reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 29 - COMMUNITY-BASED CARE DISTRESSED PROVIDER RELIEF FUND › Section 411-029-0030 - Facility Statement of Need

Current through Register Vol. 63, No. 7, July 1, 2024
Sufficient information and financial records shall be submitted
				to the Department, in addition to the application form referenced in OAR
				411-029-0040, and shall include
				each of the following:
(1) A written
			 Facility Statement of Need that includes each of the following:
(a) Written statement of how a potential
			 closure of the facility would create a lack of access to care, particularly for
			 low income and Medicaid beneficiaries in the area;
(b) Written statement of steps taken to
			 address current financial hardships, such as accessing reserve funds, being
			 approved for the Enhanced Wage Add-on Program (OAR
			 411-027-0160), employed
			 strategies to increase facility census, and recruiting and retaining permanent
			 staff;
(c) Written statement
			 demonstrating how the facility plans to be financially sustainable in the
			 future; and
(d) Written statement
			 of an amount that the facility is requesting to assist the facility out of
			 financial hardship. This amount may not reflect the approved amount by the
			 Department.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 29 - COMMUNITY-BASED CARE DISTRESSED PROVIDER RELIEF FUND › Section 411-029-0040 - Application

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Interested
			 Community-Based Care Facilities must submit a completed application form
			 designated by the Department, in addition to the information and records
			 supporting the Facility's Statement of Need, described in OAR
			 411-029-0030.
(2) These documents can be combined in the
			 application form or submitted as separate documents, at the time of
			 submission.
(3) Complete
			 applications will be accepted by the due date set by the Department.
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 29 - COMMUNITY-BASED CARE DISTRESSED PROVIDER RELIEF FUND › Section 411-029-0050 - Approval and Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department will notify all facilities, in writing, whether approved or not
			 approved.
(2) Once approved, the
			 Department will process the payment within ten (10) business days of written
			 approval.
(3) The Department will
			 only authorize funds to the extent of the appropriation authorized by the
			 Oregon legislature.
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 29 - COMMUNITY-BASED CARE DISTRESSED PROVIDER RELIEF FUND › Section 411-029-0060 - Oversight

Current through Register Vol. 63, No. 7, July 1, 2024
All payments authorized for this Program are subject to audit
				at the discretion of the Department.
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 30 - IN-HOME SERVICES › Section 411-030-0002 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rules in
			 OAR chapter 411, division 030 ensure that in-home services maximize
			 independence, empowerment, dignity, and human potential through the provision
			 of flexible, efficient, and suitable services. In-home services fill the role
			 of complementing and supplementing an individual's own personal abilities to
			 continue to live in his or her own home or the home of a relative.
(2) Medicaid in-home services are provided
			 through the Consumer-Employed Provider Program, Spousal Pay Program,
			 Independent Choices Program, and other approved service providers.
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 30 - IN-HOME SERVICES › Section 411-030-0033 - In-Home Service Living Arrangements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The following terms are used in this
			 rule:
(a) "Informal arrangement" means a paid
			 or unpaid arrangement for shelter or utility costs that does not include the
			 elements of a property manager's rental agreement.
(b) "Property manager's rental agreement"
			 means a payment arrangement for shelter or utility costs with a property owner,
			 property manager, or landlord that includes all of the following elements:
(A) The name and contact information for the
			 property manager, landlord, or leaser.
(B) The period or term of the agreement and
			 method for terminating the agreement.
(C) The number of tenants or
			 occupants.
(D) The rental fee and
			 any other charges (such as security deposits).
(E) The frequency of payments (such as
			 monthly).
(F) What costs are
			 covered by the amount of rent charged (such as shelter, utilities, or other
			 expenses).
(G) The duties and
			 responsibilities of the property manager and the tenant, such as:
(i) The person responsible for
			 maintenance;
(ii) If the property
			 is furnished or unfurnished; and
(iii) Advance notice requirements prior to an
			 increase in rent.
(c) "Provider-owned dwelling" means a
			 dwelling that is owned by a provider or the provider's spouse, when the
			 provider is proposing to be paid for providing Medicaid home and
			 community-based services, and the provider or the provider's spouse is not
			 related to an individual by blood, marriage, or adoption. Provider-owned
			 dwellings include, but are not limited to:
(A) Houses, apartments, and
			 condominiums.
