OAR 411-034-0020
State Plan Personal Care Services
(1)
State Plan personal care services are essential services that enable an individual to move into or remain in their own home. State Plan personal care services are provided in accordance with an individual’s authorized plan for services by a provider meeting the requirements in OAR 411-034-0050 (Provider Qualifications).(a)
To receive State Plan personal care services, an individual must demonstrate the need for assistance with personal care and supportive services and meet the eligibility criteria described in OAR 411-034-0030 (Eligibility for State Plan Personal Care Services).(b)
State Plan personal care services are provided directly to an eligible individual and are not meant to provide respite or other services to an individual’s natural support system. State Plan personal care services may not be implemented for the purpose of benefiting an individual’s family members or the individual’s household in general.(c)
State Plan personal care services are limited to:(A)
A minimum of 9.18 hours per service period (to equal 20 hours per month as required in the State Plan), per eligible individual for consumers served by APD or an AAA.(B)
20 hours per service period per eligible individual for consumers served by a CDDP or a Support Services Brokerage.(d)
To meet an extraordinary personal care need, an individual, representative, or legal representative may request an exception to the maximum service period hour limitation. An exception must be requested through the Central Office of the Program serving the individual. The Program has up to 45 days upon receipt of an exception request to determine whether an individual’s assessed personal care needs warrant exceeding the service period limitation and the individual shall receive a notice of the Program’s decision.(2)
Personal care services include:(a)
Basic personal hygiene -- providing or assisting an individual with such needs as bathing (tub, bed bath, shower), washing hair, grooming, shaving, nail care, foot care, dressing, skin care, mouth care, and oral hygiene;(b)
Toileting, bowel, or bladder care -- assisting to and from bathroom, on and off toilet, commode, bedpan, urinal, or other assistive device used for toileting, changing incontinence supplies, following a toileting schedule, cleansing an individual or adjusting clothing related to toileting, emptying a catheter drainage bag or assistive device, ostomy care, and bowel care;(c)
Mobility, transfers, or repositioning -- assisting an individual with ambulation or transfers with or without assistive devices, turning an individual or adjusting padding for physical comfort or pressure relief, and encouraging or assisting with range-of-motion exercises;(d)
Nutrition -- preparing meals and special diets, assisting with adequate fluid intake or adequate nutrition, assisting with food intake (feeding), monitoring to prevent choking or aspiration, assisting with special utensils, cutting food, and placing food, dishes, and utensils within reach for eating;(e)
Medication or oxygen management -- assisting with ordering, organizing, and administering oxygen or prescribed medications (including pills, drops, ointments, creams, injections, inhalers, and suppositories), monitoring for choking while taking medications, assisting with the administration of oxygen, maintaining clean oxygen equipment, and monitoring for adequate oxygen supply;(f)
Delegated nursing tasks as defined in OAR 411-034-0010 (Definitions).(3)
When any of the services listed in section (2) of this rule are essential to the health, safety, and welfare of an individual and the individual is receiving personal care paid by the Department, the following supportive services may also be provided:(a)
Housekeeping tasks necessary to maintain the eligible individual in a healthy and safe environment, including cleaning surfaces and floors, making the individual’s bed, cleaning dishes, taking out the garbage, dusting, and gathering and washing soiled clothing and linens. Only the housekeeping activities related to the eligible individual’s needs may be considered in housekeeping;(b)
Arranging for necessary medical appointments including help scheduling appointments and arranging medical transportation services (described in OAR chapter 410, division 136) and assistance with mobility and transfers or cognition in getting to and from appointments or to an office within a medical clinic or center;(c)
Observing the individual’s health status and reporting any significant changes to physicians, health care professionals, or other appropriate persons;(d)
First aid and handling of emergencies, including responding to medical incidents related to conditions such as seizures, spasms, or uncontrollable movements where assistance is needed by another person and responding to an individual’s call for help during an emergent situation or for unscheduled needs requiring immediate response; and(e)
Cognitive assistance or emotional support provided to an individual by another person due to confusion, dementia, behavioral symptoms, or mental or emotional disorders. Cognitive assistance or emotional support includes helping the individual cope with change and assisting the individual with decision-making, reassurance, orientation, memory, or other cognitive symptoms.(4)
Payment may not be made for any of the following excluded services:(a)
Shopping;(b)
Community transportation;(c)
Money management;(d)
Mileage reimbursement;(e)
Social companionship;(f)
Day care, adult day services (described in OAR chapter 411, division 066), respite, or baby-sitting services;(g)
Medicaid home delivered meals (described in OAR chapter 411, division 040);(h)
Care, grooming, or feeding of pets or other animals; or(i)
Yard work, gardening, or home repair.
Source:
Rule 411-034-0020 — State Plan Personal Care Services, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-034-0020.