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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

DIVISION 340
SUPPORT SERVICES FOR ADULTS WITH DEVELOPMENTAL DISABILITIES

411-340-0010
Statement of Purpose
(1) The rules in OAR chapter 411, division
340 prescribe standards, responsibilities, and procedures for support services brokerages
to assist adults with intellectual or developmental disabilities to identify and
address support needs and for providers paid with support services funds, including
resources available through the state plan and waiver, to provide services so that
an adult with an intellectual or developmental disability may live in his or her
own home or in the family home.
(2) Services provided under
these rules are intended to identify, strengthen, expand, and where required, supplement
private, public, formal, and informal support available to adults with intellectual
or developmental disabilities so that an adult with an intellectual or developmental
disability may exercise self-determination in the design and direction of his or
her life.
Stat. Auth.: ORS 409.050, 427.402, &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1750,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13
411-340-0020
Definitions
Unless the context indicates otherwise,
the following definitions and the definitions in OAR 411-317-0000 apply to the rules
in OAR chapter 411, division 340:
(1) "Abuse" means "abuse
of an adult" as defined in OAR 407-045-0260.
(2) "Abuse Investigation"
means the reporting and investigation activities as required by OAR 407-045-0300
and any subsequent services or supports necessary to prevent further abuse as required
by 407-045-0310.
(3) "ADL" means "activities
of daily living". ADL are basic personal everyday activities, such as eating, using
the restroom, grooming, dressing, bathing, and transferring.
(4) "Administrative Review"
means "administrator review" as defined in this rule.
(5) "Administrator Review"
means the Director of the Department reviews a decision upon request, including
the documentation related to the decision, and issues a determination.
(6) "Adult" means an individual
who is 18 years or older with an intellectual or developmental disability.
(7) "Alternative Resources"
mean possible resources, not including support services, for the provision of supports
to meet the needs of an individual. Alternative resources include, but are not limited
to, private or public insurance, vocational rehabilitation services, supports available
through the Oregon Department of Education, or other community supports.
(8) "Annual Plan" means the
written summary a personal agent completes for an individual who is not enrolled
in waiver or Community First Choice state plan services. An Annual Plan is not an
ISP and is not a plan of care for Medicaid purposes.
(9) "Assistive Devices" mean
the devices, aids, controls, supplies, or appliances described in OAR 411-340-0130
that are necessary to enable an individual to increase the ability of the individual
to perform ADL and IADLs or to perceive, control, or communicate with the home and
community environment in which the individual lives.
(10) "Assistive Technology"
means the devices, aids, controls, supplies, or appliances described in OAR 411-340-0130
that are purchased to provide support for an individual and replace the need for
direct interventions to enable self-direction of care and maximize independence
of the individual.
(11) "Attendant Care" means
assistance with ADL, IADL, and health-related tasks through cueing, monitoring,
reassurance, redirection, set-up, hands-on, standby assistance, and reminding as
described in OAR 411-340-0130.
(12) "Background Check" means
a criminal records check and abuse check as defined in OAR 407-007-0210.
(13) "Behavior Consultant"
means a contractor with specialized skills as described in OAR 411-340-0160 who
conducts functional assessments and develops a Behavior Support Plan.
(14) "Behavior Support Plan"
means the written strategy based on person-centered planning and a functional assessment
that outlines specific instructions for a primary caregiver or provider to follow
in order to reduce the frequency and intensity of the challenging behaviors of an
individual and to modify the behavior of the primary caregiver or provider, adjust
environment, and teach new skills.
(15) "Behavior Support Services"
mean the services consistent with positive behavioral theory and practice that are
provided to assist with behavioral challenges due to the intellectual or developmental
disability of an individual that prevents the individual from accomplishing ADL,
IADL, health-related tasks, and provides cognitive supports to mitigate behavior.
Behavior support services are provided in the home or community.
(16) "Brokerage" means an
entity or distinct operating unit within an existing entity that uses the principles
of self-determination to perform the functions associated with planning and implementation
of support services for individuals with intellectual or developmental disabilities.
(17) "Brokerage Director"
means the Director of a publicly or privately-operated brokerage, who is responsible
for administration and provision of services according to these rules, or the designee
of the Brokerage Director.
(18) "Career Development
Plan" means the part of an ISP that identifies:
(a) The employment goals
and objectives for an individual;
(b) The services and supports
needed to achieve those goals;
(c) The people, agencies,
and providers assigned to assist the individual to attain those goals;
(d) The obstacles to the
individual working in an individualized job in an integrated employment setting;
and
(e) The services and supports
necessary to overcome those obstacles.
(19) "Case Management Contact"
means a reciprocal interaction between a personal agent and an individual or the
legal or designated representative of the individual (as applicable).
(20) "CDDP" means "community
developmental disability program" as defined in OAR 411-320-0020.
(21) "Certificate" means
the document issued by the Department to a brokerage, or to a provider organization
requiring certification under OAR 411-340-0170(2), that certifies the brokerage
or provider organization is eligible to receive state funds for the provision of
services.
(22) "Choice" means the expression
of preference, opportunity for, and active role of an individual in decision-making
related to services received and from whom including, but not limited to, case management,
providers, services, and service settings. Individuals are supported in opportunities
to make changes when so expressed. Choice may be communicated through a variety
of methods, including orally, through sign language, or by other communication methods.
(23) "Choice Advising" means
the impartial sharing of information to individuals with intellectual or developmental
disabilities provided by a person that meets the qualifications in OAR 411-340-0150(5)
about:
(a) Case management;
(b) Service options;
(c) Service setting options;
and
(d) Provider types.
(24) "Chore Services" mean
the services described in OAR 411-340-0130 that are needed to restore a hazardous
or unsanitary situation in the home of an individual to a clean, sanitary, and safe
environment.
(25) "Collective Bargaining
Agreement" means a contract based on negotiation between organized workers and their
designated employer for purposes of collective bargaining to determine wages, hours,
rules, and working conditions.
(26) "Community Nursing Services"
mean the nursing services described in OAR 411-340-0130 that focus on the chronic
and ongoing health and safety needs of an individual living in his or her own home.
Community nursing services include an assessment, monitoring, delegation, training,
and coordination of services. Community nursing services are provided according
to the rules in OAR chapter 411, division 048 and the Oregon State Board of Nursing
rules in OAR chapter 851.
(27) "Community Transportation"
means the services described in OAR 411-340-0130 that enable an individual to gain
access to community-based state plan and waiver services, activities, and resources
that are not medical in nature. Community transportation is provided in the area
surrounding the home of the individual that is commonly used by people in the same
area to obtain ordinary goods and services.
(28) "Completed Application"
means completed application as defined in OAR 411-320-0020.
(29) "Comprehensive Services"
means developmental disability services and supports that include 24-hour residential
services and attendant care provided in a licensed home, foster home, or through
a supported living program. Comprehensive services are regulated by the Department
alone or in combination with an associated Department-regulated program for employment.
Comprehensive services are in-home services provided to an individual with an intellectual
or developmental disability when the individual receives case management services
from a CDDP. Comprehensive services do not include support services for adults with
intellectual or developmental disabilities enrolled in Brokerages.
(30) "Cost Effective" means
being responsible and accountable with Department resources by offering less costly
alternatives when providing choices that adequately meet the support needs of an
individual. Less costly alternatives include other programs available from the Department
and the utilization of assistive devices, natural supports, environmental modifications,
and alternative resources. Less costly alternatives may include resources not paid
for by the Department.
(31) "CPMS" means "Client
Process Monitoring System". CPMS is the Department computerized system for enrolling
and terminating services for individuals with intellectual or developmental disabilities.
(32) "Crisis" means "crisis"
as defined in OAR 411-320-0020.
(33) "Crisis Diversion Services"
mean the services authorized and provided according to OAR 411-320-0160 that are
intended to maintain an individual at home or in the family home while the individual
is in emergent status. Crisis diversion services include short-term residential
placement services indicated on a Support Services Brokerage Crisis Addendum.
(34) "Delegation" is the
process by which a registered nurse authorizes an unlicensed person to perform nursing
tasks and confirms that authorization in writing. Delegation may occur only after
a registered nurse follows all steps of the delegation process as outlined in OAR
chapter 851, division 47.
(35) "Department" means the
Department of Human Services.
(36) "Designated Representative"
means any adult, such as a parent, family member, guardian, advocate, or other person,
who is chosen by an individual or the legal representative of the individual, not
a paid provider for the individual, and authorized by the individual or the legal
representative of the individual to serve as the representative of the individual
or the legal representative of the individual in connection with the provision of
funded supports. An individual or a legal representative of the individual is not
required to appoint a designated representative.
(37) "Developmental Disability"
means "developmental disability" as defined in OAR 411-320-0020 and described in
411-320-0080.
(38) "Director" means the
Director of the Department of Human Services, Office of Developmental Disability
Services or Office of Licensing and Regulatory Oversight, or the designee of the
Director.
(39) "Discovery and Career
Exploration" means "discovery and career exploration" as defined in OAR 411-345-0020.
(40) "Emergent Status" means
an individual has been determined to be eligible for crisis diversion services according
to OAR 411-320-0160.
(41) "Employer" means, for
the purposes of obtaining in-home support through a personal support worker as described
in these rules, an individual or a person selected by the individual or the legal
representative of the individual to act on the behalf of the individual or the legal
representative of the individual to conduct the employer responsibilities described
in OAR 411-340-0135. An employer may also be a designated representative.
(42) "Employer-Related Supports"
mean the activities that assist an individual, and when applicable the legal or
designated representative or family members of an individual, with directing and
supervising provision of services described in the ISP for the individual. Employer-related
supports may include, but are not limited to:
(a) Education about employer
responsibilities;
(b) Orientation to basic
wage and hour issues;
(c) Use of common employer-related
tools, such as service agreements; and
(d) Fiscal intermediary services.
(43) "Employment Path Services"
means "employment path services" as defined in OAR 411-345-0020.
(44) "Employment Services"
means "employment services" as defined in OAR 411-345-0020.
(45) "Employment Specialist"
means "employment specialist" as defined in OAR 411-345-0020.
(46) "Entry" means admission
to a Department-funded developmental disability service.
(47) "Environmental Modifications"
mean the physical adaptations described in OAR 411-340-0130 that are necessary to
ensure the health, welfare, and safety of an individual in his or her own home,
or that are necessary to enable the individual to function with greater independence
around his or her own home or lead to a substitution for, or decrease in, direct
human assistance to the extent expenditures would otherwise be made for human assistance.
(48) "Environmental Safety
Modifications" mean the physical adaptations described in OAR 411-340-0130 that
are made to the exterior of the home of an individual or the home of the family
of the individual as identified in the ISP for the individual to ensure the health,
welfare, and safety of the individual or to enable the individual to function with
greater independence around the home or lead to a substitution for, or decrease
in, direct human assistance to the extent expenditures would otherwise be made for
human assistance.
(49) "Exit" means termination
or discontinuance of a Department-funded developmental disability service by a licensed
or certified provider organization.
(50) "Family":
(a) Means a unit of two or
more people that includes at least one individual with an intellectual or developmental
disability where the primary caregiver is:
(A) Related to the individual
with an intellectual or developmental disability by blood, marriage, or legal adoption;
or
(B) In a domestic relationship
where partners share:
(i) A permanent residence;
(ii) Joint responsibility
for the household in general, such as child-rearing, maintenance of the residence,
and basic living expenses; and
(iii) Joint responsibility
for supporting the individual with an intellectual or developmental disability when
the individual is related to one of the partners by blood, marriage, or legal adoption.
(b) The term "family" is
defined as described above for purposes of:
(A) Determining the eligibility
of an individual for brokerage services as a resident in the family home;
(B) Identifying people who
may apply, plan, and arrange for individual services; and
(C) Determining who may receive
family training.
(51) "Family Training" means
the training services described in OAR 411-340-0130 that are provided to the family
of an individual to increase the capacity of the family to care for, support, and
maintain the individual in the home of the individual.
(52) "Fiscal Intermediary"
means a person or entity that receives and distributes support services funds on
behalf of an employer.
(53) "Functional Needs Assessment":
(a) Means the comprehensive
assessment or re-assessment that:
(A) Documents physical, mental,
and social functioning;
(B) Identifies risk factors
and support needs; and
(C) Determines the service
level.
(b) The functional needs
assessment for an adult enrolled in a support services brokerage is known as the
Adult Needs Assessment (ANA). Effective December 31, 2014, the Department incorporates
Version C of the ANA into these rules by this reference. The ANA is maintained by
the Department at: http://www.dhs.state.or.us/spd/tools/dd/ANAadultInhome.xls. Printed
copies of a blank ANA may be obtained by calling (503) 945-6398 or writing the Department
of Human Services, Developmental Disabilities, ATTN: Rules Coordinator, 500 Summer
Street NE, E-48, Salem, OR 97301.
(54) "General Business Provider"
means an organization or entity selected by an individual and paid with support
services funds that:
(a) Is primarily in business
to provide the service chosen by the individual to the general public;
(b) Provides services for
the individual through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
individual.
(55) "Hearing" means a contested
case hearing subject to OAR 137-003-0501 to 137-003-0700, which results in a Final
Order.
(56) "Home" means the primary
residence for an individual that is not under contract with the Department to provide
services as a certified or licensed foster home, residential care facility, assisted
living facility, nursing facility, or other residential support program site.
(57) "Home Delivered Meals"
means "Home Delivered Meals" as defined in OAR 411-040-0010.
(58) "IADL" means "instrumental
activities of daily living". IADL include activities other than ADL required to
continue independent living, such as:
(a) Meal planning and preparation;
(b) Managing personal finances;
(c) Shopping for food, clothing,
and other essential items;
(d) Performing essential
household chores;
(e) Communicating by phone
or other media; and
(f) Traveling around and
participating in the community.
(59) "ICF/ID" means an intermediate
care facility for individuals with intellectual disabilities.
(60) "In-Home Expenditure
Guidelines" mean the guidelines published by the Department that describe allowable
uses for support services funds. Effective January 1, 2015, the Department incorporates
Version 2.0 of the In-home Expenditure Guidelines into these rules by this reference.
The In-home Expenditure Guidelines are maintained by the Department at: (http://www.oregon.gov/dhs/dd/adults/ss_exp_guide.pdf).
A printed copy may be obtained by calling (503) 945-6398 or writing the Department
of Human Services, Developmental Disabilities, ATTN: Rules Coordinator, 500 Summer
Street NE, E-48, Salem, Oregon 97301.
(61) "Incident Report" means
the written report of any injury, accident, act of physical aggression, use of protective
physical intervention, or unusual incident involving an individual.
(62) "Independence" means
the extent to which an individual exerts control and choice over his or her own
life.
(63) "Independent Provider"
means a person selected by an individual and paid with support services funds to
directly provide services to the individual.
(64) "Individual" means an
adult with an intellectual or developmental disability applying for, or determined
eligible for, Department-funded services. Unless otherwise specified, references
to individual also include the legal or designated representative of the individual,
who has the ability to act for the individual and to exercise the rights of the
individual.
(65) "Integration" as defined
in ORS 427.005 means:
(a) Use by individuals with
intellectual or developmental disabilities of the same community resources used
by and available to other people;
(b) Participation by individuals
with intellectual or developmental disabilities in the same community activities
in which people without disabilities participate, together with regular contact
with people without disabilities; and
(c) Residence by individuals
with intellectual or developmental disabilities in homes or in home-like settings
that are in proximity to community resources, together with regular contact with
people without disabilities in their community.
(66) "Intellectual Disability"
means "intellectual disability" as defined in OAR 411-320-0020 and described in
411-320-0080.
(67) "ISP" means "Individual
Support Plan". An ISP includes the written details of the supports, activities,
and resources required for an individual to achieve and maintain personal goals
and the health and safety. The ISP is developed at least annually to reflect decisions
and agreements made during a person-centered process of planning and information
gathering that is driven by the individual. The ISP reflects services and supports
that are important for the individual to meet the needs of the individual identified
through a functional needs assessment as well as the preferences of the individual
for providers, delivery, and frequency of services and supports. The ISP is the
plan of care for Medicaid purposes and reflects whether services are provided through
a waiver, Community First Choice state plan, natural supports, or alternative resources.
The ISP includes the Career Development Plan.
(68) "Job Coaching" means
"job coaching" as defined in OAR 411-345-0020.
(69) "Job Development" means
"job development" as defined in OAR 411-345-0020.
(70) "Legal Representative"
means an attorney at law who has been retained by or for an individual, a person
acting under the authority granted in a power of attorney, or a person or agency
authorized by a court to make decisions about services for an individual.
(71) "Level of Care" means
an individual meets the following institutional level of care for an ICF/ID:
(a) The individual has a
an intellectual disability or a developmental disability as defined in OAR 411-320-0020
and meets the eligibility criteria in OAR 411-320-0080 for developmental disability
services; and
(b) The individual has a
significant impairment in one or more areas of adaptive behavior as determined in
OAR 411-320-0080.
(72) "Natural Supports" means
the voluntary resources available to an individual from the individual's relatives,
friends, significant others, neighbors, roommates, and the community that are not
paid for by the Department.
(73) "Nursing Service Plan"
means the plan that is developed by a registered nurse based on an initial nursing
assessment, reassessment, or an update made to a nursing assessment as the result
of a monitoring visit.
(a) The Nursing Service Plan
is specific to an individual and identifies the diagnoses and health needs of the
individual and any service coordination, teaching, or delegation activities.
(b) The Nursing Service Plan
is separate from the ISP as well as any service plans developed by other health
professionals.
(74) "OHP Plus" means only
the Medicaid benefit packages provided under OAR 410-120-1210(4)(a) and (b). This
excludes individuals receiving Title XXI benefits.
(75) "OSIPM" means "Oregon
Supplemental Income Program-Medical" as described in OAR 461-001-0030. OSIPM is
Oregon Medicaid insurance coverage for individuals who meet the eligibility criteria
described in OAR chapter 461.
(76) "Person-Centered Planning":
(a) Means a timely and formal
or informal process driven by an individual, includes people chosen by the individual,
ensures the individual directs the process to the maximum extent possible, and the
individual is enabled to make informed choices and decisions consistent with 42
CFR 441.540.
(b) Person-centered planning
includes gathering and organizing information to reflect what is important to and
for the individual and to help:
(A) Determine and describe
choices about personal goals, activities, services, providers, service settings,
and lifestyle preferences;
(B) Design strategies and
networks of support to achieve goals and a preferred lifestyle using individual
strengths, relationships, and resources; and
(C) Identify, use, and strengthen
naturally occurring opportunities for support at home and in the community.
(c) The methods for gathering
information vary, but all are consistent with the cultural considerations, needs,
and preferences of the individual.
(77) "Personal Agent" means
a person who is a case manager for the provision of case management services, works
directly with individuals and the legal or designated representatives and families
of individuals, if applicable, to provide or arrange for support services as described
in these rules, meets the qualifications set forth in OAR 411-340-0150(5), and is
a trained employee of a brokerage or a person who has been engaged under contract
to the brokerage to allow the brokerage to meet responsibilities in geographic areas
where personal agent resources are severely limited. A personal agent is the person-centered
plan coordinator of an individual as defined in the Community First Choice state
plan amendment.
(78) "Personal Support Worker"
means "personal support worker" as defined in OAR 411-375-0010.
(79) "Plan Year" means 12
consecutive months that, unless otherwise set according to the conditions of OAR
411-340-0120, begins on the start date specified in the first authorized ISP for
an individual after entry to a brokerage. Subsequent plan years begin on the anniversary
of the start date of the initial ISP.
(80) "Policy Oversight Group"
means the group that meets the requirements of OAR 411-340-0150(1) that is formed
to provide individual-based leadership and advice to each brokerage regarding issues,
such as development of policy, evaluation of services, and use of resources.
(81) "Positive Behavioral
Theory and Practice" means a proactive approach to behavior and behavior interventions
that:
(a) Emphasizes the development
of functional alternative behavior and positive behavior intervention;
(b) Uses the least intrusive
intervention possible;
(c) Ensures that abusive
or demeaning interventions are never used; and
(d) Evaluates the effectiveness
of behavior interventions based on objective data.
