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Oregon Bulletin

September 1, 2013

Department of Human Services, Aging and People with Disabilities and Developmental Disabilities, Chapter 411

Rule Caption: Support Services for Adults with Developmental Disabilities — Rate Ranges

Adm. Order No.: SPD 31-2013

Filed with Sec. of State: 7-22-2013

Certified to be Effective: 8-1-13

Notice Publication Date: 6-1-2013

Rules Amended: 411-340-0020

Rules Repealed: 411-340-0020(T)

Subject: The Department of Human Services is permanently amending OAR 411-340-0020 to make permanent the support services rate ranges that became effective April 1, 2013. The rate ranges reflect the 1.25% wage increase for personal support workers required by the 2011–2013 Collective Bargaining Agreement between the Home Care Commission and the Service Employee’s International Union (SEIU), Local 503, Oregon Public Employees’ Union (OPEU).

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

411-340-0020

Definitions

As used in OAR chapter 411, division 340:

(1) “Abuse” means abuse of an adult as defined in OAR 407-045-0260.

(2) “Abuse Investigation and Protective Services” means reporting and investigation activities as required by OAR 407-045-0300 and any subsequent services or supports necessary to prevent further abuse as required by OAR 407-045-0310.

(3) “Activities of Daily Living (ADL)” mean the self-care activities accomplished by an individual for continued well-being.

(4) “Adaptive Behavior” means the degree to which an individual meets the standards of personal independence and social responsibility expected for age and culture group.

(5) “Administration of Medication” means the act of placing a medication in, or on, an individual’s body by a person responsible for the individual’s care and employed by or under contract to the individual, the individual’s legal representative, or a provider organization.

(6) “Administrative Review” means the formal process that is used when the individual or the individual’s legal representative is not satisfied with the decision made by the brokerage about a complaint involving the provision of services or a provider.

(7) “Administrator” means the Administrator of the Department, or that person’s designee. The term “Administrator” is synonymous with “Assistant Director”.

(8) “Adult” means an individual 18 years or older with developmental disabilities.

(9) “Alternative Resources” mean possible resources, not including support services, for the provision of supports to meet an individual’s needs. Alternative resources includes but is not limited to private or public insurance, vocational rehabilitation services, supports available through the Oregon Department of Education, or other community supports.

(10) “Basic Benefit” means the type and amount of support services available to each eligible individual, specifically:

(a) Access to the brokerage services listed in OAR 411-340-0120(1); and if required

(b) Access to an amount of support services funds used to assist with the purchase of supports listed in OAR 411-340-0130(6).

(11) “Basic Supplement” means an amount of support services funds in excess of the basic benefit to which an individual may have access in order to purchase necessary supports based on demonstration of extraordinary long-term need on the Basic Supplement Criteria Inventory, Form DHS 0203.

(12) “Basic Supplement Criteria Inventory (Form DHS 0203)” means the written inventory of an individual’s circumstances that is completed and scored by the brokerage to determine whether the individual is eligible for a basic supplement.

(13) “Benefit Level” means the total annual amount of support service funds for which an individual is eligible. The benefit level includes the basic benefit and any exceptions to the basic benefit financial limits.

(14) “Certificate” means a document issued by the Department to a brokerage, or to a provider organization requiring certification under OAR 411-340-0170(2), that certifies the brokerage or provider organization is eligible to receive state funds for support services.

(15) “Choice” means the individual’s expression of preference, opportunity for, and active role in decision-making related to the selection of assessments, services, providers, goals and activities, and verification of satisfaction with these services. Choice may be communicated verbally, through sign language, or by other communication methods.

(16) “Chore Services” mean services needed to maintain a clean, sanitary, and safe environment in an individual’s home. Chore services include heavy household chores such as washing floors, windows, and walls, tacking down loose rugs and tiles, and moving heavy items of furniture for safe access and egress.

(17) “Client Process Monitoring System (CPMS)” means the Department’s computerized system for enrolling and terminating services for individuals with developmental disabilities.

(18) “Community Developmental Disability Program (CDDP)” means an entity that is responsible for planning and delivery of services for individuals with developmental disabilities according to OAR chapter 411, division 320. A CDDP operates in a specific geographic service area of the state under a contract with the Department, Local Mental Health Authority, or other entity as contracted by the Department.

(19) “Community Living and Inclusion Supports” mean services that facilitate independence and promote community integration by supporting the individual to gain or maintain skills to live as independently as possible in the type of home the individual chooses. Community living and inclusion supports provide support for the individual to participate in activities in integrated settings that promote community inclusion and contribution.

(a) Community living and inclusion supports include supports designed to develop or maintain skills for self-care, ability to direct supports, care of the immediate environment, and may include instruction in skills an individual wishes to acquire, retain, or improve that enhance independence, productivity, integration, or maintain the individual’s physical and mental skills. Community living and inclusion supports include supports in the following areas:

(A) Personal skills, which includes eating, bathing, dressing, personal hygiene, and mobility;

(B) Socialization, which includes development or maintenance of self-awareness and self-control, social responsiveness, social amenities, and interpersonal skills;

(C) Community participation, recreation, or leisure, which includes the development or maintenance of skills to use available community services, facilities, or businesses;

(D) Communication, which includes development or maintenance of expressive and receptive skills in verbal and non-verbal language and the functional application of acquired reading and writing skills; and

(E) Personal environmental skills, which includes development or maintenance of skills such as planning and preparing meals, budgeting, laundry, and housecleaning.

(b) Community living and inclusion supports may or may not be work related.

(20) “Complaint” means a verbal or written expression of dissatisfaction with services or providers.

(21) “Comprehensive Services” mean a package of developmental disability services and supports that include one of the following living arrangements regulated by the Department alone or in combination with any associated employment or community inclusion program regulated by the Department:

(a) Twenty-four hour residential services including but not limited to services provided in a group home, foster home, or through a supported living program; or

(b) In-home supports provided to an individual in the individual or family home costing more than the individual cost limit.

(c) Comprehensive services do not include support services for adults enrolled in brokerages or for children enrolled in long-term supports or children’s intensive in-home services.

(22) “Cost Effective” means being responsible and accountable with Department resources by offering less costly alternatives when providing choices that adequately meet an individual’s support needs. Less costly alternatives include other programs available from the Department, the utilization of assistive devices, natural supports, architectural modifications, and alternative resources. Less costly alternatives may include resources not paid for by the Department.

(23) “Crisis” means:

(a) A situation that may result in civil court commitment under ORS 427.215 to 427.306 and for which no appropriate alternative resources are available; or

(b) Risk factors described in OAR 411-320-0160 are present for which no appropriate alternative resources are available.

(24) “Crisis Diversion Services” mean the services authorized and provided according to OAR 411-320-0160 that are intended to maintain an individual at home or in the family home while an individual is in emergent status. Crisis diversion services may include short-term residential placement services indicated on an individual’s Support Services Brokerage Plan of Care Crisis Addendum, as well as additional support as described in an Individual Support Plan.

(25) “Department” means the Department of Human Services (DHS). The term “Department” is synonymous with “Division (SPD)”.

(26) “Developmental Disability” means a neurological condition that originates in the developmental years, that is likely to continue, and significantly impacts adaptive behavior as diagnosed and measured by a qualified professional as described in OAR 411-320-0080.

(27) “Emergent Status” means an individual has been determined to be eligible for crisis diversion services according to OAR 411-320-0160..

(28) “Employer-Related Supports” mean activities that assist individuals and, when applicable, their family members with fulfilling roles and obligations as employers as described in the Individual Support Plan. Supports to the employer include but are not limited to:

(a) Education about employer responsibilities;

(b) Orientation to basic wage and hour issues;

(c) Use of common employer-related tools such as job descriptions; and

(d) Fiscal intermediary services.

(29) “Entry” means admission to a Department-funded developmental disability service provider.

(30) “Environmental Accessibility Adaptations” mean physical adaptations that are necessary to ensure the health, welfare, and safety of the individual in the home, or that enable the individual to function with greater independence in the home.

(a) Environmental accessibility adaptations include but are not limited to:

(A) Environmental modification consultation to determine the appropriate type of adaptation;

(B) Installation of shatter-proof windows;

(C) Hardening of walls or doors;

(D) Specialized, hardened, waterproof, or padded flooring;

(E) An alarm system for doors or windows;

(F) Protective covering for smoke detectors, light fixtures, and appliances;

(G) Sound and visual monitoring systems;

(H) Fencing;

(I) Installation of ramps, grab-bars, and electric door openers;

(J) Adaptation of kitchen cabinets and sinks;

(K) Widening of doorways;

(L) Handrails;

(M) Modification of bathroom facilities;

(N) Individual room air conditioners for an individual whose temperature sensitivity issues create behaviors or medical conditions that put the individual or others at risk;

(O) Installation of non-skid surfaces;

(P) Overhead track systems to assist with lifting or transferring;

(Q) Specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies necessary for the welfare of the individual; or

(R) Modifications to a vehicle to meet the unique needs of the individual (lift, interior alterations such as seats, head and leg rests and belts, special safety harnesses, or other unique modifications to keep the individual safe in the vehicle).

(b) Environmental accessibility adaptations exclude:

(A) Adaptations or improvements to the home that are of general utility and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, and central air conditioning; and

(B) Adaptations that add to the total square footage of the home.

(31) “Environmental Modification Consultant” means either an independent provider, provider organization, or general business paid with support services funds, to provide advice to an individual, the individual’s legal representative, or the individual’s personal agent about the environmental accessibility adaptation required to meet the individual’s needs.

(32) “Exit” means either termination from a Department-funded developmental disability service provider or transfer from one Department-funded service provider to another.

(33) “Family” for determining individual eligibility for brokerage services as a resident in the family home and for determining who may receive family training, means a unit of two or more persons that include at least one individual with developmental disabilities where the primary caregiver is:

(a) Related to the individual with developmental disabilities by blood, marriage, or legal adoption; or

(b) In a domestic relationship where partners share:

(A) A permanent residence;

(B) Joint responsibility for the household in general (e.g. child-rearing, maintenance of the residence, basic living expenses); and

(C) Joint responsibility for supporting a member of the household with developmental disabilities and the individual with developmental disabilities is related to one of the partners by blood, marriage, or legal adoption.

(34) “Family Training” means training and counseling services for the family of an individual that increase the family’s capacity to care for, support, and maintain the individual in the home. Family training includes:

(a) Instruction about treatment regimens and use of equipment specified in the Individual Support Plan;

(b) Information, education, and training about the individual’s developmental disability, medical, and behavioral conditions; and

(c) Counseling for the family to relieve the stress associated with caring for an individual with developmental disabilities.

(35) “Fiscal Intermediary” means a person or entity that receives and distributes support services funds on behalf of an individual who employs persons to provide services, supervision, or training in the home or community according to the Individual Support Plan.

(36) “Founded Reports” means the Department’s or Law Enforcement Authority’s (LEA) determination, based on the evidence, that there is reasonable cause to believe that conduct in violation of the child abuse statutes or rules has occurred and such conduct is attributable to the person alleged to have engaged in the conduct.

(37) “General Business Provider” means an organization or entity selected by an individual or the individual’s legal representative, and paid with support services funds that:

(a) Is primarily in business to provide the service chosen by the individual to the general public;

(b) Provides services for the individual through employees, contractors, or volunteers; and

(c) Receives compensation to recruit, supervise, and pay the persons who actually provide support for the individual.

(38) “Habilitation Services” mean services designed to assist individuals in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings. Habilitation services include supported employment and community living and inclusion supports.

(39) “Hearing” means the formal process following an action that would terminate, suspend, reduce, or deny a service. This is a formal process required by federal law (42 CFR 431.200-250). A hearing is also known as a Medicaid Fair Hearing and contested case hearing.

(40) “Home” means an individual’s primary residence that is not under contract with the Department to provide services to an individual as a licensed or certified foster home, residential care facility, assisted living facility, nursing facility, or other residential support program site.

(41) “Homemaker Services” mean the general household activities such as meal preparation and routine household services required to maintain a clean, sanitary, and safe environment in an individual’s home.

(42) “Incident Report” means a written report of any unusual incident involving an individual.

(43) “Independence” means the extent to which individuals with developmental disabilities exert control and choice over their own lives.

(44) “Independent Provider” means a person selected by an individual or the individual’s legal representative and paid with support services funds that personally provide services to the individual.

(45) “Individual” means an adult with developmental disabilities for whom services are planned and provided.

(46) “Individual Cost Limit” means the maximum annual benefit level available under the Support Services Waiver.

(47) “Individual Support Plan (ISP)” means the written details of the supports, activities, and resources required for an individual to achieve personal goals. The type of service supports needed, how supports are delivered, and the frequency of provided supports are included in the ISP. The ISP is developed at minimum annually to reflect decisions and agreements made during a person-centered process of planning and information gathering. The ISP is the individual’s plan of care for Medicaid purposes.

(48) “Integration” as defined in ORS 427.005 means:

(a) The use by individuals with developmental disabilities of the same community resources used by and available to other persons;

(b) Participation by individuals with developmental disabilities in the same community activities in which persons without a developmental disability participate, together with regular contact with persons without a developmental disability; and

(c) Individuals with developmental disabilities reside in homes or home-like settings that are in proximity to community resources and foster contact with persons in their community.

(49) “Legal Representative” means an attorney at law who has been retained by or for an individual, or a person or agency authorized by the court to make decisions about services for the individual.

(50) “Mandatory Reporter” means any public or private official as defined in OAR 407-045-0260 who, while acting in an official capacity, comes in contact with and has reasonable cause to believe an adult with developmental disabilities has suffered abuse, or comes in contact with any person whom the official has reasonable cause to believe abused an adult with developmental disabilities. Nothing contained in ORS 40.225 to 40.295 shall affect the duty to report imposed by this section of this rule, except that a psychiatrist, psychologist, clergy, or attorney is not required to report if the communication is privileged under ORS 40.225 to 40.295.

(51) “Medication” means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.

(52) “Natural Supports” or “Natural Support System” means the resources available to an individual from their relatives, friends, significant others, neighbors, roommates, and the community. Services provided by natural supports are resources that are not paid for by the Department.

(53) “Nurse” means a person who holds a current license from the Oregon Board of Nursing as a registered nurse or licensed practical nurse pursuant to ORS chapter 678.

(54) “Nursing Care Plan” means a plan developed by a registered nurse that describes the medical, nursing, psychosocial, and other needs of the individual and how those needs shall be met. The Nursing Care Plan includes which tasks shall be taught, assigned, or delegated to the qualified provider or family.

(55) “Occupational Therapy” means the services provided by a professional licensed under ORS 675.240 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(56) “OSIP-M” means Oregon Supplemental Income Program Medical.

(57) “Personal Agent” means a person who works directly with individuals and families to provide or arrange for support services as described in the Support Services Waiver and these rules, is a case manager for the provision of targeted case management services, meets the qualifications set forth in OAR 411-340-0150(5), and is:

(a) A trained employee of a brokerage; or

(b) A person who has been engaged under contract to the brokerage to allow the brokerage to meet responsibilities in geographic areas where personal agent resources are severely limited.

(58) “Personal Emergency Response Systems” mean electronic devices required by certain individuals to secure help in an emergency for safety in the community.

(59) “Person-Centered Planning” means:

(a) A process, either formal or informal, for gathering and organizing information that helps an individual:

(A) Determine and describe choices about personal goals, activities, and lifestyle preferences;

(B) Design strategies and networks of support to achieve goals and a preferred lifestyle using individual strengths, relationships, and resources; and

(C) Identify, use, and strengthen naturally occurring opportunities for support at home and in the community.

(b) The methods for gathering information vary, but all are consistent with individual needs and preferences.

(60) “Physical Therapy” means the services provided by a professional licensed under ORS 688.020 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(61) “Plan Year” means 12 consecutive months used to calculate an individual’s annual benefit level. Unless otherwise set according to the conditions of OAR 411-340-0120, the initial plan year begins on the start date specified on the individual’s first authorized Individual Support Plan (ISP) after entry to a brokerage. Subsequent plan years begin on the anniversary of the start date of the initial ISP.

(62) “Positive Behavioral Theory and Practice” means a proactive approach to individual behavior and behavior interventions that:

(a) Emphasizes the development of functional alternative behavior and positive behavior intervention;

(b) Uses the least intervention possible;

(c) Ensures that abusive or demeaning interventions are never used; and

(d) Evaluates the effectiveness of behavior interventions based on objective data.

(63) “Prescription Medication” means any medication that requires a physician prescription before it may be obtained from a pharmacist.

(64) “Primary Caregiver” means the person identified in an Individual Support Plan as providing the majority of service and support for an individual in the individual’s home.

(65) “Productivity” as defined in ORS 427.005 means:

(a) Engagement in income-producing work by an individual with developmental disabilities that is measured through improvements in income level, employment status, or job advancement; or

(b) Engagement by an individual with developmental disabilities in work contributing to a household or community.

(66) “Protection” and “Protective Services” mean necessary actions taken as soon as possible to prevent subsequent abuse or exploitation of an individual, to prevent self-destructive acts, and to safeguard an individual’s person, property, and funds.

(67) “Provider Organization” means an entity selected by an individual or the individual’s legal representative, and paid with support services funds that:

(a) Is primarily in business to provide supports for individuals with developmental disabilities;

(b) Provides supports for the individual through employees, contractors, or volunteers; and

(c) Receives compensation to recruit, supervise, and pay the persons who actually provide support for the individual.

(68) “Provider Organization Director” means the employee of a provider organization, or the employee’s designee, responsible for administration and provision of services according to these rules.

(69) “Psychotropic Medication” means a medication the prescribed intent of which is to affect or alter thought processes, mood, or behavior including but not limited to anti-psychotic, antidepressant, anxiolytic (anti-anxiety), and behavior medications. The classification of a medication depends upon its stated, intended effect when prescribed.

(70) “Quality Assurance” means a systematic procedure for assessing the effectiveness, efficiency, and appropriateness of services.

(71) “Rate Ranges” mean the rates and limits paid for some support services. The Department’s support services rate ranges as of April 1, 2013 are maintained on the Department’s website (http://www.dhs.state.or.us/spd/tools/dd/bpa/rate-guidelines-040113.pdf). Printed copies may be obtained by contacting the Department of Human Services, Developmental Disabilities, ATTN: Rule Coordinator, 500 Summer Street NE, E-10, Salem, Oregon 97301.

(72) “Regional Crisis Diversion Program” means the regional coordination of the management of crisis diversion services for a group of designated counties that is responsible for the management of the following developmental disability services:

(a) Crisis intervention services;

(b) Evaluation of requests for new or enhanced services for certain groups of individuals eligible for developmental disability services; and

(c) Other developmental disability services that the counties comprising the region agree are more effectively or automatically delivered on a regional basis.

(73) “Respite” means intermittent services provided on a periodic basis for the relief of, or due to the temporary absence of, persons normally providing the supports to individuals unable to care for themselves.

(74) “Restraint” means any physical hold, device, or chemical substance that restricts, or is meant to restrict, the movement or normal functioning of an individual.

(75) “Self-Administration of Medication” means the individual manages and takes his or her own medication, identifies his or her medication and the times and methods of administration, places the medication internally in or externally on his or her own body without staff assistance upon written order of a physician, and safely maintains the medication without supervision.

(76) “Self-Determination” means a philosophy and process by which individuals with developmental disabilities are empowered to gain control over the selection of support services that meet their needs. The basic principles of self-determination are:

(a) Freedom. The ability for an individual with a developmental disability, together with freely-chosen family and friends, to plan a life with necessary support services rather than purchasing a predefined program;

(b) Authority. The ability for an individual with a developmental disability, with the help of a social support network if needed, to control a certain sum of resources in order to purchase support services;

(c) Autonomy. The arranging of resources and personnel, both formal and informal, that shall assist an individual with a developmental disability to live a life in the community rich in community affiliations; and

(d) Responsibility. The acceptance of a valued role in an individual’s community through competitive employment, organizational affiliations, personal development, and general caring for others in the community, as well as accountability for spending public dollars in ways that are life-enhancing for individuals with developmental disabilities.

(77) “Social Benefit” means a service or financial assistance solely intended to assist an individual with a developmental disability to function in society on a level comparable to that of a person who does not have such a developmental disability.

(a) Social benefits may not:

(A) Duplicate benefits and services otherwise available to persons regardless of developmental disability;

(B) Provide financial assistance with food, clothing, shelter, and laundry needs common to persons with or without developmental disabilities; or

(C) Replace other governmental or community services available to an individual.

