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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

DIVISION 330
COMPREHENSIVE IN-HOME
SUPPORT FOR ADULTS WITH INTELLECTUAL

OR DEVELOPMENTAL DISABILITIES

411-330-0010
Statement of Purpose
The rules in OAR chapter 411, division
330 prescribe standards, responsibilities, and procedures for community developmental
disability programs providing comprehensive in-home support for adults with intellectual
or developmental disabilities to remain at home or in their family homes.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 60-2013, f. 12-27-13, cert. ef. 12-28-13
411-330-0020
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 330:
(1) "Abuse" means "abuse
of an adult" as defined in OAR 407-045-0260.
(2) "Abuse Investigation"
means the reporting and investigation activities as required by OAR 407-045-0300
and any subsequent services or supports necessary to prevent further abuse as required
by 407-045-0310.
(3) "ADL" means "activities
of daily living". ADL are basic personal everyday activities, such as eating, using
the restroom, grooming, dressing, bathing, and transferring.
(4) "Administrator Review"
means the Director of the Department reviews a decision upon request, including
the documentation related to the decision, and issues a determination.
(5) "Adult" means an individual
who is 18 years or older with an intellectual or developmental disability.
(6) "Alternative Resources"
mean possible resources for the provision of supports to meet the needs of an individual.
Alternative resources include, but are not limited to, private or public insurance,
vocational rehabilitation services, supports available through the Oregon Department
of Education, or other community supports.
(7) "Assistive Devices" mean
the devices, aids, controls, supplies, or appliances described in OAR 411-330-0110
that are necessary to enable an individual to increase the ability of the individual
to perform ADL and IADLs or to perceive, control, or communicate with the home and
community environment in which the individual lives.
(8) "Assistive Technology"
means the devices, aids, controls, supplies, or appliances described in OAR 411-330-0110
that are purchased to provide support for an individual and replace the need for
direct interventions to enable self-direction of care and maximize independence
of the individual.
(9) "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 411-330-0110.
(10) "Background Check" means
a criminal records check and abuse check as defined in OAR 407-007-0210.
(11) "Behavior Consultant"
means a contractor with specialized skills as described in OAR 411-330-0070 who
conducts functional assessments and develops a Behavior Support Plan.
(12) "Behavior Support Plan"
means the written strategy based on person-centered planning and a functional assessment
that outlines specific instructions for a primary caregiver or provider to follow
in order to reduce the frequency and intensity of the challenging behaviors of an
individual and to modify the behavior of the primary caregiver or provider, adjust
environment, and teach new skills.
(13) "Behavior Support Services"
mean the services consistent with positive behavioral theory and practice that are
provided to assist with behavioral challenges due to the intellectual or developmental
disability of an individual that prevents the individual from accomplishing ADL,
IADL, health-related tasks, and provides cognitive supports to mitigate behavior.
Behavior support services are provided in the home or community.
(14) "Career Development
Plan" means the part of an ISP that identifies:
(a) The employment goals
and objectives for an individual;
(b) The services and supports
needed to achieve those goals;
(c) The people, agencies,
and providers assigned to assist the individual to attain those goals;
(d) The obstacles to the
individual working in an individualized job in an integrated employment setting;
and
(e) The services and supports
necessary to overcome those obstacles.
(15) "CDDP" means "community
developmental disability program" as defined in OAR 411-320-0020.
(16) "Choice" means the expression
of preference, opportunity for, and active role of an individual in decision-making
related to services received and from whom including, but not limited to, case management,
providers, services, and service settings. Individuals are supported in opportunities
to make changes when so expressed. Choice may be communicated through a variety
of methods, including orally, through sign language, or by other communication methods.
(17) "Chore Services" mean
the services described in OAR 411-330-0110 that are needed to restore a hazardous
or unsanitary situation in the home of an individual to a clean, sanitary, and safe
environment.
(18) "Collective Bargaining
Agreement" means a contract based on negotiation between organized workers and their
designated employer for purposes of collective bargaining to determine wages, hours,
rules, and working conditions.
(19) "Community Nursing Services"
mean the nursing services described in OAR 411-330-0110 that focus on the chronic
and ongoing health and safety needs of an individual living in his or her own home.
Community nursing services include an assessment, monitoring, delegation, training,
and coordination of services. Community nursing services are provided according
to the rules in OAR chapter 411, division 048 and the Oregon State Board of Nursing
rules in OAR chapter 851.
(20) "Community Transportation"
means the services described in OAR 411-330-0110 that enable an individual to gain
access to community-based state plan and waiver services, activities and resources
that are not medical in nature. Community transportation is provided in the area
surrounding the home of the individual that is commonly used by people in the same
area to obtain ordinary goods and services.
(21) "Comprehensive Services"
means developmental disability services and supports that include 24-hour residential
services and attendant care provided in a licensed home, foster home, or through
a supported living program. Comprehensive services are regulated by the Department
alone or in combination with an associated Department-regulated program for employment.
Comprehensive services are in-home services provided to an individual with an intellectual
or developmental disability when the individual receives case management services
from a CDDP. Comprehensive services do not include support services for adults with
intellectual or developmental disabilities enrolled in Brokerages.
(22) "CPMS" means "Client
Process Monitoring System". CPMS is the Department computerized system for enrolling
and terminating services for individuals with intellectual or developmental disabilities.
(23) "Department" means the
Department of Human Services.
(24) "Designated Representative"
means any adult, such as a parent, family member, guardian, advocate, or other person,
who is chosen by an individual or the legal representative of the individual, not
a paid provider for the individual, and authorized by the individual or the legal
representative of the individual to serve as the representative of the individual
or the representative of the individual in connection with the provision of funded
supports. An individual or a legal representative of the individual is not required
to appoint a designated representative.
(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) "Discovery and Career
Exploration" means "discovery and career exploration" as defined in OAR 411-345-0020.
(28) "Employer" means, for
the purposes of obtaining in-home support through a personal support worker as described
in these rules, an individual or a person selected by the individual or the legal
representative of the individual to act on the behalf of the individual or the legal
representative of the individual to conduct the employer responsibilities described
in OAR 411-330-0065. An employer may also be a designated representative.
(29) "Employer-Related Supports"
mean the activities that assist an individual, and when applicable the legal or
designated representative or family members of the individual, with directing and
supervising provision of services described in the ISP for the individual. Employer-related
supports may include, but are not limited to:
(a) Education about employer
responsibilities;
(b) Orientation to basic
wage and hour issues;
(c) Use of common employer-related
tools, such as service agreements; and
(d) Fiscal intermediary services.
(30) "Employment Path Services"
means "employment path services" as defined in OAR 411-345-0020.
(31) "Employment Services"
means "employment services" as defined in OAR 411-345-0020.
(32) "Employment Specialist"
means "employment specialist" as defined in OAR 411-345-0020.
(33) "Entry" means admission
to a Department-funded developmental disability service.
(34) "Environmental Modifications"
mean the physical adaptations described in OAR 411-330-0110 that are necessary to
ensure the health, welfare, and safety of an individual in his or her own home,
or that are necessary to enable the individual to function with greater independence
around his or her own home or lead to a substitution for, or decrease in, direct
human assistance to the extent expenditures would otherwise be made for human assistance.
(35) "Environmental Safety
Modifications" mean the physical adaptations described in OAR 411-330-0110 that
are made to the exterior of the home of an individual or the home of the family
of the individual as identified in the ISP for the individual to ensure the health,
welfare, and safety of the individual or to enable the individual to function with
greater independence around the home or lead to a substitution for, or decrease
in, direct human assistance to the extent expenditures would otherwise be made for
human assistance.
(36) "Exit" means termination
or discontinuance of in-home support.
(37) "Family":
(a) Means a unit of two or
more people that includes at least one individual with an intellectual or developmental
disability where the primary caregiver is:
(A) Related to the individual
with an intellectual or developmental disability by blood, marriage, or legal adoption;
or
(B) In a domestic relationship
where partners share:
(i) A permanent residence;
(ii) Joint responsibility
for the household in general, such as child-rearing, maintenance of the residence,
and basic living expenses; and
(iii) Joint responsibility
for supporting the individual with an intellectual or developmental disability when
the individual is related to one of the partners by blood, marriage, or legal adoption.
(b) The term "family" is
defined as described above for purposes of:
(A) Determining the eligibility
of an individual for in-home support 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.
(38) "Family Training" means
the training services described in OAR 411-330-0110 that are provided to the family
of an individual to increase the capacity of the family to care for, support, and
maintain the individual in the home of the individual.
(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 re-assessment that:
(A) Documents physical, mental,
and social functioning;
(B) Identifies risk factors
and support needs; and
(C) Determines the service
level.
(b) The functional needs
assessment for an adult enrolled in comprehensive in-home supports is known as the
Adult Needs Assessment (ANA). Effective December 31, 2014, the Department incorporates
Version C of the ANA into these rules by this reference. The ANA is maintained by
the Department at: http://www.dhs.state.or.us/spd/tools/dd/ANAadultInhome.xls. Printed
copies of a blank ANA may be obtained by calling (503) 945-6398 or writing the Department
of Human Services, Developmental Disabilities, ATTN: Rules Coordinator, 500 Summer
Street NE, E-48, Salem, OR 97301.
(41) "General Business Provider"
means an organization or entity selected by an individual and paid with IHS funds
that:
(a) Is primarily in business
to provide the service chosen by the individual to the general public;
(b) Provides services for
the individual through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
individual.
(42) "Home" means the primary
residence of an individual that is not under contract with the Department to provide
services to the individual as a certified foster home or licensed or certified residential
care facility, assisted living facility, nursing facility, or other residential
support program site.
(43) "Home Delivered Meals"
means "Home Delivered Meals" as defined in OAR 411-040-0010.
(44) "IADL" means "instrumental
activities of daily living". IADL include activities other than ADL required to
continue independent living, such as:
(a) Meal planning and preparation;
(b) Managing personal finances;
(c) Shopping for food, clothing,
and other essential items;
(d) Performing essential
household chores;
(e) Communicating by phone
or other media; and
(f) Traveling around and
participating in the community.
(45) "ICF/ID" means an intermediate
care facility for individuals with intellectual disabilities.
(46) "IHS" means "in-home
support" as defined in this rule.
(47) "Immediate Family" means,
for the purpose of determining whether IHS funds may be used to pay a family member
to provide services, the spouse of an adult with an intellectual or developmental
disability.
(48) "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.
A printed copy may be obtained by calling (503) 945-6398 or writing the Department
of Human Services, Developmental Disabilities, ATTN: Rules Coordinator, 500 Summer
Street NE, E-48, Salem, Oregon 97301.
(49) "In-Home Support" means
services that are:
(a) Required for an individual
with an intellectual or developmental disability to live in the home or the family
home of the individual;
(b) Designed, selected, and
managed by the individual; and
(c) Provided in accordance
with the ISP for the individual.
(50) "Incident Report" means
the written report of any injury, accident, act of physical aggression, use of protective
physical intervention, or unusual incident involving an individual.
(51) "Independence" means
the extent to which an individual exerts control and choice over his or her own
life.
(52) "Independent Provider"
means a person selected by an individual and paid with IHS funds to directly provide
services to the individual.
(53) "Individual" means an
adult with an intellectual or developmental disability applying for, or determined
eligible for, developmental disability services. Unless otherwise specified, references
to individual also include the legal or designated representative of the individual,
who has the ability to act for the individual and to exercise the rights of the
individual.
(54) "Integration" as defined
in ORS 427.005 means:
(a) Use by individuals with
intellectual or developmental disabilities of the same community resources that
are used by and available to other people;
(b) Participation by individuals
with intellectual or developmental disabilities in the same community activities
in which people without disabilities participate, together with regular contact
with people without disabilities; and
(c) Residence by individuals
with intellectual or developmental disabilities in homes or home-like settings that
are in proximity to community resources, together with regular contact with people
without disabilities in their community.
(55) "Intellectual Disability"
means "intellectual disability" as defined in OAR 411-320-0020 and described in
OAR 411-320-0080.
(56) "ISP" means "Individual
Support Plan". An ISP includes the written details of the supports, activities,
and resources required for an individual to achieve and maintain personal goals
and health and safety. The ISP is developed at least annually to reflect decisions
and agreements made during a person-centered process of planning and information
gathering that is driven by the individual. The ISP reflects services and supports
that are important for the individual to meet the needs of the individual identified
through a functional needs assessment as well as the preferences of the individual
for providers, delivery, and frequency of services and supports. The ISP is the
plan of care for Medicaid purposes and reflects whether services are provided through
a waiver, Community First Choice state plan, natural supports, or alternative resources.
The ISP includes the Career Development Plan.
(57) "Job Coaching" means
"Job Coaching" as defined in OAR 411-345-0020.
(58) "Job Development" means
"Job Development" as defined in OAR 411-345-0020.
(59) "Legal Representative"
means an attorney at law who has been retained by or for an individual, a person
acting under the authority granted in a power of attorney, or a person or agency
authorized by a court to make decisions about services for an individual.
(60) "Natural Supports" means
the voluntary resources available to an individual from the relatives, friends,
significant others, neighbors, roommates, and the community of the individual that
are not paid for by the Department.
(61) "Nursing Service Plan"
means the plan that is developed by a registered nurse based on an initial nursing
assessment, reassessment, or an update made to a nursing assessment as the result
of a monitoring visit.
(a) The Nursing Service Plan
is specific to an individual and identifies the diagnoses and health needs of the
individual and any service coordination, teaching, or delegation activities.
(b) The Nursing Service Plan
is separate from the ISP as well as any service plans developed by other health
professionals.
(62) "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.
(63) "Oregon Intervention
System (OIS)" means 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.
(64) "OSIPM" means "Oregon
Supplemental Income Program-Medical" as described in OAR 461-001-0030. OSIPM is
Oregon Medicaid insurance coverage for individuals who meet the eligibility criteria
described in OAR chapter 461.
(65) "Person-Centered Planning":
(a) Means a timely and formal
or informal process driven by an individual, includes people chosen by the individual,
ensures the individual directs the process to the maximum extent possible, and the
individual is enabled to make informed choices and decisions consistent with 42
CFR 441.540.
(b) Person-centered planning
includes gathering and organizing information to reflect what is important to and
for the individual and to help:
(A) Determine and describe
choices about personal goals, activities, services, providers, service settings,
and lifestyle preferences;
(B) Design strategies and
networks of support to achieve goals and a preferred lifestyle using individual
strengths, relationships, and resources; and
(C) Identify, use, and strengthen
naturally occurring opportunities for support at home and in the community.
(c) The methods for gathering
information vary, but all are consistent with the cultural considerations, needs,
and preferences of the individual.
(66) "Personal Support Worker"
means "personal support worker" as defined in OAR 411-375-0010.
(67) "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.
(68) "Primary Caregiver"
means the person identified in an ISP as providing the majority of service and support
for an individual in the home of the individual.
(69) "Productivity" as defined
in ORS 427.005 means regular engagement in income-producing work, preferable competitive
employment with supports and accommodations to the extent necessary, by an individual
that is measured through improvements in income level, employment status, or job
advancement or engagement by an individual in work contributing to a household or
community.
(70) "Progress Note" means
a written record of an action taken by a services coordinator in the provision of
case management, administrative tasks, or direct services to support an individual.
A progress note may also be a recording of information related to the services,
support needs, or circumstances of the individual which is necessary for the effective
delivery of services.
(71) "Provider" means a person,
agency, organization, or business selected by an individual that provides recognized
Department-funded services and is approved by the Department or other appropriate
agency to provide Department-funded services.
(72) "Provider Organization"
means an entity, licensed or certified by the Department, selected by an individual,
and paid with IHS funds that:
(a) Is primarily in business
to provide supports for individuals with intellectual or developmental disabilities;
(b) Provides supports for
the individual through employees, contractors, or volunteers; and
(c) Receives compensation
to recruit, supervise, and pay the person who actually provides support for the
individual.
(73) "Relief Care" means
the intermittent services described in OAR 411-330-0110 that are provided on a periodic
basis for the relief of, or due to the temporary absence of, a person normally providing
supports to an individual.
(74) "Scope of Work" means
the written statement of all proposed work requirements for an environmental modification
which may include dimensions, measurements, materials, labor, and outcomes necessary
for a contractor to submit a proposal to complete such work. The scope of work is
specific to the identified tasks and requirements necessary to address the needs
outlined in the supplemental assessment referenced in the ISP and relating to the
ADL, IADL, and health-related tasks of the individual as discussed by the individual,
homeowner, service coordinator, and ISP team.
(75) "Self-Direction" means
that an individual has decision-making authority over services and takes direct
responsibility for managing services with the assistance of a system of available
supports that promotes personal choice and control over the delivery of waiver and
state plan services.
(76) "Service Agreement":
(a) Is the written agreement
consistent with an ISP that describes, at a minimum:
(A) Type of service to be
provided;
(B) Hours, rates, location
of services, and expected outcomes of services; and
(C) Any specific individual
health, safety, and emergency procedures that may be required, including action
to be taken if an individual is unable to provide for their own safety and the individual
is missing while in the community under the service of a contractor or provider
organization.
(b) For employed personal
support workers, the service agreement serves as the written job description.
(77) "Service Level" means
the amount of attendant care, hourly relief care, or skills training services determined
necessary by a functional needs assessment and made available to meet the identified
support needs of an individual.
(78) "Services Coordinator"
means "services coordinator" as defined in OAR 411-320-0020.
(79) "Skills Training" means
the activities described in OAR 411-330-0110 that are intended to maximize the independence
of an individual through training, coaching, and prompting the individual to accomplish
ADL, IADL, and health-related skills.
(80) "Social Benefit" means
the service or financial assistance solely intended to assist an individual with
an intellectual or developmental disability to function in society on a level comparable
to that of a person who does not have an intellectual or developmental disability.
Social benefits are pre-authorized by a 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 person regardless of intellectual or developmental
disability;
(B) Provide financial assistance
with food, clothing, shelter, and laundry needs common to a person with or without
an intellectual or developmental disability; or
(C) Replace other governmental
or community services available to an individual.
(b) Assistance provided as
a social benefit is reimbursement for an expense previously authorized in an ISP
or prior payment in anticipation of an expense authorized in a previously authorized
ISP.
(c) Assistance provided as
a social benefit may not exceed the actual cost of the support required by an individual
to be supported in the home of the individual.
(81) "Specialized Medical
Supplies" mean the medical and ancillary supplies described in OAR 411-330-0110,
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.
(82) "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.
(83) "Support" means the
assistance that an individual requires, solely because of the effects of an intellectual
or developmental disability, to maintain or increase independence, achieve community
presence and participation, and improve productivity. Support is subject to change
with time and circumstances.
(84) "Supported Employment
- Individual Employment Support" means "supported employment - individual employment
support" as defined in OAR 411-345-0020.
(85) "Supported Employment
- Small Group Employment" means "supported employment - small group employment"
as defined in OAR 411-345-0020.
(86) "These Rules" mean the
rules in OAR chapter 411, division 330.
(87) "Transition Costs" mean
the expenses described in OAR 411-330-0110, such as rent and utility deposits, first
month’s rent and utilities, bedding, basic kitchen supplies, and other necessities
required for an individual to make the transition from a nursing facility or ICF/ID
to a community-based home setting where the individual resides.
(88) "Unusual Incident" means
any incident involving an individual that includes serious illness or an accident,
death, injury or illness requiring inpatient or emergency hospitalization, a suicide
attempt, a fire requiring the services of a fire department, an act of physical
aggression, or any incident requiring an abuse investigation.
(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 411-330-0170.
(90) "Vehicle Modifications"
means the adaptations or alterations described in OAR 411-330-0110 that are made
to the vehicle that is the primary means of transportation for an individual in
order to accommodate the service needs of the individual.
