Division 40

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_411/411_040.html
Published: 2015

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

 

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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

DIVISION 40

MEDICAID FUNDED HOME DELIVERED
MEALS
411-040-0000
Purpose and Scope
(1) Medicaid home delivered meals may
be provided to eligible seniors and people with disabilities as part of a Medicaid
long term care services plan to assist a participant to remain in their own home.
Provision of home delivered meals reduces the reliance on paid staff during some
meal times.
(2) Home delivered meals
are available to eligible participants who choose to receive these services in lieu
of meal preparation services.
Stat. Auth.: ORS 410.070, 411.060 &
411.070
Stats. Implemented: ORS 410.070
Hist.: SSD 11-1982, f. &
ef. 10-1-82; SPD 12-2004, f. & cert. ef. 6-1-04; SPD 26-2011(Temp), f. &
cert. ef. 12-20-11 thru 6-13-12; Administrative correction, 6-27-12; SPD 14-2013(Temp),
f. & cert. ef. 7-1-13 thru 12-28-13; SPD 44-2013, f. 12-13-13, cert. ef. 12-15-13;
APD 14-2014, f. & cert. ef 6-4-14
411-040-0010
Definitions
Unless the context indicates otherwise,
the following definitions apply to the rules in OAR chapter 411, division 040:
(1) "Approved Carrier" means
the United States Postal Service, or other carrier, who can ensure providers have
passed criminal background checks to protect the well-being of the Medicaid eligible
participant. Use of an Approved Carrier must be approved by the Department, Aging
and People with Disabilities or the Area Agency on Aging (AAA).
(2) “Client Liability”
means the dollar amount participants with excess income must contribute to the cost
of service pursuant to OAR 461-160-0610 and 461-160-0620.
(3) "Department" means the
Department of Human Services (DHS).
(4) "Homebound" means that
leaving home is a significant effort to the point that leaving home unassisted is
not normally possible.
(5) "Home Delivered Meals"
means meals that are delivered to a Medicaid eligible participant in their own home
or apartment per 411-040-0035 of this rule.
(6) "Meal preparation" means
safely preparing food as defined in 411-015-0007(6).
(7) "Medicaid eligible individual"
means a participant who meets the eligibility criteria defined in OAR 411-015-0000
through 411-015-0100.
(8) "Medicaid Home Delivered
Meal Provider" means an approved home delivered meal provider that meets the qualifications
in these rules and has an active Medicaid provider number.
(9) "Natural Supports" means
resources and supports (e.g. relatives, friends, significant others, neighbors,
roommates, or the community) who are willing to voluntarily provide services to
an individual without the expectation of compensation. Natural supports are identified
in collaboration with the individual and the potential "natural support". The natural
support is required to have the skills, knowledge and ability to provide the needed
services and supports.
(10) "Nutrition education"
means a program to promote better health by providing accurate and culturally sensitive
nutrition, physical fitness, or health (as it relates to nutrition) information
and instruction to participants, caregivers, or participants and caregivers in a
group or individual setting overseen by a dietitian or individual of comparable
expertise.
(11) “Nutrition screening
survey" means the act of screening a participant’s nutrition risk.
(12) "Participant" means
a Medicaid eligible individual receiving Medicaid home delivered meals.
(13) "Provider" means Medicaid
home delivered meal provider.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0020
Client Eligibility and Responsibilities
(1) To be eligible for Medicaid home
delivered meals a participant must:
(a) Be Medicaid eligible
per 411-015-0100, and be receiving Medicaid long term services and supports in their
own home;
(b) Be home-bound;
(c) Be unable to do meal
preparation on a regular basis without assistance; and
(d) Not have natural supports
available that are willing and able to provide meal preparation services.
(2) To remain eligible for
home delivered meals, participants are responsible for payment of their specified
monthly client liability amount so home-delivered meals can be authorized.
(3) If the participant is
determined ineligible for Medicaid home delivered meals, but needs food assistance,
the case manager shall refer the participant to the nearest Aging and Disability
Resource Connection for assistance.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0030
Medicaid Home Delivered Meal Provider Qualifications
and Responsibilities
(1) To be in alignment with the provision
of services, home delivered meal providers must have contracts with, or be, an AAA
as defined in 411-002-0100(1).
(2) The provider must be
in compliance, during all stages of food service operation, with applicable federal,
state and local regulations, codes, and licensor requirements relating to fire;
health; sanitation; safety; building and other provisions relating to the public
health, safety, and welfare of meal patrons.
(3) The provider must demonstrate
that menu standards are developed to sustain and improve a participant’s health
through the provision of safe and nutritious meals that are approved by a dietician.
(4) Each provider must be
an enrolled Medicaid provider approved to provide Medicaid home delivered meals.
(5) The provider must ensure
that all requirements in OAR 411-040-0035 through 411-040-0037 are met.
(6) Providers must ensure
