Or. Admin. R. 411-030-0100 - Independent Choices Program
(1) The
Independent Choices Program (ICP) is an In-Home Services Program that empowers
participants to self-direct their own service plans and purchase goods and
services that enhance independence, dignity, choice, and well-being.
(2) The Department may not change the ICP
participation agreement without posting the changes for public notice on the
Department's website.
(3) INITIAL
ELIGIBILITY REQUIREMENTS.
(a) To be eligible
for the ICP an individual must:
(A) Meet all
requirements for in-home services as described in these rules.
(B) Develop a service plan and budget to meet
the needs identified in his or her CA/PS assessment.
(C) Sign the ICP participation
agreement.
(D) Have or be able to
establish a checking account.
(E)
Provide evidence of a stable living situation for the past three
months.
(F) Demonstrate the ability
to manage money as evidenced by timely and current utility and housing
payments.
(G) Demonstrate the
ability to manage and honor the employee provider responsibilities as outlined
in the ICP participation agreement.
(H) Complete enrollment with a Department
contracted Fiscal Intermediary to provide the required Electronic Visit
Verification (EVV) services when available and required by the
department.
(b) If a
participant is unable to direct and purchase their own in-home services, the
participant must have a representative to act on the participant's behalf. The
"representative" is the person assigned by the participant to act as the
participant's decision maker in matters pertaining to the ICP service plan and
service budget. A representative must:
(A)
Complete a background check pursuant to OAR chapter 407, division 007 and
receive a final fitness determination of approval; and
(B) Sign and adhere to the "Independent
Choices Program Representative Agreement" on behalf of the
participant.
(c) If a
participant is unable to manage the ICP cash payment accounting, tax, or
payroll responsibilities and does not have a representative, the participant
must arrange and purchase the ongoing services of a fiscal intermediary, such
as an accountant, bookkeeper, or equivalent financial services.
(A) A participant, or the participant's
representative who has met the eligibility criteria in subsection (b) of this
section, may also choose to use a fiscal intermediary.
(B) The participant is responsible for any
fees or payment to the fiscal intermediary and may allocate the fees or payment
from discretionary or other non-ICP funds.
(4) DISENROLLMENT CRITERIA. Participants may
be disenrolled from the ICP voluntarily or involuntarily. Participants who are
disenrolled from the ICP may not reapply for six months. After the six-month
disenrollment period, an individual may re-enroll and must meet all ICP
eligibility requirements.
(a) VOLUNTARY
DISENROLLMENT. Participants or representatives must provide notice to the
Department of intent to discontinue participation in the ICP. The participant
or the representative must meet with the Department to reconcile remaining ICP
cash payment either within 30 calendar days of the date of disenrollment or
before the termination date, whichever is sooner.
(b) INVOLUNTARY DISENROLLMENT. The
participant may be involuntarily disenrolled from the ICP when the participant,
representative, or employee provider does not adequately meet the participant's
service needs or carry out any of the following ICP responsibilities:
(A) Non-payment of employee's wages, as
stated in the service budget.
(B)
Failure to maintain the participant's health and well-being by obtaining
personal care as evidenced by:
(i) Decline in
functional status due to the failure to meet the participant's needs;
or
(ii) Substantiated complaints of
self-neglect, neglect, or other abuse on the part of the employee provider or
representative.
(C)
Failure to purchase goods and services according to the participant's service
plan.
(D) Failure to comply with
the legal or financial obligations as an employer.
(E) Failure to maintain a separate ICP
checking account or commingling ICP cash benefit with other assets.
(F) Inability to manage the cash benefit as
evidenced by two or more incidents of overdrafts of the participant's ICP
checking account during the last cash benefit review period.
(G) Failure to deposit monthly service
liability payment into the ICP checking account.
(H) Failure to maintain an individualized
back-up plan (as part of the participant's service plan) resulting in a
negative consequence.
(I) Failure
to sign or follow the ICP Participation Agreement.
(J) Failure to designate a representative
within 30 calendar days if a participant needs a representative, as determined
by the Department, and does not have one.
(K) Failure to abide by state and federal
labor laws.
(5) INTERRUPTION OF SERVICES. The ICP cash
benefit is terminated when a participant is absent from the home for longer
than 30 calendar days due to illness or medical treatment. The cash benefit may
resume upon the participant's return to the home, providing ICP eligibility
criteria is met.
(6) SELECTION OF
EMPLOYEE PROVIDERS.
(a) The participant or
representative carries full responsibility for locating, screening,
interviewing, hiring, training, paying, and terminating employee providers. The
participant or representative must comply with Immigration and Customs
Enforcement laws and policies.
(b)
The participant or representative must assure the employee provider's ability
to perform or assist with ADL and IADL service needs.
(c) Employee providers must complete a
background check pursuant to OAR chapter 407, division 007. If a record of a
potentially disqualifying crime is revealed, the participant or representative
may employ the provider at the participant's or representative's
discretion.
(d) A representative
may not be an employee provider regardless of relationship to the
participant.
(e) A participant's
relative may be employed as an employee provider.
(7) CASH BENEFIT.
(a) The cash benefit is determined based on
the participant's CA/PS assessment of need, service plan, level of assistance
standards in OAR 411-030-0070, and natural supports.
(b) The cash benefit is calculated by adding
the ADL task hours and the IADL task hours that the participant is eligible for
as determined in the CA/PS assessment, at the rates according to the
Department's rate schedule.
(c) The
following services, which are approved by the case manager and paid for by the
Department, are excluded from the ICP cash benefit:
(A) Long-term care community
nursing.
(B) Contracted community
transportation.
(C) Medicaid home
delivered meals.
(D) Emergency
response systems.
(d)
The cash benefit includes the employer's portion of required FICA, FUTA, and
SUTA.
(e) The cash benefit is
directly deposited into a participant's ICP designated checking
account.
(8) SERVICE
BUDGET.
(a) The service budget must identify
the cash benefit, the discretionary and contingency funds if applicable, the
reimbursement to an employee provider, and all other expenditures. The service
budget must be initially approved by a Department or AAA case
manager.
(b) The participant may
amend the service budget as long as the amendments relate to meeting the
participant's service needs and are within ICP program guidelines.
(c) A budget review to assure financial
accountability and review service budget amendments must be completed at least
every six months.
(9)
CONTINGENCY FUND.
(a) The participant may
establish a contingency fund in the service budget to purchase identified items
that are not otherwise covered by Medicaid or the Supplemental Nutrition
Assistance Program (SNAP) that substitute for personal assistance and allow for
greater independence.
(b) The
contingency fund must be approved by the case manager, identified in the
service budget, and related to service plan needs.
(c) Contingency funds may be carried over
into the next month's budget until the item is purchased.
(10) DISCRETIONARY FUND.
(a) The participant may establish a monthly
discretionary fund in the service budget to purchase items that directly relate
to the health, safety, and independence of the participant and are not
otherwise covered under Medicaid home and community-based services or
delineated in the monthly service budget.
(b) The maximum amount of discretionary funds
may be up to 10 percent of the participant's cash benefit not including
employee taxes.
(c) The
discretionary fund must be approved by the case manager, identified in the
service budget, and related to service plan needs.
(d) Discretionary funds must be used by the
end of the month.
(11)
ISSUING BENEFITS.
(a) The service plan and
service budget must be prior approved by the case manager before the first ICP
cash benefit is paid.
(b) A cash
benefit is considered issued and received by the participant when the direct
deposit is made to the participant's ICP bank account or a benefit check is
received by the participant.
(c)
The cash benefit is exempt from resource calculations for other Department
programs only while in the ICP bank account and not commingled with other
personal funds.
(d) The cash
benefit is not subject to assignment, transfer, garnishment, or levy as long as
the cash benefit is identified as a program benefit and is separate from other
money in the participant's possession.
(12) CASE MANAGER RESPONSIBILITIES.
(a) The case manager is responsible to review
and authorize service plans and service budgets that meet the ICP program
criteria.
(b) If a participant is
disenrolled, the case manager must review eligibility for other Medicaid long
term care and community-based service options and offer other alternatives if
the participant is eligible.
(c) At
least every six months, a Department or AAA case manager must complete a
service budget review to assure financial accountability and review service
budget amendments.
(d) The case
manager must assist ICP participants in enrolling with a Department contracted
Fiscal Intermediary to provide the required Electronic Visit Verification (EVV)
services.
(13) HEARING
RIGHTS. ICP participants have contested case hearing rights as described in OAR
chapter 461, division 025.
Notes
Statutory/Other Authority: ORS 410.090
Statutes/Other Implemented: ORS 410.070
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