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The Oregon Administrative Rules contain OARs filed through September 15, 2014
 
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DEPARTMENT OF HUMAN SERVICES, SELF-SUFFICIENCY PROGRAMS

 

DIVISION 125

BASIS OF NEED

461-125-0010

Deprivation as an Eligibility Requirement

(1) To be eligible for the TANF program, a dependent child (see OAR 461-001-0000) must be deprived.

(2) Deprivation is the loss of parental support or care because of the absence, death, incapacity, unemployment, or underemployment of a parent (see OAR 461-001-0000).

Stat. Auth.: ORS 411.060, 411.070, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 1-1993, f. & cert. ef. 2-1-93; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0030

Determining Deprivation of a Child

(1) In the TANF program, determination of deprivation for a child (see OAR 461-001-0000) who lives with one parent (see OAR 461-001-0000) or does not live with a parent is based on the continued absence or death of a parent.

(2) Determination of deprivation for a child who lives with two parents is based on:

(a) The unemployment or underemployment of the parent who is the primary wage earner (PWE); or

(b) The incapacity of a parent.

(3) If a child meets deprivation on more than one basis, the branch office (see OAR 461-001-0000) may choose which reason to use. However, the choice cannot adversely affect the child's eligibility.

Stat. Auth.: ORS 411.060, 411.070, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0050

Determining Deprivation for Child/Unborn without Legal Paternity

In the TANF program, deprivation is based only on incapacity, underemployment, or unemployment if:

(1) The mother and alleged father of the dependent child (see OAR 461-001-0000) or unborn are living together; and

(2) Either the mother or the alleged father claim the alleged father is, in fact, the father, and no other man has been identified as the father.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.300, 411.404, 411.632, 412.006 & 412.024
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.300, 411.404, 411.632, 412.006, 412.024 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 13- 1991, f. & cert. ef. 7-1-91; AFS 28-1992, f. & cert. ef. 10-1-92; SSP 8-2013, f. & cert. ef. 4-1-13; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0060

Deprivation Based on Death

If either parent (see OAR 461-001-0000) of a child (see OAR 461-001-0000) is deceased and the other parent has not remarried, or has remarried but the stepparent is not living in the home, the child meets TANF deprivation based on death.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 13-1991, f. & cert. ef. 7-1-91; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0090

Deprivation Based on Continued Absence of a Parent

In the TANF program, there is deprivation based on continued absence if all the following are true:

(1) The child (see OAR 461-001-0000) lives with only one parent (see OAR 461-001-0000) or does not live with any parent.

(2) The nature of the parent's absence interrupts or ends their function as a provider of maintenance, physical care, or guidance for the dependent child (see OAR 461-001-0000).

(3) The known or indefinite duration of the absence precludes counting on the parent's performance of the functions of planning for the present support and care of the dependent child.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0110

Situations of Deprivation Based on Continued Absence

In the TANF program, if the child (see OAR 461-001-0000) lives with only one parent (see OAR 461-001-0000) or does not live with any parent, deprivation based on continued absence exists if any of the following is true:

(1) The absent parent is confined to an institution and the confinement is anticipated to last more than 30 days.

(2) The absent parent is living at home only to serve a court-imposed sentence by performing unpaid public work and unpaid community service during the workday.

(3) The dependent child (see OAR 461-001-0000) is adopted by a single parent and the parent is not living with a spouse (see OAR 461-001-0000).

(4) The identity of the absent parent is not known or more than one individual is identified as the child's father and legal paternity has not been established.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0120

Situations of No Deprivation Based on Continued Absence

In the TANF program, deprivation based on continued absence does not exist if any of the following is true:

(1) The absence is due solely to the parent's participation in the uniformed services of the United States.

(2) Both parents share care, control, and supervision of the child (see OAR 461-001-0000) within each calendar month. This means:

(a) Each parent (see OAR 461-001-0000) makes significant decisions about their child's life; and

(b) The child sleeps at least 30 percent of the time during the calendar month in the home of each parent.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 13-1991, f. & cert. ef. 7-1-91; AFS 2-1992, f. 1-30-92, cert. ef. 2-1-92; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0130

Evidence of Deprivation Based on Continued Absence; MAA, MAF, TANF

In the TANF program:

(1) There is deprivation based on continued absence (except as specified in OAR 461-125-0120) if the absent parent (see OAR 461-001-0000) is not living in the same home as the dependent child (see OAR 461-001-0000), per section (2) of this rule, and the visits of the absent parent with the dependent child in the child's home do not exceed four times per week or a total of 30 hours per week.

