Or. Admin. R. 411-415-0030 - [Effective until 12/27/2022] Eligibility for Case Management Services - Entry, Exit, Transfers

(1) An individual considered for Department-funded services may not be denied case management services or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws.

(2) To be eligible for case management services, an individual must be determined eligible for developmental disabilities services by the CDDP of the county of origin as described in OAR 411-320-0080.

(a) An adult who is eligible for case management services who lives in their own or family home may select to have case management services provided by a CDDP or a Brokerage, when the Brokerage has the capacity to provide the service according to OAR 411-340-0110. When a local Brokerage is selected, but the local Brokerage does not have the capacity to provide case management, case management must be delivered by the local CDDP until the local Brokerage has capacity.

(b) A child or adult selecting services from a residential program may only have case management services delivered by a CDDP or the Department.

(c) A child who is eligible for and receives family support services as described in OAR chapter 411, division 305 may only have case management services delivered by a CDDP.

(d) A child who is eligible for and enrolled in a CIIS program as described in OAR chapter 411, division 300 may only have case management services delivered by the Department, and by the CDDP with respective roles identified in the ISP.

(e) In order to receive case management services, an individual, or as applicable the legal representative of the individual, must accept the following supports:

(A) Assistance from a CME with the design and management of Department-funded services and supports;

(B) Abuse investigations;

(C) The presence of a case manager at required entry or exit meetings;

(D) Monitoring of services (when applicable) according to OAR 411-415-0090;

(E) Case management contacts as described in OAR 411-415-0090; and

(F) Case manager access to the service record.

(3) To be eligible for case management services delivered by a CIIS services coordinator, an individual must meet the eligibility requirements for a CIIS program in OAR 411-300-0120 and be enrolled to the program.

(4) ENTRY INTO CASE MANAGEMENT.

(a) The county of origin must enter an individual who is eligible for developmental disabilities services into case management services.

(b) Upon entry into case management services, the CME must provide an explanation of the individual rights described in OAR 411-318-0010 to the individual and if applicable the legal representative of the individual.

(c) The CME must assure the availability of a case manager to address the support needs of the individual and any emergency or crisis. The CME must appropriately document the assignment of the case manager in the service record for the individual and the CME must accurately report entry into case management services in the Department's electronic payment and reporting system.

(A) Within 10 business days from the date of entry, the CME must send a written notice to the individual, and as applicable the legal representative of the individual, that includes the name, telephone number, and location of the case manager assigned to the individual.

(B) The CME must ask the individual, and as applicable the legal representative of the individual, to identify any family and other advocates to whom the CME must provide the name, telephone number, and location of the case manager.

(5) EXIT FROM CASE MANAGEMENT.

(a) A CME retains responsibility for providing case management services to an individual until the responsibility is terminated and the individual exits from case management services as described in this rule.

(b) A CME must exit an individual from case management services when any of the following occur:

(A) The individual, or as applicable the legal representative of the individual, submits a signed written request terminating case management services, or such a request is made by telephone and documented in the service record for the individual.

(B) The individual dies.

(C) The individual is determined to be ineligible for:

(i) Developmental disabilities services according to OAR 411-320-0080; or

(ii) CIIS according to OAR chapter 411, division 300.

(D) The individual is not a resident of Oregon.

(E) The individual moves out of the geographic service area of the CME. If an individual takes up residence in another geographic service area, a CME that operates in the new geographic service area may enter the individual into case management services.

(i) If an individual receiving case management from a CDDP moves to a new geographic service area, the original CDDP may continue to provide case management services to the individual. The individual, or as applicable the legal or designated representative of the individual, must request to retain case management services from the original CDDP, and both the original CDDP and the CDDP in the new location must agree in writing to the responsibilities for delivering case management services.

(ii) If an adult individual receiving case management from a Brokerage moves to a new geographic service area, the Brokerage may continue to provide case management services. The adult individual, or as applicable the legal or designated representative of the individual, must request to retain case management services from the original Brokerage, and the Department must approve. Approval may be granted if the Brokerage is available to meet the case management standards described in OAR 411-415-0050 timely and adequately and the Brokerage has the capacity to deliver the case management services.

(iii) In the case of a child moving into a foster home, host home, or 24-hour residential program, the county of parental residency or court jurisdiction must retain responsibility for case management services unless:

(I) The child is entering into a state operated group home; or

(II) An agreement between the CDDPs and the legal representative of the child is reached that describes the responsibilities for case management services.

(F) After the individual either cannot be located or has not responded after a minimum of 30 calendar days of repeated attempts by CME staff to complete ISP development, annual plan development, or monitoring activities.

(G) After the individual has been incarcerated, hospitalized, or in a nursing facility, for longer than 12 consecutive months.

(c) An exit from case management services is an exit from all developmental disabilities services, except in the case of a move by an individual within the state, but out of the geographic service area of the CME.

(d) When an individual is being exited from case management services, the CME must issue a Notification of Planned Action consistent with OAR 411-318-0020 to notify the individual, and as applicable the legal representative of the individual, of the intent of the CME to terminate case management services and any other developmental disabilities services. A Notification of Planned Action is not required when the exit from case management is due to:

(A) The death of the individual; or

(B) A move by the individual within the state, but out of the geographic service area of the CME.

(e) When a child is exited from a CIIS program, the child may remain enrolled at the CDDP for case management services if the child is eligible for developmental disabilities services according to OAR 411-320-0080.

(6) CHANGE OF CASE MANAGEMENT SERVICES PROVIDER.

(a) An available CME, chosen by the individual, or as applicable the legal or designated representative of the individual, must enter an eligible individual into the CME within 10 calendar days from the request to change the CME unless a later date is mutually agreed upon by the individual, or as applicable the legal or designated representative of the individual, and the CMEs involved in the change. The agreement must be documented in the service record by the CME of the individual at the time of the agreement.

(b) A change in CME may only be to a CDDP or Brokerage that is within the same geographic service area as the residence of the individual, unless an exception is approved by the Department.

(c) The exiting CME must assure all relevant information is provided to the entering CME to assist the entering CME in implementing an ISP or Annual Plan that best meets the support needs of the individual, including, but not limited to:

(A) A current application on the Department-mandated application;

(B) A copy of the level of care determination, if present;

(C) A copy of the current functional needs assessment, if present or if unavailable in the Department's electronic payment and reporting system;

(D) A copy of eligibility determination and records used to make the determination;

(E) Copies of financial eligibility information;

(F) Copies of any legal documents, such as guardianship papers, conservatorship, civil commitment status, probation, and parole;

(G) Copies of progress notes; and

(H) A copy of the current ISP or Annual Plan and any protocols, Service Agreements, Functional Behavior Assessments, Behavior Support Plans, and Nursing Service Plans.

Notes

Or. Admin. R. 411-415-0030

APD 34-2022, temporary amend filed 07/01/2022, effective 7/1/2022 through 12/27/2022

Statutory/Other Authority: ORS 409.050, 427.104, 427.105, 427.115, 427.154 & 430.662

Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 427.105, 427.115, 427.121, 427.154, 427.160, 430.212, 430.215, 430.610, 430.620, 430.662 & 430.664