Stat. Auth.: ORS 409.050, 430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662-670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 8-2007(Temp), f. 6-27-07, cert. ef. 7-1-07 thru 12-28-07;
SPD 20-2007, f. 12-27-07, cert. ef. 12-28-07; 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 9-2012(Temp),
f. & cert. ef. 7-10-12 thru 1-6-13; SPD 1-2013, f. & cert. ef. 1-4-13; SPD
25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 60-2013, f. 12-27-13,
cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14;
APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0030
Eligibility for In-Home Support Services
(1) An eligible individual may not be
denied in-home support or otherwise discriminated against on the basis of age, diagnostic
or disability category, race, color, creed, national origin, citizenship, income,
or duration of Oregon residence.
(2) An individual who enters
in-home support is subject to eligibility as described in this section. To be eligible
for in-home support, an individual must:
(a) Be an Oregon resident;
(b) Be determined eligible
for developmental disability services by the CDDP of the county of origin as described
in OAR 411-320-0080;
(c) Be an adult who is living
in his or her own home or the family home who is not receiving other Department-funded
in-home or community living support;
(d) Choose to use a CDDP
for assistance with design and management of in-home support;
(e) Be eligible for Community
First Choice state plan services;
(f) Be determined to meet
the level of care defined in OAR 411-320-0020; and
(g) For individuals with
excess income, contribute to the cost of service pursuant to OAR 461-160-0610 and
461-160-0620.
(3) Individuals are not eligible
for services by more than one CDDP unless the concurrent eligibility:
(a) Is necessary to effect
transition from one county to another with a change of residence; and
(b) Is part of a collaborative
plan developed by both CDDPs in which services and expenditures authorized by one
CDDP are not duplicated by the other CDDP.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 8-2007(Temp), f. 6-27-07, cert. ef. 7-1-07 thru 12-28-07;
SPD 20-2007, f. 12-27-07, cert. ef. 12-28-07; SPD 25-2013(Temp), f. & cert.
ef. 7-1-13 thru 12-28-13; SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0040
In-Home Support Service Entry and Exit
(1) The CDDP must make accurate, up-to-date,
written information about in-home support available to eligible individuals and
the legal or designated representatives of the individuals. These materials must
include:
(a) Criteria for entry, conditions
for exit, and how the limits of assistance with purchasing supports are determined;
(b) A description of processes
involved in using in-home support, including person-centered planning, evaluation,
and how to raise and resolve concerns about in-home support;
(c) Clarification of CDDP
employee responsibilities as mandatory abuse reporters;
(d) A brief description of
the responsibility of an individual and the legal or designated representative of
the individual for use of public funds; and
(e) An explanation of the
right of an individual to select and direct providers of services authorized through
the ISP and purchased with IHS funds from among those qualified according to OAR
411-330-0070, 411-330-0080, and 411-330-0090, as applicable.
(2) The CDDP must make the
information required in section (1) of this rule available using language, format,
and presentation methods appropriate for effective communication according to the
needs and abilities of the individuals.
(3) An individual may enter
in-home support when funds are authorized by the CDDP specifically to support the
individual.
(4) An eligible individual
who has entered in-home support may continue to receive in-home support as long
as the Department continues to provide funds specifically for that individual through
a contract with the CDDP and the individual continues to require the services to
remain at home or in the family home.
(5) An individual must exit
in-home support:
(a) At the end of a service
period agreed upon by all parties and specified in the ISP;
(b) At the oral or written
request of the individual to end the service relationship;
(c) No fewer than 30 days
after the CDDP has served the individual, and as applicable the legal or designated
representative of the individual, written notice of intent to exit the individual
from in-home support when the individual has been determined to no longer meet eligibility
for in-home support as described in OAR 411-330-0030, except when the individual
appeals the notice and requests continuing services in accordance with ORS Chapter
183;
(d) When the individual moves
from the service area of a CDDP, unless services are part of a time-limited plan
for transition to a new county of residence;
(e) Upon entry into support
services case management services;
(f) Upon entry into another
comprehensive service;
(g) When funds to support
the individual are no longer authorized by the CDDP of the county of origin;
(h) When the CDDP has sufficient
evidence to believe that an individual has engaged in fraud or misrepresentation,
failed to use resources as agreed upon in the ISP, refused to cooperate with documenting
expenses, or otherwise knowingly misused public funds associated with these services;
or
(i) After the individual
either cannot be located or has not responded after 30 days of repeated attempts
by CDDP staff to complete ISP development or monitoring activities, including participation
in a functional needs assessment.
(6) Any individual being
exited from in-home support must be given written notice of the intent to terminate
service consistent with OAR chapter 411, division 318.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0050
Required In-Home Support Services
(1) Each CDDP must provide or arrange
for the following services as required to meet the support needs of eligible individuals:
(a) Assistance to determine
needs and plan supports;
(b) Assistance to find and
arrange resources and supports;
(c) Education and technical
assistance to make informed decisions about support needs and direct support providers;
(d) Fiscal intermediary services;
(e) Employer-related supports;
and
(f) Assistance to monitor
and improve the quality of personal supports.
(2) A CDDP must complete
a functional needs assessment and use a person-centered planning approach to assist
an individual, and as applicable the legal or designated representative of the individual,
to establish outcomes, determine needs, plan for supports, and review and redesign
support strategies. The planning process must address the basic health and safety
needs and supports, including informed decisions by the individual regarding any
identified risks.
(3) A services coordinator
must authorize an initial ISP that addresses the needs of the individual. The needs
identified in the functional needs assessment must be addressed in the ISP for the
individual. Prior to services beginning, the ISP must be signed by the individual
or the legal or designated representative of the individual (as applicable). The
ISP and attached documents must include the information described in OAR 411-320-0120,
including:
(a) The name of the individual
and the name of the legal or designated representative of the individual (as applicable);
(b) The purpose of ISP activities,
addressing one or more of the following:
(A) Independence, such as
the degree of choice and control an individual hopes to achieve or maintain;
(B) Integration, such as
the regular access to relationships and community resources the individual hopes
to achieve or maintain;
(C) Productivity, such as
the employment or other contributing roles an individual hopes to achieve or maintain;
or
(D) Developing or maintaining
the capacity of the family to continue to provide services for the individual in
the family home.
(c) A description of the
supports required that is consistent with the support needs identified in the assessment
of the individual;
(d) The projected dates of
when specific supports are to begin and end, as well as the end date, if any, of
the period of service covered by the ISP;
(e) Projected costs with
sufficient detail to support estimates;
(f) A list of personal, community,
and alternative resources that are available to the individual and how the resources
may be applied to provide the required supports. Sources of support may include
waiver services, state plan services, state general funds, or natural supports;
(g) The manner in which services
are delivered and the frequency of services;
(h) Providers;
(i) The setting in which
the individual resides as chosen by the individual;
(j) The strengths and preferences
of the individual;
(k) Individually identified
goals and desired outcomes;
(l) The services and supports
(paid and unpaid) to assist the individual to achieve identified goals and the providers
of the services and supports, including voluntarily provided natural supports;
(m) The risk factors and
the measures in place to minimize the risk factors, including back-up plans;
(n) The identity of the person
responsible for case management and monitoring the ISP;
(o) A provision to prevent
unnecessary or inappropriate care;
(p) The alternative settings
considered by the individual;
(q) Schedule of ISP reviews;
and
(r) Any changes in support
needs identified through a functional needs assessment.
(4) As of July 1, 2014, a
Career Development Plan must be attached to the ISP of an adult in accordance with
OAR 411-345-0160.
(5) A Nursing Service Plan
must be present when IHS funds are used to purchase care and services requiring
the education and training of a licensed professional nurse.
(6) A services coordinator
must facilitate and document reviews of the ISP and resources with the individual,
and as applicable the legal or designated representative of the individual, at least
annually and as major activities or purchases are completed:
(a) Evaluate the progress
of an individual toward achieving the purposes of the ISP;
(b) Note effectiveness of
the use of IHS funds based on observation as well as the satisfaction of the individual;
and
(c) Determine whether changing
needs or availability of other resources has altered the need for continued use
of IHS funds to purchase supports.
(7) For an individual moving
to another service area within Oregon, the CDDP must collaborate with the receiving
CDDP to transfer IHS funds designated for the individual to continue the ISP for
supports.
(8) For an individual transferring
from a Brokerage to in-home support, the Brokerage ISP may be used as authorization
for available in-home support for up to 90 days.
Stat. Auth.: ORS 409.050&430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0060
Assistance with Purchasing In-Home Supports
(1) A CDDP must only use IHS funds to
assist an individual to purchase supports when:
(a) The services coordinator
has developed a written and approved ISP that meets requirements for development
and content as described in OAR 411-330-0050;
(b) For Community First Choice
state plan services, the support addresses a need that has been determined to be
necessary by a functional needs assessment;
(c) The ISP specifies cost-effective
arrangements for obtaining the required supports and applying public, private, formal,
and informal resources available to the eligible individual;
(d) The ISP identifies the
resources needed to purchase the remainder of necessary supports;
(e) The ISP is the most cost-effective
plan to safely meet the goals of the individual's ISP; and
(f) The support is consistent
with the In-home Expenditure Guidelines.
(2) Goods and services purchased
with IHS funds must be provided only as a social benefit as defined in OAR 411-330-0020.
(3) The method, amount, and
schedule of payment must be specified in written agreements between the CDDP and
the individual and the legal or designated representative of the individual (as
applicable). The CDDP is specifically prohibited from:
(a) Reimbursing an individual,
or as applicable the legal or designated representative or family of the individual,
for expenses related to services; and
(b) Advancing funds to an
individual, or as applicable the legal or designated representative or family of
the individual, to obtain services.
(4) Supports purchased for
an individual with IHS funds are limited to those described in OAR 411-330-0110.
The CDDP must arrange for these supports to be provided:
(a) In settings and under
contractual conditions that enable the individual the choice to receive supports
and services from another provider;
(b) In a manner consistent
with positive behavioral theory and practice as defined in OAR 411-330-0020;
(c) In accordance with applicable
state and federal wage and hour regulations in the case of personal care, training,
and supervision;
(d) In accordance with applicable
state or local building codes in the case of environmental modifications to the
home; and
(e) According to the Oregon
Board of Nursing rules in OAR chapter 851 when services involve performance of nursing
care or delegation, teaching, and assignment of nursing tasks.
