OAR 410-172-0830
Personal Care Attendant Service Assessment, Authorization, and Monitoring
(1)
A behavioral health case manager shall meet in person with an individual to assess the individual’s ability to perform the personal care tasks listed in this rule:(a)
An individual’s natural supports may participate in the assessment if requested by the individual;(b)
A behavioral health case manager shall assess an individual’s service needs, identify the resources meeting any, some, or all of the individual’s needs and determine if the individual is eligible for behavioral health personal care attendant services or other services;(c)
A behavioral health case manager shall meet with an individual in person at least once every 365 days to review the individual’s service needs.(2)
A behavioral health case manager shall prepare a service plan identifying the tasks for which an individual requires assistance and the number of monthly authorized service hours. The case manager shall document an individual’s natural supports that currently meet some or all of the individual’s assistance needs:(a)
The service plan shall describe the tasks to be performed by a qualified provider and shall authorize the maximum monthly hours that may be reimbursed for those services;(b)
A case manager shall consider the cost effectiveness of services that adequately meet the individual’s service needs when developing service plans;(c)
Payment for behavioral health personal care attendant services shall be prior authorized by a behavioral health case manager and based on the service needs of an individual as documented in the individual’s written service plan.(3)
When there is an indication that an individual’s personal care needs have changed, a case manager shall conduct an in-person reassessment with the individual and any of the individual’s natural supports if requested by the individual:(a)
Following annual reassessments and those conducted after a change in an individual’s personal care needs, a case manager shall review service eligibility, the cost effectiveness of the individual’s service plan, and whether the services provided are meeting the individual’s identified service needs;(b)
The case manager may adjust the hours or services in the individual’s service plan and shall authorize a new service plan, if appropriate, based on the individual’s current service needs.(4)
A behavioral health case manager shall provide ongoing coordination of behavioral health personal care attendant services, including authorizing changes in providers and service hours, addressing risks, and monitoring and providing information and referral to an individual when indicated.(5)
The Authority may not authorize services within an eligible individual’s home when:(a)
The individual’s home has dangerous conditions that jeopardize the health or safety of the individual or the provider and necessary safeguards cannot be taken to improve the setting;(b)
The services cannot be provided safely or adequately by a provider;(c)
The individual does not have the ability to make an informed decision, does not have a designated representative to make decisions on his or her behalf, and necessary safeguards cannot be provided to protect the individual’s safety, health, and welfare.(6)
A behavioral health case manager shall present an individual or the individual’s representative with information on service alternatives and provide assistance to assess other choices when a provider or service setting selected by the individual or the individual’s representative is not authorized.
Source:
Rule 410-172-0830 — Personal Care Attendant Service Assessment, Authorization, and Monitoring, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0830.