Oregon Administrative Code

411-015-0000 Purpose The purpose of establishing priorities for persons to be served is to assist the Department in addressing the following goals: (1) To enable persons eligible for and receiving services to remain in the least restrictive and least costly setting consistent wit…

411-015-0005 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 015: (1) "AAA" means "Area Agency on Aging" as defined in this rule. (2) "Activities of Daily Living (ADL)" mean those personal functional ac…

411-015-0006 Activities of Daily Living (ADL) (1) Evaluation of the individual's need for assistance in activities of daily living is based on: (a) The individual's ability to complete activities, components, and tasks rather than the services provided; (b) How the individual fun…

411-015-0007 Instrumental Activities of Daily Living (1) "Instrumental Activities of Daily Living (IADL)" or "Self-Management tasks" consists of housekeeping including laundry, shopping, transportation, medication management and meal preparation. (2) Evaluation of the individual’…

411-015-0008 Assessments (1) ASSESSMENT. (a) The assessment process: (A) Identifies an individual's ability to fully perform in a safe and dignified manner, comparable with how tasks would be performed by an individual not receiving Long Term Care Services and Supports (LTSS), th…

411-015-0010 Priority of Paid Services To determine the service priority level, an individual must be determined eligible, using the Department's standardized assessment tool, by meeting at least the requirements for Assist or Full Assist in activities of daily living as defined …

411-015-0015 Current Limitations (1) The Department has the authority to establish, by administrative rule, service eligibility within which to manage the Department's limited resources. The Department is currently able to serve: (a) Individuals determined eligible for the Medica…

411-015-0030 Extended Waiver Eligibility (EWE) (1) An individual determined to no longer meet the criteria in 411-015-0100 and assessed as Service Priority Level (SPL) 14 - 18 through the assessment process outlined in 411-015-0008 may be eligible to continue receiving Long-Term …

411-015-0100 Eligibility for Nursing Facility or Home and Community-Based Services (1) To be eligible for nursing facility services or home and community-based services, a person must: (a) Be age 18 or older. (b) Be eligible for the Medicaid OHP Plus benefit package. (A) Individu…

411-016-0000 Purpose The purpose of the Oregon Project Independence-Medicaid program is to: (1) Provide limited, non-medical assistance to delay or prevent the need for full Medicaid long term services and supports under Oregon’s 1915(c) waiver authority or any other state plan a…

411-016-0005 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 016: (1) "Activities of Daily Living (ADL)" mean those personal functional activities required by an individual for continued well-being, whi…

411-016-0010 Scope of OPI-M Services Case Management (1) Services Case Managers (SCMs) are responsible for: (a) Person-centered service plan development including goals, preferences and plan monitoring; (b) Presenting program options, service options, resources, and alternatives …

411-016-0020 Qualified Services Case Manager Services Case Managers (SCMs) must meet the following criteria: (1) Be employed by an Area Agency on Aging, the Department or a subcontractor of a Type B AAA transfer that was subcontracting to provide OPI case management prior to June…

411-016-0025 OPI-M Service Eligibility and Responsibilities of the Individual (1) For ongoing approval of an OPI-M service plan, the individual must receive case management services and the individual or their representative must participate in the person-centered service plannin…

411-016-0030 Person-Centered Service Planning (1) Services Case Managers (SCMs) must use a person-centered service planning process to develop person-centered service plans. The process must: (a) Be directed by the individual and include people chosen by the individual; (b) Occur…

411-016-0040 Service Plan Hours (1) Through a person-centered planning process with the individual, the Services Case Manager (SCM) authorizes hours to address the individual’s unmet needs or to support the unpaid caregiver relationship. (2) A service plan may have no more than a…

411-016-0050 Limitations on In-Home Services Plans (1) The AAA or Department must take necessary safeguards to protect an individual’s health, safety, and welfare when implementing an individual’s service plan in accordance with 42 CFR 441.302 and 42 CFR 441.570. When an individu…

411-016-0075 Consumer-Employer Responsibilities (1) CONSUMER-EMPLOYER RESPONSIBILITIES. To be eligible for OPI-M in-home services provided by a homecare worker, an individual or the individual’s representative must be able to: (a) Locate, screen, and hire a qualified homecare wor…

411-016-0080 Homecare Workers and Provider Qualifications (1) For the purpose of this rule, case manager as used in OAR chapter 411, division 031 means the OPI-M Services Case Manager (SCM). (2) Homecare workers must be enrolled in and follow the rules in the Consumer-Employed Pr…

411-016-0090 In-Home Agency Services and Provider Enrollment (1) For the purpose of this rule, (a) Case manager as used in OAR 411-033-0020 is synonymous with the Services Case Manager in OAR 411-014-0010; and (b) Individual as used in OAR 411-033-0020 is modified to apply to peo…

411-016-0100 Adult Day Services (ADS) and ADS Provider Qualifications (1) An eligible individual may choose to receive services from an ADS. If an individual chooses to receive ADS services, their authorized hours will be reduced by the number of hours they are at the ADS provide…

411-016-0110 Assistive Technology, Emergency Response Systems and Provider Qualifications (1) Assistive Technology such as electronic back-up systems and Emergency Response systems may be authorized in an OPI-M service plan by an OPI-M Services Case Manager for individuals who me…

411-016-0120 Assisted and Community Transportation and Provider Qualifications (1) Assisted transportation is offered through homecare workers or in-home care agencies who have a valid Medicaid provider number. Hours authorized for assisted transportation are included in the 40-h…

411-016-0130 Unpaid Caregiver Education and Training and Provider Qualifications (1) For the purposes of this rule, an unpaid caregiver means a person providing assistance that meets the following conditions: (a) Longevity/Acuity: (A) The caregiver has been providing unpaid careg…

411-016-0140 Chore Services and Provider Qualifications (1) Chore services assist individuals to maintain their health and safety and are beyond the scope of ADL and IADL tasks as defined in OAR 411-015-0006 and OAR 411-015-0007. (2) To be eligible for chore services, an individu…

411-016-0150 Community Caregiver Supportive Services and Provider Qualifications (1) Community Caregiver Supportive Service may be authorized to assist the individual and their natural support systems. (2) Through a person-centered planning process with the individual, the Servic…

411-016-0160 Evidence Based Health Promotion Services and Provider Qualifications (1) Evidence Based Health Promotion Services assist eligible individuals to maintain or improve their health or build skills to manage health conditions. These services include, but are not limited …

411-016-0170 Home Delivered Meals and Provider Qualifications (1) To be eligible for home delivered meals a participant must: (a) Be eligible for OPI-M; (b) Be unable to complete meal preparation as defined in OAR 411-015-0007 on a regular basis without assistance; and (c) Not ha…

411-016-0180 Home Modifications and Provider Qualifications (1) Home modifications may be authorized for OPI-M eligible individuals whose circumstances meet the consumer environmental modifications criteria in OAR 411-035-0055. (2) Home modifications must be eligible environmenta…

411-016-0190 Long Term Care Community Nursing Services and Provider Qualifications (1) Individuals with health-related needs as assessed by the Services Case Manager (SCM) are eligible for long term care community nursing services as described in Oregon Administrative Rule chapte…

411-016-0200 Special Medical Equipment and Supplies (1) Individuals may be eligible for specialized or durable medical equipment and medical supplies if no other payer such as Medicare, Medicaid medical benefits or other insurance is paying for the equipment or supplies. (2) Spec…

411-016-0210 Supports for Consumer Direction (1) Supports for Consumer Direction directly benefit the individual by providing skills and knowledge to become an effective employer of homecare workers, self-advocate for other services and resources and manage service plans and goal…

411-016-0300 AAA Case Management, Data Collection, Records, and Reporting (1) CASE MANAGEMENT. (a) Type A and Type B contract AAAs will provide services case management to OPI-M cases without full Medicaid medical benefits. (b) The Department may make exceptions to subsection (a)…