(5) SERVICE LIMITS. The use
of IHS funds to purchase individual supports in any plan year is limited to:
(a) The service level of
an individual as determined by a functional needs assessment. The functional needs
assessment determines the total number of hours available to meet identified needs.
The total number of hours may not be exceeded without prior approval from the Department.
The types of services that contribute to the total 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 34.
(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.
(6) When IHS funds are used
to purchase supports for individuals, the CDDP must require and document that providers
are informed of:
(a) Mandatory responsibility
to report suspected abuse of an adult;
(b) Responsibility to immediately
notify the legal or designated representative (as applicable) of the individual,
family (if services are provided to an individual in the family home), and the CDDP
of injury, illness, accidents, or any unusual circumstances that may have a serious
effect on the health, safety, physical, emotional well-being, or level of services
required by the individual for whom services are being provided; and
(c) Limits of payment:
(A) IHS payments for the
agreed-upon services must be considered full payment and the provider under no circumstances
may demand or receive additional payment for these services from the individual,
the legal or designated representative of the individual (as applicable), the family
of the individual, or any other source.
(B) The provider must bill
all third party resources before using IHS funds unless another arrangement is agreed
upon by the CDDP in the ISP for the individual.
(7) USE OF IHS FUNDS PROHIBITED.
(a) 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.
(b) Section (7)(a) of this
rule does not apply to employees of the individual, the legal or designated representative
of the individual (as applicable), or provider organizations, who were hired prior
to July 28, 2009 that remain in the current position for which the employee was
hired.
(c) IHS funds must not pay
for:
(A) Services, materials,
or activities that are illegal;
(B) Services or activities
that are carried out in a manner that constitutes abuse as defined in OAR 407-045-0260;
(C) Materials or equipment
that has been determined unsafe for the general public by recognized consumer safety
agencies;
(D) Individual or family
vehicles;
(E) Health and medical costs
that the general public normally must pay, including but not limited to:
(i) Medications;
(ii) Health insurance co-payments;
(iii) Mental health evaluation
and treatment;
(iv) Dental treatments and
appliances;
(v) Medical treatments;
(vi) Dietary supplements;
or
(vii) Treatment supplies
not related to nutrition, incontinence, or infection control;
(F) Basic or specialized
food or nutrition essential to sustain the individual including, but not limited
to, high caloric supplements, gluten-free supplements, diabetic, ketogenic, or other
metabolic supplements;
(G) Ambulance services;
(H) Legal fees including,
but not limited to, costs of representation in educational negotiations, establishing
trusts, or creating guardianships;
(I) 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 individual
for personal assistance in all home and community-based settings;
(J) Individual support that
has not been arranged according to applicable state and federal wage and hour regulations;
(K) Rate enhancements to
existing employment services under OAR chapter 411, division 345;
(L) Employee wages or contractor
payments for services when the individual is not present or available to receive
services, such as employee paid time off, hourly "no-show" charges, and contractor
preparation hours;
(M) Services, activities,
materials, or equipment that are not necessary or cost-effective and do not meet
the definition of in-home supports, supports, and social benefits as defined in
OAR 411-330-0020;
(N) Educational services
for school-age adults, including professional instruction, formal training, and
tutoring in communication, socialization, and academic skills;
(O) Services, activities,
materials, or equipment that may be obtained by the individual through other available
means, such as private or public insurance, philanthropic organizations, or other
governmental or public services;
(P) Services or activities
for which the legislative or executive branch of Oregon government has prohibited
use of public funds;
(Q) Service in circumstances
where the CDDP determines there is sufficient evidence to believe that the individual,
the legal or designated representative of the individual (as applicable), family,
or provider has engaged in fraud or misrepresentation, failed to use resources as
agreed upon in the ISP, refused to cooperate with record keeping required to document
use of IHS funds, or otherwise knowingly misused public funds associated with in-home
support;
(R) Any purchase that is
not generally accepted by the relevant mainstream professional or academic community
as an effective means to address an identified support need; or
(S) Services, supplies, or
supports that are illegal, experimental, or determined unsafe for the general public
by recognized child or consumer safety agencies.
(8) The CDDP must inform
an individual, and as applicable the legal or designated representative of an individual,
in writing of records and procedures required in OAR 411-330-0140 regarding expenditure
of IHS funds for direct assistance. During development of the ISP, the services
coordinator must determine the need or preference for the CDDP to provide support
with documentation and procedural requirements and must include delineations of
responsibility for maintenance of records in the ISP and any other 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 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0065
Standards for Employers
(1) EMPLOYER OF RECORD. An employer
of record is required when a personal support worker who is not an independent contractor
is selected by an individual to provide supports. The Department may not act as
the employer of record.
(2) SERVICE AGREEMENT. The
employer must create and maintain a service agreement for a personal support worker
that is in coordination with the services authorized in the ISP. The service agreement
serves as a written job description for the employed personal support worker.
(3) BENEFITS. Only personal
support workers qualify for benefits. The benefits provided to personal support
workers are described in OAR chapter 411, division 375.
(4) INTERVENTION. For the
purpose of this rule, "Intervention" means the action the Department or the designee
of the Department requires when an employer fails to meet the employer responsibilities
described in this rule. Intervention includes, but is not limited to:
(a) A documented review of
the employer responsibilities described in section (5) of this rule;
(b) Training related to employer
responsibilities;
(c) Corrective action taken
as a result of a personal support worker filing a complaint with the Department,
the designee of the Department, or other agency who may receive labor related complaints;
(d) Identifying an employer
representative if 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 an individual to
be eligible for in-home support provided by a personal support worker, an employer
must demonstrate the ability to:
(A) Locate, screen, and hire
a qualified personal support worker;
(B) Supervise and train the
personal support worker;
(C) Schedule work, leave,
and coverage;
(D) Track the hours worked
and verify the authorized hours completed by the personal support worker;
(E) Recognize, discuss, and
attempt to correct, with the personal support worker, any performance deficiencies
and provide appropriate, progressive, disciplinary action as needed; and
(F) Discharge an unsatisfactory
personal support worker.
(b) Indicators that an employer
may not be meeting the employer responsibilities described in subsection (a) of
this section include, but are not limited to:
(A) Personal support worker
complaints;
(B) Multiple complaints from
a personal support worker requiring intervention from the Department or CDDP as
defined in section (4) of this rule;
(C) Frequent errors on timesheets,
mileage logs, or other required documents submitted for payment that results in
repeated coaching from the Department or CDDP;
(D) Complaints to Medicaid
Fraud involving the employer; or
(E) Documented observation
by the Department or CDDP of services not being delivered as identified in an ISP.
(c) The Department or the
CDDP may require intervention as defined in section (4) of this rule when an employer
has demonstrated difficulty meeting the employer responsibilities described in subsection
(a) of this section.
(d) An individual may not
receive 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.
(A) An individual determined
ineligible to be an employer of a personal support worker and unable to designate
an employer representative, may not request in-home support provided by a personal
support worker until the next annual ISP. Improvements in health and cognitive functioning
may be factors in demonstrating the ability of the individual to meet the employer
responsibilities described in subsection (a) of this section. If an individual is
able to demonstrate the ability to meet the employer responsibilities sooner than
the next annual ISP, the individual may request the waiting period be shortened.
(B) An individual determined
ineligible to be an employer of a personal support worker is offered other available
service options that meet the service needs of the individual, including in-home
support through a contracted qualified provider organization or general business
provider when available. As an alternative to in-home support, the Department or
the designee of the Department may offer other available services through the Home
and Community Based Services Waiver or State Plan.
(6) DESIGNATION OF EMPLOYER
RESPONSIBLITIES.
(a) An individual not able
to meet all of the employer responsibilities described in section (5)(a) of this
rule must:
(A) Designate an employer
representative in order for the individual to receive or continue to receive in-home
support provided by a personal support worker; or
(B) Select a provider organization
or general business provider to provide in-home support for the individual.
(b) An individual able to
demonstrate the ability to meet some of the employer responsibilities described
in section (5)(a) of this rule must:
(A) Designate an employer
representative to fulfill the responsibilities the individual is not able to meet
in order for the individual to receive or continue to receive in-home support provided
by a personal support worker; and
(B) On a Department approved
form, document the specific employer responsibilities performed by the individual
and the employer responsibilities performed by the employer representative of the
individual.
(c) When the employer representative
of an individual is not able to meet the employer responsibilities described in
section (5)(a) or the qualifications in section (7)(c) of this rule, an individual
must:
(A) Designate a different
employer representative in order for the individual to receive or continue to receive
in-home support provided by a personal support worker; or
(B) Select a provider organization
or general business provider to provide in-home support for the individual.
(7) EMPLOYER REPRESENTATIVE.
(a) An individual, or the
legal representative of an individual, may designate an employer representative
to act on behalf of the individual, to meet the employer responsibilities described
in section (5)(a) of this rule. The legal or designated representative of an individual
may be the employer.
(b) An employer who is also
the personal support worker of in-home support must seek an alternate employer for
purposes of employment of the personal support worker. The alternate employer must:
(A) Track the hours worked
and verify the authorized hours completed by the personal support worker; and
(B) Document the specific
employer responsibilities performed by the employer on a Department approved form.
(c) The Department or the
CDDP may suspend, terminate, or deny a request for an employer representative if
the requested employer representative has:
(A) A history of substantiated
abuse of an adult as described in OAR 411-045-0250 to 411-045-0370;
(B) A history of founded
abuse of a child as described in ORS 419B.005;
(C) Participated in billing
excessive or fraudulent charges; or
(D) Failed to meet the employer
responsibilities in section (5)(a) or (7)(b) of this rule, including previous termination
as a result of failing to meet the employer responsibilities in section (5)(a) or
(7)(b).
(d) If the Department or
CDDP suspends, terminates, or denies a request for an employer representative for
the reasons described in subsection (c) of this section, an individual may select
another employer representative.
(8) NOTICE.
