Unless the context indicates otherwise, the following
definitions apply to the rules in OAR chapter 411, division 033:
(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, grooming, bathing,
personal hygiene, mobility (ambulation and transfer), elimination (toileting,
bowel, and bladder management), cognition, and behavior as defined in OAR
(3) "ADL" means
"activities of daily living" as defined in this rule.
(4) "Aging and People with Disabilities"
means the program area of Aging and People with Disabilities, within the
Department of Human Services.
"APD" means "Aging and People with Disabilities".
(6) "Area Agency on Aging (AAA)" means the
Department designated agency charged with the responsibility to provide a
comprehensive and coordinated system of services to individuals 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" means an assessment as
defined in OAR 411-015-0008
"Background Check" means a criminal background check and an abuse check under
OAR chapter 407, division 007.
"Business Days" means Monday through Friday and excludes Saturdays, Sundays,
and state or federal holidays.
"CA/PS" means the "Client Assessment and
Planning System" as defined in OAR 411-030-0020
"Case Manager" or "CM" means a
Department employee or an employee of the Department's designee that meets the
minimum qualifications in OAR 411-028-0040
who is responsible for service
eligibility, assessment of need, offering service choices to eligible
individuals, person-centered service planning, service authorization and
implementation, and evaluation of the effectiveness of Medicaid home and
"Comprehensive" means a licensing classification that describes an agency that
provides personal care services, which may include medication reminding,
medication assistance, medication administration, and nursing services (see OAR
means an individual eligible for in-home services.
"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 all available services
under the Medicaid home and community-based service options, the utilization of
assistive devices, natural supports, architectural modifications, and
alternative service resources (see OAR 411-015-0005
). Less costly alternatives
may include resources not paid for by the Department.
(15) "Department" means the Department of
Human Services (DHS).
"Enrolled In-Home Care Agency" means an incorporated entity or equivalent,
licensed in accordance with OAR chapter 333, division 536 that provides hourly
enrolled in-home services to individuals receiving services through the
Department or the Area Agency on Aging.
"Exception" means an approval for
payment of a service plan that is granted to a specific individual that exceeds
the assessed maximum hours of service as described in OAR 411-030-0070
individuals residing in his or her own home.
"Exceptional Rate" or "Exceptional
Payment" means the amount paid to a provider based on the approval of an
exception. 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
, and 411-027-0050
"Homecare Worker" means a provider, as
described in OAR 411-031-0040
, that is directly employed by an individual to
provide hourly services to the eligible individual. The term homecare worker
does not include an employee of an in-home care agency who is providing in-home
(20) "Hourly Services"
means the in-home services, including activities of daily living and
instrumental activities of daily living, that are provided at regularly
scheduled times, not including live-in services.
(21) "IADL" means "instrumental activities of
daily living" as defined in this rule.
(22) "ICP" means "Independent Choices
Program" as defined in this rule.
(23) "Independent Choices Program" means a
self-directed in-home services program in which a participant is given a cash
benefit to purchase goods and services identified in the participant's service
plan and prior approved by the Department or the Area Agency on Aging.
(24) "Individual" means a person
age 65 or older, or an adult with a physical disability, applying for or
eligible for services.
"In-Home Care Agency" or "IHCA" means an agency as defined in OAR 333-536-0005
that is primarily engaged in providing in-home care services for compensation
to an individual in that individual's place of residence. "In-home care agency"
does not include a home health agency or portion of an agency providing home
Services" as defined in OAR 411-030-0002
mean the activities of daily living
and instrumental activities of daily living that assist an individual to stay
in his or her own home or the home of a relative.
"In-Home Care Services" as defined in
, means personal care services furnished by an in-home care
agency, or an individual under an arrangement or contract with an in-home care
agency, that are necessary to assist an individual in meeting the individual's
daily needs, but do not include curative or rehabilitative services.
"Initial Screening" means a screening
required by the in-home care agency licensing rules in OAR 333-536-0055
conducted to evaluate a prospective client's service requests and needs prior
to accepting the individual for service. The extent of the screening shall be
sufficient to determine the ability of the agency to meet those requests and
needs based on the agency's overall service capability.
"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
"Liability" means the dollar amount an
individual with excess income contributes to the cost of service pursuant to
and OAR 461-160-0620
"Licensed" means an in-home care agency
as defined in OAR 333-536-0005
that is currently licensed, certified, or
registered by the proper authority within the State of Oregon.
"Mandatory Reporter" means all employees
of an in-home health service, are required by statute (ORS
- 124.095) to report
suspected abuse or neglect of a child, an older adult, a person with a physical
disability or the resident of a licensed care facility, to the Department or to
a law enforcement agency as required by OAR 411-020-0002
"Medicaid OHP Plus Benefit Package"
means only the Medicaid benefit packages provided under OAR 410-120-1210
and (b). This excludes individuals receiving Title XXI benefits.
(34) "Medicaid Performing Provider Number"
means the numeric identifier assigned to an entity or person by the Department,
following enrollment to deliver Medicaid funded services as described in these
rules. The Medicaid Performing Provider Number is used by the rendering
provider for identification and billing purposes associated with service
authorizations and payments.
"Natural Supports" or "Natural Support System" means resources and supports
(e.g. relatives, friends, neighbors, significant others, 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 supports.
"Nursing Services" means the provision
of services that are defined in OAR 333-536-0005
, that are deemed to be the
practice of nursing as defined by ORS
. These services include,
but are not limited to the delegation of specific tasks of nursing care to
unlicensed persons in accordance with the Oregon State Board of Nursing rules
in OAR chapter 851, division 047. Nursing services are not rehabilitative or
curative, but are maintenance in nature.
(37) "OHA" means the Oregon Health Authority.
Plan" means the details of the supports, desired outcomes, activities, and
resources required for an individual to achieve and maintain personal goals,
health, and safety, as described in OAR 411-004-0030
. The case manager
completes the person-centered service plan. The person-centered service plan is
the Medicaid Plan of Care.
"Personal Care Aid" means a person employed by an in-home care agency who
provides assistance with activities of daily living or assistance with personal
care tasks, household and supportive services, or medication services as
authorized by OAR chapter 333 division 536.
(40) "Provider Enrollment Application and
Agreement" refers to the conditions and agreements for being enrolled as a
provider with the Department of Human Services, Aging and People with
Disabilities (APD) or Office of Developmental Disability Services (ODDS), and
to receive a provider number.
"Rate Schedule" means the Medicaid reimbursement rate schedule maintained by
the Department in OAR 411-027-0170
(42) "Relative" means a person, excluding an
individual's spouse, who is related to the individual by blood, marriage,
domestic partnership, or adoption.
(43) "Representative" means a person either
appointed by an individual to participate in service planning on the
individual's behalf or an individual's natural support with longstanding
involvement in assuring the individual's health, safety, and welfare. A
representative may not be a paid employee or the in-home care agency.
"Service Need" means the
assistance an individual requires from another person for those functions or
activities identified in OAR 411-015-0006
(45) "Service Plan" means a written,
individualized plan for the delivery of services by the IHCA, developed by the
IHCA in conjunction with the individual or the individual's legal
representative, the DHS or AAA case manager reflecting the individual's
capabilities, choices, and if applicable, measurable goals, and managed risk
issues. The service plan defines the division of responsibility in the
implementation of the services. The service plan must incorporate all elements
identified in the person-centered service plan for which the IHCA is
responsible to deliver.
"Spouse" means a person who is legally married to an individual as defined in
Rules" mean the rules in OAR chapter 411, division 033.
(48) "Work week" is defined as 12:00 a.m. on
Sunday through 11:59 p.m. on Saturday.