Or. Admin. R. 411-435-0050 - Developmental Disabilities - Community First Choice Ancillary Services
(1) The following
ancillary services are available through the Community First Choice state plan:
(a) Assistive devices as described in section
(2) of this rule.
(b) Assistive
technology as described in section (3) of this rule.
(c) Chore services as described in section
(4) of this rule.
(d) Community
nursing services as described in section (5) of this rule.
(e) Community transportation as described in
section (6) of this rule.
(f)
Environmental modifications as described in section (7) of this rule.
(g) Professional behavior services as
described in OAR chapter 411, division 304.
(h) Transition costs as described in section
(8) of this rule.
(2)
ASSISTIVE DEVICES. Assistive devices are primarily and customarily used to meet
an ADL, IADL, or health-related support need. The purchase, rental, or repair
of an assistive device with Department funds must be limited to the types of
equipment and accessories not excluded under OAR 410-122-0080. An individual
who meets the general eligibility criteria in OAR 411-435-0030 may access this
service when assistive devices may be reasonably expected to reduce the need
for human assistance or increase the independence of an individual with meeting
an identified support need related to the completion of an ADL, IADL, or
health-related task.
(a) Assistive devices
may include the purchase of devices, aids, controls, supplies, or appliances
primarily and customarily used to enable an individual to increase the ability
of the individual to perform and support ADLs and IADLs or to communicate in
the home and community.
(b)
Assistive devices may be purchased with Department funds when the intellectual
or developmental disability of an individual otherwise prevents or limits the
independence of the individual in areas identified in a functional needs
assessment.
(c) Assistive devices
that may be purchased for the purpose described in subsection (b) of this
section must be of direct benefit to the individual.
(d) Expenditures for assistive devices are
limited to $5,000 per plan year without Department approval. Any single
purchase costing more than $1,200 or any combination of items that meet a
single assessed need totaling more than $1,200, must be approved by the
Department prior to expenditure. A case manager must request approval for
additional expenditures through the Department prior to expenditure. Approval
is based on the service and support needs and goals of the individual and a
determination by the Department of appropriateness and
cost-effectiveness.
(e) Devices
must be limited to the least costly option necessary to meet the assessed need
of an individual.
(f) Assistive
devices must meet applicable standards of manufacture, design, and
installation.
(g) Assistive devices
exclude the following:
(A) Items that do not
address the underlying current need for the device.
(B) Items intended to supplant similar items
furnished under Medicaid Title XIX, private insurance, or alternative
resources.
(C) Items that are
unsafe for an individual.
(D) Toys
or outdoor play equipment.
(E)
Equipment and furnishings of general household use.
(3) ASSISTIVE TECHNOLOGY Assistive
technology is primarily and customarily used to provide additional safety and
support and replace the need for direct interventions, to enable self-direction
of care, or increase independence. An individual who meets the general
eligibility criteria in OAR 411-435-0030 may access this service when assistive
technology may be reasonably expected to reduce the need for human assistance
or increase the independence of an individual with meeting an identified
support need related to the completion of an ADL, IADL, or health-related task.
(a) Expenditures for assistive technology are
limited to $5,000 per plan year without Department approval. Any single
purchase costing more than $1,200, or any combination of items that meet a
single assessed need totaling more than $1,200, must be approved by the
Department prior to expenditure. A case manager must request approval for
additional expenditures through the Department prior to expenditure. Approval
is based on the service and support needs and goals of the individual and a
determination by the Department of appropriateness and
cost-effectiveness.
(b) Payment for
ongoing electronic back-up systems or assistive technology costs must be paid
to providers each month after services are received.
(A) Ongoing costs do not include electricity
or batteries.
(B) Ongoing costs may
include minimally necessary data plans and the services of a company to monitor
emergency response systems.
(c) Assistive technology includes, but is not
limited to the following:
(A) Motion or sound
sensors.
(B) Two-way communication
systems.
(C) Automatic faucets and
soap dispensers.
(D) Incontinence
and fall sensors.
(E) Devices to
secure assistance in an emergency in the community.
(F) Medication minders.
(G) Alert systems for ADL or IADL
supports.
(H) Mobile electronic
devices or other electronic backup systems, including the expense necessary for
the continued operation of the assistive technology.
(4) CHORE SERVICES.
(a) To be eligible to access chore services
an individual must:
(A) Meet the general
eligibility criteria in OAR 411-435-0030; and
(B) Not be enrolled in a residential program,
unless the enrollment is in a supported living program described in OAR chapter
411, division 328 and the dwelling is not a provider owned, controlled, or
operated setting.
(b)
Chore services include heavy household chores, such as the following:
(A) Washing floors, windows, and
walls.
(B) Tacking down loose rugs
and tiles.
(C) Moving heavy items
of furniture for safe access and egress.
(c) Chore services may include yard hazard
abatement to ensure the outside of a home is safe for an individual to traverse
and enter and exit the home.
(d)
Chore services may be provided only in situations where no one else is
responsible to perform or pay for the services.
