Or. Admin. Code § 411-034-0070 - State Plan Personal Care Service Assessment, Authorization, and Monitoring

(1) PERSONAL CARE ASSESSMENT. The assessment process identifies an individual's ability to perform ADLs, IADLs, and determines an individual's ability to address health and safety concerns.

(a) A case manager must meet in person with an individual to assess the individual's ability to perform the personal care tasks listed in OAR 411-034-0020 at least once every calendar year (365 days).

(b) The individual may request that others participate in the assessment process.

(c) A case manager must consider an individual's service needs, identify the resources meeting any of the individual's needs, and determine if the individual is eligible for State Plan personal care services or other services.

(2) SERVICE PLANNING.

(a) An individual determined eligible for Personal Care services, or the individual's representative and the individual's case manager, must consider all available service options as well as assistive devices and other community-based resources to meet the service needs identified during the assessment process.

(b) The individual or the individual's representative is responsible for choosing and assisting in developing less costly service alternatives.

(c) A case manager must, in collaboration with the individual, prepare a service plan identifying the tasks for which an individual requires assistance and the number of authorized service hours per service period.

(d) When developing service plans, a case manager must consider the cost effectiveness of services that adequately meet the individual's service needs.

(A) This is accomplished by offering less costly alternatives when providing choices that adequately meet an individual's service needs.

(B) 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 Department.

(e) A case manager must document an individual's natural supports that currently meet some or all of the individual's personal care needs.

(f) A case manager must describe in the service plan the tasks to be performed by a qualified provider and must authorize the needed hours per service period that may be reimbursed for those services.

(g) A case manager must monitor the service plan and make adjustments as needed.

(h) Payment for State Plan Personal Care services must be prior authorized by a case manager and based on the service needs of an individual as documented in the individual's written service plan.

(3) SERVICE AUTHORIZATION. A case manager may authorize the following services if the individual has an assessed need though the Personal Care Assessment:

(a) Service plan hours for ADL and IADL needs;

(b) Mileage reimbursement;

(c) Nursing Services;

(d) Home Delivered Meals; and

(e) Money Management Services

(4) ONGOING MONITORING.

(a) When there is an indication that an individual's personal care needs have changed, a case manager must conduct an in-person re-assessment with the individual and any of the individual's natural supports if requested by the individual.

(b) Following re-assessments a case manager must review service eligibility, the cost effectiveness of the individual's service plan, and whether the services provided are meeting the identified service needs of the individual. The case manager may adjust the hours or services in the individual's service plan and must authorize a new service plan, if appropriate, based on the individual's current service needs.

(c) A case manager must provide ongoing coordination of State Plan personal care services, including authorizing changes in providers and service hours, addressing risks, and monitoring and providing information and referral to an individual when indicated.

(5) UNAUTHORIZED SERVICE SETTINGS AND PROVIDERS.

(a) The Department may not authorize services within an eligible individual's home when --

(A) The individual's home has dangerous conditions that jeopardize the health or safety of the individual or provider and necessary safeguards cannot be taken to improve the setting;

(B) The services cannot be provided safely or adequately by a provider;

(C) The eligible individual does not have the ability to make an informed decision, does not have a designated representative to make decisions on his or her behalf, and necessary safeguards cannot be provided to protect the safety, health, and welfare of the individual.

(b) A case manager must present an individual or the individual's representative with information on service alternatives and provide assistance to assess other choices when a provider or service setting selected by the individual or the individual's representative is not authorized.

Notes

Or. Admin. Code § 411-034-0070

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 22-2017, temporary amend filed 09/29/2017, effective 10/01/2017 through 03/29/2018; APD 8-2018, amend filed 03/28/2018, effective 3/29/2018; 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