Current through Register Vol. 63, No. 3, March 1, 2024
(1) An individual,
or their legal or designated representative as applicable, may request an
exception either orally or in writing if they believe the maximum monthly hour
limitation is not meeting, or will not meet, the individual's support
needs.
(2) The case manager must
assist the individual, or their legal or designated representative as
applicable, with the exception request including completing the Funding Review
and Exceptions Request (form 0514DD) and gathering required supporting
documents. The Funding Review and Exceptions Request must:
(a) Include an explanation of any change in
the individual's level of assistance, available resources, and relevant
documentation to support the reasons for why the maximum monthly hour
limitation is not meeting, or will not meet, the individual's support
needs.
(b) Provide a clear
description of how the individual's support needs are being met throughout a
day, including available alternative resources and natural supports as defined
in OAR 411-317-0000.
(3)
Prior to submitting the Funding Review and Exceptions Request to ODDS, the case
manager must review the individual's current needs assessment for any change in
the individual's level of assistance and available resources to meet those
needs documented in the individual's ISP or Annual Plan, SPPC Service
Authorization Plan, and any other documentation in the individual's service
record as described in OAR 411-415-0110.
(a)
If the assessment was conducted less than six months from the date of the
exception request, the case manager must conduct a reassessment when requested
by the individual, or their legal or designated representative as applicable,
to determine the individual's current level of assistance and proceed with
service authorization in accordance with OAR 411-455-0030.
(b) If the assessment was conducted at least
six months from the date of the exception request, the case manager must
conduct a reassessment to determine the individual's current level of
assistance and proceed with service authorization in accordance with OAR
411-455-0030.
(4) ODDS
has up to 30 calendar days upon receipt of a Funding Review and Exceptions
Request and relevant supporting documentation identified in section (2) of this
rule to approve or deny the exception request.
(5) ODDS may approve or deny the exception
request based on review of the individual's assessed support needs and
available resources to meet those needs.
(a)
APPROVALS. ODDS may approve an exception for the individual's documented
support needs that may be met by qualified providers within the exception
limits described in section (6) of this rule.
(b) DENIALS.
(A) ODDS may deny an exception when:
(i) The request is not within the exception
limits described in section (6) of this rule.
(ii) The individual's assessed level of
assistance may not be met by qualified providers within the exception limits
described in section (6) of this rule.
(iii) The requested assistance is not an
allowable ADL or IADL task as described in OAR 411-455-0050, or an assistance
type as described in OAR 411-455-0010.
(iv) The exceptional support needs may be met
through alternative resources or natural supports, as defined in OAR
411-317-0000, available to the individual.
(B) When an exception request is denied, ODDS
must provide a written Notification of Planned Action (form 0947) to the
individual as described in OAR 411-318-0020 and offer other options of
developmental disabilities services to the individual as described in OAR
411-415-0070(9).
(6) EXCEPTION LIMITS.
(a) Approval for additional SPPC service
hours shall be based on the frequency of the support needs and the amount of
support required for each ADL or IADL task to ensure the health and safety of
the individual. Assistance types must be:
(A)
Hands-on assistance as described in OAR 411-455-0010.
(B) On-going supervision as described in OAR
411-455-0010.
(b) Up to
two additional hours for each task per month may be granted for hands-on
assistance.
(c) Up to five
additional hours for each task per month may be granted for on-going
supervision.
Statutory/Other Authority: ORS
409.050,
427.104
& 430.662
Statutes/Other Implemented: ORS
427.007,
430.610,
430.620
& 430.662-430.670
