| Services
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In order to provide support services, brokerage staff provide the following: Assistance for individuals to determine needs, plan supports in response to needs, and develop individualized budgets based on available resources; Assistance for individuals to find and arrange the resources to provide planned supports, facilitating development and expansion of community resources required to meet the support needs of individuals served by the Brokerage; Information, education, and technical assistance for individuals to use to make informed decisions about support needs and to direct support providers; Fiscal intermediary activities in the receipt and accounting of Support Service funds on behalf of an individual in addition to making payment with the authorization of the individual; Employer-related supports, assisting individuals to fulfill roles and obligations as employers of support staff when plans call for such arrangements; and Assistance for individuals to effectively put plans into practice, including help to monitor and improve the quality of supports as well as assess and revise plan goals. (use "Back" button to return to services menu) All expenditures of Support Service funds must meet the definition of Support and the definition of Social benefit: Support means assistance individuals require - solely because of the effects of disability - to maintain or increase independence, achieve community presence and participation, and improve productivity. This assistance is flexible and subject the change with time and circumstances. Support Services are based on the principles of self determination. Social benefit or social service means a service solely intended to assist an adult with disabilities to function in society on a level comparable to that of an adult who does not have such disability. Such a benefit or service does not: a) duplicate benefits and services otherwise available to citizens regardless of disability; b) provide financial assistance with food, clothing, shelter, and laundry needs common to persons with or without disabilities; or c) replaces other governmental or community services available to an individual. Financial assistance provided as a social benefit or social service does not exceed the actual cost of the support required by an individual and must be either: A) reimbursement for an expense authorized in a previously-approved plan of service or B) an advance payment in anticipation of an expense authorized in the previously approved plan of service. Note: All expenditures of Support Services Funds are for goods or services that are “supports” and “social benefits” according to OAR 309-041-1760. Goods and services are required---solely because of the effects of disability---for an individual to live in his or her home and community, do not duplicate benefits and services otherwise available to citizens regardless of disability, are not basic food and shelter, and do not replace other available governmental or community services. Support Services Funds are paid by the Support Services Brokerage directly to a qualified provider for services performed or goods received. (use "Back" button to return to services menu) CHORE SERVICES (CPMS Service Code 725) Service Description Services needed to maintain a clean, sanitary, and safe environment in an individual's home. Includes heavy household chores. Services are provided when no one in the household is capable of either performing, or paying for, the services when no other relative, caregiver, landlord, community / volunteer agency, or third-party payer is capable of or responsible for their provision. Examples 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. These tasks include, but are not limited to: washing floors, windows and walls; tacking down loose rugs and tiles; moving heavy items of furniture for safe access. Customer Survey and progress notes include evidence and results of search for alternatives to support service funds, e.g.: no one in the household physically or cognitively able to perform the work; no one in household capable of paying for the work to be done; no option for landlord or community service agency or other person in the individual’s life to do the work. It is not okay to use Support Service fund for: Ongoing weekly home maintenance and housekeeping services. Lawn and yard maintenance. Routine expenses associated with moving residence, e.g. moving furniture and belongings, cleaning apartment to obtain cleaning deposit. Remodeling or new construction in and around the home. Pet washing and grooming. Washing vehicles. Normal household cleaning supplies. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) COMMUNITY INCLUSION SUPPORTS (CPMS Service Code 726) Service Description Instruction in skills an individual wishes to acquire, retain, or improve that enhance independence, productivity, integration, and or maintain the individual's physical and mental skills. This includes participating in activities to facilitate independence and promote community inclusion and contributions, and at any time in community settings of the person's choice. Examples Attendant care in typical adult activities such as enrolled in or auditing college courses (adults age 21 and older), recreational activities, exercise programs. Portion of payment for camp that purchases specific support for an individual provided by a qualified provider. Training and assistance in social behavior, communication, fostering relationships. Mobility training and instruction in use of local transportation services. Sheltered workshop services where goals for productivity and contribution are clearly identified. It is not okay to use Support Service fund for: Support provided by someone who does not meet the minimum provider qualifications in the Support Services Rule. Education services for school-aged individuals, including: professional instruction, formal training, and tutoring in communication, socialization, and academic skills; tuition to private schools; payment for programs or services in lieu of school. Services provided by the spouse of the individual receiving support services. Illegal activities. Services or activities carried out in a manner that constitutes abuse of an individual. Services from persons engaging in verbal mistreatment, subjecting an individual to derogatory names, phrases, profanity, ridicule, harassment, coercion or intimidation by threatening injury or withholding of services or supports. Restricting an individual's freedom of movement by seclusion in a locked room under any condition. Fees for legal advice or representation, representative payees, conservators. Vacation costs for transportation, food, shelter, and entertainment that would normally be incurred by anyone on vacation, regardless of disability, and are not strictly required by the individual's need for personal assistance in all home and community settings. Care, training, or supervision that has not been arranged according to applicable state and federal wage and hour regulation. Expenses that would normally be paid by adults without disabilities in pursuit of strictly recreational or personal interests, e.g. video rental, tickets for movies, and concerts, internet fees, 1-900 phone calls, admissions to sporting events, health club dues, horseback riding fees, conference fees. Payments to a provider for tutoring, taking notes, or writing papers for individuals in high school, college, or adult education classes. Reimbursement for activity fees, lodging, and meal expenses for personal attendants assisting individuals with community inclusion activities. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Support staff recruitment costs. Person-centered planning assistance. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Portion of camp fees not directly associated with specialized supports for the individual, e.g. board and room, administration. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) COMMUNITY LIVING SUPPORTS (CPMS Service Code 727) Service Description Services provided for the purpose of facilitating independence and promoting community integration by supporting the individual to gain or maintain skills to live as independently as possible in the type of community-based housing the individual chooses. Available to people who live alone, with roommates or family. Supports include developing or maintaining skills in self-care, directing supports, and caring for immediate environment. Examples Staff (hourly wage, FICA, FUTA) employed by individual to provide assistance with personal skills, including eating, bathing, dressing, personal hygiene and mobility. Contract with independent contractor to provide assistance with socialization, including development or maintenance of self-awareness and self-control, social responsiveness, social amenities and interpersonal skills. Contract with agency to provide shift nursing, medication administration. Independent contractor to assist with community participation, recreation or leisure, including the development or maintenance of skills. Contract with supported living agency to teach skills for meals, budgeting, laundry and housekeeping. It is not okay to use Support Service funds for: Services provided by the spouse of an adult. Services available through private insurance or health plan. Services provided by someone who does not meet the minimum provider qualifications of the Support Services Rule. Behavior management not based on positive behavioral theory and practice. Services or activities carried out in a manner that constitutes abuse of an individual. Health and medical costs and the general public normally must pay, including: medications; health insurance co-payments; dental treatments and appliances; medical treatments; dietary supplements; treatment supplies not related to nutrition incontinence, or infection control Fees for legal advice or representation, representative payees, conservators. Care, training, or supervision that has not been arranged according to applicable state and federal wage and hour regulations. Educational services for school-age individuals, including: professional instruction, formal training and tutoring in communication, and academic skills; tuition to private schools; payment for activities and services in lieu of school. Expenses that would normally be paid by adults without disabilities in pursuit of strictly recreational or personal interests, e.g. video rental, tickets for movies and concerts, internet fees, 1-900 phone calls, admissions to sporting events, health club dues, horseback riding fees, conference fees. Fees incurred by personal attendants while assisting an individual with community inclusion activities. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Rent, utilities, mortgage payments. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Person-centered planning assistance. Assisting a child without disabilities with communication, basic personal care, school activities, medical and dental services, or other activities because the child’s parent has a developmental disability that affects his or her ability to carry out normal parental responsibilities. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS ( CPMS Service Code 728) Service Description Physical adaptations which are necessary to ensure the health, welfare, and safety of the individual in the home, or which enable the individual to function with greater independence in the home. Examples 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; Sound and visual monitoring systems; Fencing; 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 room 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; Specialized electric and plumbing systems which are necessary to accommodate the medical equipment and supplies which are necessary for the welfare of the individual; Vehicle modifications to meet unique needs (e.g. lift, seats, head and leg rests and belts, special safety harnesses or other modifications to keep the individual safe in the vehicle). Repair of lift. It is not okay to use Support Service funds for: Generic fire safety equipment. General household maintenance and repair. Adaptations or improvements to the home which are of general utility and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc. Adaptations to the home that add to the total square footage of the home. Adaptations and modifications not constructed in accordance with applicable State or local building codes. Adaptations and improvements