Expenditure Guidelines
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ODDS Expenditure Guidelines
Funding Authorities:
1915(k) Community First Choice (K Plan)
1915(c) Adult’s, Children’s,CIIS and Children’s Extraordinary Needs
Waivers
Appendix A: ADL/IADL/health related tasks detail
Appendix B: Foster care and in-home services
Appendix C: Family Support (SE 150)
Appendix D: Private Duty Nursing Services (CIIS Medically Fragile Program)
Appendix E: Provider Agency rates.
• Every need identified for an individual must note on the ISP which funding authority is being used to meet the
need, or that natural support is meeting it, or that the individual is choosing to have the need go unmet.
• The services authorized in an ISP reflect an amount not to be exceeded. If some amount of an authorized service
is not required by the individual, then a claim may not be made for it by a provider. For example, if an individual is
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assessed as requiring 200 hours per month of attendant care to meet identified ADL/IADL/Health Related Tasks
but is away on vacation where a natural support is providing the services for two weeks of a month, the usual
provider is not necessarily entitled to claim the full 200 hours for that month. Similarly, Attendant Care can’t
necessarily be “bunched” into a single day or a few days of the month unless doing so aligns with the customer’s
support needs. A provider should not claim more hours in any given day than are necessary to provide the
identified supports. Paid supports are meant to meet identified needs – at the time when they are needed and in
the amount they are required - and not a way to get a monthly payment to a provider.
• Shipping and handling costs, when shipping from the source of the item is necessary to get it to the individual,
may be included in the cost of the service. If not shipped from the manufacturer/distributor/retailer directly to the
individual, costs associated with getting the item the rest of the way are not allowable (e.g., if the device was
shipped to the CDDP/CIIS/brokerage office, the cost of getting it from the office to the customer is not allowable).
• Reimbursements directly to individuals or families are not allowed, including reimbursement for supplies or
materials. All payments must be made to a vendor of services (which includes a family member when acting as a
PSW).
• All funded services must be related to the disability and not for general household use and not due to financial
need.
• Generally, when two different service types are delivered within a single unit of time by the same provider, the
service type that represents the majority of the service type should be paid. This does not apply to PSW mileage
reimbursement, which is paid on top of certain other services.
• "Family Member" means husband or wife, domestic partner, natural parent, child, sibling, adopted child, adoptive
parent, stepparent, stepchild, stepbrother, stepsister, father-in-law, mother-in-law, son-in-law, daughter-in-law,
brother-in-law, sister-in-law, grandparent, grandchild, aunt, uncle, niece, nephew, or first cousin. Spouses (legally
married) may not be Personal Support Workers for their own spouse. Parents (including adopted and
stepparents) of minor children may not be Personal Support workers for their children.
• For children enrolled in Family Support Services (SE150), see Appendix C.
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• A procedure code marked with an (L) represents a service that is eligible for Department paid language
interpretation or translation. Please review this Language Access Worker Guide to see how to access these
services and this list of vendors and Notice to Proceed.
• Staffing ratios use the convention of # attendants or staff: # individuals getting services.
• When an individual becomes ineligible for Medicaid, authorized services must be ended. See the Loss of
Medicaid Worker Guide. For Professional Behavior Services and Discovery, if the final product (TESP, FBA or
PBSP) that would have been the result is not complete, the SC/PA must end further work on it (at the end of the
notice period), at whatever point the work is at. Providers should be paid only for the work completed.
Personal Support Worker (PSW) rates:
• Rates must be consistent with the current Collective Bargaining Agreement. Current PSWs in the bargaining unit
may not be paid less than their highest hourly rate per service category in place on October 3, 2013 as long as
the PSW did not have their provider number inactivated due to not delivering services for more than one year. A
provider must show proof of their highest hourly rate and that this rate was established prior to October 3, 2013.
There are three service categories and are as follows:
o PSW hourly services (attendant care and skills training),
o Job Coaching, and
o PSW CIIS hourly services (attendant care and skills training).
• A PSW providing services in CIIS and another program may have more than one wage. When an individual
moves from CIIS into an adult program when they turn 18 their PSW providers may retain the CIIS wage for one
year; to provide transition time to complete required trainings for an enhanced or exceptional rate. The PSW’s
rate will revert to the applicable rate based on completed trainings and individual eligibility. See PT-17-053.
• If rate or other information listed in this section of these guidelines is not the same as the current Collective
Bargaining Agreement, the CBA takes precedence. The PSW rates in this guideline are for the minimum rate per
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PSW type effective beginning July 1, 2024. Further information about the CBA and PSW wages can be found in
PT-23-067.
• A PSW Specialist (formerly identified as a PSW-IC in the 13-15 Collective Bargaining Agreement) retains their
PSW-IC wage as a PSW Specialist. The wage is effective for PSW services currently authorized and any that
may be authorized, including when the PSW Specialist begins to work for a new individual. PSWs who have had
their provider number inactivated for more than sixty (60) days, or who are terminated and later reapply as a
PSW, shall only be eligible for the base hourly wage until completion of enhanced, exceptional or PDC training.
• For additional information on PSW wages, please refer to the PSW Differentials and Non-Standard Rates worker
guide.
Step
Number of Hours Worked
July 1st, 2024 Rate
1
0 - 1999.999
$19.50
2
2000.000 - 3999.999
$20.50
3
4000.000 - 5999.999
$21.50
4
6000.000 - 7999.999
$22.50
5
Over 8000.000
$23.50
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PSW Specialty
Pay Differential
84-801 - In Home Personal Care Attendant
CIIS
$2.00
84-806 - DD PSW Enhanced Skills
$1.00
84-807 - DD PSW Exceptional Skills
$3.00
84-808 - DD PSW CPR/First Aid
$0.25
84-809 - DD PSW Employment Job
Coach
$2.50
84-818 - PSW Differential (PDC)
$0.75
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Ancillary Services
The following table describes whether ancillary services may be approved by the CME for individuals enrolled
in a residential program through SE257 in a POC. See OAR 411-435 and workers guides for additional
requirements and limitations.
24-hour res (SE50),
Host Homes (SE152)
Supported Living (SE51)
Foster Care (SE158/258)
Ancillary Service
s
Assistive Devices
OK
OK
OK
Assistive Technology
OK
OK
OK
Professional Behavior
Services
OK
OK (when not included in
the SL budget)
OK
Chore Services
No
No*
No
Community
Transportation
Please see the community transportation worker guide
Environmental
Modifications
No
No*
No
Family Training
OK (ODDS exception
required for approval)
OK (ODDS exception
required for approval)
OK (ODDS exception
required for approval)
Environmental Safety
Mods
No
No*
No
Vehicle Modifications
No
No (approval considered
only for vehicles owned by
the individual)
No
Specialized Supplies
OK
OK
OK
* An ODDS exception may be requested for new, non-provider owned, controlled or operated sites)
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BASIC EXPENDITURE REQUIREMENTS
Every service authorized MUST MEET ALL TEN OF THE CRITERIA BELOW
1. DIRECTLY related to a specific goal on an individual’s ISP AND
2. REQUIRED to maintain or increase Independence and/or Community participation and/or Productivity AND
3. REQUIRED solely because of the direct effects of a developmental disability AND
4. DOES NOT replace existing voluntary support system and resources AND
5. DOES NOT replace other government benefits (OVRS, Dept. of Ed., SSI, Oregon Health Plan, Section 8)
AND
6. DOES NOT provide for basic needs of food, shelter, clothing AND
7. COST- EFFECTIVE use of public resources AND
8. NEVER a direct payment to a beneficiary AND
9. NEVER for activities that are purely diversion oriented AND
10. NEVER for services delivered outside of the U.S. or its territories.
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Funding Authority: Community First Choice (K plan)
The following services are available under the authority of the Community First Choice State Plan
Amendment:
❖ Assistive Devices
❖ Assistive Technology
❖ Attendant Care
o In Home
o Foster Care
o Day Support Activities
o On the Job
❖ Professional Behavior Services
❖ Chore Services
❖ Community Nursing Services
❖ Community Transportation
❖ Environmental Modifications
❖ Home Delivered Meals
❖ Relief Care
❖ Transition Service
In order to be eligible to receive these services, the individual must have OCCS Medical (Title XIX Medicaid), meet
the Level of Care, and have an assessed need for the service.
Notes:
❖ The Adult In-Home Support Needs Assessment (ANA) and the Child In-Home Support Needs Assessment
(CNA) tool determine attendant Care Hours in Service Elements 49, 145,149, and 151. The hours may be
allocated to ADL/IADL attendant care and any hours authorized under the State Plan Personal Care Program
(POC code OR502), as determined through a person-centered planning process.
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Assistive Devices (411-435-0050(2))
Assistive Devices
Source
POC Code
POC Name
K Plan
OR380
Assistive Devices (formerly
Specialized Medical Equipment)
Description and notes for inclusion on an ISP and POC
Assistive Devices:
Assistive Devices means any category of durable medical equipment, mechanical apparatus, or electrical
appliance used to assist and enhance an individual's independence in performing any ADL, IADL, health-related
tasks, or to communicate in the home and community.
Durable Medical Equipment (DMEs) is equipment, furnished by a durable medical equipment, prosthetics,
orthotics and supplies (DMEPOS) provider or a home health agency that can withstand repeated use, is primarily
and customarily used to serve a medical purpose. Examples of DMEs generally covered by OHP include
wheelchairs, crutches and hospital beds. DME extends to supplies and accessories that are necessary for the
effective use of covered durable medical equipment.
Equipment intended to aid in physical functioning must be recommended by a relevant professional based on their
professional experience and qualifications to make the recommendation.
Examples:
• Adaptive equipment for eating (i.e., utensils, trays, cups, bowls that are specially designed to assist an
individual to feed him/herself).
• Specially designed clothes to meet the unique needs of the individual with the disability (e.g., clothes
designed to prevent access by the individual to the stoma, Velcro closures, specially designed zippers, etc.
which could allow the person to dress/undress with less support).
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Assistive Devices (411-435-0050(2))
• Purchases, rentals, repairs for durable medical equipment covered by OHP after the OHP limit has been
reached.
More information can be found in the Assistive Devices and Technology Worker Guide.
Requirements and limits for authorization:
• Only items described in rule and cost $1200 or less may be authorized by a CME.
• Any item or any combination of items that meet a single assessed need totaling more than $1200 must have an
ODDS approval prior to purchase.
• When multiple purchases are required to fulfill an identified support need, the costs should be considered
together.
• Items must be intended to increase the person’s independence in completing an assessed ADL/IADL need and
not be solely for entertainment purposes.
• Assistive Devices cannot be funded for the convenience of a care provider or to meet the needs of a care
provider.
• For items that may be available through the OHP or other health insurance, funds must be requested from
these entities first and a denial must be documented before the item may be purchased with K plan funding.
• If the OHP or other health insurance will pay for an item but the maximum allowable rate will not cover the
specific type or brand of item desired, Department funds cannot be used to make up the difference in cost.
Individuals should consult with their health plan staff, such as the Intensive Care Manager/Exceptional Needs
Care Coordinator, if they have difficulty locating an item for the maximum allowable rate.
• These items must be intended to increase the individual’s independence in completing an assessed ADL/IADL
need and not be solely for the entertainment of the individual.
• Assistive Devices cannot be funded for the convenience of a care provider or to meet the needs of a care
provider.
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Assistive Devices (411-435-0050(2))
This service is not available for:
• Work-related items available through a Vocational Rehabilitation employment plan.
• Generic household furnishings, personal clothing (for individual or family), and other purchases made
because of financial need.
• Materials or equipment that have been determined unsafe for the general public by recognized consumer
safety agencies.
• Items which are needed solely to allow a school-aged individual to participate in school.
• Items not of direct medical or remedial benefit to the individual.
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Assistive Technology (411-435-0050(3))
Assistive Technology
Source
POC Code
POC Name
K Plan
OR321
Assistive Technology (formerly AT
Purchase – Hardware)
K Plan
OR322
(Discontinued)
K Plan
OR323
(Discontinued)
K Plan
OR325
AT Maintenance
K Plan
OR528
Personal Emergency Response Systems
Description and notes for inclusion on an ISP and POC
Please note: Beginning with Version 17 of these guidelines, OR322 and OR323 are discontinued for us. For all
one-time assistive technology purchases please use OR321, for all ongoing assistive technology purchases (such
as minimal data plans and subscriptions) please use OR325.
Electronic devices:
Electronic devices to secure assistance in an emergency in the community. (e.g., cell phone, GPS alert device,
communication device or software)
• Reminders and alert systems for ADL or IADL supports. (e.g., reminder software on a mobile device,
programmable medication reminder device, schedule prompting software, GPS guidance software, etc.)
• Mobile electronic devices or software (e.g., communication device, communication software for a mobile
device)
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Assistive Technology (411-435-0050(3))
Personal Emergency Response Systems are intended for people who:
• Do not live in a residential program; AND
• Live alone or are alone for significant parts of the day and would otherwise require extensive routine
supervision or would otherwise require an attendant while out in the community.
• Personal Emergency Response Systems are intended to be used by the individual to summon paid and
unpaid support providers for immediate assistance when the emergency is not life-threatening.
• Personal Emergency Response Systems are not intended to replace devices, such as a cell or landline
phone or home security system, to access 911 services.
Assistive technology to provide additional security and replace the need for direct interventions to allow self-
direction of care and maximize independence such as motion/sound sensors, two-way communication systems,
automatic faucets and soap dispensers, incontinent and fall sensors, or other electronic backup systems.
Data plans, subscriptions, software, accessories, etc. when necessary and appropriate for the individual to
use the technology.
Requirements and limits for authorization:
• Only items described in rule and cost less than $1200 may be authorized by a CME.
• Any item or any combination of items that meet a single assessed need totaling more than $1200 must have
an ODDS approval prior to purchase.
• When multiple purchases are required to fulfill an identified support need, such as hardware and software
purchased separately, the costs should be considered together. For example, if the total cost of a tablet
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Assistive Technology (411-435-0050(3))
computer (hardware) to implement an ISP goal is $850, and if the applications (software) are $350, the total
cost would be over $1200, and this purchase would have to be prior approved by ODDS.
• For items that may be available through the person’s OHP or other health insurance, funds must be
requested from these entities first and the denial must be documented before the item may be purchased
with K plan funding.
• Any purchase made from this category must be directly related to an assessed ADL/IADL support need of
the individual. It must increase independence or lessen the need for other paid support. ISP goals in support
of the use of this service must describe how these conditions will be met.
• Assistive technology intended for use as an augmentative communication device must be recommended by
a professional qualified to make this recommendation, typically a Speech/Language Pathologist.
• When an item is lost, stolen or becomes damaged to the point it is no longer functioning properly,
Department funds may be used to repair or replace that item. However, service planning must consider the
likelihood of the same thing happening again and account for any impacts that may have on cost
effectiveness. Documentation of the strategy to keep the Assistive Technology solution cost effective may be
requested by ODDS. Repair or replacement more than one time in a plan year requires prior authorization
from ODDS.
o Where possible, the customer’s file must record the serial number of the item.
o In the case of theft, replacement may not happen until a police report is filed. A copy of the police
report must be kept in the individual’s file.
o Whenever possible, homeowner’s, renter’s or other available insurance claims must be made prior to
replacing an item using support or in-home funds.
This service is not available for:
• General cell, home or office telephone services or service plans.
• Cell phone services for staff who use the services for general communication or for others and the costs are
not clearly separated.
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Assistive Technology (411-435-0050(3))
• Any use where privacy is not assured when systems are used for remote monitoring, particularly when they
involve tracking systems. The ISP team must have a documented discussion, involving the individual
whenever possible, about privacy and the right to discontinue the use of the monitoring equipment at any
time. The ISP team must engage in backup planning for the possibility of such a refusal or a failure of the
technology.
• Reimbursement or advance payments such as with warranties.
For more information, please review Oregon Training and Consultation (OTAC) guide on this subject.
http://oregonisp.org/at/ and the Assistive Devices and Technology Worker Guide.
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Attendant Care/Skills Training (In Home: SE 49/145/149/150/151) (OAR 411-450)
Attendant Care/Skills Training
(In Home: SE
49/145/149/150/151)
Source
POC Code
POC Name
K Plan
OR526
Attendant Care Support (ADL/IADL)
K Plan
OR526ZE
Attendant Care Support 2:1 Two Providers
K Plan
OR526ZC
Attendant Care 2:1 Single Provider
K Plan
OR526RB
Attendant Care Group (1:2)
K Plan
OR526R3
Attendant Care Group (1:3)
Description and notes for inclusion on an ISP and POC
Attendant Care, Hourly
Attendant services and supports to assist an individual in accomplishing activities of daily living, instrumental
activities of daily living and health related tasks through hands-on assistance, supervision, or cueing.
ADL is a term used to refer to daily self-care activities within an individual's place of residence, in the community,
or both. These are the most basic activities necessary for daily life. IADL activities are not necessary for
fundamental functioning, but they let an individual live more independently in a community. These activities are
more complex than ADLs. See Appendix A for further information.
Skills Training
This service may have a specific goal to develop increased skills in targeted ADL/IADL areas. Someplace in the
Chosen Services section on the ISP should specify the area and expected change to skill level.
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Attendant Care/Skills Training (In Home: SE 49/145/149/150/151) (OAR 411-450)
Training must be designed to increase the individual’s skills in completing a specific ADL/IADL activity and not be
a general educational or recreational activity.
When an individual’s desired outcome is to develop his or her ability to engage in social activities, and the chosen
provider is an agency, the attendant care should be authorized using an OR542 procedure code as a Day Support
Activity (see below). All “classes” will be considered DSA. Except for organized “classes” and attendant care at an
employment setting, any other desired outcomes that require support with ADL/IADLs for someone living in home
will have attendant care (OR526) as described in this section authorized.
Attendant care may occur in the home or community (except at a competitive integrated employment setting, for
this see On the Job Attendant Care (OR545).
These supports will very often occur with one individual and one provider (OR526NA), but they may occur in a
group of two or three (OR526RB or OR526R3). For example, it is a group activity when two siblings or spouses
are each getting support with preparing a meal at the same time, or they go to the bank together.
Other times, two attendants are needed. This is determined using the support needs identified in the ONA,
ANA/CNA and discussion with the ISP team. There are various combinations of providers that can fulfill the need
for staffing ratios above 1:1. See the eXPRS help menu topic for detailed information on How to Authorize 2:1
Attendant Care Services. All staffing ratios above 1:1 require an approved exception. See the In-Home Staffing
Ratio and Hours Exceptions for information.
Service is not available for:
• Costs for transportation, food, shelter, and entertainment normally incurred by anyone on vacation, regardless
of disability, and not strictly required by the individual’s need for personal care assistance in all home and
community settings.
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Attendant Care/Skills Training (In Home: SE 49/145/149/150/151) (OAR 411-450)
• Expenses that would normally be paid by individuals without disabilities in pursuit of strictly recreational or
personal interests, e.g., video rental, tickets for movies and concerts, internet fees, admissions to sporting
events, health club dues, horseback riding fees, conference fees.
• Services delivered within the home to individuals who pay privately for services in licensed or certified
facilities.
• Other than ADL/IADL care, classroom support (such as tutoring or note taking) for general education classes
or classes that are specifically for individuals with developmental disabilities. No classroom care is available
for children (up to 18) or individuals up to 21 enrolled in school services.
• When other, more cost effective services are available that may meet the need (such as assistive technology
or an emergency response system) and are desired by the individual.
• Driver’s education classes or 1:1 skill training around driver training.
• GED classes.
• Parenting classes.
• For transition age students or youth when services are being provided by the school system, or other systems
(i.e., MH, TANF, CW).
• For children when the support needs are not a direct result of the child’s intellectual or developmental
disability.
• Caring for a pet. Attendant care may be used to care for a service animal if it has been prescribed by a
licensed professional and has completed its training.
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Hourly agency rates
Standard
Model Agency
Community Living
Supports Agency
OR526
Attendant Care Support (1:1)
$42.24
$34.99
OR526NA/ZE
Attendant Care Support (2:1)
(2 different agency providers)
$42.24
$34.99
OR526ZC
Attendant Care Support (2:1)
(One agency)
$76.69
$64.26
OR526RB
Attendant Care Group (1:2)
(per person)
$23.23
$19.25
OR526R3
Attendant Care Group (1:3)
(per person)
$16.90
$14.00
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Attendant Care (Foster Care: SE 158/258)
Attendant Care (Foster Care: SE
158/258)
Source
POC Code
POC Name
K Plan
ORAFC
Adult Foster Care
K Plan
ORCFC
Child Foster Care
K Plan
OR526ZE
2:1 Attendant Care Support
(ADL/IADL)
Description and notes for inclusion on an ISP and POC
For a description of Adult Foster Care and Child Foster Care please see the corresponding Standards and
Procedures and OARs.
This service description and procedure codes have no relationship to relief care delivered by a Foster Care
provider.
2:1 Attendant Care, Hourly, for an individual enrolled in Children’s or Adult Foster Care.
Attendant services and supports to assist an individual in accomplishing activities of daily living, instrumental
activities of daily living and health related tasks through hands-on assistance, supervision, or cueing.
When an individual has chosen to receive Foster Care services, the services must be authorized in a Plan of Care
using SE158 and proc code ORAFC for adults, or SE258 and proc code ORCFC for a child. This represents a
basic service payment for foster care services and does not include any ancillary services, which must be
authorized separately.
When the ISP team has determined that 2:1 supports are necessary for an individual residing in a Foster Care
setting the “second” care giver must be separately authorized in a SE257 POC using OR526ZE. Please refer to
the Worker’s Guide on this topic.
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Attendant Care (Foster Care: SE 158/258)
ORAFC: Rate determined by current SNAP
ORCFC: Rate determined by current SNAP
Rate for 2:1 in Foster Care (OR526ZE)
In SE 158 (Adult Foster Care): $15.97/hour*
In SE 258 (Children’s Foster Care): $15.97/hour*
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Day Support Activities (SE49/54/149) (OAR 411-450)
Day Support Activities (SE49/54/149)
Source
POC Code
POC Name
K Plan
OR542 (W1)
DSA - Facility
K Plan
OR542 (R1)
DSA - Facility 1:1*
K Plan
OR542 (ZF)
DSA - Facility 2:1*
(One Provider)
K Plan
OR542 (ZH)
DSA - Facility 2:1*
(Two Providers)
K Plan
OR542 (W2)
DSA - Community
K Plan
OR542 (RC)
DSA – Community 1:1 in a
group*
K Plan
OR542 (ZC)
DSA – Community 2:1*
(One Agency, 2 staff)
K Plan
OR542 (ZE)
DSA – Community 2:1*
(Two Providers)
K Plan
OR542 (RS)
DSA – Community Solo
* Requires an ODDS approved exception
Description and notes for inclusion on an ISP and POC
Day Support Activities
Attendant care supports in the community that happen during scheduled, intentional, structured activities in a non-
residential setting are authorized using DSA procedure codes (OR542). Though not an employment service, for
working age individuals’ activities that contribute to the skills required for entry into the workforce should be
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Day Support Activities (SE49/54/149) (OAR 411-450)
prioritized. These activities are non-employment services that are not duplicative of the services delivered as part of
a residential program. DSA is defined as Community Living Supports and subject to OAR Chapter 411, Division
450. DSA may only be authorized to agency providers, not to a PSW.
DSA must include a focus on competencies around:
• Support with community participation - assisting an individual in acquiring, retaining, and improving skills to
use available community resources and improving self-awareness and self-control;
• Support with communication - assisting an individual in acquiring, retaining, and improving expressive and
receptive skills in verbal and non-verbal language, social responsiveness, social amenities, and interpersonal
skills.
In plain terms, attendant care services authorized as DSA should focus on things like: waiting your place in line,
appropriate eye contact, respecting personal space, taking turns in a conversation, compromising in a group
decision, age appropriate conversation topics, initiating engagement with others, recognizing the end of an
engagement, avoiding isolation, recognizing hazards or unsafe situations in the community, “stranger danger,”
coordinating personal time and location using watches, phones, computers, clocks, maps, street signs, calendars,
bus schedules, community landmarks, signage & symbols, alarms, etc.
DSA requires that an individual have a measurable goal documented in the individual's ISP that is related to
developing or maintaining skills for participating in the community.
The purpose of attendant care DSA are to:
• Provide the support necessary to build and strengthen relationships between family members, friends, and
members of the local community who are not paid to be with the person, when the individual does not have
the skills to build and strengthen relationship independently and choses to actively work on those skills.
• Find places where an individual’s interest, culture, talent, and gifts can be contributed and shared with others
with similar interests.
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Day Support Activities (SE49/54/149) (OAR 411-450)
• Provide opportunities for people to do things they enjoy as well as new and interesting things that involve the
broader community. This is accomplished by helping to develop the skills needed to discover and participate
in them.
• Support participation in clubs, association, and organizations as members and in decision-making capacities.
• Increase those skills that are necessary to initiate, plan and engage in activities - alone or with others – out in
the individual’s community.
A provider agency may offer “classes.” These would be defined as group attendant care that is regularly occurring,
organized, structured around specific ADL/IADL supports intended to maintain or increase an individual’s skill level.
These will be authorized under the DSA procedure code OR542/W1 or W2. The activity must result in the
completion of an ADL/IADL. The subjects of these “classes” do not have to be specifically related to support with
participation in the community but do have to relate to an ADL/IADL activity. An individual may choose to attend a
community-based class for the general public (not something offered by a provider agency) such as a gardening
class, or an art class. If the individual needs support with community participation or communication to participate in
one of these types of classes, the agency provider can be authorized for DSA using OR542/RS or OR542/W2.
Other types of ADL/IADL supports in such a setting would be authorized as Attendant Care (OR526).
The use of solo, group community, or facility-based DSA services must be driven by the individual’s desired
outcomes. It may be appropriate for an individual to use one or any combination. The provider must be chosen by
the individual from all available providers.
Not all community based supports are DSA. Attendant care is a DSA only when delivered in order to meet a desired
outcome related to development of a person’s ability to engage in social activities. The specific activity, context, or
setting during the delivery of DSA matters less than the purpose. DSA can be delivered at any time during the day.
Attendant Care DSA may include the following activities under certain circumstances:
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Day Support Activities (SE49/54/149) (OAR 411-450)
• Other IADL tasks for a specific individual or multiple individuals when completing them is incidental to the
delivery of support with communication or community participation. These are tasks such as:
o Shopping for food or household items for use by the home.
o Shopping for individual’s personal items.
o Laundry, haircuts, banking, and similar personal services.
• For events where sitting and being entertained, with little or no interaction with others, is the focus (movies,
concerts, etc.), the individual’s support need must be related to being in that environment appropriately. For
example, a person may like seeing movies in a theater, but needs support to remain silent or to keep from
disturbing others.
Attendant care DSA do not include:
• Medical appointments.
• Overnight trips/camping.
• Activities that are necessary for the maintenance of the individual’s household.
• ADL/IADL support, other than the support with participation in the community described above, required by an
individual to maintain an existing relationship (hanging out with friends or visiting with family).
• Accompanying a staff person of a residential program into the community on household business.
• Purely recreational activities, e.g., activities done for their own sake and not dedicated to the development of
the individual’s ability to more fully engage with the community.
• Expenses that would normally be paid by individuals without disabilities in pursuit of recreational or personal
interests, e.g., video rental, tickets for movies and concerts, internet fees, admissions to sporting events,
health club dues, horseback riding fees, conference fees.
• Any other ADL/IADL supports that are not incidental to the goal of developing competency in the IADL
described in OAR 411-450-0050(2)(b)(D) Support with participation in the community.
• Individuals who do not have support needs related to OAR 411-450-0060(2)(b)(D) Support with participation
in the community.
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Day Support Activities (SE49/54/149) (OAR 411-450)
For individuals in 24-hour residential, supported living, and foster care this service is limited 25 hours per week of
any combination of job coaching, supported employment - small group employment support, employment path
services, and DSA. Individuals residing in these settings who do not receive employment services, may receive up
to 25 hours of day support activities per week.
The person centered planning process, taking into consideration the full scope of identified needs and the available
service level, will establish the amount of attendant care DSA that is authorized for someone living in an in-home
setting.
With OR542, use of the modifiers W1, R1, ZH, or ZF indicate that the service is facility based. "Facility-Based"
means the service occurs at a fixed site that is provider owned, controlled or operated and an individual little
opportunity to interact with people who do not have a disability (except for paid staff). Facility based services must
be used as a means to facilitate community participation and must comply with HCBS rule and policy.
With OR542, use of the modifiers W2, RC, ZC, or ZE indicates that the service occurs as a group of individuals in
the community, not in a facility. The modifier RC indicates that an individual who is participating in a group activity is
assigned an agency staff member to them and has been approved by exception. The modifier RS is for a service
when an individual is engaging in DSA alone, except for an agency staff member, and does not require an
exception.
Solo (RS) DSA supports must be 1:1 (solo) and not in a group (one supported individual in the setting and one
support staff). An individual may choose to use DSA “Solo” (RS). DSA “Solo” must be face to face and not remote.
OR542 with modifiers R1, ZH, ZF, RC, ZE and ZC may only be authorized with an ODDS approved exception.
Additional information about DSA modifiers can be found in this transmittal.
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Day Support Activities (SE49/54/149) (OAR 411-450)
Separate transportation funding is not available for use during the delivery of OR542. It may be available getting to
and home from a DSA setting.
The rate associated with OR542/W1 and W2 assumes a certain level of individualized attention for things like
support with toileting, putting on a jacket, etc. A 1:1 service should not be authorized to fill this function. When an
individual’s support needs may be extraordinary, a funding exception can be requested.
Provider Agency Rates
Per Hour:
Category 1
Category 2
Category 3
Category 4
Group DSA– Community
(OR542/W2, ZE)
$17.11
$21.33
$29.77
$39.76
Group DSA– Facility
(OR542/W1, ZH)
$11.99
$15.75
$19.50
$28.39
Solo DSA OR542RS
$42.24
Solo DSA (2:1)
OR542RS
$74.52 (requires ODDS
approval)
Rate for 1:1 Group DSA
Community OR542/RC:
$41.82
Rate for 2:1 Group DSA
Community OR542/ZC:
$71.24
Rate for 1:1 Group DSA
Facility OR542/R1:
$38.59
Rate for 2:1 Group DSA
Facility OR542/ZF:
$67.64
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On the Job Attendant Care (SE54/149) (OAR 411-450)
On the Job Attendant Care
Source
POC Code
POC Name
K Plan
OR545 (NA)
On the Job Attendant Care - 1:1
K Plan
OR545 (ZE)
On the Job Attendant Care - 2:1
(Two Providers)
K Plan
OR545 (ZC)
On the Job Attendant Care - 2:1
(One Provider)*
* Requires an ODDS approved exception
Description and notes for inclusion on an ISP and POC
On the Job Attendant Care is attendant care and health related supports provided as needed in a competitive
integrated employment setting in the general workforce where a person does not need employment services but
does need strictly attendant care supports.
A PSW is not a provider type for this service when the individual lives in a residential program.
On the Job Attendant Care is a 1:1 service in a competitive integrated employment setting only. If support needs
require additional staffing, a funding exception must be requested. If one provider agency can provide both support
staff for this service, the authorization modifier should be entered as ZC. If one provider can provide one staff, and
another provider provides the second staff, or the second staff is a PSW, then one provider would use OR545/ZE
and the second provider would use OR545/NA.
OR545 using modifiers ZE and ZC may not be authorized without an ODDS approved exception. See the eXPRS
help menu topic for more information on 2:1 authorizations.
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Professional Behavior Services (SE49/50/54/145/149/150/151/257) (OAR 411-304)
Professional Behavior Services
(SE49/54/149/150/151/257*)
Source
POC Code
POC Name
K Plan
OR570ST (L)
OR570RU (L)
Behavior Consultation,
Assessment and Training
for DD
K Plan
OR310ST (L)
OR310RU (L)
Behavior Support services
(on going)
Modifiers
Modifiers are used to identify the location of the individual and to determine rates. Use the modifier RU if the
authorized provider is located greater than 70 miles from the individual’s residence and they are the most cost-
effective or only available provider.
Note for Telecommunications or Remote Services: If most or all of the service provided is completed remotely, the
Standard Rate must be authorized regardless of the distance between the authorized provider and the individual’s
residence.
Description and notes for inclusion on an ISP and POC
The need for Professional Behavior Services is determined through a functional needs assessment in combination
with the person centered planning process and documented in the Individual Support Plan. If the functional needs
assessment doesn’t explicitly identify the needs for Professional Behavior Services, the ISP team can agree to
include this services on the individual’s Support Plan.
All Professional Behavior Service activities must be for the direct benefit of the individual. Professional Behavior
Services may be implemented in the home, vocational setting and/or community. Professional Behavior Services
must meet all standards outlined in OAR 411-304.
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Professional Behavior Services (SE49/50/54/145/149/150/151/257) (OAR 411-304)
Professional Behavior Services are only delivered by a qualified Behavior Professional in accordance with OAR
411-304-0170.
Professional Behavior Services may only include:
• A Temporary Emergency Safety Plan (TESP)
• A Functional Behavior Assessment (FBA)
• A Positive Behavior Support Plan (PBSP)
• Maintenance of the PBSP
Professional Behavior Services may also include training to the Designated Person (paid or unpaid) to mitigate the
identified challenging behavior.
The inclusion of OR570 in a POC may authorize one or more of the following:
• Temporary Emergency Safety Plan (TESP)
• Functional Behavior Assessment (FBA)
• Positive Behavior Support Plan (PBSP)
The inclusion of OR310 authorizes Maintenance of the Positive Behavior Support Plan.
Instructions for authorization:
A. The SC/PA must add a separate Plan Line in eXPRS to identify each of the services/events known to be
needed at the time. An ISP change form can add additional services at a later time. The services/events
available under this service element are limited to:
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a. For OR570
i. Temporary Emergency Safety Plan (TESP)
ii. Functional Behavior Assessment (FBA)
iii. Positive Behavior Support Plan (PBSP)
b. For OR310 - Maintenance of the Positive Behavior Support plan.
B. Each service/event for OR570 must have a Service Prior Authorization (SPA) which:
a. Identifies the provider of that portion of Professional Behavior Services.
b. Identifies the date range expected for that portion of Professional Behavior Services.
c. Identifies the not to exceed amount equivalent to the Behavior Professional’s rate (using the
appropriate modifier) multiplied by the number of hours authorized for that portion of Professional
Behavior Services.
d. The SPA may be left as “draft” until the event has been completed and the corresponding document
and invoice are submitted for final payment at which point in time the SPA can be revised to reflect the
actual service cost and “submitted”. Once submitted and in “accepted” status, the SPA can be billed
against for the total cost of that portion of services.
C. The Behavior Professional bills in eXPRS following the completion and submission of the TESP, FBA or
PBSP and corresponding invoice. Maintenance may be billed when delivered consistent with the ISP or
Service Agreement.
D. The Behavior Professional bills in eXPRS once for each event/service of OR570 (TESP, FBA, PBSP) by
calculating their rate multiplied by the number of hours invoiced for the service. The number of hours
delivered may not exceed that which was indicated in the ISP and authorized in the Service Prior
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Professional Behavior Services (SE49/50/54/145/149/150/151/257) (OAR 411-304)
Authorization in eXPRS. OR 570 must be billed in separate and distinct events/services for the total cost of
that event:
a. When needed a Temporary Emergency Safety Plan (TESP) in accordance with OAR 411-304-0150
(4);
b. Functional Behavior Assessment (FBA) in accordance with OAR 411-304-0150 (5) and when indicated
c. Positive Behavior Support Plan (PBSP) in accordance with OAR 411-304-0150 (6) including:
i. Initial Training of the PBSP and
ii. Safeguarding Interventions when indicated in accordance with OAR 411-304-0145.
d. Without an ODDS approved exception, the following limits apply to OR570:
i. The sum of all OR570 events/services may not exceed the total cost of 30 hours multiplied by
the Behavior Professional’s rate except as noted below.
ii. An individual whose ONA assigned service group is “5-Very High” and whose Behavior Support
Score is ‘yes’ (5b) may be authorized for up to the cost of 45 hours multiplied by the Behavior
Professional’s rate for all OR570 events/services.
iii. An adult who receives employment or DSA services and gets in-home or residential services
who needs support with behavior in multiple settings can access an additional 10 hours per year
(40 or 55 total) to address the additional setting.
E. OR 310 may only be billed for the maintenance of the PBSP on a per-hour basis.
a. All ongoing maintenance of the PBSP must be in accordance with OAR 411-304-0150 (6).
b. Without an ODDS-approved exception, maintenance of the PSBP may not exceed 18 hours per plan
year except in c. and d. below.
c. An individual whose ONA assigned service group is ‘5-Very High’ and whose Behavior Support Score
is ‘yes,’ (5b) may be authorized for an additional 12 hours up to the cost of 30 hours total.
d. The individual is an adult who receives employment or DSA services and gets in-home or residential
services and needs support with behavior in multiple settings can access 12 hours per year (30 or 42
total) to address the additional setting.
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Professional Behavior Services (SE49/50/54/145/149/150/151/257) (OAR 411-304)
(Until eXPRS can be updated, there is a $3200 limit for plan lines that authorize this service. Thirty
hours of maintenance will cause this limit to be exceeded. In this situation non-overlapping plan
lines totaling the required amount can be authorized.)
• Authorizations of this service for an individual may only be made for an individual receiving Supported Living
Services (SE51) when the cost for behavior supports is not included in the Supported Living Budget and has
been approved by ODDS.
Professional Behavior Services Rates (OAR 411-304)
(ST)
Fewer than 70 miles from
individual’s residence
(RU)
70+ miles from individual’s
residence
$82.56/HOUR
$103.20/HOUR
Not to exceed amounts for OR570 are the maximum hours the
person is eligible for multiplied by the rate listed above.
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Chore Services (411-435-0050(4))
Chore Services
Source
POC Code
POC Name
K Plan
OR501
Chore Services
Description and notes for inclusion on an ISP and POC
Chore Services:
Chore services are used to restore a hazardous or unsanitary situation to a clean, sanitary, and safe environment
in an individual's home. Chore services include heavy household chores such as washing floors, windows, and
walls, tacking down loose rugs and tiles, and moving heavy items of furniture for safe access and egress. Chore
services may include yard hazard abatement to ensure the outside of the home is safe for the individual to
traverse and enter and exit the home.
Chore services are one-time or occasional assistance with tasks involving heavy physical labor aimed at achieving
basic cleanliness and safety that may then be maintained over a reasonable period of time by routine
housekeeping and maintenance.
This service may be authorized once, each time the following criteria is met:
• No one else is responsible to perform or pay for the services.
• The conditions prior to the service are unsanitary or hazardous.
• It is not ongoing home maintenance and housekeeping services or lawn and yard maintenance.
• Not a routine expense associated with moving residence, e.g., moving furniture and belongings, cleaning
apartment to obtain cleaning deposit.
• Not remodeling or new construction in and around the home.
• Not pet washing and grooming.
• Not washing vehicles.
• Not normal household cleaning supplies.
• Not intended to remove asbestos or lead-based paints in the home.
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Chore Services (411-435-0050(4))
• The issue that led to the hazardous or unsanitary situation is addressed (if not preventable, documentation
must support why not).
For individuals under 18, this service must be prior approved by ODDS.
Examples when another person might be responsible:
• Landlord when clean-up is from a previous tenant.
• When the individual lives in the family home.
Chore Services Rates
For all chore services authorized for implementation the rate is based on the actual cost of the service,
based on the least costly of three estimates for the work.
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Community Nursing Services (411-435-0050(5))
Community Nursing Services (LTCCN)
Source
POC Code
POC Name
K Plan
N/A*(L)
N/A
Description and notes for inclusion on an ISP and POC
Nursing Consultation:
"Nursing Assessment" means one of the following assessments selected by the RN based on the individuals
needs and situation:
Nursing Assessment: the systematic collection of data about an individual for the purpose of judging that person's
health/illness status and actual or potential health care needs. Nursing Assessment involves collecting information
about the whole person including the physical, psychological, social, cultural and spiritual aspects of the person.
Nursing Assessment includes taking a nursing history and an appraisal of the person's health/illness through
interview, physical examination and information from family/significant others and pertinent information from the
person's past health/medical record. The data collected during the Nursing Assessment process provides the
basis for a diagnosis (es), plan for intervention and evaluation. (OAR 851-047-0010(12))
At a minimum the Nursing Assessment should review:
• The person’s health support needs.
• Any environmental concerns that present challenges to the person’s health and safety.
• The person’s key health beliefs and health behaviors including behaviors that create potential and current
risk.
• Any teaching or delegation needs that should be addressed.
A “comprehensive assessment” or “focused assessment” as defined by OAR 851-045-0030.
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Community Nursing Services (411-435-0050(5))
“Comprehensive Assessment” means the extensive collection and analysis of data for assessment involves, but is
not limited to, the synthesis of the biological, psychological, social, sexual, economic, cultural and spiritual aspects
of the client’s condition or needs, within the environment of practice for the purpose of establishing nursing
diagnostic statements, and developing, implementing and evaluating a plan of care.
“Focused Assessment" means an appraisal of a client’s status and situation at hand, through observation and
collection of objective and subjective data. Focused assessment involves identification of normal and abnormal
findings, anticipation and recognition of changes or potential changes in client’s health status, and may contribute
to a comprehensive assessment performed by the Registered Nurse.
“Nursing Service Plan” means the plan that is developed by the Registered Nurse based on an individual’s initial
nursing assessment, reassessment, or updates made to a nursing assessment as a result of monitoring visits. It is
specific to the individual and identifies the individual’s diagnoses and health needs, the caregiver’s teaching
needs, and any care coordination, teaching, or delegation activities. The Nursing Service Plan is separate from the
case manager’s service plan, the foster home provider’s service plan, and any service plans developed by other
health professionals and must meet the standards in OAR 851-045 (OAR 411-048-0160(25)).
Nursing Delegation:
Nursing delegation means that a registered nurse authorizes an unlicensed person to perform tasks of nursing
care in selected situations and indicates that authorization in writing. The delegation process includes nursing
assessment of a person in a specific situation, evaluation of the ability of the unlicensed persons, teaching the
task, ensuring supervision of the unlicensed persons and re-evaluation of the task at regular intervals. The
unlicensed person, caregiver or certified nursing assistant performs tasks of nursing care under the Registered
Nurses delegated authority. (OAR 851-047-0010(7)).
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Community Nursing Services (411-435-0050(5))
Registered Nurses in the Long Term Care (LTC) Community Nursing Program (also known as Community RN,
CRN, program) delegate specific nursing tasks to specific caregivers with the purpose of ensuring that nursing
tasks are performed correctly and safely by unlicensed caregivers. Any nursing task not performed by a nurse
must be delegated or assessed by a nurse if performed by non-family members without a nursing license. Each
delegation is performed by a specific nurse and is focused on a specific task, delivered by a specific caregiver to a
specific person.
Only nurses enrolled in the Long Term Care Community Nursing Services program, which may include self-
employed nurses, home health agencies, or in home agencies, may be authorized to provide this service.
