Or. Admin. R. 411-300-0150 - Scope of CIIS and Limitations
(1) CIIS are intended to support, not
supplant, the naturally occurring supports provided by a legally responsible
primary caregiver and enable the primary caregiver to meet the needs of caring
for a child receiving CIIS. CIIS are not meant to replace other available
governmental or community services and supports. All CIIS funded by the
Department must be provided according to the Expenditure Guidelines and based
on the actual and customary costs related to best practice standards of care
for children with similar disabilities.
(2) A services coordinator must provide case
management and other supports according to OAR chapter 411, division 415 and
these rules.
(3) To be authorized
and eligible for payment by the Department, all CIIS must be:
(a) Directly related to the assessed needs of
a child or young adult.
(b)
Required to maintain the health and safety of the child.
(c) Cost effective.
(d) Considered not typical for a parent or
guardian to provide to a child of the same age.
(e) Required to help the parent or guardian
continue to meet the needs of caring for the child.
(f) Included in an approved ISP.
(g) Provided according to the Expenditure
Guidelines.
(4)
Department funds may be used to purchase a combination of the following:
(a) Ancillary services as described in OAR
chapter 411, division 435.
(b)
Community living supports as described in OAR chapter 411, division
450.
(c) Professional behavior
services as described in OAR chapter 411, division 304.
(d) State plan personal care services as
described in OAR chapter 411, division 455.
(e) Private duty nursing as described in
section (5) of this rule and OAR chapter 410, division 132.
(f) Employment services as described in OAR
chapter 411, division 345.
(5) PRIVATE DUTY NURSING.
(a) If the service needs of a child or young
adult enrolled in the Medically Fragile Children's Program require the presence
of an RN or LPN on an ongoing basis as determined medically necessary based on
their Clinical Criteria, private duty nursing services may be allocated to
ensure medically necessary supports are provided.
(A) Private duty nursing may be provided on a
shift staffing basis as necessary.
(B) Private duty nursing must be delivered by
a licensed RN or LPN, who does not have limitations of service provision as
described in OAR 410-132-0080, as determined by the service needs of the child
or young adult and documented in the ISP and Nursing Service Plan.
(C) The amount of private duty nursing
available to a child or young adult is based on the acuity level of the child
or young adult as measured by the Clinical Criteria as follows:
(i) Level 1. Score of 75 or above and on a
ventilator for 20 hours or more per day = up to a maximum of 554 nursing hours
per month.
(ii) Level 2. Score of
70 or above = up to a maximum of 462 nursing hours per month.
(iii) Level 3. Score of 65 to 69 = up to a
maximum of 385 nursing hours per month.
(iv) Level 4. Score of 60 to 64 = up to a
maximum of 339 nursing hours per month.
(v) Level 5. Score of 50 to 59 or if a child
requires ventilation for sleeping hours = up to a maximum of 293 nursing hours
per month.
(vi) Level 6. Score of
45 to 49 = up to a maximum of 140 nursing hours per month.
(b) A request for private duty
nursing services exceeding limitations in the Expenditure Guidelines must be
authorized by the Department. The approval of the Department is limited to 90
calendar days unless re-authorized. A request to exceed private duty nursing
limitations in the Expenditure Guidelines is only authorized in the following
circumstances:
(A) The child is not safely
served in the family home without the expenditure.
(B) The expenditure provides supports for the
emerging or changing service needs or behaviors of the child.
(C) A significant medical condition or event,
as documented by a primary care provider, prevents or seriously impedes the
primary caregiver from delivering services.
Notes
Statutory/Other Authority: ORS 409.050, 417.345 & 427.104
Statutes/Other Implemented: ORS 417.345, 427.007, 427.104 & 430.215
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