not necessary or cost-effective, , e.g. covering porch used for equipment storage when tarp will adequately protect the equipment, installing extra under-carpet padding throughout a rental unit when individual can be adequately protected with more portable personal safety devices. Materials or equipment that has been determined unsafe for the general public recognized child and consumer safety. Third-party payments, e.g. reimbursing individual or family members for materials, contractor payments, etc. Environmental adaptations in more than one location without specific SPD approval. (use "Back" button to return to services menu) FAMILY TRAINING (CPMS Service Code 729) Service Description Training and counseling serving for the family of an individual to increase capabilities to care for, support, and maintain the individual in the home. Services are provided by licensed psychologists, professionals licensed to practice medicine, social workers, counselors, or in organized conferences and workshops that are limited to topics related to the individual's disability, identified support needs, or specialized medical or habilitative support needs. The training is NOT provided to paid caregivers. Examples 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. Counseling for the family to relieve the stress associated with caring for an individual with disabilities. It is not okay to use Support Service funds for: Payments to individuals providing direct assistance in the family home and unable to pass a criminal history check conducted by the state. Fees for legal advice or representation, representative payees, conservators. Pay for training to carry out activities that constitute of an individual. Pay for training to carry out activities that involve verbal mistreatment, use of derogatory names, phrases, profanity, ridicule, harassment, coercion, or intimidation by threatening injury or withholding of services or supports. Pay for training to carry out activities that restrict an individual’s freedom of movement by seclusion in a locked room. Pay for family training to carry out educational activities in lieu of school for school-age individuals. Fees, travel, lodging, and other expenses for 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, videotapes, etc. Fees, travel, lodging, and other expenses for family members who are not active care providers. Training parents with disabilities to be parents in general Training for paid caregivers. Teaching family members sign language. (use "Back" button to return to services menu) HOMEMAKER Services (CPMS Service Code 730) Service Description Support consisting of general household activities such as meal preparation and routine household care provided by a trained homemaker. Services provided when person normally responsible for these activities is temporarily absent, unable to manage the home as well as care for self and individual in the home, or needs to devote additional time to care for the individual. Examples Meal preparation; Routine household care. It is not okay to use Support Services funds for: Lawn and yard maintenance Pet washing and grooming Washing vehicles Activities that are not of direct benefit to the individual with disabilities Painting, roofing, other home maintenance and repair tasks Heavy one-time cleaning tasks associated with Chore Services. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. General household cleaning supplies. (use "Back" button to return to services menu) OCCUPATIONAL THERAPY (CPMS Service Code 732) Service Description Services of a professional licensed under ORS 675.240, which are defined under the approved State Medicaid Plan, except that the amount, duration, and scope specified in the State Medicaid Plan, do not apply. See OMAP provider guide site or call OHP to determine whether an item is covered: http://www.dhs.state.or.us/policy/healthplan/archive/otpt/ Examples Only covers services that Oregon Health Plan covers. Covers services once OHP limits have been reached and there must be written proof that OHP limits have been reaches. It is not okay to use Support Services funds for: Goods and services available through either public programs (e.g. OHP, schools, or General assistance programs) for which an individual is eligible, or through an individual's private insurance. Experimental therapy and treatments. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Educational services for school age individuals, such as: professional instruction, formal training, and tutoring in communication, socialization, and academic skills; tuition to private schools; payment for activities and services in lieu of school. Health and medical costs that the general public normally must pay. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) PERSONAL EMERGENCY RESPONSE SYSTEMS (CPMS Service Code 733) Service Description Electronic devices required by certain individuals to secure help in an emergency for safety in the community. Services are limited to people who live alone or are alone for significant parts of the day and would otherwise require extensive routine supervision. Examples Portable Help button Cell phones or pagers used in a way that met the following definition; 1. as means of securing help in an emergency situation when the individual is outside the home and needs assistance due to accident, injury or inability to find their way home 2. Not for convenience or general purpose use and costs associated with non-emergency use are prohibited 3. Must be purchased from a supplier who can give monthly itemized bill and or provide service restricted to emergency use only. 4. PA will review bill monthly and make sure that only emergency use is charged to Support Services. (The cell phones which only use calling cards may be the best option for cell use.) It is not okay to use Support Services funds for: General home or office telephone services or service plans. Pager or cell phone services for staff who use the services for general communication or for other individuals and costs are not clearly separated. Minutes on phone service bills that were not used to secure help in an emergency situation when the individual was outside the home and needed assistance due to accident, injury or inability to find his or her way home. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) PHYSICAL THERAPY (CPMS Service Code 734) Service Description Services provided by a professional licensed under ORS 688.020 that are defined under the approved State Medicaid Plan, except the amount, duration and scope specified in the State Medicaid Plan do not apply See OMAP provider guide site or call OHP to determine whether an item is covered: http://www.dhs.state.or.us/policy/healthplan/archive/otpt/ Examples/Clarifications Only covers services that Oregon Health Plan covers. Generally, these services are assessment, family/provider training to carry out specific recommendations, consultation, and direct hands-on therapy provided by an appropriately-licensed or -certified professional. Covers services once OHP limits have been reached and there must be written proof that OHP limits have been reached. Best way to find out if okay to use Support Service Dollars: 1. Review current provider guides online or call OHP and see if the service is normally covered under OHP. If it is not covered, then Support Service Dollars cannot be used. 2. If it is something OHP covers and the individual has reached limited of OHP benefit or doesn’t have OHP, then it could be covered by Support Service Dollars. (Note: You must have in writing that benefit limits have been reached.) It is not okay to use Support Services funds for: Goods and services available through either public programs (e.g. OHP, schools, or Federal assistance programs) for which an individual is eligible, or through an individual's private insurance. Experimental therapy and treatments. Educational services for school age individuals, such as: professional instruction, formal training, and tutoring in communication, socialization, and academic skills; tuition to private schools; payment for activities and services in lieu of school. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Health and medical costs that the general public normally must pay. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) RESPITE CARE (CPMS Service Code 735) Service Description 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 themselves. Respite may be provided in the individual's or respite provider's home, a foster home, a group home, a licensed day care center, or a community care facility that is not a private residence. Examples Temporary respite care, which is provided on less than a 24-hour basis, e.g. staying with a neighbor for the afternoon, bringing a care provider in to the home for a few hours in the evening every few weeks to allow the caregiver to leave the house for recreation. 24-Hour overnight care which is provided in segments of 24-hour units that may be sequential, e.g. arranging for the individual to spend the weekend away from home at a care provider’s home or foster home, bringing a care provider to the individual’s home while the primary caregiver goes on vacation for a week It is not okay to use Support Services funds for: Basic meals for individual with disability unless as part of short-term stay in Medicaid-approved facility. Goods and services available through either public programs (e.g. OHP, schools, or Federal assistance programs) for which an individual is eligible, or through and individual's private insurance. Generic vacation travel and lodging expenses. Services provided by the spouse of the individual receiving support services. Services available through private insurance or health plan. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Services provided by someone who does not meet the minimum provider qualifications of the Support Services Rule. Behavior management not based on positive behavioral theory and practice. Services or activities carried out in a manner that constitutes abuse of an individual. On-going long-term service, approximately 8 hours / day, five days a week. Behavior management not based on positive behavioral theory and practice. Substitute care to allow a caregiver to attend school or work Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Specialized camps. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) SPECIAL DIETS (CPMS Service Code 736) Service Description Specially prepared food and/or particular types of food needed to sustain the individual in the family home. Special diets are ordered by a physician and monitored by a dietitian periodically. Special diets are supplements and are not intended to meet an individual's complete daily nutritional requirements. They do not provide or replace the nutritional equivalent of meals and snacks normally required regardless of disability. Examples High caloric supplements. Gluten-free supplements. Diabetic, ketogenic, or other metabolic supplements. It is not okay to use Support Services funds for: Items such as diet drinks and body-building formulas, purchased for weight loss or gain which could be achieved using generic foods and dietary guidelines. Experimental nutritional supplements or regimens, such as combinations of vitamins and minerals purported to cure or alleviate symptoms of autism, Downs' Syndrome, or other developmental disabilities and which have not achieved general professional acceptance as essential to management of these conditions. Food or equipment that can be purchased through the Oregon Health Plan or private insurance. A full nutritional regimen, i.e. the nutritional equivalent of three meals a day with snacks. (Example: Purchasing all food for an individual with real or suspected food allergies while the household food budget is used to provide generic diets to the rest of the household.) Food for the entire household. Illegal substances. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES (CPMS Service Code 737) Service Description Devices, aids, controls, supplies, or appliances which enable individuals to increase their abilities to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. Includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non durable medical equipment not available under the Medicaid State plan. All items meet applicable standards of manufacture, design, and installation. See OMAP provider guide site or call OHP to determine whether an item is covered: http://www.dhs.state.or.us/policy/healthplan/archive/dme/ Examples Incontinence items or devices. Adaptive equipment for eating (i.e. utensils, trays, cups, bowls that are specially designed to assist an individual to feed him/herself). Adaptive beds. Positioning devices. Manual Wheelchair (for mobility when power chair won’t fit in house). 