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Oregon Bulletin

June 1, 2011

 

Department of Human Services,
Seniors and People with Disabilities Division
Chapter 411

Rule Caption: Disability Determination Services Rates of Payment – Medical.

Adm. Order No.: SPD 9-2011

Filed with Sec. of State: 4-29-2011

Certified to be Effective: 5-1-11

Notice Publication Date: 4-1-2011

Rules Adopted: 411-200-0035

Rules Amended: 411-200-0010, 411-200-0020, 411-200-0030, 411-200-0040

Subject: The Department of Human Services, Seniors and People with Disabilities Division, Disability Determination Services is permanently amending the rules relating to rates of payment in OAR chapter 411, division 200.

Rules Coordinator: Christina Hartman—(503) 945-6398

411-200-0010

General Policy

(1) The Department of Human Services (Department) shall reimburse the vendor, consultant, and contractor for the cost of goods and services only if the Department has authorized payment before the provision of goods and services. The Department shall reject all invoices for goods and services without the required prior authorization.

(2) Except as provided in OAR 411-200-0030 and OAR 411-200-0035, the amount that the Department pays the vendor, consultant, and contractor for previously authorized medical or psychological services is:

(a) For vendor: The rates set forth in OAR 411-200-0030.

(b) For consultant:

(A) The lesser of the lowest fee that the consultant charges the general public or other state or federal agencies for the service; or

(B) The maximum fee prescribed by the Oregon Medical Fee and Relative Value Schedule, OAR chapter 436, division 009.

(c) For contractor: The contracted rate. The contracted rate may not exceed the maximum fee filed and prescribed by the Oregon Medical Fee and Relative Value Schedule, OAR chapter 436, division 009.

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070

Hist.: SDSD 4-2002, f. & cert. ef. 6-12-02; SPD 13-2003, f. & cert. ef. 7-1-03; SPD 7-2004, f. 3-23-04 cert. ef. 3-24-04; SPD 19-2004, f. & cert. ef. 6-23-04; SPD 12-2005, f. & cert. ef. 9-26-05; SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06; SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11

411-200-0020

Definitions

(1) “Brief Narrative” means a document that summarizes claimant treatment to date and current status, responds briefly to three to five specific questions posed by the Department, if any, and is usually one or two pages.

(2) “Comprehensive Narrative” means a document that describes an extended claimant history, addresses six or more specific topics, and is usually three or more pages.

(3) “Consultant” means an individual whose professional credentials per the policy of the Social Security Administration identify the individual either as an acceptable medical source, qualified medical source, or certified translator.

(4) “Contractor” means a consultant who has entered into a contract with the Department to provide identified services for specific fees as detailed in the contract. A contractor who provides services not covered by the contract is paid as a consultant under the payment limitations of these rules.

(5) “Department” means the Department of Human Services.

(6) “DDS” means the Disability Determination Services program within the Department, funded by and subject to the disability rating rules of the Social Security Administration.

(7) “These Rules” mean the rules in OAR chapter 411, division 200.

(8) “Vendor” means an individual or entity (such as hospitals, clinics, private practices) that provide medical evidence of record or other services at the Department’s request and may, at the Department’s request and with the Department’s prior authorization, provide a brief or comprehensive narrative of medical treatment for the Department’s review.

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070

Hist.: SDSD 4-2002, f. & cert. ef. 6-12-02; SPD 12-2005, f. & cert. ef. 9-26-05; SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06; SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11

411-200-0030

Medical Evidence of Record (MER) and Narrative Charges

(1) Except as provided by section (4) of this rule, the Department shall pay the lesser of the following fees for existing medical records when requested by the Department:

(a) The lowest fee that the vendor charges the general public or other state or federal agencies for the records; or

(b) When the invoice itemizes the number of pages provided:

(A) For 10 or fewer pages, $18.00;

(B) For 11-20 pages, $18.00 for the first 10 pages plus $0.25 per page for each additional page;

(C) For 21-40 pages, $20.50 for the first 20 pages plus $0.10 per page for each additional page; and

(D) For more than 40 pages, a maximum payment of $22.50.

(c) If the invoice does not itemize the number of pages provided, the Department shall pay a total maximum payment of $18.00.

(2) Additional payment may not be made to a vendor for second or subsequent requests when the information to be provided was available at the time the original request was processed.

(3) Records provided by a vendor, whether held in multiple locations or by multiple sources, shall be paid as a single record request regardless of whether the records are electronic or paper form, or both.

