Eligibility for State Plan Personal Care Services
(1)To be eligible for State Plan personal care services, an individual must:
(a)Require assistance (defined in OAR 411-034-0010 (Definitions)) from a qualified provider with one or more of the personal care tasks described in OAR 411-034-0020 (State Plan Personal Care Services); and
(b)Be a current recipient of a Medicaid OHP Plus benefit package.
(2)An individual is not eligible to receive State Plan personal care services if:
(a)The individual is receiving assistance with activities of daily living (as described in OAR 411-015-0006 (Activities of Daily Living (ADL))) from a licensed 24-hour residential services program (such as an adult foster home, assisted living facility, group home, or residential care facility);
(b)The individual is in a prison, hospital, sub-acute care facility, nursing facility, or other medical institution;
(c)The individual’s service needs are met through the individual’s natural support system (defined in OAR 411-034-0010 (Definitions)); or
(d)The individual’s assessed service needs are being met under other Medicaid-funded home and community-based service options of the individual’s choosing.
(3)Payment for State Plan personal care services is not intended to replace the resources available to an individual from the individual’s natural support system (defined in OAR 411-034-0010 (Definitions)).
(4)State Plan personal care services are not intended to replace routine care commonly needed by an infant or child typically provided by the infant’s or child’s parent.
(5)State Plan personal care services may not be used to replace other non-Medicaid governmental services.
(6)The Department, Division, or Designee has the authority to close the eligibility and authorization for State Plan personal care services if an individual fails to:
(a)Employ a provider that meets the requirements in OAR 411-034-0050 (Provider Qualifications); or
(b)Receive personal care from a qualified provider paid by the Department for 30 continuous calendar days or longer.
(7)State Plan personal care services must not duplicate other Medicaid services.
Rule 411-034-0030 — Eligibility for State Plan Personal Care Services,