(B) A portion of a
			 house such as basement or a garage even when remodeled to be used as a separate
			 dwelling.
(C) Trailers and mobile
			 homes.
(D) Duplexes, unless the
			 structure displays a separate address from the other residential unit and was
			 originally built as a duplex.
(d) "Provider-rented dwelling" means a
			 dwelling that is rented or leased by a provider or the provider's spouse, when
			 the provider is proposing to be paid for providing Medicaid home and
			 community-based services, and the provider or the provider's spouse is not
			 related to an individual by blood, marriage, or adoption.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0040 - Eligibility Criteria

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In-home
			 services are provided to individuals who meet the established priorities for
			 service as described in OAR chapter 411, division 015 who have been assessed to
			 be in need of in-home services. Payments for in-home services are not intended
			 to replace the resources available to an individual from the individual's
			 natural supports.
(2) An individual
			 receiving Medicaid in-home services must:
(a)
			 Meet the established priorities for service as described in OAR chapter 411,
			 division 015.
(b) Meet all the
			 eligibility requirements in OAR
			 411-015-0010 through
			 411-015-0100
(c) Reside in a living arrangement described
			 in OAR 411-030-0033.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0050 - Case Management

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 ASSESSMENT. The assessment process identifies an individual's ability to
			 perform ADLs, IADLs, and determines an individual's ability to address health
			 and safety concerns.
(a) The case manager
			 must conduct an assessment in accordance with the standards of practices
			 established by the Department in OAR
			 411-015-0008.
(b) The assessment must be conducted by a
			 case manager or other qualified Department or AAA representative with a
			 standardized assessment tool approved by the Department in the home of the
			 eligible individual, no less than annually.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0055 - Community Transportation

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Community transportation (non-medical) may be prior-authorized for reasons
			 related to an eligible individual's safety or health, in accordance with the
			 individual's service plan. Community transportation is offered through
			 contracted transportation providers or by homecare workers.
(2) Community transportation may be
			 authorized to assist an eligible individual in getting to and from the
			 individual's place of employment when the individual is approved for the
			 Employed Persons with Disabilities Program (OSIPM-EPD).
(3) Natural supports, volunteer
			 transportation, and other transportation services available to an eligible
			 individual are considered a prior resource and may not be replaced with
			 transportation paid for by the Department.
(4) Health Systems Division is a resource for
			 medical transportation to a physician, hospital, clinic, or other medical
			 service provider. Medical transportation costs are not reimbursed through
			 community transportation.
(5)
			 Community transportation is not provided by the Department to obtain medical or
			 non-medical items that may be delivered by a supplier or sent by mail order
			 without extra cost to the eligible individual.
(6) Community transportation must be prior
			 authorized by an individual's case manager and documented in the individual's
			 service plan. The Department does not pay any provider under any circumstances
			 for more than the total number of hours, miles, or rides prior authorized by
			 the Department or AAA and as documented in the individual's service plan.
(a) Contracted transportation providers are
			 reimbursed according to the terms of their contract with the Department.
			 Community transportation services provided through contracted transportation
			 providers must be prior-authorized by a case manager based on an estimate of a
			 total count of one-way rides per month.
(b) Homecare workers who use their own
			 personal vehicle for community transportation are reimbursed according to the
			 terms defined in their Collective Bargaining Agreement between the Home Care
			 Commission and Service Employees International Union, Local 503, OPEU. Any
			 mileage reimbursement authorized to a homecare worker must be based on an
			 estimate of the maximum miles required to drive to and from the destination
			 authorized in an individual's service plan. Community transportation hours are
			 authorized in accordance with OAR
			 411-030-0070.
(c) The Department or AAA does not authorize
			 reimbursement for travel to or from the residence of a homecare worker. The
			 Department or AAA only authorizes community transportation and mileage from the
			 home of an eligible individual to the destination authorized in the
			 individual's service plan and back to the individual's home.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0068 - Shift Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 individual is only eligible for shift services if the assessment and submission
			 and review of a time/task log documenting three consecutive days of care
			 provided determines the individual meets the criteria described in section (2)
			 of this rule.
(2) Individuals must
			 meet subsections (a) and either (b) or (c) of this section of the rule.
