Current through Register Vol. 63, No. 3, March 1, 2024
(1) The following
ancillary services are available through the Community First Choice state plan:
(a) Assistive devices as described in section
(3) of this rule.
(b) Assistive
technology as described in section (4) of this rule.
(c) Chore services as described in section
(5) of this rule.
(d) Community
nursing services as described in section (6) of this rule.
(e) Community transportation as described in
section (7) of this rule.
(f)
Environmental modifications as described in section (8) of this rule.
(g) Professional behavior services as
described in OAR chapter 411, division 304.
(h) Transition costs as described in section
(9) of this rule.
(2)
Assistive devices, assistive technology, community transportation,
environmental modifications, and professional behavior services may also be
available through family support funds within the service limits described in
OAR 411-305-0230.
(3) ASSISTIVE
DEVICES. Assistive devices are primarily and customarily used to assist and
maximize an individual's independence in performing an ADL, IADL, or
health-related task. The purchase, rental, or repair of an assistive device
with Department funds must be limited to the types of equipment and accessories
not excluded under OAR 410-122-0080.
(a)
Assistive devices include equipment, mechanical apparatuses, electrical
appliances, or instruments of technology, including but not limited to:
(A) Bath chairs.
(B) Mobility aids.
(C) Clocks or timers.
(D) Adaptive utensils.
(E) Adaptive switches.
(b) Prior Department approval is required for
assistive device expenditures that are over $5,000 per device, per plan year
that are funded through the Community First Choice state plan.
(c) Any single purchase costing more than
$1,200, or any combination of items that meet a single assessed need totaling
more than $1,200, must be approved by the Department prior to
expenditure.
(d) Approval is based
on the service and support needs and goals of an individual and a determination
by the Department of appropriateness and cost-effectiveness.
(4) ASSISTIVE TECHNOLOGY Assistive
technology is primarily and customarily used to provide additional security and
support, reduce or replace the need for direct intervention, enable
self-direction of care, or maximize independence.
(a) Assistive technology includes, but is not
limited to the following:
(A) Motion or sound
sensors.
(B) Two-way communication
systems.
(C) Automatic faucets and
soap dispensers.
(D) Incontinence
and fall sensors.
(E) Devices to
secure assistance in an emergency in the community.
(F) Medication minders.
(G) Alert systems for ADL or IADL
support.
(H) Mobile electronic
devices or other electronic back-up systems, including the expense necessary
for the continued operation of the assistive technology.
(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
may include batteries or back-up generators to maintain electronic back-up
systems, assistive technology, or assistive devices funded by the Department
during a power outage.
(B) Ongoing
costs may include data plans, electronic application subscriptions, and the
services of a company to monitor emergency response systems.
(c) Prior Department approval is
required for assistive technology expenditures that are over $5,000 per device,
per plan year that are funded through the Community First Choice state
plan.
(d) Any single purchase
costing more than $1,200, or any combination of items that meet a single
assessed need totaling more than $1,200, must be approved by the Department
prior to expenditure.
(e) Approval
is based on the service and support needs and goals of an individual and a
determination by the Department of appropriateness and
cost-effectiveness.
(5)
CHORE SERVICES.
(a) To be eligible to access
chore services an individual must not be enrolled in a residential program,
unless the enrollment is in a supported living program described in OAR chapter
411, division 328 and the dwelling is not a provider owned, controlled, or
operated setting.
(b) Chore
services include heavy household chores, such as the following:
(A) Washing floors, windows, and
walls.
(B) Tacking down loose rugs
and tiles.
(C) Moving heavy items
of furniture for safe access and egress.
(D) Removal of hazardous debris in the
home.
(c) Chore services
may include yard hazard removal to ensure the outside of a home is safe for an
individual to traverse and enter and exit the home.
(6) COMMUNITY NURSING SERVICES.
(a) In addition to the general eligibility
criteria listed in OAR 411-435-0030, to access community nursing services, an
individual may not be enrolled in a 24-hour residential program under OAR
chapter 411, division 325. An individual enrolled in a supported living program
under OAR chapter 411, division 328 is eligible to access community nursing
services when the cost of the service is not included in the rate paid to the
provider.
(b) Community nursing
services include the following:
(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.
(G) Collateral contact
with a case manager 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.
(c) Community nursing services exclude the
direct nursing services described in OAR chapter 411, division 380 and the
private duty nursing services described in OAR chapter 411, division
300.
(d) A Nursing Service Plan
must exist if Department funds are used for community nursing services. A case
manager must authorize the provision of community nursing services as
identified in an ISP.
(e) After an
initial nursing assessment, a nursing reassessment must be completed every six
months or sooner if a change in a medical condition requires an update to the
Nursing Service Plan.
(7) COMMUNITY TRANSPORTATION.
(a) Community transportation may only be
authorized on an ISP when:
(A) An individual
meets the general eligibility criteria in OAR 411-435-0030.
(B) Voluntary natural supports or volunteer
services are not available.
(C) The
individual is not enrolled in a residential program.
(D) It is not the responsibility of the
parent of a child.
(E) The
individual has one of the following identified in their ISP:
(i) An assessed support need for an ADL,
IADL, or health-related task during transportation.
(ii) An assessed support need for an ADL,
IADL, or health-related task at the destination or a need for waiver-funded
services at the destination.
(b) Community transportation includes, but is
not limited to the following:
(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 an ADL, IADL, health-related task, or
employment goal identified in an ISP.
(C) The purchase of a bus pass.
(c) Community transportation must
be provided in the most cost-effective manner to meet the needs identified in
the ISP for an individual.