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, etc.). Assistive technology items. Computer software (used by the individual to express needs, control supports, plan and budget supports). Augmentative Communication devices. Environmental adaptations to control lights, heat, stove, etc. Sensory Stimulation equipment and supplies that help an individual calm, provide appropriate activity or safely channel an obsession (e.g. vestibular swing, weighted blanket, tactile supplies like creams and lotions). Purchases, rentals, repairs covered by OHP for durable medical equipment after OHP limit has been reached or individual is not eligible for OHP. Supplies required to implement communication or behavior programs purchased from providers who do not have Medicaid vendor status when: 1) SPD variance has been obtained; 2) program is professionally designed to meet specific objectives; and 3) program is regularly monitored and adjusted on the basis of progress toward objectives. It is not okay to use Support Services funds for: Work-related clothing available through a Vocational Rehabilitation employment plan. Generic household furnishings, personal clothing (for individual or family), and other purchases made because of financial need. Any equipment or supplies available through Oregon Health Plan or private insurance, or easily obtained through other resources. Illegal substances or materials. Materials or equipment that has 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. Equipment that is not necessary or cost-effective. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) SPECIALIZED SUPPORTS (CPMS Service Code 738) Service Description Treatment, training, consultation or other unique services necessary to achieve outcomes in the plan of care that are not available through State Medicaid Plan services or other Support Services. Typical supports include the services of a behavior consultant, a licensed nurse or a social / sexual consultant to: a. assess the needs of the individual an d family including environmental factors b. develop a plan of support c. train caregivers to implement the support plan d. monitor implementation of the plan e. revise the plan as needed Clarifications Behavior Consultants must: a. Have necessary education and skills b. Minimum of 2 days OIS training, with a current certificate and; c. Submit resume demonstrating either 1. Bachelors in Special Education, Psychology, Speech and Communication, Occupational Therapy, Recreation, Art or Music therapy and minimum of 1years experience with people with developmental disabilities who present difficult or dangerous behaviors or 2. Minimum of 3 years experience working with people with developmental disabilities who present difficult or dangerous behavior, at least one year of which experience including the services of a behavior consultant. Social /Sexual Consultants must: a. Have education and skills necessary; and b. Submit resume demonstrating either 1. Bachelors in Special Education, Psychology, Social Work, Counseling or other behavioral science and minimum of 1 year experience with people with developmental disabilities or 2. Minimum of 3 years experience working with people with developmental disabilities who present social or sexual issues and at least 1 year of that must include providing services of a social / sexual consultant. Nursing Consultants must: a. Have a current Oregon nursing license; and b. Submit resume showing education, skills, and abilities necessary to provide nursing services in accordance with State Law, and at least 1 year of experience working with people with developmental disabilities. It is not okay to use Support Services funds for: Goods and services available through either public programs (e.g. OHP, schools, or Federal assistance programs) for which an individual is eligible, or through an individual's private insurance. Experimental therapy and treatments. Mental health services Educational services for school age individuals, such as: professional instruction, formal training, and tutoring in communication, socialization, and academic skills; tuition to private schools; payment for activities and services in lieu of school. Health and medical costs that the general public normally must pay. Fees for legal advice or representation, representative payees, conservators. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Person-centered planning assistance. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. (use "Back" button to return to services menu) SPEECH AND LANGUAGE THERAPY (CPMS Service Code 739) Service Description Services of a professional licensed under ORS 681.250 that are defined under the approved State Medicaid Plan, except the amount, duration and scope specified in the State Medicaid Plan do not apply. See OMAP provider guide site or call OHP to determine whether an item is covered: http://www.dhs.state.or.us/policy/healthplan/archive/speech/ Examples/Clarifications Only covers services that Oregon Health Plan covers. Generally, these services are assessment, family/provider training to carry out specific recommendations, consultation, and direct hands-on therapy provided by an appropriately-licensed or -certified professional. Covers services once OHP limits have been reached and there must be written proof that OHP limits have been reached. Best way to find out if okay to use Support Service Dollars: 1. Review current OMAP provider guides online or call OHP and see if the service is normally covered under OHP. If it is not covered, then Support Service Dollars cannot be used. 2. If it is something OHP covers and the individual has reached limited of OHP benefit or doesn’t have OHP, then it could be covered by Support Service Dollars. (Note: You must have in writing that benefit limits have been reached.) It is not okay to use Support Services funds for: Goods and services available through either public programs (e.g. OHP, schools, or Federal assistance programs) for which an individual is eligible, or through an individual's private insurance. Experimental therapy and treatments. Experimental therapy and treatments. Educational services for school age individuals, such as: professional instruction, formal training, and tutoring in communication, socialization, and academic skills; tuition to private schools; payment for activities and services in lieu of school. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Health and medical costs that the general public normally must pay. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. (use "Back" button to return to services menu) SUPPORTED EMPLOYMENT (CPMS Service Code 740) Service Description Provision of job training and supervision available to assist an individual who needs intensive ongoing support to choose, get and keep a job in the community business setting. Planned in partnership with public vocational assistance agencies and school districts and through SS Work Incentives when available Examples and Clarifications Job exploration and coaching. Specialized work equipment or clothing not covered by the employer (under ADA). Specialized training required for the job and not covered by employer, VR, or school. Training for coworkers on how to provide individual support on the job. Consultation re self-employment. Payment for coworkers if time is over and above regular job or activities are over and above reasonable accommodation. Community assessment. Must work with school and VR and negotiate to see what/if they can cover supports. If they confirm in writing that they cannot, then Support Service funds can be used. It is not okay to use Support Services funds for: Care, training, or supervision that has not been arranged according to applicable state and federal wage and hour regulations. Payment for the supervisory activities rendered as a normal part of the business setting. Incentive payments made to an employer to encourage or subsidize the employer's participation in a supported employment program; Payments that are passed through to users (e.g. as wages) of supported employment programs. Payments for vocational training that is not directly related to an individual's supported employment program. Payments for vocational training that is not directly related to an individual's supported employment program. Services that are not necessary or cost-effective. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Person-centered planning assistance. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) TRANSPORTATION (CPMS Service Code 731) Service Description Services that allow individuals to gain access to community services, activities, and resources that are not medical in nature. Examples and Clarifications It is not okay to use Support Services funds for: Purchase of individual or family vehicles. Routine vehicle maintenance and repair. Ambulance services Payment to a spouse of an adult recipient of these services or to a parent of a minor child who receives these services. Services that are not necessary, cost-effective, or of direct benefit to the individual with disabilities, including but not limited to payments to providers when service has not been provided, e.g. vacancies, “no-shows”. Costs for transporting someone other than the individual with disabilities. Payment to someone who cannot meet provider qualifications according to the Support Services Rule. Third-party payments, e.g. reimbursing individual or family members for payments made to providers. Payment for health and dental insurance, workers compensation insurance, paid leave, and fiscal intermediary fees for independent providers employed by individuals or families. (use "Back" button to return to services menu) Typical health and medical costs that are not purchased with Support Services funds: Home, office, or hospital physician’s services, including examination and treatment by a medical doctor, physician’s assistant, nurse practitioner, osteopathic physician Hospital facility charges Health insurance premiums and co-pays Pre-natal, maternity, and well baby care Allergy testing and injections Diagnostic lab and X-ray services, including pap smear, mammography, X-ray, ultrasound, imaging, electrocardiograms, pathology examinations Casts Dialysis Genetic testing In-patient or outpatient surgery Anesthesia for medical or dental procedures Emergency care Medications, including prescription and non-prescription medications, hormones, vitamins Pharmacy dispensing fees Alternative care, e.g. acupuncture, acupressure, hypnotherapy, chiropractic, naturopathic. Cosmetic services Designated blood donations Organ transplants Clinical programs for weight control Services and supplies used in the treatment of sex reassignment Drugs to treat sexual dysfunction Immunizations Chemical dependency, including Methadone maintenance Vision examinations and care, including radial keratotomy, photorefractive keratatectomy, orthoptics Dental services, e.g. examinations, cleaning, X-ray, fillings, root canals, oral surgery, crowns, bridges, partials, upper or lower dentures, and orthodontia. Psychiatric drug treatment or psychotherapy for diagnosed mental illness, medication review Service Description Emergent services are services for individual who live at home and are in jeopardy of losing their living situation due to inability or unavailability of the primary caregiver when no alternative resources are available. Services are provided up to 120 days, and are provided to or on behalf of, an individual to prevent civil commitment to an institution for the mentally retarded as described in ORS Chapter 427, or to prevent a permanent out-of-home placement. Services to maintain the individual in the community and stabilize the situation may include short-term residential placement as well as additional support in the individual's home. Example Respite care in or out-of-home as well as an array of community living supports. Emergent services are not paid for with support services funds, but rather through local and regional SPD crisis services. While Support Service Brokerage Personal Agents must collaborate with crisis service staff on plans and services, the crisis program should report made with crisis funds. (use "Back" button to return to services menu) |
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