oregon project independence rule and fee schedule update september 26, 2013
Post on 02-Apr-2015
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2 Why the Change?
House Bill 3037 in 2011 created need for the update Change in authorized services Create statewide consistency for the OPI waitlist
OPI Rule Group met and update rule 2012 Updated rules effective July 1, 2013
3 What has Changed?
Case Management is now called Service Coordination Individuals screened using standardized tool
Specifically looking at risk for out of home placement Update Fee for services Local AAA’s to review Fee Collection Policy Update language and readability of rule
4Specifics from the rule change Definitions:
New Authorized Home Care Supportive Service Assistive Technology Device “means any item, piece
of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of an individual.”
Check for local policy, AAA’s may add this service to their specific list of services.
5Specifics from the rule change
Definitions:
Home Delivered Meals: ... (a) Are prepared and delivered in
compliance with applicable state and local laws;
(b) Meet a minimum of 33 1/3 percent of Dietary Reference
Intakes and Dietary Guidelines;
(c) Include meal menus approved by a registered dietitian;
(d) Require an in-person initial assessment and a minimum annual
assessment; and
(e) Provide nutrition education to the individual one time per year.
6Specifics from the rule change
Definitions: Health Care Costs: means health-related expenses paid out-of-
pocket that include but are not limited to medical, dental, health insurance, prescription drugs, over-the-counter drugs, hearing aids, and eyeglasses.
Place of Residence: means the physical location of an individual’s legal residence. For purposes of these rules "place of residence" does not include an adult foster home, assisted living facility, residential care facility, or nursing facility licensed by the Department.
7Rule Requirements
At least annual CAPS assessment If consumer is under 60 must have diagnosis of Alzheimer's
Disease or a related disorder OAR 411-032-0000 (8)
Consumer cannot be receiving Medicaid, except SNAP, QMB SMB or SMF
If residing in a facility (not licensed by Department) offering services, OPI services are limited to those not available in the setting
Consumer is at risk of out of home care (SPL 18 & Risk tool)OPI Risk 0287j is completed (if waitlisted, when opened,
annually and at final determination/or closing OPI)
8 Fee Changes
• $5.00 annual fee for existing clients ends 9-30-13• One time fee of $25 effective 10-1-2013• Can be implemented for new clients only• AAA’s will have flexibility to work with clients who incur
a hardship in paying the $25 (e.g. payment plan, adjusted fee)• AAA’s criteria for flexibility will be outlined in their local
fee collection policy
9Fee Changes
New fee schedule is easier for consumers to understand and for AAA’s to administer
10% increments from 151% to 400% of Federal Poverty Level (FPL)
Change may allow low-income clients (200% FPL) who have historically refused OPI due to cost to accept services
12 Fee Schedule Information New Fee Schedule will change (lessen) current
fees charged • Fee Assessment 287k must be updated at least
annually • Seek local direction regarding early changes with
new fee schedule (likely will be in consumer’s favor)• Note that rule does not allow for non-billing
unless addressed in local OPI policy
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Presenter:
Sandy Abrams, Trainer/Policy Analyst
NorthWest Senior and Disability Services
If I didn’t have my HCW coming to help me, I don’t know if I would be able to stay in my home. OPI relieves my daughter, who is busy with her life and family, as well.
An 88 year old OPI consumer in Yamhill County
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