Or. Admin. Code § 411-034-0090

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

Section 411-034-0090 - Payment Limitations

(1) The maximum allowed hours for State Plan personal care services are limited to 270 hours per calendar year for individuals served by APD or a AAA.

(a) Individuals whose assessed service needs exceed the maximum allowed hours for State Plan personal care services in a service period may request additional hours through the exception process described in this rule. The Department Central Office may approve or deny the requests based on analysis of the individual's need and criteria for an exception.

(b) State Plan personal care service hours are authorized in accordance with an individual's service plan and may be scheduled throughout the service period to meet the service needs of the individual.

(2) Authorized LTC community nurse assessment and monitoring services are not included in the maximum hours per service period for State Plan personal care services described in section (1) of this rule.

(3) The Department does not guarantee payment for State Plan personal care services until all acceptable provider enrollment standards have been verified and both the employer and provider have been formally notified in writing that payment by the Department is authorized.

(4) In accordance with OAR 410-120-1300, all provider claims for payment must be submitted within 12 months of the date of service.

(5) Payment may not be claimed by a provider until the hours authorized for the payment period have been completed, as directed by an eligible individual or the individual's representative.

(6) Claims for Money Management may only be made by qualified money management service providers and are not included in the 270-hour limitation.

(7) Claims for Home Delivered Meals may only be made by qualified HDM providers and are not included in the 270-hour limitation.

(8) Nursing Services may only be made by licensed and enrolled long term care community nurses and the hours authorized for this service are not included in the 270 hour limitation.

Or. Admin. Code § 411-034-0090

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 16-2007, f. 10-4-07, cert. ef. 10-5-07; 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 410.020, 410.070, 410.710, 411.159 & 411.675