(b) Financial assistance provided as a social benefit may not exceed the actual cost of the support required by an individual to be supported in the individual’s home and must be either:

(A) Reimbursement for an expense previously authorized in an Individual Support Plan (ISP); or

(B) An advance payment in anticipation of an expense authorized in a previously authorized ISP.

(78) “Special Diet” means specially prepared food or particular types of food, ordered by a physician and periodically monitored by a dietician, specific to an individual’s medical condition or diagnosis that are needed to sustain an individual in the individual’s home. Special diets are supplements and are not intended to meet an individual’s complete daily nutritional requirements. Special diets may include:

(a) High caloric supplements;

(b) Gluten-free supplements; and

(c) Diabetic, ketogenic, or other metabolic supplements.

(79) “Specialized Medical Equipment and Supplies” mean devices, aids, controls, supplies, or appliances that enable individuals to increase their abilities to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. Specialized medical equipment and supplies include items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the State Medicaid Plan. Specialized medical equipment and supplies may not include items not of direct medical or remedial benefit to the individual. Specialized medical equipment and supplies must meet applicable standards of manufacture, design, and installation.

(80) “Specialized Supports” mean treatment, training, consultation, or other unique services necessary to achieve outcomes in the Individual Support Plan that are not available through State Medicaid Plan services or other support services listed in OAR 411-340-0130(6). Typical supports include the services of a behavior consultant, a licensed nurse, or a social or sexual consultant to:

(a) Assess the needs of the individual and family, including environmental factors;

(b) Develop a plan of support;

(c) Train caregivers to implement the plan of support;

(d) Monitor implementation of the plan of support; and

(e) Revise the plan of support as needed.

(81) “Speech and Language Therapy” means the services provided by a professional licensed under ORS 681.250 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(82) “Substantiated” means an abuse investigation has been completed by the Department or the Department’s designee and the preponderance of the evidence establishes the abuse occurred.

(83) “Support” means assistance that individuals require, solely because of the affects of developmental disability, to maintain or increase independence, achieve community presence and participation, and improve productivity. Support is flexible and subject to change with time and circumstances.

(84) “Supported Employment Services” means provision of job training and supervision available to assist an individual who needs intensive ongoing support to choose, get, and keep a job in a community business setting. Supported employment is a service planned in partnership with public vocational assistance agencies and school districts and through Social Security Work Incentives when available.

(85) “Support Services” mean the services of a brokerage listed in OAR 411-340-0120(1) as well as the uniquely determined activities and purchases arranged through the brokerage support services that:

(a) Complement the existing formal and informal supports that exist for an individual living in the individual’s own home or family home;

(b) Are designed, selected, and managed by the individual or the individual’s legal representative;

(c) Are provided in accordance with an Individual Support Plan; and

(d) May include purchase of supports as a social benefit required for an individual to live in the individual’s home or the family home.

(86) “Support Services Brokerage” or “Brokerage” means an entity, or distinct operating unit within an existing entity, that uses the principles of self-determination to perform the functions listed in OAR 411-340-0120(1) associated with planning and implementation of support services for individuals with developmental disabilities.

(87) “Support Services Brokerage Director” or “Brokerage Director” means the employee of a publicly or privately-operated brokerage, or that person’s designee, who is responsible for administration and provision of services according to these rules.

(88) “Support Services Brokerage Plan of Care Crisis Addendum” means the short-term plan that is required by the Department to be added to an Individual Support Plan to describe crisis diversion services an individual is to receive while the individual is in emergent status in a short-term residential placement.

(89) “Support Services Brokerage Policy Oversight Group” or “Policy Oversight Group” means the group that meets the requirements of OAR 411-340-0150(1) that is formed to provide consumer-based leadership and advice to each brokerage regarding issues such as development of policy, evaluation of services, and use of resources.

(90) “Support Services Expenditure Guideline” means a publication of the Department that describes allowable uses for support services funds.

(91) “Support Services Funds” mean public funds designated by the brokerage for assistance with the purchase of supports according to each Individual Support Plan.

(92) “These Rules” mean the rules in OAR chapter 411, division 340.

(93) “Transportation” means services that allow individuals to gain access to community services, activities, and resources that are not medical in nature.

(94) “Unusual Incident” means incidents involving serious illness or accidents, death of an individual, injury or illness of an individual requiring inpatient or emergency hospitalization, suicide attempts, a fire requiring the services of a fire department, an act of physical aggression, or any incident requiring an abuse investigation.

(95) “Volunteer” means any person assisting a service provider without pay to support the services provided to an individual.

Stat. Auth.: ORS 409.050 & 410.070Stat. Auth.: ORS 409.050 & 410.070; other HB 3618, 2010 SS

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 309-041-1760, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 38-2004(Temp), f. 12-30-04, cert. ef. 1-1-05 thru 6-30-05; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-29-08; 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 27-2011, f. & cert. ef. 12-28-11; SPD 3-2013(Temp), f. 3-20-13, cert. ef. 4-1-13 thru 9-28-13; SPD 30-2013(Temp), f. & cert. ef. 7-2-13 thru 9-28-13; SPD 31-2013, f. 7-22-13, cert. ef. 8-1-13


Rule Caption: Support Services for Adults with Intellectual or Developmental Disabilities — Definitions

Adm. Order No.: SPD 32-2013(Temp)

Filed with Sec. of State: 7-22-2013

Certified to be Effective: 8-1-13 thru 12-28-13

Notice Publication Date:

Rules Amended: 411-340-0020

Subject: The Department of Human Services (Department) is immediately amending OAR 411-340-0020 to update the definitions for support services for adults with intellectual or developmental disabilities to reflect changes made as a result of the Community First Choice State Plan.

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

411-340-0020

Definitions

Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 340:

(1) “Abuse” means abuse of an adult as defined in OAR 407-045-0260.

(2) “Abuse Investigation and Protective Services” means reporting and investigation activities as required by OAR 407-045-0300 and any subsequent services or supports necessary to prevent further abuse as required by OAR 407-045-0310.

(3) “Activities of Daily Living (ADL)” mean those personal, functional activities required by an individual for continued well-being that are essential for health and safety. .

(4) “Adaptive Behavior” means the degree to which an individual meets the standards of personal independence and social responsibility expected for age and culture group.

(5) “Administration of Medication” means the act of placing a medication in, or on, an individual’s body by a person responsible for the individual’s care and employed by or under contract to the individual, the individual’s legal representative, or a provider organization.

(6) “Administrative Review” means the formal process that is used when the individual or the individual’s legal representative is not satisfied with the decision made by the brokerage about a complaint involving the provision of services or a provider.

(7) “Administrator” means the Administrator of the Department, or that person’s designee. The term “Administrator” is synonymous with “Assistant Director”.

(8) “Adult” means an individual 18 years or older with intellectual developmental disabilities.

(9) “Alternative Resources” mean possible resources, not including support services, for the provision of supports to meet an individual’s needs. Alternative resources includes but is not limited to private or public insurance, vocational rehabilitation services, supports available through the Oregon Department of Education, or other community supports.

