exceptions may only be granted if the Department determines:
(a) The individual has service needs,
documented in the service plan, that warrant a service payment exception;
(b) The provider actually
provides the exceptional service.
(2) Service payment exceptions shall be based
on the additional hours of services required to meet the individual's assessed
and verified ADL and IADL service needs. Exceptional hours are not allowed
based solely on choice of the individual. The Department and AAA local office
staff must monitor the individual service needs and recommend adjustments to
the plan when appropriate.
Service payment exceptions in Adult Foster Homes and Residential Care
Facilities may be authorized only for individual service needs that are not
paid for by the base rate or any of the three available add-on
(4) Additional hours for
Adult Foster Homes and Residential Care Facilities are paid at the hourly rate
in the rate schedule. The Department does not authorize additional payment
exceptions for building, utilities, food, or regular maintenance.
(5) No service rate exceptions are allowed in
Assisted Living Facilities.
Exceptions above the maximum monthly hours of service in OAR 411-030-0070
in-home services, may only be granted when it is determined the placement is
the most appropriate for the resident, special services are necessary to meet
individual needs, not preference, and a provider has the capability to meet
exceptions to the assessed service need determination in Adult Foster Homes,
Residential Care Facilities, or in-home settings, and renewals of exceptions,
must be pre-authorized by the Department's APD Central Office.
(a) A consumer or consumer representative may
request an exception by requesting the rate or hours exception through their
case manager. A case manager may also determine that an exception is needed and
initiate the process.
Department and AAA local office staff shall review and approve requests for
payment exception before they are transmitted to the Department's APD Central
requests for payment exception must be sent to the Department's APD Central
Office. The request must include:
statement of individual needs that exceed the assessed rate or the maximum
monthly hours of services; and
A statement of how the individual's needs are met and the cost involved in
meeting the individual's needs.
(d) The Department's APD Central Office must
review and approve exception requests and transmit the decision and effective
date to the Department and AAA local office staff. Approval will only be
granted if the exception meets an unmet need and is reasonable to meet that
(e) The Department or
the Department's Central Office may deny exception requests. A notice of
planned action is required if the individual or their representative requested
(f) Rate exceptions
expire one year from the effective date or on the date determined by the
Department's Central Office.
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.
12-27-01, cert. ef. 1-1-02; SPD 7-2008, f. 5-29-08, cert. ef. 6-1-08; 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