(a) The provision of assistance with at least
			 one ADL or IADL task must be required sometime during each hour the individual
			 is awake in order to ensure the safety and well-being of the individual. To
			 meet this subsection, the individual, their representative, if applicable, or
			 the case manager must submit a time/task log detailing the performance of the
			 ADL and IADL tasks as defined in OAR chapter 411, division 015 for three (3)
			 consecutive 24-hour periods. The log shall include the name of the task, the
			 action performed and the duration of the task. The log must be complete and
			 acceptable to the Department to qualify.
(b) The individual is assessed as full assist
			 in mobility or elimination as defined in OAR
			 411-015-0006, and has at least
			 one of the following conditions:
(A) A
			 debilitating medical condition that includes, but is not limited to, any of the
			 following:
(i) Cachexia;
(ii) Severe neuropathy;
(iii) Coma;
(iv) Persistent or reoccurring stage 3 or 4
			 wounds;
(v) Late stage
			 cancer;
(vi) Frequent and
			 unpredictable seizures; or
(vii)
			 Debilitating muscle spasms.
(B) A spinal cord injury or similar
			 disability with permanent impairment.
(C) An acute care or hospice need that is
			 expected to last no more than six months.
(c) The individual is assessed as full assist
			 in cognition as defined in OAR
			 411-015-0006.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0070 - Maximum Hours of Service

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 LEVELS OF ASSISTANCE FOR DETERMINING SERVICE PLAN HOURS.
(a) "Minimal Assistance" means an individual
			 is able to perform the majority of an activity but requires some assistance
			 from another person.
(b)
			 "Substantial Assistance" means an individual is able to perform only a small
			 portion of the tasks that comprise an activity without assistance from another
			 person.
(c) "Full Assistance" means
			 an individual needs assistance from another person through all tasks of an
			 activity every time the activity is attempted.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0071 - Exceptions to Maximum Hours of Service

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility for In-Home Exceptions to
			 Maximum Hours of Service.
(a) If the
			 Department determines the individual's assessed service needs will not be
			 adequately met within the maximum number of hours for a specific ADL or
			 specific IADL as set forth in OAR
			 411-030-0070, and the Department
			 determines the individual meets all of the requirements in these rules and in
			 OAR 411-027-0050, then the
			 individual shall receive an exception to the maximum hours per ADL and
			 IADL.
(b) If the Department
			 determines the individual's assessed service needs will not be adequately met
			 within the maximum number of hours to address cognitive impairments, and the
			 individual meets the requirements in this rule, the individual shall receive an
			 exception to the maximum hours in cognition and other affected ADLs as
			 described in OAR 411-015-0006.
(c) The Department may deny an exception if
			 the request is:
(A) Based solely on a desire
			 for services outside of assessed service needs.
(B) Not medically appropriate.
(C) For assistance types not allowed by OAR
			 411-015-0006 and OAR
			 411-015-0007 for a particular
			 ADL or IADL.
(D) For services not
			 covered in the 1915(k) State Plan, OAR
			 411-015-0006, or OAR
			 411-015-0007.
(E) For tasks not identified in OAR
			 411-015-0006 and OAR
			 411-015-0007.
(F) Based solely on choice of the
			 individual.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0072 - Exceptions to the Homecare Worker Cap

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual receiving in-home service
			 hours may be eligible for an exception to the hourly cap on homecare worker
			 weekly hours as defined in OAR
			 411-030-0070(5)(b) and
			 (c), if:
(a) There are specific service needs that are
			 not able to be met by other resources, homecare workers or providers;
			 and
(b) The individual or their
			 representative is appropriately managing their Consumer Employer
			 Responsibilities as described in OAR 411-030-040(4)(a-f).
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0080 - Spousal Pay Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Spousal Pay Program is one of the hourly service options under in-home services
			 for those who qualify.
(2)
			 ELIGIBILITY. An individual may be eligible for the Spousal Pay Program when all
			 of the following conditions are met:
(a) The
			 individual has met all eligibility requirements for in-home services as
			 described in OAR 411-030-0040.
(b) The individual requires full assistance
			 in at least four of the six ADLs described in OAR
			 411-015-0006 as determined by
			 the assessment described in OAR chapter 411, division 015.
