Fees for Authorized Service and Fees for Service Schedule
(1)FEE FOR AUTHORIZED SERVICES.
(a)A one-time fee is applied to all individuals receiving OPI authorized services who have adjusted income levels at or below federal poverty level. The fee is due at the time eligibility for OPI authorized services has been determined.
(b)Fees for authorized services, except service coordination and home delivered meals, are charged based on a sliding fee schedule to all eligible individuals whose annual gross income exceeds the minimum, as established by the Department. For purposes of these rules, an individual’s annual gross income includes:
(A)Salaries from the household;
(B)Interest and dividends from the household;
(C)Pensions, annuities, Social Security, and railroad retirement benefits from the household; and
(D)Any other income from the household.
(i)All out-of-pocket health care costs may be deducted from the individual’s annual gross income.
(ii)All child support paid by a non-custodial parent may be deducted from the individual’s annual gross income.
(c)Individuals must receive written notification of the hourly and maximum monthly fee for service upon initial service determination and whenever there is a change.
(d)The AAA must develop procedures for assessing, billing, collecting, and expending fees.
(A)The written policy addressing individual non-payment of fees to be reviewed and approved is included in the AAA’s Area Plan.
(B)Individuals must be given a copy of the AAA’s policy pertaining to individual non-payment of fees upon initial eligibility determination.
(C)The decision to terminate OPI authorized services for non-payment of assessed fees for service is the responsibility of the local AAA.
(e)A record of surcharges and all fees for services must be kept by each AAA and reported monthly to the Department.
(A)Minimum fees and fee for service determination forms must be a part of each individual’s case record. Fee for service determination forms must meet minimum requirements for documentation as established by the Department.
(B)The maximum monthly authorized fee for services must be recorded on each individual’s case record upon initial service determination and at least annually thereafter, at time of reassessment.
(f)Nothing in these rules prevent OPI individuals, or the individual’s family, from making a donation or contribution. Such donations are used to expand services under OPI. Expansion of services is limited to services authorized in OAR 411-032-0010 (Authorized Services and Allowable Costs) as identified in the AAA’s Area Plan.
(g)The minimum fee and all fees for service are used to expand services under OPI. Expansion of services is limited to services authorized in OAR 411-032-0010 (Authorized Services and Allowable Costs) as identified in the AAA’s Area Plan.
(h)The AAAs and service providers must have a Department reviewed fee collection policy.
(2)FEE FOR SERVICE SCHEDULE.
(a)The Department, after consultation with the AAAs, develops and publishes a fee schedule for services based on the federal poverty level and distributes the schedule to the AAAs annually.
(b)The fee for service schedule is applied to the local rate specific to the service and the type of provider for the individual.
Rule 411-032-0044 — Fees for Authorized Service and Fees for Service Schedule,