OAR 411-034-0090
Payment Limitations
(1)
The maximum allowed hours for State Plan personal care services are --(a)
Capped at 9.18 hours per service period (to equal 20 hours per month as required in the State Plan), for individuals served by APD or an AAA; or(b)
Capped at 20 hours per service period for individuals served by a CDDP or a Support Services Brokerage.(c)
Individuals whose assessed service needs exceed the maximum allowed hours for State Plan personal care services in a service period may request additional hours through the exception process described in OAR 411-034-0020 (State Plan Personal Care Services). The Department Central Office may approve or deny the requests based on analysis of the individual’s need and criteria for an exception.(d)
State Plan personal care service hours are authorized in accordance with an individual’s service plan and may be scheduled throughout the service period to meet the service needs of the individual.(2)
Authorized LTC community nurse assessment and monitoring services are not included in the maximum hours per service period for State Plan personal care services described in section (1) of this rule.(3)
The Department does not guarantee payment for State Plan personal care services until all acceptable provider enrollment standards have been verified and both the employer and provider have been formally notified in writing that payment by the Department is authorized.(4)
In accordance with OAR 410-120-1300 (Timely Submission of Claims), all provider claims for payment must be submitted within 12 months of the date of service.(5)
Payment may not be claimed by a provider until the hours authorized for the payment period have been completed, as directed by an eligible individual or the individual’s representative.
Source:
Rule 411-034-0090 — Payment Limitations, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-034-0090.