(4) When the Department receives the requested records within 10 days from the date of the Department’s record request, the Department shall pay the vendor an additional $5.00. Time shall be measured from the date indicated on the Department’s written request until the date that the Department receipts the copies.

(5) The Department shall pay the vendor the amount billed up to a maximum payment of $35.00 for a brief narrative summarizing the medical treatment when requested by the Department.

(6) The Department shall pay the vendor the amount billed up to a maximum payment of $75.00 for a comprehensive narrative summarizing the medical treatment when requested by the Department.

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070

Hist.: SDSD 4-2002, f. & cert. ef. 6-12-02; SPD 12-2005, f. & cert. ef. 9-26-05; SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06; SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11

411-200-0035

Consultative Examination (CE) and Related Charges

(1) Except as provided in section (2) of this rule, the Department shall pay the lesser of the following fees for examinations and lab work when requested and pre-authorized by the Department:

(a) The lowest fee charged the general public or other state or federal agencies for the service; or

(b) The maximum fee filed and prescribed by the Oregon Medical Fee and Relative Value Schedule, OAR chapter 436, division 009.

(2) With prior written approval by a DDS manager, the Department may exceed the fee described in section (1) of this rule when financial or human considerations outweigh the difference in cost. Such considerations may include examinations in a remote geographic area or logistical concerns.

(3) The Department shall reimburse a consultant a fee of $90.00 for the preparation time invested by the consultant prior to a DDS scheduled examination if the claimant does not appear within 15 minutes of the scheduled start time and, as a result, the examination cannot be performed.

(4) The Department shall reimburse a consultant or a contractor a fee of $90.00 in the event DDS requests a records review for the Office of Disability and Adjudication Review (ODAR) prior to a DDS scheduled examination.

(5) No additional fees shall be reimbursed for certain scheduled services (e.g., blood work only, x-rays, lab tests, PFT’s, treadmills) where no preparation time is required.

(6) The Department shall reimburse a consultant a fee of $90.00 for other specific scheduled services (e.g., audiograms, Batelle) where preparation is required.

(7) The Department shall use the maximum and interpreter fees in OAR chapter 436, division 009 to reimburse a consultant the round-trip mileage to attend an examination only if the mileage exceeds 60 miles round-trip. The consultant must be a certified translator that provides interpreter services.

Stat. Auth.: ORS 409.050 410.070

Stats. Implemented: ORS 344.511 - 344.690 & 410.070

Hist.: SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11

411-200-0040

Limitations of Payments

(1) A vendor, consultant, or contractor who has entered into a price agreement or contract with one part of the Department to provide identified services must provide the same services at the same price to the Department if requested.

(2) The vendor must accept the fees prescribed by these rules as payment in full. If a vendor’s usual and customary fee for a service exceeds the fee prescribed by these rules, the client or the client’s family may not be liable to the vendor for any portion of a vendor’s usual and customary fee unless the client or the client’s family agrees in writing to assume the additional charges. Without such explicit agreement, the vendor must accept the Department’s payment as payment in full.

(3) No fee shall be paid to the consultant or contractor if DDS cancels an appointment more than 24 hours in advance of the appointed time.

(4) A contractor who provides authorized services that are not covered by the contract shall be treated as a consultant for purposes of reimbursement for those services and is subjected to the payment limitations set forth in these rules applicable to consultants.

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070

Hist.: SDSD 4-2002, f. & cert. ef. 6-12-02; SPD 12-2005, f. & cert. ef. 9-26-05; SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06; SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11

 

Rule Caption: Support Services for Adults with Developmental Disabilities.

Adm. Order No.: SPD 10-2011

Filed with Sec. of State: 5-5-2011

Certified to be Effective: 5-5-11

Notice Publication Date: 4-1-2011

Rules Amended: 411-340-0030, 411-340-0040, 411-340-0120

Rules Repealed: 411-340-0030(T), 411-340-0040(T), 411-340-0060(T), 411-340-0120(T)

Subject: In response to legislatively required budget reductions effective October 1, 2010, the Department of Human Services (DHS), Seniors and People with Disabilities Division (SPD) is permanently amending various support services rules in OAR chapter 411, division 340 to change:

      • The certification period for support services brokerages and provider organizations; and

      • The specific internal brokerage operations around the routing of written incident reports, the approval of revisions to the Individual Support Plan (ISP), and the required review of ISPs.

Rules Coordinator: Christina Hartman—(503) 945-6398

411-340-0030

Certification of Support Services Brokerages and Provider Organizations

(1) CERTIFICATE REQUIRED.

