Or. Admin. Code § 411-450-0040 - Community Living Supports Entry and Exit
(1) An individual may not access community
living supports unless community living supports are included in the
individual's current, authorized Individual Support Plan (ISP).
(2) A provider of community living supports
must agree in writing to deliver the supports identified in an individual's
ISP. Agreement may be shown by the provider's signature on a Service Agreement.
The agreement must include acknowledgement of limits and scope of service that
may be provided.
(3) Community
living supports must be terminated:
(a) At the
end of a service period agreed upon by all parties and specified in an
individual's ISP.
(b) At the oral
or written request of an individual or their legal representative to end the
service relationship.
(c) When an
individual has been determined to no longer meet eligibility for community
living supports as described in OAR
411-450-0030.
(d) When a case management entity has
sufficient evidence to believe that an individual has engaged in fraud or
misrepresentation, failed to use resources consistent with the services as
agreed upon in the individual's ISP, refused to cooperate with documenting use
of Department funds, or otherwise knowingly misused public funds associated
with community living supports.
(e)
When an individual either cannot be located or has not responded following 30
calendar days of repeated attempts by staff of the case management entity to
complete ISP development or monitoring activities, including participation in
an Oregon Needs Assessment. An individual, and as applicable the legal or
designated representative of the individual, must participate in an Oregon
Needs Assessment and provide information necessary to complete the Oregon Needs
Assessment within the time frame required by the Department.
(A) Failure to participate in the Oregon
Needs Assessment or provide information necessary to complete the assessment or
reassessment within the applicable time frame results in the denial of service
eligibility.
(B) The Department may
allow additional time if circumstances beyond the control of the individual
prevent timely participation in the Oregon Needs Assessment or timely
submission of information necessary to complete the Oregon Needs
Assessment.
(4) INVOLUNTARY REDUCTIONS AND EXITS.
(a) A provider agency must only reduce or
exit an individual involuntarily for one or more of the following reasons:
(A) The behavior of the individual poses an
imminent risk of danger to self or others.
(B) The individual experiences a medical
emergency.
(C) The provider agency
is no longer able to meet the service needs of the individual.
(D) The provider agency cannot provide the
services needed to meet the individual's goals associated with the
service.
(E) The individual is no
longer eligible for the service or the provider agency is not paid for the
service.
(F) The site closes or the
provider agency makes a programmatic change.
(G) The certification or endorsement for the
provider agency described in OAR chapter 411, division 323 is suspended,
revoked, not renewed, or voluntarily surrendered.
(b) A provider agency may give less than 30
calendar days advance written notice only in a medical emergency or when an
individual is engaging in behavior that poses an imminent danger to self or
others. The notice must be provided to the individual, the legal or designated
representative of the individual (as applicable), and the individual's case
manager immediately upon determination of the need for a reduction, transfer,
or exit.
(c) A Notice of
Involuntary Reduction or Exit is not required when:
(A) An individual requests the reduction or
exit.
(B) The end date of the
service identified on the ISP or Service Agreement is reached, if the provider
has given at least 30 calendar days written notification to the individual and
the individual's case manager of the intent to reduce or terminate
services.
(d) PROVIDER
AGENCY NOTICE OF INVOLUNTARY REDUCTION OR EXIT. A provider agency must not
reduce services, transfer, or exit an individual involuntarily without 30
calendar days advance written notice to the individual, the legal or designated
representative of the individual (as applicable), and the individuals' case
manager, except in the case of a medical emergency or when an individual is
engaging in behavior that poses an imminent danger to self or others as
described in subsection (b) of this section. The written notice must be
provided on the Notice of Involuntary Reduction or Exit form approved by the
Department and include all of the following:
(A) The reason for the reduction or
exit.
(B) The right of individuals
receiving Day Support Activities (DSA) to submit a complaint to the Department
and have the Department review the matter.
(C) The right of the individual to request a
hearing as described in subsection (f) of this section. For DSA services, the
individual has a right to a hearing if the individual is not satisfied with the
outcome of the complaint process and Department review of the matter.
(e) NOTICE OF INVOLUNTARY GROUP
REDUCTION, TRANSFER, OR EXIT. If a provider agency reduces or transfers more
than 10 individuals within any 30 calendar day period, the provider agency must
provide 60 calendar days advance written notice to each individual, the
Department, the legal or designated representative of each individual (as
applicable), and each individual's case manager.
(A) The written notice must be provided on
the Notice of Involuntary Group Reduction, Transfer, or Exit form approved by
the Department and include all of the following:
(i) The reason for the reduction, transfer,
or exit.
(ii) The right of
individuals receiving DSA to submit a complaint to the Department and have the
Department review the matter.
(iii)
The right of the individual to request a hearing as described in subsection (f)
of this section. For DSA services, the individual has a right to a hearing if
the individual is not satisfied with the outcome of the complaint and
Department review of the matter.
(B) A Notice of Involuntary Group Reduction,
Transfer, or Exit is not required when an individual requests the reduction,
transfer, or exit.
(f)
HEARING RIGHTS. An individual must be given the opportunity for a hearing under
ORS chapter 183 and OAR
411-318-0030 to dispute an
involuntary reduction or exit if the individual is not satisfied with the
complaint resolution and Department review. If an individual requests a
hearing, the individual must receive the same services until the hearing is
resolved, unless the provider is no longer delivering that service to any
individual. When an individual has been given less than 30 calendar days
advance written notice of a reduction, transfer, or exit as described in
subsection (b) of this section and the individual has requested a hearing, the
provider must reserve service availability for the individual until receipt of
the Final Order.
Notes
Statutory/Other Authority: ORS 409.050, 427.104 & 430.662
Statutes/Other Implemented: 427.104, 430.662, ORS 409.010, 427.007, 430.215 & 430.610
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