Unless the context indicates otherwise, the following
definitions apply to the rules in OAR chapter 411, division 030:
"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 as defined in OAR 411-015-0006
(2) "Adequately" means sufficient quantity to
meet the minimum need as determined by the department.
(3) "Aging and People with Disabilities
(APD)" refers to the program within the Department of Human Services primarily
responsible for serving seniors and people with disabilities as defined in OAR
chapter 411, division 015.
"Architectural Modifications" means any service leading to the alteration of
the structure of a dwelling to meet a specific service need of an eligible
(5) "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
and described in ORS
"Assessment" or "Reassessment" means an
assessment as defined in OAR 411-015-0008
(7) "Assistive Devices" means any category of
durable medical equipment, mechanical apparatus, electrical appliance, or
instrument of technology used to assist and enhance an individual's
independence in performing any activity of daily living. Assistive devices
include the use of service animals, general household items, or furniture to
assist the individual.
Plan" means the specific authorization for in-home services authorized under
the Consumer Employer Program, Independent Choices Program (ICP), or spousal
pay services that is part of the Client Assessment and Planning System and
includes set start and end dates for in-home individuals. The Benefit Plan
authorization is developed with the individual.
(9) "Business Days" means Monday through
Friday and excludes Saturdays, Sundays, and state or federal
(10) "Case Manager (CM)"
means an employee of the Department or Area Agency on Aging who assesses the
service needs of an individual applying for services, determines eligibility,
and offers service choices to the eligible individual. The case manager
authorizes and implements an individual's service plan and monitors the
services delivered as described in OAR chapter 411, division 028. For the
purposes of this rule, CM may also include Diversion/Transition
(11) "Central Office
(CO)" means the unit within the Department responsible for program and policy
development and oversight.
"Client Assessment and Planning System (CA/PS)":
Is a single data system used for:
(A) Completing a comprehensive and holistic
(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 an individual's service priority level in accordance with the rules
in OAR chapter 411, division 015, calculates the allowed service hours, and
accommodates individual participation in service planning.
(13) "Consumer-Employed Provider Program"
refers to the program described in OAR chapter 411, division 031 wherein a
provider is directly employed by an individual or their representative to
provide hourly in-home services.
(14) "Consumer-Employer" means an individual
eligible for in-home services receiving services through the Consumer-Employer
Fund" means a monetary amount that continues month to month, if approved by a
case manager, that is set aside in the Independent Choices Program service
budget to purchase identified items that substitute for personal
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 receiving services through the Department or
Area Agency on Aging.
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 (defined in OAR
). Less costly alternatives may include resources not paid for by
Medical Condition" means the individual's condition is severe, persistent, and
interferes with the individual's ability to function and participate in most
activities of daily living.
"Department" means the Department of Human Services (DHS), APD.
"Discretionary Fund" means a monetary
amount set aside in the Independent Choices Program service budget to purchase
items not otherwise delineated in the monthly service budget or agreed to be
savings for items not traditionally covered under Medicaid home and
community-based services. Discretionary funds are expended as described in OAR
means either voluntary or involuntary termination of a participant from the
Independent Choices Program.
"Employee Provider" means a worker who provides services to, and is a paid
provider for, a participant in the Independent Choices Program.
(23) "Electronic Visit Verification" means a
service which requires hourly providers to clock-in at the beginning of their
shift and clock-out at the end of their shift, so all hours worked are captured
electronically and paid accordingly.
(24) "Employment Relationship" means the
relationship of employee and employer involving an employee provider and a
a variance to APD service limits, granted or denied at DHS' discretion, based
on an individual's documented service needs warranting a deviation from the
typical services needed by the service population. This definition of exception
applies to the following areas of exception which are granted or denied at the
Department's full discretion:
(26) "FICA" is the acronym for the Social
Security payroll taxes collected under authority of the Federal Insurance
Accountability" refers to guidance and oversight which act as fiscal safeguards
to identify budget problems on a timely basis and allow corrective action to be
taken to protect the health and welfare of individuals.
(28) "FUTA" is the acronym for Federal
Unemployment Tax Assessment which is a United States payroll (or employment)
tax imposed by the federal government on both employees and
(HCW)" means a provider, as described in OAR 411-031-0040
, directly employed by
an individual to provide hourly in-home services to the eligible individual.
The term homecare worker includes:
(A) A consumer-employed provider in the
Spousal Pay and Oregon Project Independence Programs;
(B) A consumer-employed provider that
provides state plan personal care services to individuals; and
(C) A relative providing paid Medicaid
in-home services to an individual living in the relative's home.
(b) The term homecare worker does
not include an Independent Choices Program provider, or a personal support
worker enrolled through Developmental Disability Services or the Oregon Health
Services" mean the in-home services, including activities of daily living and
instrumental activities of daily living, that are provided at regularly
means a group of individuals that live together within the same dwelling. For
homeless individuals, the household consists of the individuals who consider
themselves living together.
"ICP Participant Agreement" means the form the individual signs indicating that
they understand their roles and responsibilities in the ICP program.
(33) "Independent Choices Program (ICP)"
means a self-directed in-home services program in which a participant receives
a cash benefit to purchase goods and services identified in the participant's
service plan and prior approved by the Department or Area Agency on
"Individual" means a
person age 65 or older, or an adult with a physical disability, applying for or
eligible for services per OAR 411-015-0100
(35) "Individualized Back-Up Plan" means a
plan incorporated into an Independent Choices Program service plan to address
critical contingencies or incidents that pose a risk or harm to a participant's
health and welfare.
