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The Oregon Administrative Rules contain OARs filed through April 15, 2013 
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DEPARTMENT OF HUMAN SERVICES,
CHILD WELFARE PROGRAMS
DEPARTMENT OF HUMAN SERVICES,
CHILD WELFARE PROGRAMS
DEPARTMENT OF HUMAN SERVICES, CHILD WELFARE PROGRAMS
DIVISION 50
SUPPORTIVE SERVICES
Housekeeper Services
413-050-0000
Purpose
The purpose of these rules (OAR 413-050-0000 to 413-050-0050) is to help meet the basic needs of a family to maintain and strengthen the family so a child can be maintained in the child's own home whenever possible.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0005
Definitions.
The following definitions apply to these rules (OAR 413-050-0000 to 413-050-0050):
(1) "Department" means the Department of Human Services.
(2) "District" means a Department service delivery area; a geographic region of one or more counties served by the Department and managed by a district manager.
(3) "Housekeeping provider" means an individual who carries out tasks in a home, necessary to maintain the functioning of a family.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0010
Service Description
As used in these rules (OAR 413-050-0000 to 413-050-0050):
(1) "Regular housekeeping services" are those tasks carried out within the home that are routine and necessary to maintain the functioning of a family, performed by an individual who is not a member of the household. Those tasks include, but are not limited to:
(a) Routine housecleaning and related chores;
(b) Laundry; and
(c) Food preparation and dish washing.
(2) "24-hour emergency housekeeping services" are services provided when temporary emergency circumstances require live-in housekeeping services along with regular housekeeping services. 24-hour emergency housekeeping services must be deemed necessary to keep the family intact and include temporarily providing all routine household functions, including child care, during the incapacity or short-term absence (usually not exceeding seven days) of the caregiving individual in the household.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0020
Eligibility
(1) Payment for regular housekeeping services (see OAR 413-050-0010) and 24-hour emergency housekeeping services (see OAR 413-050-0010) rendered for a child welfare client is made only on behalf of a child who is receiving Child Protective Services (CPS), Substitute Care, or Family Support Services; and
(a) A family who currently is receiving SSI, TANF, or is within the 0-79 percent State Median Income range.
(b) A foster child in the care and custody of the Department, and living in the care of a foster family.
(2) Service criteria. Regular housekeeping services or 24-hour emergency housekeeping services may be authorized when the Department determines the services offer an adequate solution to either of the following conditions:
(a) Incapacity or short-term absence (usually not exceeding seven days) of the caregiving individual in the household who is unable to fulfill routine, necessary household duties due to conditions such as chronic or acute illness, severe emotional stress, physical handicap, complication of pregnancy, medically prescribed rest, or childbirth. The need and duration of need related to physical conditions must be confirmed orally or in writing by an attending physician unless the degree of incapacity is obvious (individual is physically immobile).
(b) Certain unusual requirements for care of an ill child or a child with a disability, when the need for care and duration of care is verified by the child's attending physician, that preclude the carrying out of routine, necessary housekeeping duties by the caregiving individual in the household.
(3) Payment for regular housekeeping services and 24-hour emergency housekeeping services rendered may be made only to a housekeeping provider (see OAR 413-050-0005) approved through the Department background check requirements of this rule and Division 407, chapter 007.
(a) The housekeeping provider must submit a completed Department Criminal History Request form (DHS 301 CP). The housekeeping provider and each individual identified under paragraph (3)(f)(A) of this rule is considered a subject individual under OAR 407-007-0210 and must complete and sign an authorization for a records check and, if necessary, an authorization to release information and fingerprint cards. The housekeeping provider must fully disclose all requested information as part of the records check. The Department may approve the housekeeping provider or other subject individual unless the Department determines, based upon the information available (including information considered under OAR 407-007-0300), following a preliminary or final fitness determination (as provided in OAR 407-007-0320) and CPS records check, that the housekeeping provider or other subject individual is not eligible to provide housekeeping services.
(b) The housekeeping provider or other subject individual must not have a history of behavior that indicates a substantial risk to the health or safety of a child in the care of the housekeeping provider. A single incident may be sufficient grounds for ineligibility. This determination is based on a review of Criminal History (CH) and CPS records, an investigation of complaints, if any, and information provided by other agencies.
(c) The Department may conduct a national criminal history check through the Oregon State Police and the Federal Bureau of Investigation as specified in OAR 407-007-0250 and may withhold authorization for payment to a housekeeping provider until the national criminal history check is complete.
(d) If the Department obtains information, with respect to a housekeeping provider or other subject individual, of a potentially disqualifying crime, condition, or child protective services history, as described in OAR 407-007-0280 to 407-007-0300, the Department will conduct a weighing test under 407-007-0200 to 407-007-0370 to determine whether the housekeeping provider or other subject individual may be approved by the Department to participate in regular housekeeping or 24-hour emergency housekeeping services.
(e) If the Department obtains information regarding eligibility under this rule that indicates a substantial risk to the health and safety of a child in the care of the housekeeping provider, the Department may conduct a weighing test (see OAR 407-007-0210) as described in OAR 407-007-0200 to 407-007-0370 to determine whether the housekeeping provider or other subject individual may be approved by the Department to participate in regular housekeeping or 24-hour emergency housekeeping services.