(82) "Primary Caregiver"
means the person identified in an ISP as providing the majority of service and support
for an individual in the home of the individual.
(83) "Productivity" as defined
in ORS 427.005 means regular engagement in income-producing work, preferable competitive
employment with supports and accommodations to the extent necessary, by an individual
that is measured through improvements in income level, employment status, or job
advancement or engagement by an individual in work contributing to a household or
community.
(84) "Progress Note" means
a written record of an action taken by a personal agent in the provision of case
management, administrative tasks, or direct services to support an individual. A
progress note may also be a recording of information related to the services, support
needs, or circumstances of the individual which is necessary for the effective delivery
of support services.
(85) "Protective Services"
mean the necessary actions offered to an individual as soon as possible to prevent
subsequent abuse or exploitation of the individual, to prevent self-destructive
acts, or to safeguard the person, property, and funds of the individual.
(86) "Provider" means a person,
agency, organization, or business selected by an individual that provides recognized
Department-funded services and is approved by the Department or other appropriate
agency to provide Department-funded services.
(87) "Provider Organization"
means an entity, licensed or certified by the Department, selected by an individual,
and paid with support services funds that:
(a) Is primarily in business
to provide supports for individuals with intellectual or developmental disabilities;
(b) Provides supports for
the individual through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
individual.
(88) "Provider Organization
Director" means the Director of a provider organization who is responsible for the
administration and provision of services according to these rules, or the designee
of the Director of the provider organization.
(89) "Psychotropic Medication"
means a medication the prescribed intent of which is to affect or alter thought
processes, mood, or behavior including, but not limited to, anti-psychotic, antidepressant,
anxiolytic (anti-anxiety), and behavior medications. The classification of a medication
depends upon its stated, intended effect when prescribed.
(90) "Quality Assurance"
means a systematic procedure for assessing the effectiveness, efficiency, and appropriateness
of services.
(91) "Regional Crisis Diversion
Program" means "Regional Crisis Diversion Program" as defined in OAR 411-320-0020.
(92) "Relief Care" means
the intermittent services described in OAR 411-340-0130 that are provided on a periodic
basis for the relief of, or due to the temporary absence of, a person normally providing
supports to an individual.
(93) "Scope of Work" means
the written statement of all proposed work requirements for an environmental modification
which may include dimensions, measurements, materials, labor, and outcomes necessary
for a contractor to submit a proposal to complete such work. The scope of work is
specific to the identified tasks and requirements necessary to address the needs
outlined in the supplemental assessment, referenced in the ISP, and relating to
the ADL, IADL, and health-related tasks of the individual as discussed by the individual,
homeowner, personal agent, and ISP team.
(94) "Self-Determination"
means a philosophy and process by which individuals with intellectual or developmental
disabilities are empowered to gain control over the selection of support services
that meet their needs. The basic principles of self-determination are:
(a) Freedom. The ability
for an individual, together with freely-chosen family and friends, to plan a life
with necessary support services rather than purchasing a predefined program;
(b) Authority. The ability
for an individual, with the help of a social support network if needed, to control
resources in order to purchase support services;
(c) Autonomy. The arranging
of resources and personnel, both formal and informal, that assists an individual
to live a life in the community rich in community affiliations; and
(d) Responsibility. The acceptance
of a valued role of an individual in the community through competitive employment,
organizational affiliations, personal development, and general caring for others
in the community, as well as accountability for spending public dollars in ways
that are life-enhancing for the individual.
(95) "Self-Direction" means
that an individual has decision-making authority over services and takes direct
responsibility for managing services with the assistance of a system of available
supports that promotes personal choice and control over the delivery of waiver and
state plan services.
(96) "Service Agreement":
(a) Is the written agreement
consistent with an ISP that describes, at a minimum:
(A) Type of service to be
provided;
(B) Hours, rates, location
of services, and expected outcomes of services; and
(C) Any specific individual
health, safety, and emergency procedures that may be required, including action
to be taken if an individual is unable to provide for their own safety and the individual
is missing while in the community under the service of a contractor or provider
organization.
(b) For employed personal
support workers, the service agreement serves as the written job description.
(97) "Service Level" means
the amount of attendant care, hourly relief care, or skills training services determined
necessary by a functional needs assessment and made available to meet the identified
support needs of an individual.
(98) "Services Coordinator"
means "services coordinator" as defined in OAR 411-320-0020.
(99) "Skills Training" means
the activities described in OAR 411-340-0130 that are intended to maximize the independence
of an individual through training, coaching, and prompting the individual to accomplish
ADL, IADL, and health-related skills.
(100) "Social Benefit" means
the service or financial assistance solely intended to assist an individual with
an intellectual or developmental disability to function in society on a level comparable
to that of a person who does not have an intellectual or developmental disability.
Social benefits are pre-authorized by a personal agent and provided according to
the description and limits written in an ISP.
(a) Social benefits may not:
(A) Duplicate benefits and
services otherwise available to a person regardless of intellectual or developmental
disability;
(B) Provide financial assistance
with food, clothing, shelter, and laundry needs common to a person with or without
an intellectual or developmental disability; or
(C) Replace other governmental
or community services available to an individual.
(b) Assistance provided as
a social benefit is reimbursement for an expense previously authorized in an ISP
or prior payment in anticipation of an expense authorized in a previously authorized
ISP.
(c) Assistance provided as
a social benefit may not exceed the actual cost of the support required by an individual
to be supported in the home of the individual.
(101) "Special Diet" means
the specially prepared food or particular types of food described in OAR 411-340-0130
that are specific to the medical condition or diagnosis of an individual and in
support of an evidence-based treatment regimen.
(102) "Specialized Medical
Supplies" mean the medical and ancillary supplies described in OAR 411-340-0130,
such as:
(a) Necessary medical supplies,
specified in an ISP that are not available through state plan or alternative resources;
(b) Ancillary supplies necessary
to the proper functioning of items necessary for life support or to address physical
conditions; and
(c) Supplies necessary for
the continued operation of augmentative communication devices or systems.
(103) "Substantiated" means
an abuse investigation has been completed by the Department or the designee of the
Department and the preponderance of the evidence establishes the abuse occurred.
(104) "Support Services"
mean the services of a brokerage listed in OAR 411-340-0120 as well as the uniquely
determined activities and purchases arranged through the brokerage that:
(a) Complement the existing
formal and informal supports that exist for an individual living in her or her own
home or the family home;
(b) Are designed, selected,
and managed by an individual;
(c) Are provided in accordance
with the ISP for an individual; and
(d) May include purchase
of supports as a social benefit required for an individual to live in his or her
own home or the family home.
(105) "Support Services Brokerage
Crisis Addendum" means the short-term plan that is required by the Department to
be added to an ISP to describe crisis diversion services an individual is to receive
while the individual is in emergent status.
(106) "Support Services Funds"
mean the public funds designated by the brokerage for assistance with the purchase
of supports according to an ISP.
(107) "Supported Employment
— Individual Employment Support" means "supported employment — individual
employment support" as defined in OAR 411-345-0020.
(108) "Supported Employment
— Small Group Employment Support" means "supported employment — small
group employment support" as defined in OAR 411-345-0020.
(109) "These Rules" mean
the rules in OAR chapter 411, division 340.
(110) "Transition Costs"
mean the expenses described in OAR 411-340-0130, such as rent and utility deposits,
first month’s rent and utilities, bedding, basic kitchen supplies, and other
necessities required for an individual to make the transition from a nursing facility
or ICF/ID to a community-based home setting where the individual resides.
(111) "Unusual Incident"
means any incident involving an individual that includes serious illness or an accident,
death, injury or illness requiring inpatient or emergency hospitalization, a suicide
attempt, a fire requiring the services of a fire department, an act of physical
aggression, or any incident requiring an abuse investigation.
(112) "Variance" means the
temporary exception from a regulation or provision of these rules that may be granted
by the Department as described in OAR 411-340-0090.
(113) "Vehicle Modifications"
mean the adaptations or alterations described in OAR 411-340-0130 that are made
to the vehicle that is the primary means of transportation for an individual in
order to accommodate the service needs of the individual.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1760,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 38-2004(Temp), f. 12-30-04, cert.
ef. 1-1-05 thru 6-30-05; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f.
4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru
6-29-08; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef.
7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 5-2010,
f. 6-29-10, cert. ef. 7-1-10; SPD 27-2011, f. & cert. ef. 12-28-11; SPD 3-2013(Temp),
f. 3-20-13, cert. ef. 4-1-13 thru 9-28-13; SPD 30-2013(Temp), f. & cert. ef.
7-2-13 thru 9-28-13; SPD 31-2013, f. 7-22-13, cert. ef. 8-1-13; SPD 32-2013(Temp),
f. 7-22-13, cert. ef. 8-1-13 thru 12-28-13; SPD 50-2013, f. 12-27-13, cert. ef.
12-28-13; APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 44-2014,
f. 12-26-14, cert. ef. 12-28-14
411-340-0030
Certification of Support Services Brokerages
and Provider Organizations
(1) CERTIFICATE REQUIRED.
(a) No person or governmental
unit acting individually or jointly with any other person or governmental unit may
establish, conduct, maintain, manage, or operate a brokerage without being certified
by the Department under this rule.
(b) No person or governmental
unit acting individually or jointly with any other person or governmental unit may
establish, conduct, maintain, or operate a provider organization without either
certification under this rule or current Department license or certification as
described in OAR 411-340-0170(1).
(c) Certificates are not
transferable or assignable and are issued only for the brokerage, or for the provider
organization requiring certification under OAR 411-340-0170(2), and people or governmental
units named in the application.
(d) Certificates issued on
or after November 15, 2008 are effective for a maximum of five years.
(e) The Department shall
conduct a review of the brokerage, or the provider organization requiring certification
under OAR 411-340-0170(2), prior to the issuance of a certificate.
(2) CERTIFICATION. A brokerage,
or a provider organization requiring certification under OAR 411-340-0170(2), must
apply for an initial certificate and for a certificate renewal.
(a) The application must
be on a form provided by the Department and must include all information requested
by the Department.
(b) The applicant requesting
certification as a brokerage must identify the maximum number of individuals to
be served.
(c) To renew certification,
the brokerage or provider organization must make application at least 30 days, but
not more than 120 days, prior to the expiration date of the existing certificate.
On renewal of brokerage certification, no increase in the maximum number of individuals
to be served by the brokerage may be certified unless specifically approved by the
Department.
(d) Application for renewal
must be filed no more than 120 days prior to the expiration date of the existing
certificate and extends the effective date of the existing certificate until the
Department takes action upon the application for renewal.
(e) Failure to disclose requested
information on the application or providing incomplete or incorrect information
on the application may result in denial, revocation, or refusal to renew the certificate.
(f) Prior to issuance or
renewal of the certificate, the applicant must demonstrate to the satisfaction of
the Department that the applicant is capable of providing services identified in
a manner consistent with the requirements of these rules.
(3) CERTIFICATION EXPIRATION,
TERMINATION OF OPERATIONS, OR CERTIFICATE RETURN.
(a) Unless revoked, suspended,
or terminated earlier, each certificate to operate a brokerage or provider organization
expires on the expiration date specified on the certificate.
(b) If a certified brokerage
or provider organization is discontinued, the certificate automatically terminates
on the date operation is discontinued.
(4) CHANGE OF OWNERSHIP,
LEGAL ENTITY, LEGAL STATUS, OR MANAGEMENT CORPORATION. The brokerage, or provider
organization requiring certification under OAR 411-340-0170(2), must notify the
Department in writing of any pending action resulting in a 5 percent or more change
in ownership and of any pending change in the brokerage's or provider organization's
legal entity, legal status, or management corporation.
(5) NEW CERTIFICATE REQUIRED.
A new certificate for a brokerage or provider organization is required upon change
in a brokerage's or provider organization's ownership, legal entity, or legal status.
The brokerage or provider organization must submit a certificate application at
least 30 days prior to change in ownership, legal entity, or legal status.
(6) CERTIFICATE DENIAL, REVOCATION,
OR REFUSAL TO RENEW. The Department may deny, revoke, or refuse to renew a certificate
when the Department finds the brokerage or provider organization, the brokerage
or provider organization director, or any person holding 5 percent or greater financial
interest in the brokerage or provider organization:
(a) Demonstrates substantial
failure to comply with these rules such that the health, safety, or welfare of individuals
is jeopardized and the brokerage or provider organization fails to correct the noncompliance
within 30 calendar days of receipt of written notice of non-compliance;
(b) Has demonstrated a substantial
failure to comply with these rules such that the health, safety, or welfare of individuals
is jeopardized during two inspections within a six year period (for the purpose
of this rule, "inspection" means an on-site review of the service site by the Department
for the purpose of investigation or certification);
(c) Has been convicted of
a felony or any crime as described in OAR 407-007-0275;
(d) Has been convicted of
a misdemeanor associated with the operation of a brokerage or provider organization;
(e) Falsifies information
required by the Department to be maintained or submitted regarding services of individuals,
program finances, or individuals' funds;
(f) Has been found to have
permitted, aided, or abetted any illegal act that has had significant adverse impact
on individual health, safety, or welfare; or
(g) Has been placed on the
Office of Inspector General's list of excluded or debarred providers (http://exclusions.oig.hhs.gov/).
(7) NOTICE OF CERTIFICATE
DENIAL, REVOCATION, OR REFUSAL TO RENEW. Following a Department finding that there
is a substantial failure to comply with these rules such that the health, safety,
or welfare of individuals is jeopardized, or that one or more of the events listed
in section (6) of this rule has occurred, the Department may issue a notice of certificate
revocation, denial, or refusal to renew.
(8) IMMEDIATE SUSPENSION
OF CERTIFICATE. When the Department finds a serious and immediate threat to individual
health and safety and sets forth the specific reasons for such findings, the Department
may, by written notice to the certificate holder, immediately suspend a certificate
without a pre-suspension hearing and the brokerage or provider organization may
not continue operation.
(9) HEARING. An applicant
for a certificate or a certificate holder may request a hearing pursuant to the
contested case provisions of ORS chapter 183 upon written notice from the Department
of denial, suspension, revocation, or refusal to renew a certificate. In addition
to, or in lieu of a hearing, the applicant or certificate holder may request an
administrative review by the Department's director. An administrative review does
not preclude the right of the applicant or certificate holder to a hearing.
(a) The applicant or certificate
holder must request a hearing within 60 days of receipt of written notice by the
Department of denial, suspension, revocation, or refusal to renew a certificate.
The request for a hearing must include an admission or denial of each factual matter
alleged by the Department and must affirmatively allege a short plain statement
of each relevant, affirmative defense the applicant or certificate holder may have.
(b) In the event of a suspension
pursuant to section (8) of this rule and during the first 30 days after the suspension
of a certificate, the brokerage or provider organization may submit a written request
to the Department for an administrative review. The Department shall conduct the
review within 10 days after receipt of the request for an administrative review.
Any review requested after the end of the 30-day period following certificate suspension
is treated as a request for a hearing under subsection (a) of this section. If following
the administrative review the suspension is upheld, the brokerage or provider organization
may request a hearing pursuant to the contested case provisions of ORS chapter 183.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1770, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD
8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD
25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 5-2010, f. 6-29-10,
cert. ef. 7-1-10; SPD 25-2010(Temp), f. & cert. ef. 11-17-10 thru 5-16-11; SPD
10-2011, f. & cert. ef. 5-5-11; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13
411-340-0040
Abuse and Unusual Incidents in Support
Services Brokerages and Provider Organizations
(1) ABUSE PROHIBITED. No adult or individual
as defined in OAR 411-340-0020 shall be abused nor shall any employee, staff, or
volunteer of the brokerage or provider organization condone abuse.
(a) Brokerages and provider
organizations must have in place appropriate and adequate disciplinary policies
and procedures to address instances when a staff member has been identified as an
accused person in an abuse investigation as well as when the allegation of abuse
has been substantiated.
(b) All employees of a brokerage
or provider organization are mandatory reporters. The brokerage or provider organization
must:
(A) Notify all employees
of mandatory reporting status at least annually on forms provided by the Department;
and
(B) Provide all employees
with a Department-produced card regarding abuse reporting status and abuse reporting.
(2) INCIDENT REPORTS.
(a) A brokerage or provider
organization must prepare an incident report for instances of potential or suspected
abuse or an unusual incident as defined in OAR 411-340-0020, involving an individual
and a brokerage or provider organization employee. The incident report must be placed
in the individual's record and must include:
(A) Conditions prior to or
leading to the potential or suspected abuse or unusual incident;
(B) A description of the
potential or suspected abuse or unusual incident;
(C) Staff response at the
time; and
(D) Review by the brokerage
administration and follow-up to be taken to prevent recurrence of the potential
or suspected abuse or unusual incident.
(b) A brokerage or provider
organization must send copies of all incident reports involving potential or suspected
abuse that occurs while an individual is receiving brokerage or provider organization
services to the CDDP.
(c) A provider organization
must send copies of incident reports of all potential or suspected abuse or unusual
incidents that occur while the individual is receiving services from a provider
organization to the individual's brokerage within five working days of the potential
or suspected abuse or unusual incident.
(3) IMMEDIATE NOTIFICATION
(a) The brokerage must immediately
report to the CDDP, and the provider organization must immediately report to the
CDDP with notification to the brokerage, any incident or allegation of potential
or suspected abuse falling within the scope of OAR 407-045-0260.
(A) When an abuse investigation
has been initiated, the CDDP must provide notice according to OAR 407-045-0290.
(B) When an abuse investigation
has been completed, the CDDP must provide notice of the outcome of the investigation
according to OAR 407-045-0320.
(b) In the case of emergency
overnight hospitalization due to illness or injury to an individual, the brokerage
or provider organization must immediately notify:
(A) The individual's legal
representative, parent, next of kin, designated contact person, or other significant
person (as applicable); and
(B) In the case of a provider
organization, the individual's brokerage.
(c) In the event of the death
of an individual, the brokerage or provider organization must immediately notify:
(A) The Medical Director
of the Department;
(B) The individual’s
legal representative, parent, next of kin, designated contact person, or other significant
person (as applicable);
(C) The CDDP; and
(D) In the case of a provider
organization, the individual’s brokerage.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1780,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08;
SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef.
1-1-10 thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 25-2010(Temp),
f. & cert. ef. 11-17-10 thru 5-16-11; SPD 10-2011, f. & cert. ef. 5-5-11;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13
411-340-0050
Inspections and Investigations in Support
Service Brokerages and Provider Organizations
(1) Support services brokerages and
provider organizations certified under these rules must allow the following types
of investigations and inspections:
(a) Quality assurance and
on-site inspections;
(b) Complaint investigations;
and
(c) Abuse investigations.
(2) The Department, CDDP,
Oregon Health Authority, or proper authority performs all inspections and investigations.
(3) Any inspection or investigation
may be unannounced.
(4) All documentation and
written reports required by this rule must be:
(a) Open to inspection and
investigation by the Department, CDDP, or proper authority; and
(b) Submitted to the Department
within the time allotted.
(5) When abuse is alleged
or death of an individual has occurred and a law enforcement agency, the Department,
or CDDP has determined to initiate an investigation, the brokerage or provider organization
may not conduct an internal investigation without prior authorization from the Department.
For the purposes of this rule, an "internal investigation" is defined as:
(a) Conducting interviews
with the alleged victim, witness, the accused person, or any other person who may
have knowledge of the facts of the abuse allegation or related circumstances;
(b) Reviewing evidence relevant
to the abuse allegation, other than the initial report; or
(c) Any other actions beyond
the initial actions of determining:
(A) If there is reasonable
cause to believe that abuse has occurred;
(B) If the alleged victim
is in danger or in need of immediate protective services;
(C) If there is reason to
believe that a crime has been committed; or
(D) What, if any, immediate
personnel actions must be taken.
