The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

DIVISION 308

IN-HOME SUPPORT FOR CHILDREN WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES
411-308-0010
Statement of Purpose
(1) The rules in OAR chapter 411, division
308 prescribe standards, responsibilities, and procedures for Community Developmental
Disability Programs to partner with families and community partners in identifying
and providing in-home support for children with intellectual or developmental disabilities.
Supports are intended to maximize the independence of a child and engagement in
a life that is fully integrated into the community. Supports are designed to increase
the ability of a family to care for a child with an intellectual or developmental
disability in the family home.
(2) In-home supports are
also designed to prevent out-of-home placement or to return a child with an intellectual
or developmental disability back to the family home from a residential setting other
than the family home.
Stat. Auth.: ORS 409.050,430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 54-2013, f. 12-27-13,
cert. ef. 12-28-13; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015, f.
& cert. ef. 1-29-15
411-308-0020
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 308:
(1) "Abuse" means "abuse"
of a child as defined in ORS 419B.005.
(2) "ADL" means "activities
of daily living". ADL are basic personal everyday activities, such as eating, using
the restroom, grooming, dressing, bathing, and transferring.
(3) "Administrator Review"
means the Director of the Department reviews a decision upon request, including
the documentation related to the decision, and issues a determination.
(4) "Alternative Resources"
mean possible resources for the provision of supports to meet the needs of a child.
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.
(5) "Annual Plan" means the
written summary a services coordinator completes for a child 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.
(6) "Assistive Devices" mean
the devices, aids, controls, supplies, or appliances described in OAR 411-308-0120
that are necessary to enable a child to increase the ability of the child to perform
ADL and IADLs or to perceive, control, or communicate with the home and community
environment in which the child lives.
(7) "Assistive Technology"
means the devices, aids, controls, supplies, or appliances described in OAR 411-308-0120
that are purchased to provide support for a child and replace the need for direct
interventions to enable self-direction of care and maximize independence of the
child.
(8) "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 411-308-0120.
(9) "Background Check" means
a criminal records check and abuse check as defined in OAR 407-007-0210.
(10) "Behavior Consultant"
means a contractor with specialized skills as described in OAR 411-308-0130 who
conducts functional assessments and develops a Behavior Support Plan.
(11) "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 a
child and to modify the behavior of the primary caregiver or provider, adjust environment,
and teach new skills.
(12) "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 a child that prevents the child from accomplishing ADL, IADL, health-related
tasks, and provides cognitive supports to mitigate behavior. Behavior support services
are provided in the home or community.
(13) "CDDP" means "Community
Developmental Disability Program" as defined in OAR 411-320-0020.
(14) "Child" means an individual
who is less than 18 years of age that has a provisional determination of an intellectual
or developmental disability.
(15) "Children's Intensive
In-Home Services" mean the services described in:
(a) OAR chapter 411, division
300, Children's Intensive In-Home Services, Behavior Program;
(b) OAR chapter 411, division
350, Medically Fragile Children Services; or
(c) OAR chapter 411, division
355, Medically Involved Children's Program.
(16) "Chore Services" mean
the services described in OAR 411-308-0120 that are needed to restore a hazardous
or unsanitary situation in the family home to a clean, sanitary, and safe environment.
(17) "Community Nursing Services"
mean the nursing services described in OAR 411-308-0120 that focus on the chronic
and ongoing health and safety needs of a child living in the family 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.
(18) "Community Transportation"
means the services described in OAR 411-308-0120 that enable a child 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 family home that is commonly used by people in the same area to obtain ordinary
goods and services.
(19) "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 a
child. 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.
(20) "CPMS" means the "Client
Processing Monitoring System". CPMS is the Department computerized system for enrolling
and terminating services for individuals with intellectual or developmental disabilities.
(21) "Crisis" means "crisis"
as defined in OAR 411-320-0020.
(22) "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 047.
(23) "Department" means the
Department of Human Services.
(24) "Designated Representative"
means any adult, such as a family member, guardian, advocate, or other person, who
is chosen by the parent or guardian, not a paid provider of ODDS funded services,
and authorized by the parent or guardian to serve as the representative of the parent
or guardian in connection with the provision of ODDS funded supports. A parent or
guardian is not required to appoint a designated representative.
(25) "Developmental Disability"
means "developmental disability" as defined in OAR 411-320-0020 and described in
OAR 411-320-0080.
(26) "Director" means the
Director of the Department of Human Services, Office of Developmental Disability
Services, or the designee of the Director.
(27) "Employer" means, for
the purposes of obtaining in-home support through a personal support worker as described
in these rules, the parent or guardian or a person selected by the parent or guardian
to act on the behalf of the parent or guardian to conduct the employer responsibilities
described in OAR 411-308-0135. An employer may also be a designated representative.
(28) "Employer-Related Supports"
mean the activities that assist a family with directing and supervising provision
of services described in the ISP for a child. 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.
(29) "Employment Path Services"
means "employment path services" as defined in OAR 411-345-0020.
(30) "Employment Services"
means "employment services" as defined in OAR 411-345-0020.
(31) "Employment Specialist"
means "employment specialist" as defined in OAR 411-345-0020.
(32) "Entry" means admission
to a Department-funded developmental disability service.
(33) "Environmental Modifications"
mean the physical adaptations described in OAR 411-308-0120 that are necessary to
ensure the health, welfare, and safety of a child in the family home, or that are
necessary to enable the child to function with greater independence around the family
home or lead to a substitution for, or decrease in, direct human assistance to the
extent expenditures would otherwise be made for human assistance.
(34) "Environmental Safety
Modifications" mean the physical adaptations described in OAR 411-308-0120 that
are made to the exterior of a family home as identified in the ISP for a child to
ensure the health, welfare, and safety of the child or to enable the child to function
with greater independence around the family home or lead to a substitution for,
or decrease in, direct human assistance to the extent expenditures would otherwise
be made for human assistance.
(35) "Exit" means termination
or discontinuance of in-home support.
(36) "Family":
(a) Means a unit of two or
more people that includes at least one child with an intellectual or developmental
disability where the primary caregiver is:
(A) Related to the child
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 a child with an intellectual or developmental disability when the
child 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 a child for in-home supports 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.
(37) "Family Home" means
the primary residence for a child that is not under contract with the Department
to provide services as a certified foster home for children with intellectual or
developmental disabilities or a licensed or certified residential care facility,
assisted living facility, nursing facility, or other residential setting. A family
home may include a foster home funded by Child Welfare.
(38) "Family Training" means
the training services described in OAR 411-308-0120 that are provided to a family
to increase the capacity of the family to care for, support, and maintain a child
in the family home.
(39) "Fiscal Intermediary"
means a person or entity that receives and distributes IHS funds on behalf of an
employer.
(40) "Functional Needs Assessment":
(a) Means the comprehensive
assessment or reassessment 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 a child is known as the Child Needs Assessment (CNA). Effective December
31, 2014, the Department incorporates Version C of the CNA into these rules by this
reference. The CNA is maintained by the Department at: http://www.dhs.state.or.us/spd/tools/dd/CNAchildInhome.xls.
Printed copies of a blank CNA may be obtained by calling (503) 945-6398 or writing
the Department of Human Services, ATTN: Rules Coordinator, 500 Summer Street NE,
E-48, Salem, OR 97301.
(41) "General Business Provider"
means an organization or entity selected by a parent or guardian and paid with IHS
funds that:
(a) Is primarily in business
to provide the service chosen by the parent or guardian to the general public;
(b) Provides services for
the child through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
child.
(42) "Guardian" means the
parent of a minor child or a person or agency appointed and authorized by a court
to make decisions about services for a child.
(43) "IADL" means "instrumental
activities of daily living". IADL include activities other than ADL required to
enable a child to be independent in the family home and community, 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.
(44) "ICF/ID" means an intermediate
care facility for individuals with intellectual disabilities.
(45) "IHS Funds" means "in-home
support funds". IHS funds are public funds contracted by the Department to the CDDP
and managed by the CDDP to assist a family with the identification and selection
of supports for a child according to an ISP or Annual Plan.
(46) "In-Home Expenditure
Guidelines" mean the guidelines published by the Department that describe allowable
uses for IHS 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.
Printed copies may be obtained by calling (503) 945-6398 or writing the Department
of Human Services, ATTN: Rules Coordinator, 500 Summer Street NE, E-48, Salem, Oregon
97301.
