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Oregon Bulletin

October 1, 2011

 

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

Rule Caption: Eligibility and Entry and Exit Standards for Support Services for Adults with Developmental Disabilities

Adm. Order No.: SPD 21-2011(Temp)

Filed with Sec. of State: 8-31-2011

Certified to be Effective: 8-31-11 thru 12-28-11

Notice Publication Date:

Rules Amended: 411-340-0100, 411-340-0110

Rules Suspended: 411-340-0100(T)

Subject: The Department of Human Services (Department) is temporarily amending the support services for adults with developmental disabilities rules in OAR chapter 411, division 340 to make the receipt of support services contingent on eligibility for the federally approved Support Services Waiver in most cases. Prior to this, eligibility for the Support Services Waiver was not a requirement for support services

      The temporary rulemaking requires that all individuals not eligible for the Support Services Waiver exit brokerage services after September 30, 2011. This eligibility change was included in the 2011-2013 Legislatively Approved Budget for the Department.

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

411-340-0100

Eligibility for Support Service Brokerage Services

(1) NON-DISCRIMINATION. Individuals determined eligible according to section (2) of this rule may not be denied brokerage services or otherwise discriminated against on the basis of age, diagnostic or disability category, race, color, creed, national origin, citizenship, income, or duration of Oregon residence.

(2) ELIGIBILITY. The CDDP of an individual’s county of residence may find the individual eligible for a brokerage when:

(a) The individual is an Oregon resident who has been determined eligible for developmental disability services by the CDDP; AND

(b) The individual is an adult living in the individual’s own home or family home and not receiving other Division-paid in-home or community living support other than State Medicaid Plan services; AND

(c) The individual is not enrolled in comprehensive services; AND

(d) At the time of initial enrollment in the brokerage, the individual is not receiving short-term services from the Division because the individual is eligible for, and at imminent risk of, civil commitment under ORS chapter 427.215 through 427.306; AND

(e) The individual or the individual’s legal representative has chosen to use a brokerage for assistance with design and management of personal supports; AND

(f) The individual is an adult eligible for enrollment in the Support Services Waiver according to OAR 461-135-0750; OR

(g) The individual turns eighteen years old and:

(A) Meets the Level of Care that qualifies the individual for enrollment to the Support Services Waiver; and

(B) Had been enrolled in the Children’s Intensive In-home Services (CIIS) Program up to the individual’s 18th birthday.

(3) CONCURRENT SERVICES. Individuals are not eligible for service by more than one brokerage unless the concurrent service:

(a) Is necessary to affect transition from one brokerage to another;

(b) Is part of a collaborative plan between the affected brokerages; and

(c) Does not duplicate services and expenditures.

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 309-041-1840, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 8-2008, f. 6-27-08, cert. ef. 6-29-08; SPD 8-2009, f. & cert. ef. 7-1-09; SPD 18-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SPD 21-2011(Temp), f. & cert. ef. 8-31-11 thru 12-28-11

411-340-0110

Standards for Support Service Brokerage Entry and Exit

(1) The brokerage must make accurate, up-to-date information about the brokerage available to individuals referred for services. This information must include:

(a) A declaration of brokerage philosophy;

(b) A brief description of the services provided by the brokerage, including typical timelines for activities;

(c) A description of processes involved in using the services, including application and referral, assessment, planning, and evaluation;

(d) A declaration of brokerage employee responsibilities as mandatory abuse reporters;

(e) A brief description of individual responsibilities for use of public funds;

(f) An explanation of individual rights, including an individual’s right to:

(A) Choose a brokerage from among Division contracted brokerages in an individual’s county of residence that is serving less than the total number of individuals specified in the brokerage’s current contract with the Division;

(B) Choose a personal agent among those available in the selected brokerage;

(C) Select providers among those willing, available, and qualified according to OAR 411-340-0160, 411-340-0170, and 411-340-0180 to provide supports authorized through the ISP;

(D) Direct the services of providers; and

(E) Raise and resolve concerns about brokerage services, including specific rights to notification and hearing for Medicaid recipients according to OAR 411-340-0060(3) when services covered under Medicaid are denied, terminated, suspended, or reduced.