(a) No person or governmental unit acting individually or jointly with any other person or governmental unit may establish, conduct, maintain, manage, or operate a brokerage without being certified by the Division under this rule.

(b) No person or governmental unit acting individually or jointly with any other person or governmental unit may establish, conduct, maintain, or operate a provider organization without either certification under this rule or current Division license or certification as described in OAR 411-340-0170(1).

(c) Certificates are not transferable or assignable and are issued only for the brokerage, or for the provider organization requiring certification under OAR 411-340-0170(2), and persons or governmental units named in the application.

(d) Certificates issued on or after November 15, 2008 shall be in effect for a maximum of five years.

(e) The Division shall conduct a review of the brokerage, or the provider organization requiring certification under OAR 411-340-0170(2), prior to the issuance of a certificate.

(2) CERTIFICATION. A brokerage, or a provider organization requiring certification under OAR 411-340-0170(2), must apply for an initial certificate and for a certificate renewal.

(a) The application must be on a form provided by the Division and must include all information requested by the Division.

(b) The applicant requesting certification as a brokerage must identify the maximum number of individuals to be served.

(c) To renew certification, the brokerage or provider organization must make application at least 30 days but not more than 120 days prior to the expiration date of the existing certificate. On renewal of brokerage certification, no increase in the maximum number of individuals to be served by the brokerage may be certified unless specifically approved by the Division.

(d) Application for renewal must be filed no more than 120 days prior to the expiration date of the existing certificate and shall extend the effective date of the existing certificate until the Division takes action upon the application for renewal.

(e) Failure to disclose requested information on the application or providing incomplete or incorrect information on the application may result in denial, revocation, or refusal to renew the certificate.

(f) Prior to issuance or renewal of the certificate, the applicant must demonstrate to the satisfaction of the Division that the applicant is capable of providing services identified in a manner consistent with the requirements of these rules.

(3) CERTIFICATION EXPIRATION, TERMINATION OF OPERATIONS, OR CERTIFICATE RETURN.

(a) Unless revoked, suspended, or terminated earlier, each certificate to operate a brokerage or provider organization shall expire on the expiration date specified on the certificate.

(b) If a certified brokerage or provider organization is discontinued, the certificate automatically terminates on the date operation is discontinued.

(4) CHANGE OF OWNERSHIP, LEGAL ENTITY, LEGAL STATUS, OR MANAGEMENT CORPORATION. The brokerage, or provider organization requiring certification under OAR 411-340-0170(2), must notify the Division in writing of any pending action resulting in a 5 percent or more change in ownership and of any pending change in the brokerage’s or provider organization’s legal entity, legal status, or management corporation.

(5) NEW CERTIFICATE REQUIRED. A new certificate for a brokerage or provider organization is required upon change in a brokerage’s or provider organization’s ownership, legal entity, or legal status. The brokerage or provider organization must submit a certificate application at least 30 days prior to change in ownership, legal entity, or legal status.

(6) CERTIFICATE DENIAL, REVOCATION, OR REFUSAL TO RENEW. The Division may deny, revoke, or refuse to renew a certificate when the Division finds the brokerage or provider organization, the brokerage or provider organization director, or any person holding 5 percent or greater financial interest in the brokerage or provider organization:

(a) Demonstrates substantial failure to comply with these rules such that the health, safety, or welfare of individuals is jeopardized and the brokerage or provider organization fails to correct the noncompliance within 30 calendar days of receipt of written notice of non-compliance;

(b) Has demonstrated a substantial failure to comply with these rules such that the health, safety, or welfare of individuals is jeopardized during two inspections within a six year period (for the purpose of this rule, “inspection” means an on-site review of the service site by the Division for the purpose of investigation or certification);

(c) Has been convicted of a felony or any crime as described in OAR 407-007-0275;

(d) Has been convicted of a misdemeanor associated with the operation of a brokerage or provider organization;

(e) Falsifies information required by the Division to be maintained or submitted regarding services of individuals, program finances, or individuals’ funds;

(f) Has been found to have permitted, aided, or abetted any illegal act that has had significant adverse impact on individual health, safety, or welfare; or

(g) Has been placed on the current Centers for Medicare and Medicaid Services list of excluded or debarred providers.

(7) NOTICE OF CERTIFICATE DENIAL, REVOCATION, OR REFUSAL TO RENEW. Following a Division finding that there is a substantial failure to comply with these rules such that the health, safety, or welfare of individuals is jeopardized, or that one or more of the events listed in section (6) of this rule has occurred, the Division may issue a notice of certificate revocation, denial, or refusal to renew.

