Or. Admin. Code § 410-172-0776 - Behavioral Health Personal Care Attendant (BH PCA) Program Definitions
Unless the context indicates otherwise, the following definitions apply to the rules in OAR 410-172-0775 through OAR 410-172-0840 Personal Care Attendant Program:
(1) "Alternative
Service Resources" means other possible resources for the provision of services
to meet an individual's needs. Alternative service resources include, but are
not limited to, natural supports, risk intervention services, Community Mental
Health Programs, or other community supports. Alternative service resources are
not paid by Medicaid.
(2)
"Assistance" means an individual requires developmentally appropriate help from
another person with the personal care described in OAR
410-172-0780. Assistance may be
in the form of hands-on assistance, supervising, cueing, or redirecting so that
the individual performs the task on their own . In cases of cognitive
impairments, assistance may include cueing along with supervision to ensure
that the individual performs the task properly.
(3) "Assistive Devices" means any category of
durable medical equipment, mechanical apparatus, electrical appliance, or
instrument of technology used to assist and enhance an individual's
independence in performing any task described in OAR
410-172-0780.
(4) "Assistive Supports" means the aid of
service animals, general household items, or furniture used to assist and
enhance an individual's independence in performing any task described in OAR
410-172-0780.
(5) "Background Check" means a criminal
history check and abuse check as described in OAR chapter 407 division
007.
(6) "Personal Care Attendant
Service Coordinator" or "PCA Service Coordinator" means an employee of the
Authority or the Authority's IQA designee, who assesses the service needs of
individuals, determines eligibility, and offers service choices to eligible
individuals. A PCA Service Coordinator authorizes and implements an
individual's person-centered service plan and monitors the personal care
services delivered. The PCA Service Coordinator will meet the qualifications
set forth by the Authority and IQA as per the current contract.
(7) "Cognitive Impairments" means an
individual may be physically capable of performing ADLs or IADLs, but may have
limitations in performing these activities because of a behavioral health
condition or disability which impacts the individual's cognitive abilities.
Personal care services may be required because a cognitive impairment prevents
an individual from knowing when or how to carry out the task. In such cases,
personal assistance may include cueing along with supervision to ensure that
the individual performs the task properly.
(8) "Collective Bargaining Agreement (CBA)"
means the ratified Collective Bargaining Agreement between the Home Care
Commission and the Service Employees International Union, Local 503. The
Collective Bargaining Agreement is maintained on the Department's website:
(http://www.dhs.state.or.us/spd/tools/cm/homecare/index.htm).
Printed copies may be obtained by writing the Oregon Department of Human
Services, Aging and People with Disabilities, ATTN: Rules Coordinator, 500
Summer Street NE, E-2, Salem, Oregon 97301.
(9) "Consumer-Employer" means an individual
eligible for and receiving in-home services through the Behavioral Health
Personal Care Attendant program.
(10) "Consumer-Employer Representative" means
any adult with longstanding involvement in assuring the individual's health and
safety, appointed to participate in service planning process, and is:
(a) Chosen and appointed by the individual or
their legal representative, if applicable;
(b) Not a paid provider of individual's
Behavioral Health Personal Care Attendant services;
(c) Authorized, in writing or other method
that clearly indicates consenting choice, by the individual or legal
representative, if applicable, to serve as the individual's representative in
connection with the provision of funded supports until the individual or legal
representative modifies the authorization or notifies the agency that the
representative is no longer authorized to act on their behalf; and
(d) Responsible for performing
consumer-employer duties described in OAR
410-172-0800.
(11) "Cost Effective" means being
responsible and accountable with Authority resources. This is accomplished by
offering less costly alternatives when providing choices that adequately meet
an individual's service needs. Those choices consist of all available service
options, the utilization of assistive devices or assistive supports, natural
supports, architectural modifications, and alternative service resources. Less
costly alternatives may include resources not paid for by the
Authority.
(13) "Direct Contact" means services provided
by a PCA Service Coordinator through direct communication with an individual or
their legal representative via phone, email or face-to-face contact, as
directed by the individual, for the purposes of care coordination and
service-plan monitoring.
(14) "Duty
to Maintain Consumer-Employer Confidentiality" means a personal care attendant
will not disclose personally identifiable information about a consumer-
employer unless otherwise authorized by law.
(15) "Duty to Maintain a Drug-Free Workplace"
means:
(a) Providers shall be free of the
influence of substances that will inhibit their ability to provide personal
care services including alcohol, inhalants, prescription drugs, or other drugs,
illicit or legal, including over-the-counter medications, while responsible for
the care of an individual, while in the individual's home or care setting, or
while transporting the individual; and
(b) Provider must not manufacture, possess,
sell, offer to sell, trade, or use illegal drugs while providing authorized
services to an individual or while in the individual's home or care
setting.
(16)
"Electronic Visit Verification (EVV)" means a technological solution used to
electronically verify whether personal care providers and, later, home health
providers delivered or rendered services as billed. The federal requirement for
the data to be collected for each visit includes:
(a) Date of service;
(b) Start and end time;
(c) Type of service;
(d) Location of service;
(e) Name of service provider;
(f) Name of individual receiving
services.
