Oregon Project Independence Rule and Fee Schedule update

September 26, 2013

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

10Fee Schedule effective October 1, 2013

11Updated Forms upcoming AR

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