(10) “Alternatives to Employment - Habilitation” means assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills that takes place in a non-residential setting, separate from the home in which an individual with an intellectual or developmental disability resides.

(11) “Annual Plan” means a written summary the personal agent completes for an individual 18 years or older who is not receiving support services

(12) “Basic Benefit” means the type and amount of support services available to each eligible individual, specifically:

(a) Access to the brokerage services listed in OAR 411-340-0120(1); and if required

(b) For individuals whose entry into support services occurred prior to October 1, 2013, access to an amount of support services funds used to assist with the purchase of supports listed in OAR 411-340-0130(6).

(13) “Basic Supplement” means an amount of support services funds in excess of the basic benefit to which an individual whose entry into support services occurred prior to October 1, 2013 may have access in order to purchase necessary supports based on demonstration of extraordinary long-term need on the Basic Supplement Criteria Inventory, Form DHS 0203.

(14) “Basic Supplement Criteria Inventory (Form DHS 0203)” means the written inventory of an individual’s circumstances that is completed and scored by the brokerage to determine whether the individual whose entry into support services occurred prior to October 1, 2103 is eligible for a basic supplement.

(15) “Behavior Support Plan (BSP)” means a written strategy based on person-centered planning and a functional assessment that outlines specific instructions for a provider to follow, to cause a child’s challenging behaviors to become unnecessary, and to change the provider’s own behavior, adjust environment, and teach new skills.

(16) “Behavior Support Services” mean services that are provided to assist with behavioral challenges due to an individual’s intellectual or developmental disability that prevents the individual from accomplishing activities of daily living, instrumental activities of daily living, and health related tasks.

(17) “Benefit Level” means the total annual amount of support service funds for which an individual whose entry into support services occurred prior to October 1, 2013,is eligible. The benefit level includes the basic benefit and any exceptions to the basic benefit financial limits.

(18) “Case Management” means an organized service to assist individuals to select, obtain, and utilize resources and services.

(19) “Certificate” means a document issued by the Department to a brokerage, or to a provider organization requiring certification under OAR 411-340-0170(2), that certifies the brokerage or provider organization is eligible to receive state funds for support services.

(20) “Choice” means an individual’s expression of preference, opportunity for, and active role in decision-making related to services received and from whom, including but not limited to case management, service providers, and service settings. Personal outcomes, goals, and activities are supported in the context of balancing an individual’s rights, risks, and personal choices. Individuals are supported in opportunities to make changes when so expressed. Choice may be communicated verbally, through sign language, or by other communication methods.

(21) “Chore Services” mean the services described in OAR 411-340-0130 needed to maintain a clean, sanitary, and safe environment in an individual’s home. Chore services include heavy household chores such as washing floors, windows, and walls, tacking down loose rugs and tiles, and moving heavy items of furniture for safe access and egress. Chore services may include yard hazard abatement to ensure the outside of the home is safe for the individual to traverse and enter and exit the home.

(22) “Client Process Monitoring System (CPMS)” means the Department’s computerized system for enrolling and terminating services for individuals with intellectual or developmental disabilities.

(23) “Community Developmental Disability Program (CDDP)” means an entity that is responsible for planning and delivery of services for individuals with intellectual or developmental disabilities according to OAR chapter 411, division 320. A CDDP operates in a specific geographic service area of the state under a contract with the Department, Local Mental Health Authority, or other entity as contracted by the Department.

(24) “Community First Choice State Plan” means Oregon’s state plan amendment authorized under section 1915(k) of the Social Security Act.

(25) “Community Living and Inclusion Supports” mean services designed to assist individuals in acquiring, retaining, and improving the self-help, socialization, and non-activities of daily living or instrumental activities of daily living skills necessary to reside successfully in home and community-based settings. Community living and inclusion supports assist individuals in acquiring, retaining, and improving skills around socialization, recreation and leisure, communication, participation in the community, and ability to direct supports.

(a) Support with socialization includes assisting participants in acquiring, retaining and improving self-awareness and self control, social responsiveness, social amenities, and interpersonal skills.

(b) Support with community participation, recreation, or leisure includes assisting individuals in acquiring, retaining, and improving skills to use available community services, facilities, or businesses.

(c) Support with communication includes assisting individuals in acquiring, retaining, and improving expressive and receptive skills in verbal and non-verbal language and the functional application of acquired reading and writing skills.

(d) Supports may be work-related and include instruction in skills an individual wishes to acquire, retain, or improve that enhance independence, productivity, integration, or maintain the individual’s physical and cognitive skills.

(26) “Community Nursing Services” mean the services described in OAR 411-340-0130 that include nurse delegation and care coordination for an individual living in his or her own home. Community nursing services do not include direct nursing care and are not covered by other Medicaid spending authorities

(27) “Complaint” means a verbal or written expression of dissatisfaction with services or providers.

(28) “Comprehensive Services” mean developmental disability services and supports that include 24-hour residential services provided in a group home, foster home, or through a supported living program. Comprehensive services are regulated by the Department alone or in combination with an associated Department-regulated employment or community inclusion program. Comprehensive services are in-home services provided to an individual with an intellectual or developmental disability when the individual receives case management services from a community developmental disability program. Comprehensive services do not include support services for adults with intellectual or developmental disabilities enrolled in brokerages.

(29) “Cost Effective” means being responsible and accountable with Department resources by offering less costly alternatives when providing choices that adequately meet an individual’s support needs. Less costly alternatives include other programs available from the Department, the utilization of assistive devices, natural supports, architectural modifications, and alternative resources. Less costly alternatives may include resources not paid for by the Department.

(30) “Crisis” means:

(a) A situation that may result in civil court commitment under ORS 427.215 to 427.306 and for which no appropriate alternative resources are available; or

(b) Risk factors described in OAR 411-320-0160 are present for which no appropriate alternative resources are available.

(31) “Crisis Diversion Services” mean the services authorized and provided according to OAR 411-320-0160 that are intended to maintain an individual at home or in the family home while an individual is in emergent status. Crisis diversion services may include short-term residential placement services indicated on an individual’s Support Services Brokerage Plan of Care Crisis Addendum, as well as additional support as described in an Individual Support Plan.

(32) “Department” means the Department of Human Services (DHS). The term “Department” is synonymous with “Division (SPD)”.

(33) “Developmental Disability” means a neurological condition that originates in the developmental years, that is likely to continue, and significantly impacts adaptive behavior as diagnosed and measured by a qualified professional as described in OAR 411-320-0080.

(34) “Emergent Status” means an individual has been determined to be eligible for crisis diversion services according to OAR 411-320-0160.

(35) “Employer-Related Supports” mean activities that assist individuals and, when applicable, their family members with fulfilling roles and obligations as employers as described in the Individual Support Plan. Supports to the employer include but are not limited to:

(a) Education about employer responsibilities;

(b) Orientation to basic wage and hour issues;

(c) Use of common employer-related tools such as job descriptions; and

(d) Fiscal intermediary services.

