Oregon Administrative Code

410-200-0420 Specific Requirements; MAGI Parent or Caretaker Relative In addition to eligibility requirements applicable to the MAGI Parent or Caretaker Relative program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI…

410-200-0425 Specific Requirements; MAGI Pregnant Woman In addition to eligibility requirements applicable to the MAGI Pregnant Woman program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Pregnant Woman program. (1)…

410-200-0435 Specific Requirements; MAGI Adult In addition to eligibility requirements applicable to the MAGI Adult program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Adult program. (1) To be eligible for the MAG…

410-200-0437 Specific Requirements: OHP Bridge - Basic Medicaid. In addition to the general eligibility requirements applicable to OHP Bridge - Basic Medicaid as set out in OAR Chapter 410, Division 200, this rule describes specific eligibility requirements for OHP Bridge - Basic…

410-200-0438 Specific Requirements: OHP Bridge – Basic Health Program In addition to the general requirements applicable to OHP Bridge – Basic Health Program set forth in this Division 200, this rule describes specific eligibility requirements for OHP Bridge – Basic Health Progra…

410-200-0440 Specific Requirements; Extended Medical Assistance In addition to eligibility requirements applicable to Extended Medical Assistance (EXT) in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the EXT program. (1) Excep…

410-200-0445 Specific Requirements – Compact Of Free Association (COFA) Dental Program (1) The Compact of Free Association (COFA) Dental Program is effective January 1, 2023. (2) To be eligible for the COFA Dental Program, an individual must: (a) Be lawfully residing in the Unite…

410-200-0450 Specific Requirements – Veteran Dental Program (1) The Veteran Dental Program is effective January 1, 2023. (2) To be eligible for the Veteran Dental Program, an individual must: (a) Be a resident of Oregon; (b) Be a veteran as described in ORS 408.225, except the in…

410-200-0455 Specific Requirements - Young Adults with Special Health Care Needs In addition to the other eligibility requirements applicable to the Young Adults with Special Health Care Needs (YSHCN) program as set forth elsewhere within Chapter 410, including Division 200, this…

410-200-0521 Unwinding Period - HSD Medical Programs (1) The provisions in this rule apply to all Health Systems Division (HSD) Medical Program determinations effective April 1, 2023, through February 28, 2025. Notwithstanding any other rule to the contrary in these chapter 410 d…

411-001-0100 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Purpose (1) The purpose of the rules in OAR chapter 411, division 001 is to establish procedures for the operation of the Medicaid Long Term Care Quality and Reimbursement Advisory Council (Council)…

411-001-0110 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Definitions (1) "Authority" means the Oregon Health Authority. (2) "Council" means the Medicaid Long Term Care Quality and Reimbursement Advisory Council. (3) "Department" means the Department of Hu…

411-001-0115 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Council Administration Council By-Laws supplement ORS 410.550 to 410.555 and these rules. Statutory/Other Authority: ORS 410.070 & 410.555 Statutes/Other Implemented: ORS 410.550 - 410.555 History: …

411-001-0118 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Council Scope (1) At the beginning of each legislative session, the Council shall review the Governor's Recommended Budget for the Department. The Council may submit a recommendation in support or o…

411-001-0120 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Council Operation (1) Within 60 calendar days after receipt from the Department or Authority of any proposed change or modification to the Medicaid reimbursement system, the Council shall issue a wr…

411-001-0500 Contested Case Hearings (1) OAR 411-001-0500, 411-001-0510, and 411-001-0520 apply to all contested case hearing requests authorized under OAR chapter 411, except to the extent that: (a) There is another conflicting rule in OAR chapter 411 that applies to the hearing…

411-001-0510 Lay Representation in Contested Case Hearings (1) Subject to the approval of the Attorney General, an officer or employee of the Department of Human Services (Department) is authorized to appear on behalf of the Department in the following types of hearings conducted…

411-001-0520 Late Contested Case Hearing Requests (1) When the Department of Human Services (Department) receives a completed hearing request that is not filed within the timeframe required by the applicable rule in OAR chapter 411 but is filed no later than the deadlines set out…

411-002-0100 Definitions Relating to the Designation of Planning and Service Areas (1) “Area Agency on Aging” means the designated entity with which the Division contracts to meet the requirements of the Older Americans Act and ORS Chapter 410 in planning and providing services t…

411-002-0105 Basis for Planning and Service Area Designation (1) Boundaries for Planning and Service Areas will be designated by the Division Administrator and indicated in the current State Plan on Aging. (2) Designation of additional Planning and Service Areas shall be in compl…

411-002-0110 Designation of Area Agencies on Aging (1) Each Planning and Service Area shall have only one designated Area Agency on Aging. (2) The Administrator of the Division shall designate Area Agencies on Aging. (3) The designation shall comply with the Older Americans Act b…

411-002-0120 Area Agency on Aging Applicant Requirements (1) An applicant requesting to replace an existing Area Agency on Aging must clearly establish the need for such a change. (2) It is the responsibility of the applicant to submit sufficient information and supporting docume…

411-002-0130 Designation of a Type B1 Area Agency on Aging (1) A designated Type B1 Area Agency on Aging shall meet the requirements of OAR 411-002-0110. (2) Notwithstanding OAR 411-002-0110(4), a designated Type B1 Area Agency on Aging shall be: (a) An office or agency of a unit…

411-002-0140 Type B1 Area Agency on Aging Applicant Requirements (1) It is the responsibility of the applicant to submit sufficient information and supporting documentation to allow the Division to make a decision on a type B1 designation. (2) A Type B1 Area Agency on Aging appli…

411-002-0150 Designation and Requirements of Type B2 Area Agencies on Aging A Type B2 Area Agency on Aging must meet the requirements of OAR 411-002-0110, 411-002-0120, 411-002-0130 and the following additional requirements: Mandatory Functions — All information submitted by the …

