Oregon Administrative Code

411-035-0045 Eligible Chore Services (1) Chore services are not housekeeping services and are not to be provided by homecare workers or in-home agencies. (2) Chore services are intended to ensure the consumer’s home is safe and allows for independent living. (3) In order to ensur…

411-035-0050 Chore Service Provider Qualifications and Requirements (1) Providers of chore services must have a distinct Medicaid provider number before the work begins. (2) No monetary funds shall be released to the provider until the work is finished and meets the specification…

411-035-0055 Eligibility for Consumer Environmental Modifications (1) To be eligible for environmental modifications, a consumer may not be receiving community-based care in a licensed care setting and must meet the requirements in OAR 411-030-0033. (2) If the consumer lives in a…

411-035-0060 Eligible Environmental Modification Services (1) Environmental modifications in the consumer’s home must be: (a) To ensure the health, welfare and safety of the consumer. (b) To enable the consumer to function with greater independence. (c) To substitute for human as…

411-035-0065 Environmental Modification Provider Qualifications and Requirements (1) Providers of the environmental modification must have a distinct Medicaid provider number before the work begins. (2) Modifications over $500 must be completed by a state licensed contractor. (3)…

411-035-0070 Eligibility for Consumer Transition Services (1) Eligibility for transition services covered through the K-State Plan are restricted to consumers transitioning from a nursing facility or the Oregon State Hospital, as defined in OAR 309-091-0005(16), into a community-…

411-035-0075 Eligible Transition Services (1) Approval for services and supports must: (a) Be based on an assessed need determined during the person-centered service planning process. (b) Support the desires and goals of the consumer receiving services and supports. (2) Total exp…

411-035-0080 Transition Services Provider Qualifications and Requirements (1) Providers of cleaning or moving services must have a distinct Medicaid provider number before providing services. (2) Movers must have a certificate of authority or a permit from the Oregon Department o…

411-035-0085 Consumer Eligibility Criteria for Voluntary Consumer Training Services (1) To be eligible for K-State Plan Voluntary Consumer Training Services, consumers must be or be expected to, receive services in a setting described in OAR 411-030-0033, In-Home Service Living A…

411-035-0090 Voluntary Consumer Training Services (1) GENERAL GUIDELINES. (a) State K-Plan voluntary training services are offered on how to select; manage; and dismiss homecare workers. (b) The training must meet the needs of consumers in regards to selecting, managing, and dism…

411-035-0095 Provider Qualifications and Requirements for Voluntary Consumer Training Services (1) To ensure services are consistent with the provision of the state’s comprehensive voluntary consumer training services, providers must be approved by, or have a contract with, the O…

411-037-0010 Purpose and Scope Community Transition Services are non-recurring set-up expenses for individuals who are transitioning from licensed community based care settings or acute care hospitals to an in-home service setting defined in OAR 411-030-0033 where the person woul…

411-037-0020 Definitions (1) "Central Office" means the Program office of the Department. (2) "Consumer" means the person applying for or eligible for Medicaid home or community-based services. (3) "Department" means the Department of Human Services (DHS). (4) "Transition Service…

411-037-0030 Eligibility for Community Transition Services (1) Eligibility for community transition services are restricted to consumers transitioning from a community-based care facility or an acute care hospital to an in-home setting, described in 411-030-0033. (2) Consumers tr…

411-037-0040 Community Transition Services (1) Approval for services and supports must: (a) Be based on an assessed need determined during the person-centered service planning process. (b) Support the desires and goals of the consumer receiving services and supports. (2) Total ex…

411-037-0050 Limitations Community Transition Services: (1) Are furnished only to the extent that they are reasonable and necessary as determined through the service plan development process, clearly identified in the service plan and the person is unable to meet such expense or …

411-039-0000 Purpose The purpose of these rules is to establish minimum standards and procedures for an Agency with Choice to perform administrative employer functions and support Individuals in self-directed care and services in their home, including older adults and adults with…

411-039-0010 Definitions (1) "Abuse" means "abuse" as defined in OAR 411-020-0002 (Adult Protective Services). (2) "Activities of Daily Living (ADL)" means those personal, functional activities as defined in OAR 411-015-0006. (3) “Administrator” means the person designated by the…

411-039-0020 Application for Licensure (1) An entity or organization that establishes, conducts, or represents itself to the public as an Agency with Choice or as providing a Self-Directed Service Delivery Model to “Individuals” defined in OAR 411-039-0010(23), must be licensed a…

411-039-0030 Standards for License Renewal (1) A full and complete application for license renewal must be submitted to the Department at least 60 days prior to the expiration date of the existing license. Filing an application for renewal before the date of expiration extends th…

411-039-0040 Reporting and Billing Requirements (1) In order to receive public funds, an Agency with Choice must be licensed as an Agency with Choice and must be enrolled with the Department as a Medicaid provider. (2) An Agency with Choice must meet all requirements in OAR 411-0…

411-039-0050 Services Provided (1) The Agency with Choice must ensure that the Individual is supported in ensuring their services are adequate and responsive to their needs with a focus on self-direction. (2) The services provided by an Agency with Choice must include the provisi…

411-039-0060 Operational Standards (1) An Agency with Choice's Licensee assumes full legal, financial, and overall responsibility for the Agency with Choice's operation and contractual obligations. Any violations by Agency with Choice owners, Direct Support Workers, other staff, …

411-039-0070 Background Checks (1) An Agency with Choice must submit a Background Check request for each Subject Individual to the Background Check Unit (BCU), prior to allowing the Subject Individual to work. A Subject Individual must not begin work on a preliminary basis. Preli…

411-039-0080 Emergency and Continuity of Operations Planning (1) Each Agency with Choice must establish and maintain, as part of their application, an emergency and continuity of operations plan to ensure the stability of its administrative functions and continuity of essential b…

411-039-0090 Response to Grievances and Critical Incidents (1) The Agency with Choice must maintain in its records documentation of all internal investigations of any Grievance, Complaint or Formal Complaint, and any event described in 411-039-0060(10)(b). Documentation must be m…

411-039-0100 Administrator Qualifications and Requirements (1) The Administrator must have the education and training sufficient to administer the Agency with Choice. At a minimum, the Administrator must have two years of Management, and Professional Experience. (2) The Administr…

411-039-0110 Direct Support Worker Qualifications and Requirements (1) The services provided by an Agency with Choice must be rendered by qualified and trained employees. (2) Direct support workers who have been substantiated for Abuse or Medicaid fraud as a provider from any car…

411-039-0120 Direct Support Worker Training Requirements (1) The Agency with Choice must submit their training plan and curriculum for approval by the Department including who will be providing the training. (a) The training plan must substantially meet the training required by t…

411-039-0130 Personnel Records (1) The Agency with Choice shall maintain a personnel record for each Direct Support Worker and employee. An Individual may also maintain documentation of their interview and refences and ongoing employee records. The Individual may share that infor…

411-039-0140 Individual Choice to Receive Agency with Choice Services (1) The Case Manager must provide the Individual with neutral, comprehensive information about all available in-home service delivery models, including Agency with Choice. Upon the Individual’s request to recei…

411-039-0150 Individual Records (1) An Individual record must be maintained for every Individual and must be maintained in the Agency with Choice’s office. (2) A legible, reproducible Individual record which is easily accessible including: (a) Identification data; (b) Signed disc…

411-039-0160 Individual Rights (1) The Agency with Choice owner, Administrator and Administrator's designee as applicable must ensure that the Agency with Choice recognizes and protects the rights of each Individual. (2) The Agency with Choice must provide each Individual with a …

411-039-0170 Delivery of Services (1) In order to meet the Individual’s needs, the Agency with Choice must work with the Individual or their Authorized Representative to develop: (a) The schedule for the provision of services specifying the total number of hours to be provided pe…