(2) The Department uses the following guidelines in deciding whether the absent parent is living in the same home as the dependent child:

(a) The absent parent is not living in the same home as the dependent child if either of the following is true:

(A) The absent parent and the dependent child have been living in separate homes for 30 days or more; or

(B) The absent parent and the dependent child have been living in separate homes for less than 30 days, but at least one of the following is true:

(i) The filing group was receiving TANF when the absent parent and dependent child began living in separate homes.

(ii) The client is a victim of domestic violence (see OAR 461-001-0000).

(iii) The parents have filed for divorce or legal separation.

(iv) The absent parent and dependent child have established separate verifiable residences.

(b) The absent parent is considered to be living in the same home as the dependent child if the absent parent sleeps at least 30 percent of the time during the calendar month in the child's home.

(c) If the absent parent is living on the same property as the dependent child, they are considered to be living in the same home as the dependent child, unless all the following are true:

(A) The absent parent is the owner of the property, or is a tenant on the property. To be a tenant, the absent parent must be billed for rent.

(B) The absent parent lives independently from the dependent child and caretaker relative (see OAR 461-001-0000).

(C) The absent parent:

(i) Has and uses sleeping, bathroom and kitchen facilities separate from the dependent child and caretaker relative; or

(ii) Shares bathroom or kitchen facilities with the dependent child and caretaker relative, but the facilities are in a commercial establishment that provides room or board or both at a fair market rate.

Stat. Auth.: ORS 411.060, 411.070, 411.404, 412.049, 412-114
Stats. Implemented: ORS 411.060, 411.070, 411.117, 411.404, 412.049, 412.114
Hist.: AFS 13-1991, f. & cert. ef. 7-1-91; AFS 20-1992, f. 7-31-92, cert. ef. 8-1-92; AFS 11-1999, f. & cert. ef. 10-1-99; SSP 11-2007(Temp), f. & cert. ef. 10-1-07 thru 3-29-08; SSP 5-2008, f. 2-29-08, cert. ef. 3-1-08; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0150

Determining Primary Wage Earner (PWE); TANF

(1) The primary wage earner (PWE) is the parent who earned the most money in the 24 months before requesting assistance.

(2) Once a parent is determined to be the PWE, their status cannot change while the family remains continuously eligible for cash assistance, unless:

(a) The other parent later provides evidence that they should have been the PWE at the time of application; or

(b) The parent who is the PWE is out of the household group for at least one full calendar month. If so, the branch office must redetermine the PWE.

Stat. Auth.: ORS 411.060, 411.070, 411.404, 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.116, 411.404, 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 6-1994, f. & cert. ef. 4-1-94; AFS 23-1994, f. 9-29-94, cert. ef. 10-1-94; AFS 42-1996, f. 12-31-96, cert. ef. 1-1-97; AFS 11-1999, f. & cert. ef. 10-1-99; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP 38-2013, f. 12-31-13, cert. ef. 1-1-14

461-125-0170

Deprivation Based on Unemployment or Underemployment of the Primary Wage Earner (PWE); TANF

In the TANF program, deprivation based on the unemployment or underemployment of the PWE exists if all the following are true:

(1) A child (see OAR 461-001-0000) lives with two parents.

(2) The PWE is unemployed or underemployed.

(3) The PWE is not participating in a labor dispute.

Stat. Auth.: ORS 411.060, 411.070, 411.400, 412.006, 412.016, 412.049
Stats. Implemented: ORS 411.060, 411.070, 412.006, 412.016, 412.049, 412.064, 2011 Or. Laws 604, 2012 Or. Laws 107
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90, cert. ef. 4-1-90; AFS 28-1992, f. & cert. ef. 10-1-92; AFS 23-1994, f. 9-29-94, cert. ef. 10-1-94; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 27-1996, f. 6-27-96, cert. ef. 7-1-96; AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97; AFS 9-1997, f. & cert. ef. 7-1-97; AFS 8-1998, f. 4-28-98, cert. ef. 5-1-98; SSP 18-2009(Temp), f. 7-29-09, cert. ef. 8-1-09 thru 1-28-10; SSP 32-2009(Temp), f. & cert. ef. 10-29-09 thru 1-28-10; SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10; SSP 18-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SSP 25-2011, f. 9-30-11, cert. ef. 10-1-11; SSP 17-2012(Temp), f. & cert. ef. 5-1-12 thru 10-28-12; SSP 30-2012, f. 9-28-12, cert. ef. 10-1-12; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0190

