OAR 411-435-0030: General Eligibility for Ancillary Services

(1) An individual may not be denied ancillary 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 ancillary services, an individual must meet the following requirements: (a) Be an Oregon resident who meets the residency requirements in OAR 461-120-0010. (b) Be enrolled with a case management entity. (c) Be determined eligible for developmental disabilities services by the Community Developmental Disabilities Program of the county of origin according to OAR 411-320-0080, except for those enrolled in the following: (A) A child enrolled in the Medically Involved Children’s Program must meet the eligibility requirements in OAR 411-300-0120(7). (B) A child enrolled in the Medically Fragile Children’s Program must meet the eligibility requirements in OAR 411-300-0120(5). (C) A child enrolled in the Children's Extraordinary Needs Program must meet the eligibility requirements in OAR 411-440-0030. (d) Be receiving one of the following: (A) Family support services as described in OAR chapter 411, division 305. A child who is eligible for family support funds may access ancillary services according to the conditions in OAR 411-305-0230. (B) A Medicaid Title XIX benefit package through Oregon Supplemental Income Program-Medical (OSIPM) or Health System Division (HSD) medical programs. Individuals receiving Medicaid Title XIX through HSD medical programs for services in a nonstandard living arrangement, as defined in OAR 461-001-0000, are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding: (i) The transfer of assets as set forth in OAR 461-140-0210 through 461-140-0300. (ii) The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220. (C) A benefit package through Healthier Oregon. (e) Be determined to meet a Level of Care, as defined in OAR 411-317-0000, except for individuals receiving family support services as described in OAR chapter 411, division 305. (f) Demonstrate a need for an ancillary service as documented in an ISP or Annual Plan. (g) For individuals with excess income, contribute to the cost of service in accordance with OAR 461-160-0610 and OAR 461-160-0620, except for individuals receiving family support services as described in OAR chapter 411, division 305. (h) For services funded through the Community First Choice (K Plan) or a 1915(c) waiver, participate in a functional needs assessment and provide information necessary to complete the functional needs assessment and reassessment within the time frame required by the Department. (A) Failure to participate in the functional needs assessment or to provide information necessary to complete the functional needs assessment or reassessment within the applicable time frame results in the denial or termination of service eligibility. In the event service eligibility is denied or terminated, a written Notification of Planned Action must be provided as described in OAR 411-318-0020. (B) The Department may allow additional time if circumstances beyond the control of the individual, or as applicable the individual's legal representative, prevent timely participation in the functional needs assessment or timely submission of information necessary to complete the functional needs assessment or reassessment. (3) An individual enrolled to a residential program who meets the general eligibility criteria in this rule may be eligible for services equivalent to the ancillary services described in these rules through the residential program’s rate.