OAR 411-415-0030: Eligibility for Case Management Services - Entry, Exit, Transfers

(1) An individual may not be denied case management services or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws. (2) To be eligible for case management services, an individual must be determined eligible for developmental disabilities services by the CDDP of the county of origin as described in OAR 411-320-0080. (a) An adult who is eligible for case management services who lives in their own home or family home may select to have case management services provided by a CDDP or a Brokerage, when the Brokerage has the capacity to provide the service according to OAR 411-340-0110. When a local Brokerage is selected, but the local Brokerage does not have the capacity to provide case management, case management must be delivered by the local CDDP until the local Brokerage has capacity. (b) A child or adult selecting services from a residential program may only have case management services delivered by a CDDP or the Department. (c) A child who is eligible for and receives family support services, according to OAR chapter 411, division 305, may only have case management services delivered by a CDDP. (d) A child who is eligible for and enrolled in a CIIS program, according to OAR chapter 411, division 300, may only have case management services delivered by the Department and the CDDP, with respective roles identified in the ISP. (e) A child enrolled to the Children's Extraordinary Needs Program who meets ICF/IID Level of Care and has an intellectual disability or other developmental disability must be enrolled to a CDDP for case management services. (3) To be eligible for case management services delivered by a CIIS services coordinator, a child must: (a) Meet the eligibility requirements for a CIIS program in OAR 411-300-0120 and be enrolled to the program; or (b) Be enrolled in the Children's Extraordinary Needs Program, according to OAR chapter 411, division 440, and: (A) Meet the Nursing Facility Level of Care or the Hospital Level of Care, as defined in OAR 411-317-0000; and (B) Not meet the ICF/IID Level of Care as defined in OAR 411-317-0000. (4) In order to receive case management services, an individual, or as applicable the individual's legal representative, must accept all of the following supports: (a) Assistance from a case management entity with the design and management of Department-funded services and supports. (b) Abuse investigations. (c) The presence of a case manager at required entry or exit meetings. (d) Monitoring of services (when applicable) in accordance with OAR 411-415-0090. (e) Case management contacts as described in OAR 411-415-0090. (f) Case manager access to the individual's service record. (5) ENTRY INTO CASE MANAGEMENT. (a) The county of origin must enter an individual who is eligible for developmental disabilities services into case management services. (b) Upon entry into case management services, a case management entity must provide an explanation of the individual rights described in OAR 411-318-0010 to an individual and if applicable the individual's legal representative. (c) A case management entity must assure the availability of a case manager to address the support needs of each individual and during any emergency or crisis. (d) A case management entity must appropriately document the assignment of a case manager in an individual's service record and accurately report the individual's entry into case management services in the Department's electronic payment and reporting system. (A) Within 10 business days from an individual's date of entry, a case management entity must send a written notice to the individual, and as applicable the individual's legal representative, that includes the name, telephone number, and location of the case manager assigned to the individual. (B) A case management entity must ask an individual, and as applicable the individual's legal representative, to identify any family and other advocates to whom the case manager's name, telephone number, and location must be provided. (6) EXIT FROM CASE MANAGEMENT. (a) A case management entity retains responsibility for providing case management services to an individual until the responsibility is terminated and the individual exits from case management services as described in this rule. (b) A case management entity must exit an individual from case management services when any of the following occur: (A) The individual, or as applicable the individual's legal representative, submits a signed written request terminating case management services, or such a request is made by telephone and documented in the individual's service record. (B) The individual dies. (C) The individual is determined to be ineligible for: (i) Developmental disabilities services in accordance with OAR 411-320-0080; or (ii) CIIS in accordance with OAR chapter 411, division 300. (D) The individual is not a resident of Oregon. (E) The individual moves out of the geographic service area of the case management entity. If an individual takes up residence in another geographic service area, a case management entity that operates in the new geographic service area may enter the individual into case management services. (i) If an individual receiving case management from a CDDP moves to a new geographic service area, the original CDDP may continue to provide case management services to the individual. The individual, or as applicable the individual's legal or designated representative, must request to retain case management services from the original CDDP, and both the original CDDP and the CDDP in the new location must agree in writing to the responsibilities for delivering case management services. (ii) If an adult individual receiving case management from a Brokerage moves to a new geographic service area, the Brokerage may continue to provide case management services. The adult individual, or as applicable the individual's legal or designated representative, must request to retain case management services from the original Brokerage, and the Department must approve. Approval may be granted if the Brokerage is available to meet the case management standards described in OAR 411-415-0050 timely and adequately and the Brokerage has the capacity to deliver the case management services. (iii) In the case of a child moving into a foster home, host home, or 24-hour residential program, the county of parental residency or court jurisdiction must retain responsibility for case management services unless: (I) The child is entering into a state operated group home; or (II) An agreement between the CDDPs and the child's legal representative is reached that describes the responsibilities for case management services. (F) After the individual either cannot be located or has not responded after a minimum of 30 calendar days of repeated attempts by a case management entity to complete ISP development, Annual Plan development, or monitoring activities. (G) After the individual has been incarcerated, hospitalized, or in a nursing facility, for longer than 12 consecutive months. (c) An exit from case management services is an exit from all developmental disabilities services, except when an individual moves within Oregon but out of the geographic service area of their case management entity. (d) When an individual is being exited from case management services, the case management entity must issue a Notification of Planned Action consistent with OAR 411-318-0020 to notify the individual, and as applicable the individual's legal representative, of the case management entity's intent to terminate case management services and any other developmental disabilities services. A Notification of Planned Action is not required when the exit from case management is due to: (A) The individual's death; or (B) The individual moves within Oregon but out of the geographic service area of the case management entity. (e) When a child is exited from a CIIS program or the CEN Program, the child may remain enrolled at the CDDP for case management services if the child is eligible for developmental disabilities services according to OAR 411-320-0080. (7) CHANGE OF CASE MANAGEMENT SERVICES PROVIDER. (a) An available case management entity, chosen by an individual, or as applicable the individual's legal or designated representative, must enter an eligible individual into the case management entity within 10 calendar days from the request to change case management entities, unless a later date is mutually agreed upon by the individual, or as applicable the individual's legal or designated representative, and the case management entities involved in the change. The agreement must be documented in an individual's service record by the case management entity of the individual at the time of the agreement. (b) A change in case management entity may only be to a CDDP or Brokerage that is within the same geographic service area as the individual's residence, unless an exception is approved by the Department. (c) The exiting case management entity must assure all relevant information is provided to the entering case management entity to assist the entering case management entity in implementing an ISP or Annual Plan that best meets the individual's support needs including, but not limited to all of the following: (A) A current application on the Department-mandated application. (B) A copy of the Level of Care determination, if present. (C) A copy of the current functional needs assessment, if present or if unavailable in the Department’s electronic payment and reporting system. (D) A copy of eligibility determination and records used to make the determination. (E) Copies of financial eligibility information. (F) Copies of any legal documents, such as documents about guardianship, conservatorship, civil commitment status, probation, or parole. (G) Copies of progress notes. (H) A copy of the current ISP or Annual Plan and any protocols, Service Agreements, Functional Behavior Assessments, Behavior Support Plans, and Nursing Service Plans. (d) Incomplete, inaccurate, or missing information described in subsection (c) of this section may not cause a delay in enrollment at a selected case management entity.