(5) COMMUNITY NURSING SERVICES.
(a) In addition to the general eligibility
criteria listed in OAR 411-435-0030, to access community nursing services, an
individual may not be enrolled in a 24-hour residential program under OAR
chapter 411, division 325. An individual enrolled in a supported living program
under OAR chapter 411, division 328 is eligible to access community nursing
services when the cost of the service is not included in the rate paid to the
provider.
(b) Community nursing
services include the following:
(A) Nursing
assessments, including medication reviews.
(B) Care coordination.
(C) Monitoring.
(D) Development of a Nursing Service
Plan.
(E) Delegation and training
of nursing tasks to a provider and primary caregiver.
(F) Teaching and education of the provider
and primary caregiver and identifying supports that minimize health risks while
promoting the autonomy of an individual and self-management of
healthcare.
(G) Collateral contact
with a case manager regarding the community health status of an individual to
assist in monitoring safety and well-being and to address needed changes to the
ISP for the individual.
(c) Community nursing services exclude the
direct nursing services described in OAR chapter 411, division 380 and the
private duty nursing services described in OAR chapter 411, division
300.
(d) A Nursing Service Plan
must exist if Department funds are used for community nursing services. A case
manager must authorize the provision of community nursing services as
identified in an ISP.
(e) After an
initial nursing assessment, a nursing reassessment must be completed every six
months or sooner if a change in a medical condition requires an update to the
Nursing Service Plan.
(6) COMMUNITY TRANSPORTATION.
(a) Community transportation may only be
authorized on an ISP when:
(A) An individual
meets the general eligibility criteria in OAR 411-435-0030.
(B) Voluntary natural supports or volunteer
services are not available.
(C)
The individual is not enrolled in a residential program.
(D) It is not the responsibility of the
parent of a child.
(E) The
individual has one of the following identified in their ISP:
(i) An assessed support need for an ADL,
IADL, or health-related task during transportation.
(ii) An assessed support need for an ADL,
IADL, or health-related task at the destination or a need for waiver-funded
services at the destination.
(b) Community transportation includes, but is
not limited to the following:
(A) Community
transportation provided by a common carrier, taxicab, or bus in accordance with
standards established for these entities.
(B) Reimbursement on a per-mile basis for
transporting an individual to accomplish an ADL, IADL, health-related task, or
employment goal identified in an ISP.
(C) The purchase of a bus pass.
(c) Community transportation must
be provided in the most cost-effective manner to meet the needs identified in
the ISP for an individual.
(d)
Community transportation expenses exceeding $500 per month must be approved by
the Department.
(e) Community
transportation must be prior authorized by a case manager and documented in an
ISP. The Department does not pay any provider under any circumstances for more
than the total number of hours, miles, or rides prior authorized by the case
manager and documented in the ISP. Personal support workers who use their own
personal vehicle for community transportation are reimbursed as described in
OAR chapter 411, division 375.
(f)
Mileage reimbursement for community transportation is only authorized when a
provider is also being paid for delivering community living supports or job
coaching. Mileage may not be authorized as a stand-alone payment.
(g) Community transportation services exclude
the following:
(A) Medical
transportation.
(B) Purchase or
lease of a vehicle.
(C) Routine
vehicle maintenance and repair, insurance, and fuel.
(D) Ambulance services.
(E) Costs for transporting a person other
than the individual.
(F)
Transportation for a provider to travel to and from the workplace of the
provider.
(G) Transportation not
for the sole benefit of the individual.
(H) Transportation as part of a vacation or
trips for relaxation purposes.
(I)
Transportation provided by family members who are not personal support
workers.
(J) Reimbursement for
out-of-state travel expenses.
(K)
Mileage reimbursement to the individual or a personal support worker when the
individual owns the vehicle doing the transportation.
(L) Transportation normally provided by
schools.
(M) Transportation
normally provided by a primary caregiver for a child of similar age without
disabilities.
(N) Transportation
for a child typically the responsibility of a parent. Transportation for a
child not typically a parental responsibility is limited to transportation:
(i) Concurrent with the delivery of relief
care as described in OAR 411-450-0060; or
(ii) When included within the emergency
crisis section of a Positive Behavior Support Plan as an isolated intervention
strategy when a child is behaving in an unsafe manner that presents imminent
danger of injury to self or others.
(7) ENVIRONMENTAL MODIFICATIONS.
(a) In addition to the general eligibility
criteria stated in OAR 411-435-0030, an individual may access this service if:
(A) Environmental modification may be
reasonably expected to reduce the need for human assistance or increase the
independence of the individual with meeting an identified support need related
to the completion of an ADL, IADL, or health-related task.
(B) The individual is not enrolled in a
residential program, unless the enrollment is in a supported living program
described in OAR chapter 411, division 328 and the dwelling is not a provider
owned, controlled, or operated setting.
(b) Environmental modifications include, but
are not limited to, the following:
(A)
Installation of shatter-proof windows.
(B) Hardening of walls or doors.