(g) Indication that additional information about the brokerage is available on request. The additional information must include but not be limited to:

(A) A description of the brokerage’s organizational structure;

(B) A description of any contractual relationships the brokerage has in place or may establish to accomplish the brokerage functions required by rule; and

(C) A description of the relationship between the brokerage and the brokerage’s Policy Oversight Group.

(2) The brokerage must make information required in section (1) of this rule available using language, format, and presentation methods appropriate for effective communication according to individuals’ needs and abilities.

(3) ENTRY INTO BROKERAGE SERVICES.

(a) To enter brokerage services:

(A) An individual must be determined by the CDDP to be eligible for brokerage services according to OAR 411-340-0100(2);

(B) The individual or the individual’s legal representative must choose to receive services from a selected brokerage; and

(C) The individual must be enrolled to the Support Services Waiver unless eligibility for support services is based upon OAR 411-340-0100(2)(g).

(b) The Division may implement guidelines that govern entries when the Division has determined that such guidelines are prudent and necessary for the continued development and implementation of support services.

(c) The brokerage may not accept individuals for entry beyond the total number of individuals specified in its current contract with the Division.

(4) EXIT FROM A BROKERAGE.

(a) An individual must exit a brokerage:

(A) At the written request of the individual or the individual’s legal representative to end the service relationship;

(B) No less than 30 days after the brokerage has served written notice of intent to terminate services, when the individual either cannot be located or has not responded to repeated attempts by brokerage staff to complete ISP development and monitoring activities, and does not respond to the notice of intent to terminate;

(C) Whenever the individual’s emergent status exceeds 270 consecutive days;

(D) Upon entry into a comprehensive service; or

(E) When the individual is incarcerated or in a medical hospital, psychiatric hospital, or convalescent center and it is determined that the individual will not return home, or will not return home after 90 consecutive days.

(F) After September 30, 2011 when the individual does not meet the eligibility criteria for the Support Services Waiver under OAR 461-135-0750, except that:

(i) An individual who has applied for a disability determination from the Social Security Administration, and has applied for Medicaid in Oregon, on or before May 1, 2011, may remain enrolled in support services until a disability determination is made and eligibility for OSIP-M (Oregon Supplemental Income Program Medical) is determined. An appeal of a previous denial of disability from the Social Security Administration does not constitute an application.

(ii) An individual who has an active application with the Division’s Presumptive Medicaid Disability Determination Team dated on or before July 15, 2011 may remain enrolled in brokerage services until a disability determination is made.

(G) After ten days when an individual is eligible for support services based on OAR 411-340-0100(2)(g) and:

(i) The individual does not apply for a disability determination and OSIP-M within 10 business days of the individual’s 18th birthday; OR

(ii) The Social Security Administration or the Division’s Presumptive Medicaid Disability Determination Team finds that an individual does not have a qualifying disability; OR

(iii) The individual is determined by the State of Oregon to be ineligible for OSIP-M.

(b) Any individual being exited from a brokerage must be given written notice of the intent to terminate service at least 10 days prior to the termination regardless of Medicaid status.

(c) An individual who exits support services as a result of the application of section (4)(a)(F) of this rule may not receive continuation of benefits pending a contested case hearing if a hearing is requested to contest the decision to exit from support services.

(d) Each brokerage must have policies and procedures for notifying the CDDP of an individual’s county of residence when that individual plans to exit, or exits, brokerage services. Notification method, timelines, and content must be based on agreements between the brokerage and CDDP’s of each county in which the brokerage provides services.

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 309-041-1850, SPD 22-2003, f. 12-22-03, cert. ef. 12-28-03; SPD 32-2004, f. & cert. ef. 10-25-04; 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 21-2011(Temp), f. & cert. ef. 8-31-11 thru 12-28-11

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.

2.) Copyright 2011 Oregon Secretary of State: Terms and Conditions of Use

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