Or. Admin. Code § 411-034-0030 - Eligibility for State Plan Personal Care Services

(1) To be eligible for State Plan personal care services, an individual must:

(a) Be 18 years of age or older.

(b) Have a physical or cognitive impairment that requires the assistance from another person or delegated nursing services to complete at least one of the ADLs described in 411-034-0020(2)(a).

(c) Be a current recipient of an OHP Plus package through Medicaid or Healthier Oregon.

(2) An individual is not eligible to receive State Plan personal care services through APD if:

(a) The individual is receiving services from a licensed 24-hour residential services program (such as an adult foster home, assisted living facility, group home, nursing facility or residential care facility). Individuals in licensed care settings who meet the criteria for SPPC may receive Money Management Services;

(b) The individual is in a prison, hospital, sub-acute care facility, nursing facility, substance abuse treatment facility, state hospital or other medical institution. Individuals temporarily in an acute care hospital may continue to receive Money Management Services.;

(c) The individual's service needs are met through the individual's natural support system (defined in OAR 411-034-0010). Individuals excluded from SPPC because of natural supports but who meet the criteria for SPPC may receive Money Management Services;

(d) The individual's assessed service needs are being met under other Medicaid-funded home and community-based (HCBS) service options of the individual's choosing. Individuals in other Medicaid funded HCBS service options who meet the criteria for SPPC may receive Money Management Services in addition to their other services.

(e) The individual's primary driver of need is based on an intellectual or developmental disability, a mental illness or a substance use disorder.

(3) Payment for State Plan personal care services is not intended to replace the resources available to an individual from the individual's natural support system (defined in OAR 411-034-0010).

(4) State Plan personal care services may not be used to replace other non-Medicaid governmental services.

(5) The Department has the authority to close the eligibility and authorization for State Plan personal care services if an individual fails to:

(a) Employ a qualified provider; or

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

(6) State Plan personal care services must not duplicate other Medicaid services but may supplement other state plan or waivered services not otherwise provided in those programs.

Notes

Or. Admin. Code § 411-034-0030

SSD 2-1996, f. 3-13-96, cert. ef. 3-15-96; SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04; SPD 9-2005, f. & cert. ef. 7-1-05; SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07; SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13; APD 9-2014(Temp), f. 4-17-14, cert. ef. 4-21-14 thru 10-18-14; APD 35-2014, f. & cert. ef. 10-1-14; APD 28-2022, temporary amend filed 06/22/2022, effective 7/1/2022 through 12/27/2022; APD 57-2022, amend filed 12/22/2022, effective 12/23/2022

Statutory/Other Authority: ORS 409.050 & 410.070

Statutes/Other Implemented: ORS 409.010, 410.020, 410.070, 410.608 & 410.710