OAR 411-455-0030
Needs Assessment, Service Authorization, and Monitoring
(1)
A case manager must provide case management services as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services) consistent with the standards described in OAR 411-415-0050 (Standards for Case Management Services). Documentation for SPPC services must be in accordance with OAR 411-415-0110 (Record Requirements).(2)
NEEDS ASSESSMENT. A case manager must meet in-person with an individual initially and at least every 12 months to determine the individual’s eligibility for SPPC services or other developmental disabilities services, assess the individual’s level of assistance for SPPC, and identify resources meeting any of the individual’s personal care needs, including assistive devices or assistive technology.(a)
The assessment to determine the individual’s needs for SPPC services must be conducted by a case manager using the SPPC Needs Assessment prior to the individual receiving SPPC services.(b)
The individual, or their designated representative as applicable, may invite others to participate in the assessment.(c)
When authorizing SPPC services along with other developmental disabilities services as described in OAR 411-415-0070 (Service Planning)(9), except for family support services, a functional needs assessment is required and must be conducted in accordance with OAR 411-415-0060 (Assessment Activities).(3)
SERVICE AUTHORIZATION. A case manager may authorize SPPC services on an ISP or SPPC Service Authorization Plan (form 2796).(a)
Authorization must be:(A)
Based on an individual’s SPPC Needs Assessment described in section (2) of this rule.(B)
Calculated for up to a maximum of 270 hours per year, averaging 22 hours per month, when an individual is determined eligible unless an exception is authorized in accordance with OAR 411-455-0040 (Exceptions).(C)
Consistent with the service planning standards described in OAR 411-415-0070 (Service Planning).(b)
Authorized SPPC services:(A)
May be scheduled throughout the month to meet the support needs of an individual.(B)
Are reimbursed after services are delivered by a provider meeting the standards in OAR 411-455-0060 (Standards for Providers) as identified in an individual’s ISP or a SPPC Service Authorization Plan (form 2796) and included in a Service Agreement (form 4606).(c)
When using an ISP to authorize SPPC services, a case manager must follow the standards for the development and implementation of an ISP in accordance with OAR 411-415-0070 (Service Planning).(d)
When using a SPPC Service Authorization Plan, a case manager must provide documentation of the following:(A)
Name and provider number of the individual’s qualified provider who is to deliver the authorized SPPC services.(B)
Date when the provision of SPPC services is to begin, which is:(i)
The date when the individual has been determined eligible for SPPC services in accordance with OAR 411-455-0020 (Eligibility), and through the needs assessment process as described in section (2) of this rule; and(ii)
When a provider has been determined qualified and is enrolled in accordance with OAR 411-455-0060 (Standards for Providers) to start providing authorized SPPC services.(C)
Date when the SPPC Service Authorization Plan is to end, which must be within 12 months of the assessment date.(D)
Maximum hours and types of SPPC services authorized per month to meet the individual’s unmet support needs.(E)
Signature of the case manager authorizing the SPPC Service Authorization Plan and the date signed.(F)
Signature of the individual, or their designated representative as applicable, acknowledging the SPPC Service Authorization Plan and the date signed.(4)
MONITORING. A case manager must provide ongoing case management services as defined in OAR 411-317-0000 (General Definitions and Acronyms for Developmental Disabilities Services) consistent with the standards described in OAR 411-415-0050 (Standards for Case Management Services).(a)
The case manager must provide assistance to an individual, or their legal or designated representative as applicable, with monitoring and improving the quality of supports to assure:(A)
There is no change in the individual’s eligibility for SPPC services as described in OAR 411-455-0020 (Eligibility).(B)
SPPC services are effectively implemented and adequately meeting the assessed support needs of the individual.(b)
When there is an indication that an individual’s level of assistance has changed, the case manager must review the current SPPC service authorization and conduct an in-person reassessment in accordance with section (2) of this rule.(c)
Following an annual reassessment and a reassessment conducted after a change of an individual’s level of assistance, the case manager:(A)
May adjust the hours or SPPC services;(B)
Must authorize the adjusted hours or services on an ISP or SPPC Service Authorization Plan (form 2796) based on the individual’s current assessed level of assistance, if appropriate, as described in section (3) of this rule; and(C)
Must provide a Notification of Planned Action (form 0947) in accordance with OAR 411-455-0020 (Eligibility)(7) and OAR 411-318-0020 (Notification of Planned Action) if SPPC services are reduced, suspended, or terminated.(d)
To meet extraordinary support needs, an individual, or their legal or designated representative as applicable, may request an exception to the maximum monthly hour limitation in accordance with OAR 411-455-0040 (Exceptions).
Source:
Rule 411-455-0030 — Needs Assessment, Service Authorization, and Monitoring, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-455-0030.