Or. Admin. Code § 411-027-0005
Current through Register Vol. 64, No. 1, January 1, 2025
Section 411-027-0005 - Definitions(1) "AAA" means "Area Agency on Aging" as defined in this rule.(2) "Activities of Daily Living (ADL)" mean those personal, functional activities required by an individual for continued well-being, which are essential for health and safety. Activities include eating, dressing and grooming, bathing and personal hygiene, mobility, elimination, and cognition.(3) "Aging and People with Disabilities (APD)" means the program area of Aging and People with Disabilities, within the Department of Human Services.(4) "Area Agency on Aging (AAA)" means the Department designated agency charged with the responsibility to provide a comprehensive and coordinated system of services to older adults and adults with disabilities in a planning and service area. The term Area Agency on Aging is inclusive of both Type A and Type B Area Agencies on Aging as defined in ORS 410.040 and described in ORS 410.210-300.(5) "Assessment" or "Reassessment" means an assessment as defined in OAR 411-015-0008.(6) "Assistive Devices" means any category of durable medical equipment, mechanical apparatus, electrical appliance, or instrument of technology, service animals, general household items, or furniture used to assist and enhance an individual's independence in performing any activity of daily living.(7) "CA/PS" means the "Client Assessment and Planning System" as defined in this rule.(8) "Case Manager" means an employee of the Department or Area Agency on Aging, who assesses the service needs of an applicant, determines eligibility, and offers service choices to the eligible individual. The case manager authorizes and implements the service plan and monitors the services delivered.(9) "Central Office" means the unit within the Department responsible for program and policy development and oversight.(10) "Client Assessment and Planning System (CA/PS)":(a) Is the single entry data system used for --(A) Completing a comprehensive and holistic assessment;(B) Surveying an individual's physical, mental, and social functioning; and(C) Identifying risk factors, individual choices and preferences, and the status of service needs.(b) The CA/PS documents the level of need and calculates the individual's service priority level in accordance with the rules in OAR chapter 411, division 015, calculates the service payment rates, and accommodates individual participation in service planning.(11) "Consumer Choice" means an individual has been informed of alternatives to nursing facility services and has been given the choice of institutional services, Medicaid home and community-based service options, or the Independent Choices Program.(12) "Contracted In-Home Care Agency" means an incorporated entity or equivalent, licensed in accordance with OAR chapter 333, division 536, that provides hourly contracted in-home services to individuals served by the Department or Area Agency on Aging.(13) "Cost Effective" means being responsible and accountable with Department resources. This is accomplished by offering less costly alternatives when providing choices that adequately meet an individual's service needs. Those choices consist of the available services under the Medicaid home and community-based service options, the utilization of assistive devices, natural supports, architectural modifications, and alternative service resources (defined in OAR 411-015-0005) not paid for by the Department.(14) "Department" means the Department of Human Services (DHS).(15) "Distressed Provider Relief Fund" means the program described in OAR chapter 411, division 029 designed to provide additional compensation to providers who meet the criteria.(16) "Enhanced Wage Add-on Program" means the program described in OAR 411-027-0160 designed to provide additional compensation to providers who meet the criteria.(17) "Exception" means an approval for: (a) Payment of a service plan granted to a specific individual in his or her current residence or in the proposed residence identified in the exception request that exceeds the CA/PS assessed service payment levels for individuals residing in community-based care facilities or the maximum hours of service as described in OAR 411-030-0070 for individuals residing in his or her own home or the home of a relative.(b) A service plan granted to a specific individual and a homecare worker to exceed the limitations as described in OAR 411-030-0070 (5) based upon the service needs of the individual as determined by the Department.(c) An "exceptional rate" or "exceptional payment." The approval of an exception is based on the service needs of the individual and is contingent upon the individual's service plan meeting the requirements in OAR 411-027-0020, OAR 411-027-0025, and OAR 411-027-0050.(18) "Homecare Worker" means a provider, as described in OAR 411-031-0040, that is directly employed by a consumer to provide hourly services to the eligible consumer. (a) The term homecare worker includes consumer-employed providers in the Spousal Pay and Oregon Project Independence Programs. The term homecare worker also includes consumer-employed providers that provide state plan personal care services to older adults and adults with physical disabilities. Relatives providing Medicaid in-home services to an individual living in the relative's home are considered homecare workers.(b) The term homecare worker does not include Independent Choices Program providers or personal care attendants enrolled through the Office of Developmental Disability Services or the Addictions and Mental Health Division.(19) "Hourly Services" mean the in-home services, including activities of daily living and instrumental activities of daily living, that are provided at regularly scheduled times.(20) "Independent Choices Program (ICP)" means the self-directed in-home services program in which a participant is given a cash benefit to purchase goods and services identified in a service plan and prior approved by the Department or Area Agency on Aging.(21) "Individual" means the person applying for, or eligible for, services. The term "individual" is synonymous with "client", "participant", "consumer", and "consumer-employer."(22) "In-Home Services" mean those services that meet an individual's assessed need related to activities of daily living and instrumental activities of daily living provided in the individual's home or family's home.(23) "Instrumental Activities of Daily Living (IADL)" mean those activities, other than activities of daily living, required by an individual to continue independent living. The definitions and parameters for assessing needs in IADL are identified in OAR 411-015-0007.(24) "Natural Supports" or "Natural Support System" means resources and supports (e.g., relatives, friends, significant others, neighbors, roommates, or the community) who are willing to voluntarily provide services to an individual without the expectation of compensation. Natural supports are identified in collaboration with the individual and the potential "natural support". The natural support is required to have the skills, knowledge and ability to provide the needed services and supports.(26) "These Rules" mean the rules in OAR chapter 411, division 027.Or. Admin. Code § 411-027-0005
SPD 7-2008, f. 5-29-08, cert. ef. 6-1-08; APD 4-2014(Temp), f. & cert. ef. 3-20-14 thru 9-16-14; APD 33-2014, f. & cert. ef. 9-2-14; ADP 3-2016, f. 3-4-16, cert. ef. 3/18/2016; APD 20-2017, temporary amend filed 09/29/2017, effective 10/01/2017 through 03/29/2018; APD 9-2018, amend filed 03/28/2018, effective 3/29/2018; APD 18-2020, temporary amend filed 05/18/2020, effective 05/18/2020 through 10/30/2020; APD 27-2020, temporary amend filed 06/25/2020, effective 07/01/2020 through 10/30/2020; APD 41-2020, amend filed 10/09/2020, effective 10/15/2020; APD 31-2021, temporary amend filed 09/03/2021, effective 09/07/2021 through 03/05/2022; APD 5-2022, amend filed 03/01/2022, effective 3/3/2022; APD 41-2022, temporary amend filed 08/19/2022, effective 8/19/2022 through 2/14/2023; APD 2-2023, amend filed 02/08/2023, effective 2/10/2023Statutory/Other Authority: ORS 410.070
Statutes/Other Implemented: ORS 410.070