(c) A debilitating medical condition
			 including, but is not limited to, any of the following:
(A) Cachexia;
(B) Severe neuropathy;
(C) Coma;
(D) Persistent or reoccurring stage three or
			 four wounds;
(E) Late stage
			 cancer;
(F) Frequent and
			 unpredictable seizures;
(G)
			 Debilitating muscle spasms; or
(H)
			 A spinal cord injury or similar disability with permanent impairment.
(d) The individual would otherwise
			 require nursing facility services without Medicaid in-home services.
(e)The individual's service needs exceed in
			 both extent and duration the usual and customary services rendered by one
			 spouse to another.
(f) The spouse
			 demonstrates the capability and health to provide the services and actually
			 provides the principal services, including the majority of service plan hours,
			 for which payment has been authorized.
(g) The spouse meets all requirements for
			 enrollment as a homecare worker in the Consumer-Employed Provider Program as
			 described in OAR 411-031-0040.
(h) The spouse is not designated as a
			 representative as described in OAR
			 411-030-0040.
(i) The Department has reviewed the request
			 and approved program eligibility at enrollment and annually upon
			 re-assessment.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0090 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  409.050,
				  410.070,
				  410.090,
				  413.085
Stats. Implemented: ORS
				  410.010,
				  410.020,
				  410.070,
				  413.085
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 30 - IN-HOME SERVICES › Section 411-030-0100 - Independent Choices Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Independent Choices Program (ICP) is an In-Home Services Program that empowers
			 participants to self-direct their own service plans and purchase goods and
			 services that enhance independence, dignity, choice, and well-being.
(2) The Department may not change the ICP
			 Participation Agreement without posting the changes for public notice on the
			 Department's website.
(3) INITIAL
			 ELIGIBILITY REQUIREMENTS.
(a) To be eligible
			 for the ICP an individual must:
(A) Meet all
			 requirements for in-home services as described in these rules.
(B) Develop a service plan and budget to meet
			 the needs identified in his or her CA/PS assessment.
(C) Sign the ICP Participation Agreement.
			 Eligibility for the ICP cash benefit may not be backdated prior to the date
			 that the signed ICP Participation Agreement is received in the local
			 office.
(D) Have or be able to
			 establish a checking account.
(E)
			 Provide evidence of a stable living situation for the past three
			 months.
(F) Demonstrate the ability
			 to manage money as evidenced by timely and current utility and housing payments
			 for the past three months or previous history before hospitalization,
			 community-based care, or nursing facility stays.
(G) Demonstrate the ability to manage and
			 honor the employee provider responsibilities as outlined in the ICP
			 Participation Agreement.
(H)
			 Complete enrollment with a Department contracted Fiscal Intermediary to provide
			 the required Electronic Visit Verification (EVV) services when available and
			 required by the department.
(I) Not
			 have a history of misuse of the ICP cash benefit.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 31 - HOMECARE WORKERS ENROLLED IN THE CONSUMER-EMPLOYED PROVIDER PROGRAM › Section 411-031-0020 - 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 031:
(1) "Abuse" means abuse as defined by OAR
			 411-020-0002 and OAR
			 407-045-0260.
(2) "Active" means a homecare worker who has:
(a) A valid and current provider number
			 issued by APD;
(b) Worked and been
			 paid with public funds in any of the past 12 months as a homecare
			 worker;
(c) A valid and current
			 credential; and
(d) Met the
			 orientation and training requirements of the homecare worker program as set
			 forth in chapter 418, Division 020.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 31 - HOMECARE WORKERS ENROLLED IN THE CONSUMER-EMPLOYED PROVIDER PROGRAM › Section 411-031-0030 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The rules in OAR chapter 411, division 031 establish the
				standards and procedures governing homecare workers and the fiscal services
				provided on behalf of the Department or AAA consumer-employers to homecare
				workers enrolled in the Consumer-Employed Provider Program. Homecare workers
				provide Medicaid, Oregon Project Independence and Healthier Oregon funded
				in-home services to the Department or AAA consumers. In-home services support
				the ability of the consumer-employers to continue to live in their own
				homes.