(8) IMMEDIATE SUSPENSION OF CERTIFICATE. When the Division finds a serious and immediate threat to individual health and safety and sets forth the specific reasons for such findings, the Division may, by written notice to the certificate holder, immediately suspend a certificate without a pre-suspension hearing and the brokerage or provider organization may not continue operation.

(9) HEARING. An applicant for a certificate or a certificate holder may request a hearing pursuant to the contested case provisions of ORS chapter 183 upon written notice from the Division of denial, suspension, revocation, or refusal to renew a certificate. In addition to, or in lieu of a hearing, the applicant or certificate holder may request an administrative review by the Division’s Assistant Director. An administrative review does not preclude the right of the applicant or certificate holder to a hearing.

(a) The applicant or certificate holder must request a hearing within 60 days of receipt of written notice by the Division of denial, suspension, revocation, or refusal to renew a certificate. The request for a hearing must include an admission or denial of each factual matter alleged by the Division and must affirmatively allege a short plain statement of each relevant, affirmative defense the applicant or certificate holder may have.

(b) In the event of a suspension pursuant to section (8) of this rule and during the first 30 days after the suspension of a certificate, the brokerage or provider organization may submit a written request to the Division for an administrative review. The Division shall conduct the review within 10 days after receipt of the request for an administrative review. Any review requested after the end of the 30-day period following certificate suspension shall be treated as a request for hearing under subsection (a) of this section. If following the administrative review the suspension is upheld, the brokerage or provider organization may request a hearing pursuant to the contested case provisions of ORS chapter 183.

Stat. Auth.: ORS 409.050 & 410.070

Stats. Implemented: ORS 427.005, 427.007, & 430.610 - 430.695

Hist.: MHD 9-2001(Temp), f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02; Renumbered from 309-041-1770, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 25-2010(Temp), f. & cert. ef. 11-17-10 thru 5-16-11; SPD 10-2011, f. & cert. ef. 5-5-11

411-340-0040

Abuse and Unusual Incidents in Support Services Brokerages and Provider Organizations

(1) ABUSE PROHIBITED. No adult or individual as defined in OAR 411-340-0020 shall be abused nor shall any employee, staff, or volunteer of the brokerage or provider organization condone abuse.

(a) Brokerages and provider organizations must have in place appropriate and adequate disciplinary policies and procedures to address instances when a staff member has been identified as an accused person in an abuse investigation as well as when the allegation of abuse has been substantiated.

(b) All employees of a brokerage or provider organization are mandatory reporters. The brokerage or provider organization must:

(A) Notify all employees of mandatory reporting status at least annually on forms provided by the Department; and

(B) Provide all employees with a Department-produced card regarding abuse reporting status and abuse reporting.

(2) INCIDENT REPORTS.

(a) A brokerage or provider organization must prepare an incident report for instances of potential or suspected abuse or an unusual incident as defined in OAR 411-340-0020, involving an individual and a brokerage or provider organization employee. The incident report must be placed in the individual’s record and must include:

(A) Conditions prior to or leading to the potential or suspected abuse or unusual incident;

(B) A description of the potential or suspected abuse or unusual incident;

(C) Staff response at the time; and

(D) Review by the brokerage administration and follow-up to be taken to prevent recurrence of the potential or suspected abuse or unusual incident.

(b) A brokerage or provider organization must send copies of all incident reports involving potential or suspected abuse that occurs while an individual is receiving brokerage or provider organization services to the CDDP.

(c) A provider organization must send copies of incident reports of all potential or suspected abuse or unusual incidents that occur while the individual is receiving services from a provider organization to the individual’s brokerage within five working days of the potential or suspected abuse or unusual incident.

(3) IMMEDIATE NOTIFICATION

(a) The brokerage must immediately report to the CDDP, and the provider organization must immediately report to the CDDP with notification to the brokerage, any incident or allegation of potential or suspected abuse falling within the scope of OAR 407-045-0260.

(A) When an abuse investigation has been initiated, the CDDP must provide notice according to OAR 407-045-0290.

(B) When an abuse investigation has been completed, the CDDP must provide notice of the outcome of the investigation according to OAR 407-045-0320.

(b) In the case of emergency overnight hospitalization due to illness or injury to an individual, the brokerage or provider organization must immediately notify:

(A) The individual’s legal representative, parent, next of kin, designated contact person, or other significant person; and

(B) In the case of the provider organization, the individual’s brokerage.

