OPI Rules – Topical

Eligibility 411-032-0020

(a) In order to qualify for authorized services from an AAA or service provider, each eligible individual must:

(A) Be 60 years old or older or be under 60 years of age and diagnosed as having Alzheimer's Disease or a related disorder;

(B) Not be receiving financial assistance or Medicaid, except food stamps, or Qualified Medicare Beneficiary or Supplemental Low Income Medicare Beneficiary Programs; and

(C) Meet the requirements of the long-term care services priority rules in OAR chapter 411, division 015*.

*Note: 411-015 Long Term Care Rules mentioned in (C) require:

  • An In-home assessment 015-0008(f)
  • Use of CAPS Assessment tool 015-0008 (e)
  • SPL 18 or below 015-0015(1)(b)

*Note: Individuals not eligible based on chapter 411, division 015 rules:

  • Failure to participate in an assessment = Denial 015-0008(j)(A)
  • Individuals eligible for developmental disability services 0015(4)
  • Individuals with diagnosis of mental or emotional disorder 0015(5)
  • Individuals with substance abuse related disorder 0015(5)
  • Unless the above have a non-psychiatric diagnosis or a physical disability and the individual’s need for services is based on his or her medical non-psychiatric diagnosis, or his or her physical disability. Supporting documentation is required. 0015(5)(a)(b)(c) People often have a combination of physical and mental health / substance abuse needs. In that case the non-psychiatric and non-mental health needs must outweigh the mental / emotional / substance abuse needs.

Eligibility (continued)

Not Eligible 411-032-0020 (d)

Individuals residing in the following settings are not eligible for authorized services:

  • Nursing Facility
  • Assisted Living Facility
  • Residential Care Facility
  • Adult Foster Home

This does not restrict the ability to move an eligible individual from such institutions to their home to receive authorized services, when judged more appropriate, based on medical, financial, physical, functional, and social considerations.

No Duplication of Services 411-032-0020 (e)

(e) Any individual residing in a living setting that offers any services authorized under OAR 411-032-0010 is limited to receiving OPI authorized services that are not available in that setting.

Frequency of Service Assessments 411-032-0020(2) (d)

(d) Service determination is made:

(A) After eligibility determination; and (initial assessment)

(B) At regular intervals but not less than once every twelve months.

OPI Goals 411-032-0001

The goals of Oregon Project Independence are to:

(1) Promote quality of life and independent living among older adults and people with physical disabilities;

(2) Provide preventive and long-term care services to eligible individuals to reduce the risk for institutionalization and promote self-determination;

(3) Provide services to frail and vulnerable adults who are lacking or have limited access to other long-term care services; and

(4) Optimize eligible individuals' personal resources and natural supports.

Authorized Services411-032-0010

(a) Authorized services for which OPI funds may be expended include:*

(A) Home care supportive services limited to the following:

  • Home care;
  • Chore;
  • Assistive technology device;
  • Personal care;
  • Adult day services;
  • Registered nurse services; and
  • Home delivered meals.

(B) Service coordination.

(b) Other authorized services for which OPI funds may be expended are authorized on a case by case basis by the Director of the Department. Other authorized services may include:

Services to support community caregivers and strengthen the natural support system of individuals; Evidence-based health promotion services;

Options counseling; or Assisted transportation options that allow individuals to live at home and access the full range of community resources.

*Note: Each AAA area determines what services they offer, and service limitations based on the Area Plan. Not all AAAs offer equal services.

Definitions 411-032-0000

(Amended 7/1/2013)

(12) “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.

(14) "Chore" means assistance such as heavy housework, yard work, or sidewalk maintenance provided on an intermittent or one-time basis to assure health and safety.

(27) "Home Care" means assistance with IADLs such as housekeeping, laundry, shopping, transportation, medication management, and meal preparation.

(41) "Personal Care" means in-home services provided to maintain, strengthen, or restore an individual's functioning in their own home when an individual is dependent in one or more ADLs, or when an individual requires assistance for ADL needs. Assistance is provided either by an in-home care agency or by a homecare worker.

Confidentiality 411-032-0015 (4)

(4) CONFIDENTIALITY. The use or disclosure by any party of any information concerning a recipient of authorized services described in these rules, for any purpose not directly connected with the administration of the responsibilities of the Department, AAA, or service provider is prohibited except with written consent of the recipient, or their legal representative. Disclosure of recipient information must meet Department requirements.

Appeals 411-032-0020(4)

(4) APPEALS. Individuals for whom services are denied, disallowed, or reduced through eligibility determination or service determination are entitled to request review of the decision through the AAA grievance review procedure set forth in policy*.

(a) Individuals must continue to receive authorized services until the disposition of the local AAA grievance review.

(b) The AAA must provide the applicant with written notification of the grievance review determination decision.

(c) Applicants who disagree with the results of the AAA grievance review have a right to an administrative review with the Department, pursuant to ORS chapter 183. This information is provided to the applicant in a written notification at the time of the grievance review decision.

(d) Applicants requesting an administrative review from the Department are not eligible for continued OPI authorized.

(e) All individuals, including those who may have previously been terminated from OPI, have the right to apply for OPI authorized services at any time.

*Note: Each AAA has it’s own Grievance Procedure detailed in the Area Plan.

OPI Fees 411-032-0044 (1)

(1) FEE FOR AUTHORIZED SERVICES.

(a) A one-time fee is applied to all individuals receiving OPI authorized services who have adjusted income levels at or below federal poverty level. The fee is due at the time eligibility for OPI authorized services has been determined.

(b) Fees for authorized services, except service coordination and home delivered meals, are charged based on a sliding fee schedule* to all eligible individuals whose annual gross income exceeds the minimum, as established by the Department. For purposes of these rules, an individual's annual gross income includes:

  • Salaries from the household;
  • Interest and dividends from the household;
  • Pensions, annuities, Social Security, and railroad retirement benefits from the household; and

Any other income from the household.

  • All out-of-pocket health care costs may be deducted from the individual's annual gross income.
  • All child support paid by a non-custodial parent may be deducted from the individual's annual gross income.

(c) Individuals must receive written notification of the hourly and maximum monthly fee for service upon initial service determination and whenever there is a change.

(d) The AAA must develop procedures for assessing, billing, collecting, and expending fees.

*Note: APD publishes an updated Sliding Fee Schedule for OPI.