In order to qualify for services from an
area agency or service provider, each eligible individual must:
(A) Be 60 years old or older; or be under 60
years of age and be diagnosed as having Alzheimer's Disease or a related
(B) Not be receiving
financial assistance or Medicaid, except Food Stamps, Qualified Medicare
Beneficiary or Supplemental Low Income Medicare Beneficiary Programs;
(C) Meet the requirements of
the Long-Term Care Services Priority Rule, OAR 411, division 015.
Eligibility determination will
be required before any individual may receive services from an area agency or
service provider. The documentation required by OAR 411-032-0015
(1)(d) must be
obtained before an individual under the age of 60 may be determined to be
determination will be the responsibility of the area agency. In those instances
when eligibility determination is performed by an agency other than the area
agency, the area agency will have in place a system for evaluating the
eligibility determination process, including an independent review by the area
agency of a representative sample of cases.
(d) Any person residing in a nursing
facility, assisted living facility, residential care facility, or adult foster
care setting will not be eligible for authorized services. This will not
restrict the ability to move an eligible individual from such institutions to
their home to receive services, when judged more appropriate, based on medical,
financial, physical, functional, and social considerations.
Any person residing in a living setting
that offers any services authorized under OAR 411-032-0010
will be limited to
receiving OPI services that are not available in that setting.
(f) The Department will determine the factors
that constitute an individual being at risk of institutionalization. These
factors are currently defined in the Long-Term Care Services Priority Rules,
OAR chapter 411, division 015. These factors will be utilized by each area
agency and service provider.
Applicants will receive written notification of eligibility
Determination of Services:
of services will rest with the area agency. In those instances when
determination of services is performed by an agency other than the area agency,
the area agency will have in place a system for evaluating the determination of
service process, including an independent review by the area agency of a
representative sample of cases.
The determination of services will be based on each individual's financial,
physical, functional, medical, and social need for such services and in
accordance with OAR chapter 411 division 015.
(c) Determination of services provided under
Oregon Project Independence will be limited to the authorized services allowed
by these rules.
determination of services will be made:
After eligibility determination; and
(B) At regular intervals but not less than
once every twelve months.
Individuals will receive written
notification of determination of services:
Notice will include the maximum monthly hours of service authorized, the hourly
and maximum monthly fee, the service rate, and provider contact
(B) Written service
notification will be provided to the individual upon initial determination of
services, at annual reassessment and when there are changes to the
determination of services.
Priority of Services:
(a) Area Agencies on Aging may establish
local priorities for service authorization but will not conflict with this
rule. In event of a grievance, this rule will take precedence over local
authorized services will be:
eligible individuals already receiving authorized service as long as their
condition indicates the service is needed.
(B) Individuals who will immediately be
placed in an institution if needed authorized services are not provided and
meet the Long-Term Care Services Priority Rules, OAR chapter 411, division
(C) Individuals who are
probably to be placed in an institution if needed authorized services are not
Appeals: Persons for whom services are denied, disallowed, or reduced through
eligibility determination or service determination will be entitled to request
review of the decision through the Area Agency on Aging grievance review
procedure, set forth in agency policy.
Individuals will continue to receive services until the disposition of the
local agency grievance review.
The Area Agency will provide the applicant with written notification of the
grievance review determination decision.
(c) Applicants that disagree with the results
of the Area Agency grievance review have a right to an Administrative Review
with the Department of Human Services, Seniors and People with Disabilities
Division, pursuant to ORS Chapter 183. This information will be provided to the
applicant in a written notification at the time of the grievance review
(d) Applicants requesting
an Administrative Review from the Department will not be eligible for continued
services through Oregon Project Independence.
(e) All persons, including those who may have
previously been terminated from Oregon Project Independence, have the right to
apply for OPI services at any time.
Or. Admin. R.
SSD 11-1984, f. 11-30-84,
ef. 12-1-84; SSD 12-1988, f. & cert. ef. 12-2-89; SSD 19-1989(Temp), f.
12-29-89, cert. ef. 1-1-90; SSD 5-1990, f. & cert. ef. 2-1-90; SSD 11-1993,
f. 12-30-93, cert. ef. 1-1-94; SSD 3-1997, f. 11-28-97, cert. ef. 12-1-97; SDSD
7-1999, f. 6-30-99, cert. ef. 7-1-99; SDSD 9-2002(Temp), f. & cert. ef.
11-1-02 thru 4-29-03; SPD 11-2003, f. & cert. ef. 5-2-03; SPD 18-2004, f.
& cert. ef. 5-28-04; SPD 29-2006, f. 10-23-06, cert. ef.
Stat. Auth.: ORS
Stats. Implemented: ORS