The Department reimburses for services provided to individuals
residing in a residential care facility or an adult foster home according to
The provider must agree to accept an amount determined pursuant to OAR
for room and board and a service payment determined by the
Department pursuant to OAR 411-027-0020
as payment in full for
all services rendered to an individual.
SERVICE RATES. Service rates are based on
an individual's level of impairment and assessed need for services as
documented in CA/PS. Service eligibility levels are assigned based on the
degree of assistance an individual requires with activities of daily living and
certain procedures that must be performed by a provider.
(a) A base rate is paid for all individuals
in accordance with the rate schedule.
Additional add-on payments are made for
individuals whose assessed needs meet add-on criteria. Add-on payments are paid
in accordance with the rate schedule.
an individual is eligible for one add-on payment, an add-on payment is made in
addition to the base payment.
If an individual is eligible for two add-on payments, a total of two add-on
payments are made in addition to the base payment.
(C) If an individual is eligible for three
add-on payments, a total of three add-on payments are made in addition to the
that is eligible for Extended Waiver Eligibility, as defined and authorized in
is not eligible for an add-on payment.
Eligibility for add-on payments is made
based on individual needs as documented in CA/PS. An individual is eligible for
an add-on payment if:
(A) The individual is
full assist in mobility or eating or elimination;
(B) The individual demonstrates behavior that
pose a risk to the individual or to others and the provider must consistently
intervene to supervise or redirect; or
(C) The individual's medical treatments, as
selected and documented in CA/PS, require daily observation and monitoring with
oversight by a licensed healthcare professional, no less than quarterly, and
the facility has trained staff to provide such service and does provide the
is entitled to retain a personal allowance plus any income disregards pursuant
to OAR 461-160-0620
individual is responsible for payment of the room and board amount pursuant to
An individual eligible
for Medicaid under OAR chapter 410, division 200 and eligible for long term
care services under OAR 411-015-0100
living in community based care facilities
may be eligible for room and board assistance if the individual's gross income
is less than the room and board amount defined in OAR 461-155-0270
Department issues a special needs payment to the facility, on the individual's
behalf, for the difference between the individual's income and the room and
eligible for Medicaid under OAR chapter 410, division 200 and receiving room
and board assistance must apply for all benefits for which the individual may
be eligible, per OAR 410-200-0220
, to continue to receive the room and board
assistance. Individuals must follow all appeal options if applicable.
An individual must contribute
any income in excess of the personal allowance, income disregards, and room and
board payments to the provider toward the service payment pursuant to OAR
and OAR 461-160-0620
(d)The Department issues payment to the
provider for the difference between the service payment and the available
income of the individual.
(4) The provider may not charge the
individual, or a relative or representative of the individual, for items
included in the room and board or service payments for any items for which the
Department makes payment.
Department is not responsible for damages to the provider's home, facility or
property, or obligations entered into with the individual.
Or. Admin. R.
SDSD 3-1998, f. 2-27-98,
cert. ef. 3-1-98; SDSD 4-1998, f. 6-25-98, cert. ef. 7-1-98; SDSD 10-2001, f.
12-24-01, cert. ef. 1-1-02, Renumbered from 411-027-0100; 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; 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
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS