Or. Admin. Code § 411-015-0030 - Extended Waiver Eligibility (EWE)
(1) An individual determined to no longer
meet the criteria in 411-015-0100 and assessed as
Service Priority Level (SPL) 14 - 18 through the assessment process outlined in
411-015-0008 may be eligible to
continue receiving Long-Term Support Services (LTSS) when one of the following
circumstances causes unmet needs or health and safety risks, which would result
in the individual being institutionalized or hospitalized within 30 days:
(a) Lack of access to shelter and support
would cause the individual to deteriorate or decompensate;
(b) Without supports, the individual would
lack access to safe housing or has a documented history of eviction or threats
of eviction that would lead the individual to deteriorate or decompensate;
or
(c) Without supports, the
individual is at significant risk of abuse or exploitation.
(2) An individual who is approved
for EWE may receive the approved services and supports as defined in OAR
411-027-0020 for six calendar
months from the effective date.
(3)
An individual meeting the criteria for EWE must have a re-assessment, as
described in OAR 411-015-0008, completed no less
frequently than every 12 calendar months, or when the individual's needs or
circumstances change.
(4) EWE may
be renewed for an additional six calendar months if the individual or their
representative demonstrates:
(a) The
individual or representative is actively working with their assigned case
manager to develop a safe plan to address the circumstances identified in
section (1)(a) - (c) of this rule; and
(b) The individual or representative shows
demonstrable progress towards implementing the plan developed in subsection
(3)(a) of this rule.
(5)
Case managers may deny initial EWE if the individual does not meet the criteria
in (1) of this rule.
(6) Case
managers may deny renewals of EWE if the individual does not meet the criteria
in (1) of this rule, or if the individual or representative does not meet the
criteria in section (4) of this rule.
(7) If the case manager does not deny EWE,
they must submit initial and renewal requests for approval of EWE to the
Central Office no later than two weeks prior to the service plan being
closed.
(8) Initial and ongoing
eligibility for EWE shall be determined by APD central office on a case-by-case
basis.
(a) Ongoing eligibility will be
determined based upon an assessment and a review of the individual's progress
towards mitigating the identified risk. In order to remain eligible, the
individual must show they have been unable to mitigate the risks identified in
(1) of this rule, through development and implementation of a transition
plan.
(b) In order to ensure
engagement, case managers must have direct contact with an individual or their
representative each month as described in OAR
411-028-0020(1).
Case managers must narrate the monthly contacts in Oregon ACCESS and the steps
or actions being taken to mitigate the identified risk.
(9) An individual receiving Medicaid OHP Plus
under OAR chapter 410, division 200 is not eligible for EWE.
(10) An individual receiving home and
community-based services as a recipient of Healthier Oregon may be eligible for
EWE.
Notes
Statutory/Other Authority: ORS 410.070
Statutes/Other Implemented: ORS 410.070
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