Or. Admin. Code § 411-015-0008

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-015-0008 - Assessments

(1) ASSESSMENT.

(a) The assessment process:

(A) Identifies an individual's ability to fully perform in a safe and dignified manner, comparable with how tasks would be performed by an individual not receiving Long Term Care Services and Supports (LTSS), the tasks described within activities of daily living in OAR 411-015-0006 and instrumental activities of daily living in OAR 411-015-0007;

(B) Determines an individual's ability to address health and safety concerns; and

(C) Includes an individual's preferences to meet service needs.

(b) A case manager must conduct an assessment in accordance with the standards of practice established by the Department.

(c) A case manager must assess an individual's abilities, regardless of architectural modifications, assistive devices, or services provided in a care setting, alternative service resources, or other community providers.

(d) The time frame of reference for evaluation is 30 days prior to the assessment date, with consideration of how the individual is likely to function in the 30 days following the assessment date.

(A) To be eligible, an individual must demonstrate the need for assistance of another person within the assessment time frame and expect the need to be on-going beyond the assessment time frame.

(B) The time frame for assessing the cognition activity of daily living may be extended as described in OAR 411-015-0006.

(e) The assessment must be conducted at least annually, or when requested by an individual, using a standardized assessment tool, approved by a Department case manager, or other qualified Department or AAA representative.

(f) The initial assessment must be conducted face to face in an individual's home or care setting.

(g) All re-assessments must be conducted face to face in an individual's home or care setting unless there is a compelling reason to meet elsewhere and the individual requests an alternative location. Case managers must visit an individual's home or care setting to complete the re-assessment and identify service plan needs, as well as safety and risk concerns.

(A) Individuals must be sent a notice of the need for re-assessment a minimum of 14 days in advance.

(B) Re-assessments requested by an individual or their representative or based on a change in the individual's condition or service needs, are exempt from the 14-day advance notice requirement.

(h) An individual may request the presence of any person of their choice at any assessment.

(i) Assessment times must be scheduled within business days and hours unless extraordinary circumstances necessitate an alternate time. If an alternate time is necessary, an individual must request the after-hours appointment, and coordinate a mutually acceptable appointment time with the local Department or AAA office.

(j) An individual, or the individual's representative, has the responsibility to participate in and provide information necessary to, complete assessments and re-assessments within the time frame requested by the Department.

(A) Failure to participate in the assessment or re-assessment process or to provide requested assessment or re-assessment information within the application time frame results in a denial of service eligibility.

(B) The Department may allow additional time if circumstances beyond the control of the individual, or the individual's representative, prevent timely participation or submission of information.

(2) SERVICE PLAN.

(a) An individual being assessed, others identified by the individual, and a case manager must consider the service options as well as assistive devices, architectural modifications, and other alternative service resources as defined in OAR 411-015-0005 to meet the individual's service needs identified in the assessment process.

(b) A case manager is responsible for:

(A) Determining eligibility for specific services;

(B) Presenting service options, resources, and alternatives to an individual to assist the individual in making informed choices and decisions;

(C) Identifying goals, preferences, and risks; and

(D) Assessing the cost effectiveness of an individual's service plan.

(c) A case manager must monitor the service plan and make adjustments as needed.

(d) An eligible individual, or the individual's representative, is responsible for choosing and assisting in developing less costly service alternatives.

(e) The service plan payment must be considered full payment for home and community-based services rendered to Medicaid or Healthier Oregon recipients. Under no circumstances, may any provider demand or receive additional payment for home and community-based services authorized by the Department from an eligible individual or any other source.

Or. Admin. Code § 411-015-0008

SPD 19-2006, f. 5-26-06, cert. ef. 6-1-06; SPD 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SPD 45-2013, f. 12-13-13, cert. ef. 12-15-13; APD 35-2014, f. & cert. ef. 10-1-14; APD 12-2018, temporary amend filed 05/23/2018, effective 05/23/2018 through 11/18/2018; APD 39-2018, amend filed 11/15/2018, effective 11/18/2018; APD 25-2022, temporary amend filed 06/14/2022, effective 7/1/2022 through 12/27/2022; APD 58-2022, amend filed 12/22/2022, effective 12/23/2022

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.070