461-155-0630    Effective 01/01/23
Special Need; Community-Based Care; OSIPM

In the OSIPM program:

  1. An individual is considered living in a community-based care (see OAR 461-001-0000) facility if the individual resides at one of the following care settings licensed by the Department:

    1. Adult Foster Home.

    2. Residential Care Facility.

    3. Assisted Living Facility.

    4. Specialized Living Facility.

    5. Group Care Home.

  2. If an individual who meets the applicable income requirements begins living in a community-based care facility:

    1. Payment for room and board may be authorized during the month of admission at the initial placement, limited to the approved rate.

    2. Room and board payments may be paid to the community-based care facility during the temporary absence of the individual if all of the following criteria are met:

      1. The absence occurs because the individual is admitted to a hospital or nursing home.

      2. The Department determines the intent of the individual to return to the community-based care facility.

      3. The community-based care facility is willing to accept the room and board payment.

      4. The individual returns within the calendar month following the month in which the absence began.

  3. Spouses who each receive Supplemental Security Income (SSI) and receive services in a community-based care facility are eligible for a payment in the amount that equals the difference between the OSIPM standard for a one-person need group (see OAR 461-110-0630) and the individual's total countable (see OAR 461-001-0000) income. If one spouse (see OAR 461-001-0000) has income above the OSIPM standard, the excess income is applied to the countable income of the other spouse.

  4. The Department may authorize payment for room and board for up to three months for an incapacitated individual when the individual is determined eligible for community-based care, the individual has no legal or financial representative, and payment for room and board is necessary to secure placement. The payments are allowed while a legal or financial representative is being established and may be extended past the three month period if the Department determines additional time is needed to establish a legal or financial representative.

Statutory/Other Authority: ORS 409.050, 411.060, 411.404, 413.085, 414.685
Statutes/Other Implemented: ORS 409.010, 411.060, 411.404, 413.085, 414.685

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