OAR 411-435-0030
General Eligibility for Ancillary Services
(1)
To be eligible for ancillary services an individual must:(a)
Be an Oregon resident.(b)
Be enrolled at a CDDP, a Brokerage, or a CIIS program.(c)
Be receiving 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).(d)
Be determined to meet the level of care as defined in OAR 411-415-0020 (Definitions and Acronyms).(e)
Demonstrate a need for the ancillary service.(f)
POST ELIGIBILITY TREATMENT OF INCOME. For individuals with excess income, contribute to the cost of service pursuant to OAR 461-160-0610 (Client Liability; OSIPM (except OSIPM-EPD)) and OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM).(g)
For services available through the Community First Choice State Plan Amendment or a 1915(c) waiver, participate in a functional needs assessment and provide information necessary to complete the functional needs assessments and reassessments within the time frame required by the Department.(A)
Failure to participate in the functional needs assessment or to provide information necessary to complete the functional needs assessment or reassessment within the applicable time frame results in the denial of service eligibility. In the event service eligibility is denied, a written Notification of Planned Action must be provided as described in OAR chapter 411, division 318.(B)
The Department may allow additional time if circumstances beyond the control of the individual or legal representative prevent timely participation in the functional needs assessment or timely submission of information necessary to complete the functional needs assessment or reassessment.(h)
A child receiving direct assistance funds under family support as described in OAR 411-305-0120 is not eligible to receive ancillary services.(2)
Additional service limits are described in these rules.(3)
Individuals who meet the general eligibility criteria described in this rule may be eligible for services equivalent to the services described in these rules from a residential program when the individual is enrolled to one through the program’s all-inclusive rate.
Source:
Rule 411-435-0030 — General Eligibility for Ancillary Services, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-435-0030.