Or. Admin. Code § 411-016-0160

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-016-0160 - [Effective until 11/26/2024] Evidence Based Health Promotion Services and Provider Qualifications

(1) Evidence Based Health Promotion Services assist eligible individuals to maintain or improve their health or build skills to manage health conditions. These services include, but are not limited to:

(a) Program to Encourage Active, Rewarding Lives for Seniors (PEARLS);

(b) Healthy IDEAS (Identifying Depression Empowering Activities for Seniors);

(c) The suite of Chronic Disease Self-Management Education (CDSME) programs;

(d) Fit & Strong!;

(e) A Matter of Balance;

(f) The Otago Exercise Program (OEP);

(g) Tai Chi - Moving for Better Balance; and

(h) SHARE for Dementia (Support, Health, Activities, Resources, Education).

(2) Evidence Based Health Promotion Services must:

(a) Demonstrate through evaluation that they are effective for improving the health and well-being or reducing disease, disability and/or injury among older adults or younger people with disabilities;

(b) Been proven effective with older adult population or younger people with disabilities, using designs with or without random assignment and a control group;

(c) Have research results published in a peer-review journal;

(d) Have been carried out in one or more community site(s) identical to the program that was evaluated to be effective in the published research and shown to be effective; and

(e) Include developed dissemination products that are available to the public.

(3) Providers must at a minimum meet the following requirements:

(a) Be over the age 18;

(b) Have a high school diploma or GED;

(c) Pass a criminal background check as described in OAR chapter 407, division 007;

(d) Have demonstrated experience in assisting caregivers of older adults and people with disabilities;

(e) Are subject matter experts with demonstrated experience in their field;

(f) Meet the training, licensing or credential requirements for the service they are providing:

(g) Meet the qualifications to be a Medicaid enrolled provider and be an enrolled as a Medicaid provider; and

(h) Ensure and deliver the program meets the requirements to be Evidence-Based as described in section (2).

(4) Evidence Based Health Promotion services may not be authorized if they duplicate services available through Long Term Community Nursing, Older Americans Act programs and Services or other available resources.

(5) Evidence Based Health Promotion Services must meet the conflict-free case management expectations. When the only willing and qualified provider organization provides both case management and Evidence Based Health Promotion Services, Department approved firewalls must be in place and followed to ensure a separation of functions within the organization.

(6) Evidence Based Health Promotion services are not included in the 40-hour maximum hours.

(7) Payments.

(a) Providers may not charge OPI-M individuals for participation.

(b) Rates for OPI-M must be no more than those charged for private pay individuals, Older Americans Act Programs and constitute payment in full for services rendered.

(c) Services must be prior authorized by the Services Case Manager.

(d) Payment will be made by the Department after services have been provided and invoices have been submitted and approved by the Services Case Manager or Department representative.

Or. Admin. Code § 411-016-0160

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024

Statutory/Other Authority: Section 361 of the Older Americans Act (OAA) of 1965, as amended & ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065