OAR 411-318-0020: Notification of Planned Action

(1) An individual and the representative of the individual must receive a written Notification of Planned Action in the event a developmental disabilities service is denied, reduced, suspended, or terminated. (2) The Notification of Planned Action must be on the form prescribed by the Department (form 0947). The Notification of Planned Action must include all the following: (a) The specific date the Notification of Planned Action is mailed or hand delivered to the individual and the representative of the individual. (b) The effective date of the denial, reduction, suspension, or termination. (A) For a denial of service, the effective date is the same date the Notification of Planned Action is mailed or hand delivered to the individual and the representative of the individual. (B) For a reduction, suspension, or termination of service, the effective date is: (i) For a Notification of Planned Action mailed or hand delivered on or before the 18th of the month, the end of the calendar month in which the Notification of Planned Action is mailed or hand delivered to the individual and the representative of the individual, if applicable; or (ii) For a Notification of Planned Action mailed or hand delivered on or after the 19th of the month, the end of the calendar month following the month in which the Notification of Planned Action is mailed or hand delivered to the individual and the representative of the individual, if applicable; or (iii) No fewer than 10 calendar days after the date the Notification of Planned Action is mailed or hand delivered to the individual and the representative of the individual, if applicable. (c) The specific service or unit of service to be denied, reduced, suspended, or terminated. (d) The rationale for the denial, reduction, suspension, or termination, including a reference to the specific reports, documents, or other information relied on in making the determination. For an action taken based on the result of a completed Oregon Needs Assessment for the determination of meeting ICF/IID Level of Care, the Notification of Planned Action must identify the specific questions, and responses to those questions, related to the areas of major life activity, identified in OAR 411-317-0000 for ICF/IID Level of Care, in which an individual does not demonstrate significant impairment. (e) The specific sections of the rules or statutes upon which the determination is based. (f) Notification that the documents relied upon may be reviewed by the individual or the representative of the individual. (g) Notification that if the individual or the representative of the individual disagrees with the determination to deny, reduce, suspend, or terminate a service, the individual has the right to request a hearing, or the representative of the individual has the right to request a hearing on the behalf of the individual, as provided in ORS chapter 183 and OAR 411-318-0025. The notification of the right to a hearing must include all the following: (A) The timeline for requesting a hearing. (B) How to request a hearing. (C) The right to receive assistance from the local program in completing and submitting a request for hearing. (D) The right of the individual to receive continuing services at the same level until a Final Order has been issued or, at the request of the individual or the representative of the individual, or until the individual has exhausted the appeals processes identified in OAR 411-318-0025. (E) Notification of the time frame within which the individual or the representative of the individual must request continuing services. (F) Notification of how, when, and where the individual or the representative of the individual may request continuing services. (G) Notification that the individual may be required to repay the Department for any continuing services received during the hearing process if the Final Order upholds the determination to reduce, suspend, or terminate the services. (3) The Notification of Planned Action must be made available using language, format, and presentation methods appropriate for effective communication according to the needs and abilities of the individual and the representative of the individual.