Statutory/Other Authority: ORS
				  409.050,
				  410.070 &
				  410.090
Statutes/Other Implemented: ORS
				  410.010,
				  410.020 &
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 31 - HOMECARE WORKERS ENROLLED IN THE CONSUMER-EMPLOYED PROVIDER PROGRAM › Section 411-031-0050 - Termination, Administrative Review, and Hearing Rights

Current through Register Vol. 63, No. 7, July 1, 2024
(1) EXCLUSIONS TO
			 APPEAL AND HEARING RIGHTS. The following are excluded from the administrative
			 review and administrative hearing rights process described in this rule:
(a) Homecare workers who failed to complete a
			 background recheck;
(b) Homecare
			 workers who are not currently providing services to any consumers and whose
			 provider enrollment is inactivated while an Adult Protective Services
			 investigation is being completed;
(c) Homecare workers who have been excluded
			 by Health and Human Services, Office of Inspector General, from participation
			 in Medicaid, Medicare, or any other federal programs;
(d) Terminations or renewal denials based on
			 a background check. The homecare worker has the right to a hearing in
			 accordance with OAR 407-007-0200 to
			 407-007-0370. Homecare workers
			 receive notices from the background check unit and will not receive notices
			 from the Department;
(e) Homecare
			 workers who were inactivated based on OAR
			 411-031-0040(8)(b)(c);
			 or
(f) Homecare workers who 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 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0000 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For purposes of these rules:
(1) "Activities of Daily Living" (ADL) means
			 those personal functional activities required by an individual for continued
			 well being, health and safety. For the purposes of these rules, ADLs consist of
			 eating, dressing/grooming, bathing/personal hygiene, mobility (ambulation and
			 transfer), elimination (bowel and bladder management) and
			 cognition/behavior.
(2) "Adjusted
			 Income" means the income for all household members after deductions for
			 household medical expenses as defined in OAR
			 411-032-0040(1)(b)(D)(i).
(3)
			 "Administrative Costs" means those expenses associated with the overall
			 operation of the Oregon Project Independence (OPI) Program that are not
			 directly attributed to a service. These costs can include, but are not limited
			 to, costs associated with accounting services, indirect program costs, facility
			 expenses, etc.
(4) "Adult Day
			 Service" means a structured comprehensive program designed to meet the needs of
			 functionally and/or adults with cognitive impairments. Adult day service
			 provides individually planned service, supervision, social and related support
			 services, and health monitoring in a protective setting during any part of a
			 day, but less than 24-hour care.
(5) "Advisory Council" means an advisory
			 council of the authorized Agencies on Aging.
(6) "Alzheimer's Disease and Other Related
			 Disorders" means a progressive and degenerative neurological disease that is
			 characterized by dementia including the insidious onset of symptoms of
			 short-term memory loss, confusion, behavior changes and personality changes. It
			 includes dementia caused from any one of the following disorders:
(a) Multi-Infarct Dementia (MID);
(b) Normal Pressure Hydrocephalus
			 (NPH);
(c) Inoperable Tumors of the
			 Brain;
(d) Parkinson's
			 Disease;
(e) Creutzfeldt-Jakob
			 Disease;
(f) Huntington's
			 Disease;
(g) Multiple
			 Sclerosis;
(h) Uncommon Dementia
			 such as Pick's Disease, Wilson's Disease, and Progressive Supranuclear Palsy;
			 or
(i) All other related disorders
			 recognized by the National Alzheimer's Association.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0001 - Goals

Current through Register Vol. 63, No. 7, July 1, 2024
The goals of Oregon Project Independence are to:
(1) Promote quality of life and independent
			 living among seniors and people with physical disabilities;
(2) Provide preventive and long-term care
			 services to eligible individuals to reduce the risk for institutionalization
			 and promote self-determination;
(3)
			 Provide services to frail and vulnerable adults who are lacking or have limited
			 access to other long-term care services; and
(4) Optimize eligible individuals' personal
			 and community support resources.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.420
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0005 - Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Advisory
			 Council: Each area agency will show evidence that the advisory council of the
			 area agency, and the community were involved in the identification of need,
			 selection of services to be offered, and the development of the Area
			 Plan.
(2) Area Plan:
(a) Each area agency will submit an Area Plan
			 by a date specified and on forms provided by the Department.
