Current through Register Vol. 63, No. 3, March 1, 2024
(1)
QUALIFICATIONS. An independent provider who is qualified to provide services
must meet the following requirements:
(a) Be
at least 18 years of age.
(b) Have
approval to work based on a background check and final fitness determination
completed by the Department as described in OAR 407-007-0200 through
407-007-0370 and section (3) of this rule.
(c) Not have been convicted of any of the
disqualifying crimes listed in ORS
443.004, unless hired or
contracted with prior to July 28, 2009 and remaining in the original position
for which the independent provider was hired or contracted.
(d) Be legally eligible to work in the United
States.
(e) Demonstrate by
background, education, references, skills, and abilities, the independent
provider is capable of safely and adequately performing the tasks specified in
an ISP or Service Agreement, with such demonstration of the following confirmed
in writing by the individual, or as applicable their legal or designated
representative:
(A) Ability and sufficient
education to follow oral and written instructions and keep any required
records.
(B) Possess the physical
health, mental health, good judgment, and good personal character determined
necessary to deliver services.
(C)
Ability to communicate with the individual.
(D) Training of a nature and type sufficient
to ensure the independent provider has knowledge of emergency procedures
specific to the individual.
(f) Maintain confidentiality and safeguard
individual information. An independent provider may not share any personal
information about the individual, including medical, social service, financial,
public assistance, legal, or other personal details, unless given specific
permission by the individual or as applicable their legal
representative.
(g) Not be on the
list of excluded or debarred providers maintained by the Office of the
Inspector General (
http://exclusions.oig.hhs.gov/).
(h) Complete and submit a Provider Enrollment
Agreement to the Department and possess a current provider number issued by the
Department. A Provider Enrollment Agreement must be renewed 70 calendar days
prior to the end date of the current Provider Enrollment Agreement unless the
provider enrollment is terminated or inactivated by the Department.
(i) Have a Taxpayer 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.
(j) Possess a
current and unencumbered license if providing services requiring specific
professional education, training, and skill. The individual, or as applicable
their designated or legal representative or the case management entity, must
check the status of the professional license to verify the license is current
and unencumbered.
(k) If
transporting an individual, have a valid driver's license and proof of
insurance, as well as any other license or certification required under state
and local law depending on the nature and scope of the transportation. Copies
of a valid driver's license and proof of insurance, as well as any other
license or certification (if applicable), must be provided to a case management
entity upon authorization of community transportation and as
requested.
(l) Additional
qualifications required by applicable program rules relevant to the services
being delivered.
(m) Personal
support workers must complete mandatory training and competency evaluation
requirements outlined in OAR chapter 418, division 020.
(2) EXCLUSIONS. An independent provider may
not be authorized to deliver services to an individual in any of the following
circumstances:
(a) The independent provider is
an employee of ODDS, the Office of Administrative Hearings, or the Oregon Home
Care Commission.
(b) The
independent provider is an employee of the case management entity that delivers
services to the individual unless the following apply:
(A) The independent provider was authorized
to deliver services as a personal support worker before July 1, 2022;
and
(B) The case management entity
maintains a conflict of interest policy and monitors the employee for conflict
of interest.
(c) The
individual is a child and the independent provider is the parent of the child
unless, for the duration of the COVID-19 public health emergency, the parent
meets the qualifications in section (1) of this rule, resides with the child,
and the child:
(A) Meets the enrollment
criteria for any of the Children's Intensive In-Home Services programs;
or
(B) Has a service level of at
least 240 hours per month.
(d) The independent provider is the legal
representative of the individual and has not appointed a designated
representative to plan supports for the individual.
(e) The independent provider is the
designated representative of the individual.
(f) The independent provider is the spouse of
the individual.
(g) The independent
provider is the common law employer or the proxy of the common law employer of
the individual.
(h) The independent
provider is the case manager for the individual.
(i) The independent provider is concurrently
engaged to deliver services for the individual for new or renewed
authorizations of services starting after January 1, 2020:
(A) As an employee of an agency certified
under OAR chapter 411, division 323 providing community living supports skills
training or attendant care services other than day support activities as
defined in OAR chapter 411, division 450; or
(B) As a caregiver of an adult foster home
licensed according to OAR chapter 411, division 360.
(3) BACKGROUND CHECKS.
(a) A subject individual as defined in OAR
407-007-0210 may be approved for one position to work statewide when the
subject individual is working in the same employment role with the same
population. The Background Check Request Form must be completed by the subject
individual to show intent to work statewide.
(b) When an independent provider is approved
without restrictions following a background check final fitness determination,
the approval must meet the provider enrollment requirements for the employment
role of the independent provider.
(c) Background check approval is effective
for two years from the date of fitness determination to provide services except
in one or more of the following circumstances:
(A) A new fitness determination is conducted
resulting in a change in approval status.
(B) The Department has terminated the
provider enrollment for the independent provider.
(d) A case management entity may conduct a
background recheck if additional information about an independent provider,
such as possible criminal activity or other allegations, is discovered or
reported to the case management entity or the Department.
(e) An independent provider must self-report
any potentially disqualifying crimes under OAR 407-007-0281 and potentially
disqualifying conditions under OAR 407-007-0290 to the case management entity
within 24 hours.