Services" mean those services that meet an individual's assessed need related
to activities of daily living and instrumental activities of daily living when
the individual resides in a living arrangement that meets the criteria
described in OAR 411-030-0033
"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" refers to the dollar amount
an individual with excess income contributes to the cost of service pursuant to
and OAR 461-160-0620
"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.
(40) "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
(41) "Oregon Project
Independence (OPI)" means the program of in-home services described in OAR
chapter 411, division 032.
"OSIPM" means Oregon Supplemental Income Program-Medical as defined in OAR
. OSIPM is Oregon Medicaid insurance coverage for individuals who
meet eligibility criteria as described in OAR chapter 461.
(43) "Participant" means an individual
eligible for the Independent Choices Program.
(44) "Person-Centered Service Plan (Service
Plan)" means, for Medicaid eligible individuals, the written details of the
supports, desired outcomes, activities, and resources required for an
individual to achieve and maintain personal goals, health, and safety. The plan
is written by the case manager with input and approval from the
(45) "Provider" means
the person who renders the services.
(47) "Relative" means a person, excluding an
individual's spouse, who is related to the individual by blood, marriage, or
a person either appointed by an individual to participate in service planning
or to assist in managing the duties of a consumer-employer on the individual's
behalf or an individual's natural support with longstanding involvement in
assuring the individual's health, safety, and welfare. There are additional
responsibilities for an ICP representative as described in OAR 411-030-0100
ICP representative is not a paid employee provider regardless of relationship
to a participant.
Budget" means a participant's plan for the distribution of authorized funds
that are under the control and direction of the participant within the
Independent Choices Program. A service budget is a required component of the
participant's service plan.
"Service Need" means the assistance an individual requires from another person
for those functions or activities identified in OAR 411-015-0006
(51) "Service Period"
means specific two consecutive workweeks, defined by the Department, for a
total of 14 calendar days.
"Shift Services" are hourly services provided by awake homecare workers,
Independent Choices Program employee providers, or a contracted in-home care
agency provider to an individual who is authorized to receive 16 hours of
services during a 24-hour work period.
"Spouse" means a person that is legally
married to an individual as defined in OAR 461-001-0000
(54) "SUTA" is the acronym for State
Unemployment Tax Assessment. State unemployment taxes are paid by employers to
finance the unemployment benefit system that exists in each state.
(55) "Tasks" means distinct parts of an
activity of daily living.
"These Rules" mean the rules in OAR chapter 411, division 030.
(57) "Workweek" is defined as 12:00 a.m. on
Sunday through 11:59 p.m. on Saturday.
Or. Admin. R.
SSD 5-1983, f. 6-7-83, ef.
7-1-83; SSD 3-1985, f. & ef. 4-1-85; SSD 5-1987, f. & ef. 7-1-87; SSD
4-1993, f. 4-30-93, cert. ef. 6-1-93; SSD 6-1994, f. & cert. ef. 11-15-94;
SPD 14-2003, f. & cert. ef. 7-31-03; SPD 15-2003 f. & cert. ef.
9-30-03; SPD 18-2003(Temp), f. & cert. ef. 12-11-03 thru 6-7-04; SPD
15-2004, f. 5-28-04, cert. ef. 6-7-04; SPD 18-2005(Temp), f. 12-20-05, cert.
ef. 12-21-05 thru 6-1-06; SPD 20-2006, f. 5-26-06, cert. ef. 6-1-06; SPD
3-2007(Temp), f. 4-11-07, cert. ef. 5-1-07 thru 10-28-07; SPD 17-2007, f.
10-26-07, cert. ef. 10-28-07; SPD 4-2008(Temp), f. & cert. ef. 4-1-08 thru
9-24-08; SPD 13-2008, f. & cert. ef. 9-24-08; SPD 15-2008, f. 12-26-08,
cert. ef. 1-1-09; SPD 10-2013(Temp), f. & cert. ef. 5-23-13 thru 11-19-13;
SPD 16-2013(Temp), f. & cert. ef. 7-1-13 thru 11-19-13; SPD 43-2013, f.
10-31-13, cert. ef. 11-1-13; APD 9-2014(Temp), f. 4-17-14, cert. ef. 4-21-14
thru 10-18-14; APD 35-2014, f. & cert. ef. 10-1-14; APD 19-2015(Temp), f.
& cert. ef. 9-21-15 thru 3-18-16;
5-2016, f. 3-15-16, cert. ef.
3/18/2016; APD 18-2017(Temp), f. & cert. ef.
8-1-17 thru 1-27-18; APD 21-2017, temporary amend filed 09/29/2017, effective
10/01/2017 through 01/27/2018;
3-2018, amend filed 01/27/2018, effective
1/28/2018; APD 11-2018, temporary
amend filed 05/23/2018, effective 05/23/2018 through 11/18/2018;
40-2018, amend filed 11/15/2018, effective
11/18/2018; APD 3-2020, temporary
amend filed 02/21/2020, effective 02/21/2020 through 08/18/2020;
32-2020, amend filed 07/23/2020, effective
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS