An individual in the OSIPM (except
OSIPM-EPD) program who receives long-term care
) services must, in order to remain eligible, make the payment
required by this rule, except as provided in sections (2) to (7) of this rule.
Individuals must apply their adjusted income to the cost of the care or service
in the amount, if any, determined by the Department. This amount is the patient
liability. If the individual's adjusted income exceeds the cost of care or
service, the individual must pay the full cost of care but has no additional
An individual who
receives Supplemental Security Income (SSI), or is deemed to receive SSI under
section 1619(b) of the Social Security Act (42
eligible for OSIPM program benefits without having to make a payment.
The following end on December 31, 2021:
Patient liability for individuals
receiving home and community-based care
in-home services (see
and OAR Chapter 411, Division 030),
(b) Independent Choices Program (ICP) patient
liability for individuals in OSIPM-ICP (see OAR Chapter 411, Division 030),
(c) Liability or contribution
to the cost of services for Program of All-Inclusive Care for the Elderly
(PACE) participants (see OAR Chapter 411 Division 045).
The following individuals, if they
receive the services described in section (5) of this rule, are exempt from
payments required by this rule:
child with a disability under OAR 461-135-0830
(5) An individual identified in section (4)
of this rule is exempt from payments required by this rule if the individual
receives home and community-based care.
(6) In the initial month of placement, an
individual may be exempt from payments required under this rule if the
Department determines that the individual's income has been exhausted prior to
placement. If any income remains, the individual must contribute to the cost of
care or service.
residing in an acute care hospital or mental health residential treatment
facility is exempt from payments required by this rule while residing in the
acute care hospital or mental health residential treatment facility. If a
service benefit was received prior to admission to the acute care hospital,
payment must be made for that service. For purposes of this rule, only the
following types of treatment centers qualify as a mental health residential
(a) A mental health adult
(b) A mental health
residential treatment home.
mental health residential treatment facility.
(d) A mental health secure residential
Or. Admin. R.
AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 1-1999(Temp),
f. & cert. ef. 2-1-99 thru 7-31-99; AFS 7-1999, f. 4-27-99, cert. ef.
5-1-99; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 16-2003, f. & cert. ef.
7-1-03; SSP 22-2004, f. & cert. ef. 10-1-04; SSP 8-2005(Temp), f. &
cert. ef. 7-1-05 thru 10-1-05; SSP 9-2005(Temp), f. & cert. ef. 7-6-05 thru
10-1-05; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 19-2005, f. 12-30-05,
cert. ef. 1-1-06; SSP 14-2006, f. 9-29-06, cert. ef. 10-1-06; SSP 15-2006, f.
12-29-06, cert. ef. 1-1-07; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP
7-2007, f. 6-29-07, cert. ef. 7-1-07; SSP 23-2008, f. & cert. ef. 10-1-08;
SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10; SSP 32-2010, f. & cert. ef.
10-1-10; SSP 17-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SSP
26-2013, f. & cert. ef. 10-1-13;
22-2018, amend filed 06/05/2018, effective
12-2021, minor correction filed 02/18/2021, effective
79-2021, temporary amend filed 12/22/2021, effective
1/1/2022 through 6/29/2022;
34-2022, amend filed 04/28/2022, effective
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS