Or. Admin. Code § 411-415-0080

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

Section 411-415-0080 - Accessing Developmental Disabilities Services

(1) A case management entity is required to:

(a) Provide assistance in finding and arranging resources, services, and supports. When an individual or the individual's legal or designated representative chooses to receive supports delivered by a personal support worker, a case management entity must not limit their choice of qualified providers, including all those available on the Home Care Commission Registry.

(b) Provide information and technical assistance to an individual, and as applicable the individual's legal or designated representative, in order to make informed decisions. This may include, but is not limited to, information about support needs, settings, programs, and types of providers.

(c) Provide a brief description of the services available from the case management entity, including typical timelines for activities, required assessments, monitoring and other activities required for participation in a Medicaid program, and the planning process.

(d) Inform an individual, or as applicable the individual's legal or designated representative, of any potential conflicts of interest between the case management entity and providers available to the individual.

(e) Inform a provider of the responsibility:

(A) To carry out their duty as a mandatory reporter of suspected abuse; and

(B) To immediately notify anyone specified by an individual of any incident that occurs when the provider is delivering services when the incident may have a serious effect on the individual's health, safety, physical, or emotional well-being, or level of services required.

(2) In accordance with the rules for home and community-based services in OAR chapter 411, division 004, an individual, or as applicable the individual's legal or designated representative, must be advised regarding non-residential service options including employment services and non-residential community living supports. For services considered, a non-disability specific setting option must be presented and documented in an individual's person-centered service plan.

(3) WRITTEN INFORMATION REQUIRED. A case manager must give a provider the relevant content from an individual's ISP that is necessary for the provider to deliver the services the provider is authorized to deliver, prior to the start of services. The content must include the relevant risks included in an individual's Risk Management Plan. The risks are relevant when they may reasonably be expected to threaten the health and safety of the individual, the provider, or the community at large without appropriate precautions during the delivery of the service authorized for the provider to deliver. If an individual, or as applicable the individual's legal representative, refuses to disclose the information, a case management entity must disclose the refusal to the provider, who may choose to refuse to deliver the services.

(a) The necessary information is conveyed on a Department approved Service Agreement containing the required content. For an agency provider or independent provider who is not a personal support worker, an ISP may be used in lieu of a Service Agreement with an individual's consent.

(b) A personal support worker must be provided a copy of a finalized Service Agreement no later than seven calendar days from when a common law employer and the personal support worker signed the Service Agreement.

(c) For an agency operator of a residential program or employment program, a case manager must provide all of the following to the agency:

(A) A document indicating safety skills, including an individual's ability to evacuate from a building when warned by a signal device and adjust water temperature for bathing and washing.

(B) A brief written history of any behavioral challenges, including supervision and support needs.

(C) A record of known communicable diseases and allergies.

(D) Copies of protocols, the risk tracking record or risk identification tool, and any support documentation (if applicable).

(E) Copies of documents relating to a health care representative or health care advocate.

(F) A copy of the most recent Positive Behavior Support Plan and assessment, Nursing Service Plan, and mental health treatment plan (if applicable).

(d) In addition to subsection (c) of this section, a residential program must be given all of the following:

(A) A copy of the eligibility determination document.

(B) A medical history and information on health care supports that includes (when available):

(i) The results of a most recent physical exam.

(ii) The results of any dental evaluation.

(iii) A record of immunizations.

(iv) A record of major illnesses and hospitalizations.

(v) A written record of any current or recommended medications, treatments, diets, and aids to physical functioning.

(C) A copy of the most recent functional needs assessment. If the needs of an individual have changed over time, the previous functional needs assessments must also be provided.

(D) Copies of documents relating to the guardianship or conservatorship, power of attorney, court orders, probation and parole information, or any other legal restrictions on the rights of an individual (if applicable).

(E) Written documentation that an individual is participating in out-of-residence activities, including public school enrollment for individuals less than 21 years of age.