Some reasons to make a referral to a LTC Community Nurse include:
• The individual and their caregivers need delegation and teaching regarding the individual’s subcutaneous
insulin injections.
• The individual has a tracheotomy which needs care and suctioning.
• The individual requires nutritional supplements, medications and hydration through a gastrostomy tube.
• A case manager/caregiver or person has concerns/issues regarding an individual’s medication(s).
• An individual has had an unexpected increase in the use of emergency care, physician visits or
hospitalizations.
• The case manager believes an evaluation of the person’s placement is necessary to ensure that the
caregivers have the skills to meet the person’s needs.
• There have been changes in the person’s behavior or cognition.
• The person has nutrition or weight issues.
• The person has issues with aspiration, dehydration, constipation, seizures or pica.
• The person has pain issues.
• There is a history of recent, frequent falls.
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Community Nursing Services (411-435-0050(5))
• There is a potential for skin breakdown or recently resolved skin breakdown.
• The person or care givers needs help in following medical advice.
The focus of the LTC Community Nurse is on teaching and supporting the person and their caregivers to ensure
that the person’s health needs are met. All services are focused on the person and their choices, promoting self-
management of the person’s health condition whenever possible. The LTC Community Nurse provides oversight
of nursing tasks needed by an individual for their stable, chronic and ongoing health needs and activities of daily
living.
The LTC Community Nurse does not duplicate or replace the nursing services provided through home health,
hospice, hospital or other clinical settings. They do not provide direct hands on nursing tasks. They provide
delegation in settings where a Registered Nurse is not regularly scheduled and not available to provide direct
supervision.
Information on LTCCN, including how to:
• Access a list of LTCCN providers.
• Make a referral.
• Prior authorize LTCCN nursing hours can be found at: https://www.oregon.gov/odhs/providers-
partners/ltccn/pages/default.aspx
A webinar for services coordinators and personal agents is available.
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Community Transportation (411-435-0050(6))
Community Transportation
Source
POC Code
POC Name
K Plan
OR003
Service Related Community
Transportation, Commercial
K Plan
OR004
Service Related Community
Transportation, Mileage
K Plan
OR005
Service Related Community
Transportation, Mileage
Transport Agency
K Plan
OR553
Service Related Community
Transportation, DD Provider
K Plan
OR554
Service Plan Related
Community Transportation,
Individual Transit pass
Description and notes for inclusion on an ISP and POC
Services that allow individuals to gain access to waiver services, community services, activities and resources that
are not medical in nature.
Community transportation is provided in the area surrounding the home of the individual that is commonly used by
people in the same area to obtain ordinary goods and services.
Community Transportation, Commercial:
• Bus passes (OR554)
• Taxi rides (OR003)
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Community Transportation (411-435-0050(6))
Community Transportation, Mileage:
• Per mile reimbursement for PSW and agency providers (OR004). Must be billed concurrently with authorized
support service (OR526 or OR507).
• Per mile reimbursement for Transportation Agencies (OR005/WD- To/From Work, OR005/WE-Community
Transportation). This is a stand-alone service that cannot be delivered concurrently with other services such as
attendant care or employment services.
Non-allowable Transportation Service Expenses:
▪ Purchase of individual or family vehicles.
▪ Routine vehicle maintenance, repair, insurance, fuel.
▪ Ambulance services.
▪ Costs for transporting someone other than the individual with disabilities.
▪ Payment for costs associated with transporting an individual to a medical appointment.
To authorize Community Transportation, the individual must have an assessed need for ADL/IADL support during
transportation or have one of the following:
▪ An assessed need for ADL/IADL supports at the destination.
▪ A need for support services at the destination and identified in the ISP.
Trips must be related to recipient service plan needs and goals, are not for the benefit of others in the household
and are provided in the most cost effective manner that will meet needs specified on the plan. Community
Transportation services are not used to:
1) Replace voluntary natural supports, volunteer transportation, and other transportation services available
to the individual;
2) Compensate the service provider for travel to or from the service provider’s home.
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Community Transportation (411-435-0050(6))
Mileage reimbursement may only be applied when:
• The individual is in the vehicle with the paid provider.
• A PSW or Agency providing OR004 transportation and being reimbursed for mileage must be paid an hourly
wage as well.
• Agency mileage (OR005) includes assumptions for staffing and administrative costs. Due to this new rate,
Transport Agencies may not bill for OR005 while they deliver another service. Agency mileage is a
standalone service rate.
CMEs may authorize multiple transportation services without seeking an ODDS exception, as long as the total of
all transportation costs does not exceed $600 per month.
For individuals under 18, this service must be prior approved by ODDS unless provided concurrently with relief
care or as part of a behavior intervention in a behavioral support plan.
For more information, see the Community Transportation Worker Guide.
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Community Transportation Rates
Community Transportation OR004:
(PSW or Agency):
$.56/mile
Community Transportation OR005:
(Transport Agency):
$2.03/mile
OR003, OR554:
Cost of bus pass, voucher, etc., including
any processing fees applied by the vendor.
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Environmental Modifications (411-435-0050(7))
Environmental Modifications
Source
POC Code
POC Name
K Plan
S5165
Home Modifications
Description and notes for inclusion on an ISP and POC
Physical adaptations which enable the individual to function with greater independence in the home and are
necessary to ensure the health, welfare, and safety of the individual in the home. Environmental modifications
must be tied to supporting ADLs, IADLs and health-related tasks as identified in the service plan. Environmental
Modifications are available only for the primary residence of the individual. Environmental modifications are limited
to $5,000 per modification and to $5000 cumulatively per plan year without a prior exception approval. All
environmental modifications must begin with the exceptions process to request the development of a Scope of
Work. Please see The Guide to Home Modifications.
Home Modifications (examples include but not limited to):
• Environmental modification consultation to determine the appropriate type of adaptation;
• Installation of shatter-proof windows;
• Hardening of walls or doors; specialized, hardened, waterproof or padded flooring;
• An alarm system for doors or windows;
• Protective covering for smoke detectors, light fixtures, and appliances;
• Installation of ramps and grab-bars;
• Installation of electric door openers;
• Adaptation of kitchen cabinets/sinks;
• Widening of doorways, handrails, modification of bathroom facilities;
• Individual air conditioners for individuals whose temperature sensitivity issues create behaviors or medical
conditions that put themselves or others at risk;
• Installation of non-skid surfaces, overhead track systems to assist with lifting or transferring;
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Environmental Modifications (411-435-0050(7))
• Specialized electric and plumbing systems which are necessary to accommodate the medical equipment
and supplies which are necessary for the welfare of the individual.
All modifications must be completed by a state licensed contractor.
All dwellings must be in good repair and have the appearance of sound structure.
The identified home may not be in foreclosure or be the subject of legal proceedings regarding ownership.
Any modification requiring a permit must be inspected and be certified as in compliance with local codes by local
inspectors and be retained by the CDDP/brokerage.
Environmental modifications must be made within the existing square footage of the residence, except for external
ramps, and cannot add to the square footage of the building.
Exterior home modifications (such as fencing) may be available as a waiver service under the category
Environmental Safety Modifications.
Payment to the contractor is to be withheld until the work meets specifications. Department funds may not be used
as a deposit. For more information about how ODDS assures this when its approval is required (CMEs are
encouraged to follow a similar process) please see The Guide to Home Modifications.
The service does not include repairs that are general home repairs that any home owner is likely to incur.
RENTAL PROPERTY.
(A) Environmental modifications to rental property cannot substitute or duplicate services that are the
responsibility of the landlord under the landlord tenant laws.
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Environmental Modifications (411-435-0050(7))
(B) Environmental modifications made to a rental structure must have written authorization from the owner of
the rental property
(C) The Department does not fund work to restore the rental structure to the former condition of the rental
structure.
For more information, please see The Guide to Home Modifications.
Environmental Modifications Rates
Three estimates for all work must be obtained and the most cost effective bid will be determined by ODDS. The
estimates must be based on the same scope of work which was developed by ODDS. When the least costly
option is not selected the reason will be clarified by ODDS. A construction contractor will not be chosen based on
aesthetic/decorative concerns or materials chosen to match existing materials in the house when a less costly
alternative will meet the identified disability related support need.
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Home Delivered Meals (HDM)
Home Delivered Meals (HDM)
Source
POC Code
POC Name
K Plan
N/A
N/A
Description and notes for inclusion on an ISP and POC
HDMs are provided for participants who live in their own homes, are home-bound, are unable to do meal
preparation, and do not have another person available for meal preparation. Provision of the home delivered meal
reduces the need for reliance on paid staff during some meal times by providing meals in a cost-effective manner.
Each HDM contributes an estimated one-third of the recommended daily nutritional regimen, with appropriate
adjustments for weight and age.
If a case manager determines a person may be eligible to received HDMs, they can submit a request to the ODDS
Funding Review mailbox - ODDS.FundingReview@odhsoha.oregon.gov.
If the request is approved the case manager will receive an approval memo and can then reach out to
cau.invoice@dhsoha.oregon.gov to request a DHS DD 57 Modifier ZP Special Projects Invoice.
This invoice must be completed and return to CAU with the approval memo for payment authorization.
To be eligible for Medicaid home delivered meals a participant must:
(a) Be Medicaid eligible and be receiving Medicaid long term services and supports in their own home;
(b) Be home-bound;
(c) Be unable to do meal preparation on a regular basis without assistance;
(d) Not have natural supports available that are willing and able to provide meal preparation services; and
(e) Be an adult.
If an individual appears to meet the above criteria, contact ODDS for approval of the service.
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Relief Care (OAR 411-450)
Relief Care
Source
POC Code
POC Name
K Plan
OR507
Relief Care, Daily
K Plan
OR508
Relief Care, Hourly
Description and notes for inclusion on an ISP and POC
Relief Care is short-term care and supervision provided because of the absence, or need for relief, of persons
normally providing the care to individuals unable to care for their selves.
Relief Care may be provided in:
• The individual’s home
• A relief care provider’s home
• A foster home, a group home
• Other settings operated by an agency certified or endorsed as a Developmental Disabilities provider.
Daily Relief Care
Daily relief care may be authorized when an individual has been assessed as having ADL/IADL support needs
that are intermittent or occur at unpredictable times and the typical support to meet those needs is unavailable or
needs a break from providing that care. It is intended to meet those intermittent, unpredictable support needs by
being available throughout a 24 hour span when hourly attendant care would otherwise be available to meet the
need when it arose.
Daily care is a 24 hour unit (one day) of service. No other ADL/IADL support can be paid during that 24 hour
period, including Day Support Activities. The CME must inform the individual and relief care provider of this
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Relief Care (OAR 411-450)
condition before the relief care occurs. If ADL/IADL support needs arise and a paid provider will be required
during that 24 hour period, the 24 hour relief care provider is the one that is responsible to provide the ADL/IADL
supports. Waiver Employment services may be provided during the 24 hour period.
See PT-16-029 and AR-16-063 for more information about Relief Care provided by a PSW, in particular about the
purpose and appropriate uses of OR508 Hourly Relief Care. It should only be used as described there. OR508 is
not used with agency Relief Care providers. Per the CBA, OR508 may be approved for a PSW for a maximum of
three hours in a 24 hour period.
Relief care at a licensed Adult Foster Care Home may not happen for any length of time without prior approval of
the home’s local CDDP or Department, unless consistent with local agreements.
The temporary absence of a care provider, paid or unpaid, who provides any amount of support determined
necessary by the Functional Needs Assessment tool, is sufficient cause to authorize Daily Relief Care for the
duration of the absence up to 14 days per plan year. More than 14 days per year of relief care regardless of
provider type, for an individual who is assessed as requiring less than 24 hours of support in a day, may not be
authorized without prior approval from ODDS.
Each respite (relief) care day accessed under Nursing Facility OAR 411-070-0043(5) program is counted against
the number of allowable relief care days under K-plan.
Daily relief care does not directly affect the available hours of support; however, there may be an impact on the
amount of hourly support that is necessary when an individual accesses daily relief care. For example, if in a
normal month an individual needs 200 hours to meet the identified support needs, then the month where she is
gone for a week getting 24 hour relief care, she would likely have attendant care hours closer to 150. The
requirement is not that the available hours necessarily get reduced; it is that funds be used only to the extent that
they are necessary to meet identified support needs.
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Transition Services (411-435-0050(8))
Transition Services
Source
POC Code
POC Name
K Plan
OR406
Community Transition
Description and notes for inclusion on an ISP and POC
This service covers transition costs such as rent and utility deposits, first month’s rent and utilities, bedding, basic
kitchen supplies, and other necessities required for an individual to make the transition from a nursing facility,
institution for mental diseases, or intermediate care facility for the intellectually disabled, to a community-based
home setting where the individual resides.
OR406 represents a “generic” code for transition services.
These expenditures are limited to individuals transitioning from a nursing facility, IMD, or an ICF/IID where they
have resided, to a home or community-based setting where the individual resides.
Transition services will be limited to necessary services for individuals transitioning from an institution into a
community-based or in-home program. Services will be based on an assessed need, determined during the
person-centered service planning process and will support the desires and goals of the individual receiving
services and supports. Final approval for expenditures will be approved by ODDS prior to expenditure.
Approval will be based on individual’s need and ODDS’s determination of appropriateness and cost-effectiveness.
Financial assistance will be limited to:
• moving and move-in costs including; movers, cleaning and security deposits, payment for background/credit
check (related to housing), initial deposits for heating, lighting and phone;
• and payment of previous utility bills that may prevent the individual from receiving utility services and
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Transition Services (411-435-0050(8))
• basic household furnishing (i.e., bed) and other items necessary to re-establish a home.
Individuals will be able to access the benefit no more than twice annually, though basic household furnishing and
other items will be limited to one time per year.
Transition assistance will not supplant the legal responsibilities of a parent or guardian. Children under age 18
must obtain prior authorization from ODDS for transition services.
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Funding Authority: Adult’s, Children’s, and CIIS Waiver
Services
Services available in ALL waivers
Waiver Case Management
Vehicle Modifications
Family Training
Specialized Medical Supplies
Environmental Safety Modifications
Services available in the ADULT’S,CHILDREN’S, and CEN waivers
Individual Supported Employment- Job Coaching
Individual Supported Employment- Job
Development
Employment Path Services
Small Group Supported Employment
Discovery
Employment Path Services (Benefits Counseling)
ADULT’S waiver only
Direct Nursing Services (Adults only)
CIIS waivers only (all)
Individual Directed Goods and Services
• In order to be eligible to receive these services, the individual must have OCCS Medical, meet ICF/IDD Level
of Care (except for the Medically Involved and Medically Fragile CIIS waivers), have an assessed need for the
service, require at least one of these services every month, and have an ISP in place authorizing it.