(f) Each housekeeping provider must meet all of the following requirements:
(A) Submit the names of each of the following individuals together with their completed and signed authorizations for records checks through the Oregon State Police CH records system and the Department's CPS records system: The housekeeping provider, each individual the housekeeping provider uses to perform housekeeping services, and each individual who accompanies the housekeeping provider during the performance of housekeeping services.
(B) Report to the Department, with respect to any individual covered by paragraph (A) of this subsection, any arrest and any child protective services history.
(C) Report to the Department any change to the name of any individual covered by paragraph (A) of this subsection within 10 days of the name change.
(D) Report suspected child abuse of any child at a site receiving housekeeping services to CPS or a law enforcement agency.
(E) Provide, in a manner specified by the Department, information required to conduct CH and CPS records checks.
(F) Complete and submit a new Criminal History Request form (DHS 301 CP) every two years for the Department to review eligibility.
(g) Ineligibility for payment may result from any of the following:
(A) A finding of "failed". The Department may determine, based on available information, that a housekeeping provider does not meet the eligibility requirements in this rule. A housekeeping provider with a status of "failed" may reapply at any time by submitting a new application, additional documents, and information to the Department for review. If the additional documents and information show that the housekeeping provider meets the eligibility requirements, the Department may approve the housekeeping provider for payment if there is no other basis for ineligibility.
(B) A finding of "denied". If, after conducting a weighing test as described in this rule, the Department finds substantial risk to the health and safety of a child, the housekeeping provider must be denied approval and is ineligible for payment.
(4) Hearing rights. If the housekeeping provider is denied, the housekeeping provider has hearing rights under OAR 407-007-0330.
(a) A housekeeping provider has a right to a contested case hearing only as provided by these rules (OAR 413-050-0000 to 413-050-0050) to contest a fitness determination resulting in a denial of eligibility for payment for regular housekeeping services or 24-hour emergency housekeeping services. A hearing to contest a fitness determination resulting in a denial under these rules is governed by OAR 407-007-0330.
(b) A housekeeping provider whose application is denied and who fails to request a hearing within 45-days after notice of the denial was mailed to the housekeeping provider is not eligible to reapply for approval until 180 days following the date of the denial notice.
(c) If a housekeeping provider requests a hearing to contest a fitness determination resulting in a denial of eligibility for payment, the housekeeping provider remains ineligible for payment pending the hearing.
Stat. Auth.: ORS 181.534, 418.005
Stats. Implemented: ORS 181.534, 181.537, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0030
Eligible Children Served Jointly with Other Department Programs
(1) The Department is committed to coordination at either the worker or supervisor level to carry out the joint provision of services. The Child Welfare caseworker must coordinate housekeeper services with workers from self sufficiency programs and Seniors and People with Disabilities Division (SPD) programs to avoid duplication of services, when similar services are authorized through those programs.
(2) The Child Welfare caseworker is responsible for all other case planning and service implementation for the family as needed to assure the safety and well-being of a child.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0040
Authorization of Service
(1) Preauthorization of services. Regular housekeeping services or 24-hour emergency housekeeping services (see OAR 413-050-0010) must be authorized in advance of rendering the services.
(2) Authorization period. Each authorization for regular or 24-hour emergency housekeeping services is for a specific duration based on a reasonable estimate of the need, not to exceed 90 days for regular housekeeping services, six months for regular housekeeping services for a parent with a disability and a child in the household, and seven days for 24-hour emergency housekeeping services. A supervisor may approve an extension of up to three months for regular housekeeping services or seven days for 24-hour emergency housekeeping services.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0050
Policies Governing Payment
(1) Except as provided in this rule, the payment rate is the minimum established by the Oregon Wage and Hour Regulations. Payment may be made for regular housekeeping services (see OAR 413-050-0010) for up to 40 hours per week. Overtime is paid at time and a half for each work hour above 40 hours per week, not to exceed a maximum of 10 hours per week overtime. Overtime is calculated by determining the hours worked for each sequential 7 day period beginning with the first day worked. All hours worked over 40 for the week are overtime hours regardless of hours worked for any one day.
(2) Payment rates per day for 24-hour emergency housekeeping services may not exceed a maximum cash payment equal to 10 hours per day for hours negotiated by the family.
(3) An exception to the payment rates for regular or 24-hour emergency housekeeping services established under this rule may be made by the district manager or designee taking into consideration the local housekeeping budget constraints and the justification of such an exception under either of the following conditions:
(a) When the authorized responsibilities of the housekeeping provider (see OAR 413-050-0005) include use of the housekeeper's personal vehicle for purposes essential to maintaining the family, such as grocery shopping, reimbursement may be made at the standard rate for state employee mileage reimbursement. The Department assumes no liability resulting from use of the housekeeper's personal vehicle.
(b) Where the local rates for housekeeping services are generally higher than the rates established in this rule, and to the extent competent housekeeping providers are not available for Department services, a higher rate may be established by the district manager or designee. The district manager or designee must notify staff in the local area affected and the Department's Family Based Services program manager of the increased rates.
(4) Social Security taxes will be withheld from vendor payments. The Department pays the employer's share of Social Security taxes, except as provided in section (5) of this rule.
(5) When payment for housekeeping services is made to a business or non-profit agency, the business or agency must withhold and pay the applicable Social Security taxes.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; CWP 6-2003, f. & cert. ef. 1-7-03; CWP 4-2009, f. 2-17-09, cert. ef. 3-19-09
413-050-0200
Purpose
The purpose of these rules (OAR 413-050-0200 to 413-050-0280) is to describe service authorization criteria and methods to determine the payment rate related to the Department of Human Services Supportive or Remedial Day Care (SRDC) service.
