ORS 410.605
Private pay home care worker program

  • rules

(1)

This section establishes a program, administered by the Home Care Commission, to enable private individuals to purchase home care services from the commission through the home care registry. The commission shall administer the program in a manner that:

(a)

Builds and strengthens the home care workforce that provides home care services to medical assistance recipients by offering home care workers the opportunity to obtain additional work from private payers and by attracting additional home care workers to the home care registry;

(b)

Provides an opportunity for the rapidly growing population of elderly individuals and individuals with disabilities in this state, who are not eligible for medical assistance, to obtain high quality and affordable home care services from qualified, committed, experienced and well-trained home care workers;

(c)

Protects medical assistance recipients’ access to and receipt of home care services; and

(d)

Ensures that this state incurs no liability for the costs of home care services purchased by private payers through the program, or for any other associated program costs, that exceed the amount of revenue generated by the payments described in subsection (5) of this section.

(2)

The commission shall establish by rule the types and scope of home care services or other services that may be offered through the program. The commission shall make available to consumers and potential consumers of home care services, information about the scope of the services offered through the program, about the long term care services and support that are not available through the program and about other community resources that are available to individuals seeking long term care services and support.

(3)

The commission shall adopt standards for home care services offered through the program. The standards, to the greatest extent practicable, shall be compatible with the standards for home care services reimbursed as medical assistance and by in-home care agencies licensed under ORS 443.315 (License required).

(4)

Private payers purchasing home care services through the program must complete a standard assessment instrument prescribed by the commission that evaluates the capacity and willingness of the individual receiving services, or a person selected by the individual to act on the individual’s behalf, to effectively manage and direct the home care services. A private payer and a private pay home care worker must enter into a written service plan based on the assessment instrument that is consistent with the private pay home care worker’s capabilities, training and experience. The standard assessment instrument must be completed prior to the commencement of services.

(5)

The commission shall establish payment rates for home care services purchased by private payers through the home care registry and shall publish the rates online, showing the projected cost of each component included in calculating the payment rates. The commission shall establish the rates at levels expected to generate total revenue sufficient to reimburse up to 107 percent of the costs associated with the program including, but not limited to, the costs for:

(a)

Screening, registering and training private pay home care workers and maintaining and expanding the home care registry;

(b)

Hiring additional staff;

(c)

Providing referrals of private pay home care workers to private payers;

(d)

Paying the private pay home care workers’ wages;

(e)

Paying payroll taxes;

(f)

Paying for health insurance and employee benefits, either directly or through a trust account;

(g)

Processing payments from private payers and payments to private pay home care workers;

(h)

Paying workers’ compensation and unemployment insurance;

(i)

Publicizing the availability of the home care registry; and

(j)

Other activities undertaken to ensure the quality of private pay home care workers, the adequate provision of home care services and other administrative expenses associated with the program.

(6)

A private payer who purchases home care services through the program shall pay the commission in advance for the services.

(7)

The commission shall establish the wage rates, pay the wages and provide for employee benefits for private pay home care workers. A private pay home care worker may not accept any additional compensation for hours of work that were compensated by the program.

(8)

Private pay home care workers are subject to the same requirements as home care workers providing services reimbursed as medical assistance with respect to:

(a)

Home care worker qualifications;

(b)

Application and enrollment in the home care registry; and

(c)

Suspension or termination of enrollment in the registry.

(9)

The commission may specify requirements and procedures, in addition to those described in subsection (8) of this section, for private pay home care workers.

(10)

The commission, with the assistance of the Department of Human Services, may conduct periodic evaluations of private pay home care workers, or take other measures to determine whether the private pay home care workers continue to meet provider enrollment requirements or for other appropriate purposes.

(11)

Intentionally left blank —Ed.

(a)

If revenue generated by the payments described in subsection (5) of this section is insufficient to pay the costs of home care services purchased by private payers through the program, and other costs associated with administering the program, the commission may modify the payment rates described in subsection (5) of this section as necessary to generate sufficient revenue to pay the costs.

(b)

If the commission determines that modifying the payment rates will not generate sufficient revenue to pay the costs of the program, the commission may suspend the program following 30 days advance written notice to private payers and home care workers participating in the program.

