Or. Admin. Code § 411-455-0020

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

Section 411-455-0020 - Eligibility

(1) An individual may not be denied SPPC services or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws.

(2) To be eligible for SPPC services under these rules, an individual must meet the following requirements:

(a) Be receiving case management services through a Community Developmental Disabilities Program, a Brokerage, or Children's Intensive In-Home Services.

(b) Be an Oregon resident who meets the residency requirements in OAR 461-120-0010.

(c) Be a current recipient of:

(A) A Medicaid Title XIX benefit package through OSIPM or HSD medical programs; or

(B) A benefit package through the Healthier Oregon medical program.

(d) Require assistance from a qualified provider with one or more ADL and IADL tasks described in OAR 411-455-0050 that are not met by alternative resources or the individual's natural support system.

(3) An individual is not eligible to receive SPPC services under these rules if the individual:

(a) Is receiving assistance with personal care from a residential program or residential setting as defined in OAR 411-317-0000.

(b) Is in a hospital, sub-acute care facility, nursing facility, other medical institution, a local correctional facility (as defined in ORS 169.005), a Department of Corrections institution (as defined in ORS 421.005), or a youth correction facility (as defined in ORS 162.135).

(c) Has assessed personal care needs that are met through alternative resources or natural supports, as defined in OAR 411-317-0000, available to the individual.

(d) Has assessed personal care needs that are being met under other home and community-based service options of the individual's choosing.

(e) Is receiving benefits through the Department's Self-Sufficiency Programs (SSP), Aging and People with Disabilities (APD) or Area Agency on Aging (AAA), and not case management services through a Brokerage, Community Developmental Disabilities Program, or Children's Intensive In-Home Services.

(f) Is eligible for behavioral health personal care attendant services through the Oregon Health Authority as described in OAR 410-172-0780.

(g) Is eligible for personal care services through the Department's Child Welfare programs as described in OAR 413-090-0130.

(4) SPPC services are not intended to:

(a) Replace natural supports as defined in OAR 411-317-0000 that are available to an individual.

(b) Replace supports that are typical for a parent or guardian to provide to a child of the same age.

(c) Benefit an individual's family members or the individual's household in general.

(5) SPPC services must not duplicate other services.

(6) The Department or case management entity has the authority to terminate an individual's eligibility for SPPC services provided under these rules when any of the following occurs:

(a) The individual is no longer eligible for SPPC services for any reason described in sections (2) through (4) of this rule.

(b) The individual is exited from case management as described in OAR 411-415-0030.

(c) The individual fails to employ a provider that meets the requirements in OAR 411-455-0060.

(7) When SPPC services are denied, reduced, suspended, or terminated, a written Notification of Planned Action (form 0947) must be provided as described in OAR 411-318-0020, and other options of developmental disabilities services, as described in OAR 411-415-0070, must be offered to the individual.

Or. Admin. Code § 411-455-0020

APD 1-2019, temporary adopt filed 01/07/2019, effective 01/08/2019 through 07/05/2019; APD 22-2019, adopt filed 06/28/2019, effective 7/1/2019; APD 34-2022, temporary amend filed 07/01/2022, effective 7/1/2022 through 12/27/2022; APD 53-2022, amend filed 12/14/2022, effective 12/15/2022

Statutory/Other Authority: ORS 409.050, 427.104 & 430.662

Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.215, 430.610 & 430.662