Or. Admin. Code § 411-450-0040

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

Section 411-450-0040 - Community Living Supports Entry and Exit

(1) An individual may not access community living supports unless community living supports are included in the individual's current, authorized Individual Support Plan (ISP).

(2) A provider of community living supports must agree in writing to deliver the supports identified in an individual's ISP. Agreement may be shown by the provider's signature on a Service Agreement. The agreement must include acknowledgement of limits and scope of service that may be provided.

(3) Community living supports must be terminated:

(a) At the end of a service period agreed upon by all parties and specified in an individual's ISP.

(b) At the oral or written request of an individual or their legal representative to end the service relationship.

(c) When an individual has been determined to no longer meet eligibility for community living supports as described in OAR 411-450-0030.

(d) When a case management entity has sufficient evidence to believe that an individual has engaged in fraud or misrepresentation, failed to use resources consistent with the services as agreed upon in the individual's ISP, refused to cooperate with documenting use of Department funds, or otherwise knowingly misused public funds associated with community living supports.

(e) When an individual either cannot be located or has not responded following 30 calendar days of repeated attempts by staff of the case management entity to complete ISP development or monitoring activities, including participation in an Oregon Needs Assessment. An individual, and as applicable the legal or designated representative of the individual, must participate in an Oregon Needs Assessment and provide information necessary to complete the Oregon Needs Assessment within the time frame required by the Department.

(A) Failure to participate in the Oregon Needs Assessment or provide information necessary to complete the assessment or reassessment within the applicable time frame results in the denial of service eligibility.

(B) The Department may allow additional time if circumstances beyond the control of the individual prevent timely participation in the Oregon Needs Assessment or timely submission of information necessary to complete the Oregon Needs Assessment.

(4) INVOLUNTARY REDUCTIONS AND EXITS.

(a) A provider agency must only reduce or exit an individual involuntarily for one or more of the following reasons:

(A) The behavior of the individual poses an imminent risk of danger to self or others.

(B) The individual experiences a medical emergency.

(C) The provider agency is no longer able to meet the service needs of the individual.

(D) The provider agency cannot provide the services needed to meet the individual's goals associated with the service.

(E) The individual is no longer eligible for the service or the provider agency is not paid for the service.

(F) The site closes or the provider agency makes a programmatic change.

(G) The certification or endorsement for the provider agency described in OAR chapter 411, division 323 is suspended, revoked, not renewed, or voluntarily surrendered.

(b) A provider agency may give less than 30 calendar days advance written notice only in a medical emergency or when an individual is engaging in behavior that poses an imminent danger to self or others. The notice must be provided to the individual, the legal or designated representative of the individual (as applicable), and the individual's case manager immediately upon determination of the need for a reduction, transfer, or exit.

(c) A Notice of Involuntary Reduction or Exit is not required when:

(A) An individual requests the reduction or exit.

(B) The end date of the service identified on the ISP or Service Agreement is reached, if the provider has given at least 30 calendar days written notification to the individual and the individual's case manager of the intent to reduce or terminate services.

(d) PROVIDER AGENCY NOTICE OF INVOLUNTARY REDUCTION OR EXIT. A provider agency must not reduce services, transfer, or exit an individual involuntarily without 30 calendar days advance written notice to the individual, the legal or designated representative of the individual (as applicable), and the individuals' case manager, except in the case of a medical emergency or when an individual is engaging in behavior that poses an imminent danger to self or others as described in subsection (b) of this section. The written notice must be provided on the Notice of Involuntary Reduction or Exit form approved by the Department and include all of the following:

(A) The reason for the reduction or exit.

(B) The right of individuals receiving Day Support Activities (DSA) to submit a complaint to the Department and have the Department review the matter.

(C) The right of the individual to request a hearing as described in subsection (f) of this section. For DSA services, the individual has a right to a hearing if the individual is not satisfied with the outcome of the complaint process and Department review of the matter.

(e) NOTICE OF INVOLUNTARY GROUP REDUCTION, TRANSFER, OR EXIT. If a provider agency reduces or transfers more than 10 individuals within any 30 calendar day period, the provider agency must provide 60 calendar days advance written notice to each individual, the Department, the legal or designated representative of each individual (as applicable), and each individual's case manager.

(A) The written notice must be provided on the Notice of Involuntary Group Reduction, Transfer, or Exit form approved by the Department and include all of the following:

(i) The reason for the reduction, transfer, or exit.

(ii) The right of individuals receiving DSA to submit a complaint to the Department and have the Department review the matter.

(iii) The right of the individual to request a hearing as described in subsection (f) of this section. For DSA services, the individual has a right to a hearing if the individual is not satisfied with the outcome of the complaint and Department review of the matter.

(B) A Notice of Involuntary Group Reduction, Transfer, or Exit is not required when an individual requests the reduction, transfer, or exit.

(f) HEARING RIGHTS. An individual must be given the opportunity for a hearing under ORS chapter 183 and OAR 411-318-0030 to dispute an involuntary reduction or exit if the individual is not satisfied with the complaint resolution and Department review. If an individual requests a hearing, the individual must receive the same services until the hearing is resolved, unless the provider is no longer delivering that service to any individual. When an individual has been given less than 30 calendar days advance written notice of a reduction, transfer, or exit as described in subsection (b) of this section and the individual has requested a hearing, the provider must reserve service availability for the individual until receipt of the Final Order.

Or. Admin. Code § 411-450-0040

APD 27-2016, f. & cert. ef. 6/29/2016; APD 37-2019, amend filed 10/29/2019, effective 11/1/2019; APD 55-2022, amend filed 12/16/2022, effective 12/20/2022; APD 23-2023, amend filed 12/21/2023, effective 1/1/2024

Statutory/Other Authority: ORS 409.050, 427.104 & 430.662

Statutes/Other Implemented: 427.104, 430.662, ORS 409.010, 427.007, 430.215 & 430.610