Stat. Auth.: ORS 181.534, 181.537, 409.050, 418.005
Stats. Implemented: ORS 181.534, 181.537, 409.010, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 14-2002(Temp), f. & cert. ef. 12-19-02 thru 6-17-03; CWP 24-2003(Temp) f. & cert. ef. 6-18-03 thru 12-14-03; CWP 41-2003, f. & cert. ef. 12-12-03; CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0210
Definition
The following definitions apply to OAR 413-050-0200 to 413-050-0280:
(1) "Case plan" means a goal oriented, time limited individualized plan for the child and the child's family, developed by the Department and the parents or legal guardians, that identifies the family behaviors, conditions, or circumstances, safety threats to the child, and the expected outcomes that will improve the protective capacity of the parents or legal guardians.
(2) "CCD" means the Child Care Division of the Employment Department.
(3) "Day care provider" means a day care provider regulated by the Child Care Division (CCD) or if exempt from CCD regulation, approved by the Department for payment as a day care provider, foster parent, or relative caregiver.
(4) "Department" means the Department of Human Services.
(5) "Expert evaluation" means a written assessment prepared by a professional with specialized knowledge of a particular subject matter such as physical health, psychological health, mental health, sexual deviancy, substance abuse, and domestic violence. The assessment provides information regarding an individual's functioning in the area of the professional's specialized knowledge.
(6) "Foster parent" means a person who operates a home that has been approved by the Department to provide care for an unrelated child or young adult placed in the home by the Department.
(7) "Relative caregiver" means a person who operates a home that has been approved by the Department to provide care for a related child or young adult who is placed in the home by the Department.
(8) "SRDC" means supportive or remedial day care services, which are a time-limited day care service that the Department provides to an eligible child subject to the availability of allocated funds and other limitations prescribed in these rules (OAR 413-050-0200 to 413-050-0280).
(9) "Substitute care" means the out-of-home placement of a child or young adult who is in the legal or physical custody of the Department.
Stat. Auth.: ORS 409.050, 418.005
Stats. Implemented: ORS 409.010, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 14-2002(Temp), f. & cert. ef. 12-19-02 thru 6-17-03; CWP 24-2003(Temp) f. & cert. ef. 6-18-03 thru 12-14-03; CWP 41-2003, f. & cert. ef. 12-12-03; CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0220
Service Authorization Criteria
(1) Except as provided in sections (2), (3), and (4) of this rule and in OAR 413-050-0230, the Department may purchase Supportive or Remedial Day Care Services (SRDC) if:
(a) A child under 13 years of age is receiving Child Protective Services, Substitute Care, or Family Support Services; and
(b) SRDC will:
(A) Prevent the placement of the child into substitute care;
(B) Facilitate the child's return to the child's parent or legal guardian with an in-home safety plan;
(C) Meet the needs of a child whose physical, social, mental, or emotional needs, as documented by an expert evaluation, cannot be fully met by the parent or legal guardian;
(D) Allow a parent or legal guardian to participate in specific activities or services described in the case plan;
(E) Maintain the child's placement with his or her current relative caregiver or foster parent that is in jeopardy due the caregiver's illness; or
(F) Maintain the child's placement with his or her current relative caregiver or foster parent as part of a short term, planned support to stabilize the placement.
(2) SRDC may be used to temporarily support the employment or educational activities of a parent, legal guardian, relative caregiver, or foster parent for a maximum of one month to allow transition to another child care resource.
(3) Except as provided in section (4) of this rule, SRDC service in the child's home may be authorized when the requirements of subsections (a) or (b) of this section are met:
(a) A child, who is ordinarily in SRDC purchased by the Department, is ill.
(A) This is limited to no more than five days of care in any calendar month and may not exceed the number of hours per day already authorized.
(B) When a child who is ordinarily in SRDC purchased by the Department is ill, an additional payment may be made to a day care provider, who is either a regulated CCD provider, or if exempt from CCD regulation a Department-approved day care provider, relative caregiver, or foster parent.
(b) A child who has a disability requires care and no out-of-home day care is available or can be developed that meets the child's needs.
(A) Document the unsuccessful effort made to locate or develop a Day Care Home or Center resource; and
(B) Describe the specific problem that requires services in the child's home.
(4) The plan for care in the child's home may not exceed the cost of out-of-home day care.
(5) Case Record Documentation:
(a) The caseworker must review the appropriateness of an SRDC service as a component of the case plan. The caseworker must document that the SRDC service will be part of a coordinated, goal oriented, time limited case plan that will accomplish one or more of the purposes described in paragraphs (A) to (F) in subsection (1)(b) of this rule.
(b) The caseworker must document in the case record how the SRDC service will support or assist in achieving the case plan or maintaining the child's placement.
(6) The caseworker's supervisor must approve the use of the SRDC service.
Stat. Auth.: ORS 409.050, 418.005
Stats. Implemented: ORS 409.010, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 14-2002(Temp), f. & cert. ef. 12-19-02 thru 6-17-03; CWP 24-2003(Temp) f. & cert. ef. 6-18-03 thru 12-14-03; CWP 41-2003, f. & cert. ef. 12-12-03; CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0230
Service Limits
(1) Expenditures by the Department under these rules (OAR 413-050-0200 to 413-050-0280) are subject to the availability of state and federal funds, as applicable, and are subject to immediate curtailment by the Department if the necessary state or federal authorizations or funding are curtailed. If all allocated SRDC funds have been expended, caseworkers must document the unmet needs and notify the District Manager or designee of those unmet needs.