(F) A copy of any completed and signed forms documenting consent to an individually-based limitation described in OAR 411-004-0040. The form must be signed by the individual or, if applicable, the individual's legal representative.

(e) In addition to subsection (c) of this section, an agency provider of employment services must be given:

(A) The Career Development Plan.

(B) Protocols that are necessary to assure the individual's health and safety.

(f) When an individual is known to be accessing Vocational Rehabilitation services, the Vocational Rehabilitation counselor must be given the individual's Career Development Plan.

(g) If an individual is being entered into a residential program from their family home and the information required in subsections (c) and (d) of this section are not available, a case manager must ensure that the residential program provider assesses the individual upon entry for issues of immediate health or safety.

(A) The case manager must develop and document a plan to secure the information listed in subsections (c) and (d) of this section no later than 30 calendar days after entry.

(B) The plan must include a written justification as to why the information is not available and a copy of the plan must be given to the provider at the time of entry.

(4) CHILDREN'S EXTRAORDINARY NEEDS (CEN) PROGRAM.

(a) At least annually and regardless of service group, a case management entity must inform a child's parent or guardian that their child may be eligible for the CEN Program and provide information about how to apply for the program.

(b) If requested and regardless of service group, a case management entity must assist with adding a child to the Department's waitlist for the CEN Program.

(c) When a child has been offered enrollment to the CEN Program by the Department, a case management entity must:

(A) Attempt to contact the child's parent or guardian within two weeks from the date the Department informed the case management entity of the child's offer to enroll in the CEN Program.

(B) Inform the Department of the parent's or guardian's decision, or lack of response, no later than 60 calendar days from the date the parent or guardian was notified by the Department of the offer to enroll in the CEN Program. During the 60 calendar day period, the case management entity must make no less than three attempts to contact the parent or guardian through various formats such as phone call, text message, and email.

(C) Provide or direct a parent or guardian who chooses to participate in the CEN Program to a list of any provider agencies willing to consider employing a parent provider.

(d) Prior to a child's enrollment in the CEN Program, as described in OAR chapter 411, division 440, a CME must provide information to the child about advocating for themselves with respect to choosing and managing direct support professionals.

(5) ENTRY MEETING.

(a) No later than the date of an individual's entry into a residential program, a case manager must convene a meeting of the ISP team to review referral material in order to determine appropriateness of entry.

(b) An entry meeting may be held for entry into services other than a residential program when a member of the ISP team requests one.

(c) A potential provider may request an entry meeting and may refuse entry to an individual who refuses to permit an entry meeting.

(d) Findings of an entry meeting must be recorded in an individual's service record and distributed to ISP team members. The findings of an entry meeting must include, at a minimum:

(A) The name of the individual proposed for services.

(B) The date of the entry meeting.

(C) The date determined to be the date of entry.

(D) Documentation of the participants included in the entry meeting.

(E) Documentation of information required by section (3) of this rule when entering a residential program.

(F) Documentation of the decision to serve the individual requesting services.

(6) TRANSFER MEETING.

(a) A meeting of the ISP team must precede any transfer of an individual that was not initiated by the individual, or as applicable the individual's legal representative, unless the individual declines to have a meeting.

(b) Findings of a transfer meeting must be recorded in an individual's service record and include, at a minimum:

(A) The name of the individual considered for transfer.

(B) The date of the transfer meeting.

(C) Documentation of the participants included in the transfer meeting.

(D) Documentation of the circumstances leading to the proposed transfer.

(E) Documentation of the alternatives considered instead of transfer.

(F) Documentation of the reasons any preferences of the individual, or as applicable the legal or designated representative or family members of the individual, may not be honored.

(G) Documentation of the decision regarding the transfer, including verification of the voluntary decision to transfer or a copy of the Notice of Involuntary Reduction, Transfer, or Exit.

(H) The written plan for services for the individual after the transfer.

(7) EXIT MEETING.

(a) A case manager must offer an individual, and as applicable the individual's legal or designated representative, an opportunity to convene the ISP team prior to the individual's exit from a residential program, agency provided employment services, or community living services other than relief care.

