Or. Admin. Code § 411-450-0030 - Eligibility for Community Living Supports
(1) An individual
may not be denied community living supports or otherwise discriminated against
on the basis of race, color, religion, sex, gender identity, sexual
orientation, national origin, marital status, age, disability, source of
income, duration of Oregon residence, or other protected classes under federal
and Oregon Civil Rights laws.
(2)
To be eligible for community living supports, an individual must meet the
following requirements:
(a) Be an Oregon
resident who meets the residency requirements in OAR
461-120-0010.
(b) Be determined eligible for developmental
disabilities services by the Community Developmental Disabilities Program of
the county of origin according to OAR
411-320-0080, except for those
enrolled in the following:
(A) A child
enrolled in the Medically Involved Children's Program must meet the eligibility
requirements in OAR 411-300-0120(7).
(B) A child enrolled in the Medically Fragile
Children's Program must meet the eligibility requirements in OAR
411-300-0120(5).
(C) A child enrolled in the Children's
Extraordinary Needs Program must meet the eligibility requirements in OAR
411-440-0030.
(c) Choose to use a case
management entity for assistance with the design and management of
developmental disabilities services.
(d) Be receiving a Medicaid Title XIX benefit
package through Oregon Supplemental Income Program-Medical (OSIPM) or Health
Systems Division(HSD) medical programs or a benefit package through Healthier
Oregon.
(A) An adult is eligible for community
living supports if the adult had been receiving community living supports as a
child up to their 18th birthday and has not become ineligible due to section
(2)(d)(B) of this rule.
(B)
Eligibility for community living supports based on section (2)(d)(A) of this
rule ends if:
(i) The individual does not
apply for a disability determination and Medicaid within 10 business days of
their 18th birthday;
(ii) The
Social Security Administration or the Department's Presumptive Medicaid
Disability Determination Team finds the individual does not have a qualifying
disability; or
(iii) The individual
is determined by the state of Oregon to be ineligible for a Medicaid Title XIX
benefit package through OSIPM or HSD medical programs or a benefit package
through Healthier Oregon.
(C) Individuals receiving Medicaid Title XIX
through HSD medical programs for services in a nonstandard living arrangement,
as defined in OAR 461-001-0000, are subject to the
requirements in the same manner as if they were requesting these services under
OSIPM, including the rules regarding:
(ii) The equity value of a home which exceeds
the limits as set forth in OAR
461-145-0220.
(e) Be determined to
meet the Level of Care as defined in OAR
411-317-0000.
(f) Individuals with excess income must
contribute to the cost of services in accordance with OAR
461-160-0610 and OAR
461-160-0620.
(g) Participate in an Oregon Needs Assessment
and provide information necessary to complete the Oregon Needs Assessment prior
to receiving community living supports, annually, and as required by the
Department.
(A) Failure to participate in the
Oregon Needs Assessment or to provide information necessary to complete the
Oregon Needs Assessment within the required time frame results in the denial or
termination of service eligibility. In the event service eligibility is denied
or terminated, a written Notification of Planned Action must be provided as
described in OAR 411-318-0020.
(B) The Department may allow additional time
if circumstances beyond the control of the individual prevents timely
participation in the Oregon Needs Assessment or timely submission of
information necessary to complete the Oregon Needs Assessment.
Notes
Statutory/Other Authority: ORS 409.050, 427.024, 427.104 & 430.662
Statutes/Other Implemented: ORS 409.010, 427.007, 427.024, 427.104, 427.181, 430.215, 430.610 & 430.662
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