(2) The maximum amount of the SRDC service that the Department may authorize for any child per week is eight hours a day, five days a week.
(3) When SRDC services are used to permit a child to remain at home as an alternative to substitute care, to permit a child to return home from substitute care, to permit a parent or legal guardian to participate in specific activities or services described in the case plan, or because the child's physical, social, mental, or emotional needs were not being met by a parent or legal guardian (see OAR 413-050-0220(1)(b)(A)–(D)):
(a) The initial service authorization period is up to three months.
(b) The supervisor may approve an extension of the SRDC service authorization for up to an additional three months.
(c) The District Manager may review and approve a recommendation for the use of the SRDC service for longer than six months with documentation that the extension will prevent the child's placement in foster or shelter care in the very near future.
(4) When SRDC services are used (pursuant to OAR 413-050-0220(1)(b)(E) or (D)) to maintain a foster care or relative care placement jeopardized by illness of the relative caregiver or foster parent or as part of a short term, planned support to stabilize the placement:
(a) The initial SRDC service authorization period is one month.
(b) The supervisor may approve an extension of the SRDC service authorization at one month intervals for a maximum of three months.
(c) The District Manager may review and approve a recommendation for the use of the SRDC service for longer than three months with documentation that an extension will prevent the child's move to another substitute care placement.
(5) The caseworker and supervisor must review the use of an SRDC service before extending the SRDC service authorization for any additional period of time allowed in sections (3) or (4) of this rule and before recommending an extension for District Manager approval. The review will determine whether there is still a need for the SRDC services that meets the service criteria in OAR 413-050-0220(1).
[Publications: Publications referenced are available from the agency.]
Stat. Auth.: ORS 409.050, 418.005
Stats. Implemented: ORS 409.010, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 13-2001, f. 6-29-01, cert. ef. 7-1-01; SOSCF 14-2002(Temp), f. & cert. ef. 12-19-02 thru 6-17-03; CWP 24-2003(Temp) f. & cert. ef. 6-18-03 thru 12-14-03; CWP 41-2003, f. & cert. ef. 12-12-03; CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0235
Selecting a Day Care Provider
(1) This rule governs the selection of day care providers for an SRDC service under OAR 413-050-0200 to 413-050-0280.
(2) All day care providers must be regulated by the Child Care Division (CCD), or if exempt from CCD regulations, approved by the Department as a day care, foster care, or relative care provider.
(3) The caseworker assists the parent or legal guardian in selecting the day care provider that most closely matches the needs of the child and the family.
(4) The caseworker makes the final selection of the day care provider based on the needs of the child and goals of the case plan.
(5) Valid reasons for not selecting a person as a day care provider include behavior which may have a detrimental effect on a child, or a physical or mental problem which may adversely affect the child.
Stat. Auth.: ORS 181.534, 181.537, 409.050, 418.005
Stats. Implemented: ORS 181.534, 181.537, 409.010, 418.005
Hist.: CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0280
Determining Day Care Payment Rates
(1) The Department will pay the day care provider's standard payment rate for all children or the Department SRDC service maximum payment rate (see section (6) of this rule), whichever is less.
(2) The day care provider may not ask a parent, legal guardian, relative caregiver, or foster parent for, or accept, directly or indirectly, any additional payment for care funded by the Department unless there is a written agreement between the Department and the day care provider. (See CF 116A, "Request for an Exception".)
(3) Except as provided in section (4) of this rule, when the infant payment rate has been authorized for a child and the child reaches 30 months of age, the rate must be revised.
(a) The caseworker is responsible for revising the infant payment rate, effective no later than the first of the month after the child reaches 30 months of age.
(b) The caseworker shall send the day care provider a revised CF 116, and revise the Type of Service and authorized amounts on the CF 308 and input into IIS.
(4) Although there are no special day care rates for children who have physical, developmental, or emotional disabilities:
(a) If a child 30 months of age or over, functions below the level that is normal for children of his or her chronological age, the Department may authorize up to the infant payment rate for the care of that child.
(b) The caseworker, with supervisory approval, must document in the case record why the infant payment rate is authorized for a child 30 months or older. Documentation must include the following:
(A) The unsuccessful effort to locate a resource at the Department non-infant payment rate; and
(B) A description of the specific problem which requires services above those covered by the non-infant payment rate.
(c) The District Manager may authorize a higher payment rate than the infant payment rate when requirements of paragraphs (b)(A) and (b)(B) of this section are met and the child's need for a greater level of care is documented by an expert evaluation.
(5) Rates charged to the Department for day care services may not exceed rates charged for comparable services to children not served by the Department:
(a) Donations and subsidies of cash or in-kind services may be used to reduce charges which would otherwise be made for day care services;
(b) Such donations and subsidies must be used to reduce charges for all children in care unless the donor specifies in writing that the donation is to be used for either a specific family or category of families; and
(c) Separate records must be kept by the day care provider for all donations and subsidies received and disbursed.
(6) The maximum payment rates permitted for SRDC services are as follows:
(a) Family Day Care.
(A) Infant (under 30 months) — $1.95 an hour per child, not to exceed $414 per child per month.
(B) Non-infant (30 months or older) — $1.62 an hour per child, not to exceed $345 per child per month.
