Oregon Administrative Code

411-029-0030 Facility Statement of Need 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 in…

411-029-0040 Application (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 document…

411-029-0050 Approval and Payment (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 fund…

411-029-0060 Oversight 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 History: APD 51-2022, adopt filed 11/04/2022, effective 11/07/2022 APD 42-2022,…

411-030-0002 Purpose and Scope (1) The rules in OAR chapter 411, division 30 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 comple…

411-030-0020 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 030: (1) “Activities of Daily Living (ADL)” mean those personal, functional activities required by an individual for continued well-being, wh…

411-030-0033 In-Home Service Living Arrangements (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 ma…

411-030-0040 Eligibility Criteria (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 intende…

411-030-0050 Case Management (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 stan…

411-030-0055 Community Transportation (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 tran…

411-030-0068 Shift Services (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.…

411-030-0070 Maximum Hours of Service (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 i…

411-030-0071 Exceptions to Maximum Hours of Service (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 spe…

411-030-0072 Exceptions to the Homecare Worker Cap (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 …

411-030-0080 Spousal Pay Program (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 individ…

411-030-0100 Independent Choices Program (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 …

411-031-0020 Definitions 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 419-100-0010. (2) "Active" means a homecare worker who has: (a) A valid a…

411-031-0030 Purpose 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 …

411-031-0040 Consumer-Employed Provider Program The Consumer-Employed Provider Program contains systems and payment structure for consumers to employ care providers to meet their assessed ADL and IADL needs. The structure assumes a provider is required for ADLs and IADLs during s…

411-031-0050 Termination, Administrative Review, and Hearing Rights (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…

411-032-0000 Definitions (1) "AAA" means "Area Agency on Aging". (2) "Activities of Daily Living (ADL)" mean those personal care functional activities required by an individual for continued well being, health, and safety. For the purposes of these rules, ADLs consist of eating, …

411-032-0001 Goals The goals of Oregon Project Independence are to: (1) Promote quality of life and independent living among older adults and people with physical disabilities; (2) Provide preventive and long-term care services to eligible individuals to reduce the risk for insti…

411-032-0005 Administration (1) ADVISORY COUNCIL. Each AAA must show evidence that the advisory council of the AAA, and the community were involved in the identification of need, selection of services to be offered, and the development of an Area Plan. (2) AREA PLAN. (a) Each AAA…

411-032-0010 Authorized Services and Allowable Costs (1) AUTHORIZED SERVICES. (a) Authorized services for which OPI funds may be expended include: (A) Home care supportive services limited to the following: (i) Home care; (ii) Chore; (iii) Assistive technology device; (iv) Person…

411-032-0015 Data Collection, Records, and Reporting (1) DATA COLLECTION. (a) The collection of required program and fiscal records and data associated with OPI must be on forms and data systems as approved by the Department. (b) Each AAA and service provider must collect data on…

411-032-0020 Eligibility and Determination of Authorized Services (1) ELIGIBILITY. (a) In order to qualify for authorized services from an AAA or service provider, each eligible individual must: (A) Be 60 years old or older or be under 60 years of age and diagnosed as having Alzh…

411-032-0044 Fees for Authorized Service and Fees for Service Schedule (1) FEE FOR AUTHORIZED SERVICES. (a) A one-time fee is applied to all individuals receiving OPI authorized services who have adjusted income levels at or below federal poverty level. The fee is due at the time…

411-032-0050 Pilot for Adults with Disabilities 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 a…

411-033-0000 Purpose and Scope 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,…

411-033-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 033: (1) "AAA" means "Area Agency on Aging" as defined in this rule. (2) "Activities of Daily Living (ADL)" mean those personal, functional a…

411-033-0020 In-Home Care Agency Services (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 …

411-033-0030 Medicaid In-Home Care Agency Provider Enrollment, Requirements, and Payment (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 connectio…

411-034-0000 Purpose 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 Sta…

411-034-0010 Definitions 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, whi…

411-034-0020 State Plan Personal Care Services (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 accordanc…

411-034-0030 Eligibility for State Plan Personal Care Services (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 …

411-034-0035 Applying for State Plan Personal Care Services (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 …

411-034-0040 Employer-Employee Relationship (1) EMPLOYER RESPONSIBILITIES. An individual or the individual's representative must demonstrate the ability to: (a) Locate, screen, and hire a qualified HCW or employ an IHCA; (b) Supervise and train a HCW; (c) Schedule work, leave, an…

411-034-0050 Provider Qualifications (1) To provide personal care services to an individual who qualifies for SPPC the provider must meet the qualifications of chapter 411, division 031 or be an employee of an IHCA meeting the criteria in chapter 411, division 033. (2) To be in a…

411-034-0070 State Plan Personal Care Service Assessment, Authorization, and Monitoring (1) PERSONAL CARE 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…

411-034-0090 Payment Limitations (1) The maximum allowed hours for State Plan personal care services are limited to 270 hours per calendar year for individuals served by APD or a AAA. (a) Individuals whose assessed service needs exceed the maximum allowed hours for State Plan per…

411-034-0091 Exceptions to Maximum Hours of Service (1) Eligibility for SPPC Exceptions to Maximum Hours of Service. (a) If the Department determines the individual’s assessed service needs will not be met within the maximum 270 annual hours as set forth in Oregon’s Medicaid Stat…

411-035-0000 Purpose (1) These rules ensure individuals served by the Department of Human Services, Aging and People with Disabilities program have equal access to required and optional K-State Plan services that are not defined in other rules in OAR chapter 411. The services in …

411-035-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 035: (1) "Activities of Daily Living (ADL)" mean those personal, functional activities required by an individual for continued well-being, wh…

411-035-0015 Eligibility for Supplemental K State Plan Services To be eligible for any Medicaid Supplemental K State Plan services defined in this division, consumers must: (1) Be eligible for Medicaid long term care services and supports as described in OAR 411-015-0010 through …

411-035-0020 (Reserved) Text available via filing PDF that is stored in ORMS Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 409.050, 410.040, 410.090, 410.210 to 410.300 & 441.520 History: APD 16-2014, f. & cert. ef. 6-4-14

411-035-0025 Eligibility for Consumer Electronic Back-up Systems and Assistive Technology (1) To be eligible for electronic back-up systems or mechanisms, a consumer must not be receiving community-based care in a licensed care setting. (2) Electronic back-up systems and assistiv…

411-035-0030 Eligible Electronic Back-up Systems and Assistive Technology Services (1) Electronic Back-up Systems and Assistive Technology services must: (a) Ensure continuity of services and support the health, welfare, and safety of the consumer; (b) Enable the consumer to func…

411-035-0035 Provider Qualifications and Requirements for Electronic Back-up Systems and Assistive Technology (1) Companies providing back-up support or back-up systems must have a Medicaid provider number before providing services. (2) No monetary funds shall be released for ins…

411-035-0040 Eligibility Criteria for Chore Services (1) To be eligible for chore services, a consumer must not be receiving community-based care in a licensed care setting and must meet the requirements in OAR 411-030-0033. (2) An eligible consumer may receive chore services if …