Unemployment or Underemployment of the Principal Wage Earner (PWE)

Consider a principal wage earner (PWE) unemployed or underemployed if their monthly earned income is less than the countable income limit for their need group size.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 27-1996, f. 6-27-96, cert. ef. 7-1-96; AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97; AFS 9-1997, f. & cert. ef. 7-1-97

461-125-0230

Deprivation Based on the Incapacity of a Parent

In the TANF program, deprivation based on incapacity exists if a child (see OAR 461-001-0000) lives with two parents and:

(1) At least one parent (see OAR 461-001-0000) is receiving SSI and/or SSB based on disability or blindness; or

(2) Medical documentation establishes that the parent has a physical or mental condition that:

(a) Is expected to last for at least 30 days from the date of request (see OAR 461-115-0030) for TANF; and

(b) Substantially reduces or eliminates the parent's ability to support or care for their dependent child (see OAR 461-001-0000), taking into consideration the following:

(A) The limited job market opportunities of incapacitated individuals; and

(B) The parent's education, training, work history, age and other related factors.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0250

Criteria for Determining the Incapacity of a Parent

In the TANF program, a condition is considered to substantially reduce or eliminate the parent's ability to support or care for their dependent child (see OAR 461-001-0000) if, as a result of the condition, one of the following criteria is met:

(1) The parent (see OAR 461-001-0000) is unable to provide adequate care for the dependent child without help from others. Adequate care includes feeding, cleaning and supervising the dependent child.

(2) The parent is unable to perform any type of employment.

(3) The parent is able to perform work only in a job that is rehabilitative or in a sheltered workshop.

(4) The parent is unable to work at least 30 hours a week at employment paying at least state or federal minimum wage, whichever is greater.

(5) The number of hours the parent is able to work is substantially reduced.

(6) The parent is unable to work at their customary employment, but is able to work at employment for which they are equipped by education, training, or experience, that pays substantially less than their customary employment.

Stat. Auth.: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.081, 411.085, 411.404, 412.006 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; SSP 27-2013, f. & cert. ef. 10-1-13

461-125-0255

Change in Basis of Deprivation; TANF

In the TANF program, when an absent parent joins a household receiving TANF benefits, or another change occurs that could change the basis of deprivation, the filing group (see OAR 461-110-0330) remains eligible during a 45-day period following the timely report of the change, during which the filing group may establish TANF eligibility based on incapacity or unemployment.

Stat. Auth.: ORS 411.060, 411.070 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 412.049, 412.114, 412.161 & 418.647
Hist.: AFS 28-1992, f. & cert. ef. 10-1-92; AFS 36-1996, f. 10-31-96, cert. ef. 11-1-96; AFS 12-2001, f. 6-29-01, cert. ef. 7-1-01; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07

461-125-0260

Impairment Criteria; SFPSS

(1) To be eligible for the SFPSS program, an individual must be receiving TANF benefits and the Department has determined that the individual:

(a) Meets the listing of impairments found in 20 C.F.R. Part 404, Subpart P, Appendix 1; or

(b) Meets the medical vocational guidelines found in 20 C.F.R. Part 404, Subpart P, Appendix 2 for SSI; or

(c) Meets the definition of disability in 20 C.F.R. §§ 404.1505 or 416.905.

(2) If an individual is unable to do so, the Department will obtain medical evidence that documents a claim of physical or mental impairment.

Stat. Auth.: ORS 411.060, 411.070, 412.049 & 412.014
Stats. Implemented: ORS 411.060, 411.070, 412.049 & 412.114
Hist.: SSP 11-2007(Temp), f. & cert. ef. 10-1-07 thru 3-29-08; SSP 5-2008, f. 2-29-08, cert. ef. 3-1-08

461-125-0310

Basis of Need; OSIPM

In the OSIPM program, an individual must be one of the following:

(1) Blind (see OAR 461-125-0330) at any age (AB).

(2) Age 65 or over (see OAR 461-125-0350) (OAA).

(3) An individual with a disability (see OAR 461-125-0370) (AD).