(c)

If the commission suspends the program under paragraph (b) of this subsection, the commission shall report to the Legislative Assembly in the manner provided in ORS 192.245 (Form of report to legislature), no later than 30 days after the suspension begins:

(A)

The reasons for the suspension;

(B)

Any costs incurred by this state that exceed the revenue generated by the payments described in subsection (5) of this section; and

(C)

Any additional costs, during the remainder of the biennium in which the suspension occurs, that are anticipated to exceed the revenue generated by the payments described in subsection (5) of this section. [2014 c.116 §2]

Source: Section 410.605 — Private pay home care worker program; rules, https://www.­oregonlegislature.­gov/bills_laws/ors/ors410.­html.

410.010
State policy for seniors and people with disabilities
410.020
Implementation of state policy
410.030
Legislative findings on long term care options
410.040
Definitions for ORS 410.040 to 410.300, 410.320 and 410.619
410.050
General policy
410.060
Policy for persons with disabilities served by department
410.065
Comprehensive plan for long term care system
410.070
Duties of Department of Human Services
410.072
Determination of annual budget levels for type B area agencies
410.074
Consultation with representatives of type B area agencies on rules establishing methodology
410.075
Authority of department and Oregon Health Authority to hold title to property
410.080
Department as single state agency for specified federal programs
410.090
Department to implement supportive social services for persons age 60 and older
410.100
When department to administer area agency programs
410.120
Senior and Disabled Services Account
410.140
Records
410.150
Use of files
410.160
Limitation on estate claims
410.180
Long term care reimbursement audit manual
410.190
Representation of entities in contested case proceedings before department
410.210
Area agency advisory councils
410.220
Use of state and local resources
410.230
Expenditure of local funds not required
410.240
Operation of type A agencies
410.250
Duties of type A agencies
410.270
Operation of type B agencies
410.280
Duties of type B agencies
410.290
Conditions for designation as type B agency
410.295
Authority of type B agency to regulate adult foster homes
410.300
Transfer of state employees to type B agency
410.320
Governor’s Commission on Senior Services
410.330
Legislator members
410.340
Appointments to fill vacancies
410.410
Definitions for ORS 410.410 to 410.480
410.420
Use of funds for specified services
410.422
Oregon Project Independence Fund
410.425
Separate accounts for persons age 60 and over and for persons with Alzheimer’s disease or related disorders
410.430
Eligibility for authorized services
410.435
Expansion of Oregon Project Independence
410.440
Priorities for services
410.450
Determinations of eligibility
410.460
Computation of allowable costs
410.470
Fees
410.480
Required record keeping
410.485
Legislative findings
410.490
Duties of department
410.495
Registry for adult day care programs in state
410.505
Definitions for ORS 410.505 to 410.545
410.510
Establishment of procedure for assessment
410.515
Notice of availability of admission assessment services
410.520
When assessment to occur
410.525
Disclosure of fees
410.530
Department authority
410.535
Rules
410.540
Compliance as condition for licensure
410.545
Implementation of ORS 410.505 to 410.545 requires federal funding
410.550
Medicaid Long Term Care Quality and Reimbursement Advisory Council
410.555
Submission of changes to Medicaid reimbursement system to council
410.595
Legislative intent and findings
410.596
Statewide plan to expand access to skilled home care and personal support workforce
410.598
Training and testing for home care workers and personal support workers
410.600
Definitions for ORS 410.595 to 410.625
410.602
Home Care Commission
410.603
Developmental Disabilities and Mental Health Committee
410.604
Duties of commission
410.605
Private pay home care worker program
410.606
Referral of qualified individuals on home care registry
410.607
Home care and personal support worker classifications and payment rates
410.608
Selection of home care or personal support worker
410.612
Collective bargaining
410.614
Rights of home care and personal support workers
410.619
Home care and personal support workers not state employees
410.625
Authority of commission
410.631
Noncompetition agreements voidable by home care worker and personal support worker
410.632
Certain covenants between employer and home care worker or personal support worker voidable by worker
410.710
State policy on persons with disabilities
410.715
Person suffering brain injury to be considered person with disability
410.720
Mental health and addiction services for senior citizens and persons with disabilities
410.730
Self-Sufficiency Trust Fund
410.732
Disabilities Trust Fund
410.740
Oregon Deaf and Hard-of-Hearing Services Program
410.851
Policy on patient-based reimbursement system for long term care facilities
410.890
Civil penalty
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