(6) The Department or the
CDDP shall conduct abuse investigations as set forth in OAR 407-045-0250 to OAR
407-045-0360 and shall complete an abuse investigation and protective services report
according to OAR 407-045-0320.
(7) Upon completion of the
abuse investigation by the Department, CDDP, or a law enforcement agency, a provider
may conduct an investigation without further Department approval to determine if
any other personnel actions are necessary.
(8) Upon completion of the
abuse investigation and protective services report, in accordance with OAR 407-045-0330,
the sections of the report that are public records and not exempt from disclosure
under the public records law shall be provided to the appropriate brokerage or provider
organization.
(9) The Department may review
the brokerage implementation of these rules at least every two years or more frequently
as needed to ensure compliance.
(10) Following a Department
review, the Department shall issue a report to the brokerage identifying areas of
compliance and areas in need of improvement.
(11) If, following a review,
the brokerage is not in substantial compliance with these rules; the brokerage must
respond to a plan of improvement within 45 days of the review report being issued,
or in a time specified by the Department. The Department may conduct additional
reviews as necessary to ensure improvement measures have been achieved. The Department
may offer, or the brokerage may request, technical assistance or training.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1790, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD
8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD
25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 5-2010, f. 6-29-10,
cert. ef. 7-1-10; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 44-2014, f.
12-26-14, cert. ef. 12-28-14
411-340-0060
Complaints, Notification of Planned Action,
and Hearings
(1) COMPLAINTS.
(a) Complaints must be addressed
in accordance with OAR 411-318-0015.
(b) The brokerages must have
and implement written policies and procedures for individual complaints in accordance
with OAR 411-318-0015.
(c) Upon entry and request
and annually thereafter, the policy and procedures for complaints must be explained
and provided to an individual and the legal or designated representative of the
individual.
(2) NOTIFICATION OF PLANNED
ACTION. In the event that a developmental disability service is denied, reduced,
suspended, or terminated, a written advance Notification of Planned Action (form
SDS 0947) must be provided as described in OAR 411-318-0020.
(3) HEARINGS.
(a) Hearings must be addressed
in accordance with ORS Chapter 183 and OAR 411-318-0025.
(b) An individual may request
a hearing as provided in ORS Chapter 183 and OAR 411-318-0025.
(c) Upon entry and request
and annually thereafter, a notice of hearing rights and the policy and procedures
for hearings must be explained and provided to an individual and the legal or designated
representative of the individual (as applicable).
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1800,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert.
ef. 1-1-08 thru 6-29-08; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009,
f. & cert. ef. 7-1-09; SPD 25-2010(Temp), f. & cert. ef. 11-17-10 thru 5-16-11;
(Temp) Repealed by SPD 10, 2011, f. & cert. ef. 5-5-11; SPD 50-2013, f. 12-27-13,
cert. ef. 12-28-13; APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14;
APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0070
Support Services Brokerage and Provider
Organization Personnel Policies and Practices
(1) Brokerages and provider organizations
must maintain up-to-date written position descriptions for all staff as well as
a file, available to the Department or CDDP for inspection that includes written
documentation of the following for each staff:
(a) Reference checks and
confirmation of qualifications prior to hire;
(b) Written documentation
of an approved background check completed by the Department in accordance with OAR
407-007-0200 to 407-007-0370;
(c) Satisfactory completion
of basic orientation, including instructions for mandatory reporting and training
specific to intellectual or developmental disabilities and skills required to carry
out assigned work if the employee is to provide direct assistance to individuals;
(d) Written documentation
of employee notification of mandatory reporter status;
(e) Written documentation
of any founded report of child abuse or substantiated abuse;
(f) Written documentation
of any complaints filed against the staff and the results of the complaint process,
including any disciplinary action; and
(g) Legal eligibility to
work in the United States.
(2) Any employee providing
direct assistance to individuals must be at least 18 years of age and capable of
performing the duties of the job as described in a current job description signed
and dated by the employee.
(3) An application for employment
at the brokerage or provider organization must inquire whether an applicant has
had any founded reports of child abuse or substantiated abuse.
(4) Any employee of the brokerage
or provider organization, or any subject individual defined by OAR 407-007-0210,
who has or will have contact with an eligible individual of support services, must
have an approved background check in accordance with OAR 407-007-0200 to 407-007-0370
and under ORS 181.534.
(5) Effective July 28, 2009,
a person may not be authorized as a provider or meet qualifications as described
in this rule if the person has been convicted of any of the disqualifying crimes
listed in OAR 407-007-0275.
(6) Section (5) of this rule
does not apply to employees of the brokerage or provider organization who were hired
prior to July 28, 2009 and remain in the current position for which the employee
was hired.
(7) Each brokerage and provider
organization regulated by these rules must be a drug-free workplace.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1810, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
21-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-29-08; SPD 8-2008, f. 6-27-08,
cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f.
12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 2-2010(Temp), f. & cert. ef. 3-18-10
thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 50-2013, f. 12-27-13,
cert. ef. 12-28-13
411-340-0080
Support Service Brokerage and Provider
Organization Records
(1) CONFIDENTIALITY. Brokerage and provider
organization records of services to individuals must be kept confidential in accordance
with ORS 179.505 and any Department rules or policies pertaining to individual service
records.
(2) DISCLOSURE AND CONFIDENTIALITY.
For the purpose of disclosure from individual medical records under these rules,
brokerages, and provider organizations requiring certification under OAR 411-340-0170(2),
are considered "providers" as defined in ORS 179.505(1) and 179.505 is applicable.
(a) Access to records by
the Department does not require authorization by an individual or the legal or designated
representative or family of the individual.
(b) For the purpose of disclosure
of non-medical individual records, all or portions of the information contained
in the non-medical individual records may be exempt from public inspection under
the personal privacy information exemption to the public records law set forth in
ORS 192.502(2).
(3) GENERAL FINANCIAL POLICIES
AND PRACTICES. The brokerage or provider organization must:
(a) Maintain up-to-date accounting
records consistent with generally accepted accounting principles that accurately
reflect all revenue by source, all expenses by object of expense, and all assets,
liabilities, and equities;
(b) As a provider organization,
or as a brokerage offering services to the general public, establish and revise,
as needed, a fee schedule identifying the cost of each service provided. Billings
for Medicaid funds may not exceed the customary charges to private individuals for
any like item or services charged by the brokerage or provider organization; and
(c) Develop and implement
written statements of policy and procedure as are necessary and useful to assure
compliance with any Department rule pertaining to fraud and embezzlement.
(4) RECORDS RETENTION. Records
must be retained in accordance with OAR chapter 166, division 150, Secretary of
State, Archives Division.
(a) Financial records, supporting
documents, statistical records, and all other records (except individual records)
must be retained for at least three years after the close of the contract period.
(b) Individual records must
be kept for at least seven years.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1820, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2005, f. & cert. ef. 6-23-05; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD
8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10
thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 50-2013, f. 12-27-13,
cert. ef. 12-28-13; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0090
Support Services Brokerage and Provider
Organization Request for Variance
(1) A variance that does not adversely
impact the welfare, health, safety, or rights of individuals or violate state or
federal laws may be granted to a brokerage or provider organization:
(a) If the brokerage or provider
organization lacks the resources needed to implement the standards required in these
rules;
(b) If implementation of
the proposed alternative services, methods, concepts, or procedures shall result
in services or systems that meet or exceed the standards in these rules; or
(c) If there are other extenuating
circumstances.
(2) Variances may not be
granted to OAR 411-340-0130 and 411-340-0140.
(3) The brokerage or provider
organization requesting a variance must submit a written application to the Department
that contains the following:
(a) The section of the rule
from which the variance is sought;
(b) The reason for the proposed
variance;
(c) A description of the
alternative practice, service, method, concept, or procedure proposed, including
how the health and safety of individuals receiving services shall be protected to
the extent required by these rules;
(d) A plan and timetable
for compliance with the section of the rule from which the variance is sought; and
(e) If the variance applies
to the services to an individual, evidence that the variance is consistent with
the currently authorized ISP for the individual.
(4) The request for a variance
is approved or denied by the Department. The decision of the Department is sent
to the brokerage or provider organization and to all relevant Department programs
or offices within 45 days from the receipt of the variance request.
(5) The brokerage or provider
organization may request an administrator review of the denial of a variance request
by sending a written request for review to the Director. The decision of the Director
is the final response from the Department.
(6) The Department determines
the duration of the variance.
(7) The brokerage or the
provider organization may implement a variance only after written approval from
the Department.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1830, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2005, f. & cert. ef. 6-23-05; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD
8-2009, f. & cert. ef. 7-1-09; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0100
Eligibility for Support Services
(1) Individuals determined eligible
according to this rule may not be denied brokerage services or otherwise discriminated
against on the basis of age, diagnostic or disability category, race, color, creed,
national origin, citizenship, income, or duration of Oregon residence.
(2) Eligibility of an individual
for support services is determined by the CDDP of the county of origin according
to OAR 411-320- 0110(8).
(3) Individuals are not eligible
for services by more than one brokerage unless the concurrent eligibility:
(a) Is necessary to affect
transition from one brokerage to another;
(b) Is part of a collaborative
plan between the affected brokerages; and
(c) Does not duplicate services
and expenditures.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.40–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1840, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD
18-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SPD 21-2011(Temp), f. &
cert. ef. 8-31-11 thru 12-28-11; SPD 27-2011, f. & cert. ef. 12-28-11; SPD 13-2013(Temp),
f. & cert. ef. 7-1-13 thru 12-28-13; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14,
cert. ef. 12-28-14
411-340-0110
Standards for Support Service Brokerage
Entry and Exit
(1) The brokerage must make accurate,
up-to-date, information about the brokerage available to individuals referred for
services and the legal or designated representatives of individuals. This information
must include:
(a) A declaration of brokerage
philosophy;
(b) A brief description of
the services provided by the brokerage, including typical timelines for activities;
(c) A description of processes
involved in using the services, including application and referral, assessment,
planning, and evaluation;
(d) A declaration of brokerage
employee responsibilities as mandatory abuse reporters;
(e) A brief description of
individual responsibilities for use of public funds;
(f) An explanation of the
individual rights in OAR 411-318-0010, including the right of an individual to:
(A) Choose a brokerage from
among Department-contracted brokerages in the county of origin of an individual
that is serving less than the total number of individuals specified in the current
contract between the brokerage and the Department;
(B) Choose a personal agent
among those available in the selected brokerage;
(C) Select providers among
those willing, available, and qualified according to OAR 411-340-0160, OAR 411-340-0170,
and OAR 411-340-0180 to provide supports authorized through the ISP for the individual;
(D) Direct the services of
providers; and
(E) Raise and resolve concerns
about brokerage services, including specific rights to notification of planned action
and hearings according to OAR 411-340-0060 and the rules in OAR chapter 411, division
318.
(g) Indication that additional
information about the brokerage is available on request. The additional information
must include, but not be limited to:
(A) A description of the
organizational structure of the brokerage;
(B) A description of any
contractual relationships the brokerage has in place, or may establish, to accomplish
the brokerage functions required by rule; and
(C) A description of the
relationship between the brokerage and the Policy Oversight Group of the brokerage.
(2) The brokerage must make
the information required in section (1) of this rule available using language, format,
and presentation methods appropriate for effective communication according to the
needs and abilities of individuals.
(3) ENTRY INTO BROKERAGE
SERVICES.
(a) To enter brokerage services:
(A) An individual must be
determined eligible according to OAR 411-320-0110; and
(B) The individual must choose
to receive services from a selected brokerage.
(b) The Department may implement
guidelines that govern entries when the Department has determined that such guidelines
are prudent and necessary for the continued development and implementation of support
services.
(c) The brokerage may not
accept individuals for entry beyond the total number of individuals specified in
the current contract between the brokerage and the Department.
(4) EXIT FROM A BROKERAGE.
(a) An individual must exit
a brokerage:
(A) At the oral or written
request of an individual to end the service relationship;
(B) After an individual,
either cannot be located or has not responded after 30 days of repeated attempts
by brokerage staff to complete ISP development or monitoring activities;
(C) Upon the entry of an
individual into CDDP case management services;
(D) When an individual is
incarcerated or admitted to a medical hospital, psychiatric hospital, sub-acute
facility, nursing facility, ICF/ID, or other 24-hour residential setting and it
is determined that the individual is not returning home; or
(E) When an individual does
not reside in Oregon or resides in an area outside the geographic service area of
the brokerage.
(b) In the event an individual
exits a brokerage, a written Notification of Planned Action must be provided as
described in OAR 411-340-0060 and OAR chapter 411, division 318.
(c) Each brokerage must have
policies and procedures for notifying the CDDP of the county of origin of an individual
when the individual plans to exit, or exits, brokerage services. Notification method,
timelines, and content must be based on agreements between the brokerage and the
CDDP of each county in which the brokerage provides services.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1850,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 32-2004, f. & cert. ef. 10-25-04;
SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06;
SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09;
SPD 21-2011(Temp), f. & cert. ef. 8-31-11 thru 12-28-11; SPD 27-2011, f. &
cert. ef. 12-28-11; DVA 3-2007, f. & cert .ef. 9-25-07; SPD 13-2013(Temp), f.
& cert. ef. 7-1-13 thru 12-28-13; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14,
cert. ef. 12-28-14
411-340-0120
Support Service Brokerage Services
(1) Each brokerage must provide or arrange
for the following services as required to meet individual support needs:
(a) Assistance for individuals
to determine needs and plan supports in response to needs;
(b) Case management;
(c) Assistance for individuals
to find and arrange the resources to provide planned supports;
(d) Assistance with development
and expansion of community resources required to meet the support needs of individuals
served by the brokerage;
(e) Information, education,
and technical assistance for individuals to use to make informed decisions about
support needs and to direct providers;
(f) Fiscal intermediary services
in the receipt and accounting of support services funds on behalf of individuals
in addition to making payment to providers with the authorization of an individual;
(g) Employer-related supports;
and
(h) Assistance for individuals
to effectively put plans into practice, including help to monitor and improve the
quality of supports as well as assess and revise plan goals.
(2) SELF-DETERMINATION. Brokerages
must apply the principles of self-determination to provision of services required
in section (1) of this rule.
(3) PERSON-CENTERED PLANNING.
A brokerage must use a person-centered planning approach to assist individuals to
establish outcomes, determine needs, plan for supports, and review and redesign
support strategies.
(4) HEALTH AND SAFETY ISSUES.
The planning process must address basic health and safety needs and supports including,
but not limited to:
(a) Identification of risks,
including risk of serious neglect, intimidation, and exploitation;
(b) Informed decisions by
the individual regarding the nature of supports or other steps taken to ameliorate
any identified risks; and
(c) Education and support
to recognize and report abuse.
(5) PERSONAL AGENT SERVICES.
(a) An individual entered
into brokerage services must be assigned a personal agent for case management services.
(b) INITIAL DESIGNATION OF
PERSONAL AGENT.
(A) The brokerage must designate
a personal agent for individuals newly entered in support services within 10 business
days from the date entry becomes known to the brokerage.
(B) In the instance of an
individual transferring into a brokerage from another brokerage, the brokerage must
designate a personal agent within 10 days of entry to the new brokerage.
(C) The brokerage must send
a written notice that includes the name, telephone number, and location of the personal
agent or brokerage to the individual, and as applicable the legal or designated
representative of the individual, within 10 business days from the date entry becomes
known to the brokerage.
(D) Prior to implementation
of the initial ISP for an individual, the brokerage must ask the individual to identify
any family and other advocates to whom the brokerage must provide the name, telephone
number, and location of the personal agent.
(c) CHANGE OF PERSONAL AGENT.
Changes of personal agents initiated by the brokerage must be kept to a minimum.
If the brokerage must change personal agent assignments, the brokerage must notify
the individual, and as applicable the legal or designated representative of the
individual, and all current providers within 10 business days of the change. The
notification must be in writing and include the name, telephone number, and address
of the new personal agent, if known, or of a contact person at the brokerage.
(d) OSIPM/OHP PLUS ELIGIBILITY.
If an individual loses OSIPM or OHP Plus eligibility, a personal agent must assist
the individual in identifying why OSIPM or OHP Plus eligibility was lost. Whenever
possible, the personal agent must assist the individual in becoming eligible for
OSIPM or OHP Plus again. The personal agent must document efforts taken to assist
the individual in becoming OSIPM or OHP Plus eligible.
(e) CASE MANAGEMENT CONTACT.
Every individual who has an ISP must have a case management contact no less than
once every three months. Individuals with significant health and safety risks as
identified in the ISP must have more frequent case management contact. At least
one case management contact per year must be face to face. If an individual agrees,
other case management contacts may be made by telephone or by other interactive
methods. The outcome of the case management contact must be recorded in the progress
notes. The purpose of the case management contact is:
(A) To assure known health
and safety risks are adequately addressed;
(B) To assure that the support
needs of the individual have not significantly changed; and
(C) To assure that the individual
is satisfied with the current supports.
(6) PARTICIPATION IN PROTECTIVE
SERVICES. The brokerage and personal agent are responsible for the delivery of protective
services, in cooperation with the CDDP when necessary, through the timely completion
of activities necessary to address immediate health and safety concerns.
(7) CHOICE ADVISING. Choice
advising regarding the provision of case management and other services must be provided
to individuals who are eligible for, and desire, developmental disability services.
Choice advising must be provided at least annually. Documentation of the discussion
must be included in the service record for the individual.
(8) LEVEL OF CARE DETERMINATION.
(a) The brokerage must assure
that an individual who is eligible for OHP Plus or OSIPM or who becomes eligible
after entry into the brokerage:
(A) Receives a level of care
determination prior to accessing services and prior to an initial functional needs
assessment;
(B) Is offered the choice
between home and community-based services or institutional care;
(C) Is provided a notice
of fair hearing rights (Notification of Rights SDS 0948); and
(D) Has the level of care
determination reviewed annually not more than 60 days prior to the renewal of the
ISP, or at any time there is a significant change in a condition that qualified
the individual for the level of care.
(b) A level of care determination
may be made by a services coordinator or a personal agent.
(c) The level of care assessment
must be documented in a progress note in the record for the individual.
(9) FUNCTIONAL NEEDS ASSESSMENT.
The brokerage or CDDP must complete a functional needs assessment initially and
at least annually for any individual who is enrolled in, or is expected to enroll
in, waiver or Community First Choice state plan services.
(a) A functional needs assessment
must be completed:
(A) Not more than 45 days
from the date that the individual submitted a completed application to the CDDP
or the date the individual became eligible for OHP Plus or OSIPM;
(B) Prior to the development
of an initial ISP;
(C) Within 60 days prior
to the annual renewal of an ISP; and
(D) Within 45 days from the
date an individual requests a functional needs re-assessment.
(b) The assessment must be
conducted face to face.
(c) An individual, and as
applicable the legal or designated representative of the individual, must participate
in a functional needs assessment and provide information necessary to complete the
functional needs assessment and reassessment within the time frame required by the
Department.
(A) Failure to participate
in the functional needs assessment or provide information necessary to complete
the functional needs assessment or reassessment within the applicable time frame
results in the denial of service eligibility. In the event service eligibility is
denied, a written Notification of Planned Action must be provided as described in
OAR 411-340-0060 and OAR chapter 411, division 318.
(B) The Department may allow
additional time if circumstances beyond the control of the individual prevent timely
participation in the functional needs assessment or reassessment or timely submission
of information necessary to complete the functional needs assessment or reassessment.
(d) No fewer than 14 days
prior to conducting a functional needs assessment, the brokerage must mail a notice
of the assessment process to the individual to be assessed. The notice must include
a description and explanation of the assessment process and an explanation of the
process for appealing the results of the assessment.
(10) INDIVIDUAL SUPPORT PLANS.
(a) An individual who is
accessing waiver or Community First Choice state plan services must have an authorized
ISP.
(A) The ISP must be facilitated,
developed, and authorized by a personal agent.