Stat. Auth. ORS 411.060, 411.070, 411.404, & 411.706
Stats. Implemented: ORS 411.060, 411.070, 411.404, 411.704 & 411.706
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; SSP 8-2008, f. & cert. ef. 4-1-08; SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10

461-125-0330

Blindness as the Basis of Need

In the OSIP and OSIPM programs, a client is considered blind if any of the following is true:

(1) The client is receiving SSB or SSI benefits based on blindness. Eligibility continues as long as eligibility for SSB or SSI eligibility continues.

(2) The client was eligible for and received AB in Oregon in December 1973. These grandfathered clients continue to be eligible as long as they are continuously blind as defined by Oregon requirements that were in effect in 1973.

(3) The client meets one of the following OSIP blindness criteria:

(a) Vision of 20/200 or less in the better eye with a corrective lens.

(b) A limitation in vision field to an angle of 20 degrees or less.

Stat. Auth.: ORS 411.050, 411.060, 411.070, 411.404 & 411.706
Stats. Implemented: ORS 411.050, 411.060, 411.070, 411.404, 411.704 & 411.706
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1991, f. & cert. ef. 10-1-91; SSP 7-2005, f. & cert. ef. 7-1-05

461-125-0350

Old Age as the Basis of Need; OSIP and OSIPM

Only a person who has attained the age of 65 years may be eligible for the OSIP-OAA or OSIPM-OAA program.

Stat. Auth.: ORS 411.060, 411.070, 411.404 & 411.706
Stats. Implemented: ORS 411.060, 411.070, 411.404 & 411.706
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 27-2001, f. 12-21-01, cert. ef. 1-1-02

461-125-0370

Disability as the Basis of Need; OSIP and OSIPM

(1) In the OSIP and OSIPM programs (except OSIP-EPD and OSIPM-EPD), an individual meets the eligibility requirement to have a disability if the requirements of one of the following subsections are met:

(a) The individual is receiving Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) based on disability. Eligibility continues as long as the individual remains eligible for SSDI or SSI.

(b) The individual was eligible for and received Aid to the Disabled benefits in Oregon in December 1973. These grandfathered cases continue to be eligible as long as they are continuously disabled as defined by Oregon requirements that were in effect in 1973.

(c) The Department has determined the individual meets the listing of impairments found in 20 C.F.R. Part 404, Subpart P, Appendix 1; meets the medical vocational guidelines found in 20 C.F.R. Part 404, Subpart P, Appendix 2 for SSI; or meets the definition of disability in 20 C.F.R. 404.1505 or 416.905.

(d) The Social Security Administration (SSA) has determined the individual meets the listing of impairments found in 20 C.F.R. Part 404, Subpart P, Appendix 1; meets the medical vocational guidelines found in 20 C.F.R. Part 404, Subpart P, Appendix 2; or meets the definition of disability in 20 C.F.R. 404.1505 or 416.905.

(2) If the Department finds the individual eligible for OSIPM in the absence of a disability determination by SSA, the individual remains eligible, provided that the individual continues to meet the disability criteria for eligibility for OSIPM, until SSA denies the disability claim in a final administrative decision.

(3) For OSIP and OSIPM, a disability determination made by SSA that is unfavorable to an individual is binding on the Department unless the requirements of at least one of the following subsections are met (see 42 C.F.R. 435.541(c)(1) and (c)(4)):

(a) SSA made the determination for a reason other than disability.

(b) The individual alleges a disabling condition different from, or in addition to, that considered by SSA in making its determination.

(c) More than 12 months after the most recent SSA determination denying disability, the individual alleges that his or her condition has changed or deteriorated since that SSA determination, and the individual has not made application to SSA based on these allegations.

(d) The individual alleges less than 12 months after the most recent SSA determination denying disability that the condition which SSA evaluated has changed or deteriorated since that SSA determination; and one or both of the following apply:

(A) The individual has requested reconsideration or reopening of the most recent SSA determination denying disability and SSA has declined to consider the new allegations.

(B) It is clear that the individual no longer meets SSI eligibility requirements unrelated to disability status but may satisfy comparable Medicaid eligibility requirements.

