Or. Admin. R. 411-415-0080 - Accessing Developmental Disabilities Services

(1) A CME is required to:

(a) Provide assistance in finding and arranging resources, services, and supports. When an individual or their legal or designated representative chooses to receive supports delivered by a personal support worker, the CME must not limit their choice of qualified providers, including all those available on the Home Care Commission Registry.

(b) Provide information and technical assistance to an individual, and as applicable the legal or designated representative of the individual, in order to make informed decisions. This may include, but is not limited to, information about support needs, settings, programs, and types of providers.

(c) Provide a brief description of the services available from the CME, including typical timelines for activities, required assessments, monitoring and other activities required for participation in a Medicaid program, and the planning process.

(d) Inform the individual, or as applicable the legal or designated representative of the individual, of any potential conflicts of interest between the CME and providers available to the individual.

(e) Inform providers of the responsibility:

(A) To carry out their duty as mandatory reporters of suspected abuse; and

(B) To immediately notify anyone specified by the individual of any incident that occurs when the provider is providing services when the incident may have a serious effect on the health, safety, physical, or emotional well-being, or level of services required.

(2) LICENSED OR CERTIFIED RESIDENTIAL PLACEMENT SETTING OPTIONS. In accordance with ORS 427.121, a case manager must present at least three appropriate licensed or certified residential setting options, including at least two different types of settings, to an adult individual eligible for and desiring to receive services in a licensed or certified residential setting, or to the legal representative, prior to the entry of the adult individual into a licensed or certified residential setting. The case manager is not required to present the licensed or certified residential placement setting options if:

(a) The case manager demonstrates that three appropriate licensed or certified residential placement settings or two different types of settings are not available within the geographic area where the individual wishes to reside;

(b) The individual selects a licensed or certified residential placement setting option and waives the right to be presented with other licensed or certified residential setting options; or

(c) The individual has an imminent risk to health or safety in the current licensed or certified residential setting.

(3) In accordance with the rules for home and community-based services in OAR chapter 411, division 004, an individual, or as applicable the legal or designated representative of the individual, must be advised regarding non-residential service options including employment services and non-residential community living supports. For services considered, a non-disability specific setting option must be presented and documented in the person-centered service plan.

(4) WRITTEN INFORMATION REQUIRED. A case manager must give the relevant content from the ISP that is necessary to for each provider to deliver the services the provider is authorized to deliver, prior to the start of services. The content must include the relevant risks included in the risk management plan. The risks are relevant when they may reasonably be expected to threaten the health and safety of the individual, the provider, or the community at large without appropriate precautions during the delivery of the service authorized for the provider to deliver. If an individual, or as applicable the legal representative of the individual, refuses to disclose the information, the CME must disclose the refusal to the provider, who may choose to refuse to deliver the services.

(a) The necessary information is conveyed on a Department approved Service Agreement containing the required content. For an agency provider or independent provider who is not a personal support worker, the ISP may be used in lieu of a Service Agreement with the consent of the individual.

(b) For agency operators of a residential program or employment program, the case manager must provide to the agency:

(A) A document indicating safety skills, including the ability of the individual to evacuate from a building when warned by a signal device and adjust water temperature for bathing and washing;

(B) A brief written history of any behavioral challenges, including supervision and support needs;

(C) A record of known communicable diseases and allergies;

(D) Copies of protocols, the risk tracking record or risk identification tool, and any support documentation (if applicable);

(E) Copies of documents relating to a health care representative or health care advocate; and

(F) A copy of the most recent Behavior Support Plan and assessment, Nursing Service Plan, and mental health treatment plan (if applicable).

(c) In addition to sub-section (b) of this section, residential programs must be given:

(A) A copy of the eligibility determination document;

(B) A medical history and information on health care supports that includes (when available):

(i) The results of the most recent physical exam;

(ii) The results of any dental evaluation;

(iii) A record of immunizations;

(iv) A record of major illnesses and hospitalizations; and

(v) A written record of any current or recommended medications, treatments, diets, and aids to physical functioning.

(C) A copy of the most recent functional needs assessment. If the needs of an individual have changed over time, the previous functional needs assessments must also be provided;

(D) Copies of documents relating to the guardianship or conservatorship, power of attorney, court orders, probation and parole information, or any other legal restrictions on the rights of the individual (if applicable);

(E) Written documentation that the individual is participating in out-of-residence activities, including public school enrollment for individuals less than 21 years of age; and

(F) A copy of any completed and signed forms documenting consent to an individually-based limitation described in OAR 411-004-0040. The form must be signed by the individual, or, if applicable the legal representative of the individual.

(d) In addition to sub-section (b) of this section, agency providers of employment services must be given:

(A) The Career Development Plan.

(B) Protocols that are necessary to assure the health and safety of the individual.

(e) When an individual is known to be accessing Vocational Rehabilitation services, the Vocational Rehabilitation counselor must be given the Career Development Plan.

(f) If the individual is being entered into a residential program from the family home and the information required in subsection (b) and (c) of this section is not available, the case manager must ensure that the residential program provider assesses the individual upon entry for issues of immediate health or safety.

(A) The case manager must develop and document a plan to secure the information listed in subsection (a) of this section no later than 30 calendar days after entry.