(B) The initial ISP must
be authorized;
(i) No more than 90 days
from the date a competed application is submitted to the CDDP according to OAR 411-320-0080;
or
(ii) No later than the end
of the month following the month in which the level of care determination was made
or no more than 45 days from the date the level of care determination was made.
(C) The brokerage must provide
a written copy of the most current ISP to the individual and the legal or designated
representative of the individual (as applicable).
(D) A personal agent must
revise the ISP for the individual as needed if a revision of the ISP is requested
by the individual. The revision of the ISP must be completed within 30 days from
the request of the individual.
(b) PERSON-CENTERED ISP REQUIREMENTS.
The person-centered ISP must reflect the services and supports that are important
for the individual to meet the needs of the individual identified through a Department
approved assessment, as well as what is important to the individual with regard
to preferences for the delivery of such services and supports. Commensurate with
the level of need of the individual and the scope of services and supports, the
ISP must include:
(A) The name of the individual
and the name of the legal or designated representative of the individual (as applicable);
(B) A description of the
supports required that is consistent with support needs identified in the assessment
of the individual;
(C) The projected dates of
when specific supports are to begin and end;
(D) A list of personal, community,
and alternative resources that are available to the individual and how the resources
may be applied to provide the required supports. Sources of support may include
waiver services, Community First Choice state plan services, other state plan services,
state general funds, or natural supports;
(E) The manner in which services
are delivered and the frequency of services;
(F) Provider type;
(G) The setting in which
the individual resides as chosen by the individual;
(H) The strengths and preferences
of the individual;
(I) Individually identified
goals and desired outcomes;
(J) The services and supports
(paid and unpaid) to assist the individual to achieve identified goals and the providers
of the services and supports, including voluntarily provided natural supports;
(K) The risk factors and
the measures in place to minimize the risk factors, including back up plans for
assistance with support and service needs;
(L) The identity of the person
responsible for case management and monitoring the ISP;
(M) A provision to prevent
unnecessary or inappropriate care;
(N) The alternative settings
considered by the individual;
(O) Schedule of ISP reviews;
(P) Any changes in support
needs identified in an assessment; and
(Q) Any revisions to the
ISP that may alter:
(i) The amount of support
services funds required;
(ii) The amount of support
services required;
(iii) Types of support purchased
with support services funds; and
(iv) The type of support
provider.
(c) The ISP must be made
available using language, format, and presentation methods appropriate for effective
communication according to the needs and abilities of the individual receiving services
and the people important in supporting the individual.
(d) ISP SCHEDULE. The schedule
of the support services ISP, developed in compliance with this rule after an individual
enters a brokerage, may be adjusted with the consent of, or at the request of, an
individual.
(A) An adjustment may only
occur one time per individual upon ISP renewal.
(B) An ISP date adjustment
must be clearly documented in the ISP.
(e) ISP AUTHORIZATION.
(A) An initial and annual
ISP must be authorized prior to implementation.
(B) A revision to an initial
or annual ISP that involves the types of support purchased with support services
funds must be authorized prior to implementation.
(C) A revision to an initial
or annual ISP that does not involve the types of support purchased with support
services funds does not require authorization. Documented oral agreement to the
revision by the individual is required prior to implementation of the revision.
(D) An ISP is authorized
when:
(i) The signature of the
individual, or as applicable the legal or designated representative of the individual,
is present on the ISP or documentation is present explaining the reason an individual
who does not have a legal or designated representative may be unable to sign the
ISP.
(I) Acceptable reasons for
an individual without a legal or designated representative not to sign the ISP include
physical or behavioral inability to sign the ISP.
(II) Unavailability is not
an acceptable reason for an individual, or as applicable the legal or designated
representative of an individual, not to sign the ISP.
(III) In the case of a revision
to an initial or annual ISP that is in response to immediate, unexpected change
in circumstance, and is necessary to prevent injury or harm to the individual, documented
oral agreement may substitute for a signature for no more than 10 business days.
(ii) The signature of the
personal agent involved in the development of, or revision to, the ISP is present
on the ISP; and
(iii) A designated brokerage
representative has reviewed the ISP for compliance with Department rules and policy.
(E) For an individual transferring
from in-home comprehensive services to a brokerage, the CDDP ISP may be used as
authorization for available support services for up to 90 days.
(f) PERIODIC REVIEW OF ISP
AND RESOURCES.
(A) A personal agent must
facilitate and document reviews of the ISP and resources for an individual with
the individual and the legal or designated representative of the individual (as
applicable).
(B) At least annually, as
part of preparation for a new ISP, the personal agent must:
(i) Evaluate the progress
of the individual toward achieving the purposes of the ISP and assess and revise
goals as needed;
(ii) Note effectiveness of
the use of support services funds based on personal agent observation as well as
individual satisfaction; and
(iii) Determine whether changing
needs or availability of other resources has altered the need for continued use
of support services funds to purchase supports.
(11) ANNUAL PLANS. An Annual
Plan must be completed for individuals who do not access waiver or Community First
Choice state plan services.
(a) A personal agent must
complete an Annual Plan within 60 days of the entry of an individual into support
services, and annually thereafter if the individual is not enrolled in any waiver
or Community First Choice state plan services.
(b) A written Annual Plan
must be documented as an Annual Plan or as a comprehensive progress note in the
record for the individual and consist of:
(A) A review of the current
living situation of the individual;
(B) A review of any personal
health, safety, or behavioral concerns;
(C) A summary of the support
needs of the individual; and
(D) Actions to be taken by
the personal agent and others.
(12) PROFESSIONAL OR OTHER
SERVICE PLANS.
(a) A Nursing Service Plan
must be present when support services funds are used to purchase services requiring
the education and training of a licensed professional nurse.
(b) A Support Services Brokerage
Crisis Addendum, or other document prescribed by the Department for use in these
circumstances, must be attached to the ISP when an individual enrolled in a brokerage
is in emergent status in a short-term, out-of-home, residential placement as part
of the crisis diversion services for the individual.
(c) As of July 1, 2014, a
Career Development Plan must be attached to the ISP of an adult in accordance with
OAR 411-345-0160.
(13) TRANSITION TO ANOTHER
BROKERAGE OR TO A CDDP. At the request of an individual enrolled in brokerage services
who has selected another brokerage or CDDP to provide case management and to arrange
services, the brokerage must collaborate with the receiving brokerage or CDDP of
the county of origin of the individual to transition case management and other authorized
services.
(a) If an individual requests
case management services from a CDDP, the brokerage must notify the local CDDP of
the request within five business days. Planning for a transfer of case management
services must begin within ten business days of the request unless a later date
is mutually agreed upon by the individual, the brokerage, and the CDDP.
(b) An individual may request
case management services from another brokerage when the selected brokerage has
capacity available within the limits of the contract between the brokerage and the
Department.
(c) If an individual requests
case management services from an available brokerage, the brokerage must notify
the local CDDP of the request within five business days. Planning for a transfer
of case management services to the available brokerage must begin within ten business
days of the request unless a later date is mutually agreed upon by the individual,
the brokerage, and the CDDP of the county of origin of the individual.
(d) If the Department has
designated and contracted funds solely for the support of the transitioning individual,
the brokerage must notify the Department to consider transfer of the funds for the
individual to the receiving brokerage.
(e) The ISP in place at the
time of the transfer may remain in effect 90 days after entry to the new brokerage
while a new ISP is developed and authorized.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1860,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08;
SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2010(Temp), f. & cert. ef. 11-17-10
thru 5-16-11; SPD 10-2011, f. & cert. ef. 5-5-11; SPD 27-2011, f. & cert.
ef. 12-28-11; SPD 13-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 50-2013,
f. 12-27-13, cert. ef. 12-28-13; APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru
12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0125
Crisis Supports in Support Services
(1) The brokerage must, in conjunction
with its Regional Crisis Diversion Program, attempt to provide supports that mediate
a crisis risk factor for adults who are:
(a) Entered in support services;
and
(b) Determined to be in crisis
as described in section (2) of this rule.
(2) CRISIS DETERMINATION.
(a) An individual enrolled
in support services is eligible for crisis diversion services when:
(A) A brokerage has referred
an individual to the Regional Crisis Diversion Program because the brokerage has
determined that one or more of the following crisis risk factors, not primarily
related to a significant mental or emotional disorder or substance abuse, are present
and for which no appropriate alternative resources are available:
(i) An individual is not
receiving necessary supports to address life-threatening safety skill deficits;
(ii) An individual is not
receiving necessary supports to address life-threatening issues resulting from behavioral
or medical conditions;
(iii) An individual currently
engages in self-injurious behavior serious enough to cause injury that requires
professional medical attention;
(iv) An individual undergoes,
or is at imminent risk of undergoing, loss of primary caregiver due to the inability
of the primary caregiver to provide supports;
(v) An individual experiences
a loss of home due to a protective service action; or
(vi) An individual is not
receiving the necessary supports to address significant safety risks to others,
including but not limited to:
(I) A pattern of physical
aggression serious enough to cause injury;
(II) Fire-setting behaviors;
or
(III) Sexually aggressive
behaviors or a pattern of sexually inappropriate behaviors.
(B) The Regional Crisis Diversion
Program has determined crisis eligibility according to OAR 411-320-0160; and
(C) The ISP for the individual
has been revised to address the identified crisis risk factors and the revisions:
(i) May resolve the crisis;
and
(ii) May not contribute to
new or additional crisis risk factors.
(b) A functional needs assessment
must be completed for any individual determined to be in crisis as described in
this section of this rule.
(3) CRISIS SUPPORTS.
(a) An ISP for an individual
in emergent status may authorize short-term, out-of-home, residential placement.
Residential placement does not exit an individual from support services.
(b) The personal agent of
the individual must:
(A) Participate with the
Regional Crisis Diversion Program staff in efforts to stabilize supports and return
costs to the service level;
(B) Assist with the identification
of qualified providers who may be paid in whole, or in part, using crisis diversion
funding except in the case of short-term, out-of-home, residential placements with
a licensed or certified provider;
(C) Complete and coordinate
the Support Services Brokerage Crisis Addendum when an individual in emergent status
requires a short-term, out-of-home, residential placement; and
(D) Monitor the delivery
of supports provided, including those provided through crisis funding.
(i) Monitoring is done through
contact with the individual, any providers, and the legal or designated representative
and family of the individual (as applicable).
(ii) Monitoring is done to
collect information regarding supports provided and progress toward outcomes that
are identified as necessary to resolve the crisis.
(iii) The personal agent
must document the information described in subparagraph (ii) of this paragraph in
the record for the individual and report to the Regional Crisis Diversion Program
or CDDP as required.
(c) Support services provided
during emergent status are subject to all requirements of this rule.
(d) All supports authorized
in an ISP continue during the crisis unless prohibited by other rule, policy, or
the supports contribute to new or additional crisis risk factors.
(4) TRANSITION TO COMPREHENSIVE
SERVICES. When an individual eligible for crisis supports may have long-term support
needs that may not be met through support services:
(a) The brokerage must immediately
notify the CDDP of the county of origin of the individual;
(b) The brokerage must coordinate
with the CDDP and the Regional Crisis Diversion Program to facilitate a timely exit
from support services and entry into appropriate, alternative services; and
(c) The brokerage must assure
that information required for a potential provider of comprehensive services is
available as needed for a referral to be made.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 &430.662–430.695
Hist.: SPD 27-2011, f. &
cert. ef. 12-28-11; SPD 13-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 44-2014, f. 12-26-14, cert. ef.
12-28-14
411-340-0130
Using Support Services Funds to Purchase
Supports
(1) Support services funds may be used
to assist individuals to purchase supports described in section (8) of this rule,
in accordance with an ISP when:
(a) The supports are necessary
for an individual to live in his or her own home or in the family home or meet individual
support needs;
(b) For Community First Choice
state plan services, the support shall address a need that has been determined to
be necessary by a functional needs assessment;
(c) An enrolled individual
meets the criteria for level of care;
(d) The individual is eligible
for the services as described in section (8) of this rule;
(e) Cost-effective arrangements
for obtaining the required supports, applying public, private, formal, and informal
resources available to the eligible individual are specified in the ISP for the
individual;
(A) Support services funds
are not intended to replace the resources available to an individual from the voluntarily
provided natural supports of the individual.
(B) Support services funds
are not available when the support needs of an individual may be met by alternative
resources. Support services funds may be authorized only when alternative resources
are unavailable, insufficient, or inadequate to meet the needs of the individual.
(f) The ISP has been authorized
for implementation.
(2) A brokerage may use support
services funds to assist individuals that do not meet the criteria in section (1)(d)
of this rule when, up to the 18th birthday of the individual, the individual was
receiving children’s intensive in-home services as described in OAR chapter
411, division 300 or in-home supports as described in OAR chapter 411, division
308.
(3) An individual is no longer
eligible to access support services funds when the individual is eligible for support
services funds based on section (2) of this rule; and
(a) The individual does not
apply for a disability determination and Medicaid within 10 business days of the
18th birthday of the individual;
(b) The Social Security Administration
or the Presumptive Medicaid Disability Determination Team of the Department finds
that the individual does not have a qualifying disability; or
(c) The individual is determined
by the state of Oregon to be ineligible for OHP Plus and OSIPM.
(4) Goods and services purchased
with support services funds on behalf of individuals are provided only as social
benefits.
(5) POST ELIGIBILITY TREATMENT
OF INCOME. Individuals with excess income must contribute to the cost of service
pursuant to OAR 461-160-0610 and 461-160-0620.
(6) SERVICE LIMITS. The use
of support services funds to purchase individual supports is limited to:
(a) The service level for
an individual as determined by a functional needs assessment. The functional needs
assessment determines the total number of hours available to meet identified needs.
The total number of hours may not be exceeded without prior approval from the Department.
The types of services that contribute to the total of hours used include:
(A) Attendant care;
(B) Hourly relief care;
(C) Skills training; and
(D) State plan personal care
services as described in OAR chapter 411, division 034.
(b) Other services and supports
determined by a personal agent to be necessary to meet the support needs identified
through a person-centered planning process and consistent with the In-home Expenditure
Guidelines; and
(c) Employment services and
payment for employment services are limited to:
(A) An average of 25 hours
per week for any combination of job coaching, small group employment support, and
employment path services; and
(B) 40 hours in any one week
for job coaching if job coaching is the only service utilized.
(7) AMOUNT, METHOD, AND SCHEDULE
OF PAYMENT.
(a) The brokerage must disburse,
or arrange for disbursement of, support services funds to qualified providers on
behalf of individuals in the amount required to implement an authorized ISP. The
brokerage is specifically prohibited from reimbursement of individuals or families
of individuals for expenses related to services and from advancing funds to individuals
or families of individuals to obtain services.
(b) The method and schedule
of payment must be specified in written agreements between the brokerage and the
individual or the legal or designated representative of the individual (as applicable).
(8) TYPES OF SUPPORTS. Supports
eligible for purchase with support services funds must be consistent with the In-home
Expenditure Guidelines and are limited to:
(a) Community First Choice
state plan services. An individual who is eligible for OHP Plus and meets the Level
of Care may access Community First Choice state plan services when supported by
an assessed need.
(b) Transfer of Assets.
(A) As of October 1, 2014,
an individual receiving medical benefits under OAR chapter 410, division 200 requesting
Medicaid coverage for services in a nonstandard living arrangement (see 461-001-0000)
is subject to the requirements of the rules regarding transfer of assets (see 461-140-0210
to 461-140-0300) in the same manner as if the individual was requesting these services
under OSIPM. This includes, but is not limited to, the following assets:
(i) An annuity evaluated
according to OAR 461-145-0022;
(ii) A transfer of property
when an individual retains a life estate evaluated according to OAR 461-145-0310;
(iii) A loan made evaluated
according to OAR 461-145-0330; or
(iv) An irrevocable trust
evaluated according to OAR 461-145-0540.
(B) When an individual is
considered ineligible due to a disqualifying transfer of assets, the individual
must receive a notice meeting the requirements of OAR 461-175-0310 in the same manner
as if the individual was requesting services under OSIPM.
(c) Community First Choice
state plan services include:
(A) Behavior support services
as described in section (9) of this rule;
(B) Community nursing services
as described in section (10) of this rule;
(C) Environmental modifications
as described in section (11) of this rule; and
(D) Attendant care as described
in section (12) of this rule;
(E) Skills training as described
in section (13) of this rule;
(F) Relief care as described
in section (14) of this rule;
(G) Assistive devices as
described in section (15) of this rule;
(H) Assistive technology
as described in section (16) of this rule;
(I) Chore services as described
in section (17) of this rule;
(J) Community transportation
as described in section (18) of this rule;
(K) Transition costs as described
in section (19) of this rule; and
(L) Home delivered meals
as described in OAR chapter 411, division 040.
(d) Individuals who are eligible
for OSIPM and meet the Level of Care may access Community First Choice state plan
services and the following home and community-based waiver services:
(A) Case management as defined
in OAR 411-340-0020;
(B) Employment services as
described in section (20) of this rule that include:
(i) Supported employment
— individual employment support;
(ii) Supported employment
— small group employment support;
(iii) Employment path services;
and
(iv) Discovery and career
exploration services.
(C) Family training as described
in section (21) of this rule;
(D) Special diets as described
in section (22) of this rule;
(E) Environmental safety
modifications as described in section (23) of this rule;
(F) Vehicle modifications
as described in section (24) of this rule; and
(G) Specialized medical supplies
as described in section (25) of this rule.
(e) State Plan personal care
as described in OAR chapter 411, division 34.
(9) BEHAVIOR SUPPORT SERVICES.
(a) Behavior support services
consist of:
(A) Assessing an individual
or the needs of the family of the individual and the environment;
(B) Developing positive behavior
support strategies, including a Behavior Support Plan, by a qualified behavior consultant
as described in OAR 411-340-0160, if needed;
(C) Implementing the Behavior
Support Plan with the provider or family; and
(D) Revising and monitoring
the Behavior Support Plan as needed.
(b) Behavior support services
may include:
(A) Training, modeling, and
mentoring the family of an individual;
(B) Developing a visual communication
system as a strategy for behavior support; and
(C) Communicating, as authorized
by an individual, with school, medical, or other professionals about the strategies
and outcomes of the Behavior Support Plan.
(c) Behavior support services
exclude:
(A) Mental health therapy
or counseling;
(B) Health or mental health
plan coverage;
(C) Educational services
including, but not limited to, consultation and training for classroom staff;
(D) Adaptations to meet the
needs of an individual at school;
(E) An assessment in a school
setting;
(F) Attendant care;
(G) Skills training; or
(H) Relief care.
(10) COMMUNITY NURSING SERVICES.
(a) Community nursing services
include:
(A) Nursing assessments,
including medication reviews;
(B) Care coordination;
(C) Monitoring;
(D) Development of a Nursing
Service Plan;
(E) Delegation and training
of nursing tasks to a provider and primary caregiver;
(F) Teaching and education
of the provider and primary caregiver and identifying supports that minimize health
risks while promoting the autonomy of an individual and self-management of healthcare;
and
(G) Collateral contact with
a services coordinator regarding the community health status of an individual to
assist in monitoring safety and well-being and to address needed changes to the
ISP for the individual.
(b) Community nursing services
exclude direct nursing care.
(c) A Nursing Service Plan
must be present when support services funds are used for community nursing services.
A personal agent must authorize the provision of community nursing services as identified
in an ISP.
(d) After an initial nursing
assessment, a nursing re-assessment must be completed every six months or sooner
if a change in a medical condition requires an update to the Nursing Service Plan.
(11) ENVIRONMENTAL MODIFICATIONS.
(a) Environmental modifications
include, but are not limited to:
(A) An environmental modification
consultation to determine the appropriate type of adaptation;
(B) Installation of shatter-proof
windows;
(C) Hardening of walls or
doors;
(D) Specialized, hardened,
waterproof, or padded flooring;
(E) An alarm system for doors
or windows;
(F) Protective covering for
smoke alarms, light fixtures, and appliances;
(G) Installation of ramps,
grab-bars, and electric door openers;
(H) Adaptation of kitchen
cabinets and sinks;
(I) Widening of doorways;
(J) Handrails;
(K) Modification of bathroom
facilities;
(L) Individual room air conditioners
for an individual whose temperature sensitivity issues create behaviors or medical
conditions that put the individual or others at risk;
(M) Installation of non-skid
surfaces;
(N) Overhead track systems
to assist with lifting or transferring;
(O) Specialized electric
and plumbing systems that are necessary to accommodate the medical equipment and
supplies necessary for the welfare of the individual; and
(P) Adaptations to control
lights, heat, stove, etc.
