Oregon Administrative Code

411-040-0037 Staff and Volunteer Requirements (1) Prior to having direct contact with participants, staff and volunteers must successfully pass a criminal background check. (2) All staff and volunteers involved in food preparation will have training in: (a) Portion control; (b) F…

411-040-0040 Provider Payment (1) Providers will be reimbursed on a per meal basis, no more than 1 meal per day within the month. (2) Provider rates will be published on the Department’s rate table. Statutory/Other Authority: ORS 410.070, 411.060 & 411.070 Statutes/Other Implemen…

411-040-0050 Local Office Responsibility and Oversight (1) The Department shall establish, authorize, purchase, and monitor the standards for Medicaid paid home delivered meals. (2) Case managers must authorize Medicaid home delivered meal services. (3) Subsequent yearly nutritio…

411-040-0060 Impact on Client Liability (1) The cost for home delivered meals shall be calculated into the service plan, in addition to in-home services provided by a client-employed provider or a home care agency. (2) Participants required to make a client contribution, under OA…

411-044-0000 Purpose and Scope Lifespan respite care is a community-based system of accessible respite care services for any individual and/or family regardless of age, income, ethnicity, race, special need or situation. Lifespan respite care services can include providing respit…

411-044-0010 Definitions (1) "Department" means the Department of Human Services of the State of Oregon. (2) "Special Needs" may encompass physical, emotional, and/or mental illnesses and/or conditions an individual may experience which result in the need for ongoing care and sup…

411-044-0020 Application Procedures (1) The Department may solicit applications for the development and implementation of community-based lifespan respite care services systems. (2) Applicants shall be: (a) Private non-profit; (b) For profit; (c) Public agency; or (d) A coalition…

411-044-0030 Application Review (1) The Department shall review all applications and may request any additional information needed to assure applications are complete. (2) After an application is determined to be complete and concordant with the intended goals and outcomes of the…

411-044-0040 Selection (1) The Director of the Department of Human Services or his/her designee shall make the final decision regarding selection of community-based lifespan respite programs. (2) The Department shall notify applicants in writing of the approval or rejection of th…

411-045-0000 Purpose (1) The Program of All-inclusive Care for the Elderly (PACE) is a permanent provider type under Medicare that allows states the option to pay for PACE services under Medicaid. The PACE program is capitated by both Medicare and Medicaid to provide all medical …

411-045-0010 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 045: (1) Administrative Hearing — A hearing related to a denial, reduction, or termination of benefits that is held when requested by the PAC…

411-045-0020 Program Administration (1) A PACE program must be, or be a distinct part of, one of the following: (a) An entity of a city, county, state, or tribal government; (b) A private, not-for-profit entity organized for charitable purposes under section 501(c)(3) of the Inte…

411-045-0030 Financial (1) PACE programs will assume the risk for providing capitated services under their contracts with the Department. PACE programs must maintain sound financial management procedures, maintain protections against insolvency, and generate periodic financial re…

411-045-0040 PACE Marketing and Informational Requirements (1) The PACE program may inform the general public of its program through appropriate informational activities and media. The PACE program must ensure that prohibited marketing activities as defined in 42 CFR 460.82 are n…

411-045-0050 Enrollment (1) ELIGIBILITY: To be eligible to enroll in a PACE program a person must: (a) Reside in the PACE program's approved service area upon enrollment; (b) Be 55 years of age or older; (c) Be able to be maintained in a community-based setting at the time of enr…

411-045-0060 Disenrollment (1) PACE Participant Requests for Disenrollment: (a) All PACE participant initiated requests for disenrollment from PACE programs must be initiated by the PACE participant or his or her representative; (b) An applicant may request disenrollment if he or…

411-045-0070 Access to Care (1) PACE programs will develop written policies and procedures for communicating with, and providing care to PACE participants who have difficulty communicating due to a medical condition or who are living in a household where there is no adult availab…

411-045-0080 Provision of Services (1) PACE Services: (a) PACE covered services for all participants must be the same regardless of the source of payment. They must include all OHP covered services specified in OAR 410-141-0480 and Medicare covered services. In addition the cover…

411-045-0090 Quality Improvement System (1) A PACE program must have a planned, systematic and ongoing process for monitoring, collecting data and evaluating data and using that process for improving the quality and appropriateness of services provided to PACE participants. This …

411-045-0100 Confidentiality and Reporting (1) The PACE program must have policies and procedures that ensure maintenance of a clinical record keeping system that is consistent with state and federal regulations to which the PACE program is subject. (2) Access to clinical records…

411-045-0110 Participant Rights (1) PACE programs must have written policies and procedures that ensure PACE participants have the rights and responsibilities included in this rule. The PACE organization must inform a participant upon enrollment, in writing, of his or her rights …

411-045-0120 Grievance Process (1) PACE programs must have written policies and procedures for the receipt, disposition and documentation of all grievances from PACE participants and their representatives. The PACE program's written procedures for handling grievances, must, at a …

411-045-0130 Appeal Process (1) All denials, reductions, or terminations of services or service coverage by the PACE program must be in writing in accordance with Section (3) of this rule. PACE programs must make available to all PACE staff and contracted providers information co…

411-045-0140 Administrative Hearings (1) PACE participants are entitled to an administrative hearing by the Department regarding the action by the PACE program to deny services, payment of a claim, or to terminate, discontinue or reduce a course of treatment. PACE participants ar…

411-046-0100 Purpose (1) The rules in OAR chapter 411, division 46 establish standards and procedures for Medicaid Behavior Support Services. Behavior Support Services are provided to support a wide range of individuals who receive Medicaid funded home and community-based care se…

