OAR 411-033-0020: In-Home Care Agency Services

(1) In-home care agency (IHCA) services are one of the in-home service options available for individuals eligible for Medicaid in-home services. The in-home care agency must be licensed in accordance with OAR chapter 333, division 536 or as a licensed home health agency that has obtained the in-home care service designation from the Oregon Health Authority according to ORS 443.305–443.355. (2) Medicaid-funded in-home care services, provided by the in-home care agency, are not available to individuals who reside in a licensed or certified community based care setting or while inpatient in a hospital or nursing facility setting. (3) Prior to accepting an individual for in-home care agency services, the IHCA must complete the initial screening to evaluate a prospective client's service requests as defined in OAR 333-536-0055. (a) The IHCA shall notify the referring AAA or DHS office and individual or individual's representative via email or phone of acceptance for services. The IHCA shall begin services within five business days from the date of acceptance unless the individual's health and safety requires an earlier start date to be determined by the AAA or DHS case manager and communicated to the IHCA prior to acceptance. (b) The case manager and IHCA must review the individual's person-centered service plan to assure the IHCA’s understanding of the individual’s service plan and assessed needs. Upon completion of case manager and IHCA review, the case manager shall draft a list of tasks based upon the person-centered service plan to be completed by the IHCA. This "task list" must be signed by the IHCA and returned to the CM. (4) Services Provided. (a) The services provided by the IHCA, in accordance with OAR 333-536-0045, must be based on the case manager's assessment and the person-centered service plan of the individual. (b) Services must include the safe provision of: (A) All assessed ADL supports; (B) All assessed IADL supports; and (C) Nursing services as required in the comprehensive certification in accordance with OAR chapter 333, division 536. The IHCA must ensure the services provided include medication reminding, medication assistance, medication administration, and nursing services in accordance with OAR chapter 333, division 536. (c) If the individual requires nursing services, the IHCA must conduct nursing assessment, monitoring, intermittent nursing care, and teaching and delegation of specific tasks. Nursing services must be provided by an Oregon-licensed registered nurse in accordance with the Oregon State Board of Nursing Administrative Rules in OAR chapter 851, divisions 045, 047, and 048, and OHA, Public Health Administrative Rules in OAR chapter 333, division 536. (d) For individuals accessing both IHCA and other in-home service options, the IHCA is only responsible for teaching and delegation to the IHCA employees. If other caregivers, who are not IHCA employees, are providing services and supports that require nurse delegation, the IHCA must coordinate delegation activities with other Department assigned nurses to ensure continuity of care. (e) IHCA employees, caregivers, nursing staff, and administrators, must carry identification indicating their name and the name of the IHCA for which they work. (f) The IHCA must ensure the individual is notified of any changes in the delivery of the IHCA’s service plan, such as a change in the personal care aid who provides the in-home service, the frequency of the service and the day and time when of the services will be provided in accordance with OAR 333-536-0060 Clients’ Rights and 333-536-0065 Service Plan. (5) Complaints. (a) In accordance to OAR 333-536-0042, any person may make a complaint verbally or in writing to the OHA Public Health Division regarding an allegation as to the care or services provided by an in-home care agency or violations of in-home care agency laws or regulations. (b) Mandatory reporting. All employees of an in-home health service, which does include IHCA are required by statute (ORS 124.050–124.095) to report suspected abuse or neglect of a child, an older adult, a person with a physical disability or the resident of a licensed care facility, to the Department or to a law enforcement agency as required by OAR 411-020-0020. (6) Disclosure Statements. (a) As defined in OAR 333-536-0055, a written disclosure statement shall be signed by the individual or the individual's representative. The disclosure statement must be specific to the services provided to the Medicaid service individual. (b) The disclosure statement must include the requirements of OAR 333-536-0055, in addition to all of the following: (A) Medicaid is the source of payment for the services provided by the IHCA. The Medicaid service payment is considered full payment for Medicaid services provided by the IHCA. (B) A description of the initial assessment and service planning process. (C) A description of the services to be provided and how those services will be provided, including a discussion regarding staffing availability and coordination. (D) IHCA and individual's rights and responsibilities. (E) Individual's rights pertaining to notification of termination of services. (F) The IHCA may not include any provision in the disclosure statement that effect individual's rights or the IHCA's liability for negligence. (G) For individuals receiving IHCA services, as described in OAR 333-536-0045, the services provided must be in accordance with the Medicaid assessment and service plan and the IHCA’s written service plan developed in conjunction with an individual or individual's representative, based on the individual's or individual's representative's request, and an evaluation of the individual's physical, mental, and emotional needs. (c) The disclosure statement for Medicaid individual’s may not include language referring to "buy outs" and "finder's fees", or include language preventing individuals from full access to other in-home services. IHCAs may not charge any Medicaid individual additional fees or penalties. (7) BACKGROUND CHECKS. According to OAR 333-536-0093, the IHCA must: (a) Ensure a criminal background check has been conducted on all individuals employed by, or volunteering for the IHCA who may have direct contact through a business relationship with the consumer. (b) IHCAs receiving Medicaid reimbursement must conduct their background checks through the DHS Background Check Unit and comply with the DHS criminal records and abuse check rules found in OAR 407-007-0200 through 407-007-0370 and in accordance to the time frame specified in OAR 333-536-0093. (A) Unless, based on possible criminal activity or other allegations against an IHCA employee, a new fitness determination is conducted resulting in a change in approval status; or (B) The Department or AAA may request a recheck more frequently based on additional information discovered about an IHCA employee or volunteer, such as possible criminal activity or other allegations.