Chapter 751
AN ACT
HB 2406
Relating to home care for medically involved
children; creating new provisions; amending ORS 414.737, 417.340 and 417.342;
and declaring an emergency.
Be It Enacted by the People of
the State of
SECTION 1. ORS 417.340 is amended to read:
417.340. As used in ORS
417.340 to 417.348 and 417.349:
(1) “Child’s home”
means the home in which a child resides with the child’s biological or adoptive
parents or legal guardian. It does not include foster care, proctor care,
group home placement or other institutional placement.
[(1)] (2) “Family” means the unit that consists of:
(a) A member with a
disability or chronic illness; and
(b) One or more related
persons who reside in the same household.
[(2)] (3) “Family member with a disability or chronic illness”
means a person who has a disability or chronic illness that:
(a)
Is likely to continue indefinitely;
(b) Results in
substantial functional limitations in one or more of the following areas of
major life activity:
(A) Self-care;
(B) Receptive and
expressive language;
(C) Learning;
(D) Mobility;
(E) Self-direction;
(F) Capacity for
independent living; or
(G) Economic
self-sufficiency; and
(c) Reflects the person’s
need for special, interdisciplinary or generic care, treatment or other
services that are of lifelong duration and must be individually planned and
coordinated.
(4) “Medically
involved” means having a physical or developmental disability that requires
assistance with most activities of daily living and requires health and
personal care throughout the day and night.
SECTION 2. ORS 417.342 is amended to read:
417.342. (1) Family
support services are based on the belief that all people, regardless of
disability, chronic illness or special need, have the right to a permanent and
stable familial relationship in the community. Children have a developmental
need to grow up in a family home environment. However, nothing in ORS
417.340 to 417.348 or 417.349 is intended [to
keep a family member with a disability or chronic illness in the family home or]
to require any person with a disability or chronic illness to live in the
family home.
(2) Family support
services can provide the support necessary to enable the family to meet the
needs of caring for a family member with a disability or chronic illness at
home and, subject to available funds, shall be based on the following
principles:
(a) Family support
services may use private and volunteer resources, publicly funded services and
other flexible dollars to provide a family with the services needed to care for
the family member with a disability or chronic illness.
(b) Family support
services must be sensitive to the unique needs, strengths and multicultural
values of an individual and the family rather than fitting the individual and
family into existing services.
(c) Family support
services must be built on a relationship of respect and trust that recognizes
that families are better able to determine their own needs than have their
needs determined by the state or a public agency.
(d) Family support
services shall be provided in a manner that develops comprehensive, responsive
and flexible support to families in their role as primary caregivers for family
members with disabilities or chronic illnesses.
(e) Family support
services shall focus on the entire family and be responsive to the needs of the
individual and the family.
(f) Family support
services may be needed throughout the lifespan of the individual family member
living at home who has a disability or chronic illness.
(g) Family support
services shall be available to families before they are in crisis.
(h) Family support
services may be a service option offered to families, but not imposed on them.
(i) Family support
services shall encourage maximum use of existing social networks and natural
sources of support and should encourage community integration.
(j) Family support
services shall not be confined to a single program or set of services but shall
be a philosophy that permeates all programs and services.
SECTION 3. Sections 4 to 6 of this 2007 Act are added
to and made a part of ORS 417.340 to 417.348.
SECTION 4. The Medically Involved Home-Care Program is
created in the Department of Human Services. The department shall provide all
State Plan Medicaid and waivered services available under state and federal law
that are necessary to enable a medically involved child to be cared for in the
child’s home. The waivered services that must be available include but are not
limited to home nursing care, durable medical equipment and respite care.
SECTION 5. (1) The Department of Human Services shall
adopt by rule criteria for determining the need for and extent of assistance to
be provided to a medically involved child enrolled in the Medically Involved
Home-Care Program created by section 4 of this 2007 Act. The criteria shall
include, but are not limited to, consideration of:
(a) The medical needs of
the child;
(b) The needs of any
other family member with a disability or chronic illness in the child’s home;
(c) Family and community
support available to the child and family caregivers; and
(d) The assistance
necessary for the family to care for the child in the child’s home,
disregarding parental or legal guardian income.
