OAR 411-450-0060
Community Living Supports

(1) Department funds may be used to purchase the following community living supports available through the Community First Choice state plan:
(a) Attendant care as described in section (2) of this rule.
(b) Skills training as described in section (3) of this rule.
(c) Relief care as described in section (4) of this rule.
(2) ATTENDANT CARE SERVICES. Attendant care services include direct support provided to an individual in the home or community of the individual by a qualified provider. ADL and IADL services provided through attendant care must be necessary to permit an individual to live independently in a community-based setting.
(a) ADL services include, but are not limited to the following:
(A) Basic personal hygiene - providing or assisting with needs such as bathing (tub, bed, bath, shower), hair care, grooming, shaving, nail care, foot care, dressing, skin care, or oral hygiene.
(B) Toileting, bowel, and bladder care - assisting to and from the bathroom, on and off toilet, commode, bedpan, urinal, or other assistive device used for toileting, changing incontinence supplies, following a toileting schedule, managing menses, cleansing an individual or adjusting clothing related to toileting, emptying a catheter, drainage bag, or assistive device, ostomy care, or bowel care.
(C) Mobility, transfers, and repositioning - assisting with ambulation or transfers with or without assistive devices, turning an individual or adjusting padding for physical comfort or pressure relief, or encouraging or assisting with range-of-motion exercises.
(D) Eating - assisting with adequate fluid intake or adequate nutrition, assisting with food intake (feeding), monitoring to prevent choking or aspiration, assisting with adaptive utensils, cutting food, and placing food, dishes, and utensils within reach for eating.
(E) Cognitive assistance or emotional support provided to an individual due to an intellectual or developmental disability - helping the individual cope with change and assisting the individual with decision-making, reassurance, orientation, memory, or other cognitive functions.
(b) IADL services include, but are not limited to the following:
(A) Light housekeeping tasks necessary to maintain an individual in a healthy and safe environment - cleaning surfaces and floors, making their bed, cleaning dishes, taking out the garbage, dusting, and laundry.
(B) Grocery and other shopping necessary for the completion of other ADL and IADL tasks.
(C) Meal preparation and special diets.
(D) Support with participation in the community:
(i) Support with community participation - assisting an individual in acquiring, retaining, and improving skills to use available community resources, facilities, or businesses, and improving self-awareness and self-control.
(ii) Support with communication - assisting an individual in acquiring, retaining, and improving expressive and receptive skills in verbal and non-verbal language, social responsiveness, social amenities, and interpersonal skills, and the functional application of acquired reading and writing skills.
(c) Assistance with ADL, IADL, and health-related tasks may include cueing, monitoring, reassurance, redirection, set-up, hands-on, or standby assistance. Assistance may be provided through human assistance or the use of electronic devices or other assistive devices. Assistance may also require verbal reminding to complete any of the IADL tasks described in subsection (b) of this section.
(A) “Cueing” means giving verbal, audio, or visual clues during an activity to help an individual complete the activity without hands-on assistance.
(B) “Hands-on” means a provider physically performs all or parts of an activity because an individual is unable to do so.
(C) “Monitoring” means a provider observes an individual to determine if assistance is needed.
(D) “Reassurance” means to offer an individual encouragement and support.
(E) “Redirection” means to divert an individual to another more appropriate activity.
(F) “Set-up” means the preparation, cleaning, and maintenance of personal effects, supplies, assistive devices, or equipment so an individual may perform an activity.
(G) “Stand-by” means a provider is at the side of an individual ready to step in and take over the task if the individual is unable to complete the task independently.
(d) For a child, the primary caregiver is expected to be present or available during the provision of attendant care. ADL and IADL services provided through attendant care must support the child to live as independently as appropriate for the age of the child and support, but not supplant, the family in their primary caregiver role.
(e) DAY SUPPORT ACTIVITIES.
(A) DSA must include a focus on competencies around the IADLs identified in section (2)(b)(D) of this rule or be a class.
(B) DSA requires that an individual have a measurable goal documented in the individual’s ISP that is related to developing or maintaining skills for participating in the community.
(C) DSA may only be delivered by a provider qualified to deliver community living supports under OAR 411-450-0070 (Community Living Supports Providers and Provider Requirements)(2), (4), (5), or (6).
(D) DSA must meet staffing requirements specified in an individual’s ISP or Service Agreement. Direct service staff must be present in sufficient number to meet health, safety, and service needs. DSA may not be delivered at the same time to more than eight individuals per agency staff member.
(E) Department approval is required to authorize DSA for individuals under age 18 and is only possible when IDEA services are not available.
(F) Facility-based DSA must, at minimum, provide on-going opportunities and encouragement to individuals for going out into the broader community.
(3) SKILLS TRAINING. Skills training is specifically tied to accomplishing ADL, IADL, and other health-related tasks as identified by the functional needs assessment and ISP and permitting an individual to live independently in a community-based setting.
(a) Skills training may be applied to the use and care of assistive devices and technologies.
(b) Skills training is authorized when:
(A) The anticipated outcome of the skills training, as documented in the ISP, is measurable.
(B) Timelines for measuring progress towards the anticipated outcome are established in the ISP.
(C) Progress towards the anticipated outcomes are measured and the measurements are evaluated by a case manager no less frequently than every six months, based on the start date of the initiation of the skills training.
(c) When anticipated outcomes are not achieved within the timeframe outlined in the ISP, the case manager must reassess or redefine the use of skills training with the individual for that particular goal.