(17)
"Established Work Schedule" means the work schedule established by the
consumer-employer to best meet the consumer-employer's assessed needs and
agreed to by the personal care attendant employed by the consumer-employer. A
personal care attendant adheres to the established work schedule by arriving to
work on time, requesting absence from work in a timely manner, and notifying
the consumer-employer of unscheduled absences in a timely manner.
(18) "Evidence" means testimony, writings,
material objects, or other tangible items presented to the senses that are
offered to prove the existence or nonexistence of a fact.
(19) "Exerts Undue Influence" means a
personal care attendant assumes or attempts to assume control of an
individual's decision-making, finances, home, property, medication, social
interaction or ability to communicate, through coercion or other
non-persuasive, threatening means. Exertion of undue influence may exist
whether or not an individual willfully allows the personal care attendant to
assume such control.
(20) "Fiscal
Improprieties" means a personal care attendant committed financial misconduct
involving an individual's money, property, or benefits.
(a) Fiscal improprieties include, but are not
limited to:
(A) Financial exploitation, as
defined in OAR 411-020-0002(1)(e);
(B) Borrowing money, property, or belongings
from an individual;
(C) Taking an
individual's property or money;
(D)
Accepting or receiving items or services purchased for the personal care
attendant by the individual;
(E)
Forging an individual's signature;
(F) Falsifying payment records which includes
but is not limited to:
(i) Submitting
incorrect start and end times of work; or
(ii) Submitting payment for days that were
not worked.
(G) Claiming
to deliver services to an individual during a time also claimed for travel
between worksites;
(H) On one or
more occasions, working or claiming to work hours not prior authorized on a
consumer-employer's service plan or working or claiming to work hours over the
maximum authorized weekly number of hours allowed for the personal care
attendant as permitted under the Collective Bargaining Agreement;
(I) Claiming hours worked for an individual
while taking time off or when a relief care worker, as described in the CBA, is
paid for providing services;
(J)
Requesting or demanding payment for services from either the Authority or the
individual in excess of the amount paid following the submission and processing
of a properly completed claim;
(K)
One or more intentional acts of dishonesty for purposes of unearned financial
gain; or
(L) Creating an
overpayment whether intentionally or unintentionally and not paying it back
within six months.
(b)
Fiscal Improprieties do not include the exchange of money, gifts, or property
between a personal care attendant and an individual with whom the personal care
attendant is related unless an allegation of financial exploitation, as defined
in OAR chapter 407, division 045, has been substantiated based on an adult
protective services investigation.
(21) "Independent and Qualified Agent (IQA)"
means an entity meeting the provider qualification requirements identified in
42 CFR §
441.730 and is under contract with the
Division.
(22) "Information and
Referral" means providing referral and related activities, such as assisting
the individual to schedule appointments, to help the individual obtain needed
services, and connecting the individual with medical, social, and educational
providers or other programs and services that can provide needed services to
address identified needs of the individual.
(24) "Mandatory Abuse Reporter" means any
public or private official, including personal care attendants, who are
required per ORS 419B.005(dd),
by state abuse statutes, to report alleged abuse.
(25) "Personal Care" means the functional
activities described in OAR
410-172-0780 an individual
requires for continued well-being.
(26) "Personal Care Attendant (PCA)" means a
type of personal support worker, as defined in ORS
410.600, who is hired to provide
personal care services to an individual with a behavioral health condition or
disability who resides in their own home. A PCA can be hired by the individual,
a parent of a child, or the individual's legal representative.
(27) "Provider" or "Qualified Provider" means
a personal support worker, including personal care attendants, that is an
enrolled provider with the Authority, meets the training and education and
qualifications in OAR Chapter 418 Division 020, and that performs personal care
services for individuals not residing in a facility.
(28) "Provider Number" means an identifying
number issued to each PCA who is enrolled as a Medicaid provider through the
Authority.
(29) "Respite" means
services for the relief of a person normally providing supports to an
individual unable to care for them self.
(30) "Service Authorization" means an
individual's written plan for services that identifies:
(a) The individual's qualified provider who
is to deliver the authorized services;
(b) The date when the provision of personal
care services is to begin; and
(c)
The maximum hours per service period of personal care authorized by the
Authority or the Authority's designee.
(31) "Service Coordination" means the
functions performed by a PCA Service Coordinator and includes determining
annual service eligibility and developing a plan of authorized
services.
(32) "Service Need" means
the personal care and supportive services needed by an individual receiving
Authority services.
(33) "Service
Period" means, two consecutive work weeks for a total of 14 days beginning on a
Sunday and ending on a Saturday.
(34) "Skills, Knowledge, and Ability to
Adequately or Safely Perform the Required Work" means a PCA possesses and
demonstrates the physical, mental, organizational, and emotional skills or
abilities necessary to perform services which safely and adequately meet the
service needs of individuals.
(35)
"Termination" means a sanction prohibiting a provider's participation in the
Division's programs by canceling the provider's Authority-assigned billing
number and agreement. No payments, Title XIX, or state funds will be made for
services provided after the date of termination.
(36) "Unwelcome Nuisance to the Workplace"
includes, but is not limited to, unwelcome guests or pets invited by a PCA into
an individual's home, unwelcome behaviors, or unwelcome items resulting in the
individual's dissatisfaction or a PCA's inattention to the individual's
required service needs.
Notes
Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 413.042, 430.640, 414.025, 414.065, 430.705 & 430.715
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