled provider
			 for the Department. The details of provider qualification requirements,
			 recipient eligibility, covered services, how to obtain service authorization,
			 documentation requirements, claims submission, available electronic access
			 instructions, and other pertinent instructions and requirements are contained
			 in the service element standards and procedures, program-specific rules, or
			 provider enrollment agreement or contract.
(5) CRITERIA FOR ENROLLMENT. To be enrolled
			 providers must:
(a) Meet the requirements, if
			 applicable, of the statewide agency certification process as prescribed in OAR
			 chapter 411, division 323.
(b) Meet
			 all program-specific requirements identified in service element standards and
			 procedures, program-specific rules, provider enrollment agreements, or
			 contracts in addition to the requirements identified in these rules;
(c) Meet Department licensing, certification,
			 or service endorsement requirements for the type of community services programs
			 the provider shall deliver as described in the program-specific rules, provider
			 enrollment agreements, or contracts; and
(d) Obtain a Medicaid Agency Identification
			 Number and applicable Medicaid Performing Provider Number from the Department
			 for the specific services for which the provider is enrolling.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 370 - PROVIDER ENROLLMENT, SERVICE BILLING, AND SERVICE PAYMENT FOR DEVELOPMENTAL DISABILITIES SERVICES › Section 411-370-0040 - Variances

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Department
			 may grant a variance to these rules based upon a demonstration by the provider
			 that an alternative method or different approach provides equal or greater
			 effectiveness and does not adversely impact the welfare, health, safety, or
			 rights of individuals or violate state or federal laws.
(2) The provider requesting a variance must
			 submit, in writing, an application on a Department approved form that contains
			 the following:
(a) The section of the rule
			 from which the variance is sought;
(b) The reason for the proposed variance; and
(c) The alternative practice,
			 service, method, concept, or procedure proposed.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rules in
			 OAR chapter 411, division 375 establish the standards and procedures governing
			 independent providers and the fiscal services provided on behalf of individuals
			 who employ or contract with an independent provider.
(2) Independent providers provide home and
			 community-based waiver, state plan, and general fund services to individuals
			 eligible for developmental disabilities services and receiving supports
			 authorized by a case management entity.
Stat. Auth.: ORS
				  409.050
Stats. Implemented: ORS
				  410.600,
				  410.606-619,
				  427.007
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0030 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  409.050
Stats. Implemented: ORS
				  410.600,
				  410.606-619,
				  427.007
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0035 - Documentation and Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) SERVICE AGREEMENT.
(a) An independent provider may not provide
			 services to an individual without a completed and authorized Service Agreement.
			 For independent providers who are not personal support workers, the signature
			 of the independent provider on an individual's ISP may serve as the Service
			 Agreement.
(b) An independent
			 provider must maintain a copy of the authorized Service Agreement for the
			 authorized service period.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0040 - Fiscal and Accountability Responsibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) DIRECT SERVICE PAYMENTS. The Department,
			 case management entity, or contracted fiscal intermediary makes payment to an
			 independent provider on behalf of an individual for all services.
(a) Payment is considered full payment for
			 the services rendered. The independent provider may not, under any
			 circumstances, demand or receive additional payment for Department-funded
			 services from the individual or any other source.
(b) The Department only makes payment for
			 services authorized in an ISP, included in a Service Agreement, and delivered
			 by a provider authorized in eXPRS to deliver the service.
(c) The Department does not make Department
			 funds available to an individual or common law employer to pay an independent
			 provider.
(d) The Department only
			 makes payment to an enrolled provider who actually performs the authorized
			 services. Federal regulations prohibit the Department from making payment to a
			 collection agency.
(e) All
			 Department funds paid to a personal support worker must come through a fiscal
			 intermediary.
(f) Department funds
			 may only be paid to a personal support worker who has properly completed all
			 Department required paperwork for fiscal intermediary payments.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0045 - Overpayments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An overpayment
			 is any payment made by the Department or case management entity to an
			 independent provider that is more than the independent provider is permitted to
			 receive under DHS rules. An independent provider may only receive payment for a
			 number of hours that are actually provided and do not exceed the amount stated
			 in a Service Agreement.
(2)
			 Overpayments are categorized as follows:
(a)
			 ADMINISTRATIVE ERROR. The case management entity failed to authorize, compute,
			 or process the correct amount of service hours or wage rate.
(b) INDEPENDENT PROVIDER ERROR. The
			 Department overpays the independent provider due to a misunderstanding or
			 unintentional error.
(c) FRAUD.
			 "Fraud" means taking actions that may result in the independent provider
			 receiving a benefit in excess of the correct amount whether by intentional
			 deception, misrepresentation, or failure to account for payments or money
			 received. "Fraud" also means spending payments or money the independent
			 provider was not entitled to and any act that constitutes fraud under
			 applicable federal or state law (including
			 42
			 CFR 455.2). The Department of Justice,
			 Medicaid Fraud Unit determines when a Medicaid fraud allegation is pursued for
			 prosecution.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0050 - Benefits and Secondary Expenses for Personal Support Workers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The only
			 benefits available to personal support workers are negotiated in the Collective
			 Bargaining Agreement and provided in Oregon Revised Statute. The Collective
			 Bargaining Agreement does not include participation in the Public Employees
			 Retirement System or the Oregon Public Service Retirement Plan. Personal
			 support workers are not employees of a case management entity.
(2) Workers' compensation, as defined in
			 Oregon Revised Statute, is available to eligible personal support workers as
			 described in the Collective Bargaining Agreement. In order to receive services
			 delivered by a personal support worker, an individual, the designated common
			 law employer, or the proxy must provide written authorization and consent to
			 the Department for the provision of workers' compensation insurance for the
			 personal support worker.
(3)
			 TRANSPORTATION REIMBURSEMENT.
(a) COMMUNITY
			 TRANSPORTATION.
(A) A personal support worker
			 may be reimbursed for providing community transportation related to services if
			 the community transportation is prior authorized by a case manager and
			 reflected in the ISP for an individual in accordance with OAR
			 411-435-0050. A personal support
			 worker providing community transportation must have a valid driver's license, a
			 good driving record, and proof of insurance for the vehicle used to transport
			 the individual, as well as any other license or certificate that may be
			 required under state and local law depending on the nature and scope of the
			 transportation. Copies of a valid driver's license and proof of insurance, as
			 well as any other license or certification that may be required, must be
			 provided to any case management entity upon authorization of community
			 transportation and as requested.
(B) Community transportation services exclude
			 medical transportation. Medical transportation is provided through the Health
			 Systems Division of the Oregon Health Authority.
(C) The Department is not responsible for
			 vehicle damage or personal injury sustained while using a personal motor
			 vehicle for ISP-related transportation, except as may be covered by workers'
			 compensation.
(D) Reimbursement for
			 transporting an individual to accomplish ADL, IADL, or a health-related task
			 within the community in which the individual lives or an employment goal
			 identified in an ISP, is on a per-mile basis as outlined in the Collective
			 Bargaining Agreement.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0055 - Standards for Common Law Employers for Personal Support Workers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A common law
			 employer is required when a personal support worker is selected by an
			 individual, or as applicable their legal or designated representative, to
			 deliver supports. Only one common law employer is permitted to be the employer
			 for all personal support workers delivering services to an
			 individual.
(2) The Department,
			 provider agencies, or case management entities may not act as the common law
			 employer for a personal support worker.
(3) The relationship between a personal
			 support worker and an individual, or their designated common law employer, is
			 an employee and employer relationship.
(4) Common law employers do not qualify for
			 any benefits including, but not limited to, financial compensation.
(5) COMMON LAW EMPLOYER REQUIREMENTS.
(a) Common law employers may be one of the
			 following:
(A) The individual.
(B) The legal or designated representative of
			 the individual.
(C) A person who is
			 designated by the individual, or as applicable their legal or designated
			 representative, to act as the designated common law employer on behalf of the
			 individual.
