Or. Admin. Code § 411-450-0060

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

Section 411-450-0060 - [Effective until 11/26/2024] Community Living Supports

(1) Department funds may be used to purchase the following community living supports when included in an authorized ISP:

(a) Community living supports available through the Community First Choice state plan:

(A) Attendant care as described in section (2) of this rule.

(B) Skills training as described in section (3) of this rule.

(C) Relief care as described in section (4) of this rule.

(b) Community living supports available through the Children's Extraordinary Needs waiver:

(A) Attendant care as described in section (2) of this rule, excluding the day support activities described in subsection (2)(e).

(B) Skills training as described in section (3) of this rule.

(2) ATTENDANT CARE SERVICES. Attendant care services include direct support provided to an individual in the home or community of the individual by a qualified provider. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) services provided through attendant care must be necessary to permit an individual to live independently in a community-based setting.

(a) ADL services include, but are not limited to, the following:

(A) Basic personal hygiene. Providing or assisting with needs such as bathing (tub, bed, bath, shower), hair care, grooming, shaving, nail care, foot care, dressing, skin care, or oral hygiene.

(B) Toileting, bowel, and bladder care.

(i) Assisting to and from the bathroom or on and off toilet, commode, bedpan, urinal, or other assistive device used for toileting.

(ii) Changing incontinence supplies.

(iii) Following a toileting schedule.

(iv) Managing menses.

(v) Cleansing an individual or adjusting clothing related to toileting.

(vi) Emptying a catheter, drainage bag, or assistive device.

(vii) Ostomy care.

(viii) Bowel care.

(C) Mobility, transfers, and repositioning.

(i) Assisting with ambulation or transfers with or without assistive devices.

(ii) Turning an individual or adjusting padding for physical comfort or pressure relief.

(iii) Encouraging or assisting with range-of-motion exercises.

(D) Eating.

(i) Assisting with adequate fluid intake or adequate nutrition.

(ii) Assisting with food intake (feeding).

(iii) Monitoring to prevent choking or aspiration.

(iv) Assisting with adaptive utensils, cutting food.

(v) Placing food, dishes, and utensils within reach for eating.

(E) Cognitive assistance or emotional support provided to an individual due to an intellectual or developmental disability.

(i) Helping the individual cope with change.

(ii) Assisting the individual with decision-making, reassurance, orientation, memory, or other cognitive functions.

(b) IADL services include, but are not limited to, the following:

(A) Light housekeeping tasks necessary to maintain an individual in a healthy and safe environment.

(i) Cleaning surfaces and floors.

(ii) Making the individual's bed.

(iii) Cleaning dishes.

(iv) Taking out the garbage.

(v) Dusting.

(vi) Laundry.

(B) Grocery and other shopping necessary for the completion of other ADL and IADL tasks.

(C) Meal preparation and special diets.

(D) Support with participation in the community:

(i) Support with community participation. Assisting an individual in acquiring, retaining, and improving skills to use available community resources, facilities, or businesses, and improving self-awareness and self-control.

(ii) Support with communication. Assisting an individual in acquiring, retaining, and improving expressive and receptive skills in verbal and non-verbal language, social responsiveness, social amenities, and interpersonal skills, and the functional application of acquired reading and writing skills.

(c) Assistance with ADL, IADL, and health-related tasks may include cueing, monitoring, reassurance, redirection, set-up, hands-on, or standby assistance. Assistance may be provided through human assistance or the use of electronic devices or other assistive devices. Assistance may also require verbal reminding to complete any of the IADL tasks described in subsection (b) of this section.

(A) "Cueing" means giving verbal, audio, or visual clues during an ADL, IADL, or health-related task to help an individual complete the activity without hands-on assistance.

(B) "Hands-on" means a provider physically performs all or parts of an ADL, IADL, or health-related task because an individual is unable to do so.

(C) "Monitoring" means a provider observes an individual to determine if assistance is needed during the completion of an ADL, IADL, or health-related task.

(D) "Reassurance" means to offer an individual encouragement and support to complete an ADL, IADL, or health-related task.

(E) "Redirection" means to divert an individual to another more appropriate activity.

(F) "Set-up" means the preparation, cleaning, and maintenance of personal effects, supplies, assistive devices, or equipment so an individual may perform an ADL, IADL, or health-related task.

(G) "Stand-by" means a provider is at the side of an individual ready to step in and take over the ADL, IADL, or health-related task if the individual is unable to complete it independently.

(d) For a child, the child's primary caregiver is expected to be present or available during the provision of attendant care. ADL and IADL services provided through attendant care must support the child to live as independently as appropriate for the age of the child and support, but not supplant, the child's family in their primary caregiver role.

