461-160-0610 Effective 10/01/13
Client Liability OSIPM (except OSIPM-EPD)
- A client in the OSIPM (except OSIPM-EPD) program who receives long-term care (see OAR 461-001-0000) services must, in order to remain eligible, make the payment required by this rule, except as provided in sections (2) to (6) of this rule. The client must apply his or her adjusted income to the cost of the care or service. This amount is the client liability. If the client's adjusted income exceeds the cost of care or service, the client must pay the full cost of care but has no additional liability.
- A client who receives SSI, or is deemed to receive SSI under section 1619(b) of the Social Security Act (42 U.S.C. § 1382h(b)), is eligible for OSIPM program benefits without having to make a payment.
- The IC service payment of a client in the OSIPM-IC program is reduced by the amount of his or her liability.
- The following clients, if they receive the services described in section (5) of this rule, are exempt from payments required by this rule:
- A disabled adult child under OAR 461-135-0830.
- A widow or widower under OAR 461-135-0820.
- A Pickle amendment client under OAR 461-135-0780.
- A client identified in section (4) of this rule is exempt from payments required by this rule if the client receives --
- Home and community-based care (see OAR 461-001-0030); or
- Mental health services and lives in a mental health residential treatment facility. For purposes of this rule, only the following types of treatment centers qualify as a mental health residential treatment facility:
- A mental health adult foster home.
- A mental health residential treatment home.
- A mental health residential treatment facility.
- A mental health secure residential treatment facility.
- In the initial month of placement, a client may be exempt from payments required under this rule if the Department determines that the client's income has been exhausted prior to placement. If any income remains, the client must contribute to the cost of care or service.
- A client residing in an acute care hospital is exempt from payments required by this rule while residing in the acute care hospital. If a service benefit was received prior to admission to the acute care hospital, payment must be made for that service.
Stat. Auth.: ORS 411.060, 411.070, 411.404, 411.706
Stats. Implemented: ORS 411.060, 411.070, 411.404, 411.706