Or. Admin. Code § 410-172-0790 - Eligibility for Behavioral Health Personal Care Attendant Services

(1) To be eligible for personal care services through the BH PCA program, an individual shall:

(a) Demonstrate the need for assistance with personal care services from a qualified provider due to a disabling behavioral health condition and require medically appropriate services and meet the eligibility criteria described in this rule;

(b) Be enrolled in the Medicaid OHP Plus benefit package.

(2) An individual is not eligible to receive personal care services through the BH PCA program if:

(a) The individual is receiving personal care services from a licensed 24-hour residential services program that includes but is not limited to a foster home, residential treatment home, or residential treatment facility;

(b) The individual is in a prison, hospital, sub-acute care facility, nursing facility or other medical institution;

(c) The individual's assessed service needs are being met under other Medicaid-funded home and community-based service options of the individual's choosing;

(d) The individual's assessed service needs are met through the individual's natural support system as defined in these rules; or

(e) The individual meets any criteria under excluded services and limitation as described in OAR 410-120-1200.

(3) Behavioral health personal care attendant services are not intended to replace routine care commonly needed by an infant or child that is typically provided by the infant's or child's parent.

(4) Behavioral health personal care attendant services may not be used to replace other non-Medicaid governmental services.

(5) The Authority may close the eligibility and authorization for BH PCA services if an individual fails to:

(a) Employ a qualified provider as described in OAR chapter 418 division 020;

(b) Receive personal care from a qualified provider paid by the Authority for 30 continuous calendar days or longer.

(6) Services through the BH PCA program shall not duplicate other Medicaid services.

(7) To be eligible for personal care services through the BH PCA program, an assessment, service plan, any required prior authorization, and all Authority and DHS required forms must be current, complete, signed by a PCA Service Coordinator and placed in the individual medical record.

Notes

Or. Admin. Code § 410-172-0790

DMAP 85-2014(Temp), f. 12-24-14, cert. ef. 1-1-15 thru 6-29-15; DMAP 32-2015, f. 6-24-15, cert. ef. 6/26/2015; DMAP 36-2021, temporary amend filed 09/14/2021, effective 9/14/2021 through 3/12/2022; DMAP 38-2022, amend filed 03/23/2022, effective 3/23/2022

Statutory/Other Authority: ORS 413.042 & 430.640

Statutes/Other Implemented: ORS 413.042, 414.025, 414.065, 430.640, 430.705 & 430.715