(B) The plan must include a written justification as to why the information is not available and a copy of the plan must be given to the provider at the time of entry.

(5) ENTRY MEETING. No later than the date of entry of an individual into a residential program, a case manager must convene a meeting of the ISP team to review referral material in order to determine appropriateness of entry. An entry meeting may be held for entry into services other than a residential program when a member of the ISP team requests one. A potential provider may request an entry meeting and may refuse entry to an individual who refuses to permit one. Findings of the entry meeting must be recorded in the service record for the individual and distributed to the ISP team members. The findings of the entry meeting must include, at a minimum:

(a) The name of the individual proposed for services.

(b) The date of the entry meeting.

(c) The date determined to be the date of entry.

(d) Documentation of the participants included in the entry meeting;

(e) Documentation of information required by section (4) of this rule when entering a residential program.

(f) Documentation of the decision to serve the individual requesting services.

(6) TRANSFER MEETING. A meeting of the ISP team must precede any transfer of an individual that was not initiated by the individual, or as applicable the legal representative of the individual, unless the individual declines to have a meeting. Findings of the transfer meeting must be recorded in the service record for the individual and include, at a minimum:

(a) The name of the individual considered for transfer.

(b) The date of the transfer meeting.

(c) Documentation of the participants included in the transfer meeting.

(d) Documentation of the circumstances leading to the proposed transfer.

(e) Documentation of the alternatives considered instead of transfer.

(f) Documentation of the reasons any preferences of the individual, or as applicable the legal or designated representative or family members of the individual, may not be honored.

(g) Documentation of the decision regarding the transfer, including verification of the voluntary decision to transfer or a copy of the Notice of Involuntary Reduction, Transfer, or Exit.

(h) The written plan for services for the individual after transfer.

(7) EXIT MEETING. A case manager must offer the individual, and legal or designated representative, an opportunity to convene the ISP team prior to an exit of an individual from a residential program or from agency provided employment services. Findings of the exit meeting must be recorded in the service record for the individual and include, at a minimum:

(a) The name of the individual considered for exit.

(b) The date of the exit meeting.

(c) Documentation of the participants included in the exit meeting.

(d) Documentation of the circumstances leading to the proposed exit.

(e) Documentation of the discussion of the strategies to prevent the exit of the individual from services, unless the individual or legal representative is requesting the exit.

(f) Documentation of the decision regarding the exit of the individual, including verification of the voluntary decision to exit or a copy of the Notice of Involuntary, Reduction, Transfer, or Exit.

(g) The written plan for services for the individual after the exit.

(h) Requirements for an exit meeting may be waived if an individual or the individual's legal representative, if applicable, declines to have an exit meeting or is immediately removed from the applicable program under the following conditions:

(A) The individual or legal representative requests an immediate exit from the program; or

(B) The individual is removed by legal authority acting pursuant to civil or criminal proceedings other than detention for an individual less than 18 years of age.

(8) When services are provided by an independent provider:

(a) The case manager must provide the individual, and as applicable the designated representative of the individual, a brief description of the responsibilities for use of public funds.

(b) Using a Department approved service agreement, the CME must inform an independent provider engaged to provide supports of:

(A) The type and amount of services authorized in the ISP for the independent provider to deliver; and

(B) Behavioral, medical, known risks, and other information about the individual that is required for the provider to safely and adequately deliver services to the individual.

(c) COMMON LAW EMPLOYER. The CME must assure that a person is identified to act as a common law employer for the personal support worker consistent with OAR 411-375-0055.

(A) The CME may require intervention as defined in OAR 411-375-0055.

(B) The CME may deny a request for an employer representative if the requested employer representative has:

(i) A history of substantiated abuse of an adult as described in OAR 407-045-0250 through 407-045-0370;

(ii) A history of founded abuse of a child as described in ORS 419B.005;

(iii) Participated in billing excessive or fraudulent charges; or

(iv) Failed to meet the employer responsibilities described in OAR 411-375-0055, including previous termination as a result of failing to meet the employer.

(C) The CME shall mail a notice informing the individual, and as applicable the legal or designated representative of the individual, when:

(i) The CME denies, suspends, or terminates an employer from performing the employer responsibilities described in 411-375-0055; and

(ii) The CME denies, suspends, or terminates an employer representative from performing the employer responsibilities because the employer representative does not meet the qualifications of an employer representative.

(D) If an individual, or as applicable the legal or designated representative or employer representative of the individual, is dissatisfied with the decision of the CME to remove an employer or employer representative, the individual, or as applicable the legal or designated representative or employer representative of the individual, may request reinstatement as described in OAR 411-375-0055 or file a complaint with the CME or Department as described in OAR 411-318-0015.

Notes

Or. Admin. R. 411-415-0080

APD 28-2016, f. & cert. ef. 6/29/2016; APD 46-2018, amend filed 12/28/2018, effective 12/28/2018; APD 45-2019, amend filed 10/29/2019, effective 11/1/2019; APD 5-2020, amend filed 02/25/2020, effective 3/1/2020

Statutory/Other Authority: ORS 409.050, 427.104, 427.105, 427.115, 427.154, 430.662 & 430.731

Statutes/Other Implemented: ORS 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 & 430.731-430.768