(36) “Entry” means admission to a Department-funded developmental disability service provider.

(37) “Environmental Accessibility Adaptations” mean physical adaptations as described in OAR 411-340-0130 that are necessary to ensure the health, welfare, and safety of the individual in the home, or that enable the individual to function with greater independence in the home.

(38) “Environmental Modification Consultant” means either an independent provider, provider organization, or general business paid with support services funds, to provide advice to an individual, the individual’s legal representative, or the individual’s personal agent about the environmental accessibility adaptation required to meet the individual’s needs.

(39) “Exit” means termination or discontinuance of:

(a) Services from a service provider; or

(b) Department-funded developmental disability services.

(40) “Family” for determining individual eligibility for brokerage services as a resident in the family home and for determining who may receive family training, means a unit of two or more persons that include at least one individual with an intellectual or developmental disability where the primary caregiver is:

(a) Related to the individual with an intellectual or developmental disability by blood, marriage, or legal adoption; or

(b) In a domestic relationship where partners share:

(A) A permanent residence;

(B) Joint responsibility for the household in general (e.g. child-rearing, maintenance of the residence, basic living expenses); and

(C) Joint responsibility for supporting the individual with an intellectual or developmental disability when the individual is related to one of the partners by blood, marriage, or legal adoption.

(41) “Family Training” means training and counseling services for the family of an individual that increase the family’s capacity to care for, support, and maintain the individual in the home as described in OAR 411-340-0130. Family training includes:

(a) Instruction about treatment regimens and use of equipment specified in the Individual Support Plan;

(b) Information, education, and training about the individual’s intellectual or developmental disability, medical, and behavioral conditions; and

(c) Counseling for the family to relieve the stress associated with caring for an individual with intellectual or developmental disabilities.

(42) “Fiscal Intermediary” means a person or entity that receives and distributes support services funds on behalf of an individual who employs persons to provide services, supervision, or training in the home or community according to the Individual Support Plan.

(43) “Founded Reports” means the Department’s or Law Enforcement Authority’s (LEA) determination, based on the evidence, that there is reasonable cause to believe that conduct in violation of the child abuse statutes or rules has occurred and such conduct is attributable to the person alleged to have engaged in the conduct.

(44) “Functional Needs Assessment (FNAT)” means an assessment that documents the level of need, accommodates an individual’s participation in service planning, and includes --

(a) Completing a comprehensive and holistic assessment;

(b) Surveying physical, mental, and social functioning; and

(c) Identifying risk factors, choices and preferences, and service needs.

(45) “General Business Provider” means an organization or entity selected by an individual or the individual’s legal representative, and paid with support services funds that:

(a) Is primarily in business to provide the service chosen by the individual to the general public;

(b) Provides services for the individual through employees, contractors, or volunteers; and

(c) Receives compensation to recruit, supervise, and pay the persons who actually provide support for the individual.

(46) “Habilitation Services” mean services designed to assist individuals in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.

(47) “Hearing” means the formal process following an action that would terminate, suspend, reduce, or deny a service. This is a formal process required by federal law (42 CFR 431.200-250). A hearing is also known as a Medicaid Fair Hearing and contested case hearing.

(48) “Home” means an individual’s primary residence that is not under contract with the Department to provide services to an individual as a licensed or certified foster home, residential care facility, assisted living facility, nursing facility, or other residential support program site.

(49) “Home and Community-Based Waivered Services” mean the services approved by the Centers for Medicare and Medicaid Services in accordance with Sections 1915(c) and 1115 of the Social Security Act.

(50) “Incident Report” means a written report of any unusual incident involving an individual.

(51) “Independence” means the extent to which individuals with intellectual or developmental disabilities exert control and choice over their own lives.

(52) “Independent Provider” means a person selected by an individual or the individual’s legal representative and paid with support services funds that personally provide services to the individual.

(53) “Individual” means an adult with intellectual or developmental disabilities for whom services are planned and provided.

(54) “Individual Cost Limit” means the maximum annual benefit level available under the Support Services Waiver version OR.0375.R02.03. The support services waiver may be obtained by contacting the Department of Human Services, Developmental Disabilities, ATTN: Rule Coordinator, 500 Summer Street NE, E-10, Salem, Oregon 97301.

(55) “Individual Support Plan (ISP)” means the written details of the supports, activities, costs, and resources required for an individual to achieve personal outcomes and be supported by the family in the family home. An individual’s support needs are identified through a functional needs assessment. The manner in which services are delivered, service providers, and the frequency of services are reflected in an ISP. The ISP is developed at minimum annually to reflect decisions and agreements made during a person-centered process of planning and information gathering. An individual’s ISP is the only plan of care required by the Department for an individual receiving in-home supports.

(56) “Instrumental Activities of Daily Living (IADL)” mean those activities, other than activities of daily living, required to continue independent living.

(57) “Integration” as defined in ORS 427.005 means:

(a) The use by individuals with intellectual or developmental disabilities of the same community resources used by and available to other persons;

(b) Participation by individuals with intellectual or developmental disabilities in the same community activities in which persons without an intellectual or developmental disability participate, together with regular contact with persons without an intellectual or developmental disability; and

(c) Individuals with intellectual or developmental disabilities reside in homes or home-like settings that are in proximity to community resources and foster contact with persons in their community.

(58) “Intellectual Disability” has the meaning set forth in OAR 411-320-0020 and described in 411-320-0080.

(59) “Legal Representative” means an attorney at law who has been retained by or for an individual or a person or agency authorized by the court to make decisions about services for the individual.

(60) “Level of Care” means an assessment completed by a services coordinator has determined an individual meets institutional level of care. An individual meets institutional level of care for an intermediate care facility for individuals with intellectual or developmental disabilities if;

(a) The individual has a condition of an intellectual disability or a developmental disability as defined in OAR 411-320-0020 and meets the eligibility criteria for developmental disability services as described in OAR 411-320-0080; and

(b) The individual has a significant impairment in one or more areas of adaptive functioning. Areas of adaptive functioning include self direction, self care, home living, community use, social, communication, mobility, or health and safety.

(61) “Mandatory Reporter” means any public or private official as defined in OAR 407-045-0260 who, while acting in an official capacity, comes in contact with and has reasonable cause to believe an adult with an intellectual or developmental disability has suffered abuse, or comes in contact with any person whom the official has reasonable cause to believe abused an adult with an intellectual or developmental disability. Nothing contained in ORS 40.225 to 40.295 affects the duty to report imposed by this section of this rule, except that a psychiatrist, psychologist, clergy, or attorney is not required to report if the communication is privileged under ORS 40.225 to 40.295.

(62) “Medication” means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.

(63) “Natural Supports” or “Natural Support System” means the resources available to an individual from their relatives, friends, significant others, neighbors, roommates, and the community. Services provided by natural supports are resources that are not paid for by the Department.

(64) “Nurse” means a person who holds a current license from the Oregon Board of Nursing as a registered nurse or licensed practical nurse pursuant to ORS chapter 678.

