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)(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]
Notes of Decisions
Agency rules making placement of handicapped and elderly persons factor of their primary service needs and providing for different residential facilities to accommodate persons with different needs were consistent with provisions of this chapter in effect at time petitioner, who was mentally retarded, was refused placement at facility which primarily served elderly. Dempsey v. Senior Services Division, 92 Or App 163, 758 P2d 367 (1988)