OAR 410-173-0105: Temporary rule language in effect until 02/15/2027. 1915(i) In-Home Personal Care

(1) Except as otherwise provided in this division, OARs 410-172-0774 through 410-172-0845 apply to 1915(i) In-Home Personal Care (IHPC) services authorized under this division to ensure services are administered in a consistent and equitable manner, except where this division provides otherwise. (a) For purposes of applying OARs 410-172-0776 and 410-172-0800 through 410-172-0845 to 1915(i) IHPC services: (A) References to a person-centered service plan (PCSP) apply only to the portions of an individual's 1915(i) PCSP authorizes 1915(i) IHPC services. (B) References to a service coordinator include the Authority's Independent Qualified Agent (IQA) responsible for assessment, service authorization, person-centered service planning, monitoring, or related 1915 (i)IHPC functions under this division. (C) References to the State Plan Personal Care (SPPC) program means 1915(i) IHPC services authorized under this division. (b) Eligibility determination, assessment, service authorization, and person-centered service planning for 1915(i) IHPC services are governed by this division. (c) In the event of a conflict between OAR chapter 410, division 172 and this division, this division controls. (d) Nothing in this rule is intended to conflict with or supersede any applicable collective bargaining agreement (“CBA”) governing homecare workers (as defined in ORS 410.600(9)), personal support workers (as defined in ORS 410.600(12)), personal care attendants (as defined in OAR 418-020-0010), or direct support workers (as defined in ORS 443.360). In the event of a conflict, applicable state or federal law controls. To the extent permitted by law, the terms of the applicable CBA also control over this rule. (2) 1915(i) IHPC services support eligible individuals to meet their assessed personal care needs and live in the community, and: (a) Are authorized for eligible individuals who have received a functional needs assessment and PCSP from the Authority’s Independent and Qualified Agent (IQA) that identifies the 1915(i) IHPC necessary to the individual’s assessed needs; (b) Are provided in a manner that allows an eligible individual to direct their services and supports; (c) Assist individuals with Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) tasks, as defined in OAR 410-173-0005; and (d) Exclude services whose primary purpose is the acquisition, retention, and improvement of the skills needed to accomplish ADL/IADL tasks. (3) The Authority has established task-specific maximum service period hours for HCBS 1915(i) IHPC services based on an individual's assessed need for assistance with ADLs and IADLs. (4) Individuals who receive HCBS 1915(i) IHPC services may receive their services through one of two service delivery models: (a) PCA model with consumer-employer responsibilities as described in OAR 410-172-0800; or (b) Agency with Choice model with co-employer responsibilities as described in OAR chapter 309, division 45. (5) Regardless of the service delivery model, individuals receiving 1915(i) IHPC services retain authority to direct their services by: (a) Identifying candidates for employment; (b) Screening otherwise qualified candidates to determine their ability to meet the individual's assessed needs; (c) Directing day-to-day services consistent with the individual's person-centered service plan; and (d) Participating in the selection and dismissal of workers in accordance with the applicable service delivery model. (6) Employer responsibilities vary by service delivery model as follows: (a) Under the PCA model, the individual serves as the consumer-employer and hires, supervises, and dismisses PCAs in accordance with OAR 410-172-0800. (b) Under the Agency with Choice (AwC) model, the Agency with Choice serves as the common-law employer including answering questions and providing support for DSW hiring, supervision and conduct. The individual retains authority to direct day-to-day services and participates in the selection and dismissal of DSWs. (7) The Authority may terminate a PCA provider as described in OAR 410-172-0820. (8) ADLs include eating, bathing, dressing, toileting, maintaining continence, mobility and transferring: (a) Eating includes assisting the individual in feeding or fluid intake by any means from a receptacle into the body including gastrostomy tubes, including monitoring to prevent choking or aspiration; (b) Bathing includes assisting the individual with cleansing the body, washing hair, and using assistive devices when necessary to get in and out of the bathtub or shower; (c) Dressing includes assisting the individual with putting on, fastening, and taking off all items of clothing, braces, and artificial limbs, including obtaining and replacing items from their storage area