411-017-0000 Purpose and Effective Date (1) The OAR chapter 411, division 017 rules outline the criteria for providing crisis support to individuals who receive Long-term services and supports through the Aging and People with Disabilities program of the Oregon Department of Huma…

411-017-0010 Definitions (1) “Aging and People with Disabilities (APD)" means the program within the Oregon Department of Human Services (ODHS) primarily responsible for serving older adults and people with physical disabilities as defined in OAR chapter 411, division 015. (2) "A…

411-017-0020 Eligibility Criteria for Crisis Support (1) To be eligible for crisis supports, an individual must: (a) Be eligible for or receiving Medicaid long term services and supports, including OPI-M, from Aging and People with Disabilities; (b) Have an identified, short-term…

411-017-0030 Eligibility Criteria for Emergency Items (1) To be eligible for emergency items, an individual must meet the following requirements: (a) Be receiving Medicaid funded in-home services, including OPI-M and SPPC, from the Department; (b) Be likely to need evacuation dur…

411-017-0040 Types of Crisis Support Services (1) Services described in these Rules may include: (a) Temporary hotel stay. (b) An item or service that would normally be the responsibility of another payer, but the timeframe to secure approval puts the individual’s health or safet…

411-017-0050 Conditions for Purchase of Emergency Items (1) Emergency items must meet the following requirements: (a) Be of direct benefit to an individual; (b) Be necessary as identified in the individual’s person centered support plan; (c) Be cost-effective; and (d) Be new or p…

411-017-0060 Approval of Crisis Support Services (1) The Case Manager must ensure the risk assessment in the individual’s person-centered service plan remains up-to-date. (2) The Case Manager must complete and submit the CSP request form and provide any additional information req…

411-017-0070 Denial of Crisis Support Program Services and Request for Emergency Items (1) An individual will receive notification of the decision in writing. The decision notice will include the reason for the denial and the right to an administrative review. (2) An individual m…

411-017-0080 End to Eligibility for Emergency Items Emergency items are subject to availability and available funding as determined by the Department. Statutory/Other Authority: ORS 409.050, 410.070 & 410.090 Statutes/Other Implemented: ORS 410.070 History: APD 2-2026, adopt file…

411-018-0000 Purpose and Definitions Purpose: These rules establish standards and procedures for a long-term care facility that will be certified by the Department as an essential community provider long-term care facility. (1) “Adult Foster Home” defined in ORS 443.705 means any…

411-018-0010 Certification Process (1) A long-term care facility seeking certification as an essential community provider long-term care facility must make written application to the Department. The application must include: (a) The name under which the facility is licensed; (b) …

411-018-0020 Appeal Process (1) The Department will issue a notice of Disqualification to a facility when it has been determined the facility does not qualify for Certification. (2) The notice of Disqualification must be issued within 15 business days following receipt of the com…

411-019-0000 Purpose and Responsibilities (1) The purpose of these rules is to establish responsibilities and membership for the Oregon Deaf and Hard of Hearing Services (ODHHS) advisory committee. The goal of ODHHS is to serve members of the public and state agencies by ensuring…

411-019-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 019: (1) "Deaf" is a term that describes individuals who usually have no useful residual hearing and who generally use sign language as their…

411-019-0020 Composition of ODHHS Advisory Committee (1) The Director of the Department of Human Services shall appoint an advisory committee to advise the Director regarding the Oregon Deaf and Hard of Hearing Services Program. The Director shall try to achieve geographic divers…

411-019-0030 ODHHS Executive and Ad Hoc Committees (1) The ODHHS advisory committee shall elect an ODHHS executive committee from its membership. (2) The executive committee shall consist of two co-chairs and one secretary. (a) The executive committee reserves the right to expand…

411-020-0000 Purpose and Scope of Program (1) RESPONSIBILITY. The Department of Human Services (Department), Aging and People with Disabilities program (APD) has the responsibility to provide Adult Protective Services (APS) to older adults and to adults with physical disabilities…