(b) Environmental modifications
exclude:
(A) Adaptations or improvements
to the home that are of general utility, such as carpeting, roof repair, and central
air conditioning, unless directly related to the assessed health and safety needs
of the individual and identified in the ISP for the individual;
(B) Adaptations that add
to the total square footage of the home except for ramps that attach to the home
for the purpose of entry or exit;
(C) Adaptations outside of
the home; and
(D) General repair or maintenance
and upkeep required for the home.
(c) Environmental modifications
must be tied to supporting assessed ADL, IADL, and health-related tasks as identified
in the needs assessment and ISP for an individual.
(d) Environmental modifications
are limited to $5,000 per modification. A personal agent must request approval for
additional expenditures through the Department prior to expenditure. Approval is
based on the service and support needs and goals of the individual and the determination
by the Department of appropriateness and cost-effectiveness. In addition, separate
environmental modification projects that cumulatively total up to over $5,000 in
a plan year must be submitted to the Department for review.
(e) Environmental modifications
must be completed by a state licensed contractor with a minimum of $1,000,000 liability
insurance. Any modification requiring a permit must be inspected by a local inspector
and certified as in compliance with local codes. Certification of compliance must
be filed in the file for the contractor prior to payment.
(f) Environmental modifications
must be made within the existing square footage of the home, except for external
ramps, and may not add to the square footage of the home.
(g) Payment to the contractor
is to be withheld until the work meets specifications.
(h) A scope of work as defined
in OAR 411-340-0020 must be completed for each identified environmental modification
project. All contractors submitting bids must be given the same scope of work.
(i) Personal agents must
follow the processes outlined in the In-home Expenditure Guidelines for contractor
bids and the awarding of work.
(j) All dwellings must be
in good repair and have the appearance of sound structure.
(k) The identified home may
not be in foreclosure or be the subject of legal proceedings regarding ownership.
(l) Environmental modifications
must only be completed to the primary residence of the individual.
(m) Upgrades in materials
that are not directly related to the health and safety needs of the individual are
not paid for or permitted.
(n) Environmental modifications
are subject to Department requirements regarding materials and construction practices
based on industry standards for safety, liability, and durability, as referenced
in building codes, materials, manuals, and industry and risk management publications.
(o) RENTAL PROPERTY.
(A) Environmental modifications
to rental property may not substitute or duplicate services otherwise the responsibility
of the landlord under the landlord tenant laws, the Americans with Disabilities
Act, or the Fair Housing Act.
(B) Environmental modifications
made to a rental structure must have written authorization from the owner of the
rental property prior to the start of the work.
(C) The Department does not
fund work to restore the rental structure to the former condition of the rental
structure.
(12) ATTENDANT CARE SERVICES.
Attendant care services include direct support provided to an individual in the
home of the individual or community by a qualified personal support worker or provider
organization. ADL and IADL services provided through attendant care must support
the individual to live as independently as possible, and be based on the identified
goals, preferences, and needs of the individual.
(a) ADL services include,
but are not limited to:
(A) Basic personal hygiene
— providing or assisting with needs such as bathing (tub, bed, bath, shower),
hair care, grooming, shaving, nail care, foot care, dressing, skin care, or oral
hygiene;
(B) Toileting, bowel, and
bladder care — assisting to and from the bathroom, on and off toilet, commode,
bedpan, urinal, or other assistive device used for toileting, changing incontinence
supplies, following a toileting schedule, managing menses, cleansing an individual
or adjusting clothing related to toileting, emptying a catheter, drainage bag, or
assistive device, ostomy care, or bowel care;
(C) Mobility, transfers,
and repositioning — assisting with ambulation or transfers with or without
assistive devices, turning an individual or adjusting padding for physical comfort
or pressure relief, or encouraging or assisting with range-of-motion exercises;
(D) Nutrition - assisting
with adequate fluid intake or adequate nutrition, assisting with food intake (feeding),
monitoring to prevent choking or aspiration, assisting with adaptive utensils, cutting
food, and placing food, dishes, and utensils within reach for eating;
(E) Delegated nursing tasks;
(F) First aid and handling
emergencies — addressing medical incidents related to the conditions of an
individual, such as seizure, aspiration, constipation, or dehydration, responding
to the call of the individual for help during an emergent situation, or for unscheduled
needs requiring immediate response;
(G) Assistance with necessary
medical appointments — help scheduling appointments, arranging medical transportation
services, accompaniment to appointments, follow up from appointments, or assistance
with mobility, transfers, or cognition in getting to and from appointments; and
(H) Observation of the status
of an individual and reporting of significant changes to a physician, health care
provider, or other appropriate person.
(b) IADL services include,
but are not limited to:
(A) Light housekeeping tasks
necessary to maintain an individual in a healthy and safe environment — cleaning
surfaces and floors, making the individual's bed, cleaning dishes, taking out the
garbage, dusting, and laundry;
(B) Grocery and other shopping
necessary for the completion of other ADL and IADL tasks;
(C) Meal preparation and
special diets;
(D) Cognitive assistance
or emotional support provided to an individual due to an intellectual or developmental
disability — helping the individual cope with change and assisting the individual
with decision-making, reassurance, orientation, memory, or other cognitive functions;
(E) Medication and medical
equipment — assisting with ordering, organizing, and administering medications
(including pills, drops, ointments, creams, injections, inhalers, and suppositories),
monitoring an individual for choking while taking medications, assisting with the
administration of medications, maintaining equipment, or monitoring for adequate
medication supply; and
(F) Support in the community
around socialization and participation in the community.
(i) Support with socialization
— assisting an individual in acquiring, retaining, and improving self-awareness
and self-control, social responsiveness, social amenities, and interpersonal skills;
(ii) Support with community
participation — assisting an individual in acquiring, retaining, and improving
skills to use available community resources, facilities, or businesses; and
(iii) Support with communication
— assisting an individual in acquiring, retaining, and improving expressive
and receptive skills in verbal and non-verbal language and the functional application
of acquired reading and writing skills.
(c) Assistance with ADLs,
IADLs, and health-related tasks may include cueing, monitoring, reassurance, redirection,
set-up, hands-on, or standby assistance. Assistance may be provided through human
assistance or the use of electronic devices or other assistive devices. Assistance
may also require verbal reminding to complete any of the IADL tasks described in
subsection (b) of this section.
(A) "Cueing" means giving
verbal, audio, or visual clues during an activity to help an individual complete
the activity without hands-on assistance.
(B) "Hands-on" means a provider
physically performs all or parts of an activity because an individual is unable
to do so.
(C) "Monitoring" means a
provider observes an individual to determine if assistance is needed.
(D) "Reassurance" means to
offer an individual encouragement and support.
(E) "Redirection" means to
divert an individual to another more appropriate activity.
(F) "Set-up" means the preparation,
cleaning, and maintenance of personal effects, supplies, assistive devices, or equipment
so that an individual may perform an activity.
(G) "Stand-by" means a provider
is at the side of an individual ready to step in and take over the task if the individual
is unable to complete the task independently.
(13) SKILLS TRAINING. Skills
training is specifically tied to accomplishing ADL, IADL, and other health-related
tasks as identified by the functional needs assessment and ISP and is a means for
an individual to acquire, maintain, or enhance independence.
(a) Skills training may be
applied to the use and care of assistive devices and technologies.
(b) Skills training is authorized
when:
(A) The anticipated outcome
of the skills training, as documented in the ISP, is measurable;
(B) Timelines for measuring
progress towards the anticipated outcome are established in the ISP; and
(C) Progress towards the
anticipated outcome are measured and the measurements are evaluated by a personal
agent no less frequently than every six months, based on the start date of the initiation
of the skills training.
(c) When anticipated outcomes
are not achieved within the timeframe outlined in the ISP, the personal agent must
reassess or redefine the use of skills training with the individual for that particular
goal.
(14) RELIEF CARE.
(a) Relief care may not be
characterized as daily or periodic services provided solely to allow the primary
caregiver to attend school or work. Daily relief care may be provided in segments
that are sequential but may not exceed seven consecutive days without permission
from the Department. No more than 14 days of relief care in a plan year are allowed
without approval from the Department.
(b) Relief care may include
both day and overnight services that may be provided in:
(A) The home of the individual;
(B) A licensed or certified
setting;
(C) The home of a qualified
provider, chosen by the individual or the representative of the individual, that
is a safe setting for the individual; or
(D) The community, during
the provision of ADL, IADL, health-related tasks, and other supports identified
in the ISP for the individual.
(15) ASSISTIVE DEVICES. Assistive
devices are primarily and customarily used to meet an ADL, IADL, or health-related
support need. The purchase, rental, or repair of assistive devices with support
service funds must be limited to the types of equipment and supplies that are not
excluded under OAR 410-122-0080.
(a) Assistive devices may
include the purchase of devices, aids, controls, supplies, or appliances primarily
and customarily used to enable an individual to increase the ability of the individual
to perform and support ADLs and IADLs or to perceive, control, or communicate within
the home and community environment in which the individual lives.
(b) Assistive devices may
be purchased with support service funds when the intellectual or developmental disability
of an individual otherwise prevents or limits the independence of the individual
in areas identified in a functional needs assessment.
(c) Assistive devices that
may be purchased for the purpose described in subsection (b) of this section must
be of direct benefit to the individual and may include:
(A) Devices to secure assistance
in an emergency in the community and other reminders, such as medication minders,
alert systems for ADL or IADL supports, or mobile electronic devices; and
(B) Assistive devices, not
provided by any other funding source, to assist and enhance the independence of
an individual in performing ADLs or IADLs, such as durable medical equipment, mechanical
apparatus, or electronic devices.
(d) Expenditures for assistive
devices are limited to $5,000 per plan year without Department approval. Any single
purchase costing more than $500 must be approved by the Department prior to expenditure.
A personal agent must request approval for additional expenditures through the Department
prior to expenditure. Approval is based on the service and support needs and goals
of the individual and a determination by the Department of appropriateness and cost-effectiveness.
(e) Devices must be limited
to the least costly option necessary to meet assessed need of an individual.
(f) Assistive devices must
meet applicable standards of manufacture, design, and installation.
(g) To be authorized by a
personal agent, assistive devices must be:
(A) In addition to any assistive
devices, medical equipment, and supplies furnished under OHP, the state plan, private
insurance, or alternative resources;
(B) Determined necessary
to the daily functions of the individual; and
(C) Directly related to the
disability of the individual.
(h) Assistive devices exclude:
(A) Items that are not necessary
or of direct medical benefit to the individual or do not address the underlying
need for the device;
(B) Items intended to supplant
similar items furnished under OHP, private insurance, or alternative resources;
(C) Items that are considered
unsafe for an individual;
(D) Toys or outdoor play
equipment; and
(E) Equipment and furnishings
of general household use.
(16) ASSISTIVE TECHNOLOGY
Assistive technology is primarily and customarily used to provide additional safety
and support and replace the need for direct interventions, to enable self-direction
of care, and maximize independence. Assistive technology includes, but is not limited
to, motion or sound sensors, two-way communication systems, automatic faucets and
soap dispensers, incontinence and fall sensors, or other electronic backup systems,
including the expense necessary for the continued operation of the assistive technology;
(a) Expenditures for assistive
technology are limited to $5,000 per plan year without Department approval. Any
single purchase costing more than $500 must be approved by the Department prior
to expenditure. A personal agent must request approval for additional expenditures
through the Department prior to expenditure. Approval is based on the service and
support needs and goals of the individual and a determination by the Department
of appropriateness and cost-effectiveness.
(b) Payment for on-going
electronic back-up systems or assistive technology costs must be paid to providers
each month after services are received.
(A) Ongoing costs do not
include electricity or batteries.
(B) Ongoing costs may include
minimally necessary data plans and the services of a company to monitor emergency
response systems.
(17) CHORE SERVICES. Chore
services may be provided only in situations where no one else is responsible or
able to perform or pay for the services.
(a) Chore services include
heavy household chores, such as:
(A) Washing floors, windows,
and walls;
(B) Tacking down loose rugs
and tiles; and
(C) Moving heavy items of
furniture for safe access and egress.
(b) Chore services may include
yard hazard abatement to ensure the outside of the home is safe for the individual
to traverse and enter and exit the home.
(18) COMMUNITY TRANSPORTATION.
(a) Community transportation
includes, but is not limited to:
(A) Community transportation
provided by a common carrier, taxicab, or bus in accordance with standards established
for these entities;
(B) Reimbursement on a per-mile
basis for transporting an individual to accomplish ADL, IADL, a health-related task,
or employment goal identified in an ISP; or
(C) Assistance with the purchase
of a bus pass.
(b) Community transportation
may only be authorized when natural supports or volunteer services are not available
and one of the following is identified in the ISP of the individual:
(A) The individual has an
assessed need for ADL, IADL, or health-related task during transportation; or
(B) The individual has either
an assessed need for ADL, IADL, or health-related task at the destination or a need
for waiver funded services at the destination;
(c) Community transportation
must be provided in the most cost effective manner which meets the needs identified
in the ISP for the individual.
(d) Community transportation
expenses exceeding $500 per month must be approved by the Department.
(e) Community transportation
must be prior authorized by a personal agent and documented in an ISP. The Department
does not pay any provider under any circumstances for more than the total number
of hours, miles, or rides prior authorized by the brokerage and documented in the
ISP. Personal support workers who use their own personal vehicles for community
transportation are reimbursed as described in OAR chapter 411, division 375.
(f) Community transportation
services exclude:
(A) Medical transportation;
(B) Purchase or lease of
a vehicle;
(C) Routine vehicle maintenance
and repair, insurance, and fuel;
(D) Ambulance services;
(E) Costs for transporting
a person other than the individual;
(F) Transportation for a
provider to travel to and from the workplace of the provider;
(G) Transportation that is
not for the sole benefit of the individual;
(H) Transportation to vacation
destinations or trips for relaxation purposes;
(I) Transportation provided
by family members who are not personal support workers and are not simultaneously
providing other paid supports at the time of the transportation;
(J) Payment to the spouse
of an individual receiving support services;
(K) Reimbursement for out-of-state
travel expenses; and
(L) Mileage reimbursement
for the vehicle of the supported individual.
(19) TRANSITION COSTS.
(a) Transition costs are
limited to an individual transitioning to the home or community-based setting where
the individual resides from a nursing facility, ICF/ID, or acute care hospital.
(b) Transition costs are
based on the assessed need of an individual determined during the person-centered
service planning process and must support the desires and goals of the individual
receiving services and supports. Final approval for transition costs must be through
the Department prior to expenditure. The approval of the Department is based on
the need of an individual and the determination by the Department of appropriateness
and cost-effectiveness.
(c) Financial assistance
for transition costs is limited to:
(A) Moving and move-in costs,
including movers, cleaning and security deposits, payment for background or credit
checks (related to housing), or initial deposits for heating, lighting, and phone;
(B) Payment of previous utility
bills that may prevent the individual from receiving utility services and basic
household furnishings, such as a bed; and
(C) Other items necessary
to re-establish a home.
(d) Transition costs are
provided no more than twice annually.
(e) Transitions costs for
basic household furnishings and other items are limited to one time per year.
(20) EMPLOYMENT SERVICES.
Employment services must be:
(a) Delivered according to
OAR 411-345-0025; and
(b) Provided by an employment
specialist meeting the requirements described in OAR 411-345-0030.
(21) FAMILY TRAINING. Family
training services are provided to the family of an individual to increase the abilities
of the family to care for, support, and maintain the individual in the home of the
individual.
(a) Family training services
include:
(A) Instruction about treatment
regimens and use of equipment specified in an ISP;
(B) Information, education,
and training about the disability, medical, and behavioral conditions of an individual;
and
(C) Registration fees for
organized conferences and workshops specifically related to the intellectual or
developmental disability of the individual or the identified, specialized, medical,
or behavioral support needs of the individual.
(i) Conferences and workshops
must be prior authorized by a personal agent, directly relate to the intellectual
or developmental disability of the individual, and increase the knowledge and skills
of the family to care for and maintain the individual in the home of the individual.
(ii) Conference and workshop
costs exclude:
(I) Travel, food, and lodging
expenses;
(II) Services otherwise provided
under OHP or available through other resources; or
(III) Costs for individual
family members who are employed to care for the individual.
(b) Family training services
exclude:
(A) Mental health counseling,
treatment, or therapy;
(B) Training for a paid provider;
(C) Legal fees;
(D) Training for a family
to carry out educational activities in lieu of school;
(E) Vocational training for
family members; and
(F) Paying for training to
carry out activities that constitute abuse of an adult.
(c) Prior authorization by
the brokerage is required for attendance by family members at organized conferences
and workshops funded with support services funds.
(22) SPECIAL DIET. Special
diets are specially prepared food or particular types of food, ordered by a physician
and periodically monitored by a dietician, specific to the medical condition or
diagnosis of an individual that are needed to sustain the individual in the home
of the individual. Special diets are supplements and are not intended to meet the
complete daily nutritional requirements of the individual. Special diet supplies
must be supported by an evidence-based treatment regimen.
(23) ENVIRONMENTAL SAFETY
MODIFICATIONS.
(a) Environmental safety
modifications must be made from materials of the most cost effective type and may
not include decorative additions.
(b) Fencing may not exceed
200 linear feet without approval from the Department.
(c) Environmental safety
modifications exclude:
(A) Large gates, such as
automobile gates;
(B) Costs for paint and stain;
(C) Adaptations or improvements
to the home that are of general utility and are not for the direct safety or long-term
benefit to the individual or do not address the underlying environmental need for
the modification; and
(D) Adaptations that add
to the total square footage of the home.
(d) Environmental safety
modifications must be tied to supporting ADL, IADL, and health-related tasks as
identified in the ISP.
(e) Environmental safety
modifications are limited to $5,000 per modification. A personal agent must request
approval for additional expenditures through the Department prior to expenditure.
Approval is based on the service and support needs and goals of the individual and
the determination by the Department of appropriateness and cost-effectiveness. In
addition, separate environmental safety modification projects that cumulatively
total up to over $5,000 in a plan year must be submitted to the Department for review.
(f) Environmental safety
modifications must be completed by a state licensed contractor with a minimum of
$1,000,000 liability insurance. Any modification requiring a permit must be inspected
by a local inspector and certified as in compliance with local codes. Certification
of compliance must be filed in the file for the contractor prior to payment.
(g) Environmental safety
modifications must be made within the existing square footage of the home and may
not add to the square footage of the home.
(h) Payment to the contractor
is to be withheld until the work meets specifications.
(i) A scope of work as defined
in OAR 411-340-0020 must be completed for each identified environmental safety modification
project. All contractors submitting bids must be given the same scope of work.
(j) A personal agent must
follow the processes outlined in the In-home Expenditure Guidelines for contractor
bids and the awarding of work.
(k) All dwellings must be
in good repair and have the appearance of sound structure.
(l) The identified home may
not be in foreclosure or the subject of legal proceedings regarding ownership.
(m) Environmental safety
modifications must only be completed to the primary residence of the individual.
(n) Upgrades in materials
that are not directly related to the health and safety needs of the individual are
not paid for or permitted.
(o) Environmental safety
modifications are subject to Department requirements regarding material and construction
practices based on industry standards for safety, liability, and durability, as
referenced in building codes, materials manuals, and industry and risk management
publications.
(p) RENTAL PROPERTY.
(A) Environmental safety
modifications to rental property may not substitute or duplicate services otherwise
the responsibility of the landlord under the landlord tenant laws, the Americans
with Disabilities Act, or the Fair Housing Act.
(B) Environmental safety
modifications made to a rental structure must have written authorization from the
owner of the rental property prior to the start of the work.
(C) The Department does not
fund work to restore the rental structure to the former condition of the rental
structure.
(24) VEHICLE MODIFICATIONS.
(a) Vehicle modifications
may only be made to the vehicle primarily used by an individual to meet the unique
needs of the individual. Vehicle modifications may include a lift, interior alterations
to seats, head and leg rests, belts, special safety harnesses, other unique modifications
to keep the individual safe in the vehicle, and the upkeep and maintenance of a
modification made to the vehicle.
(b) Vehicle modifications
exclude:
(A) Adaptations or improvements
to a vehicle that are of general utility and are not of direct medical benefit to
the individual or do not address the underlying need for the modification;
(B) The purchase or lease
of a vehicle; or
(C) Routine vehicle maintenance
and repair.
(c) Vehicle modifications
are limited to $5,000 per modification. A personal agent must request approval for
additional expenditures through the Department prior to expenditure. Approval is
based on the service and support needs and goals of the individual and the determination
by the Department of appropriateness and cost-effectiveness. In addition, separate
vehicle modification projects that cumulatively total up to over $5,000 in a plan
year must be submitted to the Department for review.
(d) Vehicle modifications
must meet applicable standards of manufacture, design, and installation.
(25) SPECIALIZED MEDICAL
SUPPLIES. Specialized medical supplies do not cover services which are otherwise
available to an individual under Vocational Rehabilitation and Other Rehabilitation
Services, 29 U.S.C. 701-7961, as amended, or the Individuals with Disabilities Education
Act, 20 U.S.C. 1400 as amended. Specialized medical supplies may not overlap with,
supplant, or duplicate other services provided through a waiver, OHP, or Medicaid
state plan services.
(26) Educational services,
such as professional instruction, formal training, and tutoring in communication,
socialization, and academic skills, are not allowable expenses covered by support
services funds.
(27) CONDITIONS OF PURCHASE.
The brokerage must arrange for supports purchased with support services funds to
be provided:
(a) In settings and under
contractual conditions that enable the individual to freely choose to receive supports
and services from another qualified provider;
(A) Individuals who choose
to combine support services funds to purchase group services must receive written
instruction from the brokerage about the limits and conditions of such arrangements;
(B) Combined support services
funds may not be used to purchase existing, or create new, comprehensive services;
(C) Individual support expenses
must be separately projected, tracked, and expensed, including separate contracts,
service agreements, and timekeeping for staff working with more than one individual;
and
(D) Combined arrangements
for residential supports must include a plan for maintaining an individual at home
after the loss of roommates.
(b) In a manner consistent
with positive behavioral theory and practice and where behavior intervention is
not undertaken unless the behavior:
(A) Represents a risk to
health and safety of the individual or others;
(B) Is likely to continue
and become more serious over time;
(C) Interferes with community
participation;
(D) Results in damage to
property; or
(E) Interferes with learning,
socializing, or vocation.
(c) In accordance with applicable
state and federal wage and hour regulations in the case of personal services, training,
and supervision;
(d) In accordance with applicable
state or local building codes in the case of environmental modifications to the
home;
(e) In accordance with Oregon
Board of Nursing rules in OAR chapter 851 when services involve performance of nursing
services or delegation, teaching, and assignment of nursing tasks;
(f) In accordance with OAR
411-340-0160 through 411-340-0180 governing provider qualifications and responsibilities;
and
(g) In accordance with the
In-home Expenditure Guidelines.
(28) INDEPENDENT PROVIDER,
PROVIDER ORGANIZATION, AND GENERAL BUSINESS PROVIDER AGREEMENTS AND RESPONSIBILITIES.
When support services funds are used to purchase services, training, supervision,
or other personal assistance for individuals, the brokerage must require and document
that providers are informed of:
(a) Mandatory reporter responsibility
to report suspected abuse;
(b) Responsibility to immediately
notify the people, if any, specified by the individual of any injury, illness, accident,
or unusual circumstance that occurs when the provider is providing individual services,
training, or supervision that may have a serious effect on the health, safety, physical
or emotional well-being, or level of services required;
(c) Limits of payment:
(A) Support services fund
payments for the agreed-upon services are considered full payment and the provider
under no circumstances may demand or receive additional payment for these services
from the individual, the family of the individual, or any other source unless the
payment is a financial responsibility (spend-down) of an individual under the Medically
Needy Program; and
(B) The provider must bill
all third party resources before using support services funds unless another arrangement
is agreed upon by the brokerage and described in the ISP for an individual.
(d) The provisions of section
(29) of this rule regarding sanctions that may be imposed on providers; and
(e) The requirement to maintain
a drug-free workplace.
(29) PROVIDER TERMINATION.
(a) The provider enrollment
for a personal support worker is terminated as described in OAR chapter 411, division
375.
(b) An independent provider
who is not a personal support worker may have their provider enrollment terminated
in the following circumstances:
(A) The provider has not
provided any paid in-home services to an individual within the last previous 12
months;
(B) The provider informs
the Department, CDDP, CIIS, or brokerage that the personal support worker is no
longer providing in-home services in Oregon;
(C) The background check
for a provider results in a closed case pursuant to OAR 407-007-0325;
(D) Services to an individual,
is being investigated by adult or child protective services for suspected abuse
that poses imminent danger to current or future individuals; or
(E) Provider payments, all
or in part, for the provider have been suspended based on a credible allegation
of fraud or has a conviction of for fraud pursuant to federal law under 42 CFR 455.23.
(c) Provider enrollment may
be terminated when the brokerage or Department determines that, at some point after
the initial qualification and authorization of the provider to provide supports
purchased with support services funds, the provider has:
(A) Been convicted of any
crime that would have resulted in an unacceptable background check upon hiring or
authorization of service;
(B) Been convicted of unlawfully
manufacturing, distributing, prescribing, or dispensing a controlled substance;
(C) Surrendered his or her
professional license or had his or her professional license suspended, revoked,
or otherwise limited;
(D) Notwithstanding abuse
as defined in OAR 407-045-0260, failed to safely and adequately provide the authorized
services;
(E) Had a founded report
of child abuse or substantiated adult abuse;
(F) Failed to cooperate with
any Department or brokerage investigation or grant access to, or furnish, records
or documentation, as requested;
(G) Billed excessive or fraudulent
charges or been convicted of fraud;
(H) Made a false statement
concerning conviction of crime or substantiated abuse;
(I) Falsified required documentation;
(J) Failed to comply with
the provisions of section (28) of this rule or OAR 411-340-0140;
(K) Been suspended or terminated
as a provider by the Department or Oregon Health Authority;
(L) Violated the requirement
to maintain a drug-free work place;
(M) Failed to provide services
as required;
(N) Failed to provide a tax
identification number or social security number that matches the legal name of the
independent provider, as verified by the Internal Revenue Service or Social Security
Administration; or
(O) Has been excluded or
debarred by the Office of the Inspector General.
(d) If the brokerage or Department
makes a decision to terminate provider enrollment, the Department must issue a written
notice that includes:
(A) An explanation of the
reason for termination of the provider enrollment;
(B) The alleged violation
as listed in subsection (b) and (c) of this section; and
(C) The appeal rights of
the individual, including where to file the appeal; and
(D) For terminations based
on substantiated abuse allegations, only the limited information allowed by law.
In accordance with ORS 124.075, 124.085, 124.090, and OAR 411-020-0030, complainants,
witnesses, the name of the alleged victim, and protected health information may
not be disclosed.
(E) The effective date of
the termination.
(e) The provider may appeal
a termination within 30 days from the date the termination notice was mailed to
the provider. The provider must appeal a termination separately from any appeal
of audit findings and overpayments.
(A) A provider of Medicaid
services may appeal a termination by requesting an administrator review by the Director
of the Department.
(B) For an appeal regarding
provision of Medicaid services to be valid, written notice of the appeal must be
received by the Department within 30 days from the date the termination notice was
mailed to the provider.
(f) At the discretion of
the Department, providers who have previously been terminated or suspended by the
Department or by the Oregon Health Authority may not be authorized as providers
of Medicaid services.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1870,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 10-2004(Temp), f. & cert.
ef. 4-30-04 thru 10-25-04; SPD 32-2004, f. & cert. ef. 10-25-04; SPD 38-2004(Temp),
f. 12-30-04, cert. ef. 1-1-05 thru 6-30-05; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert.
ef. 1-1-08 thru 6-29-08; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009,
f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru
6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 27-2011, f. & cert. ef.
12-28-11; SPD 13-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 50-2013,
f. 12-27-13, cert. ef. 12-28-13; APD 26-2014(Temp), f. & cert. ef. 7-1-14 thru
12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0135
Standards for Employers
(1) EMPLOYER OF RECORD. An employer
of record is required when a personal support worker who is not an independent contractor
is selected by an individual to provide supports. The Department may not act as
the employer of record.
(2) SERVICE AGREEMENT. The
employer must create and maintain a service agreement for a personal support worker
that is in coordination with the services authorized in the ISP. The service agreement
serves as a written job description for the employed personal support worker.
(3) BENEFITS. Only personal
support workers qualify for benefits. The benefits provided to personal support
workers are described in OAR chapter 411, division 375.
(4) INTERVENTION. For the
purpose of this rule, "intervention" means the action the Department or the designee
of the Department requires when an employer fails to meet the employer responsibilities
described in this rule. Intervention includes, but is not limited to:
(a) A documented review of
the employer responsibilities described in section (5) of this rule;
(b) Training related to employer
responsibilities;
(c) Corrective action taken
as a result of a personal support worker filing a complaint with the Department,
the designee of the Department, or other agency who may receive labor related complaints;
(d) Identifying an employer
representative if an individual is not able to meet the employer responsibilities
described in section (5) of this rule; or
(e) Identifying another representative
if the current employer representative is not able to meet the employer responsibilities
described in section (5) of this rule.
(5) EMPLOYER RESPONSIBILITIES.
(a) For an individual to
be eligible for support provided by a personal support worker, an employer must
demonstrate the ability to:
(A) Locate, screen, and hire
a qualified personal support worker;
(B) Supervise and train the
personal support worker;
(C) Schedule work, leave,
and coverage;
(D) Track the hours worked
and verify the authorized hours completed by the personal support worker;
(E) Recognize, discuss, and
attempt to correct, with the personal support worker, any performance deficiencies
and provide appropriate, progressive, disciplinary action as needed; and
(F) Discharge an unsatisfactory
personal support worker.
(b) Indicators that an employer
may not be meeting the employer responsibilities described in subsection (a) of
this section include, but are not limited to:
(A) Personal support worker
complaints;
(B) Multiple complaints from
a personal support worker requiring intervention from the Department or Brokerage
as defined in section (4) of this rule;
(C) Frequent errors on timesheets,
mileage logs, or other required documents submitted for payment that results in
repeated coaching from the Department or Brokerage;
(D) Complaints to Medicaid
Fraud involving the employer; or
(E) Documented observation
by the Department or Brokerage of services not being delivered as identified in
an ISP.
(c) The Department or the
Brokerage may require intervention as defined in section (4) of this rule when an
employer has demonstrated difficulty meeting the employer responsibilities described
in subsection (a) of this section.
(d) An individual may not
receive support provided by a personal support worker if, after appropriate intervention
and assistance, an employer is not able to meet the employer responsibilities described
in subsection (a) of this section.
(A) An individual determined
ineligible to be an employer of a personal support worker and unable to designate
an employer representative, may not request support provided by a personal support
worker until the next annual ISP. Improvements in health and cognitive functioning
may be factors in demonstrating the ability of the individual to meet the employer
responsibilities described in subsection (a) of this section. If an individual is
able to demonstrate the ability to meet the employer responsibilities sooner than
the next annual ISP, the individual may request the waiting period be shortened.
(B) An individual determined
ineligible to be an employer of a personal support worker is offered other available
service options that meet the service needs of the individual, including support
through a contracted qualified provider organization or general business provider
when available. As an alternative to in-home support, the Department or the designee
of the Department may offer other available services through the Home and Community
Based Services Waiver or State Plan.
(6) DESIGNATION OF EMPLOYER
RESPONSIBLITIES.
(a) An individual not able
to meet all of the employer responsibilities described in section (5)(a) of this
rule must:
(A) Designate an employer
representative in order for the individual to receive or continue to receive in
home support provided by a personal support worker; or
(B) Select a provider organization
or general business provider to provide support for the individual.
(b) An individual able to
demonstrate the ability to meet some of the employer responsibilities described
in section (5)(a) of this rule must:
(A) Designate an employer
representative to fulfill the responsibilities the individual is not able to meet
in order for the individual to receive or continue to receive support provided by
a personal support worker; and
(B) On a Department approved
form, document the specific employer responsibilities performed by the individual
and the employer responsibilities performed by the employer representative of the
individual.
(c) When the employer representative
of an individual is not able to meet the employer responsibilities described in
section (5)(a) or the qualifications in section (7)(c) of this rule, an individual
must:
(A) Designate a different
employer representative in order for the individual to receive or continue to receive
in home support provided by a personal support worker; or
(B) Select a provider organization
or general business provider to provide in-home support for the individual.
(7) EMPLOYER REPRESENTATIVE.
(a) An individual, or the
legal representative of an individual, may designate an employer representative
to act on behalf of the individual, to meet the employer responsibilities described
in section (5)(a) of this rule. The legal or designated representative of an individual
may be the employer.
(b) An employer who is also
the personal support worker of support must seek an alternate employer for purposes
of the employment of the personal support worker. The alternate employer must:
(A) Track the hours worked
and verify the authorized hours completed by the personal support worker; and
(B) Document the specific
employer responsibilities performed by the employer on a Department approved form.
(c) The Department or the
Brokerage may suspend, terminate, or deny a request for an employer representative
if the requested employer representative has:
(A) A history of substantiated
abuse of an adult as described in OAR 411-045-0250 to 411-045-0370;
(B) A history of founded
abuse of a child as described in ORS 419B.005;
(C) Participated in billing
excessive or fraudulent charges; or
(D) Failed to meet the employer
responsibilities in section (5)(a) or (7)(b) of this rule, including previous termination
as a result of failing to meet the employer responsibilities in section (5)(a) or
(7)(b).
(d) If the Department or
Brokerage suspends, terminates, or denies a request for an employer representative
for the reasons described in subsection (c) of this section, an individual may select
another employer representative.
(8) NOTICE.
(a) The Department or the
Brokerage, respectively, shall mail a notice identifying the individual, and if
applicable the employer representative and legal or designated representative of
the individual, when:
(A) The Department or the
Brokerage denies, suspends, or terminates an employer from performing the employer
responsibilities described in sections (5)(a) or (7)(b) of this rule; and
(B) The Department or the
Brokerage denies, suspends, or terminates an employer representative from performing
the employer responsibilities described in section (5)(a) or (7)(b) of this rule
because the employer representative does not meet the qualifications in section
(7)(c) of this rule.
(b) BROKERAGE ISSUED NOTICES.
An individual receiving support from a personal support worker, or as applicable
the legal or designated representative or employer representative of the individual,
may appeal a notice issued by the Brokerage by requesting a review by Director of
the Brokerage.
(A) For an appeal regarding
denial, suspension, or termination of an employer to be valid, written notice of
the appeal and request for review must be received by the Brokerage within 45 days
from the date of the notice.
(B) The Brokerage Director
shall complete a review and issue a decision within 30 days of the date the written
appeal was received by the Brokerage.
(C) If an individual, or
as applicable the legal or designated representative or employer representative
of the individual, is dissatisfied with the decision of the Brokerage Director,
the individual, or as applicable the legal or designated representative or employer
representative of the individual, may request an administrator review by the Director
of the Department.
(D) For an appeal of the
decision of the Brokerage to be valid, written notice of the appeal and request
for an administrator review must be received by the Department within 15 days from
the date of the decision of the Brokerage.
(E) The Director shall complete
an administrator review within 30 days from the date the written appeal was received
by the Department.
(F) The determination of
the Director is the final response from the Department.
(c) DEPARTMENT ISSUED NOTICES.
An individual receiving support from a personal support worker, or as applicable
the legal or designated representative of the individual, may appeal a notice issued
by the Department by requesting an administrator review by the Director of the Department.
(A) For an appeal regarding
denial, suspension, or termination of an employer to be valid, written notice of
the appeal and request for an administrator review must be received by the Department
within 45 days of the date of the notice.
(B) The Director shall complete
an administrator review and issue a decision within 30 days from the date the written
appeal was received by the Department.
(C) The determination of
the Director is the final response from the Department.
(d) When a denial, suspension,
or termination of an employer results in the Department denying, suspending, or
terminating an individual from in-home support, the hearing rights in OAR chapter
411, division 318 apply.
Stat. Auth.: ORS 409.050, 427.402, 430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400-410, 430.610, 430.620, 430.662-695
Hist.: APD 26-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0140
Using Support Services Funds for Certain
Purchases Is Prohibited
(1) Effective July 28, 2009, support
services funds may not be used to support, in whole or in part, a provider in any
capacity who has been convicted of any of the disqualifying crimes listed in OAR
407-007-0275.
(2) Section (1) of this rule
does not apply to employees of individuals, individuals' legal representatives,
employees of general business providers, or employees of provider organizations,
who were hired prior to July 28, 2009 that remain in the current position for which
the employee was hired.
(3) Support services funds
may not be used to pay for:
(a) Services, materials,
or activities that are illegal;
(b) Services or activities
that are carried out in a manner that constitutes abuse as defined in OAR 407-045-0260;
(c) Materials or equipment
that has been determined unsafe for the general public by recognized consumer safety
agencies;
(d) Individual or family
vehicles;
(e) Health and medical costs
that the general public normally must pay, including but not limited to:
(A) Medications;
(B) Health insurance co-payments;
(C) Dental treatments and
appliances;
(D) Medical treatments;
(E) Dietary supplements,
including but not limited to vitamins and experimental herbal and dietary treatments;
or
(F) Treatment supplies not
related to nutrition, incontinence, or infection control.
(f) Ambulance services;
(g) Legal fees;
(h) Vacation costs for transportation,
food, shelter, and entertainment that are normally incurred by a person on vacation,
regardless of disability, and are not strictly required by the individual's need
for personal assistance in all home and community-based settings;
(i) Individual services,
training, or supervision that has not been arranged according to applicable state
and federal wage and hour regulations;
(j) Services, activities,
materials, or equipment that are not necessary, cost-effective, or do not meet the
definition of support or social benefits as defined in OAR 411-340-0020;
(k) Educational services
for school-age individuals over the age of 18, including professional instruction,
formal training, and tutoring in communication, socialization, and academic skills,
and post-secondary educational services, such as those provided through two- or
four-year colleges for individuals of all ages;
(l) Services provided in
a nursing facility, correctional institution, or hospital;
(m) Services, activities,
materials, or equipment that may be obtained by the individual or the individual's
family through alternative resources or natural supports;
(n) Unless under certain
conditions and limits specified in Department guidelines, employee wages or contractor
charges for time or services when the individual is not present or available to
receive services, including but not limited to employee paid time off, hourly "no
show" charge, and contractor travel and preparation hours;
(o) Services or activities
for which the legislative or executive branch of Oregon government has prohibited
use of public funds;
(p) Notwithstanding abuse
as defined in OAR 407-045-0260, services when there is sufficient evidence to believe
that an individual, or as applicable the legal or designated representative of the
individual, has engaged in fraud or misrepresentation, failed to use resources as
agreed upon in the ISP, refused to accept or delegate record keeping required to
use brokerage resources, or otherwise knowingly misused public funds associated
with brokerage services;
(q) Any purchase that is
not generally accepted by the relevant mainstream professional or academic community
as an effective means to address an identified support need; or
(r) Services, supplies, or
supports that are illegal, experimental, or determined unsafe for the general public
by recognized consumer safety agencies.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1880,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08;
SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef.
1-1-10 thru 6-30-10; SPD 2-2010(Temp), f. & cert. ef. 3-18-10 thru 6-30-10;
SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 27-2011, f. & cert. ef. 12-28-11;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 44-2014, f. 12-26-14, cert. ef.
