OAR 411-455-0020
Eligibility
(1)
An individual may not be denied SPPC services or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws.(2)
To be eligible for SPPC services under these rules, an individual must meet the following requirements:(a)
Be receiving case management services through a Community Developmental Disabilities Program, a Brokerage, or Children’s Intensive In-Home Services.(b)
Be a current recipient of a medical assistance benefit package through OSIPM or the OCCS Medical Program, including CHIP, except for Cover All Kids as defined in OAR 410-200-0015 (General Definitions).(c)
Require assistance from a qualified provider with one or more ADL and IADL tasks described in OAR 411-455-0050 (Services) that are not met by alternative resources or the individual’s natural support system.(3)
An individual is not eligible to receive SPPC services under these rules if the individual:(a)
Is receiving assistance with personal care from a residential program or residential setting as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services).(b)
Is in a hospital, sub-acute care facility, nursing facility, other medical institution, a local correctional facility (as defined in ORS 169.005 (Definitions for ORS 169.005 to 169.685 and 169.730 to 169.800)), a Department of Corrections institution (as defined in ORS 421.005 (Definitions)), or a youth correction facility (as defined in ORS 162.135 (Definitions for ORS 162.135 to 162.205)).(c)
Has assessed personal care needs that are met through alternative resources or natural supports, as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services), available to the individual.(d)
Has assessed personal care needs that are being met under other Medicaid-funded home and community-based service options of the individual’s choosing.(e)
Is receiving benefits through the Department’s Self-Sufficiency Programs (SSP), Aging and People with Disabilities (APD) or Area Agency on Aging (AAA), and not case management services through a Brokerage, Community Developmental Disabilities Program, or Children’s Intensive In-Home Services.(f)
Is eligible for behavioral health personal care attendant services through the Oregon Health Authority’s Community Mental Health Programs as described in OAR 410-172-0780 (Behavioral Health Personal Care Attendant Program).(g)
Is eligible for personal care services through the Department’s Child Welfare programs as described in OAR 413-090-0130 (Personal Care Services Eligibility).(4)
SPPC services are not intended to:(a)
Replace natural supports as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services) that are available to an individual.(b)
Replace supports that are typical for a parent or guardian to provide to a child of the same age.(c)
Benefit an individual’s family members or the individual’s household in general.(5)
SPPC services must not duplicate other Medicaid services.(6)
The Department or case management entity has the authority to terminate an individual’s eligibility for SPPC services provided under these rules when any of the following occurs:(a)
The individual is no longer eligible for SPPC services for any reason described in sections (2) through (4) of this rule.(b)
The individual is exited from case management as described in OAR 411-415-0030 (Eligibility for Case Management Services - Entry, Exit, Transfers).(c)
The individual fails to employ a provider that meets the requirements in OAR 411-455-0060 (Standards for Providers).(7)
When SPPC services are denied, reduced, suspended, or terminated, a written Notification of Planned Action (form 0947) must be provided as described in OAR 411-318-0020 (Notification of Planned Action), and other options of developmental disabilities services, as described in OAR 411-415-0070 (Service Planning)(9), must be offered to the individual.
Source:
Rule 411-455-0020 — Eligibility, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-455-0020.