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

Or. Admin. R. 411-435-0050
APD 20-2016, f. & cert. ef. 6/29/2016; APD 36-2016(Temp), f. 8-31-16, cert. ef. 9-1-16 thru 2-27-17; APD 6-2017, f. 2-21-17, cert. ef. 2/28/2017; APD 29-2017, amend filed 11/30/2017, effective 12/1/2017; APD 23-2018, temporary amend filed 07/02/2018, effective 07/02/2018 through 12/27/2018; APD 46-2018, amend filed 12/28/2018, effective 12/28/2018; APD 47-2019, amend filed 10/29/2019, effective 11/1/2019

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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