Or. Admin. Code § 411-415-0080 - Accessing Developmental Disabilities Services
(1) A case
management entity is required to:
(a) Provide
assistance in finding and arranging resources, services, and supports. When an
individual or the individual's legal or designated representative chooses to
receive supports delivered by a personal support worker, a case management
entity must not limit their choice of qualified providers, including all those
available on the Home Care Commission Registry.
(b) Provide information and technical
assistance to an individual, and as applicable the individual's legal or
designated representative, in order to make informed decisions. This may
include, but is not limited to, information about support needs, settings,
programs, and types of providers.
(c) Provide a brief description of the
services available from the case management entity, including typical timelines
for activities, required assessments, monitoring and other activities required
for participation in a Medicaid program, and the planning process.
(d) Inform an individual, or as applicable
the individual's legal or designated representative, of any potential conflicts
of interest between the case management entity and providers available to the
individual.
(e) Inform a provider
of the responsibility:
(A) To carry out their
duty as a mandatory reporter of suspected abuse; and
(B) To immediately notify anyone specified by
an individual of any incident that occurs when the provider is delivering
services when the incident may have a serious effect on the individual's
health, safety, physical, or emotional well-being, or level of services
required.
(2)
In accordance with the rules for home and community-based services in OAR
chapter 411, division 004, an individual, or as applicable the individual's
legal or designated representative, must be advised regarding non-residential
service options including employment services and non-residential community
living supports. For services considered, a non-disability specific setting
option must be presented and documented in an individual's person-centered
service plan.
(3) WRITTEN
INFORMATION REQUIRED. A case manager must give a provider the relevant content
from an individual's ISP that is necessary for the provider to deliver the
services the provider is authorized to deliver, prior to the start of services.
The content must include the relevant risks included in an individual's Risk
Management Plan. The risks are relevant when they may reasonably be expected to
threaten the health and safety of the individual, the provider, or the
community at large without appropriate precautions during the delivery of the
service authorized for the provider to deliver. If an individual, or as
applicable the individual's legal representative, refuses to disclose the
information, a case management entity must disclose the refusal to the
provider, who may choose to refuse to deliver the services.
(a) The necessary information is conveyed on
a Department approved Service Agreement containing the required content. For an
agency provider or independent provider who is not a personal support worker,
an ISP may be used in lieu of a Service Agreement with an individual's
consent.
(b) A personal support
worker must be provided a copy of a finalized Service Agreement no later than
seven calendar days from when a common law employer and the personal support
worker signed the Service Agreement.
(c) For an agency operator of a residential
program or employment program, a case manager must provide all of the following
to the agency:
(A) A document indicating
safety skills, including an individual's ability to evacuate from a building
when warned by a signal device and adjust water temperature for bathing and
washing.
(B) A brief written
history of any behavioral challenges, including supervision and support
needs.
(C) A record of known
communicable diseases and allergies.
(D) Copies of protocols, the risk tracking
record or risk identification tool, and any support documentation (if
applicable).
(E) Copies of
documents relating to a health care representative or health care
advocate.
(F) A copy of the most
recent Positive Behavior Support Plan and assessment, Nursing Service Plan, and
mental health treatment plan (if applicable).
(d) In addition to subsection (c) of this
section, a residential program must be given all of the following:
(A) A copy of the eligibility determination
document.
(B) A medical history and
information on health care supports that includes (when available):
(i) The results of a most recent physical
exam.
(ii) The results of any
dental evaluation.
(iii) A record
of immunizations.
(iv) A record of
major illnesses and hospitalizations.
(v) A written record of any current or
recommended medications, treatments, diets, and aids to physical
functioning.
(C) A copy
of the most recent functional needs assessment. If the needs of an individual
have changed over time, the previous functional needs assessments must also be
provided.
(D) Copies of documents
relating to the guardianship or conservatorship, power of attorney, court
orders, probation and parole information, or any other legal restrictions on
the rights of an individual (if applicable).
(E) Written documentation that an individual
is participating in out-of-residence activities, including public school
enrollment for individuals less than 21 years of age.
(F) A copy of any completed and signed forms
documenting consent to an individually-based limitation described in OAR
411-004-0040. The form must be
signed by the individual or, if applicable, the individual's legal
representative.
(e) In
addition to subsection (c) of this section, an agency provider of employment
services must be given:
(A) The Career
Development Plan.
(B) Protocols
that are necessary to assure the individual's health and safety.
(f) When an individual is known to
be accessing Vocational Rehabilitation services, the Vocational Rehabilitation
counselor must be given the individual's Career Development Plan.
(g) If an individual is being entered into a
residential program from their family home and the information required in
subsections (c) and (d) of this section are not available, a case manager must
ensure that the residential program provider assesses the individual upon entry
for issues of immediate health or safety.
(A)
The case manager must develop and document a plan to secure the information
listed in subsections (c) and (d) of this section no later than 30 calendar
days after entry.
(B) The plan must
include a written justification as to why the information is not available and
a copy of the plan must be given to the provider at the time of
entry.
(4)
CHILDREN'S EXTRAORDINARY NEEDS (CEN) PROGRAM.
(a) At least annually and regardless of
service group, a case management entity must inform a child's parent or
guardian that their child may be eligible for the CEN Program and provide
information about how to apply for the program.
(b) If requested and regardless of service
group, a case management entity must assist with adding a child to the
Department's waitlist for the CEN Program.
(c) When a child has been offered enrollment
to the CEN Program by the Department, a case management entity must:
(A) Attempt to contact the child's parent or
guardian within two weeks from the date the Department informed the case
management entity of the child's offer to enroll in the CEN Program.
(B) Inform the Department of the parent's or
guardian's decision, or lack of response, no later than 60 calendar days from
the date the parent or guardian was notified by the Department of the offer to
enroll in the CEN Program. During the 60 calendar day period, the case
management entity must make no less than three attempts to contact the parent
or guardian through various formats such as phone call, text message, and
email.
(C) Provide or direct a
parent or guardian who chooses to participate in the CEN Program to a list of
any provider agencies willing to consider employing a parent
provider.
(d) Prior to a
child's enrollment in the CEN Program, as described in OAR chapter 411,
division 440, a CME must provide information to the child about advocating for
themselves with respect to choosing and managing direct support
professionals.
(5) ENTRY
MEETING.
(a) No later than the date of an
individual's entry into a residential program, a case manager must convene a
meeting of the ISP team to review referral material in order to determine
appropriateness of entry.
(b) An
entry meeting may be held for entry into services other than a residential
program when a member of the ISP team requests one.
(c) A potential provider may request an entry
meeting and may refuse entry to an individual who refuses to permit an entry
meeting.
(d) Findings of an entry
meeting must be recorded in an individual's service record and distributed to
ISP team members. The findings of an entry meeting must include, at a minimum:
(A) The name of the individual proposed for
services.
(B) The date of the entry
meeting.
(C) The date determined to
be the date of entry.
(D)
Documentation of the participants included in the entry meeting.
(E) Documentation of information required by
section (3) of this rule when entering a residential program.
(F) Documentation of the decision to serve
the individual requesting services.
(6) TRANSFER MEETING.
(a) A meeting of the ISP team must precede
any transfer of an individual that was not initiated by the individual, or as
applicable the individual's legal representative, unless the individual
declines to have a meeting.
(b)
Findings of a transfer meeting must be recorded in an individual's service
record and include, at a minimum:
(A) The name
of the individual considered for transfer.
(B) The date of the transfer
meeting.
(C) Documentation of the
participants included in the transfer meeting.
(D) Documentation of the circumstances
leading to the proposed transfer.
(E) Documentation of the alternatives
considered instead of transfer.
(F)
Documentation of the reasons any preferences of the individual, or as
applicable the legal or designated representative or family members of the
individual, may not be honored.
(G)
Documentation of the decision regarding the transfer, including verification of
the voluntary decision to transfer or a copy of the Notice of Involuntary
Reduction, Transfer, or Exit.
(H)
The written plan for services for the individual after the transfer.
(7) EXIT MEETING.
(a) A case manager must offer an individual,
and as applicable the individual's legal or designated representative, an
opportunity to convene the ISP team prior to the individual's exit from a
residential program, agency provided employment services, or community living
services other than relief care.
(b) Findings of an exit meeting must be
recorded in an individual's service record and include, at a minimum:
(A) The name of the individual considered for
exit.
(B) The date of the exit
meeting.
(C) Documentation of the
participants included in the exit meeting.
(D) Documentation of the circumstances
leading to the proposed exit.
(E)
Documentation of the discussion of the strategies to prevent the individual's
exit from services, unless the individual or their legal representative is
requesting the exit.
(F)
Documentation of the decision regarding the individual's exit, including
verification of the voluntary decision to exit or a copy of the Notice of
Involuntary, Reduction, Transfer, or Exit.
(G) The written plan for services for the
individual after the exit.
(c) Requirements for an exit meeting may be
waived if an individual or the individual's legal representative, if
applicable, declines to have an exit meeting or the individual is immediately
removed from the applicable program under the following conditions:
(A) The individual or their legal
representative requests an immediate exit from the program.
(B) The individual is removed by legal
authority acting pursuant to civil or criminal proceedings other than detention
for an individual less than 18 years of age.
(8) INDEPENDENT PROVIDERS. When services are
provided by an independent provider:
(a) A
case manager must provide an individual, and as applicable the individual's
legal or designated representative, a brief description of the responsibilities
for use of public funds.
(b) Using
the Department approved Service Agreement, a case management entity must inform
an independent provider engaged to provide supports to an individual of all of
the following:
(A) The type and amount of
services authorized in the individual's ISP for the independent provider to
deliver.
(B) Behavioral, medical,
known risks, and other information about the individual that is required for
the provider to safely and adequately deliver services to the
individual.
(C) When present,
safety protocols and a copy of the most recent Positive Behavior Support Plan
and Nursing Service Plan must be attached to the Service Agreement.
(c) COMMON LAW EMPLOYER. A case
management entity must assure that a person is identified to act as a common
law employer for a personal support worker in accordance with OAR
411-375-0055.
(A) A case management entity may require
intervention as defined in OAR
411-375-0055.
(B) A case management entity may deny a
request for an employer representative if the requested employer representative
has any of the following:
(i) A history of
substantiated or founded abuse.
(ii) Participated in billing excessive or
fraudulent charges.
(iii) Failed to
meet the employer responsibilities described in OAR
411-375-0055, including previous
termination as a result of failing to meet the employer
responsibilities.
(C) A
case management entity must mail a notice informing an individual, and as
applicable the individual's legal or designated representative, when:
(i) The case management entity removes an
employer from performing the employer responsibilities described in OAR
411-375-0055.
(ii) The case management entity removes an
employer representative from performing the employer responsibilities because
the employer representative does not meet the qualifications of an employer
representative.
(D) If
an individual, or as applicable the legal or designated representative or
employer representative of the individual, is dissatisfied with the decision of
a case management entity to remove an employer or employer representative, the
individual, or as applicable their legal or designated representative or
employer representative, may request reinstatement as described in OAR
411-375-0055 or file a complaint
with the case management entity or Department as described in OAR
411-318-0015.
Notes
Statutory/Other Authority: ORS 409.050, 427.104, 427.105, 427.115, 427.154, 427.191, 430.212, 430.662 & 430.731
Statutes/Other Implemented: ORS 409.010, 427.005-427.154, 427.191, 430.212, 430.215, 430.610, 430.620, 430.662, 430.664 & 430.731-430.768
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