(a) The Department or the
CDDP, respectively, shall mail a notice identifying the individual, and if applicable
the employer representative and legal or designated representative of the individual,
when:
(A) The Department or the
CDDP denies, suspends, or terminates an employer from performing the employer responsibilities
described in sections (5)(a) or (7)(b) of this rule; and
(B) The Department or the
CDDP 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) CDDP ISSUED NOTICES.
An individual receiving in-home support, or as applicable the legal or designated
representative or employer representative of the individual, may appeal a notice
issued by the CDDP by requesting a review by the Director of the CDDP.
(A) For an appeal regarding
denial, suspension, or termination of an employer to be valid, written notice of
the appeal and request for review must be received by the CDDP within 45 days from
the date of the notice.
(B) The CDDP Director shall
complete a review and issue a decision within 30 days of the date the written appeal
was received by the CDDP.
(C) If an individual, or
as applicable the legal or designated representative or employer representative
of the individual, is dissatisfied with the decision of the CDDP Director, the individual,
or as applicable the legal or designated representative or employer representative
of the individual, may request an administrator review by the Director of the Department.
(D) For an appeal of the
decision of the CDDP to be valid, written notice of the appeal and request for an
administrator review must be received by the Department within 15 days from the
date of the decision of the CDDP.
(E) The Director shall complete
an administrator review within 30 days from the date the written appeal was received
by the Department.
(F) The determination of
the Director is the final response from the Department.
(c) DEPARTMENT ISSUED NOTICES.
An individual receiving in-home support, or as applicable the legal or designated
representative of the individual, may appeal a notice issued by the Department by
requesting an administrator review by the Director of the Department.
(A) For an appeal regarding
denial, suspension, or termination of an employer to be valid, written notice of
the appeal and request for an administrator review must be received by the Department
within 45 days from the date of the notice.
(B) The Director shall complete
an administrator review and issue a decision within 30 days of the date the written
appeal was received by the Department.
(C) The determination of
the Director is the final response from the Department.
(d) When a denial, suspension,
or termination of an employer results in the Department denying, suspending, or
terminating an individual from in-home support, the hearing rights in OAR chapter
411, division 318 apply.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 9-2012(Temp),
f. & cert. ef. 7-10-12 thru 1-6-13; SPD 1-2013, f. & cert. ef. 1-4-13; SPD
60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0070
Standards for Independent Providers Paid
with In-Home Support Funds
(1) PERSONAL SUPPORT WORKER QUALIFICATIONS.
Each personal support worker must meet the qualifications described in OAR chapter
411, division 375.
(2) INDEPENDENT PROVIDER
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 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 OAR 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;
(A) Prior background check
approval for another Department provider type is inadequate to meet background check
requirements for independent provider enrollment.
(B) Background check approval
is effective for two years from the date an independent provider is contracted with
to provide in-home support, except in the following circumstances:
(i) Based on possible criminal
activity or other allegations against the independent provider, a new fitness determination
is conducted resulting in a change in approval status; or
(ii) The background check
approval has ended because the Department has inactivated or terminated the provider
enrollment for the independent provider.
(c) Effective July 28, 2009,
not have been convicted of any of the disqualifying crimes listed in OAR 407-007-0275;
(d) Be legally eligible to
work in the United States;
(e) Not be the spouse of
an individual receiving services;
(f) Not be the employer of
record or designated representative of the individual;
(g) 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, with such demonstration
confirmed in writing by the employer including:
(A) Ability and sufficient
education to follow oral and written instructions and keep any records required;
(B) Responsibility, maturity,
and reputable character exercising sound judgment;
(C) Ability to communicate
with the individual; and
(D) Training of a nature
and type sufficient to ensure that the provider has knowledge of emergency procedures
specific to the individual;
(h) Hold a current, valid,
and unrestricted appropriate professional license or certification where services
and supervision requires specific professional education, training, and skill;
(i) Understand requirements
of maintaining confidentiality and safeguarding individual information;
(j) Not be on the list of
excluded or debarred providers maintained by the Office of Inspector General (http://exclusions.oig.hhs.gov/);
(k) Sign a Medicaid provider
agreement and be enrolled as a Medicaid provider prior to delivery of any services;
and
(l) If transporting an individual,
have a valid license to drive and proof of insurance, as well as any other license
or certification that may be required under state and local law depending on the
nature and scope of the transportation.
(3) Section (2)(c) of this
rule does not apply to employees of an employer or employees of provider organizations
who were hired prior to July 28, 2009 that remain in the current position for which
the employee was hired.
(4) All providers must self-report
any potentially disqualifying condition as described in OAR 407-007-0280 and 407-007-0290.
The provider must notify the Department or the designee of the Department within
24 hours.
(5) Independent providers,
including personal support workers, are not employees of the state, CDDP, or Brokerage.
(6) BEHAVIOR CONSULTANTS.
Behavior consultants are not personal support workers. Behavior consultants may
include, but are not limited to, autism specialists, licensed psychologists, or
other behavioral specialists. Behavior consultants providing specialized supports
must:
(a) Have education, skills,
and abilities necessary to provide behavior support services as described in OAR
411-330-0110;
(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 411-330-0110.
(7) NURSE. A nurse providing
community nursing services is not a personal support worker. The nurse must:
(a) Have a current Oregon
nursing license;
(b) Be enrolled in the Long
Term Care Community Nursing Program as described in OAR chapter 411, division 048;
and
(c) Submit a resume to the
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.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD
60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0080
Standards for Provider Organizations Paid
with In-Home Support Funds
(1) A provider organization certified,
licensed, and endorsed under OAR chapter 411, division 325 for a 24-hour residential
setting, or licensed under OAR chapter 411, division 360 for an adult foster home,
or certified under OAR chapter 411, division 340 for support services, or certified
and endorsed under OAR chapter 411, division 345 for employment services or OAR
chapter 411, division 328 for a supported living setting, does not require additional
certification as an organization to provide relief care, attendant care, skills
training, community transportation, or behavior consultation.
(2) 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.
(3) A person directed by
a provider organization to provide services paid for with IHS funds as an employee,
contractor, or volunteer, must meet the qualifications of an independent provider
outlined in OAR 411-330-0070.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0090
Standards for General Business Providers
(1) General business providers providing
services to individuals and paid with IHS funds must hold any current license appropriate
to function required by the state of Oregon or federal law or regulation including,
but not limited to:
(a) For a home health agency,
a license under ORS 443.015;
(b) For an in-home care agency,
a license under ORS 443.315;
(c) For providers of environmental
modifications involving building modifications or new construction, a current license
and bond as a building contractor as required by OAR chapter 812 (Construction Contractor's
Board) or OAR chapter 808 (Landscape Contractors Board);
(d) For environmental accessibility
consultants, a current license as a general contractor as required by OAR chapter
812, including experience evaluating homes, assessing the needs of an individual,
and developing cost-effective plans to make homes safe and accessible;
(e) For public transportation
providers, the established standards;
(f) For private transportation
providers, a business license and drivers licensed to drive in Oregon; and
(g) For vendors and medical
supply companies providing assistive devices or specialized medical supplies, a
current retail business license, including enrollment as Medicaid providers through
the Division of Medical Assistance Programs if vending medical equipment.
(2) Services provided and
paid for with IHS funds must be limited to the services within the scope of the
license of the general business provider.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13APD 25-2014(Temp), f. & cert. ef.
7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0100
Provider Termination
(1) The provider enrollment for a personal
support worker is inactivated or terminated as described in OAR chapter 411, division
375.
(2) An independent provider
who is not a personal support worker may have their provider enrollment terminated.
(a) Provider enrollment may
be terminated when the CDDP or Department determines that, at some point after the
initial qualification and authorization of the provider to provide supports purchased
with IHS funds, the provider has:
(A) Been convicted of any
crime that would have resulted in an unacceptable background check upon hiring or
authorization of service;
(B) Been convicted of unlawfully
manufacturing, distributing, prescribing, or dispensing a controlled substance;
(C) Surrendered his or her
professional license or had his or her professional license suspended, revoked,
or otherwise limited;
(D) Failed to safely and
adequately provide the services authorized;
(E) Had a founded report
of child abuse or substantiated adult abuse;
(F) Failed to cooperate with
any Department or CDDP investigation or grant access to, or furnish, records or
documentation as requested;
(G) Billed excessive or fraudulent
charges or been convicted of fraud;
(H) Made a false statement
concerning conviction of a crime or substantiated abuse;
(I) Falsified required documentation;
(J) Not adhered to the provisions
of OAR 411-330-0060(6) and 411-330-0070;
(K) Been suspended or terminated
as a provider by the Department or Oregon Health Authority;
(L) Violated the requirement
to maintain a drug-free work place;
(M) Failed to provide services
as required;
(N) Failed to provide a tax
identification number or social security number that matches the legal name of the
independent provider, as verified by the Internal Revenue Service or Social Security
Administration; or
(O) Been excluded or debarred
by the Office of the Inspector General.
(b) If the CDDP makes a decision
to terminate provider enrollment, the CDDP must issue a written notice.
(A) The written notice must
include:
(i) An explanation of the
reason for termination of the provider enrollment;
(ii) The alleged violation
as listed in section (a) of this rule; and
(iii) The appeal rights of
the independent provider, including where to file the appeal.
(B) 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.
(c) The provider may appeal
a termination within 30 days from the date the termination notice was mailed to
the provider. The provider must appeal a termination separately from any appeal
of audit findings and overpayments.
(A) A provider of Medicaid
services may appeal a termination by requesting an administrator review.
(B) For an appeal regarding
provision of Medicaid services to be valid, written notice of the appeal must be
received by the Department within 30 days from the date the termination notice was
mailed to the provider.
(d) At the discretion of
the Department, providers who have previously been terminated or suspended by the
Department or by the Oregon Health Authority may not be authorized as providers
of Medicaid services.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 60-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 25-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14,
cert. ef. 12-28-14
411-330-0110
Supports Purchased with In-Home Support
Funds
(1) For an initial or annual ISP, IHS
funds may be used to purchase a combination of the following waiver and state plan
services when the conditions of purchase in OAR 411-330-0060 are met:
(a) An individual 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 when supported by an assessed
need.
