Or. Admin. Code § 411-055-0315 - Application for Endorsement

(1) ENDORSEMENT REQUIRED. To operate as an IIC, a service provider must be endorsed under these rules.

(a) At least 60 days prior to the proposed effective date of the endorsement, a service provider must submit the following to the Department:

(A) Completed Intensive Intervention Community (IIC) application form;

(B) Standard Residency Agreement Template that meets OAR Chapter 411, Divisions 004 and 054; and

(C) Uniform Disclosure Statement (Form SDS 9098A), per OAR 411-055-0025(10) to the Department. The Department shall return incomplete forms to the service provider.

(b) The Department shall conduct an on-site inspection prior to the issuance of an endorsement to ensure the IIC complies with the physical plant requirements as described in OAR chapter 411, division 54 and OAR 411-055-0325.

(c) The endorsement shall be identified on the service provider's license and operated as a separate and distinct facility.

(2) ENDORSEMENT RENEWAL. Renewal for endorsement must be made using the RCF license renewal form, as required in OAR 411-054-0013(2), in addition to the IIC endorsement form at the time of the license renewal.

(3) RELINQUISHMENT OF ENDORSEMENT. The licensee must notify the Department in writing at least 60 days prior to the voluntary relinquishment of the endorsement. For voluntary relinquishment, the service provider must:

(a) Give all residents and their designated representatives 45-day notice.

(b) Submit a transition plan to the Department that demonstrates how the current residents shall be evaluated and assessed to reside in a setting that is not endorsed or the plan to move individuals to another HCBS setting. For Medicaid eligible individuals, the plan must include working with the affected individuals' case manager.

(c) Change service plans as appropriate to address any needs the residents may have with the transition.

(d) Notify the Department when the relinquishment process has been completed.

(4) REVOCATION OF ENDORSEMENT. The Department may issue a notice of revocation of endorsement upon finding there is substantial failure to comply with these rules such that the health, safety, or welfare of residents is jeopardized.

Notes

Or. Admin. Code § 411-055-0315

APD 20-2019, adopt filed 06/26/2019, effective 6/28/2019

Statutory/Other Authority: ORS 409.050, 410.070, 443.450

Statutes/Other Implemented: ORS 409.050, 410.070, 443.400 - 443.455, 443.991