OAR 413-090-0150: Payment Determination

(1) Payment for the personal care services identified in the personal care services plan is based on the eligible child or young adult's personal care services at a level of personal care payment that corresponds to the needs identified in the personal care services assessment and is determined by the Department. The levels of personal care are set forth in Exhibit 4. (a) If the eligible child or young adult qualifies as Level 1 (moderate care), the payment is a maximum of $352.00 per month based on the days within the month the child or young adult is eligible for and receives personal care services. (b) If the eligible child or young adult qualifies as Level 2 (intermediate care), the payment is a maximum of $705.00 per month based on the days within the month the child or young adult is eligible for and receives personal care services. (c) If the eligible child or young adult qualifies as Level 3 (advanced care), the payment is a maximum of $1057.00 per month based on the days within the month the child or young adult is eligible for and receives personal care services. (d) If the eligible child or young adult qualifies as Level 4 (intensive care), the payment is an amount authorized by the Department, based on the days within the month the child or young adult is eligible for and receives personal care services and on the intensity and frequency of the personal care services in conjunction with all other medical services provided for the child or young adult. (2) Payment for personal care services is calculated based on the number of days personal care services were provided to the eligible child or young adult. (3) Except as provided in section (4) of this rule, payment for personal care services is authorized by the Department when the personal care services assessment is completed and the contract registered nurse, program nurse consultant or manager has verified that the provider is a qualified provider. (4) If the referral for a personal care services assessment was delayed, the program nurse consultant or manager may authorize payment before the assessment is completed when personal care services were provided by a qualified provider and there is documentation of the child’s or young adult’s personal care needs.