Or. Admin. Code § 411-415-0050 - [Effective 9/27/2025] Standards for Case Management Services
(1) A Case
Management Entity (CME) must apply the principles of self-determination,
person-centered practices, diversity, equity, and inclusion to the provision of
case management services.
(2) A CME
must ensure that a case manager is available to provide case management
services and other supports to an individual.
(a) Case management services include the
activities related to:
(A) Assessment and
periodic reassessment of an eligible individual to determine service needs,
including activities that focus on needs identification, to determine the need
for any medical, educational, social, or other services including those
assessments described in OAR
411-415-0060.
(B) Development and periodic revision of an
ISP or Annual Plan based on the information collected through an assessment or
reassessment that specifies the desired outcomes, goals, and actions to address
the medical, employment, social, educational, and other services needed by an
eligible individual as described in OAR
411-415-0070.
(C) Support to access available services,
including referral and related activities to help an individual obtain needed
services as described in OAR
411-415-0080.
(D) Monitoring and follow-up activities,
including activities and contacts that are necessary to ensure an ISP or Annual
Plan is effectively implemented and adequately addresses the needs of an
eligible individual as described in OAR
411-415-0090.
(b) Other supports provided by a
CME may include, but are not limited to:
(A)
Authorizing services in the Department's electronic payment and reporting
system.
(B) Arranging
employer-related supports that may include, but are not limited to:
(i) Education about employer
responsibilities.
(ii) Orientation
to basic wage and hour issues.
(iii) Use of common employer-related tools,
such as service agreements.
(C) Assisting the Department with
establishing provider credentials.
(D) Assistance with understanding and
accessing financial, medical, and other benefits.
(3) Prior to an initial ISP, at
least annually, and at the request of an individual, or as applicable the legal
representative of the individual, a CME must provide a Notification of Rights
(form 0948), an explanation of the individual rights described in OAR
411-318-0010, and the complaint
process described in OAR
411-318-0015, to the individual
and if applicable the legal representative of the individual.
(4) A CME may not authorize services that are
delivered by an affiliated entity.
(5) Developmental disabilities services must
be authorized in accordance with OAR
411-415-0070. A case manager
must authorize any developmental disabilities services and delivery of those
services by an available, qualified provider chosen by an individual, or as
applicable the legal or designated representative of the individual, for which
the individual is eligible as described in the relevant program rules. A
provider is considered available when the provider has the capacity and
willingness to deliver services chosen by an individual.
(a) NOTIFICATION OF PLANNED ACTION. In the
event that a developmental disabilities service is denied, reduced, suspended,
or terminated, or a chosen qualified provider is not authorized to deliver a
chosen service to an individual, a written advance Notification of Planned
Action (form 0947) must be provided as described in OAR
411-318-0020.
(b) HEARINGS.
(A) An individual may request a hearing as
provided in ORS chapter 183 and OAR
411-318-0025.
(B) Hearings are addressed in accordance with
ORS chapter 183 and OAR
411-318-0025.
(c) Upon entry into case
management, upon request, and annually thereafter, a notice of hearing rights
and the policy and procedures for hearings as described in OAR chapter 411,
division 318 must be explained and provided to an individual, and as applicable
the legal or designated representative of the individual.
(6) Services authorized in an Individual
Support Plan (ISP) must be entered into the Department's electronic payment and
reporting system prior to the authorized start date of the services being
delivered by a provider.
(7) If an
individual loses eligibility for a medical assistance program delivered by the
Oregon Health Authority, a case manager must assist the individual to identify
why the eligibility was lost. Whenever possible, the case manager must assist
the individual in reestablishing the eligibility. The case manager must
document the assistance given in the service record for the
individual.
(8) CHOICE ADVISING.
Through choice advising, a CME must assure that case management and other
developmental disabilities service options, provider options, and setting
options, including non-disability specific settings and an option for a private
or shared unit in a residential program, are described to an individual
receiving case management services from the CME, or to the legal representative
of the individual.
(a) Within 10 business days
of an individual being found eligible for developmental disabilities services,
the individual must receive choice advising, including all of the following:
(A) The choice of institutional or home and
community-based services.
(B)
Options for developmental disabilities services available to the
individual.
(C) For an adult,
information about all CMEs operating in the county of origin, using materials
provided by each CME when the materials are made available.
(b) Choice advising occurs as part
of the person-centered planning process and must be conducted prior to an
initial ISP and prior to a review of the ISP when required according to OAR
411-415-0070.
(c) Prior to an individual's 18th birthday,
the individual must be offered the choice of institutional or home and
community-based services.