(b) The Area Plan must, at a minimum,
			 contain:
(A) The types and amounts of
			 authorized services to be offered;
(B) The costs of these services;
(C) How the agency will ensure timely
			 response to inquiries for service;
(D) How individuals will receive initial and
			 ongoing periodic screening for other community services, including
			 Medicaid;
(E) How eligibility will
			 be determined;
(F) How the services
			 will be provided;
(G) The agency
			 policy for prioritizing OPI service delivery;
(H) The agency policy for denial, reduction
			 or termination of services;
(I) The
			 agency policy for informing individuals of their right to grieve adverse
			 eligibility, service determination decisions, and consumer
			 complaints;
(J) How fees for
			 services will be developed, billed, collected and utilized;
(K) The agency policy for addressing
			 individual non-payment of fees, including when exceptions will be made for
			 repayment and when fees will be waived;
(L) How service providers will be monitored
			 and evaluated; and
(M) Conflict of
			 interest policy for any direct provision of services for which a fee is
			 set.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0010 - Authorized Services and Allowable Costs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Authorized Services:
(a) Oregon Project Independence funds will
			 only be expended for administration and direct service for the following
			 authorized services:
(A) Homemaker (Home
			 Care);
(B) Chore Service;
(C) Assisted Transportation
			 (Escort);
(D) Home
			 Health;
(E) Personal
			 Services;
(F) Adult Day
			 Services;
(G) Respite;
(H) Information and Assistance;
(I) Registered Nurses;
(J) Home Delivered Meals;
(K) Other services authorized by the
			 administrator of the Department or his or her designee;
(L) Planning for long term care services;
			 and
(M) Public education on long
			 term care planning and resources.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0015 - Data Collection, Records, and Reporting

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Data Collection:
(a) The collection of required program and
			 fiscal data associated with Oregon Project Independence will be on forms and
			 data systems as approved by the Department.
(b) Each area agency and service provider
			 will collect data as required by the Department on eligible individuals
			 receiving authorized service.
(c)
			 All authorized service data collected on eligible individuals, supported by
			 Oregon Project Independence, will contain the individual's Social Security
			 Number and date of birth.
(d) For
			 individuals under the age of 60, documentation will be placed in the
			 individual's file that the person has been diagnosed as having Alzheimer's
			 Disease or other related disorder. Documentation must come verbally or in
			 writing from the individual's physician. The type of "other related disorder"
			 will also be specified in this documentation.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0020 - Eligibility and Determination of Authorized Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility:
(a) In order to qualify for services from an
			 area agency or service provider, each eligible individual must:
(A) Be 60 years old or older; or be under 60
			 years of age and be diagnosed as having Alzheimer's Disease or a related
			 disorder;
(B) Not be receiving
			 financial assistance or Medicaid, except Food Stamps, Qualified Medicare
			 Beneficiary or Supplemental Low Income Medicare Beneficiary Programs;
			 and
(C) Meet the requirements of
			 the Long-Term Care Services Priority Rule, OAR 411, division 015.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 32 - OREGON PROJECT INDEPENDENCE › Section 411-032-0050 - Pilot for Adults with Disabilities

Current through Register Vol. 63, No. 7, July 1, 2024
This rule applies from July 1, 2021 through June 30,
				2023.
(1) The purpose of this rule is
			 to set out the policies that apply to the expansion of Oregon Project
			 Independence services to adults with physical disabilities. The pilot allows
			 the Department to study the potential to transition Oregon Project Independence
			 to a statewide, age neutral, program that assesses and serves seniors and
			 persons with physical disabilities based on their functional needs.
(2) "Disability" means, for the purposes of
			 this rule, a physical, cognitive, or emotional impairment which, for an
			 individual, constitutes or results in a functional limitation in one or more of
			 the activities of daily living defined in OAR
			 411-015-0006, or in one or more
			 of the instrumental activities of daily living defined in OAR
			 411-015-0007.
(3) "Adult" means, for purposes of this rule,
			 any person 19 to 59 years of age.
(4) OAR
			 411-032-0000 to
			 411-032-0044 apply to this pilot
			 program, except as noted below:
(a) Authorized
			 Services and Allowable Costs. Authorized services may not be available in all
			 service areas. Authorized services for the pilot funds include home care
			 supportive services, service coordination, and other services, including the
			 following:
(A) Home care.