411-046-0110 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 046: (1) "Abuse" means Abuse of an adult or elderly person as defined in ORS 124.050-095 and 430.735–430.765; and as defined in OAR 411-020-0…

411-046-0120 Eligibility (1) Individuals must meet the following requirements to receive Behavior Support Services: (a) Be eligible for home and community-based care services provided through APD; and (b) Be receiving services through either State Plan K Community First Choice or…

411-046-0130 Limitations (1) Behavior Support Services, defined in this rule, may not be provided to: (a) Individuals who are receiving: (A) Specific needs setting contracted rate for "enhanced care services"; or (B) Services through Developmental Disabilities per OAR chapter 411…

411-046-0140 Behavior Support Services (1) Behavior Support Services assist individuals with behavioral challenges, due to their disability, in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks. (2) Behavior Support Servic…

411-046-0150 Authorizations (1) Behavior Support Services must be prior-authorized by the eligible individual’s case manager using the referral process noted in OAR 411-046-0140(4)(a). The Case manager is responsible for ensuring the individual is eligible for an initial referral…

411-046-0160 Communication (1) Required Reporting. Behavior consultants must report suspected or known neglect or abuse of all adults and elderly individuals as required by ORS 124.050 to 095, 430.735 to 765 and 419B to 419B.045. (2) Confidentiality. (a) Behavior consultants must…

411-046-0170 Documentation (1) Compliance with documentation standards in this rule and completion of mandatory Department forms is intended to ensure communication between case managers and home and community-based care providers. (2) The documentation requirements in this rule …

411-046-0180 Qualifications for Providers and Behavior Consultants (1) The Department shall select qualified providers according to standards: (a) In these rules; (b) In OAR 407-120-0320; and (c) In OAR chapter 410, division 120, as applicable. (2) Providers must be enrolled as a…

411-046-0190 Disenrollment or Termination (1) Medicaid providers of Behavior Support Services, their behavior consultant employees, or subcontractors may be terminated or prohibited from providing services for any of the following: (a) Violation of any part of these rules; (b) Vi…

411-046-0200 Compensation and Billing (1) All billing and claims must comply with OAR 407-120-0330; OAR 407-120-0340; and chapter 410, division 120, as applicable. (2) Compensation for Behavior Support Services in supplemental or specific needs setting contracts shall be defined …

411-046-0210 Continuing Education Requirements (1) Behavior consultants must maintain a record verifying completion of at least 12 hours of continuing education per year in person-centered care or behavior support training that is provided by a Department approved trainer or trai…

411-046-0220 Exceptions to Rules (1) Exceptions to these rules may be made by the Department central office and must be granted by the Department in writing. Implementation of an exception may not occur without written approval. (2) On a case specific basis, the following excepti…

411-048-0150 Purpose (1) The rules in OAR chapter 411, division 048 establish standards and procedures for Medicaid enrolled providers who provide long term care community nursing services. Long term care community nursing services provide ongoing registered nurse (RN) services t…

411-048-0160 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 048: (1) "AAA" means the Area Agency on Aging designated by the Department that is responsible for providing a comprehensive and coordinated …

411-048-0170 Eligibility and Limitations (1) ELIGIBILITY. Long term care community nursing services may be provided by an RN to an individual if the individual meets the following requirements: (a) The individual must be determined eligible for Medicaid-funded home and community-…

411-048-0180 Long Term Care Community Nursing Services When authorized by an individual's case manager, the following long term care community nursing services must be provided by an RN in accordance with these rules and the scope of practice as stated in the OSBN rules in OAR ch…

411-048-0190 Communication and Notification Practices (1) MANDATORY REPORTING. The RN must report suspected or known neglect or abuse of all older adults, adults, and children as required by ORS 124.050 to 095, ORS 418, ORS 430.735 to 765, ORS 441, ORS 419B.005 to 045, ORS 676.15…

411-048-0200 Additional Documentation Requirements (1) The RN must meet the documentation, record keeping, and communication standards as required by the Department. The RN who meets the Department’s standards remains responsible to also document in accordance with the Nurse Prac…

411-048-0210 Qualifications for Enrolled Medicaid Providers (1) The Department may determine the number and type of enrolled Medicaid providers in a geographic area to assure that there is an appropriate number of qualified enrolled Medicaid providers to meet the needs of individ…

411-048-0220 Medicaid Provider Disenrollment / Termination (1) Enrolled Medicaid providers of long term care community nursing services, or RN employees of an agency enrolled as a Medicaid provider delivering long term care community nursing services may be denied enrollment, ter…

411-048-0230 Compensation and Billing (1) All long term care community nursing services must be authorized by an individual's case manager using Department approved forms provided by the Department prior to the delivery of long term care community nursing services. (2) All billin…

411-048-0240 Orientation Requirements (1) A self-employed RN or agency administrator as described in OAR 411-048-0210 must complete an orientation with the Local Office for the area they intend to provide services. The orientation must be completed prior to accepting Referrals as…

411-048-0250 Variances (1) The Department may grant a variance to these rules. Implementation of a variance may not occur without the Department's written approval. (2) A request for a variance to these rules must include but not be limited to the following standards: (a) A writt…

411-049-0100 Purpose (1) The purpose of the rules in OAR chapter 411, division 049, 050, 051, and 052 is to establish the minimum standards and procedures for Adult Foster Homes (AFH) that provide care and services for adults who are older or adults with physical disabilities in …

411-049-0102 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 049, 050, 051, and 052: (1) "AAA" means an Area Agency on Aging, which is an established public agency within a planning and service area des…