(b) Day Care Center Group Day Care Homes.
(A) Infant (under 30 months) — usual and customary rates, not to exceed $549 per child per month.
(B) Non-infant (30 months and older) — usual and customary rates, not to exceed $435 per child per month.
(c) Care in the child's home: The day care provider in the child's home will be paid the Oregon minimum wage, regardless of the number of children served or the age of the child.
Stat. Auth.: ORS 409.050, 418.005
Stats. Implemented: ORS 409.010, 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 14-2002(Temp), f. & cert. ef. 12-19-02 thru 6-17-03; CWP 24-2003(Temp) f. & cert. ef. 6-18-03 thru 12-14-03; CWP 41-2003, f. & cert. ef. 12-12-03; CWP 17-2007(Temp), f. & cert. ef. 11-1-07 thru 4-28-08; CWP 1-2008, f. & cert. ef. 4-1-08
413-050-0400
Purpose
The purpose of these rules is to describe the special medical services provided by the Department of Human Services (DHS).
Stat. Auth.: HB 2004
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02
413-050-0405
Definitions
(1) "Administrative Exams": DHS uses the DMAP definition for Administrative Medical Examinations and Reports found in OAR 410-120-0000 which is: "Examinations, evaluations, and reports, including copies of medical records, requested on the DMAP 729 form through the local DHS office or requested and/or approved by DMAP to establish client eligibility for a medical assistance program or for casework planning."
(2) "Other Medical Expenditure": Any payment to a licensed medical provider for a service provided to a person in the household who is not eligible or potentially eligible for Title XIX or GA (General Assistance), or for a certain service provided to an eligible Title XIX or GA client which is not covered under Administrative Exams using the Medical Service Authorization and Invoice form, CF 501A.
[ED. NOTE: Forms referenced are available from the agency.]
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02
413-050-0410
Payment for Medical Services for Administrative Exams and Other Medical
(1) Medical expenditures can be authorized from "Administrative Exams" or from "Other Medical." In addition, for cases designated permanent planning, the Adoption Services Unit may authorize payment of certain medical services. See OAR 413-050-0450 below.
(2) "Administrative Exams" and "Other Medical" expenditures must be authorized by the local DHS manager or designee prior to the medical service. (Emergency appointments excepted).
(3) Payment for "Administrative Exams" and "Other Medical" expenditures will be made only to medical service providers who are both licensed in their state and enrolled with the Division of Medical Assistance Programs (DMAP) for participation in the Medicaid Program (Title XIX). Such providers must have an assigned active provider number from DMAP to receive payment for their services. (See exception procedures for unlicensed or non-registered consultants or trainers in CAF Policy I-C.4.2.1 (6)).
(4) Payment for "Administrative Exams" and "Other Medical" expenditures will be at the current published DMAP rate for the procedure code billed.
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02
413-050-0420
Administrative Exams Payments
"Administrative Exams" are provided to children in DHS's care and custody who are eligible or potentially eligible for Title XIX or GA (General Assistance). "Administrative Exams" are also provided to parents or other adults identified on the Face Sheet in the child's case record. Parents or adults must be Medicaid or GA eligible and have medical coverage through the Oregon Health Plan on the date of service. Expenditures are federally matchable and will be paid through DMAP. An "Administrative Exam" expenditure includes any payment to a medical provider for a physical examination, psychological/psychiatric evaluation, or copies of medical records in connection with:
(1) Protective Service assessments when medical treatment or examination is necessary to evaluate and plan for child safety as per I-B.2.2(6)(a)-(f). "Administrative Exam" payments may be authorized regardless of whether placement is made; or
(2) Casework planning for Title XIX or GA eligible children in substitute care; or
(3) Evaluation and/or testing for children in their own home to determine if out-of-home placement is an appropriate case plan. "Administrative Exam" payments may be authorized regardless of whether placement is made;
(4) Copies of hospital or medical records.
(5) Psychiatric or psychological evaluations of parents or other adults identified in the child's case record. Parents or adults must be Medicaid or GA eligible through the Oregon Health Plan.
(6) Urinalysis collection and screening for children and/or parents or other adults identified in the child's case record. Parents or adults must be Medicaid or GA eligible through the Oregon Health Plan.
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02
413-050-0430
Other Medical Payments
"Other Medical" payments are not federally matchable and are paid out of General Fund dollars. "Other Medical" is to be used for required medical services for a child in Department care and custody by court order or Voluntary Placement or Custody Agreement either in or out of substitute care, or parents or other adults identified in the child's case record. "Other Medical" is only to be used if the service is not available through Mental Health or OMAP as a Medicaid service. Payments from "Other Medical" may be made in the following situations:
(1) Drug and alcohol assessments for persons not eligible for Title XIX or the Oregon Health Plan.
(2) A one-time emergency medical need for children in the custody of the Department that have been returned home. This is limited to children of low-income families not eligible for medical services through the Department.
(3) Therapy for Children in Substitute Care, if recommended by a licensed psychiatrist or psychologist who evaluated the child, and the type of therapy and/or the therapist recommended is unavailable from the local mental health clinic or through the mental health plan (MHO) in which the child is enrolled. The therapist must be enrolled with DMAP or, failing that, there must be a signed contract in place prior to the therapy being provided. Funding availability will be determined by the District Manager or Designee (who may want to consult with the Assistant Field Administrator or the Medical Assistance Resource Coordinator to determine that there are no other resources available for funding).
