OAR 411-016-0050: Limitations on In-Home Services Plans

(1) The AAA or Department must take necessary safeguards to protect an individual’s health, safety, and welfare when implementing an individual’s service plan in accordance with 42 CFR 441.302 and 42 CFR 441.570. When an individual with the ability to make an informed decision selects a service choice that jeopardizes health and safety, AAA or Department staff shall offer or recommend options to the individual to minimize those risks. For this rule, an “informed decision” means the individual understands the benefits, risks, and consequences of the service choice selected. Minimizing risks may include offering or recommending one or more of the following: (a) Natural supports to help with safety or health emergencies; (b) An emergency response system; (c) A back-up plan for assistance with service needs; (d) Resources for emergency disaster planning; (e) A referral for long term care community nursing services; (f) Resources for provider and consumer training; (g) Assistive devices; or (h) Home modifications. (2) The Department or a AAA with the approval of the Department may decide not to authorize a service provider, a service or a combination of services selected by an eligible individual or the individual’s representative when: (a) There are dangerous conditions that jeopardize the health or safety of the individual and necessary safeguards cannot be taken to improve the situation; (b) Services cannot be provided safely or adequately by the service provider based on: (A) The extent of the individual’s service needs; or (B) The choices or preferences of the eligible individual or the individual’s representative; (c) Dangerous conditions jeopardize the health or safety of the service provider that is authorized and paid for by the Department, and necessary safeguards cannot be taken to minimize the dangers; or (d) The individual does not have the ability to make an informed decision, does not have a representative to make decisions on their behalf, and the AAA or Department cannot take necessary safeguards to protect the safety, health, and welfare of the individual. (3) The Services Case Manager (SCM) must present the individual or the individual’s representative with information on service alternatives and provide assistance to assess other choices when the service provider or service setting selected by the individual or the individual’s representative is not authorized. The SCM must document in the case file the service alternatives offered. (4) The service plan payment is payment in full for the Oregon Project Independence-Medicaid services. Under no circumstances, may any Medicaid-paid provider demand or receive additional payment from an eligible individual, or other entity on behalf of the individual, for any services in the OPI-M service plan.