Oregon Project Independence 2013 Rule & Fee Schedule ChangesInformation for AAA DirectorsSeptember 19, 2013

2Summary of rule changes

411-035-0000 Definitions Multiple changes and updates Wording updated to reflect current practices, improve

readability and establish consistency with other DHS rules NEW/Updated

• #12 Assistive Technology Device• #22 Evidence-Based Health Promotion• # 26 Health Care Costs• # 28 Home Care Supportive Services• # 30 Home Delivered Meals• # 40 Options Counseling• # 42 Place of Residence• # 49 Service Coordination• # 50 Service Coordination Costs

3Summary of rule changes

Authorized services including those specified by House Bill 3037 411-034-005 Administration Section (5) updated (a “non compliance may result in a

reduction or termination of OPI funding 411-032-0010 Authorized Services

Home care supportive services NEW Assistive technology device

“means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of an individual.”

4 Summary of rule changes 411-032-0010 new or updated

No Longer Allowed in this section of rule Assisted Transportation* Planning for long term care*Home Health Public education - LTC planningRespite* Information and AssistanceOther services authorized...*see page 6

5Summary of rule changes

411-032-0010 new or updated

Service coordination is the term replacing “case

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

6 Summary of rule changes 411-032-0010 new or updated

(b) Other authorized services for which OPI funds may be expended are authorized on a case by case basis by the Director of the Department. Other authorized services may include: (A) Services to support community caregivers and strengthen the natural support system of individuals;* (B) Evidence-based health promotion services; (C) Options counseling or (D) Assisted transportation options that allow individuals to live at home and access the full range of community resources. *

7 Summary of rule changes REPEALED 411-032-0013 Fee-Based Services 411-034-0020 3) Priority for Authorized Services

Now clarified to support AAA agreement to use the OPI Risk Form (287k)

411-034-0044 Fee for Authorized Services Change to ONE time fee for those with zero contribution Section 1 (c) regarding donation for OPI funded HDM Repealed Section 1 h – AAA’s not required to make a second attempt to

collect one time fee, but must have a department reviewed fee collection policy

Section 2 Fee for Service Schedule Updated language regarding fees

8Local Implications from Rule Changes

Assistive Technology Device • Will need to create local policy regarding what is allowed, if

you have cost caps or preferred vendors• Address the responsibility for monthly cost (Emergency

Response System or Medication Dispensing System Home Delivered Meals

• Are prepared and delivered in compliance with applicable state and local laws;

• Meet a minimum of 33 1/3 percent of Dietary Reference Intakes and Dietary Guidelines;

• Include meal menus approved by a registered dietitian; • Require an in-person initial assessment and a minimum annual

assessment; and • Provide nutrition education to the individual one time per year.

9 Local Implications from Rule Changes Changing terminology from Case Management to

Case Coordination in local policy

Will need authorization from the Director of the Department or Designee if OPI funds are used for:

• Services to support community caregivers• Evidence-based health promotion• Options counseling• Assisted transportation

10Local Implications from Rule Changes

Update Fee policy and processes• One time fee of $25 effective 10-1-2013• Can be implemented for new clients only• AAA’s will have flexibility to work with clients who

incur a hardship in paying the $25 (e.g. payment plan, adjusted fee)

• AAA’s criteria for flexibility will be outlined in the fee collection policy

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

11New OPI Fee Schedule effective 10-1-2013

Adjusted Net Income Range (% of Poverty) Income Description Household = 1 Household = 2 Household = 3+ Cost Share (as

%of unit price) 2013 Federal Poverty 48 States

1 Household 2 Household 3 Household

0 - 150% Yearly $0 to $17,235 $0 to $23,265 $0 to $29,295 0% $11,490 $ 15,510 $ 19,530

