Oregon Project Independence OPI Module 1 Program Basics

Oregon Project Independence OPI Module 1 - Program Basics for AAA Spring 2014

OPI Module 1 is an overview of OPI for new AAA staff not familiar with the program or for those who need a refresher of the program basics.

OPI is funded through the Oregon General Fund. The Department of Human Services, Seniors & People with Disabilities allocates OPI funds to local Area Agencies on Aging to implement this program. See: 411 -032 -0005 (5)

Area Agencies on Aging AAAs provide contracted authorized services to older adults and those individuals with physical disabilities, living within various AAA planning and service areas (PSA), statewide.

Oregon Project Independence is a program governed by Oregon Administrative Rules (OARs) Chapter 411 Division 32. The OAR’s are the basis for AAA policies and procedures for the program. Oversight for OPI is provided by the DHS State Unit on Aging (SUA).

Oregon Project Independence The Basics

The Goals of OPI 411 -032 -0001 Promote quality of life and independent living among older adults and people with disabilities. Provide preventive and long term care services to eligible individuals to reduce the risk for institutionalization and promote self-determination.

The Goals of OPI 411 -032 -0001 Provide services to frail and vulnerable adults who are lacking or have limited access to other long term care services. Optimize eligible individual’s personal resources and natural supports.

Who is Eligible for OPI ? 411 -032 -0020 In order to qualify for authorized services from a AAA service provider, each eligible individual must meet the following criteria:

OPI Eligibility v Be 60 years old or older v Or, be under age 60 and diagnosed as having Alzheimer’s Disease or a related disorder OAR 411 -032 -0020 (1)(a)

v Alzheimer’s Disease or related disorder 411 -032 -0000 (8) Means a progressive and degenerative neurological disease that is characterized by dementia. It includes dementia caused from any one of the following disorders: Ø Multi-Infarct Dementia (MID) Ø Normal Pressure Hydrocephalus (NPH) Ø Inoperable tumors of the brain, Ø Parkinson’s, Creutzfeldt-Jakob Disease, and Huntington’s Disease

v Alzheimer’s Disease or related disorder Continued… Ø Multiple Sclerosis Ø Uncommon dementia such as Pick’s or Wilson’s disease, or Supranuclear Palsy. Ø Or all other related disorders recognized by the Alzheimer’s association.

OPI Eligibility v Not be receiving financial assistance or Medicaid, except… Food Stamps Ø QMB (Qualified Medicare Beneficiary) This benefit pays the Medicare premium and the 20% co-pay. Ø SMB (Supplemental Low Income Medicare Beneficiary Programs) This benefit pays the Medicare premium only. Ø h The intent is to target low income individuals who are not receiving medical services through the Oregon Health Plan or longterm services supported by Medicaid programs.

v OPI Eligibility Meet the requirements of the long-term care services priority rules OAR 411 division 015. h This means… The applicant’s OPI eligibility determination is governed by the Division 015 Long Term Service rules, including: Ø The requirement of a standardized assessment tool – Oregon ACCESS, CAPS; Ø The requirement that an assessment be done face to face, in a person’s home or care setting, and Ø Determining an applicant’s Service Priority Level (SPL). See: 411 -015 -0008 (1) 411 -015 -0010

A note on the Oregon ACCESS, CAPS assessment: Ø When beginning an OPI assessment, use only the OPI assessment type for CAPS. Ø Please do not use a Title XIX assessment type; as this may cause system problems.

Following is a list of the Service Priority Levels as defined by OAR 411 -015 -0010

Service Priority Levels OAR 411 -015 -0010 SPL 1 Requires Full Assistance in Mobility, Eating, Elimination, and Cognition. SPL 2 Requires Full Assistance in Mobility, Eating, and Cognition. SPL 3 Requires Full Assistance in Mobility, or Cognition, or Eating. SPL 4 Requires Full Assistance in Elimination. SPL 5 Requires Substantial Assistance with Mobility, Assistance with Elimination and Assistance with Eating. SPL 6 Requires Substantial Assistance with Mobility and Assistance with Eating. SPL 7 Requires Substantial Assistance with Mobility and Assistance with Eating. SPL 8 Requires Minimal Assistance with Mobility and Assistance with Eating and Elimination. SPL 9 Requires Assistance with Eating and Elimination.

Service Priority Levels OAR 411 -015 -0010 SPL 10 Requires Substantial Assistance with Mobility SPL 11 Requires Minimal Assistance with Mobility and Assistance with Elimination. SPL 12 Requires Minimal Assistance with Mobility and Assistance with Eating. SPL 13 Requires Assistance in Elimination. SPL 14 Requires Assistance with Eating. SPL 15 Requires Minimal Assistance with Mobility. SPL 16 Requires Full Assistance in Bathing or Dressing. SPL 17 Requires Assistance in Bathing or Dressing. SPL 18 Independent in the above levels but requires structured living for supervision for complex medical problems or a complex medication regimen.

v An eligibility determination is required before any individual may be authorized services from an AAA or service provider. v Any documentation required (see next slide) by OAR 411 -032 -0015 for eligibility must be obtained before an individual under the age of 60 may be determined eligible and given services. 411 -032 -0020 (1)(b)

The documentation required by OAR 411 -032 -0015 (1)(d) for individuals under age 60: Documentation that the individual has been diagnosed as having Alzheimer's Disease or a related disorder can be received verbally or in writing from the individual's physician. The type of "related disorder" must be specified by the physician. The information received should be reviewed, narrated in Oregon ACCESS, and placed in the case file, (if in written form).

v Confidentiality: 411 -032 -0015 (4) AAA’s are contracted with the state to adhere to all DHS confidentiality rules for OPI recipients. Please follow confidentiality policy and obtain written consent of the recipient or their legal representative for release of information.

v Who is not eligible for authorized services? § Any Individual residing in a Nursing Facility § Assisted Living Facility § Residential Care Facility § or Adult Foster Home setting § This does not restrict the ability of an eligible individual to move from an institution to their home to receive authorized services, when judged more appropriate. 411 -032 -0020 (1)(d)

v Any individual residing in a living setting that offers any services authorized under the OPI rules, is limited to receiving OPI authorized services that are not already available in that setting. 411 -032 -0020 (1)(e) The intent is to avoid the duplication of services and avoid replacing services already paid for and provided. The savings allows a greater number of people to be served with OPI funds.

Who May Apply for OPI ? 411 -032 -0020 (4)(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.

v Service Determination 411 -032 -0020 (2)(d) An individual’s services are determined after eligibility has been established, and at regular intervals, but not less than once every 12 months. This means an individual needs an Annual CAPS assessment.

Written Notification: v Individuals must receive written notification of the services determination. 411 -032 -0020 (2)(e) This is done using Form 287 L

The Written Notice Includes: v The maximum monthly hours of authorized services, v The hourly and maximum monthly fee, v The service rate, v And provider contact information. 411 -032 -0020 (2)(e)(A)

Written Notification of service determination must be provided: v 1. Upon initial service determination v 2. At the annual reassessment v 3. When there are changes to the service determination 411 -032 -0020 (2)(e)(B)

v OPI Form 287 L Service Agreement is the mandatory form for notification.

A note on OPI Forms: OPI rules state: “The collection of required program and fiscal records and data associated with OPI must be on forms and data systems as approved by the Department. ” 411 -032 -0015 (1)(a) Future training will focus on the OPI mandatory forms and their use.

OPI Fees: 411 -032 -0044 A One-Time fee is applied to all individuals receiving OPI authorized services who have adjusted income levels at or below the poverty level. Ø All individuals whose annual gross income exceeds the minimum, are charged based on a sliding fee schedule as established by the Department. Ø Note: A new OPI Fee Schedule was adopted effective 10 -1 -13 Ø

OPI Fees: 411 -032 -0015 (1)(a) & 411 -032 -0044(d) How fees for OPI services are developed, billed, collected, and utilized is contained in each AAA Area Plan. The Area Plan also contains policy for addressing individual non-payment of fees, including when exceptions are made for repayment and when fees are waived.

Grievance Process 411 -032 -0020 (4) 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.

Grievance Process 411 -032 -0020 (4) Individuals must continue to receive authorized services until the disposition of the local AAA grievance review. The AAA must provide the applicant with written notification of the grievance review determination decision.

What Can OPI Funds Be Used For ? Local AAA Authorized Services: 411 -032 -0010 (1)(a)(A) ü Adult Day Home Care Services ü Chore ü Registered Nurse ü Assistive services technology ü Personal care ü Home delivered meals ü

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 Home Care: means assistance with IADLs such as housekeeping, laundry, shopping, transportation, medication management, and meal preparation. ü 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. ü

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 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 the individual. (Note: Local policy will dictate what is allowed and ü whether or not monthly costs are allowed. )

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 ü 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 ADL’s, or when an individual requires assistance for ADL needs. Assistance is provided either by an inhome care agency or by a home care worker.

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 ü Adult Day Service: means a community-based group program designed to meet the needs of adults with functional impairments through service plans. These structured, comprehensive, nonresidential programs provide health, social and related support services in a protective setting during part of a day, but for less than 24 hours a day.

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 ü Registered Nurse Services: mean services provided by a registered nurse on a shortterm or intermittent basis, that include but are not limited to: a. ) Interviewing b. ) Assessing the ability to perform tasks, c. ) Preparing a plan that includes treatment needed, d. ) Monitoring medication, e. ) Training and educating providers.

What Can OPI Funds Be Used For ? Definitions 411 -032 -0000 ü Home Delivered Meals: mean a service that includes a meal provided to an eligible individual in the individual’s place of residence. HDM a. ) Are prepared and delivered in compliance with applicable state and local laws, b. ) Meet a minimum of 33 & one third percent of Dietary Reference Intakes and Dietary Guidelines. (see other OAR requirements)

Other Authorized Services: 411 -032 -0010 (1)(b) Authorized on a case by case basis by the DHS Director (Central Office): ü Services to support community caregivers and strengthen the natural support system of individuals. ü Evidenced-based health promotion services. (These services help participants adopt healthy behaviors, improve their health status, and reduce the use of health services)

Other Authorized Services: 411 -032 -0010 (1)(b) Options counseling. ü Assisted transportation options that allow individuals to live at home and access the full range of community resources. ü (Definition: Escort services )

Service Determination: Service determination – is the process of determining the proper authorized service for each eligible individual. This determination rests with the AAA. 411 -032 -0020 (2)(a) & 032 -0000 The AAA determines which authorized services they can offer according to the Area Plan. The Area Plan includes, among other things, the types and amounts of services to be offered and the costs of authorized services. 411 -032 -0005 (1)(b)

v Authorized Allowable Costs: 411 -032 -0010 (2)(3) Allowable costs by AAAs are costs associated with the direct provision of authorized services to individuals and such administrative costs as may be required to assure adequate services and to provide information to the Department. Administrative costs cannot exceed ten percent of OPI funds.

Questions?

Oregon Project Independence State Unit on Aging Contacts: Suanne Jackson AAA Liaison; ADRC State Unit on Aging State of Oregon, DHS, APD 676 Church St NE Salem, OR 97301 Phone: 503 -373 -1750 Elaine Young Manager: State Unit on Aging, OPI State of Oregon, DHS, APD 676 Church St NE Salem, OR 97301 Phone: 503 -373 -1726 suanne. jackson@state. or. us elaine. young@state. or. us