Or. Admin. Code § 411-046-0120

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-046-0120 - Eligibility

(1) Individuals must meet the following requirements to receive Behavior Support Services:

(a) Be eligible for home and community-based care services provided through APD; and

(b) Be receiving services through either State Plan K Community First Choice or Independent Choices.

(2) Behavior Support Services may be provided to eligible individuals noted in (1) above who may benefit from the service or have caregivers who may benefit from the service based on the individual's functional needs assessment that is performed by the case manager. An eligible individual includes, but is not limited to:

(a) An individual at risk of requiring behavior interventions;

(b) An individual whose caregiver requests assistance in developing person-centered interventions;

(c) An individual with a placement failure related to their behavior;

(d) An individual at risk of involuntary move out or who has received an eviction notice;

(e) An individual receiving Medicaid service payments to support behavior interventions, such as a behavior add-on or an exception; or

(f) An individual whose provider receives a payment for costs associated with interventions needed to address the individual's challenging behaviors.

(3) All Behavior Support Services must be pre-authorized by:

(a) The eligible individual's case manager; or

(b) A Department authorized placement in a home or community-based care setting where the Medicaid service payment includes Behavior Support Services.

(4) Eligible individuals, or their designated representative, may request or refuse to participate in Behavior Support Services. Consultation may still be provided to the care provider.

Or. Admin. Code § 411-046-0120

APD 17-2014, f. & cert. ef. 6-23-14

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070