Spousal Pay Program is one of the hourly service options under in-home services
for those who qualify.
ELIGIBILITY. An individual may be eligible for the Spousal Pay Program when all
of the following conditions are met:
individual has met all eligibility requirements for in-home services as
described in OAR 411-030-0040
The individual requires full assistance in at least four of the six ADLs
described in OAR 411-015-0006
as determined by the assessment described in OAR
chapter 411, division 015.
debilitating medical condition including, but is not limited to, any of the
(B) Severe neuropathy;
(D) Persistent or reoccurring stage three or
(E) Late stage
(F) Frequent and
Debilitating muscle spasms; or
A spinal cord injury or similar disability with permanent impairment.
(d) The individual would otherwise
require nursing facility services without Medicaid in-home services.
(e)The individual's service needs exceed in
both extent and duration the usual and customary services rendered by one
spouse to another.
(f) The spouse
demonstrates the capability and health to provide the services and actually
provides the principal services, including the majority of service plan hours,
for which payment has been authorized.
The spouse meets all requirements for
enrollment as a homecare worker in the Consumer-Employed Provider Program as
described in OAR 411-031-0040
The spouse is not designated as a representative as described in OAR
(i) The Department
has reviewed the request and approved program eligibility at enrollment and
annually upon re-assessment.
(a) All payments must be prior authorized by
the Department or the Department's designee.
(b) The hours authorized to the spousal pay
provider in an individual's service plan must consist of one-half of the
assessed hours for IADLs and all of the hours for specific ADLs based on the
service needs of the individual.
(c) Except as described otherwise in
subsection (d) of this section, spousal pay providers are paid at hourly
homecare worker rates for ADLs and IADLs as defined in the rate
(d) Homecare workers who
marry their consumer-employer are not paid under the spousal pay program.
Service plans are based on the needs of the consumer. Hours assigned must
reflect the service needs with no reduction in hours. The consumer does not
need to meet the spousal pay eligibility criteria as described in section (3)
of this rule. Hours authorized in CA/PS will be completed in the same manner as
other in-home service plans, which include hourly or Independent Choices
(e) Spousal pay providers
may not claim payment from the Department for hours that the spousal pay
provider did not work.
spousal pay HCW may not act as the consumer-employer.
(4) Spousal pay providers are subject to the
provisions in OAR chapter 411, division 031 governing homecare workers enrolled
in the Consumer-Employed Provider Program.
Individuals receiving Spousal Pay Program
services who have excess income must contribute to the cost of services
pursuant to OAR 461-160-0610
and OAR 461-160-0620
Or. Admin. R.
SSD 4-1984, f. 4-27-84,
ef. 5-1-84; SSD 3-1985, f. & ef. 4-1-85; SSD 4-1993, f. 4-30-93, cert. ef.
6-1-93, Renumbered from 411-030-0027; SDSD 2-2000, f. 3-27-00, cert. ef.
4-1-00; SPD 2-2003(Temp), f. 1-31-03, cert. ef. 2-1-03 thru 7-30-03; SPD
14-2003, f. & cert. ef. 7-31-03; SPD 15-2003 f. & cert. ef. 9-30-03;
SPD 15-2004, f. 5-28-04, cert. ef. 6-7-04; 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 15-2008, f. 12-26-08, cert. ef.
1-1-09; SPD 13-2012(Temp), f. & cert. ef. 9-26-12 thru 3-25-13; SPD 4-2013,
f. 3-25-13, cert. ef. 3-26-13; SPD 10-2013(Temp), f. & cert. ef. 5-23-13
thru 11-19-13; SPD 43-2013, f. 10-31-13, cert. ef. 11-1-13;
5-2016, f. 3-15-16, cert. ef.
3/18/2016; APD 21-2017, temporary adopt filed
09/29/2017, effective 10/01/2017 through 01/27/2018; APD 18-2017(Temp), f.
& cert. ef. 8-1-17 thru 1-27-18;
3-2018, amend filed 01/27/2018, effective
Statutory/Other Authority: ORS 409.050, 410.070 &
Statutes/Other Implemented: ORS 410.010, 410.020, 410.070,
411.802 & 411.803