411-435-0060 - Developmental Disabilities - Waiver Ancillary Services

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.

(APD 20-2016, f. & cert. ef. 6-29-16; 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. 2-28-17; 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)

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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