Or. Admin. R. 411-318-0020 - Notification of Planned Action
(1) An individual and the representative of
the individual must receive a written Notification of Planned Action in the
event a developmental disabilities service is denied, reduced, suspended, or
terminated.
(2) The Notification of
Planned Action must be on the form prescribed by the Department (form 0947).
The Notification of Planned Action must include all the following:
(a) The specific date the Notification of
Planned Action is mailed or hand delivered to the individual and the
representative of the individual.
(b) The effective date of the denial,
reduction, suspension, or termination.
(A)
For a denial of service, the effective date is the same date the Notification
of Planned Action is mailed or hand delivered to the individual and the
representative of the individual.
(B) For a reduction, suspension, or
termination of service, the effective date is:
(i) For a Notification of Planned Action
mailed or hand delivered on or before the 18th of the month, the end of the
calendar month in which the Notification of Planned Action is mailed or hand
delivered to the individual and the representative of the individual, if
applicable; or
(ii) For a
Notification of Planned Action mailed or hand delivered on or after the 19th of
the month, the end of the calendar month following the month in which the
Notification of Planned Action is mailed or hand delivered to the individual
and the representative of the individual, if applicable; or
(iii) No fewer than 10 calendar days after
the date the Notification of Planned Action is mailed or hand delivered to the
individual and the representative of the individual, if applicable.
(c) The specific service
or unit of service to be denied, reduced, suspended, or terminated.
(d) The rationale for the denial, reduction,
suspension, or termination, including a reference to the specific reports,
documents, or other information relied on in making the determination. For an
action taken based on the result of a completed Oregon Needs Assessment for the
determination of meeting ICF/IID Level of Care, the Notification of Planned
Action must identify the specific questions, and responses to those questions,
related to the areas of major life activity, identified in OAR 411-317-0000 for
ICF/IID Level of Care, in which an individual does not demonstrate significant
impairment.
(e) The specific
sections of the rules or statutes upon which the determination is
based.
(f) Notification that the
documents relied upon may be reviewed by the individual or the representative
of the individual.
(g)
Notification that if the individual or the representative of the individual
disagrees with the determination to deny, reduce, suspend, or terminate a
service, the individual has the right to request a hearing, or the
representative of the individual has the right to request a hearing on the
behalf of the individual, as provided in ORS chapter 183 and OAR 411-318-0025.
The notification of the right to a hearing must include all the following:
(A) The timeline for requesting a
hearing.
(B) How to request a
hearing.
(C) The right to receive
assistance from the local program in completing and submitting a request for
hearing.
(D) The right of the
individual to receive continuing services at the same level until a Final Order
has been issued or, at the request of the individual or the representative of
the individual, or until the individual has exhausted the appeals processes
identified in OAR 411-318-0025.
(E)
Notification of the time frame within which the individual or the
representative of the individual must request continuing services.
(F) Notification of how, when, and where the
individual or the representative of the individual may request continuing
services.
(G) Notification that the
individual may be required to repay the Department for any continuing services
received during the hearing process if the Final Order upholds the
determination to reduce, suspend, or terminate the services.
(3) The Notification of
Planned Action must be made available using language, format, and presentation
methods appropriate for effective communication according to the needs and
abilities of the individual and the representative of the individual.
Notes
Statutory/Other Authority: ORS 409.050 & 427.107
Statutes/Other Implemented: ORS 183.411-183.471, 409.010, 427.107 & 427.109
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