(47) "In-Home Support" means
individualized planning and service coordination, arranging for services to be provided
in accordance with an ISP or Annual Plan, and purchase of supports that are not
available through other resources that are required for a child with an intellectual
or developmental disability who is eligible for in-home support services to live
in the family home. In-home supports are designed to:
(a) Support a child to be
independent and to be engaged in a life that is fully integrated in the community.
(b) Prevent unwanted out-of-home
placement and maintain family unity; and
(c) Whenever possible, reunite
a family with a child who has been placed out of the family home.
(48) "Incident Report" means
the written report of any injury, accident, act of physical aggression, use of protective
physical intervention, or unusual incident involving a child.
(49) "Independent Provider"
means a person selected by a parent or guardian and paid with IHS funds to directly
provide services to a child.
(50) "Individual" means a
child or an adult with an intellectual or developmental disability applying for,
or determined eligible for, Department-funded services.
(51) "Intellectual Disability"
means "intellectual disability" as defined in OAR 411-320-0020 and described in
OAR 411-320-0080.
(52) "ISP" means "Individual
Support Plan". An ISP includes the written details of the supports, activities,
and resources required for a child to achieve and maintain personal goals and 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. The
ISP reflects services and supports that are important to meet the needs of the child
identified through a functional needs assessment as well as the preferences 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, the Community First Choice state plan, natural supports, or alternative
resources.
(53) "Job Development" means
"job development" as defined in OAR 411-345-0020.
(54) "Natural Supports" mean
the parental responsibilities for a child who is less than 18 years of age and the
voluntary resources available to the child from relatives, friends, neighbors, and
the community that are not paid for by the Department.
(55) "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 a child and identifies the diagnoses and health needs of the child
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.
(56) "ODDS" means the Department
of Human Services, Office of Developmental Disability Services.
(57) "OHP" means the Oregon
Health Plan.
(58) "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.
(59) "OIS" means "Oregon
Intervention System". OIS is the system of providing training of elements of positive
behavior support and non-aversive behavior intervention. OIS uses principles of
pro-active support and describes approved protective physical intervention techniques
that are used to maintain health and safety.
(60) "OSIPM" means "Oregon
Supplemental Income Program-Medical" as described in OAR 461-001-0030. OSIPM is
Oregon Medicaid insurance coverage for children who meet the eligibility criteria
described in OAR chapter 461.
(61) "Parent" means the biological
parent, adoptive parent, or stepparent of a child. Unless otherwise specified, references
to parent also include a person chosen by the parent or guardian to serve as the
designated representative of the parent or guardian in connection with the provision
of ODDS funded supports.
(62) "Person-Centered Planning":
(a) Means a timely and formal
or informal process driven by a child, includes people chosen by the child, ensures
the child directs the process to the maximum extent possible, and the child 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 child 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 child.
(63) "Personal Support Worker"
means "personal support worker" as defined in OAR 411-375-0010.
(64) "Plan Year" means 12
consecutive months from the start date specified on an authorized ISP or Annual
Plan.
(65) "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.
(66) "Primary Caregiver"
means the parent, guardian, relative, or other non-paid parental figure of a child
that provides direct care at the times that a paid provider is not available. In
this context, the term parent or guardian may include a designated representative.
(67) "Protective Physical
Intervention" means any manual physical holding of, or contact with, a child that
restricts freedom of movement.
(68) "Provider" means a person,
agency, organization, or business selected by a parent or guardian that provides
recognized Department-funded services and is approved by the Department or other
appropriate agency to provide Department-funded services.
(69) "Provider Organization"
means an entity licensed or certified by the Department that is selected by a parent
or guardian and paid with IHS funds that:
(a) Is primarily in business
to provide supports for children with intellectual or developmental disabilities;
(b) Provides supports for
a child through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
child.
(70) "Quality Assurance"
means a systematic procedure for assessing the effectiveness, efficiency, and appropriateness
of services.
(71) "Regional Process" means
a standardized set of procedures through which the needs of a child and funding
to implement supports are reviewed for approval. The regional process includes review
of the potential risk of out-of-home placement, the appropriateness of the proposed
supports, and cost effectiveness of the Annual Plan for the child. A child who meets
the general fund eligibility under OAR 411-308-0060 may be granted access to in-home
supports through the regional process.
(72) "Relief Care" means
the intermittent services described in OAR 411-308-0120 that are provided on a periodic
basis for the relief of, or due to the temporary absence of, a primary caregiver.
(73) "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 an ISP and relating to the
ADL, IADL, and health-related tasks of a child as discussed by the parent or guardian,
services coordinator, and ISP team.
(74) "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 a child is unable to provide for the their own safety and the child
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.
(75) "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 a child.
(76) "Skills Training" means
the activities described in OAR 411-308-0120 that are intended to maximize the independence
of a child through training, coaching, and prompting the child to accomplish ADL,
IADL, and health-related skills.
(77) "Social Benefit" means
the service or financial assistance solely intended to assist a child with an intellectual
or developmental disability to function in society on a level comparable to that
of a child who does not have an intellectual or developmental disability. Social
benefits are pre-authorized by a services coordinator 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 child regardless of intellectual or developmental
disability;
(B) Replace normal parental
responsibilities for the services, education, recreation, and general supervision
of a child;
(C) Provide financial assistance
with food, clothing, shelter, and laundry needs common to a child with or without
an intellectual or developmental disability; or
(D) Replace other governmental
or community services available to a child.
(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 a child
to be supported in the family home.
(78) "Specialized Medical
Supplies" mean the medical and ancillary supplies described in OAR 411-308-0120,
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.
(79) "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.
(80) "Supplant" means take
the place of.
(81) "Support" means the
assistance that a child and a family requires, solely because of the effects of
an intellectual or developmental disability of the child, to maintain or increase
the age-appropriate independence of the child, achieve age-appropriate community
presence and participation of the child, and to maintain the child in the family
home. Support is subject to change with time and circumstances.
(82) "Supported Employment
- Individual Employment Support" means "supported employment - individual employment
support" as defined in OAR 411-345-0020.
(83) "Supported Employment
- Small Group Employment Support" means "supported employment - small group employment
support" as defined in OAR 411-345-0020.
(84) "Support Services Brokerage"
means "Brokerage" as defined in OAR 411-340-0020.
(85) "These Rules" mean the
rules in OAR chapter 411, division 308.
(86) "Transition Costs" mean
the expenses described in OAR 411-308-0120 required for a child to make the transition
to the family home from a nursing facility or ICF/ID.
(87) "Unacceptable Background
Check" means an administrative process that produces information related to the
background of a person that precludes the person from being an independent provider
for one or more of the following reasons:
(a) Under OAR 407-007-0275,
the person applying to be an independent provider has been found ineligible due
to ORS 443.004;
(b) Under OAR 407-007-0275,
the person was enrolled as an independent provider for the first time, or after
any break in enrollment, after July 28, 2009 and has been found ineligible due to
ORS 443.004; or
(c) A background check and
fitness determination has been conducted resulting in a "denied" status as defined
in OAR 407-007-0210.
(88) "Unusual Incident" means
any incident involving a child 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.
(89) "Variance" means the
temporary exception from a regulation or provision of these rules that may be granted
by the Department as described in OAR 411-308-0150.
(90) "Vehicle Modifications"
mean the adaptations or alterations described in OAR 411-308-0120 that are made
to the vehicle that is the primary means of transportation for a child in order
to accommodate the service needs of the child.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD
20-2011, f. & cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13
thru 12-28-13; SPD 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14;
APD 2-2015, f. & cert. ef. 1-29-15
411-308-0030
In-Home Support Administration and Operation
(1) FISCAL INTERMEDIARY SERVICES. The
CDDP must provide, or arrange a third party to provide, fiscal intermediary services.
The fiscal intermediary receives and distributes IHS funds on behalf of a family.
The responsibilities of the fiscal intermediary include payments to vendors as well
as all activities and records related to payroll and payment of employer-related
taxes and fees as an agent of the family who employs a person to provide services,
supervision, or training in the family home or community. In this capacity, the
fiscal intermediary may not recruit, hire, supervise, evaluate, dismiss, or otherwise
discipline employees.
(2) GENERAL RECORD REQUIREMENTS.
(a) DISCLOSURE. For the purpose
of disclosure from medical records under these rules, a CDDP is considered a "public
provider" as defined in ORS 179.505 and ORS 179.505 is applicable.