(4) If a binding SSA disability determination is not in place, the determination of disability to qualify for OSIPM is made by the Presumptive Medicaid Disability Determination Team, composed of a medical or psychological consultant and another individual who is qualified to interpret and evaluate medical reports, other evidence relating to the individual’s physical or mental impairments, and (as necessary) to determine the capacities of the individual to perform substantial gainful activity, as specified in 20 C.F.R. Part 416, Subpart J (see 42 C.F.R. 435.541(f)(2)).

(5) The Presumptive Medicaid Disability Determination Team obtains and reviews medical reports and other non-medical evidence pertaining to the individual and the claimed disability. The medical report and non-medical evidence must include diagnosis and other information in accordance with the requirements for evidence applicable to disability determinations under the SSI program specified in 20 CFR Part 416, Subpart I. The Presumptive Medicaid Disability Determination Team then makes a decision about medical eligibility and whether and when a redetermination shall be made (see 42 C.F.R. 435.541(f)(1) and (3)).

(6) In the OSIP-EPD and OSIPM-EPD programs, an individual is disabled (see OAR 461-001-0035) or has a disability (see 461-001-0035) if the individual has a physical or mental impairment, or a combination of these impairments, that meets the definition of disability used by SSA when determining eligibility for SSI or SSDI under 20 C.F.R. Part 404. The determination is made as follows:

(a) A determination by SSA that the individual is disabled or has a disability is accepted by the Department.

(b) If the individual was determined to have a disability by SSA and lost their SSDI eligibility due to their own income, the SSA determination remains effective for one year from the date that the individual loses eligibility for SSDI.

(c) If there is no currently effective SSA determination finding the individual has a disability, the case is referred to the Department’s central office for a disability determination (see OAR 461-001-0035) using the standards of 20 C.F.R. Parts 404 and 416 and considering all relevant medical and vocational information.

(d) For OSIPM-EPD, an individual is engaging in substantial gainful activity (SGA, see OAR 461-001-0035) if the earnings of the individual are at or above the EPD Income Standard.

(e) For OSIPM-EPD, any work activity engaged in during the OSIPM-EPD application process or certification period is not evaluated as past relevant work (PRW, see OAR 461-001-0035).

(7) An individual who is served by a branch office (see OAR 461-001-0000) in Benton, Clackamas, Clatsop, Columbia, Lane, Lincoln, Linn, Marion, Polk, Tillamook, Washington, or Yamhill County and who has been determined by the Presumptive Medicaid Disability Determination Team (PMDDT) to have a disability (see section (1) of this rule) may receive free assistance from the Department with applications and administrative appeals for Social Security Disability Insurance (SSD) benefits in order to meet the requirements of OAR 461-120-0330 (Requirement to Pursue Assets).

Stat. Auth.: ORS 409.050, 411.060, 411.070, 411.404 & 411.706
Stats. Implemented: ORS 409.010, 411.060, 411.070, 411.404, 411.704 & 411.706
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1991, f. & cert. ef. 10-1-91; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 1-1999(Temp), f. & cert. ef. 2-1-99 thru 7-31-99; AFS 7-1999, f. 4-27-99, cert. ef. 5-1-99; SSP 9-2003(Temp), f. & cert. ef. 4-11-03 thru 6-30-03; SSP 16-2003, f. & cert. ef. 7-1-03; SSP 23-2003, f. & cert. ef. 10-1-03; SSP 22-2004, f. & cert. ef. 10-1-04; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP 20-2014(Temp), f. & cert. ef. 8-1-14 thru 1-28-15; SSP 22-2014(Temp), f. 8-29-14, cert. ef. 9-1-14 thru 1-28-15

461-125-0510

Impairment Criteria; GA, GAM

(1) To be eligible for GA and GAM, an individual must meet one of the following criteria:

(a) Have a physical or mental impairment that meets or equals the listing of impairments found in 20 CFR 404, Subpart P, Appendix 1, in effect November 1, 2003, and can be expected to:

(A) Last for a continuous period of not less than 12 months from the date of request; or

(B) Result in death within 12 months from the date of request.

(b) Be 55 years of age or older and meet the following requirements:

(A) Have a severe physical or mental impairment that does not meet the listing of impairments referred to in subsection (a) of this section but will:

(i) Prevent the individual from returning to any past relevant work for a period of not less than 12 months from the date of request; or

(ii) Result in death within 12 months from the date of request.

(B) Be limited to sedentary residual functioning capacity as defined in 20 CFR 404, subpart P, appendix 2, in effect November 1, 2003.

(c) Be 55 years of age or older and have all of the following:

(A) A severe physical or mental impairment that does not meet the listing of impairments referred to in subsection (a) of this section but will:

(i) Last for a period of not less than 12 months from the date of request; or

(ii) Result in death within 12 months from the date of request.

(B) Less than a 12th grade education, as evidenced by the lack of a high school diploma or GED.

(C) A history of no past relevant work as defined in section (2) of this rule in the last 15 years.

(d) Be age 50 or older but not yet age 55: and

(A) Have a severe physical or mental impairment that does not meet the listing of impairments referred to in subsection (a) of this section but will:

(i) Last for a period of not less than 12 months from the date of request; or

(ii) Result in death within 12 months from the date of request.

(B) Be illiterate or unable to communicate in English.

(C) Be limited to light residual functioning capacity as defined in 20 CFR 404, subpart P, appendix 2, in effect November 1, 2003.

(D) Have a past relevant work history of "unskilled" or "none."

(e) Be age 50 or older but not yet age 55: and

(A) Have a severe physical or mental impairment that does not meet the listing of impairments referred to in subsection (a) of this section but will:

(i) Last for a period of not less than 12 months from the date of request; or

(ii) Result in death within 12 months from the date of request.

(B) Have less than a High School education.

(C) Be limited to sedentary residual functioning capacity as defined in 20 CFR 404, subpart P, appendix 2, in effect November 1, 2003.

(D) Have a past relevant work history of "unskilled" or "none."

(f) Be age 45 or older but not yet age 50: and

(A) Have a severe physical or mental impairment that does not meet the listing of impairments referred to in subsection (a) of this section but will:

(i) Last for a period of not less than 12 months from the date of request; or

(ii) Result in death within 12 months from the date of request.

(B) Be illiterate or unable to communicate in English.

(C) Be limited to sedentary residual functioning capacity as defined in 20 CFR 404, subpart P, appendix 2, in effect November 1, 2003.

(D) Have a past relevant work history of unskilled or none.

(2) As used in this rule:

(a) "Basic work activity" means any kind of work activity that averages at least eight hours a day for which income is received, regardless of the adequacy to meet the client's needs. Work performed against medical advice or at an activity center or sheltered workshop is not basic work activity.

(b) "Equaling" means the medical findings are at least equal in severity and duration to the listed findings. If the client's impairment is not listed, the Department considers the listed impairment most like the client's impairment to decide whether the client's impairment is medically equal to the listed impairment. If the client has more than one impairment, and none of them meets or equals a listed impairment, the Department reviews the symptoms, signs, and laboratory findings about the client's impairments to determine whether the combination of those impairments is medically equal to a listed impairment.

(c) "Light work" means work that requires lifting no more than 20 pounds at a time with frequent lifting or carrying objects weighing up to 10 pounds and requires occasional stooping. It also requires standing or walking for a total of approximately six hours of an eight-hour workday.

(d) "Past relevant work" means work that the individual has performed in the last 15 years and that constitutes substantial gainful activity as defined in 20 CFR 404.1574 and 404.1575, in effect November 1, 2003. Also, the past relevant work must have lasted long enough for the individual to learn the techniques, acquire the necessary information, and develop the facilities needed for average performance of the job situation.

(e) "Sedentary work" means work that requires lifting no more than 10 pounds at a time and occasionally lifting or carrying articles such as docket files, ledgers, and small tools. Although sitting is involved, a certain amount of walking and standing is often necessary in carrying out job duties. Periods of walking and standing should total no more than two hours of an eight-hour workday and sitting should total approximately six hours of an eight-hour workday. Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand finger actions.

(f) "Severe mental impairment" means a mental impairment that significantly limits the individual's ability to do basic work activity.

(g) "Severe physical impairment" means a physical impairment that significantly limits the individual's physical ability to do basic work activity.

(h) "Unskilled work" is work that requires little or no judgment to do simple duties that can be learned on the job within 30 days.

(3) An applicant is not eligible for GA or GAM if drug addiction or alcoholism is material to his or her disability.

(4) If the client is unable to do so, the Department will obtain medical evidence that documents a claim of physical or mental impairment.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 411.060, 411.070, 411.404 & 411.710
Stats. Implemented: ORS 411.060, 411.070, 411.404 & 411.710
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; AFS 6-1994, f. & cert. ef. 4-1-94; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 40-1995, f. 12-26-95, cert. ef. 1-1-96; AFS 21-1996, f. 5-30-96, cert. ef. 6-1-96; AFS 24-1996(Temp), f. & cert. ef. 6-11-96; AFS 34-1996, f. 9-26-96, cert. ef. 10-1-96; AFS 24-1997, f. 12-31-97, cert. ef. 1-1-98; AFS 9-1999, f. & cert. ef. 7-1-99; AFS 10-2000, f. 3-31-00, cert. ef. 4-1-00; AFS 23-2000(Temp), f. 9-29-00, cert. ef. 10-1-00 thru 12-31-00; AFS 34-2000, f. 12-22-00, cert. ef. 1-1-01; AFS 35-2000(Temp), f. 12-29-00, cert. ef. 1-1-01 thru 3-31-01; AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01; AFS 12-2001, f. 6-29-01, cert. ef. 7-1-01; AFS 4-2002(Temp), f. & cert. ef. 4-1-02 thru 6-30-02; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 29-2003(Temp), f. 10-31-03, cert. ef. 11-1-03 thru 3-31-04; SSP 6-2004, f. & cert. ef. 4-1-04; SSP 15-2004(Temp), f. & cert. ef. 6-1-04 thru 9-30-04; SSP 22-2004, f. & cert. ef. 10-1-04

461-125-0810

Using Administrative Medical Examinations

(1) When the Department is responsible for making a decision of GA or SFPSS disability determination, OSIP or OSIPM disability or OSIP or OSIPM blindness, or TANF incapacity, the client may select a qualified medical provider to complete the medical evaluation described in OAR 461-125-0830.

(2) A decision to deny or end benefits must be reconsidered when additional medical documentation relevant to the decision is received by the Department within 30 days of the original effective date of denial or termination.

Stat. Auth.: ORS 411.060, 411.070, 411.404, 411.706, 411.710, 412.014 & 412.049
Stats. Implemented: ORS 411.060, 411.070, 411.404, 411.706, 411.710, 412.014 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 28-1992, f. & cert. ef. 10-1-92; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 7-1999, f. 4-27-99, cert. ef. 5-1-99; AFS 3-2000, f. 1-31-00, cert. ef. 2-1-00; SSP 11-2007(Temp), f. & cert. ef. 10-1-07 thru 3-29-08; SSP 5-2008, f. 2-29-08, cert. ef. 3-1-08

461-125-0830

Medical Documentation, Disability and Other Determinations

(1) Medical documentation must be written and must contain all the following:

(a) A diagnosis in medical terminology, including an explanation of whether the impairment limits the individual's ability to perform normal functions and, if so, how.

(b) A prognosis, including an expected recovery time frame.

(c) Clinical findings from physical examination, psychiatric evaluation, X rays, or a laboratory procedure, including specific data supporting diagnosis of a condition that causes disability, either on a medical or psychiatric basis.

(2) Except as provided otherwise in section (3) of this rule:

(a) To determine eligibility, the Department will accept evaluations from the following medical sources: medical evaluations only from licensed physicians, including psychiatrists, osteopaths, and ophthalmologists; mental evaluations only from psychiatrists and licensed or certified psychologists; and measurement of visual acuity and visual fields only from ophthalmologists and licensed optometrists.

(b) The Department will accept supplemental medical and vocational information to augment evaluations from acceptable medical sources, from a licensed social worker, licensed physical or occupational therapist, or licensed nurse practitioner.

(3) Except for eligibility determinations in the OSIP, OSIPM, QMB, and SFPSS programs, the Department will also accept medical evaluations from licensed nurse practitioners and physician assistants; and mental evaluations from psychiatric mental health nurse practitioners.

(4) The client must provide or cooperate in obtaining sufficient medical documentation for the Department to determine eligibility.

Stat. Auth.: ORS 409.050, 411.060, 411.070, 411.404, 411.710, 412.006, 412.009, 412.014 & 412.049
Stats. Implemented: ORS 409.010, 411.060. 411.070, 411.404, 411.710, 412.006, 412.009, 412.014 & 412.049
Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 28-1992, f. & cert. ef. 10-1-92; AFS 3-2000, f. 1-31-00, cert. ef. 2-1-00; SSP 39-2012(Temp), f. 12-28-12, cert. ef. 1-1-13 thru 6-30-13; SSP 8-2013, f. & cert. ef. 4-1-13

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