(i) A designated common law
			 employer or proxy must sign a Department-approved form affirming the designated
			 common law employer or proxy is able to fulfill the responsibilities, or
			 responsibilities delegated to them, as outlined in subsection (b) of this
			 section.
(ii) A designated common
			 law employer must not have any of the following:
(I) A history of substantiated abuse of an
			 adult as described in OAR
			 407-045-0250 through
			 407-045-0370.
(II) A history of substantiated abuse of an
			 adult as described in OAR chapter 411, division 020.
(III) A history of founded abuse of a child
			 as described in ORS 419B.005.
(IV) A conviction of any crime in ORS
			 443.004.
(iii) A common law employer must not
			 currently be employed as a provider in any capacity for the individual
			 receiving services.
(iv) A common
			 law employer must meet federal and state requirements to enter into an
			 employment relationship.
(v) A
			 common law employer may not have an indictment or conviction of fraud according
			 to
			 42 CFR
			 455.23.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0060 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  409.050
Stats. Implemented: ORS
				  410.600,
				  410.606-619,
				  427.007
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0070 - Inactivation and Termination of Independent Providers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An independent provider is not paid for
			 work performed while their provider number is inactivated, inactivated in an
			 emergency, or terminated.
(2)
			 STANDARD INACTIVATION. The Department may inactivate a provider number for an
			 independent provider for any of the following reasons until the independent
			 provider takes action to reinstate their provider enrollment:
(a) The independent provider informs the case
			 management entity the independent provider is no longer providing services in
			 Oregon.
(b) For a personal support
			 worker, the personal support worker fails to participate in a required
			 orientation for personal support workers as described in the Collective
			 Bargaining Agreement.
(c) The
			 background check for an independent provider results in a closed case pursuant
			 to OAR 407-007-0320.
(d) More than two years have passed since the
			 date on the most recent background check final fitness determination for an
			 independent provider.
(e) More than
			 two years have passed since the signature date on the most recent Provider
			 Enrollment Application and Agreement for an independent provider.
(f) The independent provider fails to
			 participate in training required by the Department.
(g) The independent provider does not request
			 a hearing within 10 business days of a notice of proposed
			 termination.
(h) For a personal
			 support worker, the personal support worker has not provided any paid services
			 to any individual in the last 18 months.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 375 - INDEPENDENT PROVIDERS DELIVERING DEVELOPMENTAL DISABILITIES SERVICES › Section 411-375-0080 - Hearing Rights

Current through Register Vol. 63, No. 7, July 1, 2024
(1) EXCLUSIONS.
			 The following are excluded from the hearings process described in this rule:
(a) Terminations based on a background check.
			 The independent provider has the right to a hearing in accordance with OAR
			 407-007-0200 through
			 407-007-0370.
(b) Termination based on being excluded or
			 debarred by the Office of the Inspector General.
(c) Termination based on a conviction for
			 fraud according to
			 42 CFR
			 455.23.
(d) Standard inactivation as described in OAR
			 411-375-0070.
(e) Independent
			 providers that are denied a provider enrollment number at the time of initial
			 application.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0010 - Statement of Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rules in
			 OAR chapter 411, division 380 establish standards and procedures for the
			 provision of direct nursing services for adults with intellectual or
			 developmental disabilities and complex health management support needs. These
			 rules define eligibility for services, prescribe Medicaid provider enrollment
			 conditions, and enact service and documentation requirements.
(2) Direct nursing services provide medical
			 tasks to adults with intellectual or developmental disabilities and complex
			 health management support needs in order to live as independently as possible
			 in their home and community.
Stat. Auth.: ORS
				  409.050,
				  413.085
Stats. Implemented: ORS
				  409.050,
				  413.085
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0020 - Definitions and Acronyms

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the following definitions, OAR
				411-317-0000 includes general
				definitions for words and terms frequently used in OAR chapter 411, division
				380. If a word or term is defined differently in OAR
				411-317-0000, the definition in
				this rule applies.