in the immediate environment; (d) Toileting includes assisting the individual in getting to and from, on and off, the toilet, commode, or bedpan for elimination of feces and urine. This includes cleansing after elimination and adjusting clothing as necessary or requested; (e) Maintaining Continence includes reminders to use the toilet or commode, developing a continence schedule, assisting the individual with external cleansing of Foley catheter, emptying urinals, emptying bedside commode, emptying catheter drainage bag, maintenance bowel care, changing and replacing incontinence products, including colostomy or ileostomy bags; (f) Transferring includes assisting the individual with mobility, transfers, ambulation, and repositioning by any means, including use of an assistive device and turning or adjusting padding for physical comfort or pressure relief and encouraging or assisting with range of motion exercises. (9) IADLs capture more complex life activities and include personal hygiene, light housework, laundry, meal preparation, shopping, using electronic communication devices, medication management and money management: (a) Personal hygiene includes performing or assisting the individual with activities required to keep one’s desired appearance, secure or fasten clothing, comb/brush hair, nail care, foot care, skin care, menstrual care, mouth care and oral hygiene, etc.; (b) Light housework includes performing or assisting the individual with housekeeping tasks necessary to maintain the individual in a healthy and safe living environment; (c) Laundry includes performing or assisting the individual with laundering or cleaning of clothing, bedding, and other linens; (d) Meal preparation includes performing or assisting the individual with healthy meal planning and preparation, ensuring special diets are followed; (e) Shopping includes performing or assisting the individual in planning for and purchasing of essential items including clothing, groceries, prescribed medication, hygiene products and basic household necessities; (f) Using the telephone or other electronic communication devices includes performing or assisting the individual in arranging necessary appointments and making desired phone calls using a telephone, smart phone, tablet or other similar electronic device for communication purposes, including entering the phone number and connecting to secure telecommunication platforms; (g) Medication assistance includes helping the individual with oral medications prescribed for the individual by a licensed medical professional, which are ordinarily self-administered described below: (A) Organizing and preparing medication; (B) Supervision or cueing to ensure the individual is taking medication as prescribed; (C) Documenting and monitoring any notable side effects; (D) Refilling prescriptions; and (E) Assisting with use, maintenance, and cleaning of in-home medical equipment authorized by a licensed medical professional, including: (i) Monitoring the individual’s condition; (ii) Ordering and maintaining necessary supplies; (iii) Use, maintenance, and cleaning of in-home medical equipment must be performed by PCA in compliance with manufacturers guidelines; and (iv) PCA must have received prior training and education from an RN, when applicable, in how to correctly perform these tasks. (h) Money Management includes performing or assisting the individual with budgeting, making payments for monthly expenses and use of personal funds for desired items and activities. (10) Personal care services may be required due to cognitive impairments that prevent an individual from knowing when or how to carry out ADL/IADL tasks. In such cases, personal assistance may include cueing along with supervision to ensure the individual performs the task properly. (11) Services outside the ADLs in section (8) and the IADLs in section (9) above are not eligible for payment. Payment may not be made by the Authority for any of the following excluded services: (a) Shopping for entertainment purposes or non-essential items; (b) Social companionship; (c) Day care, partial hospitalization, respite or baby-sitting services; (d) Care, grooming, or feeding of pets or other animals except incidental assistance directly related to an assessed ADL or IADL need; or (e) Yard work, gardening, or home repair. (12) Delegated nursing tasks by a Registered Nurse (RN) under Oregon’s Nurse Practice Act may be considered personal care services when the RN provides appropriate training and delegation of the listed nursing tasks in accordance with the OAR chapter 851, division 047. (13) Levels of assistance for determining IHPC service plan hours: (a) "Minimal Assistance" means an individual can perform the majority of an activity but requires some assistance from another person. Even with assistive devices, the individual requires