(A) Access to records by
the Department does not require authorization by the family.
(B) For the purposes of disclosure
from non-medical records, all or portions of the information contained in the non-medical
record may be exempt from public inspection under the personal privacy information
exemption to the public records law set forth in ORS 192.502(2).
(b) SERVICE RECORDS. Records
for children who receive in-home support must be kept up-to-date and must include:
(A) An easily accessed summary
of basic information as described in OAR 411-320-0070, including the date of entry
into in-home support;
(B) Records related to receipt
and disbursement of IHS funds, including expenditure authorizations, expenditure
verification, copies of CPMS expenditure reports, verification that providers meet
requirements of OAR 411-308-0130, and documentation of the acceptance or delegation
from the family of the record keeping responsibilities outlined in these rules.
Records must include:
(i) Itemized invoices and
receipts to record the purchase of any single item;
(ii) Signed contracts and
itemized invoices for any services purchased from independent contractors and professionals;
(iii) Written professional
support plans, assessments, and reviews to document the acceptable provision of
behavior support, nursing, and other professional training and consultation services;
and
(iv) Pay records to record
employee services, including timesheets signed by both employee and employer.
(C) Incident reports, including
those involving CDDP staff;
(D) A functional needs assessment
and other assessments used to determine required supports, preferences, and resources;
(E) When a child is not Medicaid
Title XIX eligible, documentation of general fund eligibility;
(F) ISP or Annual Plan and
reviews;
(G) Correspondence and notes
from the services coordinator related to plan development and outcomes; and
(H) Family satisfaction information.
(3) RIGHTS OF A CHILD.
(a) The rights of a child
are described in OAR 411-318-0010.
(b) The individual rights
described in OAR 411-318-0010 must be provided as described in OAR 411-320-0060.
(4) COMPLAINTS.
(a) Complaints must be addressed
in accordance with OAR 411-318-0015.
(b) The policy and procedures
for complaints must be explained and provided as described in OAR 411-320-0175.
(5) NOTIFICATION OF PLANNED
ACTION. In the event 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.
(6) HEARINGS.
(a) Hearings must be addressed
in accordance with ORS chapter 183 and OAR 411-318-0025.
(b) A parent or guardian
may request a hearing as provided in ORS chapter 183 and OAR 411-318-0025.
(c) A notice of hearing rights
and the policy and procedures for hearings as described in OAR chapter 411, division
318 must be explained and provided as described in OAR 411-320-0175.
(7) OTHER OPERATING POLICIES
AND PROCEDURES. The CDDP 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 CDDP to accomplish the objectives of the CDDP and to meet
the requirements of these rules and other applicable standards and rules.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0040
Required In-Home Support
(1) The CDDP must provide or arrange
for the following services as required to meet the support needs of children receiving
in-home support in the family home:
(a) SERVICE COORDINATION.
(A) Assistance for families
to determine needs, plan supports in response to needs, and develop individualized
plans based on available natural supports and alternative resources;
(B) Assistance for families
to find and arrange the resources to provide planned supports;
(C) Assistance for families
and children (as appropriate) to effectively put an ISP or Annual Plan into practice,
including help to monitor and improve the quality of personal supports and to assess
and revise the goals of the ISP or Annual Plan; and
(D) Assistance to families
to access information, referral, and local capacity building services through the
family support program under OAR chapter 411, division 305.
(b) EMPLOYER-RELATED SUPPORTS.
(A) Fiscal intermediary services
in the receipt and accounting of IHS funds on behalf of families in addition to
making payment with the authorization of the family; and
(B) Assistance for families
to fulfill roles and obligations as employers when providers are paid with IHS funds.
(2) The CDDP must inform
families about in-home support when a child is determined eligible for developmental
disability services. The CDDP must provide accurate, up-to-date information that
must include:
(a) The criteria for entry
and for determining supports, including information about eligibility for in-home
supports and how these supports are different from family support services provided
under OAR chapter 411, division 305;
(b) An overview of common
processes encountered in using in-home support, including the in-home support planning
process and the regional process (as applicable);
(c) The responsibility of
providers of in-home support and CDDP employees as mandatory reporters of child
abuse;
(d) A description of the
responsibilities of the family in regards to the use of public funds;
(e) An explanation of the
rights of the family to select and direct providers from among those qualified according
to OAR 411-308-0130 to provide services authorized through an ISP or Annual Plan
and purchased with IHS funds; and
(f) Information on complaint
and hearing rights and how to raise and resolve concerns about in-home supports.
(3) The CDDP must make the
information required in sections (1) and (2) of this rule available using language,
format, and presentation methods appropriate for effective communication according
to the needs and abilities of each family.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015, f. & cert. ef. 1-29-15
411-308-0050
Financial Limits of In-Home Support
(1) The use of IHS funds to purchase
supports is limited to:
(a) The service level for
a child as determined by a functional needs assessment. The functional needs assessment
determines the total number of hours needed to meet the identified needs of the
child. The total number of hours may not be exceeded without prior approval from
the Department. The types of services that contribute to the total number of hours
used include;
(A) Attendant care;
(B) Hourly relief care;
(C) Skills training; and
(D) State plan personal care
service hours as described in OAR chapter 411, division 034.
(b) Other services and supports
determined by a services coordinator 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.
(2) For a child who is not
Medicaid Title XIX eligible:
(a) Support must be limited
to:
(A) The amount of support
determined to be necessary to prevent out-of-home placement that is specified in
an Annual Plan and does not exceed the maximum allowable monthly plan amount published
in the In-home Expenditure Guidelines in any month during the plan year; and
(B) The amount of time necessary
for a child to transition into waiver or Community First Choice state plan services,
if eligible.
(b) Payment rates used to
establish the limits of financial assistance for a specific service in an Annual
Plan must be based on the In-home Expenditure Guidelines.
Stat. Auth.: ORS 409.050 & 430.620
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662-670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD 20-2011, f. &
cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0060
Eligibility for In-Home Support
(1) STANDARD ELIGIBILITY.
(a) In order to be eligible
for in-home support, a child must:
(A) Be under the age of 18;
(B) Be receiving Medicaid
Title XIX benefits under OSIPM or OHP Plus. This does not include CHIP Title XXI
benefits;
(C) For a child with excess
income, contribute to the cost of services pursuant to OAR 461-160-0610 and 461-160-0620;
(D) Be determined eligible
for developmental disability services by the CDDP of the county of origin as described
in OAR 411-320-0080;
(E) Meet the level of care
as defined in OAR 411-320-0020;
(F) Reside in the family
home; and
(G) Be safely served in the
family home.
(b) TRANSFER OF ASSETS.
(A) As of October 1, 2014,
a child 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 child 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 a child retains a life estate evaluated according to OAR 461-145-0310;
(iii) A loan evaluated according
to OAR 461-145-0330; or
(iv) An irrevocable trust
evaluated according to OAR 461-145-0540;
(B) When a child is considered
ineligible due to a disqualifying transfer of assets, the parent or guardian and
child must receive a notice meeting the requirements of OAR 461-175-0310 in the
same manner as if the child was requesting services under OSIPM.
(2) GENERAL FUND ELIGIBILITY.
When the standard eligibility criterion described in section (1)(a)(B) of this rule
is not met, the CDDP of the county of origin may find a child eligible for in-home
support when the child:
(a) Is experiencing a crisis
and may be safely served in the family home;
(b) Has exhausted all appropriate
alternative resources including, but not limited to, natural supports and family
support as defined in OAR 411-305-0020;
(c) Does not receive or may
stop receiving other Department-paid in-home or community living services other
than Medicaid state plan personal care services, adoption assistance, or short-term
crisis diversion services as described in 411-320-0160 to prevent out-of-home placement;
and
(d) Is at risk of out-of-home
placement and requires in-home support to be maintained in the family home; or
(e) Resides in a Department-paid
residential setting and requires in-home support to return to the family home.
(3) CONCURRENT ELIGIBLITY.
A child not eligible for in-home support from more than one CDDP unless the concurrent
service:
(a) Is necessary to transition
from one county to another with a change of residence;
(b) Is part of a collaborative
plan developed by both CDDPs; and
(c) Does not duplicate services
and expenditures.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD 20-2011, f. &
cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0070
In-Home Support Entry, Duration, and Exit
(1) ENTRY.
(a) For standard eligibility,
a CDDP must:
(A) Confirm a child meets
the standard eligibility criteria described in OAR 411-308-0060; and
(B) Complete a level of care
determination, a functional needs assessment, an ISP, and authorize funds for services
as described in OAR 411-308-0080.