(d) For a child, the primary caregiver is expected to be present or available during the provision of skills training. ADL and IADL services provided through skills training must support the child to live as independently as appropriate for the age of the child and support, but not supplant, the family in their primary caregiver role.
(e) Skills training may not replace or supplant the services of the educational system in fulfilling its obligation to educate an individual.
(4) RELIEF CARE.
(a) Relief care may not be characterized as daily or periodic services provided solely to allow a primary caregiver to attend school or work. Daily relief care may be provided in segments that are sequential.
(b) Relief care may be provided in any of the following:
(A) The home of an individual.
(B) A licensed or certified setting.
(C) The home of a qualified provider, chosen by the individual or their representative, that is a safe setting for the individual.
(D) The community, during the provision of ADL, IADL, health-related tasks, and other supports identified in the ISP for the individual.
(c) No other community living supports may be provided to an individual during a 24-hour unit of daily relief care.
(5) Community living supports may be delivered:
(a) Individually or in a group as indicated by the outcome of the person-centered planning process for the individual.
(b) In the home, community, or a facility.
(A) Community living supports are facility-based if delivered at a fixed site outside of the home of the individual operated, owned, or controlled by a service provider.
(B) DSA may not be provided in a residential setting.
(6) SETTING LIMITATIONS.
(a) An individual who lives in their own home or family home is eligible for the community living supports described in these rules for which the individual has an assessed need and the person-centered planning process determines to be appropriate unless:
(A) The Department determines the health and safety of the individual may not be reasonably assured through the delivery of community living supports; or
(B) Dangerous conditions in the service setting jeopardize the health or safety of the individual or provider, and the individual, or their legal or designated representative, is unable or unwilling to implement necessary safeguards to minimize the dangers.
(b) An individual enrolled to a residential program, an adult foster home licensed under OAR chapter 411, division 049, or an assisted living facility licensed under OAR chapter 411, division 054 is not eligible for the following:
(A) Community living supports provided by a personal support worker.
(B) Community living supports delivered in the home of the individual, whether the home is a licensed setting or not.
(C) Relief care.
(c) A child living in a Behavior Rehabilitation Services (BRS) program as described in OAR 410-170-0000 (Administration of the Behavior Rehabilitation Services (BRS) Program) through 410-170-0120 (Compliance Reviews and Sanctions), or Psychiatric Residential Treatment Services (PRTS) as defined in OAR 309-022-0105 (Definitions), is not eligible for community living supports.
(7) SERVICE LIMITS.
(a) All community living supports must be authorized in an ISP as described in OAR 411-415-0070 (Service Planning).
(b) For an individual residing in their own home or family home, the amount of community living supports in any plan year is limited to the service level determined by an ANA-C for an adult, or CNA-C for a child, when conducted as described in the ANA/CNA Manual.
(c) If an individual was receiving community living supports on October 31, 2016, the service level for that individual is the higher service level of:
(A) The service level in place on October 31, 2016; or
(B) The highest service level determined by an ANA or CNA after October 31, 2016.
(d) An increase in service level must be based on a reassessment.
(e) The Department may approve a request for a temporary increased service level when an individual requires an additional number of hours to respond to the Coronavirus (COVID-19) pandemic. When the federally declared public health emergency is ended, service levels must be reduced to the number of hours available immediately prior to the increase granted under this subsection. The Department shall provide individuals with a Notification of Planned Action as described in OAR 411-318-0020 (Notification of Planned Action), including the opportunity for a hearing according to ORS chapter 183 and OAR 411-318-0025 (Contested Case Hearings for Reductions, Suspensions, Terminations, or Denials).
(f) An individual’s service level may not be reduced below the service level in place on October 31, 2016.
(g) The ANA-C or CNA-C determines the following:
(A) The service level. The service level may not be exceeded without prior approval from the Department. The service level applies to hours used for the following:
(i) Attendant care as described in this rule.
(ii) Skills training as described in this rule.
(iii) State plan personal care service hours as described in OAR chapter 411, division 455.
(B) The staffing level. The need for two staff to be available simultaneously to provide community living supports to an individual. When such a need is identified, the ANA-C or CNA-C determines the maximum number of hours two staff may be simultaneously available.
(h) The Department may approve a service level or staffing level greater than was determined by the ANA-C or CNA-C if the individual is unable to have their support needs met within the assessed service level because the individual has:
(A) Intermittent needs that cannot be scheduled that must be met throughout the day to keep the individual healthy and safe;
(B) A specific support that takes an exceptional amount of time and there is justification of the amount of time needed; or
(C) Support needs that must be met in order to prevent a serious risk of institutionalization.
(i) The Department may put limits on how Department funds and resources are used, as long as those limited funds and resources are adequate to meet the needs of the individual.
(j) For an individual enrolled in a residential program, an adult foster home licensed under OAR chapter 411, division 049, or an assisted living facility licensed under OAR chapter 411, division 054, receipt of any combination of job coaching, supported employment - small group employment support, employment path services, and DSA may not exceed 25 hours per week. Individuals residing in these settings who do not receive employment services, may receive up to 25 hours of DSA per week.
(k) No more than 14 days of relief care in a plan year are allowed without approval from the Department. Each day of respite services described in and provided under OAR 411-070-0043 (Pre-Admission Screening and Resident Review (PASRR))(5) contributes to the 14 day limit for relief care.

Source: Rule 411-450-0060 — Community Living Supports, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-450-0060.

Last Updated

Jun. 8, 2021

Rule 411-450-0060’s source at or​.us