411-039-0180 Initial Visit and Monitoring (1) A representative of the Agency with Choice, who is not the Direct Support Worker, must contact the Individual at least every six months. Monitoring contacts may occur by phone or by other electronic means determined jointly with the I…

411-039-0190 Quality Assurance and Performance Improvement (1) An Agency with Choice must establish and maintain an effective, quality assurance and performance improvement program that evaluates and monitors the quality, safety, retention of Direct Support Workers, and appropria…

411-039-0200 Program Review and Investigations (1) The Department must conduct a program review as defined in OAR 411-039-0030(3). (2) The Department must conduct and complete an investigation upon receipt of information or allegations an Agency with Choice is not operating in co…

411-039-0210 Complaints (1) Any person who believes these rules have been violated may file a Complaint verbally or in writing to the Department regarding an allegation as to the services provided by an Agency with Choice or violations of Agency with Choice laws or regulations. (…

411-039-0220 Abuse Reporting and Investigations (1) Agency with Choice employees, agents and Licensee must not permit, aid, or engage in Abuse of Individuals who are served by the Agency with Choice. All Agency with Choice staff are Mandatory Reporters of Abuse. (a) All Agency wi…

411-039-0230 Enforcement (1) Upon receipt of a statement of deficiencies, an Agency with Choice must be provided an opportunity to dispute the Department’s program review findings but must still comply with sections (2) and (3) of this rule. (a) If an Agency with Choice desires a…

411-039-0240 Civil Penalties (1) An Agency with Choice that violates applicable laws, rules, or a final order as determined by the Department, may be subject to the imposition of a civil penalty not to exceed $1,000 per violation. (2) An Individual or entity who operates an AWC w…

411-039-0250 Conditions (1) Conditions may be attached to a license and take effect immediately upon issuance by the Department. The type of condition attached to a license must directly relate to a risk of harm or potential risk of harm to Individuals. Conditions may be attached…

411-039-0260 Denial, Suspension or Revocation of License (1) The Department may deny, suspend, or revoke the license of an Agency with Choice, in accordance with Oregon Laws 2024, chapter 37, section 1 (13), for the Agency with Choice’s failure to comply with these rules or if a …

411-039-0270 Financial Transparency and Reporting Requirements (1) The rate paid to the Agency with Choice requires that: (a) The Agency with Choice will ensure that no less than 85 percent of the total payments to the Agency with Choice is spent on total compensation for Direct …

411-040-0000 Purpose and Scope (1) Medicaid home delivered meals may be provided to eligible seniors and people with disabilities as part of a Medicaid long term care services plan to assist a participant to remain in their own home. Provision of home delivered meals reduces the …

411-040-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 040: (1) "Approved Carrier" means the United States Postal Service, or other carrier, who can ensure providers have passed criminal backgroun…

411-040-0020 Client Eligibility and Responsibilities (1) To be eligible for Medicaid home delivered meals a participant must: (a) Be Medicaid eligible per 411-015-0100, and be receiving Medicaid long term services and supports in their own home; (b) Be home-bound; (c) Be unable t…

411-040-0030 Medicaid Home Delivered Meal Provider Qualifications and Responsibilities (1) To be in alignment with the provision of services, home delivered meal providers must have contracts with, or be, an AAA as defined in 411-002-0100(1). (2) The provider must be in complianc…

411-040-0035 Meal Requirements (1) Each meal served must meet the current United States Department of Agriculture and Health and Human Services Dietary Guidelines and contain at least 33-1/3 percent of the current Dietary Reference Intakes as established by the Food and Nutrition…

411-040-0036 Service Requirements (1) Except as provided in subsection (2), providers must provide: (a) In-person delivery whereby a paid staff or volunteer delivers the meal to the participant’s home. To the extent possible, the staff or volunteers must report any changes in par…