12-28-14
411-340-0150
Standards for Support Services Brokerage
Administration and Operations
(1) POLICY OVERSIGHT GROUP. The brokerage
must develop and implement procedures for incorporating the direction, guidance,
and advice of individuals and family members of individuals in the administration
of the organization.
(a) The brokerage must establish
and utilize a Policy Oversight Group, of which the membership majority must be individuals
with intellectual or developmental disabilities and family members of individuals
with intellectual or developmental disabilities.
(b) Brokerage procedures
must be developed and implemented to assure the Policy Oversight Group has the maximum
authority that may be legally assigned or delegated over important program operational
decisions, including such areas as program policy development, program planning
and goal setting, budgeting and resource allocation, selection of key personnel,
program evaluation and quality assurance, and complaint resolution.
(c) If the Policy Oversight
Group is not also the governing body of the brokerage, then the brokerage must develop
and implement a written procedure that describes specific steps of appeal or remediation
to resolve conflicts between the Policy Oversight Group and the governing body of
the brokerage.
(d) A Policy Oversight Group
must develop and implement operating policies and procedures.
(2) FULL-TIME BROKERAGE DIRECTOR
REQUIRED. The brokerage must employ a full-time director who is responsible for
the daily operations of the brokerage in compliance with these rules and who has
authority to make budget, staffing, policy, and procedural decisions for the brokerage.
(3) DIRECTOR QUALIFICATIONS.
In addition to the general staff qualifications of OAR 411-340-0070(1) and (2),
the brokerage director must have:
(a) A minimum of a bachelor's
degree and two years' experience, including supervision, in the field of intellectual
or developmental disabilities, social services, mental health, or a related field;
or
(b) Six years of experience,
including supervision, in the field of intellectual or developmental disabilities,
social services, or mental health.
(4) FISCAL INTERMEDIARY REQUIREMENTS.
(a) A fiscal intermediary
must:
(A) Demonstrate a practical
understanding of laws, rules, and conditions that accompany the use of public resources;
(B) Develop and implement
accounting systems that operate effectively on a large scale as well as track individual
budgets;
(C) Establish and meet the
time lines for payments that meet individuals' needs;
(D) Develop and implement
an effective payroll system, including meeting payroll-related tax obligations;
(E) Generate service, management,
and statistical information and reports required by the brokerage director and Policy
Oversight Group to effectively manage the brokerage and by individuals to effectively
manage supports;
(F) Maintain flexibility
to adapt to changing circumstances of individuals; and
(G) Provide training and
technical assistance to individuals as required and specified in the individuals'
ISPs.
(b) A fiscal intermediary
may not recruit, hire, supervise, evaluate, dismiss, or otherwise discipline those
employed to provide services described in an individual's authorized ISP.
(c) FISCAL INTERMEDIARY QUALIFICATIONS.
(A) A fiscal intermediary
may not:
(i) Be a provider of support
services paid using support services funds; or
(ii) Be a family member or
other representative of an individual for whom they provide fiscal intermediary
services.
(B) The brokerage must obtain
and maintain written evidence that:
(i) Contractors providing
fiscal intermediary services have sufficient education, training, or work experience
to effectively and efficiently perform all required activities; and
(ii) Employees providing
fiscal intermediary services have sufficient education, training, or work experience
to effectively and efficiently perform all required activities prior to hire or
that the brokerage has provided requisite education, training, and experience.
(5) PERSONAL AGENT QUALIFICATIONS.
(a) Each personal agent must
have knowledge of the public service system for developmental disability services
in Oregon and at least:
(A) A bachelor’s degree
in a behavioral science, social science, or a closely related field; or
(B) A bachelor’s degree
in any field and one year of human services related experience, such as work providing
assistance to individuals and groups with issues, such as economical disadvantages,
employment, abuse and neglect, substance abuse, aging, disabilities, prevention,
health, cultural competencies, or housing; or
(C) An associate’s
degree in a behavioral science, social science, or a closely related field and two
years of human services related experience, such as work providing assistance to
individuals and groups with issues, such as economical disadvantages, employment,
abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural
competencies, or housing; or
(D) Three years of human
services related experience.
(b) A brokerage must submit
a written variance request to the Department prior to employing a person not meeting
the minimum qualifications for a personal agent set forth in subsection (a) of this
section. The variance request must include:
(A) An acceptable rationale
for the need to employ a person who does not meet the qualifications; and
(B) A proposed alternative
plan for education and training to correct the deficiencies.
(i) The proposal must specify
activities, timelines, and responsibility for costs incurred in completing the alternative
plan.
(ii) A person who fails to
complete the alternative plan for education and training to correct the deficiencies
may not fulfill the requirements for the qualifications.
(6) PERSONAL AGENT TRAINING.
The brokerage must provide or arrange for personal agents to receive training needed
to provide or arrange for brokerage services, including but not limited to:
(a) Principles of self-determination;
(b) Person-centered planning
processes;
(c) Identification and use
of alternative support resources;
(d) Fiscal intermediary services;
(e) Basic employer and employee
roles and responsibilities;
(f) Developing new resources;
(g) Major public health and
welfare benefits;
(h) Constructing and adjusting
individualized support plans; and
(i) Assisting individuals
to judge and improve quality of personal supports.
(7) INDIVIDUAL RECORD REQUIREMENTS.
The brokerage must maintain current, up-to-date records for each individual receiving
services and must make these records available to the Department upon request. The
individual or the individual’s legal representative may access any portion
of the individual's record upon request. Individual records must include, at minimum:
(a) Application and eligibility
information received from the referring CDDP;
(b) An easily-accessed summary
of basic information, including the individual's name, family name (if applicable),
individual's legal or designated representative (if applicable), address, telephone
number, date of entry into the program, date of birth, gender, marital status, individual
financial resource information, and plan year anniversary date;
(c) Documents related to
determining eligibility for brokerage services;
(d) Records related to receipt
and disbursement of funds, including expenditure authorizations, expenditure verification,
copies of CPMS expenditure reports, and verification that providers meet the requirements
of OAR 411-340-0160 through 411-340-0180;
(e) Documentation, signed
by the individual, or as applicable the individual's legal or designated representative,
that the individual, or as applicable the individual's legal or designated representative,
has been informed of responsibilities associated with the use of support services
funds;
(f) Incident reports;
(g) The completed functional
needs assessment and other assessments used to determine supports required, preferences,
and resources;
(h) ISP and reviews. If an
individual is unable to sign the ISP, the individual's record must document that
the individual was informed of the contents of the ISP and that the individual's
agreement to the ISP was obtained to the extent possible;
(i) Names of those who participated
in the development of the ISP. If an individual was not able to participate in the
development of the ISP, the individual's record must document the reason;
(j) Written service agreements.
A written service agreement must be consistent with the individual's ISP and must
describe, at a minimum:
(A) Type of service to be
provided;
(B) Hours, rates, location
of services, and expected outcomes of services; and
(C) Any specific individual
health, safety, and emergency procedures that may be required, including action
to be taken if an individual is unable to provide for the individual's own safety
and the individual is missing while in the community under the service of a contractor
or provider organization.
(k) Personal agent correspondence
and notes related to resource development and plan outcomes;
(l) Progress notes. Progress
notes must include documentation of the delivery of services by a personal agent
to support each case service provided. Progress notes must be recorded chronologically
and documented consistent with brokerage policies and procedures. All late entries
must be appropriately documented. Progress notes must, at a minimum, include:
(A) The month, day, and year
the services were rendered and the month, day, and year the entry was made if different
from the date service was rendered;
(B) The name of the individual
receiving services;
(C) The name of the brokerage,
the person providing the service (i.e., the personal agent's signature and title),
and the date the entry was recorded and signed;
(D) The specific services
provided and actions taken or planned, if any;
(E) Place of service. Place
of service means the name of the brokerage and where the brokerage is located, including
the address. The place of service may be a standard heading on each page of the
progress notes; and
(F) The names of other participants
(including titles and agency representation, if any) in notes pertaining to meetings
with or discussions about the individual.
(m) Information about individual
satisfaction with personal supports and the brokerage's services.
(8) SPECIAL RECORD REQUIREMENTS
FOR SUPPORT SERVICES FUND EXPENDITURES.
(a) The brokerage must develop
and implement written policies and procedures concerning use of support services
funds. These policies and procedures must include but may not be limited to:
(A) Minimum acceptable records
of expenditures:
(i) Itemized invoices and
receipts to record purchase of any single item;
(ii) A trip log indicating
purpose, date, and total miles to verify vehicle mileage reimbursement;
(iii) Itemized invoices for
any services purchased from independent contractors, provider organizations, and
professionals. Itemized invoices must include:
(I) The name of the individual
to whom services were provided;
(II) The date of the services;
and
(III) A description of the
services.
(iv) Pay records, including
timesheets signed by both employee and employer, to record employee services; and
(v) Documentation that services
provided were consistent with an individual's authorized ISP.
(B) Procedures for confirming
the receipt, and securing the use of, assistive devices, environmental safety modifications,
and environmental modifications.
(i) When an assistive device
is obtained for the exclusive use of an individual, the brokerage must record the
purpose, final cost, and date of receipt.
(ii) The brokerage must secure
use of equipment or furnishings costing more than $500 through a written agreement
between the brokerage and the individual or the individual's legal representative
that specifies the time period the item is to be available to the individual and
the responsibilities of all parties if the item is lost, damaged, or sold within
that time period.
(iii) The brokerage must
ensure that projects for environmental modifications and environmental safety modifications
involving renovation or new construction in an individual's home or property costing
$5,000 or more per single instance or cumulatively over several modifications:
(I) Are approved by the Department
before work begins and before final payment is made;
(II) Are completed or supervised
by a contractor licensed and bonded in Oregon; and
(b) Any goods purchased with
support services funds that are not used according to an individual's ISP or according
to an agreement securing the state's use may be immediately recovered.
(c) Failure to furnish written
documentation upon the written request from the Department, the Oregon Department
of Justice Medicaid Fraud Unit, Centers for Medicare and Medicaid Services, or their
authorized representatives, immediately or within timeframes specified in the written
request, may be deemed reason to recover payments or deny further assistance.
(9) QUALITY ASSURANCE.
(a) The Policy Oversight
Group must develop a Quality Assurance Plan and review the plan at least twice a
year. The Quality Assurance Plan must include a written statement of values, organizational
outcomes, activities, and measures of progress that:
(A) Uses information from
a broad range of individuals, legal or designated representatives, professionals,
and other sources to determine community support needs and preferences;
(B) Involves individuals
in ongoing evaluation of the quality of their personal supports; and
(C) Monitors:
(i) Customer satisfaction
with the services of the brokerage and with individual plans in areas, such as individual
access to supports, sustaining important personal relationships, flexible and unique
support strategies, individual choice and control over supports, responsiveness
of the brokerage to changing needs, and preferences of the individuals; and
(ii) Service outcomes in
areas such as achievement of personal goals and effective use of resources.
(b) The brokerage must participate
in statewide evaluation, quality assurance, and regulation activities as directed
by the Department.
(10) BROKERAGE REFFERRAL
TO AFFILIATED ENTITIES.
(a) When a brokerage is part
of, or otherwise directly affiliated with, an entity that also provides services
that an individual may purchase using private or support services funds, brokerage
staff may not refer, recommend, or otherwise encourage the individual to utilize
this entity to provide services unless:
(A) The brokerage conducts
a review of provider options that demonstrates that the entity's services are cost-effective
and best-suited to provide the services determined by the individual to be the most
effective and desirable for meeting needs and circumstances represented in the individual's
ISP; and
(B) The entity is freely
selected by the individual and is the clear choice by the individual among all available
alternatives.
(b) The brokerage must develop
and implement a policy that addresses individual selection of an entity that the
brokerage is a part of, or otherwise directly affiliated, to provide services purchased
with private or support services funds. This policy must address, at minimum:
(A) Disclosure of the relationship
between the brokerage and the potential provider;
(B) Provision of information
about all other potential providers to the individual, or as applicable the individual's
legal or designated representative, without bias;
(C) A process for arriving
at the option for selecting a provider;
(D) Verification of the fact
that the providers were freely chosen among all alternatives;
(E) Collection and review
of data on services purchased by an individual enrolled in the brokerage by an entity
that the brokerage is a part of or otherwise directly affiliated; and
(F) Training of personal
agents and individuals in issues related to the selection of providers.
(11) GENERAL OPERATING POLICIES
AND PRACTICES. The brokerage must develop and implement such written statements
of policy and procedure in addition to those specifically required by this rule
as are necessary and useful to enable the brokerage to accomplish the brokerage's
objectives and to meet the requirements of these rules and other applicable standards
and rules.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1890,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 32-2004, f. & cert. ef. 10-25-04;
SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06;
SPD 21-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-29-08; SPD 8-2008, f. 6-27-08,
cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 27-2011, f. &
cert. ef. 12-28-11; SPD 13-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 26-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0160
Standards for Independent Providers Paid
with Support Services Funds
(1) PERSONAL SUPPORT WORKER QUALIFICATIONS.
Each personal support worker must meet the qualifications described in OAR chapter
411, division 375.
(2) INDEPENDENT PROVIDER
QUALIFICATIONS. Each independent provider who is not a personal support worker who
is paid as a contractor or a self-employed person that is selected to provide the
services and supports in OAR 411-340-0130 must:
(a) Be at least 18 years
of age;
(b) Have approval to work
based on current Department policy and a background check completed by the Department
in accordance with OAR 407-007-0200 to 407-007-0370. A subject individual as defined
in 407-007-0210 may be approved for one position to work with multiple individuals
statewide when the subject individual is working in the same employment role. The
Department Background Check Request form must be completed by the subject individual
to show intent to work statewide;
(A) Prior background check
approval for another Department provider type is inadequate to meet background check
requirements for independent provider enrollment.
(B) Background check approval
is effective for two years from the date an independent provider is contracted with
to provide in-home support, except in the following circumstances:
(i) Based on possible criminal
activity or other allegations against the independent provider, a new fitness determination
is conducted resulting in a change in approval status; or
(ii) The background check
approval has ended because the Department has inactivated or terminated the provider
enrollment for the independent provider.
(c) Effective July 28, 2009,
not have been convicted of any of the disqualifying crimes listed in OAR 407-007-0275;
(d) Be legally eligible to
work in the United States;
(e) Not be the spouse of
an individual receiving services;
(f) Demonstrate by background,
education, references, skills, and abilities that he or she is capable of safely
and adequately performing the tasks specified the ISP, with such demonstration confirmed
in writing by the individual, or as applicable the individual's legal or designated
representative, and including:
(A) Ability and sufficient
education to follow oral and written instructions and keep any records required;
(B) Responsibility, maturity,
and reputable character exercising sound judgment;
(C) Ability to communicate
with the individual; and
(D) Training of a nature
and type sufficient to ensure that the provider has knowledge of emergency procedures
specific to the individual.
(g) Hold a current, valid,
and unrestricted appropriate professional license or certification where services
and supervision requires specific professional education, training, and skill;
(h) Understand requirements
of maintaining confidentiality and safeguarding individual information;
(i) Not be on the list of
excluded or debarred providers maintained by the Office of the Inspector General
(http://exclusions.oig.hhs.gov/);
(j) If transporting an individual,
have a valid license to drive and proof of insurance, as well as any other license
or certification that may be required under state and local law, depending on the
nature and scope of the transportation; and
(k) Sign a Medicaid provider
agreement and be enrolled as a Medicaid provider prior to delivery of any services.
(3) Section (2)(c) of this
rule does not apply to employees of individuals, legal or designated representatives,
employees of general business providers, or employees of provider organizations,
who were hired prior to July 28, 2009 that remain in the current position for which
the employee was hired.
(4) All providers must self-report
any potentially disqualifying condition as described in OAR 407-007-0280 and 407-007-0290.
The provider must notify the Department or the designee of the Department within
24 hours.
(5) Independent providers,
including personal support workers, are not employees of the state, CDDP, or Brokerage.
(6) BEHAVIOR CONSULTANTS.
Behavior consultants are not personal support workers. Behavior consultants may
include, but are not limited to, autism specialists, licensed psychologists, or
other behavioral specialists. Behavior consultants providing specialized supports
must:
(a) Have education, skills,
and abilities necessary to provide behavior support services as described in OAR
411-340-0130;
(b) Have received current
certification demonstrating completion of OIS training; and
(c) Submit a resume or the
equivalent to the brokerage indicating at least one of the following:
(A) A bachelor's degree in
special education, psychology, speech and communication, occupational therapy, recreation,
art or music therapy, or a behavioral science field, and at least one year of experience
with individuals who present difficult or dangerous behaviors; or
(B) Three years' experience
with individuals who present difficult or dangerous behaviors and at least one year
of that experience includes providing the services of a behavior consultant as described
in OAR 411-340-0130.
(7) NURSE. A nurse providing
community nursing services is not a personal support worker. The nurse must:
(a) Have a current Oregon
nursing license;
(b) Be enrolled in the Long
Term Care Community Nursing Program as described in OAR chapter 411, division 048;
and
(c) Submit a resume to the
brokerage indicating the education, skills, and abilities necessary to provide nursing
services in accordance with state law, including at least one year of experience
with individuals.
(8) DIETICIANS. Dieticians
providing special diets must be licensed according to ORS 691.415 through 691.465.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1900, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD
8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD
25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 2-2010(Temp), f.
& cert. ef. 3-18-10 thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10;
SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 26-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0170
Standards for Provider Organizations Paid
with Support Services Funds
(1) PROVIDER ORGANIZATIONS WITH CURRENT
LICENSE OR CERTIFICATION. A provider organization certified, licensed, and endorsed
under OAR chapter 411, division 325 for a 24-hour residential setting, or licensed
under OAR chapter 411, division 360 for an adult foster home, or certified and endorsed
under OAR chapter 411, division 345 for employment services or OAR chapter 411,
division 328 for a supported living setting, does not require additional certification
as an organization to provide relief care, attendant care, skills training, community
transportation, or behavior consultation.
(a) Current license, certification,
or endorsement is considered sufficient demonstration of ability to:
(A) Recruit, hire, supervise,
and train qualified staff;
(B) Provide services according
to ISPs; and
(C) Develop and implement
operating policies and procedures required for managing an organization and delivering
services, including provisions for safeguarding individuals receiving services.
(b) Provider organizations
must assure that all people directed by the provider organization as employees,
contractors, or volunteers to provide services paid for with support services funds
meet the standards for qualification of independent providers described in OAR 411-340-0160.
(c) Provider organizations
developing new sites, owned or leased by the provider organization, that are not
reviewed as a condition of the current license or certification and where individuals
are regularly present and receiving services purchased with support services funds,
must meet the conditions of section (2)(f) of this rule in each such site.
(2) PROVIDER ORGANIZATIONS
REQUIRING CERTIFICATION. A provider organization without a current license or certification
as described in section (1) of this rule must be certified as a provider organization
according to OAR 411-340-0030 prior to selection for providing the services listed
in OAR 411-340-0130 and paid for with support services funds.
(a) The provider organization
must develop and implement policies and procedures required for administration and
operation in compliance with these rules, including but not limited to:
(A) Policies and procedures
required in OAR 411-340-0040, 411-340-0050, 411-340-0070, 411-340-0080, and 411-340-0090
related to abuse and unusual incidents, inspections and investigations, personnel
policies and practices, records, and variances.
(B) Individual rights. The
provider organization must have, and implement, written policies and procedures
that protect the individual rights described in OAR 411-318-0010 and that:
(i) Provide for individual
participation in selection, training, and evaluation of staff assigned to provide
services to individuals;
(ii) Protect individuals
during hours of service from financial exploitation that may include, but is not
limited to:
(I) Staff borrowing from
or loaning money to individuals;
(II) Witnessing wills in
which the staff or provider organization is beneficiary; or
(III) Adding the name of
the staff member or provider organization to the bank account or other personal
property of the individual without approval of the individual or the legal representative
of the individual (as applicable).