(C) Specialized, hardened, waterproof, or
padded flooring.
(D) An alarm
system for doors or windows.
(E)
Protective covering for smoke alarms, light fixtures, and appliances.
(F) Installation of ramps, grab-bars, and
electric door openers.
(G)
Adaptation of kitchen cabinets and sinks.
(H) Widening of doorways.
(I) Handrails.
(J) Modification of bathroom
facilities.
(K) Individual room air
conditioners for an individual whose temperature sensitivity issues create
behaviors or medical conditions that put the individual or others at
risk.
(L) Installation of non-skid
surfaces.
(M) Overhead track
systems to assist with lifting or transferring.
(N) Specialized electric and plumbing systems
necessary to accommodate the medical equipment and supplies necessary for the
welfare of the individual.
(O)
Adaptations to control the home environment, including lights and
heat.
(c) Environmental
modifications exclude the following:
(A)
Adaptations or improvements to the home that are of general utility, such as
carpeting, roof repair, and central air conditioning, unless directly related
to the assessed health and safety needs of the individual and identified in the
ISP for the individual as the most cost-effective solution.
(B) Adaptations that add to the total square
footage of the home, except for ramps that attach to the home for the purpose
of entry or exit.
(C) Adaptations
outside of the home, except for ramps that attach to the home for the purpose
of entry or exit.
(D) General
repair or maintenance and upkeep required for the home.
(d) Environmental modifications are limited
to $5,000 per modification. A case manager must request approval for additional
expenditures through the Department prior to authorization of the service in an
ISP. Approval is based on the service and support needs and goals of the
individual and the determination by the Department of appropriateness and
cost-effectiveness. Separate environmental modification projects that
cumulatively total up to over $5,000 in a plan year must be submitted to the
Department for review.
(e) Any
modification requiring a permit must be inspected by a local inspector and
certified as in compliance with local codes. Certification of compliance must
be filed in the file for the contractor prior to payment.
(f) Payment to the contractor is to be
withheld until the work meets specifications.
(g) A scope of work must be completed for
each identified environmental modification project. All contractors submitting
bids must be given the same scope of work.
(h) For all environmental modifications, a
case management entity must assure the acquisition of at least three written
bids from providers meeting the qualifications in OAR 411-435-0080. When it is
not possible to reasonably obtain three written bids, exceptions to this
requirement may be granted by the Department.
(i) A case manager must assure the processes
outlined in the Expenditure Guidelines are followed for contractor bids and the
awarding of work.
(j) All dwellings
must be in good repair and have the appearance of sound structure.
(k) The identified home may not be in
foreclosure or be the subject of legal proceedings regarding
ownership.
(l) Environmental
modifications must only be completed to the primary residence of the
individual.
(m) Upgrades in
materials not directly related to the health and safety needs of the individual
are not paid for or permitted.
(n)
Environmental modifications are subject to Department requirements regarding
material and construction practices based on industry standards for safety,
liability, and durability, as referenced in building codes, materials, manuals,
and industry and risk management publications.
(o) RENTAL PROPERTY.
(A) Environmental modifications to rental
property may not substitute or duplicate services otherwise the responsibility
of the landlord under the landlord tenant laws, the Americans with Disabilities
Act, or the Fair Housing Act.
(B)
Environmental modifications made to a rental structure must have written
authorization from the owner of the rental property prior to the start of the
work.
(C) The Department does not
fund work to restore the rental structure to the former condition of the rental
structure.
(8) TRANSITION COSTS.
(a) To be eligible to access transition
costs, an individual must meet the general eligibility criteria in OAR
411-435-0030 and not be enrolled in a residential program.
(b) Transition costs are limited to an
individual transitioning from residing in a nursing facility or intermediate
care facility for individuals with intellectual disabilities to residing in a
community-based home when the cost for the transition is not included in the
rate paid to the provider.
(c)
Transition costs are based on the assessed need of an individual determined
during the person-centered planning process and must support the desires and
goals of the individual receiving services and supports.
(d) Final approval for transition costs must
be through the Department prior to expenditure. The approval of the Department
is based on the need of an individual and the determination by the Department
of appropriateness and cost-effectiveness.
(e) Financial assistance for transition costs
is limited to the following:
(A) Moving and
move-in costs, including movers, cleaning and security deposits, payment for
background or credit checks (related to housing), or initial deposits for
heating, lighting, and phone.
(B)
Payment of previous utility bills that may prevent the individual from
receiving utility services.
(C)
Basic household furnishings, such as a bed.
(D) Other items necessary to re-establish a
home.
(f) Transition
costs are provided no more than twice annually.
(g) Transitions costs for basic household
furnishings and other items are limited to one time per year.
(h) Transition costs may not supplant the
legal responsibility of the parent or guardian of a child. In this context, the
term parent or guardian does not include a designated representative.
Notes
Statutory/Other Authority: ORS 409.050, 427.104 & 430.662
Statutes/Other Implemented: ORS 427.007, 427.104, 430.610, 430.620 & 430.662-430.670
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