(B) Chore services.
(C) Assistive Technology.
(D) Personal care services.
(E) Adult day services.
(F) Registered nurse services.
(G) Home delivered meals.
(H) Services to support community caregivers
			 and strengthen the natural support system of individuals.
(I) Evidence-based health promotion
			 services.
(J) Options
			 counseling.
(K) Assisted
			 transportation options that allow individuals to live at home and access the
			 full range of community resources.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 33 - IN-HOME CARE AGENCIES PROVIDING MEDICAID IN-HOME SERVICES › Section 411-033-0000 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
The rules in OAR chapter 411, division 033 ensure in-home care
				agencies, as one of the Medicaid in-home service provider options, provide
				services to maximize independence, empowerment, dignity, and human potential
				through the provision of flexible, efficient, and suitable services. In-home
				services fill the role of complementing and supplementing an individual's
				personal abilities, so the individual is able to continue to live in their own
				home.
Stat. Auth.: ORS
				  409.050,
				  410.070,
				  410.090,
				  413.085
Stats. Implemented: ORS
				  410.010,
				  410.020,
				  410.070,
				  413.085
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 33 - IN-HOME CARE AGENCIES PROVIDING MEDICAID IN-HOME SERVICES › Section 411-033-0020 - In-Home Care Agency Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 In-home care agency (IHCA) services are one of the in-home service options
			 available for individuals eligible for Medicaid in-home services. The in-home
			 care agency must be licensed in accordance with OAR chapter 333, division 536
			 or as a licensed home health agency that has obtained the in-home care service
			 designation from the Oregon Health Authority according to ORS
			 443.305-443.355.
(2) Medicaid-funded in-home care services,
			 provided by the in-home care agency, are not available to individuals who
			 reside in a licensed or certified community based care setting or while
			 inpatient in a hospital or nursing facility setting.
(3) Prior to accepting an individual for
			 in-home care agency services, the IHCA must complete the initial screening to
			 evaluate a prospective client's service requests as defined in OAR
			 333-536-0055.
(a) The IHCA shall notify the referring AAA
			 or DHS office and individual or individual's representative via email or phone
			 of acceptance for services. The IHCA shall begin services within five business
			 days from the date of acceptance unless the individual's health and safety
			 requires an earlier start date to be determined by the AAA or DHS case manager
			 and communicated to the IHCA prior to acceptance.
(b) The case manager and IHCA must review the
			 individual's person-centered service plan to assure the IHCA's understanding of
			 the individual's service plan and assessed needs. Upon completion of case
			 manager and IHCA review, the case manager shall draft a list of tasks based
			 upon the person-centered service plan to be completed by the IHCA. This "task
			 list" must be signed by the IHCA and returned to the CM.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 33 - IN-HOME CARE AGENCIES PROVIDING MEDICAID IN-HOME SERVICES › Section 411-033-0030 - Medicaid In-Home Care Agency Provider Enrollment, Requirements, and Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PROVIDER
			 ENROLLMENT.
(a) Application and Agreement. A
			 provider must be an enrolled Medicaid provider in order to be eligible to
			 receive payment from the Department for claims in connection with services
			 provided by an IHCA.
(b) The
			 criteria for provider enrollment includes, but is not limited to:
(A) Meeting all program-specific
			 requirements;
(B) Providing a copy
			 of the IHCA agency's current OHA Public Health issued comprehensive classified
			 license;
(C) Obtaining a Medicaid
			 Provider Number;
(D) Current
			 Business registration and assumed business name (DBA), if applicable, with the
			 Oregon Secretary of State's Corporations Division; and
(E) Completing a Medicaid Provider Enrollment
			 Agreement.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The rules in OAR chapter 411, division 034 ensure State Plan
				personal care services support and augment independence, empowerment, dignity,
				and human potential through the provision of flexible, efficient, and suitable
				services to individuals eligible for State Plan personal care services served
				through Aging and People with Disabilities. State Plan personal care services
				are intended to supplement an individual's own personal abilities and
				resources.