(b) For general fund eligibility,
a CDDP must:
(A) Determine crisis eligibility
and have confirmation from the Regional Crisis Diversion Program that a child meets
the crisis diversion criteria;
(B) Complete an Annual Plan,
based on the collaboration between the Regional Crisis Diversion Program and the
CDDP, that includes strategies to resolve identified crisis risk factors and possible
resources; and
(C) Have the Annual Plan
approved by the Department prior to implementation of proposed crisis intervention
services.
(2) CHANGE OF COUNTY OF RESIDENCE.
If a child and the family move outside the service area of a CDDP, the originating
CDDP must arrange for services purchased with IHS funds to continue, to the extent
possible, in the new county of residence. The originating CDDP must:
(a) Provide information to
the family about the need to apply for services in the new CDDP and assist the family
with the application for services if necessary; and
(b) Contact the new CDDP
to negotiate the date on which the in-home support, including responsibility for
payments, transfers to the new CDDP.
(3) EXIT.
(a) For standard eligibility,
a child must exit in-home support when the child:
(A) Is no longer receiving
Medicaid Title XIX;
(B) The parent or guardian
submits a written request to end in-home supports;
(C) Turns 18 years of age;
(D) Is no longer eligible
for developmental disability services as determined by the CDDP of the county of
origin as described in OAR 411-320-0080;
(E) Does not meet the level
of care as defined in OAR 411-320-0020;
(F) May not be safely served
in the family home;
(G) No longer resides in
the family home;
(H) Moves to a county outside
the service area of the CDDP, unless transition services have been previously arranged
and authorized by the CDDP as required in section (2) of this rule;
(I) The parent or guardian
either cannot be located or has not responded after 30 days of repeated attempts
by CDDP staff to complete the ISP development and monitoring activities and does
not respond to a notice of intent to terminate; or
(J) The CDDP has sufficient
evidence that the parent or guardian has engaged in fraud or misrepresentation,
failed to use resources as agreed upon in the ISP, refused to cooperate with documenting
expenses of IHS funds, or otherwise knowingly misused public funds associated with
in-home support.
(b) For general fund eligibility,
a child must exit in-home support when the child:
(A) No longer needs in-home
support to prevent out-of-home placement;
(B) Meets the standard eligibility
requirements for in-home support;
(C) Turns 18 years of age;
(D) Is no longer eligible
for developmental disability services determined by the CDDP of the county of origin
as described in OAR 411-320-0080;
(E) May not be safely served
in the family home;
(F) No longer resides in
the family home;
(G) Moves to a county outside
the service area of the CDDP, unless transition services have been previously arranged
and authorized by the CDDP as required in section (2) of this rule;
(H) The parent or guardian
either cannot be located or has not responded after 30 days of repeated attempts
by CDDP staff to complete the Annual Plan development and monitoring activities
and does not respond to a notice of intent to terminate; or
(I) The CDDP has sufficient
evidence that the parent or guardian has engaged in fraud or misrepresentation,
failed to use resources as agreed upon in the Annual Plan, refused to cooperate
with documenting expenses of IHS funds, or otherwise knowingly misused public funds
associated with in-home support.
(c) When a child is being
exited from in-home support, a written Notification of Planned Action must be provided
as described in OAR 411-318-0020.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD 20-2011, f. &
cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0080
Required In-Home Support Services
(1) The CDDP must provide an annual
planning process to assist families in establishing outcomes, determining needs,
planning for supports, and reviewing and redesigning support strategies for all
children eligible for in-home support.
(a) The planning process
must occur in a manner that:
(A) Identifies and applies
existing abilities, relationships, and resources while strengthening naturally occurring
opportunities for support at home and in the community; and
(B) Is consistent in both
style and setting with the needs and preferences of the child and the family including,
but not limited to, informal interviews, informal observations in home and community
settings, or formally structured meetings.
(b) For standard eligibility,
a functional needs assessment must be completed using a person-centered planning
approach.
(2) The CDDP, the child (as
appropriate), and the family must develop a written ISP or Annual Plan for the child
as a result of the planning process prior to purchasing supports with IHS funds
and annually thereafter.
(a) The ISP or Annual Plan
must include, but not be limited to:
(A) The legal name of the
child and the name of the parent (if different than the last name of the child)
or the name of the guardian;
(B) A description of the
supports required that is consistent with the support needs identified in an assessment
of the child;
(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 child 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 identity of the person
responsible for case management and monitoring the ISP or Annual Plan;
(F) Signatures of the services
coordinator, the parent or guardian, and the child (as appropriate); and
(G) The review schedule of
the ISP or Annual Plan.
(b) For a child accessing
in-home supports through general fund eligibility, a plan to reduce or eliminate
the need for in-home supports through general funds must be included. The plan may
include assisting the child to access waiver or Community First Choice state plan
services, if eligible.
(c) An ISP must also include
the following:
(A) The manner in which services
are delivered and the frequency of services;
(B) Provider type;
(C) The strengths and preferences
of the child;
(D) Individually identified
goals and desired outcomes;
(E) The services and supports
(paid and unpaid) to assist the child to achieve identified goals and the providers
of the services and supports, including voluntarily provided natural supports;
(F) The risk factors and
the measures in place to minimize the risk factors, including back-up plans for
assistance with support and service needs; and
(G) A provision to prevent
unnecessary or inappropriate care.
(3) An ISP or Annual Plan,
or records supporting development of an ISP or Annual Plan, must include evidence
that:
(a) When the child is not
Medicaid eligible, IHS funds are used only to purchase goods or services necessary
to prevent the child from out-of-home placement or to return the child from a community
placement to the family home;
(b) The services coordinator
has assessed the availability of other means for providing the supports before using
IHS funds and other public, private, formal, and informal resources available to
the child have been applied and new resources have been developed whenever possible;
(c) Basic health and safety
needs and supports have been addressed including, but not limited to, identification
of risks including risk of serious neglect, intimidation, and exploitation;
(d) Informed decisions by
the parent or guardian regarding the nature of supports or other steps taken to
ameliorate any identified risks; and
(e) Education and support
for the child and the family to recognize and report abuse.
(4) The services coordinator
must obtain a Nursing Service Plan when in-home supports are used to purchase services
requiring the education and training of a nurse.
(5) The services coordinator
must obtain a Behavior Support Plan when the Behavior Support Plan is implemented
by the family or providers during the plan year.
(6) In-home supports may
only be provided after an ISP or Annual Plan is developed as described in this rule,
authorized by the CDDP, and signed by the parent or guardian.
(7) At least annually, the
services coordinator must conduct and document reviews of an ISP or Annual Plan
and resources with a family as follows:
(a) Evaluate progress toward
achieving the purposes of the ISP or Annual Plan;
(b) Note effectiveness of
purchases based on services coordinator observation and family satisfaction;
(c) Determine whether changing
needs or availability of other resources have altered the need for specific supports
or continued use of in-home supports; and
(d) For a child who meets
the general fund eligibility under OAR 411-308-0060, a quarterly review of the continued
risk for out-of-home placement and the availability of alternative resources, including
eligibility for waiver and Community First Choice state plan services.
(8) When a child and family
move to a different county, the originating CDDP must assist in-home support recipients
by:
(a) Continuing in-home supports
authorized by the ISP or Annual Plan which is current at the time of the move, if
the support is available, until the transfer date agreed upon according to OAR 411-308-0070;
and
(b) Transferring the unexpended
portion of the in-home supports to the new CDDP of residence.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD 20-2011, f. &
cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0090
Managing and Accessing In-Home Support
Funds
(1) IHS funds contracted to a CDDP by
the Department to serve a specifically-named child must only be used to support
that specified child. Services must be provided according to an approved ISP or
Annual Plan. The IHS funds may only be used to purchase supports described in OAR
411-308-0120. Continuing need for services must be regularly reviewed according
to the procedures described in these rules.
(2) No child receiving in-home
support may concurrently receive services through:
(a) Children’s intensive
in-home services as defined in OAR 411-308-0020;
(b) Direct assistance funds
under family support as described in OAR 411-305-0120; or
(c) In-home support from
another CDDP unless short-term concurrent services are necessary when a child moves
from one CDDP to another and the concurrent supports are arranged in accordance
with OAR 411-308-0060.