(d) Prior
to an individual's 17th birthday, the individual must be informed about all
CMEs operating in the county of origin that will be available to the individual
as an adult, using materials provided by each CME when the materials are made
available.
(e) Prior to entry into
a 1915(c) Home and Community-Based Services waiver, an individual, or as
applicable the individual's legal representative, must be informed of the
individual's choice to receive home and community-based or institutional
services and verify the individual's choice using the Freedom of Choice form
(ODHS 2808).
(f) A CME must present
to an adult at least three types of community living settings as defined in ORS
427.101, including an option for
services in the adult's own or family home, annually and when an adult is
moving from one community living setting to another community living setting
unless:
(A) The adult is at imminent risk to
health or safety in the adult's current placement setting; or
(B) The adult is moving from one
non-residential program setting to another non-residential program
setting.
(g) If a CME is
affiliated with an agency provider of developmental disabilities services in
addition to case management services, the CME must disclose the relationship
and inform the individual, or as applicable the legal or designated
representative of the individual, that the CME cannot authorize the affiliated
provider. The CME must discuss other case management provider options when the
individual, or as applicable the legal or designated representative of the
individual, expresses interest in receiving services from the affiliated
provider.
(9) A case
manager must coordinate services with the Child Welfare caseworker assigned to
a child to ensure the provision of required supports from the Department,
Community Developmental Disabilities Program (CDDP), and Child
Welfare.
(10) A case manager must
participate in transition planning by attending Individualized Education
Program (IEP) meetings or other transition planning meetings for a student 16
years of age or older to discuss the transition of the student to adult living
and work situations, unless the attendance of the case manager is refused by
the parent or guardian of the student or the student if the student is 18 years
of age or older. A case manager must participate in transition planning for a
student as young as 14 years of age if transition planning is deemed
appropriate by the student's IEP team, unless the attendance of the case
manager is refused by the parent or guardian of the student.
(11) When appropriate, a case manager must
coordinate with Vocational Rehabilitation regarding employment services. When
appropriate, a case manager must facilitate referrals to Vocational
Rehabilitation.
(12) HEALTH CARE
ADVOCATES.
(a) For an individual determined to
be incapable as defined in OAR
411-390-0120, and who does not
have a guardian with medical decision-making authority or a health care
representative, a case manager must have a documented discussion with the
individual's ISP team regarding the appointment of a health care advocate as
described in OAR chapter 411, division 390 when a significant medical procedure
or treatment is being considered. The case manager must assure the individual
is informed of all of the following:
(A) The
ISP team's decision to seek a health care advocate, prior to the appointment of
the health care advocate.
(B) The
name of the appointed health care advocate.
(C) The proposed decision about any
significant medical procedure or treatment.
(b) A case manager must give an individual's
health care advocate appointed according to OAR chapter 411, division 390 a
copy of OAR chapter 411, division 390 and document this in the individual's
service record.
(c) A case
management entity must provide health care advocate training materials to a
potential health care advocate prior to appointment and any health care
decision-making.
(13) A
case manager who becomes aware that a health care representative is considering
withholding or withdrawing life-sustaining procedures for an individual, must
provide the health care representative with any information in the case
manager's possession that is related to the individual's values, beliefs, and
preferences with respect to the withholding or withdrawing of life-sustaining
procedures.
(14) EXCEPTIONS.
(a) If an individual eligible for community
living supports as described in OAR chapter 411, division 450, or the
individual's legal or designated representative, requests an exception to the
service level, for a staff ratio greater than 1:1, or expresses concerns that
the individual's service needs are not being met after exhausting available
resources, the case manager must help the individual apply for an exception as
described in OAR 411-450-0065, including
completing a funding review and exception request, and gathering documentation
required by the Department.
(b) If
the individual's case manager assesses that the individual's needs exceed the
available resources or require a staffing ratio greater than 1:1, the case
manager must work with the individual to determine the appropriate hour
allocation and staffing ratio and submit a Funding Review and Exception Request
Form, or other form designated by the Department to request an exception, if
necessary. The form is submitted to the Department or the Department's
designee.
(c) When required by the
Department, an individual's case manager must complete a Funding Review and
Exception Request Form, or other form designated by the Department to request
an exception, to inform an exception request.
(d) A CME has 14 calendar days, or a later
time determined by the Department, from the date of a request from the
Department for information related to an exception request to provide the
information or inform the Department the information is not
available.
(15) SERVICE
LEVEL SETTING. A CME must use the Adult In-Home Support Needs Assessment,
Version C (ANA-C), for an adult, or the Child In-Home Support Needs Assessment,
Version C (CNA-C), for a child, to establish an ANA-C or CNA-C service level
for a person intending to access in-home, hourly attendant care who:
(a) Is newly eligible for development
disabilities services;
(b) Is going
to access in-home, hourly attendant care following a period of more than one
year when hourly in-home attendant care was not authorized for the individual;
or
(c) Is leaving a residential
service.