(4) Consultation with a licensed or registered provider regarding the case or treatment planning for a specific child. Field staff's consultation with licensed experts in human behavior offers an alternative to costly individual evaluations for families or children who are experiencing severe medical, behavioral or emotional problems. Frequently, the case record contains information accumulated over time which a consultant, trained to evaluate and interpret such data, can assess to assist the agency in developing or managing a timely and well-focused case plan.
(5) Medical care for children in detention. ORS 418.034 mandates payment of the cost of medical care for the child in detention, including emergency medical care, if the child is in custody of the Department. "Medical care" means emergency medical care or medical care for a medical condition that existed prior to the child's being held in a juvenile detention facility or in a local correctional facility or lockup.
(6) Evaluations of parents when required by the Department for casework planning to determine the parents' emotional stability, intellectual capacity, parenting capacity or maturity. These may include medical, psychiatric, psychological evaluations or drug and alcohol assessments. This does not include ongoing treatment or services. Payment from "Other Medical" for the above services will not be made for parents in permanent planning cases or for parents who are Medicaid eligible through the Oregon Health Plan.
(7) Parent/child and/or sibling interaction evaluation.
(8) Protective service physical examinations authorized for the purpose of the legal investigation only and when out-of-home care is not a consideration.
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02; CWP 13-2003, f. & cert. ef. 1-9-03
413-050-0440
Medical Services "Permanent Planning"
In cases designated permanent planning, the Department will make payments for necessary evaluations of parents, stepparents and/or live-in companions. This includes psychological, psychiatric and neurological evaluations, drug and alcohol assessments and parent-child interaction assessments. These services must be authorized in writing by the Adoption Services Unit prior to the services being provided.
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02; CWP 13-2003, f. & cert. ef. 1-9-03
413-050-0450
Medical Consultation and Training for Staff
(1) Consultation and training for DHS staff on health services problems will be paid upon approval of the Assistant Field Administrator or designee. The consultant or trainer is not required to be licensed or registered, nor to have an assigned provider number from DMAP.
(2) Payment will be made only where there is a contract which was written and signed prior to the performance of services. (See OAR 413-330-0010.)
Stat. Auth.: ORS 418.005
Stats. Implemented: Title XIX
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 1-29-95; SOSCF 40-2001, f. 12-31-01, cert. ef. 1-1-02
413-050-0500
Policy
These rules (OAR 413-050-0500 to 413-050-0590) provide procedures for the Department of Human Services (Department) to fund programs from the Domestic Violence Fund. The 1981 Oregon Legislature established this fund to provide intervention on behalf of and support for victims of domestic violence. The Department is authorized to enter into grant contracts with public agencies or private non-profit organizations to support operation by those organizations and agencies of programs designed to prevent, identify, and treat family violence
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610-108.660
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0510
Definitions
(1) "Crisis line" is defined in ORS 108.610(2) and means an emergency telephone service staffed by persons who are trained to provide emergency peer counseling, information, referral, and advocacy to victims of domestic violence and their families.
(2) "Domestic and Sexual Violence Fund Advisory Committee" means the Domestic and Sexual Violence Fund Advisory Committee established in OAR 413-050-0530.
(3) (a) "Domestic violence", defined by ORS 108.610, means the physical injury, sexual abuse or forced imprisonment, or threat thereof, of a person by another person who is related by blood, marriage or intimate cohabitation at the present or has been related at some time in the past, to the extent that the person's health or welfare is harmed or threatened thereby.
(b) "Domestic violence" includes a pattern of assaultive or coercive behaviors including physical, sexual, psychological, and emotional abuses, as well as economic coercion that adults use against their intimate partners to gain power and control in that relationship.
(4) "Domestic Violence Fund" means the fund established by ORS 108.660.
(5) "Family Violence Prevention Program" means the program within the Department funded by the Domestic Violence Fund and other related funds as available to provide shelter and related services to victims of domestic violence.
(6) "Grantee" means a proposer that has been awarded a grant by the Department from the Domestic Violence Fund to support one or more of the projects and programs described in OAR 413-050-0515.
(7) "Proposer" means a public agency or private non-profit organization that meets the minimum criteria contained in OAR 413-050-0515 and that applies to the Department for funding from the Domestic Violence Fund to support one or more of the projects and programs described in OAR 413-050-0570.
(8) "Safe house" means a place of temporary refuge, offered on an as needed basis to survivors of domestic violence and their families.
(9) "Shelter home" or "shelter facility" means a place of temporary refuge, offered on a 24 hours a day, seven days a week basis to survivors of domestic violence and their children.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 13-2004, f. & cert. ef. 7-1-04; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0515
Qualified Services
The Department uses the Domestic Violence Fund to make grants to nonprofit private organizations and public agencies to fund programs and projects designed to prevent, identify, and treat domestic violence. Grants from the Domestic Violence Fund may be made to:
(1) Fund shelter homes for victims of domestic violence
(2) Fund crisis lines providing services to victims of domestic violence and their families
(3) Fund safe houses for victims of domestic violence and their families
(4) Develop and establish programs for professional and paraprofessional personnel in the fields of social work, law enforcement, education, law, medicine, and other relevant fields who are engaged in the field of the prevention, identification, and treatment of domestic violence and training programs in methods of preventing domestic violence
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0530
Advisory Committee
(1) The Domestic and Sexual Violence Fund Advisory Committee (DSVFAC) established in OAR 413-050-0530 serves as the advisory committee to the Domestic Violence Fund Program. Members are elected and serve terms in accordance with the bylaws established by the advisory committee. Copies of DSVFAC bylaws and other open records are available by contacting the Department.
