Or. Admin. Code § 411-300-0150 - Scope of CIIS and Limitations
(1)
CIIS are intended to support, not supplant, the naturally occurring supports
provided by a legally responsible primary caregiver and enable the primary
caregiver to meet the needs of caring for a child receiving CIIS. CIIS are not
meant to replace other available governmental or community services and
supports. All CIIS funded by the Department must be provided according to the
Expenditure Guidelines and based on the actual and customary costs related to
best practice standards of care for children with similar
disabilities.
(2) A services
coordinator must provide case management and other supports according to OAR
chapter 411, division 415 and these rules.
(3) To be authorized and eligible for payment
by the Department, all CIIS must be:
(a)
Directly related to the assessed needs of a child or young adult.
(b) Required to maintain the health and
safety of the child.
(c) Cost
effective.
(d) Considered not
typical for a parent or guardian to provide to a child of the same
age.
(e) Required to help the
parent or guardian continue to meet the needs of caring for the
child.
(f) Included in an approved
ISP.
(g) Provided according to the
Expenditure Guidelines.
(4) Department funds may be used to purchase
a combination of the following:
(a) Ancillary
services as described in OAR chapter 411, division 435.
(b) Community living supports as described in
OAR chapter 411, division 450.
(c)
Professional behavior services as described in OAR chapter 411, division
304.
(d) State plan personal care
services as described in OAR chapter 411, division 455.
(e) Private duty nursing as described in
section (5) of this rule and OAR chapter 410, division 132.
(f) Employment services as described in OAR
chapter 411, division 345.
(5) PRIVATE DUTY NURSING.
(a) If the service needs of a child or young
adult enrolled in the Medically Fragile Children's Program require the presence
of an RN or LPN on an ongoing basis as determined medically necessary based on
their Clinical Criteria, private duty nursing services may be allocated to
ensure medically necessary supports are provided.
(A) Private duty nursing may be provided on a
shift staffing basis as necessary.
(B) Private duty nursing must be delivered by
a licensed RN or LPN, who does not have limitations of service provision as
described in OAR 410-132-0080, as determined by
the service needs of the child or young adult and documented in the ISP and
Nursing Service Plan.
(C) The
amount of private duty nursing available to a child or young adult is based on
the acuity level of the child or young adult as measured by the Clinical
Criteria as follows:
(i) Level 1. Score of 75
or above and on a ventilator for 20 hours or more per day = up to a maximum of
554 nursing hours per month.
(ii)
Level 2. Score of 70 or above = up to a maximum of 462 nursing hours per
month.
(iii) Level 3. Score of 65
to 69 = up to a maximum of 385 nursing hours per month.
(iv) Level 4. Score of 60 to 64 = up to a
maximum of 339 nursing hours per month.
(v) Level 5. Score of 50 to 59 or if a child
requires ventilation for sleeping hours = up to a maximum of 293 nursing hours
per month.
(vi) Level 6. Score of
45 to 49 = up to a maximum of 140 nursing hours per month.
(b) A request for private duty
nursing services exceeding limitations in the Expenditure Guidelines must be
authorized by the Department. The approval of the Department is limited to 90
calendar days unless re-authorized. A request to exceed private duty nursing
limitations in the Expenditure Guidelines is only authorized in the following
circumstances:
(A) The child is not safely
served in the family home without the expenditure.
(B) The expenditure provides supports for the
emerging or changing service needs or behaviors of the child.
(C) A significant medical condition or event,
as documented by a primary care provider, prevents or seriously impedes the
primary caregiver from delivering services.
Notes
Statutory/Other Authority: ORS 409.050, 417.345 & 427.104
Statutes/Other Implemented: ORS 417.345, 427.007, 427.104 & 430.215
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