• Individual Supported Employment, Small Group Supported Employment, Discovery/Career Exploration, and
Employment Path Services are collectively known as Employment Services.
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
Individual Supported Employment – Job
Coaching
Source
POC Code
POC Name
Waiver
OR401
(W5)
Supported Employment Job
Coaching – Initial Support
Waiver
OR401
(W6)
Supported Employment Job
Coaching – Ongoing Support
Waiver
OR401
(W4)
Supported Employment Job
Coaching – Maintenance
Support
Waiver
OR401
(S1)
Supported Employment Job
Coaching – Self Employment
(Exception Only)
Waiver
OR401
(WV)
Supported Employment Job
Coaching – Without VR
Description and notes for inclusion on an ISP and POC
The expected outcome of Job Coaching is sustained paid employment, at or above the minimum wage, and in an
integrated setting in the general workforce, in a job that meets personal and career goals.
Job Coaching includes initial, ongoing, or maintenance support to:
• Maintain and advance in an individualized job in a competitive integrated employment setting in the general
workforce for which an individual is compensated at or above the minimum wage, but not less than the
customary wage and level of benefits paid by the employer for the same or similar work performed by
individuals without disabilities; or
• Maintain self-employment. Funds may not be used to defray the expenses associated with operating a
business.
• Job Coaching does not include support in a volunteer position.
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
• As written in 411-345-0025 personal care or attendant care provided as an incidental part of job coaching is
considered a component part of the employment service.
More specific examples of Job Coaching include:
• Supporting the new employee to learn the job.
• Supporting the person to identify and develop any needed adaptations or accommodations.
• Coordination with a residential provider, transportation provider, or the person’s natural supports to ensure
supports are in place so that the individual will be successful on the job. This includes, for example, support
to arrive at work on time, support to ensure proper hygiene, support to ensure the individual’s work clothing
has been laundered and is ready, support to ensure the individual has snacks or meals that will be needed
at work, etc.
• Coordinating with others who support the person with services such as behavioral, medical, or other
supports.
• Assisting the employee to develop communication with supervisors and co-workers.
• Assisting the employee to develop work appropriate relationships with supervisors and co-workers.
• Collaborating with the employee and the employer to develop natural supports.
• Coaching to advance in a career as evidenced by a job coach fading support, raises, more hours, increased
responsibility and/or promotion, etc.
Ongoing and Maintenance Job Coaching:
It is expected that, for most people, the degree and intensity of these supports will decrease around the time the
rate for ongoing and/or maintenance Job Coaching begins.
One sign of successful job coaching is that the person has become more independent, allowing the job coach to
fade as much as possible.
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
• An employment related goal must be clearly documented in the individual’s ISP and Career Development Plan
(CDP). The employment goal must be related to maintaining or advancing in competitive integrated
employment in the general workforce.
• For Job Coaching, the ISP and CDP may also include employment goals that reflect the individual’s interest in
advancing in his or her chosen career path if that is what the individual desires.
• This service may be authorized and billed for each hour the supported individual has been paid for work
performed on the job. This rate methodology is intended to incentivize outcomes that include an increase in the
number of hours the supported person works, job coach fading, and the development of natural supports
(demonstrated to be associated with a person's increased success on the job), the rate methodology pays
based on the number of hours the supported person works.
o This rate methodology does not include the hours the supported individual is paid for time off benefits,
including paid vacation, sick time, jury duty, etc.
o This rate methodology does not apply to Personal Support Workers, whose rates are subject to
collective bargaining.
o This rate methodology presumes a minimal amount of direct contact. The contract requirements are
outlined in the ISP and related documents; however, the minimum contacts must also be met as
outlined below and in the related Job Coaching Workers Guide.
• In order to bill for the hours the supported individual works, the provider must provide, at minimum, the hours
and support required by the individual’s ISP.
Review of Provider Documentation:
• The provider must maintain the supported individual’s pay stubs, or other records made in the regular course of
business, that document the hours the supported individual worked.
• This documentation must be made available upon request by the SC/PA, ODDS, Licensing, or CMS.
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
Self-Employment:
• Job Coaching Supports for Self-Employment must be authorized under OR401/S1. The authorization will
require manual entry of the appropriate rate according to the phase of job coaching appropriate to the
individual, as well as the appropriate payment category. All other Job Coaching requirements outlined in the
Job Coaching Worker Guide apply to this service.
• For long term job coaching for self-employment, the person must first close successfully through VR.
• ODDS must approve job coaching for self-employment.
• Evidence of the self-employment must be documented and reviewed by the individual’s case manager on an
annual basis. Documentation may include, but is not limited to, business filings with the Secretary of State, tax
records submitted to the Internal Revenue Service, or an annual business plan.
Job Coaching Limitations:
• Job Coaching is limited to 40 hours per week.
• If an individual is using Job Coaching in combination with Small Group Supported Employment and
Employment Path Services, the combination is limited to 25 hours per week.
• Job Coaching may only be authorized for up to two years (6 months of Initial and 18 months of On-going)
without the Services Coordinator (SC) or Personal Agent’s (PA) approval; any request for job coaching beyond
two years must be approved annually by the SC or PA. Documentation of the type of work being done and
reason for the Maintenance Job Coaching approval must be maintained in the individual’s file and documented
on the “Maintenance Job Coaching Request” form.
• The initial job coaching rate is available for the first 6 months of job coaching. The ongoing job coaching rate is
available for the subsequent 18 months. The availability of the ODDS initial and ongoing job coaching rates are
reduced by the amount of time the individual utilizes VR job coaching.
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
o If, for example, the individual utilized 3 months of VR job coaching, then 3 months of the ODDS initial
job coaching rate would be available and 18 months of the ongoing job coaching rate would be
available.
o If the individual utilizes 2 months of VR job coaching, then 4 months of the ODDS initial job coaching
rate would be available and 18 months of the ongoing job coaching rate would be available.
• Job Coaching Without VR can be authorized in accordance with the related transmittal. The authorization will
require manual entry of the appropriate rate according to the phase of job coaching appropriate to the
individual, as well as the appropriate payment category.
• Job Coaching Supports for individuals who have reached stabilization in a job without the use of Vocational
Rehabilitation Services must be authorized under OR401/WV. The authorization will require manual entry of the
appropriate rate according to the phase of job coaching appropriate to the individual, as well as the appropriate
payment category. All other Job Coaching requirements outlined in the Job Coaching Worker Guide apply to
this service.
Direct (face to face) Contact Requirements:
Job Coach
Stage
Minimum
monthly
contacts
required:
Initial
4
Ongoing
2
The Case manager should authorize the phase of job coaching that best matches the person's support needs.
Note that the person's ISP/CDP may require more than the minimum contacts outlined here.
Maintenance Job Coaching:
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Individual Supported Employment – Job Coaching (ADULT’S and CHILDREN’S waiver service)
(OAR 411-345)
The maintenance job coaching rate may continue for up to 12 additional months so long as the individual
continues to require primarily job coaching. If the individual's primary support on the job is and ADL, then
attendant care (OR545) should be authorized.
See the Job Coaching Worker Guide for additional details.
Individual Supported
Employment – Job Coaching
(Hourly Rates)
Category 1
Category 2
Category 3
& Category 4
Initial Job Coaching
(OR401/W5) - Agency Provider
$32.07
$49.82
$71.93
Ongoing Job Coaching
(OR401/W6) - Agency Provider
$25.66
$49.82
$71.93
Maintenance Job Coaching
(OR401/W4) - Agency Provider
$19.24
$49.82
$71.93
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Individual Supported Employment – Job Development (ADULT and CHILD waiver service) (OAR 411-345)
Individual Supported Employment – Job
Development
Source
POC Code
POC Name
Waiver
OR401
(W3)
Initial Placement Outcome
Payment
Waiver
OR401
(W9)
90 day Retention Outcome
Payment
Description and notes for inclusion on an ISP and POC
The expected outcome of Job Development is sustained paid employment, at or above the minimum wage, and in
an integrated setting in the general workforce, in a job that meets personal and career goals.
Job Development includes support to obtain a job in competitive integrated employment in the general workforce,
including:
• Compensation at or above the minimum wage, but ideally not less than the customary wage and level of
benefits paid by the employer for the same or similar work performed by individuals without disabilities.
• Support to an individual who needs a different job or position to earn at least minimum wage. This service does
not include support to develop a job in a small group supported employment setting.
This service does not pay to develop:
• Jobs in a provider controlled setting.
• Jobs that pay less than the minimum wage.
Examples of Job Development activities include:
• Contacting employers.
• Assisting the job seeker to complete employment applications.
• Negotiating job tasks with an employer.
• Accompanying the person to interviews.
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Individual Supported Employment – Job Development (ADULT and CHILD waiver service) (OAR 411-345)
• Support to develop self-employment business opportunities, including accessing business financial resources
for self-employment, and launching a business.
• Competitive integrated employment must be a goal clearly documented in the individual’s ISP and in the Career
Development Plan (CDP).
• If an individual has a job in a competitive integrated employment setting and is seeking job development for
support to change the job or position to earn at least minimum wage, or to develop self-employment
opportunities, then the goal must be clearly documented in the ISP and CDP.
• ODDS funded Job Development is only available in the very limited circumstances when it is not available
through VR.
• Documentation must be maintained to demonstrate that the service is not available under a program funded
under section 110 of the Rehabilitation Act of 1973.
• ODDS Job Development may be authorized in the very limited circumstances where it is not available through
VR and ODDS has granted approval to authorize ODDS Job Development.
The SC/PA must outline the requirements for the job that will be developed based on the employment goals of the
individual. This includes, at minimum, the number of hours the individual would like to work and the wage the
individual would like to earn (must be minimum wage or better).
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Individual Supported Employment –
Job Development (Outcome Based Rates)
Category 1
Category 2
Category 3 &
Category 4
Job Development – Initial Placement
(OR401/W3) (Agency Provider /
Independent Provider)
$2,429.86
$3,037.33
$3,644.80
Job Development – 90+ Days Job Retention
(OR401 W9) (Agency Provider /
Independent Provider)
$1,518.67
$1,822.40
$2,429.86
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Small Group Supported Employment (ADULT and CHILD waiver service) (OAR 411-345)
Small Group Supported Employment
Source
POC Code
POC Name
Waiver
OR543
(W2)
Small Group Supported
Employment
Waiver
OR543
(RC)
Small Group Supported
Employment – 1:1*
Waiver
OR543
(ZE)
Small Group Supported
Employment – 2:1 (Two
Providers)*
Waiver
OR543
(ZC)
Small Group Supported
Employment – 2:1 (One
Provider)*
* Requires an ODDS approved exception
Description and notes for inclusion on an ISP and POC
The expected outcome of Small Group Supported Employment is sustained paid employment and work
experience leading to further career development and individual integrated employment in the general workforce
for which an individual is compensated at or above the minimum wage.
Small Group Supported Employment includes services and training activities in regular business, industry and
community settings for groups of two (2) to eight (8) individuals. This service must be provided in a manner that
promotes integration into the work place and interaction with people without disabilities in those work places.
This service does not include:
• Support in a volunteer position.
• Support at a site that is owned or operated (leased) by a provider.
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Small Group Supported Employment (ADULT and CHILD waiver service) (OAR 411-345)
• An employment related goal must be clearly documented in the individual’s ISP and Career Development Plan
(CDP). The employment goal must be related to obtaining, maintaining or advancing in competitive integrated
employment in the general workforce.
• Small Group Supported Employment must be provided in a manner that promotes integration into the work
place and interaction with people without disabilities in those work places.
• This service is limited to 25 hours per week. This service can be combined with Job Coaching and Employment
Path Services subject to this 25 hour limitation.
• Unlike the rate methodology for Individual Supported Employment – Job Coaching, the rate methodology for
this service is based on the number of support hours provided.
All jobs supported by this service must earn minimum wage or better. Jobs that do not pay minimum wage or
better would be more accurately supported by Employment Path Services.
• OR543 using modifiers RC, ZE and ZC may not be authorized without an ODDS approved exception.
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Small Group Supported Employment (Hourly Rates)
Small Group Supported
Employment
(OR543/W2/ZE)
Category 1
Category 2
Category 3
Category 4
$22.46
$25.97
$31.45
$42.50
Small Group Supported Employment (OR543/RC, ZE)
1:1 Agency Provider
$43.91
Small Group Supported Employment (OR543/ZC)
2:1 Agency Provider
$73.76
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Discovery (ADULT and CHILD waiver service) (OAR 411-345)
Discovery
Source
POC Code
POC Name
Waiver
OR539(WA)
(L)
Discovery
Description and notes for inclusion on an ISP and POC
The expected outcome of Discovery is sustained paid employment and work experience leading to further career
development and individual integrated employment in the general workforce for which an individual is
compensated at or above the minimum wage.
Discovery includes:
• A comprehensive and person-centered employment planning support service to better inform an individual
seeking Individual Integrated Employment and develop a Discovery Profile.
• Discovery is a service an individual may use when he or she has determined that he or she wants to actively
pursue a job in an individual integrated employment setting within the coming year but the individual or job
developer may require further information to determine the career or work environment in which the
individual would be most successful. Discovery is intended to be a precursor to inform and effectively utilize
VR Job Development, although Discovery is not a prerequisite to VR Job Development.
• Discovery includes a series of work or volunteer related activities to inform the individual and the Job
Developer about individual’s strength’s, interests, abilities, skills, experiences, and support needs, as well as
identify the conditions or employment settings in which the individual will be successful. It is also an
opportunity for the individual to begin active pursuit of individual integrated employment.
• Activities completed during Discovery may include (but are not limited to) job and task analysis activities,
assessment for use of assistive technology to promote increased independence in the workplace, job
shadowing, informational interviewing, employment preparation (including but not limited to resume
development), and paid work experience or volunteerism to assist an individual in identifying transferable
skills and job or career interests).
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Discovery (ADULT and CHILD waiver service) (OAR 411-345)
• Payment for this service requires the completion of a Discovery Profile. The Discovery Profile must meet
requirements established by the Department. The profile used may be the template made available by the
Department. If the Department’s profile is not used, the profile used must be pre- approved by the
Department. A completed profile may be eligible for translation by the Department. See the Worker’s Guide:
Translation Services.
• Participating in Discovery and the Discovery Profile should inform and enhance VR Job Development.