(2) The Department will consult with the advisory committee regarding the administration of the Family Violence Prevention Program and each proposed change that substantially affects the program's operation.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610-108.660
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 16-1998, f. & cert. ef. 8-13-98; SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0535
Criminal History Checks
(1) A grantee must obtain a criminal history record check on each potential employee or volunteer who will work with victims of domestic violence.
(2) A grantee must develop a written policy or procedure that governs the review of the criminal history record of potential employees and volunteers and the determination of whether a potential employee or volunteer, if there is a criminal history, poses a risk to working safely with victims of domestic violence. The policy or procedure must provide that the review include an examination of:
(a) The severity and nature of crime that appears in the criminal history;
(b) The number of criminal offenses;
(c) The time elapsed since commission of each crime;
(d) The circumstances surrounding each crime;
(e) The subject individual's participation in counseling, therapy, education, or employment evidencing rehabilitation or a change in behavior, and
(f) The police or arrest report and whether that report confirms the employee's or volunteer's explanation of the crime.
(3) If the grantee determines that the potential employee or volunteer does not pose a risk to working safely with victims of domestic violence and chooses to hire the employee or volunteer, the grantee must explain in writing the reasons for hiring the individual. The written explanation must address how the potential employee or volunteer is presently suitable or able to work with victims of domestic violence in a safe and trustworthy manner, based on the policy or procedure described in section (2) of this rule. The grantee must place the written explanation in the personnel file of the employee or volunteer along with the employee's or volunteer's criminal history record.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 -108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0555
Shelter Standards
Grantees that provide shelter homes or shelter facilities must:
(1) Comply with applicable zoning, fire, sanitary and safety regulations.
(2) Post emergency instructions in English and other primary languages used in the geographic area where the shelter home is located.
(3) Maintain an operating telephone.
(4) Provide drinking water that meets Health Division standards.
(5) Maintain medicines in locked cabinets or areas.
(6) Have first aid supplies available.
(7) Protect children from items of potential danger.
(8) Have kitchen and emergency food supplies available reflective of the cultures present in the community.
(9) Have emergency clothing available.
(10) Maintain liability and fire insurance.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0560
Allocation of Funds
The Department uses an equitable distribution method for funding programs throughout the state. The distribution method must be reviewed by the Domestic and Sexual Violence Fund Advisory Committee.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0565
Department Selection Criteria and Rules
The Department will conduct periodically, at least once every five years, an application process for grant from the Domestic Violence Fund. The Department may conduct the application process jointly with other agencies of the State of Oregon that also award grants or provide financial assistance to nonprofit organizations that provide intervention and support services to victims of domestic violence. The application process includes but is not necessarily limited to:
(1) Public notification of the availability of financial assistance from the Domestic Violence Fund;
(2) Issuance of a request for grant proposals; and
(3) Evaluation of the proposals and the award of grants from the Domestic Violence Fund in accordance with the process and criteria set forth in the request for grant proposals and this division of administrative rules.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0570
Applications for Funding
To be considered for funding, a proposer must include the following minimum information in its proposal:
(1) Official business name of the proposer.
(2) Business address of the proposer.
(3) Name of the persons authorized to represent the proposer in any negotiations and to sign grant contract documents.
(4) Geographic areas the proposer is proposing to serve.
(5) A statement that no attempt has been made or will be made by the proposer to induce any other person or firm to submit or not submit a proposal, except through efforts to submit collaborative proposals.
(6) A statement that the proposer accepts all of the terms and conditions contained in the request for grant proposals.
(7) A written narrative describing how the proposer will provide services and meet the requirements of these rules.
(8) All other information required by the request for grant proposals.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0575
Evaluation Process
(1) An evaluation committee of the Department reviews proposals in accordance with the process and criteria set forth in the request for grant proposals and this division of administrative rules. Because the State of Oregon wishes to fund programs to deal with victims of domestic violence offenses in all geographic areas of the state, the Department considers, as part of the evaluation process, the geographic area of the state that will be served by the proposer.
(2) The Department will approve, approve in part and reject in part, or reject each received proposal within 60 days after the submission deadline.
(3) The Department will provide written notification by mail to each proposer no later than five working days after the final action is taken on its proposal.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0585
Confidentiality
(1) If a grantee keeps the location of premises used to provide services under these rules confidential, the Department will not release that information.
(2) Grantees must keep all individual information relating to people served by programs operating under these rules confidential.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 108.610 - 108.660
Hist.: SOSCF 2-2002, f. & cert. ef. 3-5-02; CWP 7-2003, f. & cert. ef. 1-7-03; CWP 18-2004, f. 12-30-04, cert. ef. 1-1-05
413-050-0600
Purpose
These rules provide guidelines on the Targeted Case Management Program and information about how individuals and organizations can become qualified targeted case management service providers for children receiving services from Child Welfare or Oregon Youth Authority (OYA).
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0700
413-050-0610
Definitions
(1) "Case Manager": An employee of a provider organization who has completed the Division of Medical Assistance Programs (DMAP) approved case manager training.
(2) "Client": For purposes of this policy, a child receiving target case management services.
(3) "In-Home Setting": the home of the child's parent or legal guardian.
