Or. Admin. Code § 411-016-0170 - Home Delivered Meals and Provider Qualifications

(1) To be eligible for home delivered meals a participant must:

(a) Be eligible for OPI-M;

(b) Be unable to complete meal preparation as defined in OAR 411-015-0007 on a regular basis without assistance; and

(c) Not have natural supports available that are willing and able to provide meal preparation services.

(2) Home Delivered Meals must meet the conflict-free case management expectations. When the only willing and qualified provider organization provides both case management and Home Delivered Meals, Department approved firewalls must be in place and followed to ensure a separation of functions within the organization.

(3) Services Case Managers (SCMs) must perform all the functions of case managers authorizing Medicaid home delivered meals as described in OAR 411-040-0050.

(4) If a participant is determined ineligible for Medicaid home delivered meals, but needs food assistance, the SCM shall refer the participant to the nearest Aging and Disability Resource Connection for assistance.

(5) OPI-M Home Delivered Meals providers must meet:

(a) The qualifications and responsibilities for Medicaid paid Home Delivered Meal providers in OAR 411-040-0030; and

(b) The service requirements in OAR 411-040-0036, and

(c) The staff and volunteer requirements in OAR 411-040-0037.

(6) OPI-M paid meals must meet the requirements in OAR 411-040-0035.

(7) The payment rate for Home Delivered Meals is documented in OAR 411-027-0170.

(8) Home Delivered Meals must be prior authorized by the SCM.

(9) Providers may be paid for no more than two meals per day per participant within the month. This service does not constitute the full nutritional regiment.

(10) OPI-M home delivered meals may be authorized in combination with other in-home services if meals are an appropriate resource to meet an identified need.

(11) If OPI-M home delivered meals are authorized, the service plan should be updated to address any duplicative meal preparation services.

Notes

Or. Admin. Code § 411-016-0170

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024; APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024

Statutory/Other Authority: ORS 410.070 & 411.070

Statutes/Other Implemented: ORS 410.060, 410.070, 410.240, 410.250, 410.270, 410.280 & 414.065