Monthly $0 to $1,436 $0 to $1,939 $0 to $2,441 $17,235 $23,265 $29,295

151 - 175% Yearly $17,236 to $20,108 $23,266 to $27,143 $29,296 to $34,178 5%Monthly $1,437 to $1,676 $1,940 to $2,262 $2,442 to $2,848 $20,108 $27,143 $34,178

176 – 200% Yearly $20,109 to $22,980 $27,144 to $31,020 $34,179 to $39,060 10%Monthly $1,677 to $1,915 $2,263 to $2,585 $2,849 to $3,255 $22,980 $31,020 $39,060

201 - 225% Yearly $22,981 to $25,853 $31,021 to $34,898 $39,061 to $43,943 20%Monthly $1,916 to $2,154 $2,586 to $2,908 $3,256 to $3,662 $25,853 $34,898 $43,943

226 - 250% Yearly $25,854 to $28,725 $34,899 to $38,775 $43,944 to $48,825 30%Monthly $2,155 to $2,394 $2,909 to $3,231 $3,663 to $4,069 $28,725 $38,775 $48,825

251 – 300% Yearly $28,726 to $31,598 $38,776 to $42,653 $48,826 to $53,708 40%Monthly $2,395 to $2,633 $3,232 to $3,554 $4,070 to $4,476 $31,598 $42,653 $53,708

276 - 300% Yearly $31,599 to $34,470 $42,654 to $46,530 $53,709 to $58,590 50%Monthly $2,634 to $2,873 $3,555 to $3,878 $4,477 to $4,883 $34,470 $46,530 $58,590

301 – 325% Yearly $31,599 to $37,343 $42,654 to $50,408 $53,709 to $63,473 60%Monthly $2,634 to $3,112 $3,555 to $4,201 $4,477 to $5,289 $37,343 $50,408 $63,473

326 – 350% Yearly $37,344 to $40,215 $50,409 to $54,285 $63,474 to $68,355 70%Monthly $3,113 to $3,351 $4,202 to $4,524 $5,290 to $5,696 $40,215 $54,285 $68,355

351 – 375% Yearly $40,216 to $43,088 $54,286 to $58,163 $68,356 to $73,238 80%Monthly $3,352 to $3,591 $4,525 to $4,847 $5,697 to $6,103 $43,088 $58,163 $73,238

376 - 400% Yearly $43,089 to $45,960 $58,164 to $62,040 $73,239 to $78,120 90%Monthly $3,592 to $3,830 $4,848 to $5,170 $6,104 to $6,510 $45,960 $62,040 $78,120

over 400% Yearly $45,961  + $62,041  + $78,121  + 100%Monthly $3,830  + $5,170  + $6,510  + $45,961 $62,041 $78,121

12OPI Fee Schedule Easier for consumers to understand and for AAA’s to administer 10% increments from 151% to 400% of Federal Poverty Level

(FPL) Change may allow low-income clients (200% FPL) who have

historically refused OPI due to cost to accept services New Fee Schedule will change (lessen) current fees charged

• Local decision for application of new fee schedule• Training next week for staff will be Fee Assessment must be

updated at least annually • Directing staff to seek local direction regarding early changes

with new fee schedule (likely to be in consumer’s favor)• Note that rule does not allow for non-billing unless addressed

in local OPI policy

13Local Implications from Rule Changes

Policies updated to include the use of updated OPI forms• 287J - OPI Risk

• Updated annually at review and at final disposition• Note risk score tracking tool is available & helpful for

compulation• 287 K - OPI Fee Assessment

• Updated Annually• 287 L - OPI Service Agreement

• Updated annually and when Fee Assessment or service plan changes

• UPDATED Forms and Fee Schedule coming next week

14

“

”

If I didn’t have my HCW coming to help me, I don’t know if I would be able to

stay in my home. OPI relieves my daughter, who is busy with her life and

family, as well.

Zeda, 88 year old OPI consumer in Yamhill County

Presenter:Sandy Abrams, Trainer/Policy AnalystNorthWest Senior and Disability Services