(d)
Community transportation expenses exceeding $500 per month must be approved by
the Department.
(e) Community
transportation must be prior authorized by a case manager 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 case
manager 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)
Mileage reimbursement for community transportation is only authorized when a
provider is also being paid for delivering community living supports or job
coaching. Mileage may not be authorized as a stand-alone payment.
(g) Community transportation services exclude
the following:
(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 not
for the sole benefit of the individual.
(H) Transportation as part of a vacation or
trips for relaxation purposes.
(I)
Transportation provided by family members who are not personal support
workers.
(J) Reimbursement for
out-of-state travel expenses.
(K)
Mileage reimbursement to the individual or a personal support worker when the
individual owns the vehicle doing the transportation.
(L) Transportation normally provided by
schools.
(M) Transportation
normally provided by a primary caregiver for a child of similar age without
disabilities.
(N) Transportation
for a child typically the responsibility of a parent. Transportation for a
child not typically a parental responsibility is limited to transportation:
(i) Concurrent with the delivery of relief
care as described in OAR 411-450-0060; or
(ii) When included within the emergency
crisis section of a Positive Behavior Support Plan as an isolated intervention
strategy when a child is behaving in an unsafe manner that presents imminent
danger of injury to self or others.
(8) ENVIRONMENTAL MODIFICATIONS.
(a) An individual may access environmental
modifications if:
(A) The environmental
modification is related to the completion of an ADL, IADL, or health-related
task.
(B) The individual is not
enrolled in a residential program, unless the enrollment is in a supported
living program described in OAR chapter 411, division 328 and the dwelling is
not a provider owned, controlled, or operated setting.
(b) Environmental modifications include, but
are not limited to, the following:
(A)
Installation of shatter-proof windows.
(B) Hardening of walls or doors.
(C) Specialized, hardened, waterproof, or
padded flooring.
(D) An alarm
system for doors or windows.
(E)
Protective covering for smoke alarms, light fixtures, and appliances.
(F) Installation of ramps, grab-bars, and
electric door openers.
(G)
Adaptation of kitchen cabinets and sinks.
(H) Widening of doorways.
(I) Handrails.
(J) Modification of bathroom
facilities.
(K) Installation of
non-skid surfaces.
(L) Overhead
track systems to assist with lifting or transferring.
(M) Specialized electric and plumbing systems
necessary to accommodate the medical equipment and supplies necessary for the
welfare of an individual.
(N)
Adaptations to control the home environment, including lights and
heat.
(O) Adaptations or
improvements to the home that are of general utility and directly related to
the completion of an ADL, IADL, or health-related task.
(c) Environmental modifications exclude the
following:
(A) Adaptations or improvements to
the home not directly related to the completion of an ADL, IADL, or
health-related task.
(B)
Adaptations that add to the total square footage of the home.
(C) Adaptations outside of the home, except
for ramps that attach to the home for the purpose of entry or exit.
(D) General repair or maintenance and upkeep
required for the home.
(d) Department approval is required for
environmental modification expenditures that are over $5,000 per modification,
per plan year that are funded through the Community First Choice state plan.
(A) A case manager must request approval for
additional expenditures through the Department prior to expenditure.
(B) Approval is based on the service and
support needs and goals of an individual and a determination by the Department
of appropriateness and cost-effectiveness.
(C) 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) Any modification requiring a permit must
be inspected by a local inspector and certified as in compliance with local
codes. A contractor must have the certificate prior to payment.
(f) Payment to the contractor is to be
withheld until the work is complete and meets specifications.
(g) A scope of work must be completed for
each identified environmental modification project. All contractors submitting
bids must be given the same scope of work.
(h) For all environmental modifications, a
case management entity must attempt to acquire at least three written bids from
providers meeting the qualifications in OAR 411-435-0080. When it is not
reasonable to obtain three written bids, exceptions to this requirement may be
granted by the Department.
(i) A
case manager must assure the processes outlined in the Expenditure Guidelines
are followed for contractor bids and the awarding of work.
(j) All dwellings must be in good repair and
have sound structure to safely support the environmental
modification.
(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 an
individual.
(m) 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.
(n) RENTAL PROPERTY.
(A) Environmental modifications to a rental
property may not substitute or duplicate services otherwise the responsibility
of the landlord as outlined in 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 a rental property to the condition it was in prior to the installation
of an environmental modification.
(9) TRANSITION COSTS.
(a) To be eligible to access transition
costs, an individual must not be enrolled in a residential program.
(b) Transition costs are limited to an
individual transitioning from residing in the state hospital, a nursing
facility, or an intermediate care facility, to residing in a community-based
home when the cost for the transition is not included in the rate paid to a
provider or typically provided by a residential program.
(c) Transition costs are based on the
assessed need of an individual determined during the person-centered planning
process and must support the desires and goals of the individual receiving
services and supports.
(d) Final
approval for transition costs must be through the Department prior to
expenditure.
(e) Financial
assistance for transition costs is limited to the following:
(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.
(C) Basic household
furnishings, such as a bed.
(D)
Other items necessary to re-establish a home.
(f) Transition costs are provided no more
than twice annually.
(g)
Transitions costs for basic household furnishings and other items included
under subsections (e)(C) and (D) are limited to one time per year.
(h) Transition costs may not supplant the
legal responsibility of the parent or guardian of a child. In this context, the
term parent or guardian does not include a designated representative.
Statutory/Other Authority: ORS
409.050,
427.104 & 430.662
Statutes/Other Implemented: ORS
409.010,
427.007,
427.104,
430.215,
430.610 &
430.662