Or. Admin. Code § 411-016-0010

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

Section 411-016-0010 - [Effective until 11/26/2024] Scope of OPI-M Services Case Management

(1) Services Case Managers are responsible for:

(a) Person-centered service plan development including goals, preferences and plan monitoring;

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

(c) Risk assessment and monitoring, including:

(A) Identifying and documenting risks;

(B) Working with an individual to eliminate or reduce risks;

(C) Developing and implementing a Risk Mitigation Plan;

(D) Monitoring risks at least quarterly and more frequently if needed; and

(E) Adjusting an individual's person-centered service plan as needed.

(d) Other program coordination such as helping an individual navigate or coordinate with other social, health, and assistance programs;

(e) Assisting with crisis response and intervention such as participating in problem resolution with an individual or the individual's representative;

(f) Authorizing services to meet the service choices, assessed need and preferences of the individual, considering natural supports and other alternative service resources and service plan related notifications;

(g) Service provision issues such as assisting an individual with problem solving to resolve providers, services or hours issues that do not meet the individual's needs;

(h) Documentation of changes in condition, service plan adjustments and reasons for adjustments, service alternatives, completion of required forms and other service plan case management requirements including narration; and,

(i) Completing an Unpaid Caregiver assessment if Community Caregiver Supportive Services or Caregiver Education and Training is requested.

(2) Fiscal Intermediary Responsibilities: Services case managers are responsible for the following tasks if fiscal intermediary services are available:

(a) Enrolling the individual into fiscal intermediary services;

(b) Coordinating and reviewing benefit expenditures;

(c) Resolving payment issues with fiscal intermediary; and

(d) Problem solving and monitoring fiscal intermediary services defined in provider contracts.

(3) Case management services must meet the conflict-free case management expectations. When the only willing and qualified provider organization provides both case management and direct services, Department approved firewalls must be in place and followed to ensure a separation of functions within the organization. Conflict-free case management protects against conflicts of interest, fraud and misuse of funding to benefit a provider.

Or. Admin. Code § 411-016-0010

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065