OAR 461-155-0700
Special Need; Personal Incidentals and Room and Board Allowances; OSIPM
(1)
In the following circumstances, personal incidentals and room and board allowances may be paid for an individual to reside in a community based care facility (see OAR 461-155-0630 (Special Need; Community Based Care; OSIPM)) to avoid placement in a nursing facility or leave a nursing facility or an acute care hospital, when an individual meets the requirements of one of the following subsections:(a)
Is determined to be eligible based on a disability determination made by the Department (see OAR 461-125-0370 (Disability as the Basis of Need)).(A)
To receive this payment, the individual must pursue SSI by making application with the Social Security Administration (SSA) and appealing denials until SSA makes a final administrative decision. If SSI is denied at the final SSA administrative level, the individual is no longer eligible for this payment.(B)
The payment is the difference between the countable (see OAR 461-001-0000 (Definitions for Chapter 461)) income of the individual and the OSIPM program adjusted income standard (see OAR 461-155-0250 (Income and Payment Standard; OSIPM)).(b)
Is leaving a nursing facility and limited to a maximum SSI payment of $30 or to a maximum Veterans benefit payment of $90. The payment is the difference between the countable income of the individual and the OSIPM program adjusted income standard (see OAR 461-155-0250 (Income and Payment Standard; OSIPM)).(c)
Is a qualified non-citizen under OAR 461-120-0125 (Alien Status) who is not eligible for SSI due to not meeting the requirements to become a naturalized citizen within the SSI time limit.(A)
The individual must pursue naturalization.(B)
The payment is the difference between the countable income of the individual and the OSIPM adjusted income standard (see OAR 461-155-0250 (Income and Payment Standard; OSIPM)).(d)
Does not have sufficient income to divert to the community spouse (see OAR 461-001-0030 (Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care)) due to the difference between the personal needs allowance related to a nursing facility placement and the personal needs allowance and room and board related to a community based care facility placement. The allowance is issued only when the individual or community spouse requests or chooses a nursing facility placement rather than a community based care facility placement because the community spouse needs the resulting higher diversion amount to meet his or her monthly expenses.(A)
For all individuals, the allowance is the difference between the amount of the individual’s income that would be available to divert to the community spouse under a nursing facility placement and the amount of the individual’s income available under the community based care facility placement, using the liability calculation as outlined in OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM).(B)
For an individual whose income is less than the adjusted OSIPM program standard, the allowance is the amount calculated under paragraph (A) of this subsection plus the difference between the OSIPM program adjusted income standard and the individual’s countable income.(a)
The individual’s SSI must have been suspended due to placement in a public institution.(b)
The individual must pursue reinstatement of SSI, and verification must be provided to the Department.(c)
The payment is the difference between the countable income of the individual and the OSIPM Room and Board Standard (see OAR 461-155-0270 (Room and Board Standard; OSIPM)).(d)
If SSI is reinstated or reinstatement of SSI is denied, the individual is no longer eligible for this allowance.(3)
The payment amount is prorated in the first month for an individual who moves to a community based care facility on any day other than the first day of the month.
Source:
Rule 461-155-0700 — Special Need; Personal Incidentals and Room and Board Allowances; OSIPM, https://secure.sos.state.or.us/oard/view.action?ruleNumber=461-155-0700.