• Discovery is a service that may be authorized by a Service Coordinator or Personal Agent when an
individual has determined he or she wants to actively pursue an individual integrated job within the coming
ISP year but may require further exploration to determine what career he or she may be most successful in.
• SCs/PAs authorize Discovery in the ISP and Career Development Plan and make a referral to VR.
Depending on the individual’s circumstances, it may be most effective to make the referral when authorizing
the Discovery service in order to expedite the VR eligibility process.
• Career Development Planning is not required to access ODDS Employment Services although it is
considered Best Practice.
• Discovery is not required to access VR services.
• The SC/PA must ensure that the Discovery provider has the required qualifications and training.
Payment Requirements:
• A completed Discovery Profile as verified by the Service Coordinator or Personal Agent.
• Discovery must be completed within a three month period. A three month extension (bringing the total to six
months) may be granted by the SC/PA if there is a legitimate cause documented in the ISP. This may
include, but is not limited to, situations where an extension is required because of medical necessity, or
where opportunities to participate in a work experience are outside the three month time period.
• The SC/PA must ensure that the completed Discovery Profile is submitted to VR along with the referral. The
VR referral must be documented in the ISP and Career Development Plan. The referral to VR should occur
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Discovery (ADULT and CHILD waiver service) (OAR 411-345)
at a time that will ensure a seamless transition from Discovery to VR Job Development. This should be
coordinated between the SC/PA, the provider, and VR. Factors that impact the time of referral might include
the estimated timeline for VR intake and eligibility, the length of time between Discovery authorization and
completing the Discovery service, as well as other individual circumstances.
Discovery (OR539/WA)
(Outcome Based Rates)
Agency Provider /
Independent Provider
Category 1
Category 2
Category 3 &
Category 4
$2,184.54
$2,496.61
$2,808.69
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Employment Path Services (ADULT and CHILD waiver service) (OAR 411-345)
Employment Path Services
Source
POC Code
POC Name
Waiver
OR541 (W1)
Employment Path Services - Facility
Waiver
OR541 (R1)
Employment Path Services – Facility 1:1*
Waiver
OR541 (ZF)
Employment Path Services – Facility 2:1
(One Provider)*
Waiver
OR541 (ZH)
Employment Path Services – Facility 2:1
(Two Providers)*
Waiver
OR541 (W2)
Employment Path Services - Community
Waiver
OR541 (RC)
Employment Path Services – Community,
1:1*
Waiver
OR541 (ZC)
Employment Path Services – Community 2:1
(One Provider)*
Waiver
OR541 (ZE)
Employment Path Services – Community 2:1
(Two Providers)*
Waiver
OR541 (RS)
Employment Path Services – Community,
1:1 Solo
* Requires an ODDS approved exception
Description and notes for inclusion on an ISP and POC
The expected outcome of Employment Path Services is sustained paid employment and work experience leading
to further career development and competitive integrated employment in the general workforce. Employment path
also includes individualized benefits counseling as outlined below.
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Employment Path Services (ADULT and CHILD waiver service) (OAR 411-345)
Employment Path Services include:
• Time limited support to participate in, for example: time limited community work experiences in the community
(paid or unpaid), internships, job shadowing, informational interviews, resume building, etc.
• Training general or non-job-task-specific skills that can be used in competitive integrated employment in the
general workforce.
• Services to improve an individual’s employability in the general workforce through learning and work
experiences.
• A time limited service as defined by the individual’s ISP.
• Producing services or goods may be incidental to this service, but the primary purpose must be support to
develop general skills that can be transferred to competitive integrated employment.
ODDS services may not be used in sheltered work settings. Employment Path Facility should only be utilized for
training (not work) that cannot be delivered in the general community. There must be a community component.
• An employment related goal must be clearly documented in the ISP and in the Career Development Plan
(CDP). The employment goal must be related to maintaining or advancing in competitive integrated
employment in the general workforce.
• All Employment Path Services must be used in combination with a service component that is in a non-disability
specific setting in the general community and away from the provider site (e.g., employment path in
combination with an internship or job shadow at a general community business; job coaching; discovery; small
group; or VR services).
• The ISP and CDP must include goals to develop general habilitative or non-job-task-specific skills that can be
used in an individual integrated job in the general workforce.
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Employment Path Services (ADULT and CHILD waiver service) (OAR 411-345)
• This service is limited to 25 hours per week. This service can be combined with Job Coaching and Small Group
Supported Employment subject to this limitation. This service is provided over a limited time period specified by
the individual’s ISP/CDP. The ISP/CDP must document progress towards gaining the skills for which the
service was authorized.
• If progress is not made towards developing the skills outlined in the ISP/CDP, and towards obtaining individual
integrated employment, it may be appropriate to evaluate whether the provider is the most effective and
appropriate provider of this service or whether this is an appropriate service to support the individual in working
towards his or her goals to pursue individual integrated employment.
• Unlike the rate methodology for Individual Supported Employment – Job Coaching, the rate methodology for
this service is based on the number of service hours provided.
• Solo (RS) Employment Path is for support to participate in individualized community work experiences (e.g.,
support to participate in community work experiences, internships, job shadowing, informational interviews,
resume building, etc.). The service must be 1:1 “Solo” and not in a group (one supported individual in the
setting and one support staff). Employment Path “Solo” Services may not occur at a provider site. The 1:1
Employment Path “Solo” Service is limited to 25 hours per week for a combination of Employment Services.
Employment Path “Solo” must be face to face and not remote.
• OR541 using modifiers R1, ZE, ZF, ZC, ZH and RC may not be authorized without an ODDS approved
exception.
• The modifier RC indicates that an individual who is participating in a group activity is assigned an agency staff
member to them and has been approved by exception.
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Employment Path
(Hourly Service
Rates)
Category 1
Category 2
Category 3
Category 4
Employment Path
Community -
OR541/W2, ZE
$21.28
$24.66
$29.71
$39.83
Employment Path
Facility –
OR541/W1, ZH.
$13.48
$17.32
$22.46
$28.27
Employment Path
Community -
OR541/RC 1:1
$41.71
Employment Path
Facility - OR541/R1 1:1
$38.44
Employment
Path
Community
- OR541/RS
(Solo)
$42.29
Employment Path
Community -
OR541/ZC 2:1
$71.01
Employment Path
Facility - OR541/ZF 2:1
$67.37
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Employment Path – Benefits Counseling Services (ADULT and CHILD waiver service) (OAR 411-345)
Employment Path Services
Waiver
OR541 (WB)
Employment Path Community
Benefits Counseling Level 1 (Information &
Referral)
Waiver
OR541 (WC)
Employment Path Community
Benefits Counseling Level 2 (Work Incentive
Summary (WIS) or Benefits Summary &
Analysis (BSA))
Description and notes for inclusion on an ISP and POC
The expected outcome of Employment Path Services is sustained paid employment and work experience leading
to further career development and competitive integrated employment in the general workforce. Employment path
also includes individualized benefits counseling.
Benefits counseling may include:
1. Level 1 (Information and referral); and
2. Level 2 (Work Incentive Summary (WIS) or Benefits Summary and Analysis (BSA)).
As outlined above, Employment Path Services are limited to 25 hours per week. This service can be combined
with Job Coaching and Small Group Supported Employment subject to this limitation.
Individualized benefits counseling can be used as part of employment path services under the following
guidelines:
o It is estimated that up to 3 hours may be needed (per plan year) for Information & referral (Level One
Benefits Counseling) per plan year. An outcome of this service includes a write up of the advisement.
In the event that more than 3 hours are needed, an exception must be requested.
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Employment Path – Benefits Counseling Services (ADULT and CHILD waiver service) (OAR 411-345)
o It is estimated that up to 12 hours may be needed (per plan year) for Level Two (Work Incentive
Summary (WIS) or Benefits Summary and Analysis (BSA)) per plan year. In the event that more than
12 hours are needed, an exception must be requested.
Note: If additional benefits counseling is required, or the person needs additional support to implement action items
identified, then a referral should be made to WIN or WIPA. It is important to keep in mind that the entire support
team should be actively involved in benefits planning so they are able to provide ongoing supports after services
end. Natural supports should be brought in whenever possible.
Employment Path Services Benefits Counseling (Rates)
Employment Path Community -
OR541 WB and WC
$42.29
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Family Training (ADULT, CHILD, CIIS waiver service) (411-435-0060(2))
Family Training
Source
POC Code
POC Name
Waiver
OR360
Family Training
Description and notes for inclusion on an ISP and POC
Training services for the family of an individual to increase capabilities of the family to care for, support and
maintain the individual in the home.
Services are provided in organized conferences and workshops that are limited to topics related to the individual’s
disability, identified support needs, or specialized medical or habilitation support needs.
• Oregon Intervention Systems training when an approved Positive Behavior Support Plan indicates the training
is required to deliver the behavior supports outlined within the plan.
• Instruction about treatment regimens and use of equipment specified in the Individual Support Plan.
• Information, education and training about the individual’s disability, medical, and behavioral conditions.
• Training to safely manage challenging behavior.
Non-allowable Family Training Service Expenses:
• Pay for family training to carry out educational activities in lieu of school for school-age individuals.
• Conferences when the training is on topics not directly required to carry out the support plan of the individual
with disabilities or when training essential for an individual’s care may be effectively provided through less
expensive means such as use of state and local experts, books, electronically, etc.
• Fees, travel, lodging, and other expenses for family members.
• Training for paid caregivers, including family.
• Teaching family members sign language.
• Mental Health Counseling, treatment or therapy.
• Parenting classes.
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Family Training (ADULT, CHILD, CIIS waiver service) (411-435-0060(2))
• Services provided by licensed psychologists, professionals licensed to practice medicine, social workers,
counselors 1:1 to family members.
Family Training (Rates)
Independent Provider: $240 per event
Provider Organization: $240 per event
Family Training events that meet the criteria above for authorization, but exceed the $240 limit, may only be
approved by ODDS through an exception request.
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Environmental Safety Modifications (ADULT, CHILD, CIIS waiver service) (411-435-0060(3))
Environmental Safety Modifications
Source
POC Code
POC Name
Waiver
OR561
Environmental Safety Mods
Description and notes for inclusion on an ISP and POC
“Environmental Safety Modifications" mean the physical adaptations described in OAR 411-435-0060 that are
made to the exterior of the home of an individual as identified in the ISP for the individual to ensure the health,
welfare, and safety of the individual or to enable the individual to function with greater independence around the
home. Environmental safety modifications are available only for the primary residence of the individual.
Environmental safety modifications are limited to $5,000 per modification and to $5,000 cumulatively per plan year
without a prior exception approval. All environmental safety modifications must begin with the exceptions process
to request the development of a Scope of Work. Please see The Guide to Home Modifications.
These supports would most typically be:
• A fence to assure the safety of an individual who has a documented history of leaving the safety of the home
and who does not have the skills to be safe in the community.
• A pathway for an individual who may have an unsteady gate or who uses an assistive device to ambulate and
lacks a safe path to and from the house.
Services must be:
• Completed by a State licensed contractor.
• In compliance with existing local ordinances – i.e., requirement of the local building permit and inspection.
SC/PA must obtain the certification of compliance prior to releasing payment.
• Completed and meet specifications prior to payment to the contractor. Department funds may not be used as a
deposit.
• Authorized in writing by the owner of the rental structure prior to initiation of the work. This does not preclude
any reasonable accommodations required under the Americans with Disabilities Act, or Fair Housing Act.
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Environmental Safety Modifications (ADULT, CHILD, CIIS waiver service) (411-435-0060(3))
• Adaptations or improvements that are of general utility are not included in this service.
• The appearance of the fence cannot figure into the authorization of a fence. It must be the most cost-effective
solution; aesthetic considerations cannot cause the cost to increase. Vinyl fencing is not permitted as it can
rarely be the most cost effective and has proven to be less effective at preventing elopement.
• Fencing will be limited to 200 ft. Approval will only be made if fewer than 200 ft. of fencing will not assure the
health and safety of the individual.
• Fencing cannot be more than 6’ in height.
• Large gates such as automobile gates are not permitted.
• Paths may only be of the shortest length to assure the individual can access a vehicle or a sidewalk that allows
access to the community beyond the individual’s home. Unless necessary for egress in an emergency, paths
that do not contribute to greater access are not permitted (for example, a path through a garden or around the
backyard)
• Local ordinances may impact the options available within this service and must be followed.
• Three bids are required and the lowest bid will be chosen by ODDS.
• The construction requirements for the K plan service “Environmental Modifications” also apply to this service.
Payment to the contractor is to be withheld until the work meets specifications. Department funds may not be used
as a deposit. For more information about how ODDS assures this when its approval is required (CMEs are
encouraged to follow a similar process) please see The Guide to Home Modifications.
For more information on this service, see the Environmental Safety Modification Policy Worker Guide and the
Modifications Implementation Worker Guide.
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Vehicle Modifications (ADULT, CHILD, CIIS waiver service) (411-435-0060(4))
Vehicle Modifications
Source
POC Code
POC Name
Waiver
T2039
Vehicle Mod
Description and notes for inclusion on an ISP and POC
Vehicle Modifications are adaptations or alterations made to a vehicle that is the primary means of transportation
for an individual in order to accommodate their service needs. Vehicle modifications are specified by the service
plan as necessary to enable the individual to integrate more fully into the community and to ensure the health,
welfare and safety of the individual.
Vehicle modifications may include a lift, interior alterations to seats, head and leg rests, belts, special safety
harnesses, other unique modifications to keep the individual safe in the vehicle.
The service is not for:
• adaptations or improvements to the vehicle that are of general utility and are not of direct medical or
remedial benefit to the individual.
• Purchase or lease of a vehicle.
• Upkeep, repair and maintenance of a vehicle except for the upkeep, repair or maintenance is of the
modifications.
• Modifications to the car of a paid provider of services.
The maintenance or repair of a modification previously authorized by ODDS may be permitted.
Repair of a vehicle modification, when more cost-effective, will be authorized in lieu of a replacement.
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Vehicle Modifications (ADULT, CHILD, CIIS waiver service) (411-435-0060(4))
Vehicle modifications are limited to $5,000 per modification. A SC/PA may request approval for additional
expenditures through the Department prior to expenditure. Approval is based on the service needs and goals of
the individual and the determination by the Department of appropriateness and cost-effectiveness.
Vehicle modifications must meet applicable standards of manufacture, design, and installation.
Three cost estimates must be obtained prior to authorizing this service.
Payment to the contractor or vendor is to be withheld until the work meets specifications and final payment is
approved. Department funds may not be used as a deposit, advance payment, or reimbursement.