(3) Children receiving in-home
support via general fund eligibility may receive short-term crisis diversion services
provided through the CDDP or region. Children receiving in-home support via general
fund eligibility may utilize family support information and referral services, other
than direct assistance funds under family support while receiving in-home support.
The CDDP must clearly document the services and demonstrate that the services are
arranged in a manner that does not allow duplication of funding.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD
20-2011, f. & cert. ef. 8-1-11; SPD 54-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015, f. & cert. ef. 1-29-15
411-308-0100
Conditions for In-Home Support Purchases
(1) A CDDP must only use IHS funds to
assist families to purchase supports for the purpose defined in OAR 411-308-0010
and in accordance with an ISP or Annual Plan that meets the requirements for development
and content as described in OAR 411-308-0080.
(2) The CDDP must arrange
for supports purchased with IHS funds to be provided:
(a) In settings and under
purchasing arrangements and conditions that enable a family to receive supports
and services from a qualified provider as described in OAR 411-308-0130;
(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
the health and safety of a child 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 care services,
training, and supervision;
(d) In accordance with applicable
state or local building codes in the case of environmental modifications to the
family 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
411-308-0130 governing provider qualifications; and
(g) In accordance with the
In-Home Expenditure Guidelines.
(3) When IHS funds are used
to purchase services, training, supervision beyond basic supervision provided by
a parent or guardian, or other personal care assistance for a child, the CDDP must
require and document that providers are informed of:
(a) Mandatory reporter responsibility
to report suspected child abuse;
(b) Responsibility to immediately
notify the parent or guardian, or any other person specified by the parent or guardian,
of any injury, illness, accident, or unusual circumstance involving the child 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) 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 family or any other
source.
(B) The provider must bill
all third party resources before using IHS funds.
(d) The provisions of provider
termination as described in OAR 411-308-0130;
(e) The requirement to maintain
a drug-free workplace; and
(f) The payment process,
including payroll or contractor payment schedules or timelines.
(4) The method and schedule
of payment must be specified in written agreements between the CDDP and the parent
or guardian.
(a) Support expenses must
be separately projected, tracked, and expensed, including separate contracts, service
agreements, and timekeeping for staff working with more than one eligible child.
(b) The CDDP is specifically
prohibited from reimbursing a family for expenses or advancing funds to a family
to obtain services. The CDDP must issue payment, or arrange a fiscal intermediary
to issue payment, directly to a qualified provider on behalf of a family after approved
services described in an ISP or Annual Plan have been satisfactorily delivered.
(5) The CDDP must inform
families in writing of records and procedures required in OAR 411-308-0030 regarding
expenditure of IHS funds. During development of an ISP or Annual Plan, the services
coordinator must determine the need or preference for the CDDP to provide support
with documentation and procedural requirements and must delineate responsibility
for maintenance of records in written service agreements.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0110
Using In-Home Support Funds for Certain
Purchases is Prohibited
(1) Effective July 28, 2009, IHS 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 an employee of a parent or guardian, employee of a general business
provider, or employee of a provider organization who was hired prior to July 28,
2009 that remains in the current position for which the employee was hired.
(3) IHS funds may not be
used for:
(a) Services, supplies, or
supports that are illegal, experimental, or determined unsafe for the general public
by a recognized child or consumer safety agency;
(b) Services or activities
that are carried out in a manner that constitutes abuse of a child;
(c) Services from a person
who engages in verbal mistreatment and subjects a child to the use of derogatory
names, phrases, profanity, ridicule, harassment, coercion, or intimidation by threatening
injury or withholding of services or supports;
(d) Services that restrict
the freedom of movement of a child by seclusion in a locked room under any condition;
(e) Purchase or lease of
a vehicle;
(f) Purchase of a service
animal or costs associated with the care of a service animal;
(g) Health and medical costs
that the general public normally must pay including, but not limited to:
(A) Medical or therapeutic
treatments;
(B) Health insurance co-payments
and deductibles;
(C) Prescribed or over-the-counter
medications;
(D) Mental health treatments
and counseling;
(E) Dental treatments and
appliances;
(F) Dietary supplements including,
but not limited to, vitamins and experimental herbal and dietary treatments; or
(G) Treatment supplies not
related to nutrition, incontinence, or infection control;
(h) Ambulance service;
(i) Legal fees including,
but not limited to, the cost of representation in educational negotiations, establishment
of trusts, or creation of guardianship;
(j) 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 need of the child
for personal assistance in a home and community-based setting;
(k) Services, training, support,
or supervision that has not been arranged according to applicable state and federal
wage and hour regulations;
(l) 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;
(m) Unless under certain
conditions and limits specified in Department guidelines, employee wages or contractor
charges for time or services when a child is not present or available to receive
services including, but not limited to, employee paid time off, hourly "no show"
charges, or contractor travel and preparation hours;
(n) Services, activities,
materials, or equipment that are not necessary, not in accordance with the In-home
Expenditure Guidelines, not cost effective, or do not meet the definition of support
or social benefit as defined in OAR 411-308-0020;
(o) Public education and
services provided as part of a free and appropriate education for children and young
adults under the Individuals with Disabilities Education Act;
(p) Services provided in
a nursing facility, correctional institution, residential setting, or hospital;
(q) Services, activities,
materials, or equipment that the CDDP determines may be reasonably obtained by a
family through alternative resources or natural supports;
(r) Services or activities
for which the legislative or executive branch of Oregon government has prohibited
use of public funds;
(s) Services when there is
sufficient evidence to believe that a parent or guardian, or a provider chosen by
a family, has engaged in fraud or misrepresentation, failed to use resources as
agreed upon in an ISP or Annual Plan, refused to accept or delegate record keeping
required to document use of IHS funds, or otherwise knowingly misused public funds
associated with in-home support; or
(t) Notwithstanding abuse
as defined in ORS 419B.005, services that, in the opinion of a services coordinator,
are characterized by failure to act or neglect that leads to or is in imminent danger
of causing physical injury through negligent omission, treatment, or maltreatment
of a child. Examples include, but are not limited to, the failure to provide a child
with adequate food, clothing, shelter, medical services, supervision, or through
condoning or permitting abuse of a child by any other person. However, no child
may be considered neglected for the sole reason that a family relies on treatment
through prayer alone in lieu of medical treatment.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 39-2014, f. 12-26-14, cert. ef.
12-28-14; APD 2-2015, f. & cert. ef. 1-29-15
411-308-0120
Supports Purchased with In-Home Support
Funds
(1) When conditions of purchase are
met and provided purchases are not prohibited under OAR 411-308-0110, IHS funds
may be used to purchase a combination of the following supports based upon the needs
of a child as determined by a services coordinator and consistent with a functional
needs assessment, initial or annual ISP, and OSIPM or OHP Plus benefits a child
qualifies for:
(a) Community First Choice
state plan services. A child who is eligible for OHP Plus and meets the level of
care as defined in OAR 411-320-0020 may access Community First Choice state plan
services:
(A) Behavior support services
as described in section (2) of this rule;
(B) Community nursing services
as described in section (3) of this rule;
(C) Environmental modifications
as described in section (4) of this rule;
(D) Attendant care as described
in section (5) of this rule;
(E) Skills training as described
in section (6) of this rule;
(F) Relief care as described
in section (7) of this rule;
(G) Assistive devices as
described in section (8) of this rule;
(H) Assistive technology
as described in section (9) of this rule;
(I) Chore services as described
in section (10) of this rule;
(J) Community transportation
as described in section (11) of this rule; and
(K) Transition costs as described
in section (12) of this rule.
(b) Home and community-based
waiver services. A child who is eligible for OSIPM and meets the level of care as
defined in OAR 411-320-0020 may access Community First Choice state plan services
and the following home and community-based waiver services:
(A) Case management as defined
in OAR 411-320-0020;
(B) Employment services as
described in section (13) of this rule;
(C) Family training as described
in section (14) of this rule;
(D) Environmental safety
modifications as described in section (15) of this rule;
(E) Vehicle modifications
as described in section (16) of this rule; and
(F) Specialized medical supplies
as described in section (17) of this rule.
(c) State Plan personal care
services. A child who is eligible for OHP Plus through Title XXI, has personal care
supportive needs, and does not meet the level of care as defined in OAR 411-320-0020
may access State Plan personal care services if the child meets the eligibility
criteria described in OAR chapter 411, division 034.
(2) BEHAVIOR SUPPORT SERVICES.