(16) A CME must
implement procedures to address individual, designated representative, or
family complaints regarding service delivery that have not been resolved using
the complaint procedures of a provider agency. The complaint procedures must be
consistent with the requirements in OAR
411-318-0015.
(17) A case manager must coordinate with
other state, public, and private agencies regarding services to
individuals.
(18) When appropriate,
a case manager must facilitate referrals to nursing facilities as described in
OAR 411-070-0043.
(19) A case manager must coordinate and
monitor the services provided to an eligible individual living in a nursing
facility.
(20) A Department case
manager must make referrals for entry and participate in all entry meetings for
children in residential programs, CIIS, and the Stabilization and Crisis
Unit.
(21) A CME must provide case
management services to individuals who are eligible for and desire them. If an
individual receiving case management services from a CDDP is receiving other
developmental disabilities services in more than one county, the county of
origin must be responsible for case management services unless otherwise
negotiated and documented in writing with the mutually agreed upon
conditions.
(22) CHANGE OF CASE
MANAGER.
(a) If a CME changes the assignment
of an individual's case manager for any reason, the CME must notify the
individual, the legal and designated representative of the individual (as
applicable), and all providers within 10 business days of the change. The
notification must be in writing and include the name, telephone number, email
address, and mailing address of the new case manager.
(b) An individual receiving services, or as
applicable the legal or designated representative of the individual, may
request a new case manager within the same CME or request a change of
CME.
(23) FAMILY
RECONNECTION. A CME and a case manager must provide assistance to the
Department when a family member is attempting to reconnect with an individual
who was previously discharged from Fairview Training Center or Eastern Oregon
Training Center or an individual who is currently receiving developmental
disabilities services.
(a) If a family member
contacts a CME for assistance in locating an individual, the CME must refer the
family member to the Department. A family member may contact the Department
directly.
(b) The Department shall
send the family member a Department form requesting further information to be
used in providing notification to the individual. The form shall include the
following information:
(A) Name of
requestor.
(B) Address of requestor
and other contact information.
(C)
Relationship to individual.
(D)
Reason for wanting to reconnect.
(E) Last time the family had
contact.
(c) The
Department shall determine:
(A) If the
individual was previously a resident of Fairview Training Center or Eastern
Oregon Training Center.
(B) If the
individual is deceased or living.
(C) Whether the individual is currently or
previously enrolled in Department services.
(D) The county in which services are being
provided, if applicable.
(d) With permission from the individual, the
Department shall notify the family member if the individual is enrolled or no
longer enrolled in Department services within 10 business days from the receipt
of the request.
(e) If the
individual is enrolled in Department services, the Department shall send the
completed family information form to the individual and the case
manager.
(f) If the individual is
deceased, the Department shall follow the process for identifying the personal
representative of the individual in accordance with ORS
192.573.
(A) If the personal representative and the
requesting family member are the same, the Department shall inform the personal
representative that the individual is deceased.
(B) If the personal representative is
different from the requesting family member, the Department shall contact the
personal representative for permission before sharing information about the
individual with the requesting family member. The Department must make a good
faith effort to find the personal representative and obtain a decision
concerning the sharing of information as soon as practicable.
(g) When an individual is located,
the CME must facilitate a meeting with the individual to discuss and determine
if the individual wishes to have contact with the family member.
(A) The case manager must assist the
individual in evaluating the information to make a decision regarding
initiating contact, including providing the information from the form and any
relevant history with the family member that may support contact or present a
risk to the individual.
(B) If the
individual does not have a legal representative or is unable to express their
wishes, the ISP team of the individual must be convened to review factors and
choose the best response for the individual after evaluating the
situation.
(h) If the
individual wishes to have contact, the individual or ISP team designee may
directly contact the family member to make arrangements for the
contact.
(i) If the individual does
not wish to have contact, the CME must notify the Department. The Department
shall inform the family member in writing that no contact is
requested.
(j) The notification to
the family member regarding the decision of the individual must be within 60
business days from the receipt of the information form from the family
member.
(k) The decision by the
individual is not appealable.
Notes
To view attachments referenced in rule text, click here to view rule.
Statutory/Other Authority: ORS 127.765, 409.050, 427.104, 427.105, 427.115, 427.154, 430.212, 430.662 & 430.731
Statutes/Other Implemented: ORS 127.765, 430.212, 430.662, 409.010, 427.005-427.154, 430.215, 430.610, 430.620, 430.664 & 430.731-430.768
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