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Waiver Case Management (ADULT, CHILD, CIIS waiver service) (OAR 411-415)
Waiver Case Management
Source
POC Code
POC Name
Waiver
These are authorized as a CPA in eXPRS
and not in a POC.
Description and notes for inclusion on an ISP and POC
Waiver Case Management is available for any individual enrolled to the comprehensive or support services
waiver. Non-waiver (other) case management is available to every other enrolled individual. Both waiver and non-
waiver case management include the following assistance:
Assessment and periodic reassessment of individual needs. These annual assessment activities (more
frequent with significant change in condition) include:
• Taking client history;
• Evaluation of the extent and nature of recipient’s needs (medical, social, educational, and other services) and
completing related documentation;
• Gathering information from other sources such as family members, medical providers, social workers, and
educators (if necessary), to form a complete assessment of the individual.
Development (and periodic revision) of a specific care plan that:
• Is based on the information collected through the assessment;
• Specifies the goals and actions to address the medical, social, educational, and other services needed by the
individual;
• Includes activities such as ensuring the active participation of the eligible individual, and working with the
individual (or the individual’s authorized health care decision maker) and others to develop those goals; and
• Identifies a course.
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Waiver Case Management (ADULT, CHILD, CIIS waiver service) (OAR 411-415)
Referral and related activities to help an eligible individual obtain needed services including activities that
help link and individual with:
• Medical, social, educational providers; or
• Other programs and services capable of providing needed services to address identified needs and achieve
goals specified in the care plan such as making referrals to providers for needed services, and scheduling
appointments for the individual.
Monitoring and follow-up activities. Activities, and contact, necessary to ensure the care plan is implemented
and adequately addressing the individual's needs. The activities, and contact, may be with the individual, his or
her family members, providers, other entities or individuals and may be conducted as frequently as necessary;
including at least one annual monitoring to assure following conditions are met:
• Services are being furnished in accordance with the individual's service plan;
• Services in the service plan are adequate; and
• If there are changes in the needs or status of the individual, necessary adjustments are made to the service
plan and to service arrangements with providers.
• See the Indirect Case Management Monitoring worker’s guide for more information.
Waiver or Non-Waiver Case Management services must be authorized as a service on an ISP. It may be a
general type of service inclusive of the activities listed under the service description or may also include specific
activities related to an individual’s ISP as identified through the person centered planning process.
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Specialized Medical Supplies (ADULT, CHILD, CIIS waiver service) (411-435-0060(5))
Specialized Medical Supplies
Source
POC Code
POC Name
Waiver
OR562
Spec Med Supply
Description and notes for inclusion on an ISP and POC
Specialized Medical Supplies means medical and ancillary supplies such as:
• Necessary medical supplies, specified in the ISP that are not available under the state plan or private
insurance.
• Ancillary supplies necessary to the proper functioning of items necessary for life support or to address
physical conditions.
• Supplies that are necessary for the continued operation of augmentative communication devices or systems.
• Incontinence items or devices, specified in the ISP that are not available under the State plan.
This service is not available for:
• Supplies that have been determined unsafe for the general public by recognized consumer safety agencies.
• Items which are needed solely to allow a school-aged individual to participate in school.
• Items not of direct medical or remedial benefit to the individual.
• Items of general household use to complete general household tasks such as cleaning and laundry.
• Items that may be available through the individual’s health insurance provider. A denial for the item
must be obtained prior to any Department funding expenditure.
Single authorizations of over $500 will pend for Department approval, as will cumulative authorizations
over $5000.
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Direct Nursing Services (ADULT waiver service) (OAR 411-380)
Direct Nursing Services
Source
POC Code
POC Name
Waiver
N/A
N/A
Description and notes for inclusion on an ISP and POC
Direct Nursing services are nursing supports for individuals 21 years of age and older with complex medical
needs (usually technology dependent) delivered on a shift staff basis in an individual’s home or a licensed Adult
Foster Care home. These nursing services include direct “hands on” nursing interventions, skilled nursing tasks,
treatments and therapies with continuous assessment & reassessment of the medical conditions as part of each
shift (4-16 hours). Individuals are determined eligible (by the Department) for hours based on an acuity level score
as measured by a Direct Nursing Service Criteria completed by an ODDS RN Health Management Specialist.
ODDS issues a formal memo to CMEs documenting eligible hours.
If an individual has been determined eligible for Direct Nursing Services the number of eligible monthly hours
should be identified in the ISP under the “Other Chosen Services” section of the current form. If an individual has
access to Third Party Resources (Private Insurance) for Direct Nursing it should be noted on the ISP as those
hours must be accessed first before DNS. The ISP team may want to identify potential health outcomes under the
Chosen Services section of the ISP. Examples could include, “reduce hospitalizations” “stabilize health condition”,
or “reduce risk of secondary infection”.
An Adult Foster Home-DD provider licensed by the Department may provide Direct Nursing services to individuals
(up to 40 hours per week) in the AFH:
• If the AFH-DD provider meets the requirements as an enrolled Medicaid Direct Nurse Provider as described in
OAR 411-380-0060 and has a separate and distinct Medicaid provider number.
• If there is more than one individual who resides in the AFH-DD and requires direct nursing service.
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Direct Nursing Services (ADULT waiver service) (OAR 411-380)
• The provider must assure the needs of other individuals in the home are met up to and including additional
staffing, such as resident managers, substitute caregivers or other nurses in the home. Documentation must
record staffing coverage.
For Individuals in an In-Home setting Direct nursing services may not duplicate or occur at the same time as
attendant care services, except when the delivery of attendant care is provided by a personal support worker or
provider agency as defined in OAR 411-317-0000, and the individual:
a) Has been assessed needing Department approved 2:1 attendant care supports based on the results of a
functional needs assessment;
b) Is attending employment or day service activities; or
c) Needs 2:1 staffing in the community.
PRIVATE DUTY NURSING FOR YOUNG ADULTS AGE 18-THRU 20.
Please consult Appendix D for more information.
Nurse Providers must have a current and unencumbered RN or LPN license issued by the Oregon State Board of
Nursing and must be a qualified Medicaid Enrolled Nurse provider of Direct Nursing services. For more
information, please see the Direct Nursing Services-Medicaid Provider Enrollment worker’s guide.
In addition, qualified Medicaid Direct Nurse Providers must have a Prior Authorization each month to be paid for
services. Nurse providers receive the prior authorization and are paid through the Medicaid Management
Information System (MMIS) not through eXPRS. Please see the Direct Nursing MMIS Authorization and Payment
Procedures worker’s guide for more information.
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Direct Nursing Services (ADULT waiver service) (OAR 411-380)
Direct Nursing Services (Rates)
Nurse Provider payment rates. Below are standardized Direct Nursing rates by hours and units (a unit is a quarter
hour). MMIS payment requires billing by units. All providers must be paid these rates:
Hourly Rate
Unit Rate
Agency RN rate
$94.52
$23.63
Agency LPN rate
$58.88
$14.72
Self-employed RN
$6196.
$15.49
Self-employed LPN
$39.08
$9.77
* Hourly rates are not evenly divisible by 4. The corresponding unit rates are rounded up to the nearest full cent to
conform to the structure of the MMIS billing system.
** 1 unit = .25 hour. All positions are billed by the unit in MMIS.
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Individual Directed Goods and Services (CIIS waiver service) (411-435-0070)
Individual Directed Goods and Services
Source
POC Code
POC Name
Waiver
OR518
Individual Directed Goods and
Services
Description and notes for inclusion on an ISP and POC
The purpose of individual-directed goods and services must be to support the child in developing self-help or
adaptive skills, and to help provide the primary caregiver necessary training or support to continue re-enforcing
those adaptive skills with the child in the home and community.
The long-term goal for these goods and services must be to:
• Decrease the need for other Medicaid services;
• Promote inclusion of a child in the community;
• Increase the safety of a child in the family home.
Adaptive skills are those skills needed for the child to be independent in daily activities. Helping the child
learn those skills will give the child a sense of independence and lessen the strain on the family in the day-to-day
care for the child. These skills can be learned through adaptive play equipment and materials.
Individual-directed goods and services:
• Provides equipment and supplies that must be recommended by a relevant health care professional (i.e.,
occupational therapist, speech pathologist) or by a Behavior Professional.
• Must be prior authorized by CIIS Service Coordinator in coordination with the health care professionals (i.e.,
occupational therapist, speech pathologist) or Behavior Professional, and/or the education professionals (i.e.,
special education specialist) as necessary. The purpose of coordination is to ensure that goods and services
are targeted to specific adaptive skills/self-help development for the child, and that funding is not duplicative.
Coordination is also to ensure consistency in expectations and re-enforcement in different settings for the child
(i.e., at home and at school).
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Individual Directed Goods and Services (CIIS waiver service) (411-435-0070)
Must be directly address the disability related needs of a child, identified and documented in the ISP as
needed services to support the child’s long-term goals and outcomes, and supported with a written
recommendation from a health care professional or Behavior Professional. Service coordinator and involved
parties must provide follow ups with the child and the family to monitor progress to ensure the outcomes for the
child are being met. Monitoring is also to ensure the family members are receiving necessary support in helping
the child to reach personal goals in gaining self-help/adaptive skills.
Non-allowable Individual Directed Goods and Services Expenses:
• Otherwise available through the child, parent or guardian’s own resources or another source, such as OHP,
waiver or state plan services.
• Experimental or prohibited treatment.
• Normally purchased by a family for a typically developing child of the same age.
• Limit of $2400/year without CIIS approval.
• Any single good or service costing more than $500 in a plan year must be approved by CIIS.
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APPENDIX A: Supplemental ADL/IADL Information (Back to top)
ADL services include but are not limited to:
(A) Basic personal hygiene -- providing or assisting an individual with such needs as bathing (tub, bed, bath,
shower), hair care, grooming, shaving, nail care, foot care, dressing, skin care, and oral hygiene;
(B) Toileting, bowel, and bladder care -- assisting an individual to and from bathroom, on and off toilet,
commode, bedpan, urinal, or other assistive device used for toileting, changing incontinence supplies,
following a toileting schedule, managing menses, cleansing an individual or adjusting clothing related to
toileting, emptying catheter drainage bag or assistive device, ostomy care, or bowel care;
(C) Mobility, transfers, and repositioning -- assisting an individual with ambulation or transfers with or without
assistive devices, turning the individual or adjusting padding for physical comfort or pressure relief, or
encouraging or assisting with range-of-motion exercises;
(D) Nutrition -- preparing meals and special diets, assisting an individual with adequate fluid intake or
adequate nutrition, assisting with food intake (feeding), monitoring to prevent choking or aspiration, assisting
with adaptive utensils, cutting food, and placing food, dishes, and utensils within reach for eating;
(E) Medication and medical equipment – including but not limited to assisting with ordering, organizing, and
administering medications (including pills, drops, ointments, creams, injections, inhalers, and suppositories),
monitoring an individual for choking while taking medications, assisting with the administration of medications,
maintaining equipment, and monitoring for adequate medication supply;
(F) Delegated nursing tasks.
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IADL services include but are not limited to:
(A) Light housekeeping tasks necessary to maintain an individual in a healthy and safe environment - cleaning
surfaces and floors, making the individual's bed, cleaning dishes, taking out the garbage, dusting, and laundry;
(B) Grocery and other shopping necessary for the completion of other ADL and IADL tasks;
(C) Cognitive assistance or emotional support provided to an individual due to an intellectual or developmental
disability - helping the individual cope with change and assisting the individual with decision-making,
reassurance, orientation, memory, or other cognitive functions;
(D) Support in the community around socialization and participation in the community;
(E) Medication and medical equipment - assisting with ordering, organizing, and administering medications
(including pills, drops, ointments, creams, injections, inhalers, and suppositories), monitoring an individual for
choking while taking medications, assisting with the administration of medications, maintaining equipment, or
monitoring for adequate medication supply;
(F) First aid and handling emergencies - addressing medical incidents related to the conditions of an
individual, such as seizure, aspiration, constipation, or dehydration or responding
to the call of the individual for help during an emergent situation or for unscheduled needs requiring immediate
response;
(G) Assistance with necessary medical appointments - help scheduling appointments, arranging medical
transportation services, accompaniment to appointments, follow up from appointments, or assistance with
mobility, transfers, or cognition in getting to and from appointments; and
(H) Observation of the status of an individual and reporting of significant changes to a physician, health care
professional, or other appropriate person.
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Attendant care assistance means an individual requires help with ADLs. Assistance may be provided through the
use of electronic devices or other assistive devices.
(A) "Cueing" means giving verbal, audio, or visual clues during an activity to help an individual complete the
activity without hands-on assistance.
(B) "Hands-on" means a provider physically performs all or parts of an activity because an individual is unable
to do so.
(C) "Monitoring" means a provider observes an individual to determine if assistance is needed.
(D) "Reassurance" means to offer an individual encouragement and support.
(E) "Redirection" means to divert an individual to another more appropriate activity.
(F) "Set-up" means the preparation, cleaning, and maintenance of personal effects, supplies, assistive
devices, or equipment so that an individual may perform an activity.
(G) "Stand-by" means a provider is at the side of an individual ready to step in and take over the task should
the individual be unable to complete the task independently.
Health-related tasks means specific tasks related to the needs of an individual, which can be
delegated or assigned by licensed health-care professionals under State law to be performed
by an attendant.
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Indirect Supports:
Cues/reminders to complete ADL/IADL and health related tasks do not necessarily have to occur face to face when
the following conditions are met:
1. The individual lives alone or with someone
incapable of providing natural supports and
there is no one else in the person’s life to act a
natural support to meet a particular need.
Compensation for these supports is never paid to a family
member, spouse or friend living in the home of the individual.
2.There are documented health and safety
issues that the individual cannot manage
independently.
Need for this service and absence of natural support is
documented and is part of the Individual Support Plan. If the
individual lives in a family home, there needs to be a
documented pattern of multiple unsuccessful attempts to utilize
family or other natural supports.
3. Does not replace supports customarily
provided by the SC/PA.
The SC/PA must review ability to meet some or all of the
specific in-direct supports prior to using Department funds.
4. When possible, the method of providing these
supports is in the presence of the individual.
As often as possible, these services should be provided directly
in order to foster self-direction and training opportunities. This
requirement should be included on the Individual Support Plan
and service agreement language.
5. Units of service for these supports must be
specified in the Individual Support Plan and
service agreement.