(4) "MMIS": The Division of Medical Assistance Programs' (DMAP) Medical Management Information System.
(5) "DMAP-Approved Case Manager Training": Training provided to an employee of a provider organization by Department TCM program coordinators or their designees.
(6) "Target Population": Children under 21 who are currently residing in an in-home setting, a shelter home, foster home, group home, residential care facility, independent living situation financially supported through Child Welfare or the Oregon Youth Authority (OYA).
Exception: Children placed outside the geographical boundaries of the State of Oregon or children in non-Child Welfare-paid relative placements are not eligible to receive Title XIX reimbursement for targeted case management services under the current state plan.
(7) "Targeted Case Management" (also referred to as TCM): Activities performed by the case manager to assist children in the Target Population to obtain necessary medical, social, educational, counseling, or other services.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0710
413-050-0620
Targeted Case Management Services
Targeted Case management services include:
(1) Assessment. After a client is determined to be in need of targeted case management services, the case manager assesses the specific areas of concern, family strengths, and resources, community resources, and extended family resources available to resolve those identified issues. At assessment, the case manager makes preliminary decisions about needed medical, social, educational or other services and the level of agency intervention.
(2) Case Planning. The case manager develops a case plan, in conjunction with the client and family, to identify the goals and objectives which are designed to resolve the issues of concern identified through the assessment process. Case planning includes setting of activities to be completed by the case manager, the family, and the clients. This activity will include accessing medical, social, educational, and other services to meet the client's needs.
(3) Case Plan Implementation. The case manager will link the client and the family with appropriate agencies and medical, social, educational, and other services through calling or visiting these resources. The case manager will facilitate implementation of services through assisting the client and family to access them and through assuring that clients and providers fully understand how these services support the case plan.
(4) Case Plan Coordination. After these linkages have been completed, the case manager will ascertain, on an ongoing basis, whether or not the medical, social, educational, or other services have been accessed as planned, and the level of involvement of the client and family. Coordination activities include, but are not limited to personal, mail and telephone contacts with providers, as well as meetings with the client and family to assure that the services are being provided and used as planned.
(5) Case Plan Reassessment. The case manager will determine whether or not medical, social, educational, or other services continue to be adequate to meet the goals and objectives identified in the case plan. Reassessment decisions include those to continue, change, or terminate services. This may include assisting clients to access different medical, social, educational, or other services beyond those already provided. Reassessment activities include, but are not limited to, staffings and mail, personal and telephone contacts with involved parties.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0720
413-050-0630
Targeted Case Management Providers
Targeted case management providers are organizations or individuals who are certified as meeting the following criteria:
(1) A minimum of three years experience of successful work with children and families, involving a demonstrated capacity to provide all core elements of case management including assessment, case planning, case plan implementation, case plan coordination and case plan reassessment.
(2) A minimum of three years case management experience in coordinating and linking community medical, social, educational and other resources as required by the target population.
(3) A minimum of three years experience working with the target population.
(4) Administrative capacity to ensure quality of services in accordance with state and federal requirements.
(5) Financial management system which provides documentation of services and costs.
(6) Capacity to document and maintain individual case records in accordance with state and federal requirements.
(7) Demonstrated commitment to assure referral consistent with section 1902a(23) of the Social Security Act, Freedom of Choice of Providers; and
(8) A minimum of three years experience demonstrating capacity to meet the case management service needs of the target population.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0730
413-050-0640
Case Manager Qualifications
(1) Completion of training in case management curriculum approved by the Division of Medical Assistance Programs (DMAP).
(2) Basic knowledge of behavior management techniques, family dynamics, child development, family counseling techniques, emotional and behavioral disorders.
(3) Skill in interviewing to gather data and complete needs assessments in preparation of narratives/reports, development of service plans, and in individual and group communications; and
(4) Ability to work in court systems, to learn state and federal rules, laws and guidelines relation to child welfare, and to gain knowledge about community resources.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0740
413-050-0650
Targeted Case Management Provider Designation
Renumbered to all potential targeted case management providers must comply with applicable licensing and/or regulatory requirements set forth by federal and state statutes and regulations. Additionally, potential providers must comply with the requirements set forth in the DMAP publication General Rules and General Information, "Conditions of Provider Participation" referencing OAR 410-120-1260, Provider Enrollment; The Provider Agreement; and Enrollment of Billing Providers.
[Publications: Publications referenced are available from the agency.]
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0750
413-050-0660
TCM Case Manager
The TCM case manager:
(1) Is a private individual or works for a provider organization.
(2) Possesses case manager qualifications identified in 413-050-0640.
(3) Maintains case records which document the following information:
(a) Name of the recipient of the service (client);
(b) Date of service;
(c) Name of the provider agency and/or the person providing the service;
(d) Nature, extent or units of service; and
(e) Place of service delivery.
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0760
413-050-0670
Targeted Case Management Billing
The targeted case management provider will:
(1) Verify that the client receiving the TCM service is in the target population.
(2) Bill third-party resources, including the child's trust account.
(3) Establish a rate (fee) in conjunction with the Department.
(4) Comply with all DMAP billing requirements, using either a Medicaid form 1500 or an electronic billing process through the MMIS system.
[ED. NOTE: Forms referenced in this rule are available from the agency.]
Stat. Auth.: ORS 418.005
Stats. Implemented: ORS 418.005
Hist.: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95; SOSCF 5-2000, f. & cert.. ef. 2-22-00; Renumbered from 413-100-0770
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