Or. Admin. Code § 411-450-0050

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

Section 411-450-0050 - Minimum Standards for Community Living Supports

(1) Abuse of an individual is prohibited. Abuse is not tolerated by any employee, staff, or volunteer of an individual, provider agency, or case management entity.

(2) Community living supports, purchased with Department funds, must be provided only as a social benefit.

(3) Community living supports must be delivered in a manner consistent with positive behavioral theory and practice, and where behavior intervention is not undertaken unless a behavior:

(a) Represents a risk to the health and safety of an individual or others;

(b) Is likely to continue and become more serious over time;

(c) Interferes with community participation;

(d) Results in damage to property; or

(e) Interferes with learning, socializing, or vocation.

(4) Community living supports must be delivered in accordance with applicable state and federal wage and hour regulations.

(5) For a child, community living supports are considered to be for supports that are not typical for a parent or guardian to provide to a child of the same age.

(6) Community living supports are reimbursed in accordance with the Expenditure Guidelines.

(7) Community living supports must be delivered as identified in an individual's Individual Support Plan (ISP) or Service Agreement.

(8) Department funds may not be used for:

(a) A reimbursement to an individual, or the legal or designated representative or family member of the individual, for expenses related to community living supports.

(b) An advance payment of funds to an individual, or the legal or designated representative or family member of the individual, to obtain community living supports.

(c) Services or activities that are carried out in a manner that constitutes abuse as defined in OAR 411-317-0000.

(d) Services that restrict the freedom of movement of an individual by seclusion in a locked room under any condition.

(e) Vacation costs that are normally incurred by a person on vacation, regardless of disability, and are not strictly required by the need of an individual for Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), or health-related tasks in a home and community-based setting.

(f) Rate enhancements to existing employment services under OAR chapter 411, division 345.

(g) Services or supports that are not necessary to meet support needs identified by the Oregon Needs Assessment (ONA) or are not cost-effective.

(h) Services that do not meet:

(A) The description of community living supports as described in these rules; or

(B) The definition of a social benefit in OAR 411-317-0000.

(i) DSA when an individual does not have a goal related to community participation as described in OAR 411-450-0060(2)(b)(D).

(j) Educational services for school-age individuals, including professional instruction, formal training, and tutoring in communication, socialization, and academic skills.

(k) Services, activities, materials, or equipment that may be obtained by an individual through other available means, such as private or public insurance, philanthropic organizations, or other governmental or public services.

(l) Services or activities for which the legislative or executive branch of Oregon government has prohibited use of public funds.

(m) Services in circumstances where a case management entity has sufficient evidence to believe that an individual, a legal or designated representative of an individual (as applicable), or a provider, has engaged in fraud, misrepresentation, failed to use resources as agreed upon in an ISP, refused to cooperate with documenting use of Department funds, or otherwise knowingly misused public funds associated with community living supports.

(n) Services provided in a nursing facility, correctional institution, or mental health facility.

(o) Services provided in an acute care hospital unless an individual's ISP authorizes attendant care for the individual in an acute care hospital. An ISP may only authorize attendant care for an individual who has been admitted to an acute care hospital when the support is not a duplication of service that the hospital provides and the individual has one of the following:

(A) Challenging behavior that interferes with getting medical care. The challenging behavior must require specific training or experience to support and must be able to be mitigated by a developmental disability service provider to an extent that medical care is improved.

(B) An inability to independently communicate with hospital staff that interferes with getting medical care. This must not be solely due to limited or emerging English proficiency.

(C) Support with one or more ADL that may only be adequately met by someone familiar with the individual.

(p) Unless under certain conditions and limits specified in Department guidelines, employee wages or provider agency charges for time or services when an individual is not present or available to receive services including, but not limited to, hourly "no show" charge and provider travel and preparation hours.

(q) Costs associated with training a Personal Support Worker (PSW), other independent provider, or provider agency staff to deliver services.

(r) Services that are not delivered in a home and community-based setting.

(s) Services available to an individual under Vocational Rehabilitation and Other Rehabilitation Services, 29 U.S.C. § 701-796l, as amended.

(t) Services available to an individual under the Individuals with Disabilities Education Act (IDEA).

(u) Notwithstanding abuse as defined in OAR 411-317-0000, services that a case management entity determines are characterized by failure to act or neglect that leads to, or is in imminent danger of causing, physical injury through negligent omission, treatment, or maltreatment of an individual.

(v) Support generally provided for a child of similar age without disabilities by a child's parent, guardian, or other family members.

(w) Supports and services that are funded by child welfare in the family home.

(x) Educational and supportive services provided by schools as part of a free and appropriate public education for children and young adults under the IDEA.

(y) Home schooling.

(z) Services delivered outside of the United States or the territories of the United States.

(aa) Services, supports, materials, or activities that are illegal or in support of illegal conduct.

Or. Admin. Code § 411-450-0050

APD 27-2016, f. & cert. ef. 6/29/2016; 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 37-2019, amend filed 10/29/2019, effective 11/1/2019; APD 38-2020, temporary amend filed 09/08/2020, effective 9/8/2020 through 3/6/2021; APD 8-2021, amend filed 02/11/2021, effective 3/1/2021; 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