Or. Admin. R. 461-160-0610 - Patient Liability; OSIPM (except OSIPM-EPD)
(1) An individual in the OSIPM (except
OSIPM-EPD) program who receives long-term care (see OAR
461-001-0000) 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
liability.
(2) An individual who
receives Supplemental Security Income (SSI), or is deemed to receive SSI under
section 1619(b) of the Social Security Act (42
U.S.C. §
1382h(b)), is
eligible for OSIPM program benefits without having to make a payment.
(3) The following end on December 31, 2021:
(a) Patient liability for individuals
receiving home and community-based care in-home services (see
OAR 461-001-0030 and OAR Chapter 411, Division 030),
(b) Independent Choices Program (ICP) patient
liability for individuals in OSIPM-ICP (see OAR Chapter 411, Division 030),
and
(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).
(4) The following individuals, if they
receive the services described in section (5) of this rule, are exempt from
payments required by this rule:
(b) A widow or widower under OAR
461-135-0820.
(c) A Pickle
amendment individual under OAR 461-135-0780.
(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.
(7) An individual
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
treatment facility:
(a) A mental health adult
foster home.
(b) A mental health
residential treatment home.
(c) A
mental health residential treatment facility.
(d) A mental health secure residential
treatment facility.
Notes
Statutory/Other Authority: ORS 409.050, 411.060, 411.070, 411.404, 411.706, 413.085 & 414.685
Statutes/Other Implemented: ORS 409.010, 411.060, 411.070, 411.404 & 411.706
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(1) An individual in the OSIPM (except OSIPM-EPD) program who receives long-term care (see OAR 461-001-0000) 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 liability.
(2) An individual who receives Supplemental Security Income (SSI), or is deemed to receive SSI under section 1619(b) of the Social Security Act (42 U.S.C. § 1382h(b)), is eligible for OSIPM program benefits without having to make a payment.
(3) The following end on December 31, 2021:
(a) Patient liability for individuals receiving home and community-based care in-home services (see OAR 461-001-0030 and OAR Chapter 411, Division 030),
(b) Independent Choices Program (ICP) patient liability for individuals in OSIPM-ICP (see OAR Chapter 411, Division 030), and
(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).
(4) The following individuals, if they receive the services described in section (5) of this rule, are exempt from payments required by this rule:
(a) An adult child with a disability under OAR 461-135-0830.
(b) A widow or widower under OAR 461-135-0820.
(c) A Pickle amendment individual under OAR 461-135-0780.
(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.
(7) An individual 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 treatment facility:
(a) A mental health adult foster home.
(b) A mental health residential treatment home.
(c) A mental health residential treatment facility.
(d) A mental health secure residential treatment facility.
Notes
Statutory/Other Authority: ORS 409.050, 411.060, 411.070, 411.404, 411.706, 413.085 & 414.685
Statutes/Other Implemented: ORS 409.010, 411.060, 411.070, 411.404 & 411.706