Oregon ACCESS 8/31/15 Changes Presented by: APD LTC Policy Unit on 9/2/15

Oregon ACCESS changes This training covers the changes that have occurred in Oregon Access on 8/31/15. Related PT’s and IM’s: APD-IM-15-064 (OA changes) APD-IM-15-067 (Mainframe changes) APD-PT-15-023 (Hourly Cap Policy) APD-PT-15-025 (Live-in/Shift Services Policy) APD-PT-05-028 (Exceptions Policy)

When Do the Changes Go Into Effect? The Hourly Cap is applied to all assessments, regardless of when the assessment was created. Any service plan segment with a start date of 8/31/15 or later will be impacted. The Live-in/Shift Services criteria is applied to any assessment that is created on or after 8/31/15. Assessments and service plans prior to 8/31/15 do not have to meet the new criteria. Existing live-in and shift services plans may continue until the new assessment occurs. A new assessment is needed: At the annual review or at the request of the individual. If the individual has not received live-in/shift services within the last 30 days (days in the hospital or receiving skilled care are not counted).

Live-in Services Folder Two statements added. Sleep question is no longer asked, however for potential live-in plans, it is important to document how much care is needed during the typical sleeping hours.

Justification for Live-in or Shift Services Comments should be added to support the need for live-in or shift services.

Live-in/Shift Services Eligible Final eligibility is determined by Central Office.

Live-in/Shift Care Not Eligible This indicates that the person is not eligible. This scenario occurs when someone indicates a need in the Live-in Services folder, but does not have the corresponding Full Assist. Live-in/Shift Services eligibility are viewed in the Full Benefit Results Screen.

Full Benefit Results Screen The number is a variable. Formula is 496-ADL total-IADL total. Please note the hours being assigned in Live-in Services. This number is calculated by using the number 496, then subtracting the total number of ADL and IADL hours. Please note that the Spousal Pay button has been re-labeled to “SPL Summary”. Also, final approval for Live-in or Shift Services are approved by CO.

Updated 514 Exceptions Form Until this is added to the form server, please use the link on APD CM Tools under “Recent Updates”.

Initial Completion of Hours Authorization Segment The hours will first appear in the Min, Sub, and Full categories.

Exiting and Re-entering Hours Authorization Segment When exiting and returning, the ADL hours will all populate under ADL Full.

Exception Request for Live-in This example is someone that was determined not to be eligible for Live-in/Shift Services in the CA/PS. However, if the person meets the exception criteria, or if you determine that the individual really should have live-in services, the hours must be entered into the Exception column. Note that this line will always show up on the Hours Authorization screen (which is not the case for the other ADL and IADL’s). Please note that when an a live-in services exception has been approved, the live-in services will not show up on the needs association or on the task list.

Hours Authorization for the HCW Hours are authorized under the ADL Full, IADL, and Live-in Services.

Copy and Creating a Plan Prior to 8/31/15 The hours must be “cleared” when you copy and create an existing plan that was created prior to 8/31/15.

Spousal Pay Plan Change Once a new Spousal Pay assessment occurs, staff must select the Hourly Spousal Pay service. The IADL hours will cut in half like before. The rate of pay will be the same as an hourly.

Live-in Service Approval Live-in Services must be approved by Central Office, even if there are no exception hours assigned. The plan segment must also have a live-in HCW.

Scenario: Hours Segment approved Live-in Services for 439 hours. Plan #1: Tier 3 Approval (due to Live-in HCW not being assigned all hours and is below 496). Plan #1: Tier 1 or 2 Approval (Live-in HCW has been assigned all 439 hours). Please develop the service plan (assignment of hours) as much as possible before sending to CO. That way, if necessary, we can approve the plan segment at the same time as the hours segment. Within the same assessment, if a new hours segment is created, Tier 2 can approve it if it is the same number of hours as the last one. However, if it changes, it must be re-approved by CO. New assessments must also be re-approved by CO.

50 Hour Cap (220 a Month) Approval If a new hours segment is created within the same or in a different assessment, Tier 3 must re-approve. Central Office must also approve a HCW in the plan level if it is above 220 hours.

Scenario: Plan #1 approved HCW Aaron for 250 hours and HCW David for 30 hours. Plan #2: Tier 3 Approval (due to increased hours for Aaron) Plan #2: Tier 2 Approval (Aaron still is above 220, but now is only assigned 240.

Scenario: Plan #1 approved HCW Aaron for 250 hours and HCW David for 30 hours. Plan #2: Tier 3 Approval (due to change in HCW, even though hours are the same). Plan #2: Tier 1 Approval (Both HCW hours are below 221).

ADL Roll-Up on the 546N For an Hourly HCW, the staff person entering in the voucher will combine the ADL and Self Management total into one line. For a live-in HCW, the Self Management and Live-in Services hours are separated out still.

ADL Service Levels Combined with IADL HATH screen prior to implementation HATH screen after implementation This change occurs for all vouchers 9/1/15 and later.

Contact Information Policy Questions: DOL.Questions@dhaoha.state.or.us OA Functionality and Training: OregonAccess.release@state.or.us OA Service Desk: ServiceDesk@state.or.us or 503-945-5623. Contacts: Chris Ellis - christopher.m.ellis@dhsoha.state.or.us Mat Rapoza - mathew.g.rapoza@dhsoha.state.or.us Christine Maciel - christine.c.maciel@dhsoha.state.or.us Kelsey Weigel - kelsey.c.weigel@dhsoha.state.or.us Suzy Quinlan - suzy.quinlan@dhsoha.state.or.us Darwin Frankenhoff - darwin.j.frankenhoff@dhsoha.state.or.us