(65) “Nursing Care Plan” means a plan developed by a registered nurse that describes the medical, nursing, psychosocial, and other needs of the individual and how those needs are met. The Nursing Care Plan includes the tasks that are taught, assigned, or delegated to the qualified provider or family.

(66) “Occupational Therapy” means the services described in OAR 411-340-0130 provided by a professional licensed under ORS 675.240 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(67) “OSIP-M” means Oregon Supplemental Income Program-Medical as defined in OAR 461-101-0010. OSIPM is Oregon Medicaid insurance coverage for individuals who meet eligibility criteria as described in OAR chapter 461.

(68) “Personal Agent” means a person who works directly with individuals and families to provide or arrange for support services as described in these rules, is a case manager for the provision of case management services, meets the qualifications set forth in OAR 411-340-0150(5), and is:

(a) A trained employee of a brokerage; or

(b) A person who has been engaged under contract to the brokerage to allow the brokerage to meet responsibilities in geographic areas where personal agent resources are severely limited.

(69) “Personal Care Services” means assistance with activities of daily living, instrumental activities of daily living, and health-related tasks through cueing, monitoring, reassurance, redirection, set-up, hands-on, standby assistance, and reminding.

(70) “Personal Support Worker”:

(a) Means a person:

(A) Who is hired by an individual with an intellectual or developmental disability or the individual’s legal representative;

(B) Who receives money from the Department for the purpose of providing personal care services to the individual in the individual’s home or community; and

(C) Whose compensation is provided in whole or in part through the Department or community developmental disability program.

(b) This definition of personal support worker is intended to reflect the term as defined in ORS 410.600.

(71) “Person-Centered Planning” means:

(a) A process, either formal or informal, for gathering and organizing information that helps an individual:

(A) Determine and describe choices about personal goals, activities, and lifestyle preferences;

(B) Design strategies and networks of support to achieve goals and a preferred lifestyle using individual strengths, relationships, and resources; and

(C) Identify, use, and strengthen naturally occurring opportunities for support at home and in the community.

(b) The methods for gathering information vary, but all are consistent with individual needs and preferences.

(72) “Physical Therapy” means the services described in OAR 411-340-0130 provided by a professional licensed under ORS 688.020 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(73) “Plan Year” means 12 consecutive months that, unless otherwise set according to the conditions of OAR 411-340-0120, begins on the start date specified on the individual’s first authorized Individual Support Plan (ISP) after entry to a brokerage. Subsequent plan years begin on the anniversary of the start date of the initial ISP.

(74) “Positive Behavioral Theory and Practice” means a proactive approach to individual behavior and behavior interventions that:

(a) Emphasizes the development of functional alternative behavior and positive behavior intervention;

(b) Uses the least intervention possible;

(c) Ensures that abusive or demeaning interventions are never used; and

(d) Evaluates the effectiveness of behavior interventions based on objective data.

(75) “Prescription Medication” means any medication that requires a physician prescription before it may be obtained from a pharmacist.

(76) “Prevocational Services” are services described in OAR 411-340-0130 that are not job-task oriented that are aimed at preparing an individual with an intellectual or developmental disability for paid or unpaid employment. Prevocational services include teaching such concepts as compliance, attendance, task completion, problem solving, and safety. Prevocational services are provided to individuals not expected to be able to join the general work force or participate in a transitional sheltered workshop within one year.

(77) “Primary Caregiver” means the person identified in an Individual Support Plan as providing the majority of service and support for an individual in the individual’s home.

(78) “Productivity” as defined in ORS 427.005 means:

(a) Engagement in income-producing work by an individual with intellectual or developmental disabilities that is measured through improvements in income level, employment status, or job advancement; or

(b) Engagement by an individual with intellectual or developmental disabilities in work contributing to a household or community.

(79) “Protection” and “Protective Services” mean necessary actions taken as soon as possible to prevent subsequent abuse or exploitation of an individual, to prevent self-destructive acts, and to safeguard an individual’s person, property, and funds.

(80) “Provider Organization” means an entity selected by an individual or the individual’s representative, and paid with support services funds that:

(a) Is primarily in business to provide supports for individuals with intellectual or developmental disabilities;

(b) Provides supports for the individual through employees, contractors, or volunteers; and

(c) Receives compensation to recruit, supervise, and pay the persons who actually provide support for the individual.

(81) “Provider Organization Director” means the employee of a provider organization, or the employee’s designee, responsible for administration and provision of services according to these rules.

(82) “Psychotropic Medication” means a medication the prescribed intent of which is to affect or alter thought processes, mood, or behavior including but not limited to anti-psychotic, antidepressant, anxiolytic (anti-anxiety), and behavior medications. The classification of a medication depends upon its stated, intended effect when prescribed.

(83) “Quality Assurance” means a systematic procedure for assessing the effectiveness, efficiency, and appropriateness of services.

(84) “Rate Guidelines” mean the guidelines for rates and limits paid for some support services. The Department’s support services rate guidelines as of April 1, 2013 are maintained on the Department’s website (http://www.dhs.state.or.us/spd/tools/dd/bpa/rate-guidelines-040113.pdf). Printed copies may be obtained by contacting the Department of Human Services, Developmental Disabilities, ATTN: Rule Coordinator, 500 Summer Street NE, E-10, Salem, Oregon 97301.

(85) “Regional Crisis Diversion Program” means the regional coordination of the management of crisis diversion services for a group of designated counties that is responsible for the management of the following developmental disability services:

(a) Crisis intervention services;

(b) Evaluation of requests for new or enhanced services for certain groups of individuals eligible for developmental disability services; and

(c) Other developmental disability services that the counties comprising the region agree are more effectively or automatically delivered on a regional basis.

(86) “Representative” means a person selected by an individual or the individual’s legal representative to act on the individual’s behalf to direct the individual’s Individual Support Plan.

(87) “Respite” means intermittent services as described in OAR 411-340-0130 provided on a periodic basis, but not more than 14 consecutive days, for the relief of, or due to the temporary absence of, a person normally providing supports to an individual with an intellectual or developmental disability unable to care for him or herself.

(88) “Restraint” means any physical hold, device, or chemical substance that restricts, or is meant to restrict, the movement or normal functioning of an individual.

(89) “Self-Administration of Medication” means the individual manages and takes his or her own medication, identifies his or her medication and the times and methods of administration, places the medication internally in or externally on his or her own body without staff assistance upon written order of a physician, and safely maintains the medication without supervision.

(90) “Self-Determination” means a philosophy and process by which individuals with intellectual or developmental disabilities are empowered to gain control over the selection of support services that meet their needs. The basic principles of self-determination are:

(a) Freedom. The ability for an individual with an intellectual or developmental disability, together with freely-chosen family and friends, to plan a life with necessary support services rather than purchasing a predefined program;

(b) Authority. The ability for an individual with an intellectual or developmental disability, with the help of a social support network if needed, to control a certain sum of resources in order to purchase support services;

(c) Autonomy. The arranging of resources and personnel, both formal and informal, that assists an individual with an intellectual or developmental disability to live a life in the community rich in community affiliations; and

(d) Responsibility. The acceptance of a valued role in an individual’s community through competitive employment, organizational affiliations, personal development, and general caring for others in the community, as well as accountability for spending public dollars in ways that are life-enhancing for individuals with intellectual or developmental disabilities.