(c) In the event of the death of an individual, the brokerage or provider organization must immediately notify:

(A) The Medical Director of the Division;

(B) The individual’s legal representative, parent, next of kin, designated contact person, or other significant person;

(C) The CDDP; and

(D) In the case of a provider organization, the individual’s brokerage.

Stat. Auth.: ORS 409.050 & 410.070

Stats. Implemented: ORS 427.005, 427.007, & 430.610 - 430.695

Hist.: MHD 9-2001(Temp), f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02; MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1780, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 5-2010, f. 6-29-10, cert. ef. 7-1-10; SPD 25-2010(Temp), f. & cert. ef. 11-17-10 thru 5-16-11; SPD 10-2011, f. & cert. ef. 5-5-11

411-340-0120

Support Service Brokerage Services

(1) Each brokerage must provide or arrange for the following services as required to meet individual support needs:

(a) Assistance for individuals to determine needs, plan supports in response to needs, and develop individualized budgets based on available resources;

(b) Assistance for individuals to find and arrange the resources to provide planned supports;

(c) Assistance with development and expansion of community resources required to meet the support needs of individuals served by the brokerage;

(d) Information, education, and technical assistance for individuals to use to make informed decisions about support needs and to direct providers;

(e) Fiscal intermediary services in the receipt and accounting of support services funds on behalf of an individual in addition to making payment to providers with the authorization of the individual;

(f) Employer-related supports; and

(g) Assistance for individuals to effectively put plans into practice, including help to monitor and improve the quality of supports as well as assess and revise plan goals.

(2) SELF-DETERMINATION. Brokerages must apply the principles of self-determination to provision of services required in section (1) of this rule.

(3) PERSON-CENTERED PLANNING. A brokerage must use a person-centered planning approach to assist individuals to establish outcomes, determine needs, plan for supports, and review and redesign support strategies.

(4) HEALTH AND SAFETY ISSUES. The planning process must address basic health and safety needs and supports including but not limited to:

(a) Identification of risks, including risk of serious neglect, intimidation, and exploitation;

(b) Informed decisions by the individual or the individual’s legal representative regarding the nature of supports or other steps taken to ameliorate any identified risks; and

(c) Education and support to recognize and report abuse.

(5) MEDICAID WAIVERS. The brokerage must assure that individuals who become eligible for Medicaid after entry into the brokerage are offered the choice of home and community-based waiver services, provided a notice of fair hearing rights, and have a completed Title XIX Waiver form that is reviewed annually or at any time there is a significant change.

(6) WRITTEN PLAN REQUIRED.

(a) Unless circumstances allow exception under subsection (b) of this section, the personal agent must write an ISP dated within 90 days of an individual’s entry into brokerage services and at least annually thereafter. A written copy of the most current ISP must be provided to the individual and the individual’s legal representative. The ISP or attached documents must include:

(A) The individual’s name;

(B) A description of the supports required, including the reason the support is necessary;

(C) Projected dates of when specific supports are to begin and end;

(D) Projected costs, with sufficient detail to support estimates;

(E) A list of personal, community, and public resources that are available to the individual and how they shall be applied to provide the required supports;

(F) The providers, or when the provider is unknown or is likely to change frequently, the type of provider (i.e. independent provider, provider organization, or general business provider), of supports to be purchased with support services funds;

(G) Schedule of ISP reviews; and

(H) Any revisions to paragraphs (A) to (G) of this section that may alter:

(i) The amount of support services funds required;

(ii) The amount of support services required;

(iii) Types of support purchased with support services funds; and

(iv) The type of support provider.

(b) The schedule of the support services ISP developed in compliance with section (3) of this rule after an individual enters a brokerage may be adjusted one time for any individual entering a brokerage in certain circumstances. Such an adjustment shall interrupt any plan year in progress and establish a new plan year for the individual beginning on the date the first new ISP is authorized. Circumstances where this adjustment is permitted include:

(A) Brokerages, with the consent of the individual, may designate a new ISP start date.

(i) This adjustment may only occur one time per individual upon ISP renewal.

(ii) The individual’s benefit level must be pro-rated based on the shortened plan year in order to not exceed the annual benefit level for which the individual is eligible.

(iii) ISP date adjustments shall be clearly documented on the ISP.

