461-001-0030 Effective 04/01/18
Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care
These terms apply to rules in Chapter 461 about OSIP and OSIPM long-term care and home and community-based care clients:
- Community spouse: An individual who is legally married (see OAR 461-001-0000) to an institutionalized spouse and is not in a medical institution or nursing facility.
- Continuous period of care: Reside for a period of at least 30 consecutive days or until death in a long-term care facility, home and community-based care setting, or an acute care hospital. There must be sufficient evidence to show there is a reasonable expectation that the client will remain in care for at least 30 consecutive days. For the purposes of this policy, an interruption in care (for example, leaving and then returning to a nursing home, or switching from one type of care to another) that lasts less than 30 days is not considered a break in the 30 consecutive days of care. A new period of care begins if care is interrupted for 30 or more days.
- Eligible dependent:
- For cases with a community spouse:
- An "eligible dependent" is one of the following:
- A child of the institutionalized spouse or community spouse who resides with the community spouse, and who must also be either a minor (under the age of 21) or 21 or older but still a tax dependent of either spouse.
- A parent or sibling of the institutionalized spouse or community spouse who resides with the community spouse and is claimed as a tax dependent by either spouse.
- A grandchild of the institutionalized spouse or community spouse is not considered an "eligible dependent".
- For cases without a community spouse, an "eligible dependent" resides with the institutionalized spouse and is either a minor child (under the age of 21) of the institutionalized spouse, or a child 21 or older but still a tax dependent of the institutionalized spouse.
- Home and community-based care: Title XIX services needed to keep an individual out of a long-term care facility. These services are:
- In-home services except for state plan personal care services.
- Residential care facility services.
- Assisted living facility services.
- Adult foster care services.
- Home adaptations to accommodate a client's physical condition.
- Home-delivered meals provided in conjunction with in-home services.
- Specialized living facility services.
- Adult day care services.
- Community transition services.
- Home and community-based care client: A client receiving home and community-based care for a continuous period.
- Institutionalized spouse: An individual who is in long-term care or receiving home and community-based care for a continuous period and is married to a community spouse.
Statutory/Other Authority: ORS 409.050, 411.060, 411.083, 411.404, 413.085, 414.685
Statutes/Other Implemented: ORS 409.010, 411.060, 411.083, 411.404, 42 USC 1396r, 42 CFR 435.726
Effective 01/01/07 this rule has been renumbered from 461-160-0560.