Or. Admin. R. 411-435-0060 - Developmental Disabilities - Waiver Ancillary Services
(1) The following ancillary services are
available through the Children's and Adults' 1915(c) Waivers, Medically
Involved Children's Waiver, Medically Fragile (Hospital) Model Waiver, and
Behavioral (ICF/IID) Model Waiver:
(a) Family
training as described in section (2) of this rule.
(b) Environmental safety modifications as
described in section (3) of this rule.
(c) Vehicle modifications as described in
section (4) of this rule.
(d)
Specialized medical supplies as described in section (5) of this
rule.
(2) FAMILY
TRAINING.
(a) To be eligible to access family
training, an individual must meet the general eligibility criteria in OAR
411-435-0030 and not be enrolled in a residential program. Family training must
be delivered in an organized conference or workshop.
(b) Family training services include the
following:
(A) Instruction about treatment
regimens and use of equipment specified in an ISP.
(B) Information, education, and training
about the disability, medical, and behavioral conditions of an
individual.
(C) Registration fees
for organized conferences and workshops specifically related to the
intellectual or developmental disability of the individual or the identified,
specialized, medical, or behavioral support needs of the individual.
(i) Conferences and workshops must be prior
authorized by a case manager, directly relate to the intellectual or
developmental disability of the individual, and increase the knowledge and
skills of the family to care for and maintain the individual in the home of the
individual.
(ii) Conference and
workshop costs exclude the following:
(I)
Travel, food, and lodging expenses.
(II) Services otherwise provided under OHP or
available through other resources.
(III) Costs for individual family members who
are employed to care for the individual.
(c) Family training services
exclude the following:
(A) Mental health
counseling, treatment, or therapy.
(B) Training for a paid provider, including a
paid family member.
(C) Legal
fees.
(D) Training for a family to
carry out educational activities in lieu of school.
(E) Vocational training for family
members.
(F) Paying for training to
carry out activities or interventions the Department deems to constitute abuse
of an individual.
(d)
Prior authorization by the case manager is required for attendance by family
members at organized conferences and workshops funded with Department
funds.
(3) ENVIRONMENTAL
SAFETY MODIFICATIONS.
(a) To be eligible to
access environmental safety modifications, an individual must meet the general
eligibility criteria in OAR 411-435-0030 and 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 safety modifications must
be made using materials of the most cost effective type and may not include
decorative additions.
(c) Fencing
may not exceed 200 linear feet without approval from the Department.
(d) Environmental safety modifications
exclude the following:
(A) Large gates, such
as automobile gates.
(B) Costs for
paint and stain.
(C) Adaptations or
improvements to the home that are of general utility and not for the direct
safety or long-term benefit to the individual or do not address the underlying
environmental need for the modification.
(D) Adaptations adding to the total square
footage of the home.
(E)
Adaptations prohibited by local codes and ordinances or neighborhood Covenants,
Conditions, and Restrictions (CCR).
(e) Environmental safety modifications must
be tied to supporting ADL, IADL, and health-related tasks as identified in the
ISP.
(f) Environmental safety
modifications are limited to $5,000 per modification. 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 the determination by the Department of appropriateness and
cost-effectiveness. Separate environmental safety modification projects that
cumulatively total up to over $5,000 in a plan year must be submitted to the
Department for review.
(g)
Environmental safety modifications must be completed by a state licensed
contractor with a minimum of $1,000,000 liability insurance. 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.
(h) Environmental safety modifications must
be made within the existing square footage of the home and may not add to the
square footage of the home.
(i)
Payment to the contractor is to be withheld until the work meets
specifications.
(j) A scope of work
as defined in OAR 411-435-0020 must be completed for each identified
environmental safety modification project. All contractors submitting bids must
be given the same scope of work.
(k) For all environmental safety
modifications, a minimum of three written bids are required from providers
meeting the qualifications in OAR 411-435-0080.
(l) A case manager must follow the processes
outlined in the Expenditure Guidelines for contractor bids and the awarding of
work.
(m) The identified home may
not be in foreclosure or the subject of legal proceedings regarding
ownership.
(n) Environmental safety
modifications must only be completed to the primary residence of the
individual.
(o) Upgrades in
materials not directly related to the health and safety needs of the individual
are not paid for or permitted.
(p)
Environmental safety 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.
(q) RENTAL PROPERTY.
(A) Environmental safety 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 safety 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.
(4)
VEHICLE MODIFICATIONS.
(a) To be eligible to
access vehicle modifications, an individual must meet the general eligibility
criteria in OAR 411-435-0030 and not be enrolled in a residential
program.
(b) Vehicle modifications
may only be made to the vehicle primarily used by an individual to meet the
unique needs of the individual. Vehicle modifications may include a lift,
interior alterations to seats, head and leg rests, belts, special safety
harnesses, other unique modifications to keep the individual safe in the
vehicle, and the upkeep and maintenance of a modification made to the
vehicle.
(c) Vehicle modifications
exclude the following:
(A) Adaptations or
improvements to a vehicle that are of general utility and not of direct medical
benefit to the individual or do not address the underlying need for the
modification.
(B) The purchase or
lease of a vehicle.
(C) Routine
vehicle maintenance and repair.
(d) Vehicle modifications are limited to
$5,000 per modification. 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 the determination
by the Department of appropriateness and cost-effectiveness. Separate vehicle
modification projects that cumulatively total up to over $5,000 in a plan year
must be submitted to the Department for review.
(e) Vehicle modifications must meet
applicable standards of manufacture, design, and installation.
(5) SPECIALIZED MEDICAL SUPPLIES.
Specialized medical supplies do not cover services which are otherwise
available to an individual under Vocational Rehabilitation and Other
Rehabilitation Services, 29 U.S.C. 701-796l, as amended, or the Individuals
with Disabilities Education Act,
20 U.S.C.
1400 as amended. Specialized medical supplies
may not overlap with, supplant, or duplicate other services provided through a
waiver, OHP, or Medicaid state plan services. To be eligible to access
specialized medical supplies an individual must meet the general eligibility
criteria in OAR 411-435-0030.
Notes
Statutory/Other Authority: ORS 409.050, 427.104 & 430.662
Statutes/Other Implemented: ORS 427.005, 427.007, 430.610, 430.620 & 430.662-430.670
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