(1) "Acuity Level"
			 means the amount of the medically related support needs of an individual as
			 measured by the Direct Nursing Services Criteria.
(2) "Authorization" means the approval of a
			 case management entity for the planning, provision, and payment of direct
			 nursing services.
(3) "Case
			 Management Entity" means the Community Developmental Disabilities Program or
			 Brokerage contracted to deliver the functions of case management.
(4) "Complex Health Management Support Needs"
			 mean those medical or nursing tasks, activities, or duties in response to a
			 health condition or series of conditions that impacts all aspects of the care
			 of an individual, requiring oversight by a nurse and physician.
(5) "Direct Nursing Services" mean the
			 services described in OAR
			 411-380-0050 determined
			 medically necessary to support an individual with complex health management
			 support needs in their home and community. Direct nursing services are provided
			 on a shift staffing basis.
(6)
			 "Direct Nursing Services Agency" means an agency certified under OAR chapter
			 411, division 323 and endorsed to deliver direct nursing services under these
			 rules.
(7) "Direct Nursing Services
			 Criteria" means the assessment to measure the acuity and support level of
			 nursing tasks to determine eligibility for direct nursing services.
(8) "Enrolled Medicaid Provider" means a
			 provider that meets and completes all the requirements in these rules, OAR
			 407-120-0300 through
			 407-120-0400, and OAR chapter
			 410, division 120, as applicable.
(9) "Home Health Agency" has the meaning
			 given that term in ORS
			 443.014.
(10) "HSD" means Health Systems Division,
			 Medical Assistance Programs under OHA.
(11) "Individual" means an adult, 21 years of
			 age or older, eligible for direct nursing services according to OAR
			 411-380-0030.
(12) "In-Home Care Agency" has the meaning
			 given that term in ORS
			 443.305.
(13) "ISP" means "Individual Support
			 Plan".
(14) "LPN" means a licensed
			 practical nurse who holds a current license from the Oregon State Board of
			 Nursing according to ORS chapter 678 and OAR chapter 851, division 045. An LPN
			 providing direct nursing services under these rules is either one of the
			 following:
(a) An independent contractor who
			 is an enrolled Medicaid provider.
(b) An employee of an in-home care agency,
			 home health agency, or direct nursing services agency.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0030 - Eligibility and Limitations for Direct Nursing Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) NON-DISCRIMINATION. An individual may not
			 be denied direct nursing services or otherwise discriminated against on the
			 basis of race, color, religion, sex, gender identity, sexual orientation,
			 national origin, marital status, age, disability, source of income, duration of
			 Oregon residence, or other protected classes under federal and Oregon Civil
			 Rights laws.
(2) ELIGIBILITY. To be
			 eligible for direct nursing services, an individual must meet the following
			 requirements:
(a) Be 21 years of age or
			 older.
(b) Be an Oregon resident
			 who meets the residency requirements in OAR
			 461-120-0010.
(c) Be determined eligible for developmental
			 disabilities services by a Community Developmental Disabilities Program in the
			 county of origin as described in OAR
			 411-320-0080.
(d) Be receiving one of the following:
(A) A Medicaid Title XIX benefit package
			 through OSIPM or HSD medical programs. Individuals receiving Medicaid Title XIX
			 through HSD medical programs 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 the individual requested these services
			 under OSIPM, including the rules regarding:
(i) The transfer of assets as set forth in
			 OAR 461-140-0210 through
			 461-140-0300.
(ii) The equity value of a home which exceeds
			 the limits as set forth in OAR
			 461-145-0220.
(B) A benefit package through the
			 Healthier Oregon medical program.
(e) Be determined to meet the ICF/IID Level
			 of Care as defined in OAR
			 411-317-0000.
(f) Based on a functional needs assessment,
			 require oversight for complex health management support needs.
(g) Score 45 or higher on the Direct Nursing
			 Services Criteria completed by the Department.
(h) Have health impairments requiring
			 long-term direct nursing services determined medically necessary and
			 appropriate based on the order of a physician.