(B) Transition of individuals receiving family support services for children with developmental disabilities regulated by OAR chapter 411, division 305, children’s intensive in-home services (CIIS) regulated by OAR chapter 411, division 300, or medically fragile children (MFC) services regulated by OAR chapter 411, division 350, when those individuals are 18 years of age. The date of the individual’s first new support services ISP after enrollment in the brokerage may be adjusted to correspond to the expiration date of the individual’s Annual Plan of Care in place at the time the individual turns 18 years of age when the Annual Plan of Care, developed while the individual is still receiving family support, CIIS, or MFC services, has been authorized for implementation prior to or upon the individual’s enrollment in the brokerage.

(C) Transition of individuals receiving other Division-paid services who are required by the Division to transition to support services. The date of the individual’s first support services ISP may be adjusted to correspond to the expiration date of the individual’s plan for services when the plan for services:

(i) Has been developed according to regulations governing Division-paid services the individual receives prior to transition;

(ii) Is current at the time designated by the Division for transition to support services; and

(iii) Is authorized for implementation prior to or upon the individual’s enrollment in the brokerage.

(7) PROFESSIONAL OR OTHER SERVICE PLANS.

(a) A Nursing Care Plan must be attached to the ISP when support services funds are used to purchase services requiring the education and training of a licensed professional nurse.

(b) A Support Services Brokerage Plan of Care Crisis Addendum, or other document prescribed by the Division for use in these circumstances, must be attached when an individual enrolled in a brokerage:

(A) Has been determined by the CDDP of the individual’s county of residence as eligible for crisis diversion services according to OAR 411-320-0160; and

(B) Is in emergent status in a short-term out-of-home residential placement as part of the individual’s crisis diversion services. This short-term plan must be coordinated by staff of the CDDP of the individual’s county of residence.

(8) INDIVIDUAL SERVICE PLAN AUTHORIZATION.

(a) An initial and annual ISP must be authorized prior to implementation.

(b) A revision to the annual or initial ISP that involves the types of support purchased with support services funds must be authorized prior to implementation.

(c) A revision to the annual or initial ISP that does not involve the types of support purchased with support services funds does not require authorization. Documented verbal agreement to the revision by the individual or the individual’s legal representative is required prior to implementation of the revision.

(d) An ISP is authorized when:

(A) The signature of the individual or the individual’s legal representative is present on the ISP or documentation is present explaining the reason an individual who does not have a legal representative may be unable to sign the ISP.

(i) Acceptable reasons for an individual without a legal representative not to sign the ISP include physical or behavioral inability to sign the ISP.

(ii) Unavailability of the individual is not an acceptable reason for the individual or the individual’s legal representative not to sign the ISP.

(iii) In the case of a revision to the initial or annual ISP that is in response to immediate, unexpected change in circumstance, and is necessary to prevent injury or harm to the individual, documented verbal agreement may substitute for a signature for no more than 10 working days.

(B) The signature of the personal agent involved in the development of, or revision to, the ISP is present on the ISP; and

(C) A designated brokerage representative has reviewed the ISP for compliance with Division rules and policy.

(9) PERIODIC REVIEW OF PLAN AND RESOURCES.

(a) The personal agent must conduct and document reviews of plans and resources with the individual and the individual’s legal representative.

(b) At least annually as part of preparation for a new ISP, the personal agent must:

(A) Evaluate progress toward achieving the purposes of the ISP, assessing and revising goals as needed;

(B) Note effectiveness of the use of support funds based on personal agent observation as well as individual satisfaction;

(C) Determine whether changing needs or availability of other resources has altered the need for continued use of support services funds to purchase supports; and

(D) Record final support services fund costs.

(10) TRANSITION TO ANOTHER BROKERAGE. At the request of an individual enrolled in brokerage services who has selected another brokerage, the brokerage must collaborate with the receiving brokerage and the CDDP of the individual’s county of residence to transition support services.

(a) If the Division has designated and contracted funds solely for the support of the transitioning individual, the brokerage must notify the Division to consider transfer of the funds for the individual to the receiving brokerage.

(b) The ISP in place at the time of request for transfer may remain in effect 90 days after enrollment in the new brokerage while a new ISP is negotiated and authorized.

Stat. Auth.: ORS 409.050 & 410.070

Stats. Implemented: ORS 427.005, 427.007, & 430.610 - 430.695

Hist.: MHD 9-2001(Temp), f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02; MHD 5-2002, f. 2-26-02 cert. ef. 2-27-02; MHD 4-2003(Temp); f. & cert. ef. 7-1-03 thru 12-27-03; Renumbered from 309-041-1860, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 25-2010(Temp), f. & cert. ef. 11-17-10 thru 5-16-11; SPD 10-2011, f. & cert. ef. 5-5-11

Notes
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