Behavior support services may be authorized to support a primary caregiver in their
caregiving role and to respond to specific problems identified by a child, primary
caregiver, or a services coordinator. Positive behavior support services are used
to enable a child to develop, maintain, or enhance skills to accomplish ADLs, IADLs,
and health-related tasks.
(a) A behavior consultant
must
(A) Work with the child and
primary caregiver to identify:
(i) Areas of the family home
life that are of most concern for the child and the parent or guardian;
(ii) The formal or informal
responses the family or the provider has used in those areas; and
(iii) The unique characteristics
of the child and family that may influence the responses that may work with the
child.
(B) Assess the child. The
assessment must include:
(i) Specific identification
of the behaviors or areas of concern;
(ii) Identification of the
settings or events likely to be associated with, or to trigger, the behavior;
(iii) Identification of early
warning signs of the behavior;
(iv) Identification of the
probable reasons that are causing the behavior and the needs of the child that are
met by the behavior, including the possibility that the behavior is:
(I) An effort to communicate;
(II) The result of a medical
condition;
(III) The result of an environmental
cause; or
(IV) The symptom of an emotional
or psychiatric disorder.
(v) Evaluation and identification
of the impact of disabilities (i.e. autism, blindness, deafness, etc.) that impact
the development of strategies and affect the child and the area of concern; and
(vi) An assessment of current
communication strategies.
(C) Develop a variety of
positive strategies that assist the primary caregiver and the provider to help the
child use acceptable, alternative actions to meet the needs of the child in the
safest, most positive, and cost effective manner. These strategies may include changes
in the physical and social environment, developing effective communication, and
appropriate responses by the primary caregiver.
(i) When interventions in
behavior are necessary, the interventions must be performed in accordance with positive
behavioral theory and practice as defined in OAR 411-308-0020.
(ii) The least intrusive
intervention possible to keep the child and others safe must be used.
(iii) Abusive or demeaning
interventions must never be used.
(iv) The strategies must
be adapted to the specific disabilities of the child and the style or culture of
the family.
(D) Develop a written Behavior
Support Plan using clear, concrete language that is understandable to the primary
caregiver and the provider that describes the assessment, strategies, and procedures
to be used;
(E) Develop emergency and
crisis procedures to be used to keep the child, primary caregiver, and the provider
safe. When interventions in the behavior of the child are necessary, positive, preventative,
non-aversive interventions that conform to OIS must be utilized. The use of protective
physical intervention must be part of the Behavior Support Plan for the child. When
protective physical intervention is required, the protective physical intervention
must only be used as a last resort and the provider must be appropriately trained
in OIS;
(F) Teach the primary caregiver
and the provider the strategies and procedures to be used; and
(G) Monitor and revise the
Behavior Support Plan as needed.
(b) Behavior support services
may include:
(A) Training, modeling, and
mentoring the family of a child;
(B) Developing a visual communication
system as a strategy for behavior support; and
(C) Communicating, as authorized
by a parent or guardian, 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 a child at school;
(E) An assessment in a school
setting;
(F) Attendant care; or
(G) Relief care.
(3) 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 a primary caregiver and provider and identifying supports that minimize health
risks while promoting the autonomy of a child and self-management of healthcare;
and
(G) Collateral contact with
a services coordinator regarding the community health status of a child to assist
in monitoring safety and well-being and to address needed changes to the ISP for
the child.
(b) Community nursing services
exclude direct nursing care.
(c) A Nursing Service Plan
must be present when IHS funds are used for community nursing services. A services
coordinator 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.
(4) 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 a child whose temperature sensitivity issues create behaviors or medical conditions
that put the child 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 child; and
(P) Adaptations to control
lights, heat, stove, etc.
(b) Environmental modifications
exclude:
(A) Adaptations or improvements
to the family 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 child and identified in the ISP for the child;
(B) Adaptations that add
to the total square footage of the family 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 family home.
(c) Environmental modifications
must be tied to supporting assessed ADL, IADL, and health-related tasks as identified
in the ISP for the child.
(d) Environmental modifications
are limited to $5,000 per modification. A services coordinator 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 child and a 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 family home, except for external
ramps, and may not add to the square footage of the family home.
(g) Payment to the contractor
is to be withheld until the work meets specifications.
(h) A scope of work as defined
in OAR 411-308-0020 must be completed for each identified environmental modification
project. All contractors submitting bids must be given the same scope of work.
(i) A services coordinator
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 the subject of legal proceedings regarding ownership.
(l) Environmental modifications
must only be completed to the family home.
(m) Upgrades in materials
that are not directly related to the assessed health and safety needs of the child
are not paid for or permitted.
(n) Environmental 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.
(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.
(5) ATTENDANT CARE. Attendant
care services include direct support provided to a child in the family home or community
by a qualified personal support worker or provider organization. ADL and IADL services
provided through attendant care must support the child to live as independently
as appropriate for the age of the child, support the family in their primary caregiver
role, and be based on the identified goals, preferences, and needs of the child.
The primary caregiver is expected to be present or available during the provision
of attendant care.
(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 a child 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 a child 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 a child,
such as seizure, aspiration, constipation, or dehydration or responding to the call
of the child 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 a child and reporting of significant changes to a physician, health care provider,
or other appropriate person.
(b) IADL services include,
but are not limited to, the following services provided solely for the benefit of
the child:
(A) Light housekeeping tasks
necessary to maintain a child in a healthy and safe environment - cleaning surfaces
and floors, making the child'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 a child due to an intellectual or developmental
disability — helping the child cope with change and assisting the child 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
a child for choking while taking medications, assisting with the administration
of medications, maintaining equipment, or monitoring for adequate medication supply;
and
(F) Social support in the
community around socialization and participation in the community:
(i) Support with socialization
— assisting a child in acquiring, retaining, and improving self-awareness and self-control,
social responsiveness, social amenities, and interpersonal skills;
(ii) Support with community
participation — assisting a child in acquiring, retaining, and improving skills
to use available community resources, facilities, or businesses; and
(iii) Support with communication
— assisting a child 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 a child complete the activity
without hands-on assistance.
(B) "Hands-on" means a provider
physically performs all or parts of an activity because a child is unable to do
so.
(C) "Monitoring" means a
provider observes a child to determine if assistance is needed.
(D) "Reassurance" means to
offer a child encouragement and support.
(E) "Redirection" means to
divert a child to another more appropriate activity.
(F) "Set-up" means the preparation,
cleaning, and maintenance of personal effects, supplies, assistive devices, or equipment
so that a child may perform an activity.
(G) "Stand-by" means a provider
is at the side of a child ready to step in and take over the task if the child is
unable to complete the task independently.
(d) Attendant care services
must:
(A) Be prior authorized by
the services coordinator before services begin;
(B) Be delivered through
the most cost effective method as determined by the services coordinator; and
(C) Only be provided when
the child is present to receive services.
(e) Attendant care services
exclude:
(A) Hours that supplant parental
responsibilities or other natural supports and services as defined in this rule
available from the family, community, other government or public services, insurance
plans, schools, philanthropic organizations, friends, or relatives;
(B) Hours solely to allow
the primary caregiver to work or attend school;
(C) Hours that exceed what
is necessary to support the child based on the functional needs assessment;
(D) Support generally provided
for a child of similar age without disabilities by the parent or guardian or other
family members;
(E) Supports and services
that are funded by Child Welfare in the family home;
(F) Educational and supportive
services provided by schools as part of a free and appropriate public education
for children and young adults under the Individuals with Disabilities Education
Act;
(G) Services provided by
the family; and
(H) Home schooling.
(f) Attendant care services
may not be provided on a 24-hour shift-staffing basis.
(6) 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
a child 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 services
coordinator 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 services coordinator
must reassess or redefine the use of skills training with the child for that particular
goal.
(d) Skills training does
not replace the responsibilities of the school system.
(7) 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 7 consecutive days without permission from
the Department. No more than 14 days of relief care in a plan year are allowed without
permission from the Department.
(b) Relief care may include
both day and overnight services that may be provided in:
(A) The family home;
(B) A licensed or certified
setting;
(C) The home of a qualified
provider, chosen by the parent or guardian, is a safe setting for the child; or
(D) The community, during
the provision of ADL, IADL, health-related tasks, and other supports identified
in the ISP.
