Or. Admin. Code § 411-016-0300

Current through Register Vol. 64, No. 1, January 1, 2025

Section 411-016-0300 - AAA Case Management, Data Collection, Records, and Reporting

(1) CASE MANAGEMENT.

(a) Type A and Type B contract AAAs will provide services case management to OPI-M cases without full Medicaid medical benefits.

(b) The Department may make exceptions to subsection (a) if the individual has an ongoing relationship with the AAA.

(c) Type A and Type B contract AAAs may provide services case management to individuals receiving Medicare Savings Programs.

(d) The Department's local office or the Type B transfer AAA will provide case management services to individuals eligible for full Medicaid medical benefits.

(2) DATA COLLECTION.

(a) The collection of required program and fiscal records and data associated with OPI-M must be on forms and data systems as approved by the Department.

(b) Each AAA and service provider must collect and maintain required data on eligible individuals receiving authorized services as required by the Department, including required Race, Ethnicity, Language and Disability (REALD) and Sexual Orientation and Gender Identity/Expression (SOGIE) data when Oregon ACCESS or other state data systems can include the data.

(c) All authorized service data collected on eligible individuals, supported by OPI-M must contain the individual's Social Security Number and date of birth.

(3) RECORDS.

(a) Each AAA must maintain all records, documents, and accounting procedures that reflect all administrative costs, program support costs, direct service costs, and service case management costs expended on OPI-M. These records must be retained for not less than seven years.

(b) Each AAA must make these records available upon request to the Department or to those duly authorized by the Department.

(4) FISCAL AND PROGRAM REPORTING:

(a) Fiscal and program reports must be completed on forms provided by the Department.

(b) Fiscal and program reports must be submitted to the Department by the specified due dates.

(c) Fiscal and program reports must, at a minimum, include:

(A) Current cumulative expenditures;

(B) Administrative costs;

(C) Program support costs;

(D) Services case management costs; and

(E) Demographic, social, medical, physical, functional, and financial data as required by the Department in the Department's Client Assessment/Planning System (CA/PS) and in the Oregon ACCESS database.

(5) CONFIDENTIALITY. The use or disclosure by any party of any information concerning a recipient of authorized services described in these rules, for any purpose not directly connected with the administration of the responsibilities of the Department, AAA, or service provider is prohibited except with written consent of the recipient, or the individual's representative. Disclosure of recipient information must meet Department requirements.

(6) COMMUNICATION. The AAA must respond to communication and OPI-M referrals for services from APD within five business days. Responses to communication from eligible individuals and their representatives must also occur within five business days.

(7) OTHER INFORMATION. AAAs will provide other information required under the OPI-M and 1115 Demonstration Waiver, including the Special Terms and Conditions, approved by the Centers for Medicare & Medicaid Services or by Department policy on OPI-M waiver administration.

Or. Admin. Code § 411-016-0300

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024; APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070, 410.480 & 414.065