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APPENDIX B: SE49/145/149/151 IN FOSTER CARE SETTINGS (Back to top)
A Foster Care setting exists when an individual with a developmental disability lives in the home of a non-relative
and that non-relative provides residential care to the person with disabilities. "Residential care" means the provision
of room and board and services that assist the resident in activities of daily living, such as assistance with bathing,
dressing, grooming, eating, medication management, money management or recreation. Payment for Residential
care is not necessary for a Foster Care setting to exist. A situation where a landlord does not live with the individual
but does provide care to an individual with a developmental disability living in their building, is not necessarily a
Foster Care setting. If uncertainty exists as to whether an arrangement meets the definition of Foster Care, contact
the Foster Care subject matter expert at ODDS.
Relief care is allowed to take place in a DD or APD licensed Foster Care setting as part of an authorized support
services ISP. The proposed relief stay must be reported to and approved by the CDDP before it occurs. A stay in a
DD licensed Foster Care Home by a non-resident cannot exceed 14 consecutive days per OAR 411-360-0190(9).
An ODDS approval to exceed the fourteen day limit imposed on the K plan service for the individual does not
change this limit imposed on the Foster Care provider. The Foster Care provider may request a variance to this rule,
which may or may not be granted. When any service is delivered by a Foster Care provider, the provider cannot be
responsible for a resident of the home while at the same time delivering a service to a participant of an in home
program. A foster care provider may not deliver services to individuals who are not residents of the foster care home
if those services are not based out of the licensed setting (i.e., the provider cannot go to the home of the individual
to deliver relief care). For children accessing SE151 in a Child Welfare-funded foster care setting, refer to DD-PT-
22-008.
The information in this appendix applies whether the setting is licensed yet or not. There are two scenarios in which
a participant of an in home program customer can live in a licensed foster care setting and be enrolled in an in home
program (though it would be highly unlikely to occur with an individual in the in home comprehensive program), each
has limitations on allowable expenses. The customer is either 1) privately paying for Foster Care, including Room
and Board and residential care or 2) the customer is living in a Foster Care Home but is paying for Room and Board
only. In neither case can a non-relative who lives in their own home with a participant of an in home program (i.e.,
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the foster provider) be paid using Department funds. An additional consideration in these scenarios is that the non-
enrolled individual who lives in the home likely counts against the home’s licensed capacity. The licensing entity
should be consulted when these arrangements are being discussed.
Additional
Documentation:
Support Services/In-Home Funds:
Customer is privately
paying for Foster Care,
including Room and Board
and residential care.
(Review SPD-PT-05-025 for
details about this
arrangement)
Copy of Foster Care
ISP
(required)
• Cannot be used for services in the home.
• Cannot be used for Services that are provided by the
Foster Care provider according to the Foster Care
ISP (see relevant Foster Care OARs on the following
page).
• Foster Care provider, resident manager and
substitute staff are not eligible to be paid with
Department Funds for individuals living in the Foster
Care setting.
Customer is living in a
Foster Care Home but is
paying for Room and Board
only
Rental Agreement or
documented
assurance that no
residential care is
being provided.
• May be used for any disability related expenses, in
home or out of home.
• Foster Care provider, resident manager and
substitute staff are not eligible to be paid with
Department Funds.
Customer is living in the
home of a relative and the
relative is a licensed foster
care provider
• Cannot be used to pay the relative for supports while
having responsibility for the Foster Care residents.
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Family Support (FS) services are 100% General Fund and are not available for children who are enrolled in K-plan
or Waiver services. Those enrolled in State Plan Personal Care (SPPC) only can still access FS services – within
the parameters of each program. With regards to the FS program, CDDPs are required to have a plan of how to
best manage usage of FS funds to serve as many children as possible within the program intent – outlined in the
purpose section of the FS rules. For example, some families may need case management/service coordination only
– i.e., connection to resources. With regards to the SPPC program, the personal care support needs must be due to
the child’s own abilities and resources, which include what’s naturally provided by parents and other means – i.e.,
assistive technologies.
Other things to keep in mind when thinking about services and supports for children and their family: How much
support does the child need? What combination of paid/unpaid supports is best to meet the child’s support needs,
long-term goals and outcomes? As with any ODDS-funded services, cost effectiveness should always be
considered.
All the same standards associated with the authorization of any services described in these Expenditure Guidelines
also apply to Family Support services. Additionally, Family Support (SE150) rules require that the purchase: must
be directly tied to the identified support needs of the child under OAR 411-305-0225; be an allowable support under
OAR 411-305-0235; meet the conditions outlined in OAR 411-305-0230; and adhere to the annual limit of $1418.12
per child. The following services are available under SE150:
Assistive Devices (OR380)
Environmental Modifications (S5165)
Assistive Technology (OR321 - OR325)
Environmental Safety Modifications (use S5165 as a
workaround)
Attendant Care (OR526)
Family Training (OR360)
Professional Behavior Services (OR570, OR310)
**Respite (OR507 daily, OR530, hourly)
Appendix C: Family Support (SE150) OAR chapter 411, division 305 (Back to top)
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**Community Inclusion (OR527)
Skills Training (OR526)
Community Transportation (OR003, OR004, OR005,
OR554)
Specialized Medical Supplies (OR562)
The following guidance is for 2 additional services unique to the Family Support program, Community Inclusion and
Respite. Note that provider agencies for these 2 services may also be licensed under ORS 446.330 per OAR 411-
305-0240(3); they still have to meet the standards described in OAR 411-450-0080 per OAR 411-305-0240(2). And
because camps/provider agencies licensed under ORS 446.330 are not qualified provider types as required per
OAR 411-305-0240(1), they do need to be certified, endorsed, and have a provider number to be paid through
eXPRS.
Community Inclusion (OR527): The purpose of these supports is to assist a child in acquiring, retaining or
improving skills that enhance independence and integration in the community. These supports encourage a child to
participate in organized group recreation or leisure activities in a community-based setting that are available to all
children. The participation or registration cost of an organized activity may be up to $150 per plan year.
Supports may be provided by a PSW or provider agency chosen by the child (as appropriate) or the child’s legal
representative, and in accordance with the provider standards. Examples include:
• Boys and Girls club activities
• Parks and Recreation events (i.e., swimming, outdoor learning)
• Learning opportunities in the community (i.e., shopping, using transportation system)
Respite (OR530 hourly, OR507 daily): The purpose of these supports is to provide a temporary break for the
primary caregiver from the daily demands of ongoing care of a child with I/DD. Respite may be utilized on a periodic
or intermittent basis – daily or hourly – provided by a PSW or provider agency chosen by the child (as appropriate)
or the child’s legal representative, and in accordance with the provider standards.
• Daily respite: The POC code and daily rate for this service is the same as for Daily Relief.
• Hourly respite: the POC code for this service is OR530. The hourly rate is the same as for Attendant Care.
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Note: Respite can be utilized as daily or hourly services independently – OR530 do not have to be authorized in
conjunction with OR507. Use OR508 in conjunction with OR507 as described in PT-16-029 and AR-16-063.
Keep in mind that for all services authorized, Family Support funds cannot exceed the total annual limit of $1418.12.
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APPENDIX D: Private Duty Nursing Services (Back to top)
Private Duty Nursing Services
(CIIS Medically Fragile only, OAR 411-300)
Private Duty Nursing Services
Source
MMIS Code
POC Name
Medicaid
State Plan
T1030
Nursing Visit, RN
T1031
Nursing Visit, LPN
S9123
Shift Care, RN
S9124
Shift Care, LPN
Description and notes for inclusion on an ISP and POC
The purpose of the Private Duty Nursing (PDN) is to reduce the cost of healthcare services through equally
effective, more conservative, and/or less costly treatment. Children must have complex medical needs and require
continuous skilled nursing care that can be provided safely outside an institution (i.e., hospital, skilled nursing
facility) on a day-to-day basis. PDN services must be prior authorized based on the service level determined by
the MFCU (Medical Fragile Care Unit) Criteria. and meet the level of service criteria that measure specific nursing
interventions needed.
The need for private duty nursing (or direct hands-on nursing) shall be established based on a physician’s
order, nursing assessment, nursing care plan, documentation of condition and medical appropriateness, identified
skilled nursing needs, goals and objectives of care provided. OAR 410-132-0020 (3)
A nursing visit is authorized when the need for a reassessment and evaluation is required for a child who has
non-critical or stable conditions with a moderate probability that complications would arise without skilled nursing
management of a treatment program on an intermittent basis. An LPN must be supervised by a RN.
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Private Duty Nursing Services
(CIIS Medically Fragile only, OAR 411-300)
Shift care nursing is authorized when the need for a reassessment and evaluation is required for a child who
has critical or unstable conditions that are expected to rapidly change that complications would arise without
skilled nursing management of a treatment program supplied in a specified block of time.
Appropriate shift care nursing services is based on the acuity level of the child as measured by the MFCU Clinical
Criteria (DHS 0519, 05/13):
▪ Level 1. Score of 75 or greater and on a ventilator for 20 hours or more per day = up to a maximum of 554
nursing hours per month;
▪ Level 2. Score of 70 or above= up to a maximum of 462 nursing hours per month;
▪ Level 3. Score of 65 to 69 = up to a maximum of 385 nursing hours per month;
▪ Level 4. Score of 60 to 64 = up to a maximum of 339 nursing hours per month;
▪ Level 5. Score of 50 to 59 or if a child requires ventilation for sleeping hours = up to a maximum of 293
nursing hours per month; and
Level 6. Score of 45 to 49 = up to a maximum of 140 nursing hours per month.
The nursing service plan and documentation supporting the medical appropriateness for PDN must meet the
standards of the Oregon State Board of Nursing. The nursing service plan must be reviewed, updated, and
submitted to the MFCU whenever the child’s needs change. Increases or decreases in the level of care and
number of hours or visits authorized shall be based on a change in the condition of the child, limitations of the
program, and the ability of the family or delegated caregivers to provide care.
All PDN services require prior authorization by a CIIS Service Coordinator.
Private Duty Nursing – MMIS Rates
Paid through MMIS at rates established by the Department
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APPENDIX E: Provider Agency Rates (Back to top)
Hourly Attendant Care
Hourly agency rates
Standard
Model Agency
Community Living
Supports Agency
OR526
Attendant Care Support (1:1)
$42.24
$34.99
OR526NA/ZE
Attendant Care Support (2:1)
(2 different agency providers)
$42.24
$34.99
OR526ZC
Attendant Care Support (2:1)
(One agency)
$76.69
$64.26
OR526/RB
Attendant Care Group (1:2)
(per person)
$23.23
$19.25
OR526/R3
Attendant Care Group (1:3)
(per person)
$16.90
$14.00
OR545/NA/ZE
On the Job Attendant Care
(1:1)
$42.24
$42.24
OR545/ZC
On the Job Attendant Care
(2:1)
$76.69
$76.69
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Day Support Activities
Provider Agency Rates
Per Hour:
Category 1
Category 2
Category 3
Category 4
Group DSA–
Community
(OR542/W2, ZE)
$17.11
$21.33
$29.77
$39.76
Group DSA– Facility
(OR542/W1, ZH)
$11.99
$15.75
$19.50
$28.39
Solo DSA OR542/RS
$42.24
Solo DSA (2:1)
OR542RS
$74.52
Rate for 1:1 Group
DSA Community
OR542/RC:
$41.82
Rate for 2:1 Group DSA
Community OR542/ZC:
$71.24
Rate for 1:1 Group
DSA Facility
OR542/R1:
$38.59
Rate for 2:1 Group DSA
Facility OR542/ZF:
$67.64
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Job Coaching
Individual Supported
Employment – Job Coaching
(Hourly Rates)
Category 1
Category 2
Category 3
& Category 4
Initial Job Coaching
(OR401/W5)
$32.07
$49.82
$71.93
Ongoing Job Coaching
(OR401/W6)
$25.66
$49.82
$71.93
Maintenance Job Coaching
(OR401/W4)
$19.24
$49.82
$71.93
Job Development
Individual Supported Employment –
Job Development (Outcome Based Rates)
Category 1
Category 2
Category 3 &
Category 4
Job Development – Initial Placement
(OR401/W3)
$2,429.86
$3,037.33
$3,644.80
Job Development – 90+ Days Job Retention
(OR401 W9)
$1,518.67
$1,822.40
$2,429.86
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Small Group Supported Employment (Hourly Rates)
Small Group Supported
Employment (OR543/W2)
Category 1
Category 2
Category 3
Category 4
$22.46
$25.97
$31.45
$42.50
Small Group Supported Employment
(OR543/RC, ZE) 1:1 in a group
$43.91
Small Group Supported Employment
(OR543/ZC) 2:1 in a group
$73.76
Discovery
Discovery (Outcome
Based Rates)
(OR539/WA)
Category 1
Category 2
Category 3
and 4
$2,184.54
$2,496.61
$2,808.69
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Employment Path
Employment Path
(Hourly Service
Rates)
Category 1
Category 2
Category 3
Category 4
Employment Path
Community -
OR541/W2, ZE
$21.28
$24.66
$29.71
$39.83
Employment Path
Facility –
OR541/W1
$13.48
$17.32
$22.46
$28.27
Employment Path
Community -
OR541/RC 1:1
$41.71
Employment Path
Facility - OR541/R1 1:1
$38.44
Employment
Path
Community
- OR541/RS
(Solo)
$42.29
Employment Path
Community -
OR541/ZC 2:1
$71.01
Employment Path
Facility - OR541/ZF 2:1
$67.37
Employment Path – Benefits counseling (per hour)
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OR541 WB and WC
$42.29
Adult’s 24-Hour Residential Rates (per day, based on 344 days/year)
Payment Category
3 or fewer residents
4-5 residents
6+ residents
Payment Category 1
$300.14
$234.81
$160.94
Payment Category 2
$410.20
$349.85
$189.81
Payment Category 3
$561.69
$434.62
$283.79
Payment Category 4
$687.54
$561.20
$321.40
Children’s 24-Hour Residential Rates (per day, based on 344 days/year)
3 or fewer
residents
4 residents
5 residents
Payment Category 1
$518.25
$476.79
$388.85
Payment Category 2
$619.65
$552.11
$449.08
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Payment Category 3
$725.13
$709.72
$576.16
Payment Category 4
$855.73
$812.66
$658.72
Host Homes
Payment Category 1
$130.46
Payment Category 2
$183.16
Payment Category 3
$257.43
Payment Category 4
$327.38
Professional Behavior Services Hourly Rates
For Agencies and Independent Behavior Professionals
(ST)
Fewer than 70 miles
from individual’s
residence
(RU)
70+ miles from individual’s
residence
$82.56
$103.20
Supported Living
Rate is based on the result of the
Supported Living Budget Tool.