Statutory/Other Authority: ORS
				  409.050 &
				  410.070
Statutes/Other Implemented: ORS
				  410.020,
				  410.070 &
				  410.710
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless the context indicates otherwise, the following
				definitions apply to the rules in OAR chapter 411, division 034:
(1) "Activity of Daily Living (ADLs)" means
			 those personal functional activities required by an individual for continued
			 well-being, which are essential for health and safety. ADLs for these rules
			 means Basic Personal Hygiene, Medication and Oxygen Management, Mobility,
			 Toileting, Nutrition and Nursing Services.
(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, Older Americans
			 Act 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
			 terms AAA and Area Agency on Aging are inclusive of both Type A and Type B Area
			 Agencies on Aging as defined in ORS
			 410.040 and described in ORS
			 410.210 to
			 410.300.
(5) "Assistance" means an individual requires
			 help from another person with the personal care or supportive services
			 described in OAR 411-034-0020.
(6) "Assistance Types" mean assistance from
			 another person in the form of hands-on assistance (actually performing a
			 personal care task for a person) or cueing (redirecting) so that the person
			 performs the task by themselves. Other types of assistance may be defined in
			 specific ADLs or IADLs. Specific assistance types include:
(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 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0020 - State Plan Personal Care Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) State Plan personal care services are
			 essential services that enable an individual to move into or remain in their
			 own home while also safely navigating their community. State Plan personal care
			 services are provided in accordance with an individual's authorized plan for
			 services by a qualified provider.
(a) State
			 Plan personal care services are provided directly to an eligible individual and
			 are not meant to provide respite or other services to an individual's natural
			 support system. State Plan personal care services may not be implemented for
			 the purpose of benefiting an individual's family members or the individual's
			 household in general.
(b) State
			 Plan personal care services are limited to 270 hours per calendar year per
			 individual served by APD or an AAA.
(c) When an individual's State Plan Personal
			 Care service needs exceed the annual maximum of 270 hours an exception must be
			 submitted.
(A) To submit an exception the
			 Local Office (LO) must complete 514PC and submit to Central Office (CO)
			 regardless of the number of hours requested.
(B) If an individual requests an exception,
			 but their service plan does not exceed 270 hours annual the request for an
			 exception may be approved or denied by the LO.
(C) CO has up to 45 days upon receipt of a
			 completed exception request to determine whether an individual's assessed
			 personal care needs warrant exceeding the service plan limitation.
(D) The individual shall receive written
			 notice of the Department's decision.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0030 - Eligibility for State Plan Personal Care Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible for State Plan personal
			 care services, an individual must:
(a) Be 18
			 years of age or older.
(b) Have a
			 physical or cognitive impairment that requires the assistance from another
			 person or delegated nursing services to complete at least one of the ADLs
			 described in 411-034-0020(2)(a).
(c) Be a current recipient of an OHP Plus
			 package through Medicaid or Healthier Oregon.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 34 - STATE PLAN PERSONAL CARE SERVICES › Section 411-034-0035 - Applying for State Plan Personal Care Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Individuals eligible for state plan
			 personal care services as described in OAR
			 410-172-0790(1)
			 must apply through the local community mental health program or agency
			 contracted with Health Systems Division (HSD). An individual applying for State
			 Plan personal care services that is not eligible for or receiving services
			 through ODDS or APD is referred to the appropriate HSD office.
(2) An individual with an intellectual or
			 developmental disability eligible for or receiving services through the
			 Department's Office of Developmental Disabilities Services (ODDS), a Community
			 Developmental Disability Program (CDDP), or Support Services Brokerage must
			 apply for State Plan personal care services through the local CDDP or the local
			 support services brokerage.
(3) An
			 older adult or an adult with a disability eligible for or receiving case
			 management services from the Department's Aging and People with Disabilities
			 (APD) or Area Agency on Aging (AAA) must apply for State Plan personal care
			 services through the local APD or AAA office.
(4) Individuals receiving benefits through
			 the Department's Self-Sufficiency Programs (SSP) must apply for State Plan
			 personal care services through the local APD or AAA office. APD/AAA is
			 responsible for service assessment and for any planning and payment
			 authorization for State Plan personal care services, if the applicant is
			 determined eligible.
Statutory/Other Authority: ORS
				  409.050 &
				  410.070
Statutes/Other Implemented: ORS
				  410.020,
				  410.070,
				  410.608,
				  410.710 &
				  411.116