Or. Admin. Code § 411-375-0020

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

Section 411-375-0020 - Qualifications, Exclusions, and Enrollment Responsibilities for Independent Providers

(1) QUALIFICATIONS. An independent provider who is qualified to provide services must meet the following requirements:

(a) Be at least 18 years of age.

(b) Have approval to work based on a background check and final fitness determination completed by the Department as described in OAR 407-007-0200 through 407-007-0370 and section (3) of this rule.

(c) Not have been convicted of any of the disqualifying crimes listed in ORS 443.004, unless hired or contracted with prior to July 28, 2009 and remaining in the original position for which the independent provider was hired or contracted.

(d) Be legally eligible to work in the United States.

(e) Demonstrate by background, education, references, skills, and abilities, the independent provider is capable of safely and adequately performing the tasks specified in an ISP or Service Agreement, with such demonstration of the following confirmed in writing by the individual, or as applicable their legal or designated representative:

(A) Ability and sufficient education to follow oral and written instructions and keep any required records.

(B) Possess the physical health, mental health, good judgment, and good personal character determined necessary to deliver services.

(C) Ability to communicate with the individual.

(D) Training of a nature and type sufficient to ensure the independent provider has knowledge of emergency procedures specific to the individual.

(f) Maintain confidentiality and safeguard individual information. An independent provider may not share any personal information about the individual, including medical, social service, financial, public assistance, legal, or other personal details, unless given specific permission by the individual or as applicable their legal representative.

(g) Not be on the list of excluded or debarred providers maintained by the Office of the Inspector General (http://exclusions.oig.hhs.gov/).

(h) Complete and submit a Provider Enrollment Agreement to the Department and possess a current provider number issued by the Department. A Provider Enrollment Agreement must be renewed 70 calendar days prior to the end date of the current Provider Enrollment Agreement unless the provider enrollment is terminated or inactivated by the Department.

(i) Have a Taxpayer Identification Number or Social Security number that matches the legal name of the independent provider as verified by the Internal Revenue Service or Social Security Administration.

(j) Possess a current and unencumbered license if providing services requiring specific professional education, training, and skill. The individual, or as applicable their designated or legal representative or the case management entity, must check the status of the professional license to verify the license is current and unencumbered.

(k) If transporting an individual, have a valid driver's license and proof of insurance, as well as any other license or certification required under state and local law depending on the nature and scope of the transportation. Copies of a valid driver's license and proof of insurance, as well as any other license or certification (if applicable), must be provided to a case management entity upon authorization of community transportation and as requested.

(l) Additional qualifications required by applicable program rules relevant to the services being delivered.

(m) Personal support workers must complete mandatory training and competency evaluation requirements outlined in OAR chapter 418, division 020.

(2) EXCLUSIONS. An independent provider may not be authorized to deliver services to an individual in any of the following circumstances:

(a) The independent provider is an employee of ODDS, the Office of Administrative Hearings, or the Oregon Home Care Commission.

(b) The independent provider is an employee of the case management entity that delivers services to the individual unless the following apply:

(A) The independent provider was authorized to deliver services as a personal support worker before July 1, 2022; and

(B) The case management entity maintains a conflict of interest policy and monitors the employee for conflict of interest.

(c) The individual is a child and the independent provider is the parent of the child unless, for the duration of the COVID-19 public health emergency, the parent meets the qualifications in section (1) of this rule, resides with the child, and the child:

(A) Meets the enrollment criteria for any of the Children's Intensive In-Home Services programs; or

(B) Has a service level of at least 240 hours per month.

(d) The independent provider is the legal representative of the individual and has not appointed a designated representative to plan supports for the individual.

(e) The independent provider is the designated representative of the individual.

(f) The independent provider is the spouse of the individual.

(g) The independent provider is the common law employer or the proxy of the common law employer of the individual.

(h) The independent provider is the case manager for the individual.

(i) The independent provider is concurrently engaged to deliver services for the individual for new or renewed authorizations of services starting after January 1, 2020:

(A) As an employee of an agency certified under OAR chapter 411, division 323 providing community living supports skills training or attendant care services other than day support activities as defined in OAR chapter 411, division 450; or

(B) As a caregiver of an adult foster home licensed according to OAR chapter 411, division 360.

(3) BACKGROUND CHECKS.

(a) A subject individual as defined in OAR 407-007-0210 may be approved for one position to work statewide when the subject individual is working in the same employment role with the same population. The Background Check Request Form must be completed by the subject individual to show intent to work statewide.

(b) When an independent provider is approved without restrictions following a background check final fitness determination, the approval must meet the provider enrollment requirements for the employment role of the independent provider.

(c) Background check approval is effective for two years from the date of fitness determination to provide services except in one or more of the following circumstances:

(A) A new fitness determination is conducted resulting in a change in approval status.

(B) The Department has terminated the provider enrollment for the independent provider.

(d) A case management entity may conduct a background recheck if additional information about an independent provider, such as possible criminal activity or other allegations, is discovered or reported to the case management entity or the Department.

(e) An independent provider must self-report any potentially disqualifying crimes under OAR 407-007-0281 and potentially disqualifying conditions under OAR 407-007-0290 to the case management entity within 24 hours.

(4) ENROLLMENT RESPONSIBILITIES.

(a) The Department may deny provider enrollment in any of the following circumstances:

(A) The applicant has been suspended or terminated as a provider by another division within the Department or by the Oregon Health Authority.

(B) The applicant has a history of violating the protective service and abuse rules or has a founded report of child abuse or substantiated adult abuse.

(C) The applicant has committed fiscal improprieties.