(b) Transfer of Assets.
(A) As of October 1, 2014,
an individual receiving medical benefits under chapter 410, division 200 requesting
Medicaid coverage for services in a nonstandard living arrangement (see OAR 461-001-0000)
is subject to the requirements of the rules regarding transfer of assets (see OAR
461-140-0210 to 461-140-0300) in the same manner as if the individual was requesting
these services under OSIPM. This includes, but is not limited to, the following
assets:
(i) An annuity evaluated
according to OAR 461-145-0022;
(ii) A transfer of property
when an individual retains a life estate evaluated according to OAR 461-145-0310;
(iii) A loan evaluated according
to OAR 461-145-0330; or
(iv) An irrevocable trust
evaluated according to OAR 461-145-0540;
(B) When an individual is
considered ineligible due to a disqualifying transfer of assets, the individual
must receive a notice meeting the requirements of OAR 461-175-0310 in the same manner
as if the individual was requesting services under OSIPM.
(c) Community First Choice
state plan services include:
(A) Behavior support services
as described in section (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;
(K) Transition costs as described
in section (12) of this rule; and
(L) Home delivered meals
as described in OAR chapter 411, division 40.
(d) Individuals who are eligible
for OSIPM and meet 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 that include:
(i) Supported employment
— individual employment support;
(ii) Supported employment
— small group employment support;
(iii) Employment path services;
and
(iv) Discovery and career
exploration services;
(C) Family training as described
in section (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.
(e) State Plan personal care
as described in OAR chapter 411, division 34.
(2) BEHAVIOR SUPPORT SERVICES.
(a) Behavior support services
consist of:
(A) Assessing an individual
or the needs of the family of the individual and the environment;
(B) Developing positive behavior
support strategies, including a Behavior Support Plan, by a qualified behavior consultant
as described in OAR 411-330-0070, if needed;
(C) Implementing the Behavior
Support Plan with the provider or family; and
(D) Revising and monitoring
the Behavior Support Plan as needed.
(b) Behavior support services
may include:
(A) Training, modeling, and
mentoring the family of an individual;
(B) Developing a visual communication
system as a strategy for behavior support; and
(C) Communicating, as authorized
by an individual, with school, medical, or other professionals about the strategies
and outcomes of the Behavior Support Plan.
(c) Behavior support services
exclude:
(A) Mental health therapy
or counseling;
(B) Health or mental health
plan coverage;
(C) Educational services
including, but not limited to, consultation and training for classroom staff;
(D) Adaptations to meet the
needs of an individual at school;
(E) An assessment in a school
setting;
(F) Attendant care;
(G) Skills training; or
(H) Relief care.
(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 the provider and primary caregiver and identifying supports that minimize health
risks while promoting the autonomy of an individual and self-management of healthcare;
and
(G) Collateral contact with
a services coordinator regarding the community health status of an individual to
assist in monitoring safety and well-being and to address needed changes to the
ISP for the individual.
(b) Community nursing services
exclude direct nursing care.
(c) A Nursing Service Plan
must be present when 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 an individual whose temperature sensitivity issues create behaviors or medical
conditions that put the individual or others at risk;
(M) Installation of non-skid
surfaces;
(N) Overhead track systems
to assist with lifting or transferring;
(O) Specialized electric
and plumbing systems that are necessary to accommodate the medical equipment and
supplies necessary for the welfare of the individual; and
(P) Adaptations to control
lights, heat, stove, etc.
(b) Environmental modifications
exclude:
(A) Adaptations or improvements
to the home that are of general utility, such as carpeting, roof repair, and central
air conditioning, unless directly related to the assessed health and safety needs
of the individual and identified in the ISP for the individual;
(B) Adaptations that add
to the total square footage of the home except for ramps that attach to the home
for the purpose of entry or exit;
(C) Adaptations outside of
the home; and
(D) General repair or maintenance
and upkeep required for the home.
(c) Environmental modifications
must be tied to supporting assessed ADL, IADL, and health-related tasks as identified
in the needs assessment and ISP for an individual.
(d) Environmental modifications
are limited to $5,000 per modification. A 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 individual and the determination
by the Department of appropriateness and cost-effectiveness. In addition, separate
environmental modification projects that cumulatively total up to over $5,000 in
a plan year must be submitted to the Department for review.
(e) Environmental modifications
must be completed by a state licensed contractor with a minimum of $1,000,000 liability
insurance. Any modification requiring a permit must be inspected by a local inspector
and certified as in compliance with local codes. Certification of compliance must
be filed in the file for the contractor prior to payment.
(f) Environmental modifications
must be made within the existing square footage of the home, except for external
ramps, and may not add to the square footage of the home.
(g) Payment to the contractor
is to be withheld until the work meets specifications.
(h) A scope of work as defined
in OAR 411-330-0020 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 be the subject of legal proceedings regarding ownership.
(l) Environmental modifications
must only be completed to the primary residence of the individual.
(m) Upgrades in materials
that are not directly related to the health and safety needs of the individual are
not paid for or permitted.
(n) Environmental modifications
are subject to Department requirements regarding 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 SERVICES.
Attendant care services include direct support provided to an individual in the
home of the individual or community by a qualified personal support worker or provider
organization. ADL and IADL services provided through attendant care must support
the individual to live as independently as possible, and be based on the identified
goals, preferences, and needs of the individual.
(a) ADL services include,
but are not limited to:
(A) Basic personal hygiene
— providing or assisting with needs such as bathing (tub, bed, bath, shower),
hair care, grooming, shaving, nail care, foot care, dressing, skin care, or oral
hygiene;
(B) Toileting, bowel, and
bladder care — assisting to and from the bathroom, on and off toilet, commode,
bedpan, urinal, or other assistive device used for toileting, changing incontinence
supplies, following a toileting schedule, managing menses, cleansing an individual
or adjusting clothing related to toileting, emptying a catheter, drainage bag, or
assistive device, ostomy care, or bowel care;
(C) Mobility, transfers,
and repositioning — assisting with ambulation or transfers with or without
assistive devices, turning an individual or adjusting padding for physical comfort
or pressure relief, or encouraging or assisting with range-of-motion exercises;
(D) Nutrition — assisting
with adequate fluid intake or adequate nutrition, assisting with food intake (feeding),
monitoring to prevent choking or aspiration, assisting with adaptive utensils, cutting
food, and placing food, dishes, and utensils within reach for eating;
(E) Delegated nursing tasks;
(F) First aid and handling
emergencies — addressing medical incidents related to the conditions of an
individual, such as seizure, aspiration, constipation, or dehydration, responding
to the call of the individual for help during an emergent situation, or for unscheduled
needs requiring immediate response;
(G) Assistance with necessary
medical appointments — help scheduling appointments, arranging medical transportation
services, accompaniment to appointments, follow up from appointments, or assistance
with mobility, transfers, or cognition in getting to and from appointments; and
(H) Observation of the status
of an individual and reporting of significant changes to a physician, health care
provider, or other appropriate person.
(b) IADL services include,
but are not limited to:
(A) Light housekeeping tasks
necessary to maintain an individual in a healthy and safe environment — cleaning
surfaces and floors, making the individual's bed, cleaning dishes, taking out the
garbage, dusting, and laundry;
(B) Grocery and other shopping
necessary for the completion of other ADL and IADL tasks;
(C) Meal preparation and
special diets;
(D) Cognitive assistance
or emotional support provided to an individual due to an intellectual or developmental
disability — helping the individual cope with change and assisting the individual
with decision-making, reassurance, orientation, memory, or other cognitive functions;
(E) Medication and medical
equipment — assisting with ordering, organizing, and administering medications
(including pills, drops, ointments, creams, injections, inhalers, and suppositories),
monitoring an individual for choking while taking medications, assisting with the
administration of medications, maintaining equipment, or monitoring for adequate
medication supply; and
(F) Support in the community
around socialization and participation in the community:
(i) Support with socialization
— assisting an individual in acquiring, retaining, and improving self-awareness
and self-control, social responsiveness, social amenities, and interpersonal skills;
(ii) Support with community
participation — assisting an individual in acquiring, retaining, and improving
skills to use available community resources, facilities, or businesses; and
(iii) Support with communication
— assisting an individual in acquiring, retaining, and improving expressive
and receptive skills in verbal and non-verbal language and the functional application
of acquired reading and writing skills.
(c) Assistance with ADLs,
IADLs, and health-related tasks may include cueing, monitoring, reassurance, redirection,
set-up, hands-on, or standby assistance. Assistance may be provided through human
assistance or the use of electronic devices or other assistive devices. Assistance
may also require verbal reminding to complete any of the IADL tasks described in
subsection (b) of this section.
(A) "Cueing" means giving
verbal, audio, or visual clues during an activity to help an individual complete
the activity without hands-on assistance.
(B) "Hands-on" means a provider
physically performs all or parts of an activity because an individual is unable
to do so.
(C) "Monitoring" means a
provider observes an individual to determine if assistance is needed.
(D) "Reassurance" means to
offer an individual encouragement and support.
(E) "Redirection" means to
divert an individual to another more appropriate activity.
(F) "Set-up" means the preparation,
cleaning, and maintenance of personal effects, supplies, assistive devices, or equipment
so that an individual may perform an activity.
(G) "Stand-by" means a provider
is at the side of an individual ready to step in and take over the task if the individual
is unable to complete the task independently.
(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
an individual to acquire, maintain, or enhance independence.
(a) Skills training may be
applied to the use and care of assistive devices and technologies.
(b) Skills training is authorized
when:
(A) The anticipated outcome
of the skills training, as documented in the ISP, is measurable;
(B) Timelines for measuring
progress towards the anticipated outcome are established in the ISP; and
(C) Progress towards the
anticipated outcomes 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 individual for that
particular goal.
(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 seven consecutive days without permission
from the Department. No more than 14 days of relief care in a plan year are allowed
without approval from the Department.
