Or. Admin. Code § 410-120-2025

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-120-2025 - HRSN Person-Centered Service Plan (PCSP).

(1) Upon authorization of HRSN Services, the MCE or, as applicable, the Authority, shall, together with the HRSN-Authorized Member, update their Care Plan as outlined in OAR 410-141-3870 to include an HRSN PCSP for authorized the HRSN Service(s).

(2) The HRSN PCSP shall be a written component of the Member's Care Plan as outlined in OAR 410-141-3870 and developed with and agreed upon by the Member, the Member's Representative, or both, as applicable.

(3) If the HRSN Authorized Member does not have a Care Plan in place in accordance with OAR 410-141-3870, the HRSN PCSP shall serve as their Care Plan and must be included in the Member's Care Profile as outlined in OAR 410-141-3865.

(4) MCEs and the Authority shall ensure the HRSN PCSP includes all of the following elements:

(a) The Authorized HRSN Service(s),

(b) The Authorized HRSN Service duration,

(c) Whether the Member accepts or declines the Authorized HRSN Service(s),

(d) The HRSN Service Provider, as applicable, to which the Member is referred, which must reflect the Member choice, or a mutually agreeable option if choices are limited,

(e) The determination that the Authorized HRSN Service, unit(s) of service, and service duration are Clinically Appropriate based on HRSN Clinical and Social Risk Factors for the Authorized HRSN Service,

(f) The goals of the HRSN Service(s) for which the Member has been authorized, and is the subject of the HRSN PCSP identifying other HRSN Services and other OHP or other benefit programs or services the Member may need (if not already included in the Member's Care Plan),

(g) The follow-up and transition plan, including conducting rescreening for HRSN Services prior to the conclusion of the then-current Authorized HRSN Service,

(h) The designated person or team within the MCE or the Authority that is responsible for managing the HRSN-Authorized Member's HRSN Services, and

(i) Updates to include all date(s) on which the HRSN Service(s) was delivered.

(5) The MCE or, as applicable, the Authority, is responsible for managing the HRSN Authorized Member's HRSN Services and HRSN PCSP. The HRSN PCSP must, in accordance with OAR 410-141-3870, include relevant information from providers involved in the HRSN Authorized Member's care.

(6) The MCE or, the Authority, as applicable must ensure and document the Member's HRSN Service needs are being and have been met by the HRSN Service Provider in compliance with the Member's HRSN PCSP.

(7) When is convenient for the HRSN Authorized Member, either before or after the HRSN Service delivery, depending upon the urgency of receipt of the HRSN Service, the MCE or, as applicable, the Authority, shall have no less than one meeting with the HRSN-Authorized Member, their Representative, or both, as applicable, either in person or by telephone or videoconference, during development of the HRSN PCSP, unless such Member declines participation.

(8) If efforts to have a meeting with the HRSN Authorized Member are unsuccessful, or if the HRSN Authorized Member expressly declines to participate in the development of the HRSN PCSP, the HRSN Authorized Member is still entitled to receive the HRSN Services for which they have been authorized. Neither the MCE nor the Authority has the right to the deny provision of HRSN Services due to the Member's desire to not participate in the development of the HRSN PCSP. In all such circumstances, the MCE or the Authority must document:

(a) The efforts made to have one or more meetings with the Member, including identifying the specific attempts and barriers to having the meetings; and

(b) The Member's reasons for not participating in the HRSN PCSP to the maximum extent feasible; and

(c) If the HRSN Authorized Member declines participation in the HRSN PCSP or attempts to schedule meetings are unsuccessful, the HRSN Eligibility Screening shall serve as justification for provision of HRSN Services and shall be documented to the Member's Care Plan in lieu of an HRSN PCSP as required in OAR 410-141-3870.

(9) A Representative may receive an HRSN Service on behalf of a child who has been Authorized to receive an HRSN Service their child's if it is developmentally appropriate, as determined through the development of the HRSN PCSP.

Or. Admin. Code § 410-120-2025

DMAP 130-2024, adopt filed 10/24/2024, effective 11/1/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: 414.572, 414.605, 414.665, 414.719 & 414.632