(D) The applicant has demonstrated a lack of skills, knowledge, or ability to adequately or safely provide services.

(E) The applicant has an unacceptable background check or the background check results in a closed case pursuant to OAR 407-007-0320.

(F) The applicant is on the list of excluded or debarred providers maintained by the Office of the Inspector General (http://exclusions.oig.hhs.gov/).

(G) The case management entity has documentation that the applicant is not capable of performing required services in a professionally competent, safe, legal, or ethical manner.

(H) The Taxpayer Identification Number or Social Security number for the applicant does not match the legal name of the applicant as verified by the Internal Revenue Service or Social Security Administration.

(b) CONTINUED ENROLLMENT.

(A) An independent provider is responsible for maintaining an active provider number by:

(i) Completing and submitting a new Provider Enrollment Agreement to the Department at least 70 calendar days prior to the end date of the Provider Enrollment Agreement.

(ii) Completing and submitting a Background Check Request Form and receiving approval to work by the Department at least 70 calendar days prior to the end of the background check approval period.

(iii) Completing and submitting properly completed paperwork at the request of the Department that is required to receive payment.

(iv) Maintaining valid contact information with the Department including current address, email address, and telephone number.

(v) Completing and submitting required paperwork at the request of the Department.

(B) An independent provider is responsible to attend trainings and maintain certifications as required by applicable program rules.

(C) A personal support worker must complete mandatory training and competency evaluation requirements outlined in OAR chapter 418, division 020.

(5) An individual, or as applicable their legal or designated representative, has the right to choose any independent provider who meets all additional program qualifications for the services to be delivered and is enrolled as a provider as described in this rule.

(6) PERSONAL SUPPORT WORKERS.

(a) ORIENTATION. A personal support worker must complete orientation by the timelines specified in OAR chapter 418, division 020.

(b) RESTRICTED PERSONAL SUPPORT WORKER PROVIDER ENROLLMENT.

(A) The Department may enroll an applicant as a restricted personal support worker. A restricted personal support worker may only provide services to a specific individual who is a family member, neighbor, or friend.

(i) After conducting a weighing test as described in OAR 407-007-0200 through 407-007-0370, the Department may approve a restricted enrollment for an applicant with a prior criminal record, unless according to OAR 407-007-0275 the applicant has been found ineligible due to ORS 443.004.

(ii) The Department may approve a restricted enrollment for an applicant based on their lack of skills, knowledge, or ability to adequately or safely provide services.

(B) To remove restricted personal support worker status, the applicant must complete a new application and background check and be approved by the Department.

(c) ENHANCED AND EXCEPTIONAL PERSONAL SUPPORT WORKERS.

(A) ENHANCED PERSONAL SUPPORT WORKERS.

(i) A personal support worker must be certified by the Oregon Home Care Commission as an enhanced personal support worker to deliver services to individuals who require advanced medically-driven services and supports or behaviorally-driven services and supports, as identified by a functional needs assessment.

(ii) Enhanced personal support workers are paid for providing ADL and IADL services at the enhanced personal support worker rate set forth in the Collective Bargaining Agreement. The enhanced personal support worker rate is effective the first day of the month following the month in which both:

(I) The personal support worker is certified by the Oregon Home Care Commission to deliver services.

(II) The outcome of the functional needs assessment for an individual indicates the need for assistance with advanced medically-driven services and supports or behaviorally-driven services and supports.

(B) EXCEPTIONAL PERSONAL SUPPORT WORKER.

(i) A personal support worker must be certified by the Oregon Home Care Commission as an exceptional personal support worker to deliver services to individuals who require assistance with extensive medically-driven services and supports or behaviorally-driven services and supports, as identified by a functional needs assessment.

(ii) Exceptional personal support workers are paid for providing ADL and IADL services at the exceptional personal support worker rate set forth in the Collective Bargaining Agreement. The exceptional personal support worker rate is effective the first day of the month following the month in which both:

(I) The personal support worker is certified by the Oregon Home Care Commission to deliver services.

(II) The outcome of the functional needs assessment for an individual indicates the need for assistance with extensive medically-driven services and supports or behaviorally-driven services and supports, and at least 20 hours per day of attendant care support excluding 2:1 support hours.

(C) A personal support worker who has been certified by the Oregon Home Care Commission to provide enhanced or exceptional supports may not receive the enhanced or exceptional rate when providing services to an individual whose functional needs assessment does not indicate the need for assistance with advanced or extensive medically-driven services and supports or behaviorally-driven services and supports, except as required by the Collective Bargaining Agreement.

Or. Admin. Code § 411-375-0020

APD 30-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 48-2014, f. 12-26-14, cert. ef. 12/28/2014; APD 29-2016, f. & cert. ef. 6/29/2016; APD 33-2016(Temp), f. 8-30-16, cert. ef. 9-1-16 thru 2-27-17; APD 4-2017, f. 2-21-17, cert. ef. 2/28/2017; APD 8-2019, amend filed 01/24/2019, effective 1/25/2019; APD 38-2019, amend filed 10/29/2019, effective 11/1/2019; APD 1-2021, temporary amend filed 01/12/2021, effective 1/12/2021 through 7/10/2021; APD 26-2021, amend filed 06/30/2021, effective 7/1/2021; APD 26-2022, minor correction filed 06/15/2022, effective 6/15/2022; APD 31-2022, temporary amend filed 06/25/2022, effective 7/1/2022 through 12/27/2022; APD 52-2022, amend filed 12/14/2022, effective 12/15/2022

Statutory/Other Authority: ORS 409.050 & 410.598

Statutes/Other Implemented: ORS 409.010, 410.598, 410.600, 410.606-410.619 & 427.007