(e) DAY SUPPORT ACTIVITIES (DSA).

(A) DSA must include a focus on competencies around the IADLs identified in section (2)(b)(D) of this rule or be a class.

(B) DSA requires that an individual have a measurable goal documented in the individual's ISP that is related to developing or maintaining skills for participating in the community.

(C) DSA may only be delivered by a provider qualified to deliver community living supports according to OAR 411-450-0070(2) or (4).

(D) DSA must meet staffing requirements specified in an individual's ISP or Service Agreement. Direct service staff must be present in sufficient number to meet health, safety, and service needs. DSA may not be delivered at the same time to more than eight individuals per agency staff member.

(E) Department approval is required to authorize DSA for individuals under age 18. DSA is only possible when IDEA services are not available.

(F) Facility-based DSA must, at minimum, provide on-going opportunities and encouragement to individuals for going out into the broader community.

(G) An individual may access DSA at a 1:1 (or greater) staffing ratio if any of the following apply:

(i) The individual does not want to participate in a group activity, the DSA is authorized in the individual's ISP, and the individual has a desired outcome to support the DSA.

(ii) The support needs of the individual require a 1:1 (or greater) staffing ratio in a group activity.

(iii) The DSA occur without other individuals receiving paid services at the same time from the same provider agency and the individual has a desired outcome to support the DSA.

(H) A provider agency may not design or allow a group activity where 1:1 is provided but not necessary to support an individual.

(3) SKILLS TRAINING. Skills training is specifically tied to accomplishing ADL, IADL, and other health-related tasks as identified by a functional needs assessment and an ISP and permitting an individual to live independently in a community-based setting.

(a) Skills training may be applied to the use and care of assistive devices and technologies.

(b) Skills training is authorized when:

(A) The anticipated outcome of the skills training, as documented in the ISP, is measurable.

(B) Timelines for measuring progress towards the anticipated outcome are established in the ISP.

(C) Progress towards the anticipated outcomes are measured and the measurements are evaluated by a case manager no less frequently than every six months, based on the start date of the initiation of the skills training.

(c) When anticipated outcomes are not achieved within the timeframe outlined in an individual's ISP, the individual's case manager must reassess or redefine the use of skills training with the individual for that particular goal.

(d) For a child, the child's primary caregiver is expected to be present or available during the provision of skills training. ADL and IADL services provided through skills training must support the child to live as independently as appropriate for the age of the child and support, but not supplant, the child's family in their primary caregiver role.

(e) Skills training may not replace or supplant the services of the educational system in fulfilling its obligation to educate an individual.

(4) RELIEF CARE.

(a) Relief care may not be characterized as daily or periodic services provided solely to allow a primary caregiver to attend school or work. Daily relief care may be provided in segments that are sequential.

(b) Relief care may be provided in any of the following:

(A) The home of an individual.

(B) A licensed or certified setting.

(C) The home of a qualified provider, chosen by an individual or their legal or designated representative, that is a safe setting for the individual.

(D) The community, during the provision of ADL, IADL, health-related tasks, and other supports identified in an individual's ISP.

(c) No other community living supports may be provided to an individual during a 24-hour unit of daily relief care.

(5) Community living supports may be delivered:

(a) Individually or in a group as indicated by the outcome of the person-centered planning process for an individual.

(b) In an individual's home, community, or a facility.

(A) Community living supports are facility-based if delivered outside of an individual's home at a fixed site operated, owned, or controlled by a provider.

(B) DSA may not be provided in a residential setting.

(6) SETTING LIMITATIONS.

(a) An individual may receive community living supports if the individual:

(A) Resides in a setting the individual owns, leases, or rents or is on the property deed, mortgage, or title.

(B) Resides in a setting, either through an informal arrangement or rental agreement, owned, leased, or rented by a family member.

(C) Has no permanent residence.

(b) An individual is not eligible for community living supports, other than DSA, if the individual resides in one of the following:

(A) A provider-owned dwelling or a provider-rented dwelling through an informal or formal arrangement.

(B) A provider owned, controlled, or operated setting, including a setting owned, controlled, or operated by an employee of a provider agency.

(c) An individual is not eligible for community living supports in a specific setting if:

(A) The Department determines the health and safety of the individual may not be reasonably maintained in the setting; or

(B) Dangerous conditions in the setting jeopardize the health or safety of the individual or provider, and the individual, or their legal or designated representative, is unable or unwilling to implement necessary safeguards to minimize the dangers.

(d) An individual enrolled in a residential program, an adult foster home for older adults or adults with physical disabilities licensed in accordance with OAR chapter 411, division 049, or a residential care or assisted living facility licensed in accordance with OAR chapter 411, division 054, is not eligible for the following:

(A) Community living supports provided by a personal support worker.

(B) Community living supports delivered in the home of the individual, whether the home is a licensed setting or not.

(C) Relief care.

(e) A child living in a Behavior Rehabilitation Services (BRS) Program as described in OAR chapter 410, division 170, or Psychiatric Residential Treatment Facility (PRTF) as defined in OAR 309-022-0105, is not eligible for community living supports.

(7) SERVICE LIMITS.

(a) All hour allocations, and staffing ratios greater than 1:1, for community living supports must be included in an authorized ISP.

(b) An individual who has had a completed Oregon Needs Assessment (ONA) is assigned to a service group for the purpose of determining a service level upon the individual's initial ISP or the first annual ISP renewal following the adoption of this rule, and annually thereafter. An individual may only be assigned to one service group. The service groups are:

(A) Very Low.

(B) Low.

(C) Moderate.

(D) High.

(E) Very High.

(F) Infant/Toddler.

(c) Service groups are determined by applying a numeric value based on the responses to specific items being assessed in the ONA and using the values to calculate scores (the value of each item by response may be found in table 4). This is done for seven areas of the ONA, generating the following seven scores:

(A) General Support Need (GSN) score.

(B) The Medical Support Need (MSN) score.

(C) The Support Person Performs score.

(D) The Behavior Support Need (BSN) score.

(E) The Behavior Intervention/Management Frequency score.

(F) The Positive Behavior Support Plan (PBSP) score.

(G) Emergency/Crisis Services score.

(d) The scores described in subsection (c) of this section are used to assign an individual a service group number according to table 1.

(e) The service group number identified in subsection (d) of this section assigns an individual to a service group based on the individual's age at the time the ONA was submitted, as shown in table 2.

(f) For an individual not enrolled to a residential program who has been assigned to a service group as described in subsection (b) of this section, the maximum monthly hour allocation that may be included in an authorized ISP for the assigned service group, by the age of the individual on the submission date of the ONA, is the greater of:

(A) Without an approved exception as described in OAR 411-450-0065, the service level shown in table 3;

(B) With an approved exception as described in OAR 411-450-0065, an amount up to the amount approved by the Department, no earlier than the date of the exception approval;

(C) The service level for the individual on the last day of an ISP that expires between December 2023 and December 2024, as determined by an Adult Needs Assessment, Version C (ANA-C) for an adult, or a Child Needs Assessment, Version C (CNA-C) for a child. This does not include hours that have been included for the purpose of increasing a staff ratio;

(D) An amount up to the number of private duty nursing hours determined as described in OAR 411-300-0150 for a child in the Medically Fragile Children's program; or

(E) For an individual initially accessing hourly attendant care services, the greater of an amount:

(i) Determined by an ANA-C for an adult, or a CNA-C for a child. This does not include hours that have been included for the purpose of increasing a staff ratio; or

(ii) A condition described in (A), (B), (C), or (D) of this subsection.

(g) A change to the score of an Oregon Needs Assessment must only result from an assessment conducted by an assessor who meets the qualification and training requirements identified in OAR 411-425-0035 and is employed by a case management entity or the Department.

(h) The ANA-C or CNA-C determines the following for an individual who has not been assigned to a service group under subsection (b) of this section:

(A) Without an approved exception as described in OAR 411-450-0065, the service level. The service level may not be exceeded without prior approval from the Department.

(B) Without an approved exception as described in OAR 411-450-0065 and when such a need is identified, the ANA-C or CNA-C determines the maximum number of hours two staff may be simultaneously available.

(i) An hour allocation included in an authorized ISP may not exceed the number of hours of community living supports that are determined by the person-centered planning process and informed by the ISP team to be necessary to meet identified support needs after consideration and assignment of voluntary natural supports and alternative resources.

(j) An increase to an hour allocation must be based on:

(A) An increase in support needs identified following a completed reassessment using an ONA conducted by an assessor;

(B) A short-term increase in support needs based on a change in the support needs expected to last no more than 90 calendar days, documented in the service record;

(C) The loss of a natural support or alternative resource identified in the ISP as the means of meeting an identified need;

(D) A choice not to continue the use of a natural support; or

(E) A choice to meet a previously unmet, identified need.

(k) When an ONA assigns an individual to a service group with a lower service level than the hour allocation authorized in an ISP at the time of the ONA, the individual may have access to the amount authorized in the ISP for no longer than the end of the month that follows the month in which the ONA was conducted. (The example used in this subsection of this rule is illustrative only and limited to the facts it contains.) Example: An ONA completed on April 10th assigned an adult to service group 2. The previous ONA had assigned the adult to service group 3. The hour allocation within the service level for service group 3 is available to the adult through May 31st.