(b) Findings of an exit meeting must be recorded in an individual's service record and include, at a minimum:

(A) The name of the individual considered for exit.

(B) The date of the exit meeting.

(C) Documentation of the participants included in the exit meeting.

(D) Documentation of the circumstances leading to the proposed exit.

(E) Documentation of the discussion of the strategies to prevent the individual's exit from services, unless the individual or their legal representative is requesting the exit.

(F) Documentation of the decision regarding the individual's exit, including verification of the voluntary decision to exit or a copy of the Notice of Involuntary, Reduction, Transfer, or Exit.

(G) The written plan for services for the individual after the exit.

(c) Requirements for an exit meeting may be waived if an individual or the individual's legal representative, if applicable, declines to have an exit meeting or the individual is immediately removed from the applicable program under the following conditions:

(A) The individual or their legal representative requests an immediate exit from the program.

(B) The individual is removed by legal authority acting pursuant to civil or criminal proceedings other than detention for an individual less than 18 years of age.

(8) INDEPENDENT PROVIDERS. When services are provided by an independent provider:

(a) A case manager must provide an individual, and as applicable the individual's legal or designated representative, a brief description of the responsibilities for use of public funds.

(b) Using the Department approved Service Agreement, a case management entity must inform an independent provider engaged to provide supports to an individual of all of the following:

(A) The type and amount of services authorized in the individual's ISP for the independent provider to deliver.

(B) Behavioral, medical, known risks, and other information about the individual that is required for the provider to safely and adequately deliver services to the individual.

(C) When present, safety protocols and a copy of the most recent Positive Behavior Support Plan and Nursing Service Plan must be attached to the Service Agreement.

(c) COMMON LAW EMPLOYER. A case management entity must assure that a person is identified to act as a common law employer for a personal support worker in accordance with OAR 411-375-0055.

(A) A case management entity may require intervention as defined in OAR 411-375-0055.

(B) A case management entity may deny a request for an employer representative if the requested employer representative has any of the following:

(i) A history of substantiated or founded abuse.

(ii) Participated in billing excessive or fraudulent charges.

(iii) Failed to meet the employer responsibilities described in OAR 411-375-0055, including previous termination as a result of failing to meet the employer responsibilities.

(C) A case management entity must mail a notice informing an individual, and as applicable the individual's legal or designated representative, when:

(i) The case management entity removes an employer from performing the employer responsibilities described in OAR 411-375-0055.

(ii) The case management entity removes an employer representative from performing the employer responsibilities because the employer representative does not meet the qualifications of an employer representative.

(D) If an individual, or as applicable the legal or designated representative or employer representative of the individual, is dissatisfied with the decision of a case management entity to remove an employer or employer representative, the individual, or as applicable their legal or designated representative or employer representative, may request reinstatement as described in OAR 411-375-0055 or file a complaint with the case management entity or Department as described in OAR 411-318-0015.

Or. Admin. Code § 411-415-0080

APD 28-2016, f. & cert. ef. 6/29/2016; APD 46-2018, amend filed 12/28/2018, effective 12/28/2018; APD 45-2019, amend filed 10/29/2019, effective 11/1/2019; APD 5-2020, amend filed 02/25/2020, effective 3/1/2020; APD 5-2023, amend filed 05/01/2023, effective 5/1/2023; APD 25-2024, temporary amend filed 05/31/2024, effective 5/31/2024 through 11/26/2024; APD 60-2024, amend filed 10/25/2024, effective 10/25/2024; APD 61-2024, amend filed 10/28/2024, effective 10/28/2024

Statutory/Other Authority: ORS 409.050, 427.104, 427.105, 427.115, 427.154, 427.191, 430.212, 430.662 & 430.731

Statutes/Other Implemented: ORS 409.010, 427.005-427.154, 427.191, 430.212, 430.215, 430.610, 430.620, 430.662, 430.664 & 430.731-430.768