Or. Admin. Code § 461-001-0030

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

Section 461-001-0030 - Definitions; OSIPM Nursing Facility Services or Home and Community-Based Care

These terms apply to rules in Chapter 461 about Oregon Supplemental Income Program Medical (OSIPM) nursing facility services and home and community-based care:

(1)Community spouse: An individual who is legally married (see OAR 461-001-0000) to an institutionalized spouse (see section (5) of this rule) and meets all of the following requirements:

(a) The individual is not residing in the Oregon State Hospital, or its equivalent if residing in another state.

(b) The individual is not residing in an acute care hospital or nursing facility for a continuous period of care (see section (2) of this rule).

(2)Continuous period of care: Reside for a period of at least 30 consecutive days or until death in a nursing facility, home and community-based care (see section (4) of this rule) setting, or an acute care hospital. There must be sufficient evidence to show there is a reasonable expectation that the client will remain in care for at least 30 consecutive days. For the purposes of this policy, an interruption in care (for example, leaving and then returning to a nursing home, or switching from one type of care to another) that lasts less than 30 days is not considered a break in the 30 consecutive days of care. A new period of care begins if care is interrupted for 30 or more days.

(3)Eligible dependent:

(a) For cases with a community spouse (see section (1) of this rule):

(A) An "eligible dependent" is one of the following:

(i) A child of the institutionalized spouse or community spouse who resides with the community spouse, and who must also be either a minor (under the age of 21) or 21 or older but still a tax dependent of either spouse.

(ii) A parent or sibling of the institutionalized spouse or community spouse who resides with the community spouse and is claimed as a tax dependent by either spouse.

(B) A grandchild of the institutionalized spouse or community spouse is not considered an "eligible dependent".

(b) For cases without a community spouse, an "eligible dependent" resides with the individual and is either a minor child (under the age of 21) of the individual, or a child 21 or older but still a tax dependent of the individual.

(4)Home and community-based care: Title XIX services needed to keep an individual out of a nursing facility or an intermediate care facility for individuals with intellectual disabilities (ICF-ID), not including 1915(i) Home and community-based services (see division 173 of OAR chapter 410). These services are:

(a) In-home services except for state plan personal care services.

(b) Residential care facility services.

(c) Assisted living facility services.

(d) Adult foster care services.

(e) Specialized living facility services.

(f) Adult day care services.

(5)Institutionalized spouse: An individual who is married to a community spouse, not residing in the Oregon State Hospital, or its equivalent if in another state, and meets one of the following requirements:

(a) The individual is residing in an acute care hospital or nursing facility for a continuous period of care.

(b) The individual is applying for or receiving services in a nursing facility or home and community-based services.

Or. Admin. Code § 461-001-0030

AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 2-1992, f. 1-30-92, cert. ef. 2-1-92; AFS 6-1994, f. & cert. ef. 4-1-94; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 23-1995, f. 9-20-95, cert. ef. 10-1-95; AFS 3-2000, f. 1-31-00, cert. ef. 2-1-00; AFS 5-2002, f. & cert. ef. 4-1-02; SSP 8-2004, f. & cert. ef. 4-1-04; SSP 4-2005, f. & cert. ef. 4-1-05; Renumbered from 461-160-0560, SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP 13-2009, f. & cert. ef. 7-1-09; SSP 17-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SSP 26-2013, f. & cert. ef. 10-1-13; SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14; SSP 11-2018, amend filed 03/09/2018, effective 4/1/2018; SSP 51-2023, temporary amend filed 12/11/2023, effective 12/11/2023 through 6/7/2024; SSP 30-2024, amend filed 03/26/2024, effective 4/1/2024; SSP 55-2024, amend filed 09/30/2024, effective 10/1/2024

Statutory/Other Authority: 411.060, ORS 409.050, 411.083, 411.404, 413.085 & 414.685

Statutes/Other Implemented: 411.060, 411.700, ORS 409.010, 411.083, 411.404, 42 USC 1396r & 42 CFR 435.726