Or. Admin. Code § 461-001-0030 - Definitions; OSIPM Nursing Facility Services or Home and Community-Based Care
These terms apply to rules in Chapter 461 about Oregon Supplemental Income Program Medical (OSIPM) nursing facility services and home and community-based care:
(1)
Community spouse: An
individual who is legally married (see OAR
461-001-0000) to an
institutionalized spouse (see section (5) of this rule) and
meets all of the following requirements:
(a)
The individual is not residing in the Oregon State Hospital, or its equivalent
if residing in another state.
(b)
The individual is not residing in an acute care hospital or nursing facility
for a continuous period of care (see section (2) of this
rule).
(2)
Continuous period of care: Reside for a period of at least 30
consecutive days or until death in a nursing facility, home and
community-based care (see section (4) of this rule) setting, or an
acute care hospital. There must be sufficient evidence to show there is a
reasonable expectation that the client will remain in care for at least 30
consecutive days. For the purposes of this policy, an interruption in care (for
example, leaving and then returning to a nursing home, or switching from one
type of care to another) that lasts less than 30 days is not considered a break
in the 30 consecutive days of care. A new period of care begins if care is
interrupted for 30 or more days.
(3)
Eligible dependent:
(a) For cases with a community
spouse (see section (1) of this rule):
(A) An "eligible dependent" is one of the
following:
(i) A child of the
institutionalized spouse or community spouse
who resides with the community spouse, and who must also be
either a minor (under the age of 21) or 21 or older but still a tax dependent
of either spouse.
(ii) A parent or
sibling of the institutionalized spouse or community
spouse who resides with the community spouse and is
claimed as a tax dependent by either spouse.
(B) A grandchild of the
institutionalized spouse or community spouse
is not considered an "eligible dependent".
(b) For cases without a community
spouse, an "eligible dependent" resides with the individual and is
either a minor child (under the age of 21) of the individual, or a child 21 or
older but still a tax dependent of the individual.
(4)
Home and community-based
care: Title XIX services needed to keep an individual out of a nursing
facility or an intermediate care facility for individuals with intellectual
disabilities (ICF-ID), not including 1915(i) Home and community-based services
(see division 173 of OAR chapter 410). These services are:
(a) In-home services except for state plan
personal care services.
(b)
Residential care facility services.
(c) Assisted living facility
services.
(d) Adult foster care
services.
(e) Specialized living
facility services.
(f) Adult day
care services.
(5)
Institutionalized spouse: An individual who is married to a
community spouse, not residing in the Oregon State Hospital,
or its equivalent if in another state, and meets one of the following
requirements:
(a) The individual is residing
in an acute care hospital or nursing facility for a continuous period
of care.
(b) The
individual is applying for or receiving services in a nursing facility or
home and community-based services.
Notes
Statutory/Other Authority: 411.060, ORS 409.050, 411.083, 411.404, 413.085 & 414.685
Statutes/Other Implemented: 411.060, 411.700, ORS 409.010, 411.083, 411.404, 42 USC 1396r & 42 CFR 435.726
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