Or. Admin. Code § 411-034-0020

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

Section 411-034-0020 - State Plan Personal Care Services

(1) State Plan personal care services are essential services that enable an individual to move into or remain in their own home while also safely navigating their community. State Plan personal care services are provided in accordance with an individual's authorized plan for services by a qualified provider.

(a) State Plan personal care services are provided directly to an eligible individual and are not meant to provide respite or other services to an individual's natural support system. State Plan personal care services may not be implemented for the purpose of benefiting an individual's family members or the individual's household in general.

(b) State Plan personal care services are limited to 270 hours per calendar year per individual served by APD or an AAA.

(c) When an individual's State Plan Personal Care service needs exceed the annual maximum of 270 hours an exception must be submitted.

(A) To submit an exception the Local Office (LO) must complete 514PC and submit to Central Office (CO) regardless of the number of hours requested.

(B) If an individual requests an exception, but their service plan does not exceed 270 hours annual the request for an exception may be approved or denied by the LO.

(C) CO has up to 45 days upon receipt of a completed exception request to determine whether an individual's assessed personal care needs warrant exceeding the service plan limitation.

(D) The individual shall receive written notice of the Department's decision.

(2) Personal care services include:

(a) Activities of Daily Living (ADLs):

(A) Basic Personal Hygiene means performing or assisting with activities required to keep an individual healthy, appearance neat, combing/brushing hair, foot care, skin care, mouth care and oral hygiene, and include the following:

(i) Bathing means assisting the individual with cleansing the body, washing hair, shaving, nail care, and using assistive devices when necessary to get in and out of the bathtub or shower.

(ii) Dressing means assisting the individual with putting on, fastening, and taking off all items of clothing, braces, and artificial limbs, including obtaining and replacing items from their storage area in the immediate environment.

(B) Nutrition includes eating and meal preparation as defined below:

(i) Eating means assisting the individual in feeding or fluid intake by any means from a receptacle into the body. Includes monitoring to prevent choking or aspiration.

(ii) Meal preparation means performing or assisting with healthy meal planning and preparation, ensuring special diets are followed, if needed.

(C) Medication or Oxygen Management- assist with medications which are ordinarily self-administered. Includes setting up pill dispensing systems, administering medication, observation to ensure individual is taking medication as ordered, documenting and monitoring any notable side effects, and refilling prescriptions in a timely manner. Assist with use, maintenance, and cleaning of in-home oxygen equipment, monitoring client's condition, ordering and maintaining necessary oxygen supplies.

(D) Mobility means assisting the individual with mobility, transfers and repositioning including turning or adjusting padding for physical comfort or pressure relief and encouraging or assisting with range of motion exercises and the use of devices that assist with mobility.

(E) Toileting means assisting the individual in getting to and from, on and off, the toilet, commode or bedpan for elimination of feces and urine. This includes cleansing after elimination and removing and adjusting clothing as necessary. It also includes Maintaining Continence as defined below:

(i) Catheter care including external cleansing of a catheter, emptying catheter drainage bag, changing external catheter supplies,

(ii) Maintenance bowel care,

(iii) Changing and replacing incontinence products,

(iv) Colostomy or ileostomy Care including, emptying bags, cleaning the stoma and other activities necessary for the safe maintenance and disposal of supplies; or

(v) Cueing to prevent incontinence.

(b) Instrumental Activities of Daily Living (IADLs)

(A) Housework means perform or assist with housekeeping tasks necessary to maintain the individual in a healthy and safe living environment. Only the housekeeping activities related to the eligible individual's needs may be considered in housekeeping.

(B) Laundry- perform or assist with laundering or cleaning of clothing, bedding and other items used by the individual or on behalf of the individual.

(C) Transportation- assist individual in getting to and from necessary appointments and community activities through available means of transportation. This includes mileage reimbursement when community transportation is a required care need. Reasonable mileage reimbursement may only be authorized if the homecare worker or IHCA provider is using their own vehicle.

(D) Grocery Shopping- perform or assist individual in planning for and purchasing basic needs and household items.

(E) Using the Telephone- perform or assist individual in arranging necessary appointments and making desired phone calls or the use of other communication devices.

(F) Money Management- perform or assist with budgeting, making payments for monthly expenses and use of personal funds for desired items and activities.

(c) Cognitive Impairments

(A) An individual may be physically capable of performing ADLs or IADLs but may have limitations in performing these activities because of a cognitive impairment. Personal care services may be required because a cognitive impairment prevents an individual from knowing when or how to carry out the task.

(B) In such cases, personal assistance may include cueing along with supervision to ensure that the individual performs the task properly.

(d) Delegated nursing tasks in accordance with OAR 851-047-0000, OAR 851-047-0010, and OAR 851-047-0030, the RN's written authorization of a delegated nursing task includes assessing a specific eligible individual, evaluating an unlicensed person's ability to perform a specific nursing task, teaching the nursing task, and supervising and re-evaluating the individual and the unlicensed person at regular intervals.

(e) Long Term Care Community Nursing as defined in OAR chapter 411 division 048.

(3) Payment may not be made for any of the following excluded services:

(a) Social companionship;

(b) Adult day services (described in OAR chapter 411, division 066),

(c) Respite, or baby-sitting services;

(d) Care, grooming, or feeding of pets or other animals; or

(e) Yard work, gardening, or home repair.

Or. Admin. Code § 411-034-0020

SSD 2-1996, f. 3-13-96, cert. ef. 3-15-96; SPD 35-2004, f. 11-30-04, cert. ef. 12-1-04; SPD 9-2005, f. & cert. ef. 7-1-05; SPD 16-2007, f. 10-4-07, cert. ef. 10-5-07; SPD 31-2010, f. 12-29-10, cert. ef. 1-1-11; SDP 19-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 48-2013, f. 12-13-13, cert. ef. 12-15-13; APD 22-2017, temporary amend filed 09/29/2017, effective 10/01/2017 through 03/29/2018; APD 8-2018, amend filed 03/28/2018, effective 3/29/2018; APD 28-2022, temporary amend filed 06/22/2022, effective 7/1/2022 through 12/27/2022; APD 57-2022, amend filed 12/22/2022, effective 12/23/2022

Statutory/Other Authority: ORS 409.050 & 410.070

Statutes/Other Implemented: ORS 409.010, 410.020, 410.070 & 410.608