(4)
ENROLLMENT RESPONSIBILITIES.
(a) The
Department may deny provider enrollment in any of the following circumstances:
(A) The applicant has been suspended or
terminated as a provider by another division within the Department or by the
Oregon Health Authority.
(B) The
applicant has a history of violating the protective service and abuse rules or
has a founded report of child abuse or substantiated adult abuse.
(C) The applicant has committed fiscal
improprieties.
(D) The applicant
has demonstrated a lack of skills, knowledge, or ability to adequately or
safely provide services.
(E) The
applicant has an unacceptable background check or the background check results
in a closed case pursuant to OAR 407-007-0320.
(F) The applicant is on the list of excluded
or debarred providers maintained by the Office of the Inspector General (
http://exclusions.oig.hhs.gov/).
(G) The case management entity has
documentation that the applicant is not capable of performing required services
in a professionally competent, safe, legal, or ethical manner.
(H) The Taxpayer Identification Number or
Social Security number for the applicant does not match the legal name of the
applicant as verified by the Internal Revenue Service or Social Security
Administration.
(b)
CONTINUED ENROLLMENT.
(A) An independent
provider is responsible for maintaining an active provider number by:
(i) Completing and submitting a new Provider
Enrollment Agreement to the Department at least 70 calendar days prior to the
end date of the Provider Enrollment Agreement.
(ii) Completing and submitting a Background
Check Request Form and receiving approval to work by the Department at least 70
calendar days prior to the end of the background check approval
period.
(iii) Completing and
submitting properly completed paperwork at the request of the Department that
is required to receive payment.
(iv) Maintaining valid contact information
with the Department including current address, email address, and telephone
number.
(v) Completing and
submitting required paperwork at the request of the Department.
(B) An independent provider is
responsible to attend trainings and maintain certifications as required by
applicable program rules.
(C) A
personal support worker must complete mandatory training and competency
evaluation requirements outlined in OAR chapter 418, division 020.
(5) An individual, or
as applicable their legal or designated representative, has the right to choose
any independent provider who meets all additional program qualifications for
the services to be delivered and is enrolled as a provider as described in this
rule.
(6) PERSONAL SUPPORT WORKERS.
(a) ORIENTATION. A personal support worker
must complete orientation by the timelines specified in OAR chapter 418,
division 020.
(b) RESTRICTED
PERSONAL SUPPORT WORKER PROVIDER ENROLLMENT.
(A) The Department may enroll an applicant as
a restricted personal support worker. A restricted personal support worker may
only provide services to a specific individual who is a family member,
neighbor, or friend.
(i) After conducting a
weighing test as described in OAR 407-007-0200 through 407-007-0370, the
Department may approve a restricted enrollment for an applicant with a prior
criminal record, unless according to OAR 407-007-0275 the applicant has been
found ineligible due to ORS
443.004.
(ii) The Department may approve a restricted
enrollment for an applicant based on their lack of skills, knowledge, or
ability to adequately or safely provide services.
(B) To remove restricted personal support
worker status, the applicant must complete a new application and background
check and be approved by the Department.
(c) ENHANCED AND EXCEPTIONAL PERSONAL SUPPORT
WORKERS.
(A) ENHANCED PERSONAL SUPPORT
WORKERS.
(i) A personal support worker must be
certified by the Oregon Home Care Commission as an enhanced personal support
worker to deliver services to individuals who require advanced medically-driven
services and supports or behaviorally-driven services and supports, as
identified by a functional needs assessment.
(ii) Enhanced personal support workers are
paid for providing ADL and IADL services at the enhanced personal support
worker rate set forth in the Collective Bargaining Agreement. The enhanced
personal support worker rate is effective the first day of the month following
the month in which both:
(I) The personal
support worker is certified by the Oregon Home Care Commission to deliver
services.
(II) The outcome of the
functional needs assessment for an individual indicates the need for assistance
with advanced medically-driven services and supports or behaviorally-driven
services and supports.
(B) EXCEPTIONAL PERSONAL SUPPORT WORKER.
(i) A personal support worker must be
certified by the Oregon Home Care Commission as an exceptional personal support
worker to deliver services to individuals who require assistance with extensive
medically-driven services and supports or behaviorally-driven services and
supports, as identified by a functional needs assessment.
(ii) Exceptional personal support workers are
paid for providing ADL and IADL services at the exceptional personal support
worker rate set forth in the Collective Bargaining Agreement. The exceptional
personal support worker rate is effective the first day of the month following
the month in which both:
(I) The personal
support worker is certified by the Oregon Home Care Commission to deliver
services.
(II) The outcome of the
functional needs assessment for an individual indicates the need for assistance
with extensive medically-driven services and supports or behaviorally-driven
services and supports, and at least 20 hours per day of attendant care support
excluding 2:1 support hours.
(C) A personal support worker who has been
certified by the Oregon Home Care Commission to provide enhanced or exceptional
supports may not receive the enhanced or exceptional rate when providing
services to an individual whose functional needs assessment does not indicate
the need for assistance with advanced or extensive medically-driven services
and supports or behaviorally-driven services and supports, except as required
by the Collective Bargaining Agreement.
Statutes/Other Implemented: ORS
409.010,
410.598,
410.600,
410.606-410.619 &
427.007