Or. Admin. Code § 418-040-0080 - Fiscal Responsibilities
(1)
Oregon Home Care Commission Fiscal Responsibilities.
(a) The Commission shall establish the
Homecare Choice provider wage rate.
(b) The Commission may contract with a fiscal
intermediary for the following responsibilities:
(A) Making payments to Homecare Choice
providers on behalf of participants for services rendered. Payment is
considered payment in full.
(B)
Acting on behalf of participants, by applying applicable Federal Insurance
Contributions Act (FICA) regulations, to:
(i)
Withhold Homecare Choice provider contributions from payments; and
(ii) Submit participant contributions, and
the amounts withheld from provider payments, to the Social Security
Administration.
(C)
Applying standard income tax withholding practices in accordance with 26 CFR 31
and withholding state and federal income taxes on all payments to Homecare
Choice providers.
(c)
The Commission will issue a refund of a participant's unused service payment
after all expenses of the participant have been paid. The portion of the
service payment intended to reimburse the Commission for its costs shall not be
refunded.
(A) Refunds may only be issued to
the individual who authorized the original payment.
(B) Refunds shall not be issued in cash.
(d) The Commission is
not a trustee and has no fiduciary obligation to the participant or payer with
respect to advance service payments.
(e) Advance payments may be comingled with
other advance payments from participants in the Homecare Choice Program, but
will be accounted for separately in the records of the Commission. The
participant, or payer, is not entitled to any interest earnings on the funds
and no interest will be credited to the participant or payer, or paid in the
event of a refund.
(f) The state
will honor a garnishment or attachment of the participant's or payer's advance
payment in the event it is served with a writ.
(g) If funds are not available to pay a
provider because the Commission is required to hold or transfer funds under a
legal proceeding involving the participant, or payer, participant's
participation in the Homecare Choice program will be terminated as provided for
in OAR 418-040-0020.
(2) Homecare Choice Participant Fiscal
Responsibilities.
(a) Participants shall pay
the Commission in advance for homecare services. Services may not commence
until payment is received and verified by the Commission.
(b) Upon enrollment in the program,
participants must submit an initial prepayment to cover two service periods.
The amount of the prepayment is calculated by multiplying the program service
rate by the number of anticipated service hours for each service period.
Thereafter, participants must submit a prepayment equal to the current service
period, while enrolled in the program, and maintain an account balance equal to
a two-week service period.
(A) If the account
balance does not equal an amount necessary to pay the hours to be worked in the
current service period, the participant must submit additional funds to restore
the balance to the required level.
(B) If the participant increases the number
of purchased hours per service period after the initial prepayment is
established, the on-going prepayment must also be increased to equal the
current service period.
(C) The
funds are held for the convenience of the participant or payer.
(D) Advance payments may be considered part
of the participant's or payer's estate in the event of a bankruptcy and subject
to the automatic stay, or in the event of participant's death, will be refunded
to the participant's estate, less any administrative fee due to the Commission.
(c) The participant is
subject to the U.S. Department of Labor Fair Labor Standards Act and may elect
to have a provider work more than 40 hours per week. The purchase of service
hours that exceed 40 hours per week for an individual provider is considered
overtime and shall be calculated in the pre-payment.
(A) The overtime rate equals one and one-half
of the provider's hourly wage rate plus the increased cost of any payroll taxes
as a result of overtime.
(B) In
the event of unanticipated overtime, the additional cost will be deducted from
the participant's account balance and the account balance must be replenished
in the next service payment.
(d) Acceptable payment methods for services
include, credit or debit card transactions, personal checks, certified checks,
cashier's checks, and money orders.
(A) As
allowed by law, the Commission may charge a Non-Sufficient Fund fee if the
participant's personal check is not processed by his or her issuing bank due to
insufficient funds.
(B)
Participants must provide an alternate form of payment method if the credit
card used to purchase services is invalid or if a personal check is returned
due to insufficient funds.
(C) If
a participant challenges program charges on the participant's credit card and
the charges are found to be valid after a chargeback investigation, the
participant must pay by personal check, cashier's check, or money order for the
disputed charges.
(e)
Participants must submit payment to the Commission for mileage reimbursement
for providers that use his or her personal vehicle for authorized service
related transportation.
(A) Providers are
reimbursed at the mileage reimbursement rate determined by the participant.
(B) The Commission, participant,
and DHS are not responsible for vehicle damage when a provider uses his or her
personal motor vehicle.
(C) The
Commission, participant, and DHS are not responsible for personal injury
sustained when a provider uses his or her personal vehicle, except as may be
covered under workers' compensation.
(3) Homecare Choice Provider Fiscal
Responsibilities. Homecare Choice providers:
(a) Must comply with state and federal wage
and tax laws by completing, submitting, and retaining necessary documents
provided by a fiscal intermediary contracted by the Commission.
(b) Must not accept any additional
compensation for hours of work that were compensated by the Homecare Choice
Program.
(c) Must only claim
payment for authorized services provided that have been validated by
participants with whom they are employed.
(d) Shall not claim payment for services
delivered by another individual.
(e) Are responsible for the completion and
accuracy of timekeeping records and all submitted claims.
Notes
Stat. Auth.: ORS 410.602
Stats. Implemented: ORS 410.595-625
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