(b) Relief care may include
both day and overnight services that may be provided in:
(A) The home of the individual;
(B) A licensed or certified
setting;
(C) The home of a qualified
provider, chosen by the individual or the representative of the individual, that
is a safe setting for the individual; or
(D) The community, during
the provision of ADL, IADL, health-related tasks, and other supports identified
in the ISP for the individual.
(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 with IHS funds
must be limited to the types of equipment and supplies that are not excluded under
OAR 410-122-0080.
(a) Assistive devices may
include the purchase of devices, aids, controls, supplies, or appliances primarily
and customarily used to enable an individual to increase the ability of the individual
to perform and support ADLs and IADLs or to perceive, control, or communicate within
the home and community environment in which the individual lives.
(b) Assistive devices may
be purchased with IHS funds when the intellectual or developmental disability of
an individual otherwise prevents or limits the independence of the individual in
areas identified in a functional needs assessment.
(c) Assistive devices that
may be purchased for the purpose described in subsection (b) of this section must
be of direct benefit to the individual and may include:
(A) Devices to secure assistance
in an emergency in the community and other reminders, such as medication minders,
alert systems for ADL or IADL supports, or mobile electronic devices; and
(B) Assistive devices, not
provided by any other funding source, to assist and enhance the independence of
an individual in performing ADLs or IADLs, such as durable medical equipment, mechanical
apparatus, or electronic devices.
(d) Expenditures for assistive
devices are limited to $5,000 per plan year without Department approval. Any single
purchase costing more than $500 must be approved by the Department prior to expenditure.
A 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 individual and a determination by the Department of appropriateness
and cost-effectiveness.
(e) Devices must be limited
to the least costly option necessary to meet the assessed need of an individual.
(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. and supplies furnished under OHP, the state plan, private
insurance, or alternative resources;
(B) Determined necessary
to the daily functions of the individual; and
(C) Directly related to the
disability of the individual.
(h) Assistive devices exclude:
(A) Items that are not necessary
or of direct medical benefit to the individual or do not address the underlying
need for the device;
(B) Items intended to supplant
similar items furnished under OHP, private insurance, or alternative resources;
(C) Items that are considered
unsafe for an individual;
(D) Toys or outdoor play
equipment; and
(E) Equipment and furnishings
of general household use.
(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,
including the expense necessary for the continued operation of the assistive technology.
(a) Expenditures for assistive
technology are limited to $5,000 per plan year without Department approval. Any
single purchase costing more than $500 must be approved by the Department prior
to expenditure. A 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 individual 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 home is safe for the individual
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 an individual to accomplish ADL, IADL, a health-related task,
or employment goal identified in an ISP; or
(C) Assistance with the purchase
of a bus pass.
(b) Community transportation
may only be authorized when natural supports or volunteer services are not available
and one of the following is identified in the ISP of the individual:
(A) The individual has an
assessed need for ADL, IADL, or health-related task during transportation; or
(B) The individual has either
an assessed need for ADL, IADL, or health-related task at the destination or a need
for waiver funded services at the destination.
(c) Community transportation
must be provided in the most cost effective manner which meets the needs identified
in the ISP for the individual.
(d) Community transportation
expenses exceeding $500 per month must be approved by the Department.
(e) Community transportation
must be prior authorized by a 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 vehicle
for community transportation are reimbursed as described in OAR chapter 411, division
375.
(f) Community transportation
services exclude:
(A) Medical transportation;
(B) Purchase or lease of
a vehicle;
(C) Routine vehicle maintenance
and repair, insurance and fuel;
(D) Ambulance services;
(E) Costs for transporting
a person other than the individual;
(F) Transportation for a
provider to travel to and from the workplace of the provider;
(G) Transportation that is
not for the sole benefit of the individual;
(H) Transportation to vacation
destinations or trips for relaxation purposes;
(I) Transportation provided
by family members who are not personal support workers and are not simultaneously
providing other paid supports at the time of the transportation;
(I) Payment to the spouse
of an individual receiving in-home support;
(J) Reimbursement for out-of-state
travel expenses; and
(K) Mileage reimbursement
for the vehicle of the supported individual.
(12) TRANSITION COSTS.
(a) Transition costs are
limited to an individual transitioning to the home or community-based setting where
the individual resides from a nursing facility, ICF/ID, or acute care hospital.
(b) Transition costs are
based on an the assessed need of an individual determined during the person-centered
service planning process and must support the desires and goals of the individual
receiving services and supports. Final approval for transition costs must be through
the Department prior to expenditure. The approval of the Department is based on
the need of an individual and the determination by the Department of appropriateness
and cost-effectiveness.
(c) Financial assistance
for transition costs is limited to:
(A) Moving and move-in costs,
including movers, cleaning and security deposits, payment for background or credit
checks (related to housing), or initial deposits for heating, lighting, and phone;
(B) Payment of previous utility
bills that may prevent the individual from receiving utility services and basic
household furnishings, such as a bed; and
(C) Other items necessary
to re-establish a home.
(d) Transition costs are
provided no more than twice annually.
(e) Transitions costs for
basic household furnishings and other items are limited to one time per year.
(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 an individual to increase the abilities
of the family to care for, support, and maintain the individual in the home of the
individual.
(a) Family training services
include:
(A) Instruction about treatment
regimens and use of equipment specified in an ISP;
(B) Information, education,
and training about the disability, medical, and behavioral conditions of an individual;
and
(C) Registration fees for
organized conferences and workshops specifically related to the intellectual or
developmental disability of the individual or the identified, specialized, medical,
or behavioral support needs of the individual.
(i) Conferences and workshops
must be prior authorized by a services coordinator, directly relate to the intellectual
or developmental disability of the individual, and increase the knowledge and skills
of the family to care for and maintain the individual in the home of the individual.
(ii) Conference and workshop
costs exclude:
(I) Travel, food, and lodging
expenses;
(II) Services otherwise provided
under OHP or available through other resources; or
(III) Costs for individual
family members who are employed to care for the individual.
(b) Family training services
exclude:
(A) Mental health counseling,
treatment, or therapy;
(B) Training for a paid provider;
(C) Legal fees;
(D) Training for a family
to carry out educational activities in lieu of school;
(E) Vocational training for
family members; and
(F) Paying for training to
carry out activities that constitute abuse of an adult.
(c) Prior authorization by
the CDDP is required for attendance by family members at organized conferences and
workshops funded with IHS funds.
(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 home that are of general utility and are not for the direct safety or long-term
benefit to the individual or do not address the underlying environmental need for
the modification; and
(D) Adaptations that add
to the total square footage of the home.
(d) Environmental safety
modifications must be tied to supporting ADL, IADL, and health-related tasks as
identified in the ISP.
(e) Environmental safety
modifications are limited to $5,000 per modification. A 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 individual and
the determination by the Department of appropriateness and cost-effectiveness. In
addition, separate environmental safety modification projects that cumulatively
total up to over $5,000 in a plan year must be submitted to the Department for review.
(f) Environmental safety
modifications must be completed by a state licensed contractor with a minimum of
$1,000,000 liability insurance. Any modification requiring a permit must be inspected
by a local inspector and certified as in compliance with local codes. Certification
of compliance must be filed in the file for the contractor prior to payment.
(g) Environmental safety
modifications must be made within the existing square footage of the home and may
not add to the square footage of the home.
(h) Payment to the contractor
is to be withheld until the work meets specifications.
(i) A scope of work as defined
in OAR 411-330-0020 must be completed for each identified environmental safety modification
project. All contractors submitting bids must be given the same scope of work.
(j) A 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 safety
modifications must only be completed to the primary residence of the individual.
(n) Upgrades in materials
that are not directly related to the health and safety needs of the individual are
not paid for or permitted.
(o) Environmental safety
modifications are subject to Department requirements regarding material and construction
practices based on industry standards for safety, liability, and durability, as
referenced in building codes, materials manuals, and industry and risk management
publications.
(p) RENTAL PROPERTY.
(A) Environmental safety
modifications to rental property may not substitute or duplicate services otherwise
the responsibility of the landlord under the landlord tenant laws, the Americans
with Disabilities Act, or the Fair Housing Act.
(B) Environmental safety
modifications made to a rental structure must have written authorization from the
owner of the rental property prior to the start of the work.
(C) The Department does not
fund work to restore the rental structure to the former condition of the rental
structure.
(16) VEHICLE MODIFICATIONS.
(a) Vehicle modifications
may only be made to the vehicle primarily used by an individual to meet the unique
needs of the individual. Vehicle modifications may include a lift, interior alterations
to seats, head and leg rests, belts, special safety harnesses, other unique modifications
to keep the individual safe in the vehicle, and the upkeep and maintenance of a
modification made to the vehicle.
(b) Vehicle modifications
exclude:
(A) Adaptations or improvements
to a vehicle that are of general utility and are not of direct medical benefit to
the individual or do not address the underlying need for the modification;
(B) The purchase or lease
of a vehicle; or
(C) Routine vehicle maintenance
and repair.
(c) Vehicle modifications
are limited to $5,000 per modification. A 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 individual and the determination
by the Department of appropriateness and cost-effectiveness. In addition, separate
vehicle modification projects that cumulatively total up to over $5,000 in a plan
year must be submitted to the Department for review.
(d) Vehicle modifications
must meet applicable standards of manufacture, design, and installation.
(17) SPECIALIZED MEDICAL
SUPPLIES. Specialized medical supplies do not cover services which are otherwise
available to an individual under Vocational Rehabilitation and Other Rehabilitation
Services, 29 U.S.C. 701-7961, as amended, or the Individuals with Disabilities Education
Act, 20 U.S.C. 1400 as amended. Specialized medical supplies may not overlap with,
supplant, or duplicate other services provided through a waiver, OHP, or Medicaid
state plan services.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 25-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13;
SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp), f. & cert.
ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0120
Abuse and Unusual Incidents
(1) ABUSE PROHIBITED. No adult or individual,
as defined by OAR 411-330-0020, shall be abused nor shall abuse be tolerated by
any employee, staff, or volunteer of an individual, provider organization, or CDDP.
(2) UNUSUAL INCIDENTS.