that anyone who delivers meals:
(a) Have passed a background
check as defined in OAR 407-007-0275; or
(b) Uses an approved carrier.
(7) All requests for Medicaid
home delivered meals received by the provider must be referred to the Department
or the Medicaid AAA office for prior authorization.
(8) Meal providers must not
solicit program income or voluntary donations from Medicaid eligible participants.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0035
Meal Requirements
(1) Each meal served must meet the current
United States Department of Agriculture and Health and Human Services Dietary Guidelines
and contain at least 33-1/3 percent of the current Dietary Reference Intakes as
established by the Food and Nutrition Board of the National Academy of Science-National
Research Council.
(2) Foods must be prepared,
served, and transported:
(a) With the least possible
manual contact;
(b) With suitable utensils;
and
(c) On surfaces that have
been cleaned, rinsed, and sanitized to prevent cross contamination prior to use.
(3) Meals may be hot, cold,
frozen, dried, or canned with a satisfactory storage life.
(4) Meal frequency.
(a) In areas where the frequency
of serving meals five or more days per week is not feasible, per the area plan,
nutrition providers have the ability to provide meals at less frequent intervals.
(b) For participants whose
case managers have assessed the participant as having low risks, during the Medicaid
Risk Assessment process and as part of the individualized service plan, the provider
may be authorized to provide frozen meals not to exceed 31 days’ worth of
meals.
(5) All providers will have
a safety plan to ensure participants will receive meals during emergencies, weather-related
conditions, and natural disasters. Plans could include, but are not limited to,
shelf-stable emergency meal packages, four-wheel drive vehicles, and volunteer arrangements
with other community resources.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0036
Service Requirements
(1) Except as provided in subsection
(2), providers must provide:
(a) In-person delivery whereby
a paid staff or volunteer delivers the meal to the participant’s home. To
the extent possible, the staff or volunteers must report any changes in participant’s
condition or concerns to the participant’s case manager.
(b) Nutrition screening survey.
(A)The nutrition screening
survey must be designed to indicate signs of poor nutritional health. In situations
in which the screening shows that the individual has poor nutritional health, the
provider will contact the participant’s Medicaid case manager.
(B) Nutrition screening surveys
will be completed at intake and at annual updates.
(c) Nutrition education.
(A) Nutrition education will
be provided a minimum of one time per year.
(B) Nutrition education is
required to be offered at the first nutrition risk assessment.
(2) In situations where the
AAA has approved alternative delivery carriers, the home delivered meal provider
must have weekly contact with the participant to determine if there are any changes
in condition or concerns.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0037
Staff and Volunteer Requirements
(1) Prior to having direct contact with
participants, staff and volunteers must successfully pass a criminal background
check.
(2) All staff and volunteers
involved in food preparation will have training in:
(a) Portion control;
(b) FDA Food Code practices
for sanitary handling of food;
(c) Oregon food safety requirements;
and
(d) Agency safety policies
and procedures.
(3) All staff and volunteers
having direct contact with a participant will have training in:
(a) Protecting confidentiality;
(b) How to report concerns,
which may include: change of condition; self-neglect, and abuse, to appropriate
staff for follow-up; and
(c) When to report to the
case manager any participants considered high risk, as a result of the nutrition
risk assessment.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0040
Provider Payment
(1) Providers will be reimbursed on
a per meal basis, no more than 1 meal per day within the month.
(2) Provider rates will be
published on the Department’s rate table.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0050
Local Office Responsibility and Oversight
(1) The Department shall establish,
authorize, purchase, and monitor the standards for Medicaid paid home delivered
meals.
(2) Case managers must authorize
Medicaid home delivered meal services.
(3) Subsequent yearly nutrition
education:
(a) May be determined by
local Medicaid home delivered meal providers; and
(b) Will be monitored by
the Medicaid case manager at least annually.
(4) Provision of the home
delivered meals reduces the need for reliance on paid staff during some meal times,
so meal preparation hours in the service plan must be reduced.
(5) The Department shall
make payments to Medicaid paid home delivered meal providers for all home-delivered
meals provided to participants.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14
411-040-0060
Impact on Client Liability
(1) The cost for home delivered meals
shall be calculated into the service plan, in addition to in-home services provided
by a client-employed provider or a home care agency.
(2) Participants required
to make a client contribution, under OAR 461-185-0050, must have their home-delivered
meal costs added to cost of care calculations.
Stat. Auth.: ORS 410.070, 411.060, &
411.070
Stats. Implemented: ORS 410.070
Hist.: APD 14-2014, f. &
cert. ef 6-4-14

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