(2) Subject to limits on
enrollment required by state or federal law, services offered through the
Medically Involved Home-Care Program shall be made available to children meeting the criteria established by the department by rule.
Priority for enrollment shall be given to:
(a) A child transferring
to the child’s home from nursing home placement, foster care placement or other
out-of-home placement;
(b) A child living at
home who is at risk of nursing home placement, foster care placement or other
out-of-home placement;
(c) A child who does not
otherwise qualify for medical assistance under ORS chapter 414 and for whom the
department pays family support payments pursuant to ORS 430.215 that exceed
$10,000 per year; and
(d) A child who is at
risk of losing eligibility for medical assistance under ORS chapter 414 due to
a caregiver’s employment or an increase in a caregiver’s earnings.
(3) As used in sections
4 to 6 of this 2007 Act, “child” means a person under
18 years of age.
SECTION 6. (1) The Department of Human Services shall
enroll no fewer than 125 medically involved children in the Medically Involved
Home-Care Program beginning January 1, 2008. The department shall enroll an
additional 25 medically involved children each calendar year thereafter, to the
maximum number allowed by federal law or under the terms of the federal
approval.
(2) Moneys appropriated
to the department for the Medically Involved Home-Care Program may not be used
to supplant moneys appropriated to the department for the Children’s Intensive
In-Home Services program.
SECTION 7. Within 30 days after the effective date of
this 2007 Act, the Director of Human Services shall seek any form of federal
approval from the Centers for Medicare and Medicaid Services that is necessary
to implement the Medically Involved Home-Care Program. The director shall
notify Legislative Counsel upon receipt or denial of necessary federal
approval.
SECTION 8. ORS 414.737 is amended to read:
414.737. (1) Except as
provided in subsections (2) and (3) of this section, a person who is eligible
for or receiving physical health, dental, mental health or chemical dependency
services under ORS 414.705 to 414.750 must be enrolled in the prepaid managed
care health services organizations to receive the health services for which the
person is eligible.
(2) Subsection (1) of
this section does not apply to:
(a) A person who is a
noncitizen and who is eligible only for labor and delivery services and
emergency treatment services;
(b) A person who is an
American Indian and Alaskan Native beneficiary; and
(c) A person whom the
department may by rule exempt from the mandatory enrollment requirement of
subsection (1) of this section, including but not limited to:
(A) A person who is also
eligible for Medicare;
(B) A woman in her third
trimester of pregnancy at the time of enrollment;
(C) A person under 19
years of age who has been placed in adoptive or foster care out of state;
(D) A person under 18
years of age who is medically fragile and who has special health care needs;
(E) A person
receiving services under the Medically Involved Home-Care Program created by
section 4 of this 2007 Act; and
[(E)] (F) A person with major
medical coverage.
(3) Subsection (1) of
this section does not apply to a person who resides in a designated area in
which a prepaid managed care health services organization providing physical
health, dental, mental health or chemical dependency services is not able to
assign an enrollee to a person or entity that is primarily responsible for coordinating
the physical health, dental, mental health or chemical dependency services
provided to the enrollee.
(4) As used in this
section, “American Indian and Alaskan Native beneficiary” means:
(a) A member of a
federally recognized Indian tribe, band or group;
(b) An Eskimo or Aleut
or other Alaskan Native enrolled by the United States Secretary of the Interior
pursuant to the Alaska Native Claims Settlement Act, 43 U.S.C. 1601; or
(c) A person who is
considered by the United States Secretary of the Interior to be an Indian for
any purpose.
SECTION 9. Sections 3 to 6 of this 2007 Act and the
amendments to ORS 414.737, 417.340 and 417.342 by sections 1, 2 and 8 of this
2007 Act become operative upon receipt of the necessary federal approval described
in section 7 of this 2007 Act.
SECTION 10. This 2007 Act being necessary for the
immediate preservation of the public peace, health and safety, an emergency is
declared to exist, and this 2007 Act takes effect on its passage.
Approved by the Governor July 12, 2007
Filed in the office of Secretary of State July 16, 2007
Effective date July 12, 2007
__________