(l) When an ONA assigns an individual to a service group with a higher service level than the hour allocation authorized in an ISP at the time of the ONA, the individual may have access to an hour allocation within the new service level when it has been included in the authorized ISP.

(m) Unless an hour allocation below the service level is agreed to in advance and included in the individual's ISP, an individual must be given the opportunity for a hearing under ORS chapter 183 and OAR 411-318-0025 for any reduction in the authorized hour allocation.

(n) An hour allocation may not be reduced for anyone who has not been assigned to a service group as described in subsection (b) of this section.

(o) An hour allocation may not be reduced below the service level for the individual on the last day of an ISP that expires between December 2023 and December 2024, as determined by an ANA-C for an adult, or a CNA-C for a child. This does not include hours that have been included for the purpose of increasing a staff ratio.

(p) Any individual who is denied a requested hour allocation in an authorized ISP:

(A) Must be provided a Notice of Planned Action and given the opportunity for a hearing as described in ORS chapter 183 and OAR 411-318-0025; and

(B) May request an exception as described in OAR 411-450-0065.

(q) A child enrolled in the CEN Program may not receive more than a total of 20 hours of attendant care from one or more parent providers in a workweek, not to exceed the child's total monthly hour allocation.

(8) STAFF RATIOS.

(a) Community living supports are delivered by a staffing ratio of one provider (agency employee, personal support worker, etc.) to one or more individuals, unless the need for two or more providers to be available simultaneously to provide community living supports to an individual has been determined to be necessary following a person centered planning process and, except as noted in section (7)(e)(B) of this rule, confirmed by review of an exception request as described in OAR 411-450-0065.

(b) The number of hours allocated for a staffing ratio of greater than 1:1 may not exceed the number of hours required to meet the need that requires the higher ratio.

(c) Unless agreed to in advance and included in the individual's authorized ISP, an individual must be given the opportunity for a hearing under ORS chapter 183 and OAR 411-318-0025 for any reduction in the authorized staffing ratio.

(d) Any individual who is denied a requested staffing ratio in an authorized ISP:

(A) Must be provided a Notice of Planned Action and given the opportunity for a hearing as described in ORS chapter 183 and OAR 411-318-0025; and

(B) May request an exception as described in OAR 411-450-0065.

(9) The Department may put limits on how Department funds and resources are used, as long as those limited funds and resources are adequate to meet the needs of an individual.

(10) For an individual enrolled in a residential program, an adult foster home for older adults or adults with physical disabilities licensed in accordance with OAR chapter 411, division 049, or a residential care or assisted living facility licensed in accordance with OAR chapter 411, division 054, receipt of any combination of job coaching, supported employment - small group employment support, employment path services, and DSA may not exceed 25 hours per week. Individuals residing in these settings, who do not receive employment services, may receive up to 25 hours of DSA per week.

(11) No more than 14 days of relief care in a plan year are allowed without approval from the Department. Each day of respite care described in and provided according to OAR 411-070-0043(5) contributes to the 14 day limit for relief care.

Or. Admin. Code § 411-450-0060

APD 27-2016, f. & cert. ef. 6/29/2016; APD 35-2016(Temp), f. 8-31-16, cert. ef. 9-1-16 thru 2-27-17; APD 37-2016(Temp), f. & cert. ef. 9-15-16 thru 2-27-17; APD 2-2017, f. 2-21-17, cert. ef. 2/28/2017; APD 23-2018, temporary amend filed 07/02/2018, effective 07/02/2018 through 12/27/2018; APD 46-2018, amend filed 12/28/2018, effective 12/28/2018; APD 7-2019, minor correction filed 01/07/2019, effective 1/7/2019; APD 37-2019, amend filed 10/29/2019, effective 11/1/2019; APD 10-2020, minor correction filed 04/16/2020, effective 04/16/2020; APD 14-2020, temporary amend filed 04/28/2020, effective 04/28/2020 through 10/23/2020; APD 44-2020, amend filed 10/09/2020, effective 10/15/2020; APD 55-2022, amend filed 12/16/2022, effective 12/20/2022; APD 23-2023, amend filed 12/21/2023, effective 1/1/2024; APD 25-2024, temporary amend filed 05/31/2024, effective 5/31/2024 through 11/26/2024

To view attachments referenced in rule text, click here to view rule.

Statutory/Other Authority: ORS 409.050, 427.024, 427.104 & 430.662

Statutes/Other Implemented: ORS 409.10, 427.007, 427.024, 427.104, 427.181, 430.215, 430.610 & 430.662