(c) Relief care services
are not authorized for the following:
(A) Solely to allow the primary
caregiver of the child to attend school or work;
(B) For more than 7 consecutive
overnight stays without permission from the Department;
(C) For more than 10 days
per individual plan year when provided at a camp that meets provider qualifications;
(D) For vacation, travel,
and lodging expenses; or
(E) To pay for room and board.
(8) 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 an assistive device must be limited
to the types of equipment 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 a child to increase the ability of the child to perform
and support ADLs and IADLs or to perceive, control, or communicate within the family
home and community environment in which the child lives.
(b) Assistive devices may
be purchased with IHS funds when the intellectual or developmental disability of
a child otherwise prevents or limits the independence of the child to assist in
areas identified in a functional needs assessment.
(c) Assistive devices that
may be purchased for the purpose described in subsection (a) of this section must
be of direct benefit to the child 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.
(B) Assistive devices not
provided by any other funding source to assist and enhance the independence of a
child 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 services coordinator 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 child and a determination by the Department of appropriateness
and cost-effectiveness.
(e) Devices must be limited
to the least costly option necessary to meet the assessed need of a child.
(f) Assistive devices must
meet applicable standards of manufacture, design, and installation.
(g) To be authorized by a
services coordinator, assistive devices must be:
(A) In addition to any assistive
devices, medical equipment, or supplies furnished under OHP, private insurance,
or alternative resources;
(B) Determined necessary
to the daily functions of a child; and
(C) Directly related to the
disability of a child.
(h) Assistive devices exclude:
(A) Items that are not necessary
or of direct medical benefit to the child 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 a child;
(D) Toys or outdoor play
equipment; and
(E) Equipment and furnishings
of general household use.
(9) 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.
(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 services coordinator 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 child and a determination by the Department of appropriateness
and cost-effectiveness.
(b) Payment for ongoing 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.
(10) 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 family home is safe for the child
to traverse and enter and exit the home.
(11) 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 a child to accomplish ADL, IADL, a health-related task, or
employment goal as 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 for the child:
(A) The child has an assessed
need for ADL, IADL, or a health-related task during transportation; or
(B) The child has either
an assessed need for ADL, IADL, or a 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 child.
(d) Community transportation
expenses exceeding $500 per month must be approved by the Department.
(e) Community transportation
must be prior authorized by a services coordinator 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 services coordinator 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
excludes:
(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 child.
(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 child;
(H) Transportation to vacation
destinations or trips for relaxation purposes;
(I) Transportation provided
by family members;
(J) Transportation normally
provided by schools;
(K) Transportation normally
provided by a primary caregiver for a child of similar age without disabilities;
(L) Reimbursement for out-of-state
travel expenses; and
(M) Transportation services
that may be obtained through other means, such as OHP or other alternative resources
available to the child.
(12) TRANSITION COSTS.
(a) Transition costs are
limited to a child transitioning to the family home from a nursing facility, ICF/ID,
or acute care hospital.
(b) Transition costs are
based on the assessed need of a child determined during the person-centered service
planning process and must support the desires and goals of the child 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 the
child 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 child 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) Transition costs for
basic household furnishings and other items are limited to one time per year.
(f) Transition costs may
not supplant the legal responsibility of the parent or guardian. In this context,
the term parent or guardian does not include a designated representative.
(13) 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.
(14) FAMILY TRAINING. Family
training services are provided to the family of a child to increase the abilities
of the family to care for, support, and maintain the child in the family home.
(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 a child;
and
(C) Registration fees for
organized conferences and workshops specifically related to the intellectual or
developmental disability of the child or the identified, specialized, medical, or
behavioral support needs of the child.
(i) Conferences and workshops
must be prior authorized by a services coordinator, directly relate to the intellectual
or developmental disability of a child, and increase the knowledge and skills of
the family to care for and maintain the child in the family home.
(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 child.
(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 a child.
(15) 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 family home that are of general utility and are not for the direct safety
or long-term benefit to the child or do not address the underlying environmental
need for the modification; and
(D) Adaptations that add
to the total square footage of the family home.
(d) Environmental safety
modifications must be tied to supporting ADL, IADL, and health-related tasks as
identified in the ISP for the child.
(e) Environmental safety
modifications are limited to $5,000 per modification. A services coordinator 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 child and a
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 family home
and may not add to the square footage of the family home.
(h) Payment to the contractor
is to be withheld until the work meets specifications.
(i) A scope of work as defined
in OAR 411-308-0020 must be completed for each identified environmental modification
project. All contractors submitting bids must be given the same scope of work.
(j) A services coordinator
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 modifications
must only be completed to the family home.
(n) Upgrades in materials
that are not directly related to the health and safety needs of the child are not
paid for or permitted.
(o) Environmental 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 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.
(16) VEHICLE MODIFICATIONS.
(a) Vehicle modifications
may only be made to the vehicle primarily used by a child to meet the unique needs
of the child. Vehicle modifications may include a lift, interior alterations to
seats, head and leg rests, belts, special safety harnesses, other unique modifications
to keep the child 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
a child 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 services coordinator 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 child and a 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.
(17) SPECIALIZED MEDICAL
SUPPLIES. Specialized medical supplies do not cover services which are otherwise
available to a child 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.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 4-2011(Temp), f. & cert. ef. 2-1-11 thru 7-31-11; SPD 20-2011, f. &
cert. ef. 8-1-11; SPD 21-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0130
Standards for Providers Paid with In-Home
Support Funds
(1) PROVIDER QUALIFICATIONS.
(a) PERSONAL SUPPORT WORKERS.
A personal support worker must meet the qualifications described in OAR chapter
411, division 375.
(b) INDEPENDENT PROVIDERS
WHO ARE NOT PERSONAL SUPPORT WORKERS. An independent provider who is not a personal
support worker who is paid as a contractor or a self-employed person and selected
to provide in-home supports must:
(A) Be at least 18 years
of age;
(B) Have approval to work
based on 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
Background Check Request Form must be completed by the subject individual to show
intent to work statewide;
(i) Prior background check
approval for another Department provider type is inadequate to meet background check
requirements for independent provider enrollment.
(ii) Background check approval
is effective for two years from the date an independent provider is contracted with
to provide in-home services, 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 primary caregiver,
parent, adoptive parent, stepparent, foster parent, or other person legally responsible
for the child receiving supports;
(F) Demonstrate by background,
education, references, skills, and abilities that he or she is capable of safely
and adequately performing the tasks specified in the ISP or Annual Plan for the
child, with such demonstration confirmed in writing by the parent or guardian, including:
(i) Ability and sufficient
education to follow oral and written instructions and keep any records required;
(ii) Responsibility, maturity,
and reputable character exercising sound judgment;
(iii) Ability to communicate
with the parent or guardian; and
(iv) Training of a nature
and type sufficient to ensure that the provider has knowledge of emergency procedures
specific to the child.
(G) Hold 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 information about the child and
family;
(I) Not be on the list of
excluded or debarred providers maintained by the Office of Inspector General (http://exclusions.oig.hhs.gov/);
(J) If transporting the child,
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.
(c) Subsection (b)(C) of
this section does not apply to employees of a parent or guardian, employees of a
general business provider, or employees of a provider organization, who were hired
prior to July 28, 2009 and remain in the current position for which the employee
was hired.
(d) All providers must self-report
any potentially disqualifying condition as described in OAR 407-007-0280 and OAR
407-007-0290. The provider must notify the Department or the designee of the Department
within 24 hours.
(e) All providers are mandatory
reporters and are required to report suspected child abuse to their local Department
office or to the police in the manner described in ORS 419B.010.
(2) PROVIDER TERMINATION.
(a) PERSONAL SUPPORT WORKERS.
The provider enrollment for a personal support worker is inactivated or terminated
as described in OAR chapter 411, division 375.
(b) INDEPENDENT PROVIDERS
WHO ARE NOT PERSONAL SUPPORT WORKERS.
(A) The provider enrollment
for an independent provider who is not a personal support worker may be inactivated
in the following circumstances:
(i) The provider has not
provided any paid in-home services to an individual within the last previous 12
months;
(ii) The provider informs
the Department, CDDP, CIIS, or Support Services Brokerage that the provider is no
longer providing in-home services in Oregon;
(iii) The background check
for the provider results in a closed case pursuant to OAR 407-007-0325;
(iv) Services provided by
the provider are being investigated by adult or child protective services for suspected
abuse that poses imminent danger to current or future children; or
(v) Provider payments, all
or in part, for the provider have been suspended based on a credible allegation
of fraud or a conviction of fraud pursuant to federal law under 42 CFR 455.23.
