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Oregon Project Independence 2013 Rule & Fee Schedule Changes. Information for AAA Directors September 19, 2013. Summary of rule changes 411-035-0000 Definitions. Multiple changes and updates

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oregon project independence 2013 rule fee schedule changes

Oregon Project Independence 2013 Rule & Fee Schedule Changes

Information for AAA Directors

September 19, 2013

summary of rule changes 411 035 0000 definitions
Summary of rule changes 411-035-0000 Definitions
  • Multiple changes and updates
  • Wording updated to reflect current practices, improve readability and establish consistency with other DHS rules
  • NEW/Updated
        • #12 Assistive Technology Device
        • #22 Evidence-Based Health Promotion
        • # 26 Health Care Costs
        • # 28 Home Care Supportive Services
        • # 30 Home Delivered Meals
        • # 40 Options Counseling
        • # 42 Place of Residence
        • # 49 Service Coordination
        • # 50 Service Coordination Costs
summary of rule changes
Summary of rule changes
  • Authorized services including those specified by House Bill 3037
  • 411-034-005 Administration
  • Section (5) updated (a “non compliance may result in a reduction or termination of OPI funding
  • 411-032-0010 Authorized Services

Home care supportive services

      • NEW 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.”

summary of rule changes1
Summary of rule changes

411-032-0010 new or updated

  • No Longer Allowed in this section of rule

Assisted Transportation*Planning for long term care*

Home Health Public education - LTC planning

Respite*

Information and Assistance

Other services authorized...

*see page 6

summary of rule changes2
Summary of rule changes

411-032-0010 new or updated

  • Service coordination

is the term replacing “case management”

It is a service designed to individualize and integrate social and health care options with an individual being served. The goal of service coordination is to provide access to an array of service options to assure appropriate levels of service and to maximize coordination in the service delivery system.

summary of rule changes 411 032 0010 new or updated
Summary of rule changes 411-032-0010 new or updated
  • (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:

(A) Services to support community caregivers and strengthen the natural support system of individuals;*

(B) Evidence-based health promotion services;

(C) Options counseling or

(D) Assisted transportation options that allow individuals to live at home and access the full range of community resources.*

summary of rule changes3
Summary of rule changes
  • REPEALED411-032-0013 Fee-Based Services
  • 411-034-0020 3) Priority for Authorized Services
    • Now clarified to support AAA agreement to use the OPI Risk Form (287k)
  • 411-034-0044 Fee for Authorized Services
    • Change to ONE time fee for those with zero contribution
    • Section 1 (c) regarding donation for OPI funded HDM Repealed
    • Section 1 h – AAA’s not required to make a second attempt to collect one time fee, but must have a department reviewed fee collection policy
    • Section 2 Fee for Service Schedule
      • Updated language regarding fees
local implications from rule changes
Local Implications from Rule Changes
  • Assistive Technology Device
    • Will need to create local policy regarding what is allowed, if you have cost caps or preferred vendors
    • Address the responsibility for monthly cost (Emergency Response System or Medication Dispensing System
  • Home Delivered Meals
    • Are prepared and delivered in compliance with applicable state and local laws;
    • Meet a minimum of 33 1/3 percent of Dietary Reference Intakes and Dietary Guidelines;
    • Include meal menus approved by a registered dietitian;
    • Require an in-person initial assessment and a minimum annual assessment; and
    • Provide nutrition education to the individual one time per year.
local implications from rule changes1
Local Implications from Rule Changes
  • Changing terminology from Case Management to Case Coordination in local policy
  • Will need authorization from the Director of the Department or Designee if OPI funds are used for:
      • Services to support community caregivers
      • Evidence-based health promotion
      • Options counseling
      • Assisted transportation
local implications from rule changes2
Local Implications from Rule Changes
  • Update Fee policy and processes
    • 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 the fee collection policy

The current $5.00 annual fee for existing clients needs to be stopped

opi fee schedule
OPI Fee Schedule
  • 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
  • New Fee Schedule will change (lessen) current fees charged
    • Local decision for application of new fee schedule
    • Training next week for staff will be Fee Assessment must be updated at least annually
    • Directing staff to seek local direction regarding early changes with new fee schedule (likely to be in consumer’s favor)
    • Note that rule does not allow for non-billing unless addressed in local OPI policy
local implications from rule changes3
Local Implications from Rule Changes
  • Policies updated to include the use of updated OPI forms
    • 287J - OPI Risk
      • Updated annually at review and at final disposition
      • Note risk score tracking tool is available & helpful for compulation
    • 287 K - OPI Fee Assessment
      • Updated Annually
    • 287 L - OPI Service Agreement
      • Updated annually and when Fee Assessment or service plan changes
    • UPDATED Forms and Fee Schedule coming next week
slide14

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.Zeda, 88 year old OPI consumer in Yamhill County

Presenter:

Sandy Abrams, Trainer/Policy Analyst

NorthWest Senior and Disability Services