(a) A written report that
describes any injury, accident, act of physical aggression, or unusual incident
involving an individual and a CDDP employee must be prepared at the time of the
incident and placed in the individual's service record. The report must include:
(A) Conditions prior to,
or leading to, the incident;
(B) A description of the
incident;
(C) Staff response at the
time; and
(D) Administrative review
and follow-up to be taken to prevent recurrence of the injury, accident, physical
aggression, or unusual incident.
(b) The CDDP must notify
the Department immediately of an incident or allegation of abuse falling within
the scope of OAR 407-045-0260.
(A) When an abuse investigation
has been initiated, the CDDP must provide notification in accordance with OAR 407-045-0290.
(B) When an abuse investigation
has been completed, the CDDP must provide notification in accordance with OAR 407-045-0320.
(c) In the case of a serious
illness, injury, or death of an individual, the CDDP must immediately notify the
individual's legal or designated representative, parent, next of kin, and designated
contact person, as applicable.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 60-2013, f. 12-27-13, cert. ef. 12-28-13
411-330-0130
Complaints, Notification of Planned Action,
and Hearings
(1) 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.
(2) NOTIFICATION OF PLANNED
ACTION. In the event that a developmental disability service is denied, reduced,
suspended, or terminated, a written advance Notification of Planned Action (form
SDS 0947) must be provided as described in OAR 411-318-0020.
(3) HEARINGS.
(a) Hearings must be addressed
in accordance with ORS Chapter 183 and OAR 411-318-0025.
(b) An individual may request
a hearing as provided in ORS Chapter 183 and OAR 411-318-0025.
(c) 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 411-320-0175.
[Publications: Publications referenced
are available from the agency.]
Stat. Auth.: ORS 409.050
&430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13; APD 25-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0140
In-Home Support Service Operation
(1) PERSONNEL POLICIES AND PRACTICES.
The CDDP must maintain up-to-date written position descriptions for all services
coordinators coordinating in-home support that includes written documentation of
the following for each staff person:
(a) Reference checks and
confirmation of qualifications prior to hire;
(b) Satisfactory completion
of basic orientation, including mandatory abuse reporting training;
(c) Satisfactory completion
of job-related in-service training;
(d) Department approval to
work based on a background check;
(e) Notification and acknowledgement
of mandatory abuse reporter status;
(f) Any founded reports of
child abuse or substantiated adult abuse;
(g) Any grievances filed
against the staff person and the results of the grievance process, including, if
any, disciplinary action; and
(h) Legal U.S. worker status.
(2) SERVICES COORDINATOR
TRAINING. The CDDP must provide or arrange for services coordinators to receive
training needed to provide or arrange for the in-home support.
(3) RECORD REQUIREMENTS.
The CDDP must maintain records in compliance with this rule, OAR 411-320-0070, applicable
state and federal law, and other state rules regarding audits and clinical records
and confidentiality.
(a) DISCLOSURE AND CONFIDENTIALITY.
For the purpose of disclosure from individual medical records under these rules,
the CDDPs are considered "providers" as defined in ORS 179.505(1) and ORS 179.505
is applicable.
(A) Access to records by
the Department does not require authorization by an individual or the legal or designated
representative or family of the individual.
(B) For the purposes of disclosure
of non-medical individual records, all or portions of the information contained
in the non-medical individual records may be exempt from public inspection under
the personal privacy information exemption to the public records law set forth in
ORS 192.502(2).
(b) INDIVIDUAL RECORDS. The
CDDP must maintain, and make available on request for Department review, up-to-date
records for each individual receiving in-home support. These records must include:
(A) An easily-accessed summary
of basic information including individual name, family name (if applicable), name
of the legal or designated representative of the individual(as applicable), or conservator
of the individual (if applicable), address, telephone number, date of entry into
services, date of birth, gender, marital status, and individual financial resource
information.
(B) Records related to receipt
and disbursement of public and private support funds including expenditure authorizations,
expenditure verification, copies of CPMS expenditure reports, verification that
providers meet requirements of OAR 411-330-0070, and documentation that the individual,
and as applicable the legal or designated representative of the individual, understand
and accept or delegate record keeping responsibilities outlined in this rule;
(C) Incident reports involving
CDDP staff;
(D) Assessments used to determine
supports required, preferences, and resources;
(E) ISP and reviews;
(F) Services coordinator
correspondence and notes related to resource development and plan outcomes; and
(G) Customer satisfaction
information.
(c) SPECIAL REQUIREMENTS
FOR IHS DIRECT ASSISTANCE EXPENDITURES. The CDDP must develop and implement written
policies and procedures concerning use of IHS funds to purchase goods and services
to meet the supports needs of an individual that are described in the ISP. These
policies and procedures must include, but are not limited to:
(A) Minimum acceptable records
of expenditures and under what conditions these records must be maintained by the
individual, or as applicable the legal or designated representative or family of
the individual:
(i) Itemized invoices and
receipts to record the purchase of any single item;
(ii) A trip log indicating
purpose, date, and total miles to verify vehicle mileage reimbursement;
(iii) Signed contracts and
itemized invoices for any services purchased from independent contractors and business
providers;
(iv) Pay records to record
employee services, including timesheets signed by both employee and employer; and
(v) Documentation that services
provided were consistent with the authorized ISP for an individual.
(B) Return of purchased goods.
(i) Any goods purchased with
IHS funds that are not used according to an ISP or according to an agreement securing
the use of the state may be immediately recovered.
(ii) Failure to furnish written
documentation upon written request from the Department, the Oregon Department of
Justice Medicaid Fraud Unit, or Centers for Medicare and Medicaid Services, or as
applicable their authorized representatives, immediately or within timeframes specified
in the written request, may be deemed reason to recover payments or deny further
assistance.
(d) GENERAL FINANCIAL POLICIES
AND PRACTICES. The CDDP must:
(A) Maintain up-to-date accounting
records accurately and consistent with generally accepted accounting principles
that reflect all revenue by source, all expenses by object of expense, and all assets,
liabilities, and equities.
(B) Develop and implement
written statements of policy and procedure as are necessary and useful to assure
compliance with any Department administrative rule pertaining to fraud and embezzlement.
(e) RECORDS RETENTION. Records
must be retained in accordance with OAR chapter 166, Secretary of State, Archives
Division.
(A) Financial records, supporting
documents, statistical records, and all other records (except individual records)
must be retained for at least three years after the close of the contract period,
or until audited.
(B) Individual records must
be kept for at least seven years.
(4) OTHER OPERATING POLICIES
AND PRACTICES. 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.
[Publications: Publications referenced
are available from the agency.]
Stat. Auth.: ORS 409.050
&430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 60-2013, f. 12-27-13, cert. ef. 12-28-13;
APD 43-2014, f. 12-26-14, cert. ef. 12-28-14
411-330-0150
Quality Assurance
The CDDP must participate in statewide
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 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13
411-330-0160
Inspections and Investigations
(1) The CDDP must allow the following
types of investigations and inspections to be performed by the Department, or other
proper authority:
(a) Quality assurance and
on-site inspections;
(b) Complaint investigations;
and
(c) Abuse investigations.
(2) Any inspection or investigation
may be unannounced.
(3) All documentation and
written reports required by these rules must be:
(a) Open to inspection and
investigation by the Department or other proper authority; and
(b) Submitted to or be made
available for review by the Department, or other proper authority within the time
allotted.
(4) When abuse is alleged
or death of an individual has occurred and a law enforcement agency or the Department
has determined to initiate an investigation, the CDDP may not conduct an internal
investigation without prior authorization from the Department. For the purposes
of this section, an internal investigation is defined as:
(a) Conducting interviews
of the alleged victim, witness, the accused person, or any other person who may
have knowledge of the facts of the abuse allegation or related circumstances;
(b) Reviewing evidence relevant
to the abuse allegation other than the initial report; or
(c) Any other actions beyond
the initial actions of determining:
(A) If there is reasonable
cause to believe that abuse has occurred;
(B) If the alleged victim
is in danger or in need of immediate protective services;
(C) If there is reason to
believe that a crime has been committed; or
(D) What, if any, immediate
personnel actions must be taken.
(5) Abuse investigations
must be completed as described in OAR 407-045-0250 to OAR 407-045-0360 and must
include an Abuse Investigation and Protective Services Report according to OAR 407-045-0320.
(6) Upon completion of the
abuse investigation by the Department, the Department's designee, or a law enforcement
agency, the CDDP may conduct an investigation without further Department approval
to determine if any other personnel actions are necessary.
(7) Upon completion of the
Abuse Investigation and Protective Service Report, according to OAR 407-045-0330,
the sections of the report that are public records and not exempt from disclosure
under the public records law must be provided to the appropriate service provider.
(8) The provider must implement
the actions necessary within the deadlines listed, to prevent further abuse as stated
in the report.
(9) A plan of improvement
must be submitted to the Department for any noncompliance found during an inspection
under this rule.
Stat. Auth.: ORS 409.050 &430.662
Stats. Implemented: ORS 427.005,
427.007, 430.610, 430.620, 430.662 - 430.670
Hist.: SPD 21-2003, f. 12-22-03,
cert. ef. 12-28-03; 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 60-2013, f. 12-27-13, cert. ef. 12-28-13
411-330-0170
Variances
(1) A variance may be granted to a CDDP
if the CDDP lacks the resources needed to implement the standards required in these
rules, if implementation of the proposed alternative services, methods, concepts,
or procedures shall result in services or systems that meet or exceed the standards
in these rules, or if there are other extenuating circumstances. OAR 411-330-0060(6)
and 411-330-0110 are specifically excluded from variance.
(2) 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) The alternative practice,
service, method, concept, or procedure proposed;
(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 an individual's service, evidence that the variance is consistent with the individual's
current ISP.
(3) The Department's director
may approve or deny the request for a variance. The director's decision is final.
(4) The Department must notify
the CDDP of the Department's decision. The decision notice must be sent within 45
calendar days of the receipt of the request by the Department with a copy sent to
all relevant Department programs or offices.
(5) 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 21-2003, f. 12-22-03,
cert. ef. 12-28-03; SPD 60-2013, f. 12-27-13, cert. ef. 12-28-13

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