OAR 411-328-0790
Entry, Exit, and Transfer
(1)
NON-DISCRIMINATION. An individual considered for Department-funded services may not be discriminated against because of race, color, creed, age, disability, national origin, gender, religion, duration of Oregon residence, method of payment, or other forms of discrimination under applicable state or federal law.(2)
QUALIFICATIONS FOR DEPARTMENT-FUNDED SERVICES. An individual who enters supported living is subject to eligibility as described in this section. To be eligible for supported living, an individual must:(a)
Be an Oregon resident;(b)
Be receiving a Medicaid Title XIX (OHP) benefit package through OSIPM or OCCS medical program. Individuals receiving Medicaid OHP under OCCS medical coverage for services in a nonstandard living arrangement as defined in OAR 461-001-0000 (Definitions for Chapter 461) are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding:(A)
The transfer of assets as set forth in OAR 461-140-0210 (Asset Transfer; General Information and Timelines) to 461-140-0300 (Adjustments to the Disqualification for Asset Transfer); and(B)
The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220 (Home).(c)
Be determined eligible for developmental disability services by the CDDP of the county of origin as described in OAR 411-320-0080 (Application and Eligibility Determination);(d)
Meet the level of care as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services);(e)
Be an individual who is not receiving other Department-funded in-home or community living support;(f)
Have access to the financial resources to afford living expenses, such as food, utilities, rent, and other housing expenses; and(g)
Be eligible for Community First Choice state plan services.(3)
ENTRY.(a)
A provider must participate in an entry meeting prior to the onset of services to an individual.(b)
Prior to or upon an entry ISP team meeting, a provider must demonstrate effort to acquire the following individual information from the referring case management entity:(A)
A copy of the eligibility determination document;(B)
A statement indicating safety skills, including the ability of the individual to evacuate from a building when warned by a signal device and adjust water temperature for bathing and washing;(C)
A brief written history of any behavioral challenges, including supervision and support needs;(D)
A medical history and information on health care supports that includes (when available):(i)
The results of the most recent physical exam;(ii)
The results of any dental evaluation;(iii)
A record of immunizations;(iv)
A record of known communicable diseases and allergies; and(v)
A record of major illnesses and hospitalizations.(E)
A written record of any current or recommended medications, treatments, diets, and aids to physical functioning;(F)
A copy of the most recent needs assessment. If the needs of the individual have changed over time, the previous needs assessments must also be provided;(G)
Copies of protocols, the risk tracking record, and any support documentation (if available);(H)
Copies of documents relating to the guardianship, conservatorship, health care representation, power of attorney, court orders, probation and parole information, or any other legal restriction on the rights of the individual (if applicable);(I)
Written documentation to explain why preferences or choices of the individual may not be honored at that time;(J)
A copy of the most recent ISP or Service Agreement, Behavior Support Plan, and assessment (if available);(K)
Information related to the lifestyle, activities, and other choices and preferences; and(L)
Documentation of financial resources.(4)
VOLUNTARY TRANSFERS AND EXITS.(a)
A provider must promptly notify the case manager if an individual or the legal or designated representative of the individual gives notice of the intent to exit or abruptly exits services.(b)
A provider must notify the case manager prior to the voluntary transfer or exit of an individual from services.(c)
Notification and authorization of the voluntary transfer or exit of the individual must be documented in the record for the individual.(5)
INVOLUNTARY REDUCTIONS, TRANSFERS, AND EXITS.(a)
A provider must only reduce, transfer, or exit an individual involuntarily for one or more of the following reasons:(A)
The behavior of the individual poses an imminent risk of danger to self or others;(B)
The individual experiences a medical emergency;(C)
The service needs of the individual exceed the ability of the provider;(D)
The individual fails to pay for services; or(E)
The certification or endorsement for the provider described in OAR chapter 411, division 323 is suspended, revoked, not renewed, or voluntarily surrendered.(b)
NOTICE OF INVOLUNTARY REDUCTION, TRANSFER, OR EXIT. A provider must not reduce services, transfer, or exit an individual involuntarily without 30 days advance written notice to the individual, the legal or designated representative of the individual (as applicable), and the case manager, except in the case of a medical emergency or when an individual is engaging in behavior that poses an imminent danger to self or others as described in subsection (c) of this section.(A)
The written notice must be provided on the Notice of Involuntary Reduction, Transfer, or Exit form approved by the Department and include:(i)
The reason for the reduction, transfer, or exit; and(ii)
The right of the individual to a hearing as described in subsection (d) of this section.(B)
A Notice of Involuntary Reduction, Transfer, or Exit is not required when an individual requests the reduction, transfer, or exit.(c)
A provider may give less than 30 days advance written notice only in a medical emergency or when an individual is engaging in behavior that poses an imminent danger to self or others. The notice must be provided to the individual, the legal or designated representative of the individual (as applicable), and the case manager immediately upon determination of the need for a reduction, transfer, or exit.(d)
HEARING RIGHTS. An individual must be given the opportunity for a hearing under ORS Chapter 183 (Administrative Procedures Act) and OAR 411-318-0030 (Contested Case Hearings for Provider Notices of Involuntary Reductions, Transfers, or Exits) to dispute an involuntary reduction, transfer, or exit. If an individual or the legal or designated representative of the individual requests a hearing, the individual must receive the same services until the hearing is resolved. When an individual has been given less than 30 days advance written notice of a reduction, transfer, or exit as described in subsection (c) of this section and the individual has requested a hearing, the provider must reserve service availability for the individual until receipt of the Final Order.(6)
EXIT MEETING. A provider must participate in an exit meeting before any decision to exit an individual is made if required by the case management entity.(7)
TRANSFER MEETING.A provider must participate in a transfer meeting before any decision to transfer an individual is made if required by the case management entity.
Source:
Rule 411-328-0790 — Entry, Exit, and Transfer, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-328-0790.