assistance of another person for a task at least once in a 30-day period. The assistance needed shall be related to ADL and IADL needs documented in the PCSP. This means hands-on assistance, cueing, or stand-by presence during the activity; (b) "Substantial Assistance" means an individual can perform only a small portion of the tasks that comprise an activity without assistance from another person. The individual requires assistance with a task at least once in a 30-day period; (c) "Full Assistance" means an individual needs assistance from another person through all tasks of an activity every time the activity is attempted. Even with assistive devices, the individual is unable to accomplish any tasks without the assistance of another person. This means the individual needs hands-on assistance of another person through all tasks of the activity, every time the activity is attempted. (14) Maximum service period hours for ADL services: (a) The person-centered planning process uses the following maximum hours limitations for each two-week service period for ADL tasks. Maximum hours in each assistance level are not guaranteed. Hours authorized must be based on the service needs of an individual as determined by the IQA during the person-centered service planning process; (b) For in-home benefit plans the following maximums apply: (A) Eating: (i) Minimal assistance, up to three (3) hours; (ii) Substantial assistance, up to nine (9) hours; (iii) Full assistance, up to fourteen (14) hours; (B) Dressing and grooming: (i) Minimal assistance, up to two (2) hours; (ii) Substantial assistance, up to seven (7) hours; (iii) Full assistance, up to nine (9) hours; (C) Bathing and personal hygiene: (i) Minimal assistance, up to five (5) hours; (ii) Substantial assistance, up to seven (7) hours; (iii) Full assistance, up to twelve (12) hours; (D) Mobility and transferring: (i) Minimal assistance, up to five (5) hours; (ii) Substantial assistance, up to seven (7) hours; (iii) Full assistance, up to twelve (12) hours; (E) Toileting and maintaining continence (bowel, and bladder): (i) Minimal assistance, up to five (5) hours; (ii) Substantial assistance, up to nine (9) hours; (iii) Full assistance, up to fourteen (14) hours; (F) Cognition: (i) Minimal assistance, up to three (3) hours; (ii) Substantial assistance, up to six (6) hours; (iii) Full assistance, up to twelve (12) hours. (c) PCSP hours for ADLs may only be authorized for an individual if the individual requires assistance (minimal, substantial, or full assist) from another person in the tasks associated with the activity of daily living as determined by a service assessment applying the parameters in this rule. (d) The IQA may authorize fewer hours than the maximum number of hours in any or all ADL tasks based on their assessment of the individual’s unmet need. (e) The IQA must document the reason for authorizing fewer hours than the maximum number of hours allowed. The IQA may authorize fewer hours than the maximum for any of the following reasons: (A) Reduced frequency or duration of an ADL need; (B) Durable medical equipment or home modification reduces need for assistance; (C) Individual preference; (D) Natural supports as defined in OAR 410-173-0005; (E) Provided or funded by another agency. (f) For households with two or more eligible individuals, each individual's ADL service needs must be considered separately. (15) Maximum service period hours for IADL services: (a) The person-centered planning process uses the following limitations for time allotments for IADL tasks. Maximum hours in each assistance level are not guaranteed. Hours authorized must be based on the unmet service needs of an individual as determined by the IQA during the person-centered service planning process: (A) Medication management: (i) Minimal assistance, up to one (1) hour; (ii) Substantial assistance, up to two (2) hours; (iii) Full assistance, up to five (5) hours; (B) Personal Hygiene: (i) Minimal assistance, up to five (5) hours; (ii) Substantial assistance, up to seven (7) hours; (iii) Full assistance, up to twelve (12) hours; (C) Meal Preparation: (i) Minimal assistance: (I) Breakfast, up to one (1) hour; (II) Lunch, up to one (1) hour; (III) Supper, up to two (2) hours; (ii) Substantial assistance: (I) Breakfast, up to two (2) hours; (II) Lunch, up to two (2) hours; (III) Supper, up to three (3) hours; (iii) Full assistance: (I) Breakfast, up to five (5) hours; (II) Lunch, up to five (5) hours; (III) Supper, up to six (6) hours; (D) Shopping: (i) Minimal assistance, up to one (1) hour; (ii) Substantial assistance, up to two (2) hours; (iii) Full assistance, up to three (3) hours; (E) Housekeeping and Laundry: (i) Minimal assistance, up to two (2) hours; (ii) Substantial assistance, up to five (5) hours; (iii) Full assistance, up to nine (9) hours; (F) Money Management: (i) Minimal assistance, up to one (1) hours; (ii) Substantial assistance, up to (two 2) hours; (iii) Full assistance, up to three (3) hours; (G) Use of Electronic Communication Devices or telephone: (i) Minimal assistance, up to one (1) hours; (ii) Substantial assistance, up to two (2) hours; (iii) Full assistance, up to three (3) hours; (b) Service plan hours for IADL tasks may only be authorized for an individual if the individual requires assistance (minimal, substantial, or full assist) from another person in that IADL task as determined by a service assessment applying the parameters in these rules. Hours authorized must incorporate the frequency and the duration of the tasks within each IADL. For housekeeping, the size of the home may be used to reduce the hours. For meal preparation, hours must be reduced if an individual is receiving Medicaid home delivered meals. (c) The IQA may authorize fewer hours than the maximum number of hours in any or all IADLs based on their assessment of the individual's unmet need. (d) The IQA must document the reason for authorizing fewer hours than the maximum hours. The IQA may reduce hours for any of the following reasons: (A) Reduced frequency or duration of an IADL need; (B) Durable medical equipment or home modification reduces need for assistance; (C) Individual preference; (D) Natural supports; (E) Provided by or funded by another agency; (F) Small living space. (e) When two or more individuals eligible for IADL task hours live in the same household: (A) Medication management and transportation shall be authorized separately for each eligible individual. (B) For shared IADL tasks, payment is made for the individual with the highest of the allotments in meal preparation, shopping, and housekeeping and laundry and a total of two (2) additional IADL hours per service period for each additional individual to allow for the specific IADL needs of the additional individual’s specific IADL needs. (16) When one or more eligible individuals are living in the same household and receiving in-home services, the total number of hours authorized for ADLs and IADLs may not exceed 24 hours within any 24-hour period in the same household unless an exception is granted as described in this rule. (17) The Authority may approve an exception to the maximum service period hours when an individual's assessed needs cannot be adequately met within the standard assessed service limitations. (a) The determination to authorize additional hours may be based on: (A) An initial assessment or reassessment; (B) Information identified through the person-centered service planning process; or (C) Information provided by the individual or the individual's authorized representative and those who participated in the assessment and person- centered service planning process. (b) Additional hours authorized under this section must be necessary to maintain the individual's health, safety, and welfare and be documented in the individual's PCSP. (18) A PCA is limited to 16 hours of awake care during a 24-hour work period. (19) All PCAs are limited to 60 hours per week unless the individual has received an exception described in (17). (20) In an emergency or unanticipated situation where the PCA must provide critical care to ensure the health or safety of the individual and the IQA is unavailable to provide prior authorization, the following shall be permitted if the PCA or individual notifies the IQA within two (2) business days of the date the additional hours were first: (a) Worked that exceed the hours authorized on the individual’s PCSP; (b) Worked that exceed the maximum service period hours authorized by sections (14) and (15) of this rule; or (c) Worked that exceed the awake care limitation in section (18) of this rule when the PCA must remain awake to provide necessary ADL care. (21) A provider may not receive payment from the Authority for more than the total amount authorized by the Authority on the service plan authorization form. All service payments must receive prior authorization by the IQA. This section shall be waived unless the emergency provisions in section (20) of this rule are met. (22) The IQA must assess and utilize as appropriate, natural supports, cost-effective assistive devices, durable medical equipment, housing accommodations, and alternative service resources as described in this rule that may reduce the need for paid assistance. (23) The Authority may authorize paid in-home services only to the extent necessary to supplement potential or existing resources within an individual's natural supports system. (24) Payment by the Authority for Medicaid IHPC services are only made for the tasks described in this rule as ADL or IADL tasks. Services must be authorized to meet the needs of an eligible individual and may not be provided to benefit an entire household.