(91) “Skills Training” means activities intended to increase an individual’s independence through training, coaching, and prompting the individual to accomplish activities of daily living, instrumental activities of daily living, and health-related skills as described in OAR 411-340-0130.

(92) “Social Benefit” means a service or financial assistance solely intended to assist an individual with an intellectual or developmental disability to function in society on a level comparable to that of a person who does not have such an intellectual or developmental disability. Social benefits are pre-authorized by an individual’s personal agent and provided according to the description and financial limits written in an Individual Support Plan.

(a) Social benefits may not:

(A) Duplicate benefits and services otherwise available to persons regardless of intellectual or developmental disability;

(B) Provide financial assistance with food, clothing, shelter, and laundry needs common to persons with or without intellectual or developmental disabilities; or

(C) Replace other governmental or community services available to an individual.

(b) Financial assistance provided as a social benefit may not exceed the actual cost of the support required by an individual to be supported in the individual’s home and must be either:

(A) Reimbursement for an expense previously authorized in an Individual Support Plan (ISP); or

(B) An advance payment in anticipation of an expense authorized in a previously authorized ISP.

(93) “Special Diet” means specially prepared food or particular types of food, ordered by a physician and periodically monitored by a dietician, specific to an individual’s medical condition or diagnosis that are needed to sustain an individual in the individual’s home. Special diets are supplements and are not intended to meet an individual’s complete daily nutritional requirements. Special diets may include:

(a) High caloric supplements;

(b) Gluten-free supplements; and

(c) Diabetic, ketogenic, or other metabolic supplements.

(94) “Specialized Equipment and Supplies” mean the devices, aids, controls, supplies, or appliances that enable individuals to increase their abilities to perform activities of daily living or to perceive, control, or communicate with the environment in which they live as described in OAR 411-340-0130. Specialized medical equipment and supplies include items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the State Medicaid Plan. Specialized medical equipment and supplies may not include items not of direct medical or remedial benefit to the individual. Specialized medical equipment and supplies must meet applicable standards of manufacture, design, and installation.

(95) “Specialized Supports” mean treatment, training, consultation, or other unique services provided by a social or sexual consultant to achieve outcomes in an Individual Support Plan that are not available through State Medicaid Plan services or other support services listed in OAR 411-340-0130. Specialized supports include:

(a) Assessing the needs of the individual and family, including environmental factors;

(b) Developing a plan of support;

(c) Training caregivers to implement the plan of support;

(d) Monitoring implementation of the plan of support; and

(e) Revising the plan of support as needed.

(96) “Speech, Hearing, and Language Services” mean the services as described in OAR 411-340-0130 provided by a professional licensed under ORS 681.250 that are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan do not apply.

(97) “Substantiated” means an abuse investigation has been completed by the Department or the Department’s designee and the preponderance of the evidence establishes the abuse occurred.

(98) “Support” means the assistance that an individual requires, solely because of the affects of intellectual or developmental disability, to maintain or increase independence, achieve community presence and participation, and improve productivity. Support is flexible and subject to change with time and circumstances.

(99) “Supported Employment Services” means provision of job training and supervision available to assist an individual who needs intensive ongoing support to choose, get, and keep a job in a community business setting. Supported employment is a service planned in partnership with public vocational assistance agencies and school districts and through Social Security Work Incentives when available.

(100) “Support Services” mean the services of a brokerage listed in OAR 411-340-0120 as well as the uniquely determined activities and purchases arranged through the brokerage support services that:

(a) Complement the existing formal and informal supports that exist for an individual living in the individual’s own home or family home;

(b) Are designed, selected, and managed by the individual or the individual’s representative;

(c) Are provided in accordance with an Individual Support Plan; and

(d) May include purchase of supports as a social benefit required for an individual to live in the individual’s home or the family home.

(101) “Support Services Brokerage” or “Brokerage” means an entity, or distinct operating unit within an existing entity, that uses the principles of self-determination to perform the functions listed in OAR 411-340-0120(1) associated with planning and implementation of support services for individuals with intellectual or developmental disabilities.

(102) “Support Services Brokerage Director” or “Brokerage Director” means the employee of a publicly or privately-operated brokerage, or that person’s designee, who is responsible for administration and provision of services according to these rules.

(103) “Support Services Brokerage Plan of Care Crisis Addendum” means the short-term plan that is required by the Department to be added to an Individual Support Plan to describe crisis diversion services an individual is to receive while the individual is in emergent status in a short-term residential placement.

(104) “Support Services Brokerage Policy Oversight Group” or “Policy Oversight Group” means the group that meets the requirements of OAR 411-340-0150(1) that is formed to provide consumer-based leadership and advice to each brokerage regarding issues such as development of policy, evaluation of services, and use of resources.

(105) “Support Services Expenditure Guideline” means a publication of the Department that describes allowable uses for support services funds.

(106) “Support Services Funds” mean public funds designated by the brokerage for assistance with the purchase of supports according to each Individual Support Plan.

(107) “These Rules” mean the rules in OAR chapter 411, division 340.

(108) “Transition Costs” mean expenses such as rent and utility deposits, first month’s rent and utilities, bedding, basic kitchen supplies, and other necessities required for an individual to make the transition from a nursing facility or intermediate care facility for the intellectually disabled to a community-based home setting where the individual resides as described in OAR 411-340-0130.

(109) “Transportation” means services as described in OAR 411-340-0130 that allow individuals to gain access to community services, activities, and resources that are not medical in nature.

(110) “Unusual Incident” means incidents involving serious illness or accidents, death of an individual, injury or illness of an individual requiring inpatient or emergency hospitalization, suicide attempts, a fire requiring the services of a fire department, an act of physical aggression, or any incident requiring an abuse investigation.

(111) “Volunteer” means any person assisting a service provider without pay to support the services provided to an individual.

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 309-041-1760, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 38-2004(Temp), f. 12-30-04, cert. ef. 1-1-05 thru 6-30-05; SPD 8-2005, f. & cert. ef. 6-23-05; SPD 17-2006, f. 4-26-06, cert. ef. 5-1-06; SPD 21-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-29-08; 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 27-2011, f. & cert. ef. 12-28-11; SPD 3-2013(Temp), f. 3-20-13, cert. ef. 4-1-13 thru 9-28-13; SPD 30-2013(Temp), f. & cert. ef. 7-2-13 thru 9-28-13; SPD 31-2013, f. 7-22-13, cert. ef. 8-1-13; SPD 32-2013(Temp), f. 7-22-13, cert. ef. 8-1-13 thru 12-28-13

Notes
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