OAR 411-015-0030: Extended Waiver Eligibility (EWE)

(1) An individual determined to no longer meet the criteria in 411-015-0100 and assessed as Service Priority Level (SPL) 14 - 18 through the assessment process outlined in 411-015-0008 may be eligible to continue receiving Long-Term Support Services (LTSS) when one of the following circumstances causes unmet needs or health and safety risks, which would result in the individual being institutionalized or hospitalized within 30 days: (a) Lack of access to shelter and support would cause the individual to deteriorate or decompensate; (b) Without supports, the individual would lack access to safe housing or has a documented history of eviction or threats of eviction that would lead the individual to deteriorate or decompensate; or (c) Without supports, the individual is at significant risk of abuse or exploitation. (2) An individual who is approved for EWE may receive the approved services and supports as defined in OAR 411-027-0020 for six calendar months from the effective date. (3) An individual meeting the criteria for EWE must have a re-assessment, as described in OAR 411-015-0008, completed no less frequently than every 12 calendar months, or when the individual’s needs or circumstances change. (4) EWE may be renewed for an additional six calendar months if the individual or their representative demonstrates: (a) The individual or representative is actively working with their assigned case manager to develop a safe plan to address the circumstances identified in section (1)(a) - (c) of this rule; and (b) The individual or representative shows demonstrable progress towards implementing the plan developed in subsection (3)(a) of this rule. (5) Case managers may deny initial EWE if the individual does not meet the criteria in (1) of this rule. (6) Case managers may deny renewals of EWE if the individual does not meet the criteria in (1) of this rule, or if the individual or representative does not meet the criteria in section (4) of this rule. (7) If the case manager does not deny EWE, they must submit initial and renewal requests for approval of EWE to the Central Office no later than two weeks prior to the service plan being closed. (8) Initial and ongoing eligibility for EWE shall be determined by APD central office on a case-by-case basis. (a) Ongoing eligibility will be determined based upon an assessment and a review of the individual’s progress towards mitigating the identified risk. In order to remain eligible, the individual must show they have been unable to mitigate the risks identified in (1) of this rule, through development and implementation of a transition plan. (b) In order to ensure engagement, case managers must have direct contact with an individual or their representative each month as described in OAR 411-028-0020(1). Case managers must narrate the monthly contacts in Oregon ACCESS and the steps or actions being taken to mitigate the identified risk. (9) An individual receiving Medicaid OHP Plus under OAR chapter 410, division 200 is not eligible for EWE. (10) An individual receiving home and community-based services as a recipient of Healthier Oregon may be eligible for EWE.