411-002-0155 State Employee Supervision in a Type B1 or Type B2 Contract AAA General Requirements: (1) The Department of Human Services (the Department) and the AAA Contracted local government entities, in the best interest of the affected State employees, must collaborate and co…

411-002-0160 Changing from a Type A or Type B1 AAA to a Type B2 AAA (1) Type A or Type B1 Area Agencies on Aging may request to change their model of service delivery to a Type B2 Area Agency on Aging. The process for requesting the change is as follows: (a) The AAA notifies the …

411-002-0170 Withdrawal of Area Agency on Aging Designation (1) In carrying out provisions of the Older Americans Act and ORS 410.100, the Division must withdraw the agency designation whenever it, after reasonable notice and opportunity for an Administrative Review and efforts a…

411-002-0175 Methodology To Determine Budget Levels for Type B Area Agencies on Aging That Have Elected To Have Employment Transfer (1) Definitions: (a) A “Type B Transfer AAA” means a Type B Area Agency on Aging that has elected to have employees transferred to employment by the…

411-004-0000 Statement of Purpose The rules in OAR chapter 411, division 4 provide a foundation of standards to support the network of Medicaid-funded and private pay residential and non-residential Home and Community-Based Services (HCBS), Home and Community-Based (HCB) settings…

411-004-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 4: (1) "CMS" means the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2) "Competitive Integrated …

411-004-0020 Home and Community-Based Services and Settings (1) Residential and non-residential HCB settings must have all of the following qualities: (a) The setting is integrated in and supports the same degree of access to the greater community as people not receiving HCBS, in…

411-004-0030 Person-Centered Service Plans (1) PERSON-CENTERED SERVICE PLANNING PROCESS. A person-centered service plan must be developed through a person-centered service planning process. The person-centered service planning process: (a) Is driven by the individual; (b) Include…

411-004-0040 Individually-Based Limitations This rule will begin being implemented January 1, 2017. The requirements in this rule must be in place no later than June 30, 2020. Individual program rules may require compliance to this rule earlier than June 30, 2020. (1) When the co…

411-005-0010 Disclosure of Information to the Client or Third Party This rule applies to programs covered by chapter 411 of the Oregon Administrative Rules. (1) Except as provided in section (2) of this rule and OAR 410-014-0030: (a) The Department must make information in a clie…

411-005-0015 Release of Information to a Law Enforcement Officer For any program covered by OAR chapter 411: (1) The Department may provide client information only to a law enforcement officer in any of the following situations: (a) The law enforcement officer is involved in carr…

411-005-0020 Release of Information to a State or Federal Legislative Body or Committee (1) The Department may not disclose any information identifying any client by name or address to any committee, advisory board, legislative body, or individual member of such committee, board,…

411-005-0035 Release of Information in Judicial Proceedings (1) Client specific information must not be divulged in any judicial proceeding unless: (a) The proceeding is directly connected with administration of public assistance or service under chapter 411 of the Oregon Adminis…

411-005-0045 Release of Alcohol and Drug and Mental Health Reports (1) Unauthorized use, disclosure and redisclosure of alcohol and drug treatment information and mental health information is prohibited. (2) A client has the right to restrict to what entity or person and for what…

411-011-0000 Provision of Services by Area Agencies on Aging (AAAs) (1) “No supportive or nutrition services will be directly provided by the State agency or an Area Agency on Aging, except where, in the judgment of the State agency, provision of such services by the state agency…

411-011-0005 Competitive Procurement (1) General Requirements: (a) The Competition in Contracting Act of 1984 requires that, in the procurement of services, there be a solicitation, and that it be designed to achieve full and open competition for the procurement; (b) A competitiv…

411-011-0010 Competitive Procurement for Nutrition Services (1) In accordance with the Older Americans Act, as amended through 1984: “No contract awarded after September 30, 1982, shall be entered into for the provision of nutrition services unless such contract has been awarded …

411-011-0015 Response by Area Agency on Aging to Requests for Proposal (1) An Area Agency on Aging may respond to its own Request for Proposal (RFP). In doing so, it shall process the evaluation of responses to such a Request for Proposal in the following manner: (a) The Area Age…

411-014-0000 Purpose The purpose of these rules is to define the eligibility requirements for the Oregon Project Independence-Medicaid (OPI-M) Program. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 65-2024, adopt filed 11/20/2024, eff…

411-014-0005 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 014: (1) "Activities of Daily Living (ADL)" mean those personal functional activities required by an individual for continued well-being, whi…

411-014-0020 Eligibility and Limitations for Oregon Project Independence-Medicaid (1) To be eligible for Oregon Project Independence- Medicaid services, an individual must: (a) Be age 18 or older; (b) If aged 18-59, meet the criteria for disability in OAR 461-125-0370 used for th…

411-014-0025 Financial Eligibility for OPI-M (1) The income and resource methodology for OSIPM outlined in OAR chapter 461 is used to determine financial eligibility for the OPI-M except as follows: (a) In OPI-M an individual must have adjusted income (see OAR 461-001-0000) that …

411-014-0030 Scope of OPI-M Eligibility Case Management (1) Eligibility Case Managers are responsible for: (a) Eligibility related, consultation, and referral tasks including: (A) Service eligibility assessments and service eligibility determinations as described OAR 411-014-0040…

411-014-0035 Qualified Case Manager Eligibility case managers must meet the qualifications in OAR 411-028-0040. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065 History: APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024 APD…

411-014-0040 Assessments (1) Assessments must be conducted by eligibility case managers and in accordance with OAR 411-015-0008 except that the service eligibility assessment and determination is made every 24-months in accordance with the continuous eligibility standard in OPI-M…