(C) Complaints.
(i) Complaints must be addressed
in accordance with OAR 411-318-0015.
(ii) The provider organization
must have and implement written policies and procedures for individual complaints
in accordance with OAR 411-318-0015.
(iii) Upon entry and request
and annually thereafter, the policy and procedures for complaints must be explained
and provided to an individual and the legal or designated representative of the
individual.
(D) Policies and procedures
appropriate to scope of service including, but not limited to, those required to
meet minimum standards set forth in subsections (f) to (k) of this section and consistent
with written service agreements for individuals currently receiving services.
(b) The provider organization
must deliver services according to a written service agreement.
(c) The provider organization
must maintain a current record for each individual receiving services. The record
must include:
(A) The name, current home
address, and home phone number of the individual;
(B) A current written service
agreement signed and dated by the individual;
(C) Contact information for
the legal or designated representative of the individual (as applicable) and any
other people designated by the individual to be contacted in case of incident or
emergency;
(D) Contact information for
the brokerage assisting the individual to obtain services; and
(E) Records of service provided,
including type of services, dates, hours, and personnel involved.
(d) Staff, contractors, or
volunteers who provide services to individuals must meet independent provider qualifications
in OAR 411-340-0160. Additionally, those staff, contractors, or volunteers must
have current CPR and first aid certification obtained from a recognized training
agency prior to working alone with an individual.
(e) The provider organization
must ensure that employees, contractors, and volunteers receive appropriate and
necessary training.
(f) Provider organizations
that own or lease sites, provide services to individuals at those sites, and regularly
have individuals present and receiving services at those sites, must meet the following
minimum requirements:
(A) A written emergency plan
must be developed and implemented and must include instructions for staff and volunteers
in the event of fire, explosion, accident, or other emergency including evacuation
of individuals served.
(B) Posting of emergency
information:
(i) The telephone numbers
of the local fire, police department, and ambulance service, or "911" must be posted
by designated telephones; and
(ii) The telephone numbers
of the provider organization director and other people to be contacted in case of
emergency must be posted by designated telephones.
(C) A documented safety review
must be conducted quarterly to ensure that the service site is free of hazards.
Safety review reports must be kept in a central location by the provider organization
for three years.
(D) The provider organization
must train all individuals when the individuals begin attending the service site
to leave the site in response to an alarm or other emergency signal and to cooperate
with assistance to exit the site.
(i) Each provider organization
must conduct an unannounced evacuation drill each month when individuals are present.
(ii) Exit routes must vary
based on the location of a simulated fire.
(iii) Any individual failing
to evacuate the service site unassisted within the established time limits set by
the local fire authority for the site must be provided specialized training or support
in evacuation procedures.
(iv) Written documentation
must be made at the time of the drill and kept by the provider organization for
at least two years following the drill. The written documentation must include:
(I) The date and time of
the drill;
(II) The location of the
simulated fire;
(III) The last names of all
individuals and staff present at the time of the drill;
(IV) The amount of time required
by each individual to evacuate if the individual needs more than the established
time limit; and
(V) The signature of the
staff conducting the drill.
(v) In sites providing services
to individuals who are medically fragile or have severe physical limitations, requirements
of evacuation drill conduct may be modified. The modified plan must:
(I) Be developed with the
local fire authority, the individual or the individual's legal or designated representative
(as applicable), and the provider organization director; and
(II) Be submitted as a variance
request according to OAR 411-340-0090.
(E) The provider organization
must provide necessary adaptations to ensure fire safety for sensory and physically
impaired individuals.
(F) At least once every three
years, the provider organization must conduct a health and safety inspection.
(i) The inspection must cover
all areas and buildings where services are delivered to individuals, including administrative
offices and storage areas.
(ii) The inspection must
be performed by:
(I) The Oregon Occupational
Safety and Health Division;
(II) The provider organization's
worker's compensation insurance carrier; or
(III) An appropriate expert,
such as a licensed safety engineer or consultant as approved by the Department;
and
(IV) The Oregon Health Authority,
Public Health Division, when necessary.
(iii) The inspection must
cover:
(I) Hazardous material handling
and storage;
(II) Machinery and equipment
used at the service site;
(III) Safety equipment;
(IV) Physical environment;
and
(V) Food handling, when necessary.
(iv) The documented results
of the inspection, including recommended modifications or changes and documentation
of any resulting action taken, must be kept by the provider for five years.
(G) The provider organization
must ensure that each service site has received initial fire and life safety inspections
performed by the local fire authority or a Deputy State Fire Marshal. The documented
results of the inspection, including documentation of recommended modifications
or changes and documentation of any resulting action taken, must be kept by the
provider for five years.
(H) Direct service staff
must be present in sufficient number to meet health, safety, and service needs specified
in the individual written agreements of the individuals present. When individuals
are present, staff must have the following minimum skills and training:
(i) At least one staff member
on duty with CPR certification at all times;
(ii) At least one staff member
on duty with current First Aid certification at all times;
(iii) At least one staff
member on duty with training to meet other specific medical needs identified in
the individual service agreement; and
(iv) At least one staff member
on duty with training to meet other specific behavior intervention needs as identified
in individual service agreements.
(g) Provider organizations
providing services to individuals that involve assistance with meeting health and
medical needs must:
(A) Develop and implement
written policies and procedures addressing:
(i) Emergency medical intervention;
(ii) Treatment and documentation
of illness and health care concerns;
(iii) Administering, storing,
and disposing of prescription and non-prescription drugs, including self-administration;
(iv) Emergency medical procedures,
including the handling of bodily fluids; and
(v) Confidentiality of medical
records;
(B) Maintain a current written
record for each individual receiving assistance with meeting health and medical
needs that includes:
(i) Health status;
(ii) Changes in health status
observed during hours of service;
(iii) Any remedial and corrective
action required and when such actions were taken if occurring during hours of service;
and
(iv) A description of any
restrictions on activities due to medical limitations.
(C) If providing medication
administration when an individual is unable to self-administer medications and there
is no other responsible person present who may lawfully direct administration of
medications, the provider organization must:
(i) Have a written order
or copy of the written order, signed by a physician or physician designee, before
any medication, prescription or non-prescription, is administered;
(ii) Administer medications
per written orders;
(iii) Administer medications
from containers labeled as specified per physician written order;
(iv) Keep medications secure
and unavailable to any other individual and stored as prescribed;
(v) Record administration
on an individualized Medication Administration Record (MAR), including treatments
and PRN, or "as needed", orders;
(vi) Not administer unused,
discontinued, outdated, or recalled drugs; and
(vii) Not administer PRN
psychotropic medication. PRN orders may not be accepted for psychotropic medication.
(D) Maintain a MAR (if required).
The MAR must include:
(i) The name of the individual;
(ii) The brand name or generic
name of the medication, including the prescribed dosage and frequency of administration
as contained on physician order and medication;
(iii) Times and dates the
administration or self-administration of the medication occurs;
(iv) The signature of the
staff administering the medication or monitoring the self-administration of the
medication;
(v) Method of administration;
(vi) Documentation of any
known allergies or adverse reactions to a medication;
(vii) Documentation and an
explanation of why a PRN, or "as needed", medication was administered and the results
of such administration; and
(viii) An explanation of
any medication administration irregularity with documentation of a review by the
provider organization director.
(E) Provide safeguards to
prevent adverse medication reactions, including:
(i) Maintaining information
about the effects and side-effects of medications the provider organization has
agreed to administer;
(ii) Communicating any concerns
regarding any medication usage, effectiveness, or effects to the individual or the
individual's legal or designated representative (as applicable); and
(iii) Prohibiting the use
of one individual's medications by another individual or person.
(F) Maintain a record of
visits to medical professionals, consultants, or therapists if facilitated or provided
by the provider organization.
(h) Provider organizations
that own or operate vehicles that transport individuals must:
(A) Maintain the vehicles
in safe operating condition;
(B) Comply with Department
of Motor Vehicles laws;
(C) Maintain insurance coverage
on the vehicles and all authorized drivers;
(D) Carry a first aid kit
in each vehicle; and
(E) Assign drivers who meet
applicable Department of Motor Vehicles requirements to operate vehicles that transport
individuals.
(i) If assisting with management
of funds, the provider organization must have and implement written policies and
procedures related to the oversight of the individual's financial resources that
include:
(A) Procedures that prohibit
inappropriately expending an individual's personal funds, theft of an individual's
personal funds, using an individual's funds for staff's own benefit, commingling
an individual's personal funds with the provider organization's or another individual's
funds, or the provider organization becoming an individual's legal or designated
representative; and
(B) The provider organization's
reimbursement to the individual of any funds that are missing due to theft or mismanagement
on the part of any staff of the provider organization, or of any funds within the
custody of the provider organization that are missing. Such reimbursement must be
made within 10 business days of the verification that funds are missing.
(j) Additional standards
for assisting individuals to manage difficult behavior.
(A) The provider organization
must have, and implement, a written policy concerning behavior intervention procedures.
The provider organization must inform the individual, and as applicable the individual's
legal or designated representative, of the behavior intervention policy and procedures
prior to finalizing the individual's written service agreement.
(B) Any intervention to alter
an individual's behavior must be based on positive behavioral theory and practice
and must be:
(i) Approved in writing by
the individual or the individual's legal or designated representative (as applicable);
and
(ii) Described in detail
in the individual's record.
(C) Psychotropic medications
and medications for behavior must be:
(i) Prescribed by a physician
through a written order; and
(ii) Monitored by the prescribing
physician for desired responses and adverse consequences.
(k) Additional standards
for supports that involve protective physical intervention.
(A) The provider organization
must only employ protective physical intervention:
(i) As part of an individual's
ISP;
(ii) As an emergency measure,
but only if absolutely necessary to protect the individual or others from immediate
injury; or
(iii) As a health-related
protection prescribed by a physician, but only if necessary for individual protection
during the time that a medical condition exists.
(B) Provider organization
staff members who need to apply protective physical intervention under an individual's
service agreement must be trained by a Department-approved trainer and documentation
of the training must be maintained in the staff members' personnel file.
(C) Protective physical intervention
in emergency situations must:
(i) Be only used until the
individual is no longer a threat to self or others;
(ii) Be authorized by the
provider organization director or the physician of the individual within one hour
of application of the protective physical intervention;
(iii) Result in the immediate
notification of the individual's legal or designated representative (as applicable);
and
(iv) Prompt a review of the
individual's written service agreement, initiated by the provider organization,
if protective physical intervention is used more than three times in a six month
period.
(D) Protective physical intervention
must be designed to avoid physical injury to an individual or others and to minimize
physical and psychological discomfort.
(E) All use of protective
physical intervention must be documented and reported according to procedures described
in OAR 411-340-0040. The report must include:
(i) The name of the individual
to whom the protective physical intervention is applied;
(ii) The date, type, and
length of time of the application of protective physical intervention;
(iii) The name and position
of the person authorizing the use of the protective physical intervention;
(iv) The name of the staff
member applying the protective physical intervention; and
(v) Description of the incident.
(l) Additional standards
for supports that involve employment services are found in OAR 411-345-0160.
(3) CERTIFICATE ADMINISTRATIVE
SANCTION. An administrative sanction may be imposed for non-compliance with these
rules. An administrative sanction includes one or more of the following actions:
(a) Conditions;
(b) Denial, revocation, or
refusal to renew a certificate; or
(c) Immediate suspension
of a certificate.
(4) CERTIFICATE CONDITIONS.
(a) The Department may attach
conditions to a certificate that limit, restrict, or specify other criteria for
operation of the provider organization. The type of condition attached to a certificate
must directly relate to the risk of harm or potential risk of harm to individuals.
(b) The Department may attach
a condition to a certificate upon a finding that:
(A) Information on the application
or initial inspection requires a condition to protect the health, safety, or welfare
of individuals;
(B) A threat to the health,
safety, or welfare of an individual exists;
(C) There is reliable evidence
of abuse, neglect, or exploitation; or
(D) The provider organization
is not being operated in compliance with these rules.
(c) Conditions that the Department
may impose on a certificate include, but are not limited to:
(A) Restricting the total
number of individuals to whom a provider organization may provide services;
(B) Restricting the total
number of individuals to whom a provider organization may provide services based
upon the capability and capacity of the provider organization and staff to meet
the health and safety needs of all individuals;
(C) Restricting the type
of support and services the provider organization may provide to individuals based
upon the capability and capacity of the provider organization and staff to meet
the health and safety needs of all individuals;
(D) Requiring additional
staff or staff qualifications;
(E) Requiring additional
training;
(F) Restricting the provider
organization from allowing a person on the premises who may be a threat to the health,
safety, or welfare of an individual;
(G) Requiring additional
documentation; or
(H) Restricting admissions.
(d) NOTICE OF CERTIFICATE
CONDITIONS. The Department issues a written notice to the provider organization
when the Department imposes conditions on the certificate of the provider organization.
The written notice of certificate conditions includes the conditions imposed by
the Department, the reason for the conditions, and the opportunity to request a
hearing under ORS chapter 183. Conditions take effect immediately upon issuance
of the written notice of certificate conditions or at a later date as indicated
on the notice and are a Final Order of the Department unless later rescinded through
the hearing process. The conditions imposed remain in effect until the Department
has sufficient cause to believe the situation that warranted the condition has been
remedied.
(e) HEARING. The provider
organization may request a hearing in accordance with ORS Chapter 183 and this rule
upon receipt of written notice of certificate conditions. The request for a hearing
must be in writing.
(A) The provider organization
must request a hearing within 21 days of receipt of the written notice of certificate
conditions.
(B) In addition to, or in-lieu
of a hearing, a provider organization may request an administrative review as described
in section (7) of this rule. The administrative review does not diminish a provider
organization's right to a hearing.
(f) The provider organization
may send a written request to the Department to remove a condition if the provider
organization believes the situation that warranted the condition has been remedied.
(5) CERTIFICATE DENIAL, REFUSAL
TO RENEW, OR REVOCATION.
(a) The Department may deny,
refuse to renew, or revoke a certificate when the Department finds the provider
organization, or any person holding 5 percent or greater ownership interest in the
provider organization:
(A) Demonstrates substantial
failure to comply with these rules or the corresponding program rules such that
the health, safety, or welfare of individuals is jeopardized and the provider organization
fails to correct the non-compliance within 30 days from the receipt of written notice
of non-compliance;
(B) Has demonstrated a substantial
failure to comply with these rules or the corresponding program rules such that
the health, safety, or welfare of individuals is jeopardized;
(C) Has been convicted of
any crime that would have resulted in an unacceptable background check upon hiring
or authorization of services;
(D) Has been convicted of
a misdemeanor associated with the operation of a provider organization or services;
(E) Falsifies information
required by the Department to be maintained or submitted regarding individual services,
provider organization finances, or funds belonging to the individuals;
(F) Has been found to have
permitted, aided, or abetted any illegal act that has had significant adverse impact
on individual health, safety, or welfare; or
(G) Has been placed on the
current Centers for Medicare and Medicaid Services list of excluded or debarred
providers maintained by the Office of the Inspector General.
(b) NOTICE OF CERTIFICATE
DENIAL, REVOCATION, OR REFUSAL TO RENEW. The Department may issue a notice of denial,
refusal to renew, or revocation of a certificate following a Department finding
that there is a substantial failure to comply with these rules or the corresponding
program rules such that the health, safety, or welfare of individuals is jeopardized,
or that one or more of the events listed in subsection (a) of this section has occurred.
(c) HEARING. An applicant
for a certificate or a certified provider organization, as applicable, may request
a hearing in accordance with ORS chapter 183, this rule, and ORS 443.440 for a 24-hour
residential setting, upon written notice from the Department of denial, refusal
to renew, or revocation of the certificate. The request for a hearing must be in
writing.
(A) DENIAL. The applicant
must request a hearing within 60 days from the receipt of the written notice of
denial.
(B) REFUSAL TO RENEW. The
provider organization must request a hearing within 60 days from the receipt of
the written notice of refusal to renew.
(C) REVOCATION. The provider
organization must request a hearing within 21 days from the receipt of the written
notice of revocation.
(i) In addition to, or in-lieu
of a hearing, the provider organization may request an administrative review as
described in section (7) of this rule.
(ii)The administrative review
does not diminish the right of the provider organization to a hearing.
(6) IMMEDIATE SUSPENSION
OF CERTIFICATE.
(a) When the Department finds
a serious and immediate threat to individual health and safety and sets forth the
specific reasons for such findings, the Department may, by written notice to the
provider organization, immediately suspend a certificate without a pre-suspension
hearing and the provider organization may not continue operating.
(b) HEARING. The provider
organization may request a hearing in accordance with ORS chapter 183 and this rule
upon written notice from the Department of the immediate suspension of the certificate.
The request for a hearing must be in writing.
(A) The provider organization
must request a hearing within 21 days from the receipt of the written notice of
suspension.
(B) In addition to, or in-lieu
of a hearing, the provider organization may request an administrative review as
described in section (7) of this rule. The request for an administrative review
must be in writing. The administrative review does not diminish right of the provider
organization to a hearing.
(7) ADMINISTRATIVE REVIEW.
(a) The provider organization,
in addition to the right to a hearing, may request an administrative review. The
request for an administrative review must be in writing.
(b) The Department must receive
a written request for an administrative review within 10 business days from the
receipt of the notice of suspension, revocation, or imposition of conditions. The
provider organization may submit, along with the written request for an administrative
review, any additional written materials the provider organization wishes to have
considered during the administrative review.
(c) The determination of
the administrative review is issued in writing within 10 business days from the
receipt of the written request for an administrative review, or by a later date
as agreed to by the provider organization.
(d) The provider organization
may request a hearing if the decision of the Department is to affirm the suspension,
revocation, or condition. The request for a hearing must be in writing. The Department
must receive the written request for a hearing within 21 days from the receipt of
the original written notice of suspension, revocation, or imposition of conditions.
(8) INFORMAL CONFERENCE.
Unless an administrative review has been completed as described in section (7) of
this rule, a provider organization requesting a hearing may have an informal conference
with the Department.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1910,
SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05;
SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert.
ef. 1-1-08 thru 6-29-08; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009,
f. & cert. ef. 7-1-09; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13; APD 26-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 44-2014, f. 12-26-14, cert. ef. 12-28-14
411-340-0180
Standards for General Business Providers
Paid with Support Services Funds
(1) General business providers providing
services to individuals and paid with support services funds must hold any current
license appropriate to function required by the state of Oregon or federal law or
regulation, including but not limited to:
(a) For a home health agency,
a license under ORS 443.015;
(b) For an in-home care agency,
a license under ORS 443.315;
(c) For providers of environmental
modifications involving building modifications or new construction, a current license
and bond as a building contractor as required by either OAR chapter 812 (Construction
Contractor's Board) or OAR chapter 808 (Landscape Contractors Board);
(d) For environmental accessibility
consultants, a current license as a general contractor as required by OAR chapter
812, including experience evaluating homes, assessing the needs of an individual,
and developing cost-effective plans to make homes safe and accessible;
(e) For public transportation
providers, the established standards;
(f) For private transportation
providers, a business license and drivers licensed to drive in Oregon;
(g) For vendors and medical
supply companies assistive devices or specialized medical supplies, a current retail
business license, including enrollment as Medicaid providers through the Division
of Medical Assistance Programs if vending medical equipment;
(h) A current business license
for providers of personal emergency response systems; and
(i) Retail business licenses
for vendors and supply companies providing special diets.
(2) Services provided and
paid for with support services funds must be limited to the services within the
scope of the license of the general business provider.
Stat. Auth.: ORS 409.050, 427.402 &
430.662
Stats. Implemented: ORS 427.005,
427.007, 427.400–427.410, 430.610, 430.620 & 430.662–430.695
Hist.: MHD 9-2001(Temp),
f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02;
Renumbered from 309-041-1920, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD
17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08;
SPD 8-2009, f. & cert. ef. 7-1-09; SPD 50-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 44-2014, f. 12-26-14, cert. ef. 12-28-14

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