Oregon Administrative Rules|Section 411-435-0040 - Conditions of Purchase

                                                
Current through Register Vol. 60, No. 12, December 1, 2021 
(1) Ancillary services must be authorized in an ISP consistent with OAR 411-415-0070.
 
(2) All ancillary services purchased must be in accordance with the Expenditure Guidelines.
 
(3) Department funds may not be used for: 
(a) A reimbursement to an individual, or the legal or designated representative or family of the individual, for expenses related to ancillary services.
 
(b) An advance payment of funds to an individual, or the legal or designated representative or family of the individual, to obtain ancillary services.
 
(c) Services, materials, or activities that are illegal.
 
(d) Services or activities that are carried out in a manner that constitutes abuse as defined in OAR 407-045-0260.
 
(e) Materials or equipment that has been determined unsafe for the general public by recognized consumer safety agencies.
 
(f) The purchase of a vehicle.
 
(g) Health and medical costs that the general public normally must pay, including, but not limited to: 
(A) Medications;
 
(B) Health insurance co-payments;
 
(C) Mental health evaluation and treatment;
 
(D) Dental treatments and appliances;
 
(E) Medical treatments;
 
(F) Dietary supplements; or
 
(G) Treatment supplies not related to nutrition, incontinence, or infection control.
 
(h) Ambulance services.
 
(i) Legal fees including, but not limited to, costs of representation in educational negotiations, establishing trusts, or creating guardianships.
 
(j) Vacation costs that are normally incurred by a person on vacation, regardless of disability, and are not strictly required by the need of the individual for personal assistance in all home and community-based settings.
 
(k) Services or supports that are not necessary or cost-effective.
 
(l) Services that do not meet the description of ancillary services as described these rules, or that do not meet the definition of social benefits as defined in OAR 411-317-0000.
 
(m) Services, activities, materials, or equipment that may be obtained by the individual through other available means, such as private or public insurance, philanthropic organizations, or other governmental or public services.
 
(n) Services or activities for which the legislative or executive branch of Oregon government has prohibited use of public funds.
 
(o) Any purchase that is not generally accepted by the relevant mainstream professional or academic community as an effective means to address an identified support need.
 
(p) Services, supplies, or supports that are illegal, experimental, or determined unsafe for the general public by recognized child or consumer safety agencies.
 
(q) Services provided in a nursing facility, correctional institution, or hospital.
 
(r) Services, activities, materials, or equipment that may be obtained by the individual or the individual's family through alternative resources or natural supports.
 
(s) Services when there is sufficient evidence to believe that an individual or legal representative, or a provider chosen by an individual, has engaged in fraud or misrepresentation, failed to use resources as agreed upon in an ISP, refused to accept or delegate record keeping required to document use of Department funds.
 
Or. Admin. R. 411-435-0040
APD 20-2016, f. & cert. ef. 6-29-16; APD 23-2018, temporary amend filed 07/02/2018, effective 07/02/2018 through 12/27/2018; APD 46-2018, amend filed 12/28/2018, effective 12/28/2018
Statutory/Other Authority: ORS 409.050, 427.104 & 430.662
 
Statutes/Other Implemented: ORS 427.005, 427.007, 430.610, 430.620 & 430.662-430.670
This section was updated on 1/22/2019 by overlay.