(B) The provider enrollment
for an independent provider, who is not a personal support worker, may be terminated
when the Department determines after enrollment that the independent provider has:
(i) Been convicted of any
crime that would have resulted in an unacceptable background check upon hiring or
authorization of service;
(ii) Been convicted of unlawfully
manufacturing, distributing, prescribing, or dispensing a controlled substance;
(iii) Surrendered his or
her professional license or had his or her professional license suspended, revoked,
or otherwise limited;
(iv) Failed to safely and
adequately provide the authorized services;
(v) Had a founded report
of child abuse or substantiated adult abuse;
(vi) Failed to cooperate
with any Department or CDDP investigation or grant access to, or furnish, records
or documentation, as requested;
(vii) Billed excessive or
fraudulent charges or been convicted of fraud;
(viii) Made a false statement
concerning conviction of crime or substantiated abuse;
(ix) Falsified required documentation;
(x) Been suspended or terminated
as a provider by the Department or Oregon Health Authority;
(xi) Violated the requirement
to maintain a drug-free work place;
(xii) Failed to provide services
as required;
(xiii) 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
(xiv) Has been excluded or
debarred by the Office of the Inspector General.
(C) If the CDDP or Department
makes a decision to terminate the provider enrollment of an independent provider
who is not a personal support worker, the CDDP or Department must issue a written
notice.
(i) The written notice must
include:
(I) An explanation of the
reason for termination of the provider enrollment;
(II) The alleged violation
as listed in subsection (A) or (B) of this section;
(III) The appeal rights for
the independent provider, including how to file an appeal; and
(IV) The effective date of
the termination.
(ii) For terminations based
on substantiated abuse allegations, the notice may only contain 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.
(D) The provider may appeal
a termination within 30 days of 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.
(i) A provider of Medicaid
services may appeal a termination by requesting an administrator review.
(ii) 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 of the date the termination notice was
mailed to the provider.
(E) 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.
(3) Independent providers,
including personal support workers, are not employees of the state, CDDP, or Support
Services Brokerage.
(4) 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
411-308-0120;
(b) Have current certification
demonstrating completion of OIS training; and
(c) Submit a resume or the
equivalent to the CDDP 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 of 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 411-308-0120.
(5) NURSES. 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
CDDP indicating the education, skills, and abilities necessary to provide nursing
services in accordance with Oregon law, including at least one year of experience
with individuals with intellectual or developmental disabilities.
(6) PROVIDER ORGANIZATIONS
WITH CURRENT LICENSE OR CERTIFICATION.
(a) The following provider
organizations may not require additional certification as an organization to provide
relief care, attendant care, skills training, community transportation, or behavior
support services:
(A) 24-hour residential settings
certified, endorsed, and licensed under OAR chapter 411, division 325;
(B) Foster homes for children
certified under OAR chapter 411, division 346;
(C) Foster homes for adults
licensed under OAR chapter 411, division 360;
(D) Employment settings certified
and endorsed under OAR chapter 411, division 345; and
(E) Supported living settings
certified and endorsed under OAR chapter 411, division 328.
(b) 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 an ISP; and
(C) Develop and implement
operating policies and procedures required for managing an organization and delivering
services, including provisions for safeguarding individuals receiving services.
(c) Provider organizations
must assure that all people directed by the provider organization as employees,
contractors, or volunteers to provide services paid for with IHS funds meet the
standards for independent providers described in this rule.
(7) GENERAL BUSINESS PROVIDERS.
General business providers providing services to children paid with IHS funds must
hold any current license appropriate to operate required by the state of Oregon
or federal law or regulation. Services purchased with IHS funds must be limited
to those within the scope of the license of the general business provider. Licenses
for general business providers include, but are 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 Contractor's Board), as applicable;
(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 a child, and
developing cost-effective plans to make homes safe and accessible;
(e) For public and private
transportation providers, a business license, vehicle insurance in compliance with
the laws of the Department of Motor Vehicles, and operators with a valid license
to drive;
(f) For vendors and medical
supply companies providing assistive devices, a current retail business license
and, if vending medical equipment, be enrolled as Medicaid providers through the
Division of Medical Assistance Programs; and
(g) For providers of personal
emergency response systems, a current business license.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
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 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 21-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14; APD 2-2015,
f. & cert. ef. 1-29-15
411-308-0135
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 the parent or guardian 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 a person 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 a child to be eligible
for in-home support provided by an employed 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 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;
(D) Complaints to Medicaid
Fraud involving the employer; or
(E) Documented observation
by the Department of services not being delivered as identified in an ISP.
(c) The Department 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) A child may not receive
in-home 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. The child may receive in-home support provided
by a provider organization or general business provider, when available.
(6) DESIGNATION OF EMPLOYER
RESPONSIBLITIES.
(a) A parent or guardian
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 child 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 child.
(b) A parent or guardian
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 parent or guardian is not able
to meet in order for the child to receive or continue to receive in-home support
provided by a personal support worker; and
(B) On a Department approved
form, document the specific employer responsibilities to be performed by the parent
or guardian and the employer responsibilities to be performed by the employer representative.
(c) When an employer representative
is not able to meet the employer responsibilities described in section (5)(a) or
the qualifications in section (7)(c) of this rule, the parent or guardian must:
(A) Designate a different
employer representative in order for the child 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 child.
(7) EMPLOYER REPRESENTATIVE.
(a) A parent or guardian
may designate an employer representative to act on behalf of the parent or guardian
to meet the employer responsibilities described in section (5)(a) of this rule.
(b) If a personal support
worker is selected by the parent or guardian to act as the employer, the parent
or guardian 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 may suspend,
terminate, or deny a request for an employer representative if the requested employer
representative has:
(A) A founded report of child
abuse or substantiated adult abuse;
(B) Participated in billing
excessive or fraudulent charges; or
(C) 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) of this rule.
(d) If the Department suspends,
terminates, or denies a request for an employer representative for the reasons described
in subsection (c) of this section, the parent or guardian may select another employer
representative.
(8) NOTICE.
(a) The Department shall
mail a notice to the parent or guardian when:
(A) The Department 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 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) If the parent or guardian
does not agree with the action taken by the Department, the parent or guardian may
request an administrator review.
(A) The request for an administrator
review must be made in writing and received by the Department within 45 days from
the date of the notice.
(B) The determination of
the Director is issued in writing within 30 days from the date the written request
for an administrator review was received by the Department.
(C) The determination of
the Director is the final response from the Department.
(c) When a denial, suspension,
or termination of an employer results in the Department denying, suspending, or
terminating a child from in-home support, the hearing rights in OAR chapter 411,
division 318 apply.
Stat. Auth.: ORS 409.050, 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662-670
Hist.: APD 21-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14;
APD 2-2015, f. & cert. ef. 1-29-15
411-308-0140
Quality Assurance
The CDDP must participate in statewide
quality assurance, service evaluation, and regulation activities as directed by
the Department in OAR 411-320-0045.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 39-2014, f. 12-26-14, cert. ef.
12-28-14; APD 2-2015, f. & cert. ef. 1-29-15
411-308-0150
Variances
(1) The Department may grant a variance
to these rules:
(a) If the CDDP lacks the
resources needed to implement the standards required in these rules;
(b) If implementation of
the proposed alternative practice, service, method, concept, or procedure shall
result in services or systems that meet or exceed the standards in these rules and
does not adversely impact the welfare, health, safety, or rights of individuals
or violate state or federal laws; or
(c) If there are other extenuating
circumstances.
(2) Variances are not granted
for OAR 411-308-0110 and OAR 411-308-0130.
(3) The CDDP 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 for a child, evidence that the variance is consistent with the currently
authorized ISP or Annual Plan for the child.
(4) The request for a variance
is approved or denied by the Department. The decision of the Department is sent
to the CDDP and to all relevant Department programs or offices within 30 days from
the receipt of the variance request.
(5)The CDDP 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 CDDP may implement
a variance only after written approval from the Department.
Stat. Auth.: ORS 409.050 & 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 7-2009(Temp),
f. & cert. ef. 7-1-09 thru 12-28-09; SPD 20-2009, f. 12-23-09, cert. ef. 12-28-09;
SPD 54-2013, f. 12-27-13, cert. ef. 12-28-13; APD 39-2014, f. 12-26-14, cert. ef.
12-28-14; APD 2-2015, f. & cert. ef. 1-29-15

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