(1) "AAA" means "Area Agency on Aging" as
defined in this rule.
"Activities of Daily Living (ADL)" mean those personal, functional activities
required by an individual for continued well-being, which are essential for
health and safety. Activities include eating, dressing and grooming, bathing
and personal hygiene, mobility, elimination, and cognition.
(3) "Aging and People with Disabilities
(APD)" means the program area of Aging and People with Disabilities, within the
Department of Human Services.
"Area Agency on Aging (AAA)" means the Department designated agency charged
with the responsibility to provide a comprehensive and coordinated system of
services to older adults and adults with disabilities in a planning and service
area. The term Area Agency on Aging is inclusive of both Type A and Type B Area
Agencies on Aging as defined in ORS
410.040 and described in ORS
"Assessment" or "Reassessment" means an
assessment as defined in OAR 411-015-0008
(6) "Assistive Devices" means any category of
durable medical equipment, mechanical apparatus, electrical appliance, or
instrument of technology, service animals, general household items, or
furniture used to assist and enhance an individual's independence in performing
any activity of daily living.
"CA/PS" means the "Client Assessment and Planning System" as defined in this
(8) "Case Manager" means an
employee of the Department or Area Agency on Aging, who assesses the service
needs of an applicant, determines eligibility, and offers service choices to
the eligible individual. The case manager authorizes and implements the service
plan and monitors the services delivered.
(9) "Central Office" means the unit within
the Department responsible for program and policy development and
and Planning System (CA/PS)":
single entry data system used for --
Completing a comprehensive and holistic assessment;
(B) Surveying an individual's physical,
mental, and social functioning; and
(C) Identifying risk factors, individual
choices and preferences, and the status of service needs.
(b) The CA/PS documents the level of need and
calculates the individual's service priority level in accordance with the rules
in OAR chapter 411, division 015, calculates the service payment rates, and
accommodates individual participation in service planning.
(11) "Consumer Choice" means an individual
has been informed of alternatives to nursing facility services and has been
given the choice of institutional services, Medicaid home and community-based
service options, or the Independent Choices Program.
(12) "Contracted In-Home Care Agency" means
an incorporated entity or equivalent, licensed in accordance with OAR chapter
333, division 536, that provides hourly contracted in-home services to
individuals served by the Department or Area Agency on Aging.
"Cost Effective" means being responsible
and accountable with Department resources. This is accomplished by offering
less costly alternatives when providing choices that adequately meet an
individual's service needs. Those choices consist of the available services
under the Medicaid home and community-based service options, the utilization of
assistive devices, natural supports, architectural modifications, and
alternative service resources (defined in OAR 411-015-0005
) not paid for by the
(14) "Department" means
the Department of Human Services (DHS).
(15) "Distressed Provider Relief Fund" means
the program described in OAR chapter 411, division 029 designed to provide
additional compensation to providers who meet the criteria.
"Enhanced Wage Add-on Program" means the
program described in OAR 411-027-0160
designed to provide additional
compensation to providers who meet the criteria.
"Exception" means an approval for:
Payment of a service plan granted to a
specific individual in his or her current residence or in the proposed
residence identified in the exception request that exceeds the CA/PS assessed
service payment levels for individuals residing in community-based care
facilities or the maximum hours of service as described in OAR 411-030-0070
individuals residing in his or her own home or the home of a
A service plan
granted to a specific individual and a homecare worker to exceed the
limitations as described in OAR 411-030-0070
(5) based upon the service needs
of the individual as determined by the Department.
An "exceptional rate" or "exceptional
payment." The approval of an exception is based on the service needs of the
individual and is contingent upon the individual's service plan meeting the
requirements in OAR 411-027-0020
, OAR 411-027-0025
, and OAR
"Homecare Worker" means a provider, as described in OAR 411-031-0040
, that is
directly employed by a consumer to provide hourly services to the eligible
(a) The term homecare worker
includes consumer-employed providers in the Spousal Pay and Oregon Project
Independence Programs. The term homecare worker also includes consumer-employed
providers that provide state plan personal care services to older adults and
adults with physical disabilities. Relatives providing Medicaid in-home
services to an individual living in the relative's home are considered homecare
(b) The term homecare
worker does not include Independent Choices Program providers or personal care
attendants enrolled through the Office of Developmental Disability Services or
the Addictions and Mental Health Division.
(19) "Hourly Services" mean the in-home
services, including activities of daily living and instrumental activities of
daily living, that are provided at regularly scheduled times.
(20) "Independent Choices Program (ICP)"
means the self-directed in-home services program in which a participant is
given a cash benefit to purchase goods and services identified in a service
plan and prior approved by the Department or Area Agency on Aging.
(21) "Individual" means the person applying
for, or eligible for, services. The term "individual" is synonymous with
"client", "participant", "consumer", and "consumer-employer."
(22) "In-Home Services" mean those services
that meet an individual's assessed need related to activities of daily living
and instrumental activities of daily living provided in the individual's home
or family's home.
"Instrumental Activities of Daily Living (IADL)" mean those activities, other
than activities of daily living, required by an individual to continue
independent living. The definitions and parameters for assessing needs in IADL
are identified in OAR 411-015-0007
(24) "Natural Supports" or "Natural Support
System" 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
(26) "These Rules" mean the rules in OAR
chapter 411, division 027.
Or. Admin. R.
SPD 7-2008, f. 5-29-08,
cert. ef. 6-1-08; APD 4-2014(Temp), f. & cert. ef. 3-20-14 thru 9-16-14;
APD 33-2014, f. & cert. ef. 9-2-14;
3-2016, f. 3-4-16, cert. ef.
3/18/2016; APD 20-2017, temporary amend filed
09/29/2017, effective 10/01/2017 through 03/29/2018;
9-2018, amend filed 03/28/2018, effective
3/29/2018; APD 18-2020, temporary
amend filed 05/18/2020, effective 05/18/2020 through 10/30/2020; APD 27-2020,
temporary amend filed 06/25/2020, effective 07/01/2020 through 10/30/2020;
41-2020, amend filed 10/09/2020, effective
10/15/2020; APD 31-2021, temporary
amend filed 09/03/2021, effective 09/07/2021 through 03/05/2022;
5-2022, amend filed 03/01/2022, effective
41-2022, temporary amend filed 08/19/2022, effective
8/19/2022 through 2/14/2023;
2-2023, amend filed 02/08/2023, effective
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS