1. (1) “Abuse” means abuse as defined in ORS 430.735 and ORS 419B.005.
2. (2) “Activities of Daily Living (ADLs)” means those personal, functional activities as defined in OAR 410-173-0005.
3. (3) “Administrator” means the person designated by the licensee through an employment agreement to be responsible for the daily operations and maintenance of the Agency with Choice.
4. (4) “Agency with Choice (AWC)” means an organization licensed by the Oregon Health Authority that provides self-directed Agency with Choice Services for compensation to individuals primarily at the individual’s home and their community.
5. (5) “Agency with Choice Services” means services provided to individuals by an Agency with Choice operating within a self-directed service delivery model and include the services specified in these rules.  Agency with Choice services do not include nursing procedures or tasks that require nursing delegation or teaching as defined in OAR Chapter 851, Division 047.
6. (6) “Applicant” means the person, entity, or governmental organization who applies for an Agency with Choice license.
7. (7) “Authority” means the Oregon Health Authority.

8. (8) “Authorized Representative” may include one of the following for the purpose of these rules:

   1. (a) “Legal Representative” means a person who has been legally designated by court order to make financial or health care decisions on behalf of another individual.  The legal representative only has authority to act within the scope and limits of their authority as designated by the court or other agreement.  For the purpose of these rules, authorized presentative and legal representative are synonymous.
   2. (b) A person designated by an individual or the individual’s legal representative to act on behalf of the individual in making decisions on matters pertaining to the planning and implementation of an in-home person-centered service plan; and
   3. (c) In no instance may can an authorized representative be a Direct Support Worker of home and community-based services (HCBS) nor an employee of the Agency with Choice for an individual for whom they provide services.  The Authority shall verify the authorized representative is not providing paid services as contained in this section.
9. (9) “Background Check” means a criminal records check and abuse check as defined in OAR 407-007-0010, ORS 409.025 and 409.027, as adopted and incorporated by OAR 943-007, that includes a final fitness determination that the subject individual is fit to hold a position and have direct access to or otherwise provide care and services necessary for the health, welfare, maintenance, or protection of an individual.
10. (10) “Back-up Plan” means a plan developed by the individual or the individual’s authorized representative in coordination with the Agency with Choice to ensure uninterrupted services and supports in the event of planned or unplanned absences of the direct support worker or in case of an emergency.  The back-up plan should include the name and contact information and the specific ways in which the back-up direct support worker will support the individual.
11. (11) “Behavioral Health” means mental health, mental illness, addiction disorders, and substance use disorders.
12. (12) “Behavioral Health Division (Division)” means the section within the Oregon Health Authority responsible for program and policy development and oversight of behavioral health facilities and services.
13. (13) “Care Coordinator" means an Authority employee or an employee of the Authority’s designee that meets the minimum qualifications in OAR 309-019-0125 who is responsible for offering service choices to eligible Individuals and evaluation of the effectiveness of Medicaid home and community-based services.
14. (14) “Change of Condition” means an individual’s care needs, health or functioning have changed to the point that additional or different supports may be necessary.
15. (15) "Change of Ownership " means adding or removing one or more owners which constitutes a change of more than five percent interest in Agency with Choice ownership.
16. (16) “Community Mental Health Program (CMHP)” means an entity that is responsible for planning and delivery of safety net services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse in a specific geographic area of the state under a contract with the Division or Local Mental Health Authority pursuant to OAR chapter 309 division 014.
17. (17) “Complaint” means dissatisfaction relating to an Agency with Choice expressed by the individual or their authorized representative.
18. (18) “Cultural Competence” means the ability to interact effectively with people from different cultures, languages, races and other backgrounds.
19. (19) “Direct Support Worker (DSW)” means a person employed by an Agency with Choice, to assist individuals with activities of daily living, instrumental activities of daily living and health related tasks identified in the individual’s person-centered service plan and further denoted in the DSW’s job description as required by these rules.  Direct support worker does not mean a homecare worker or personal support worker as defined in ORS 410.600, or personal care attendant as defined in OAR 410-172-0776.
20. (20) “Division” means the Behavioral Health Division of the Oregon Health Authority (OHA).

21. (21) “Drug-Free Workplace” means the Agency with Choice ensures direct support workers:

    1. (a) Are prohibited from using or being under the influence of alcohol, inhalants,  or drugs, including prescription and over-the-counter medications that prevents duties from being performed; and
       (b) Are prohibited from manufacturing, possessing, selling, using or offering to sell, trade, or use illegal drugs while providing services to an individual or while in the individual’s home.
22. (22) “Electronic Visit Verification (EVV)” means a system under which visits conducted as part of the person-centered service plan are electronically verified at the time of service and meets the requirements specified in United State Code 42 USC §1396b(l).
    (23) “Formal Complaint” means a formal filing with the Authority that alleges the Agency with Choice Agency has not adhered to a material aspect of the Agency with Choice statue or administrative rules.
23. (24) “Grievance” means a formal, written dissatisfaction submitted by an individual or authorized representative regarding the failure of an Agency with Choice to follow required rules, policies, or services.
24. (25) “Independent Qualified Agent (IQA)” means an entity meeting the qualification requirements identified in 42 CFR §441.730 and under contract with the Authority responsible for service eligibility, assessment of need, person-centered service planning, and service authorization.
25. (26) “Individual” means a person receiving Agency with Choice services and supports who is approved for home and community-based services by the Authority as defined in OAR 410-173-0005.
26. (27) “Instrumental Activities of Daily Living (IADLs)” means those activities defined in OAR 410-173-0005
27. (28) "Investigative Authority" means the Office of Training, Investigations, and Safety (OTIS), or local Community Mental Health Programs that contracts with the Authority to receive and investigate alleged abuse and assess protective services under OAR Chapter 943, Division 45.
28. (29) “Licensee” means the person or entity who has been issue an Agency with Choice license.
29. (30) “Management experience”, means verifiable experience in the administration, supervision, or management in health-related or long-term services, and supports fields including at a minimum, hiring, assigning, evaluating, promoting and responsibility for implementing disciplinary actions.

30. (31) “Mandatory Reporter” means any public or private official who is required by Oregon Revised Statute (ORS) to report suspected abuse to the Authority or law enforcement agency as it applies to a:

    1. (a) "Child" defined in ORS 419B.005;
    2. (b) "Child in care" as defined in ORS 418.257; or
    3. (c) "Adult" with developmental disabilities or mental illness as defined in ORS 430.735.
    4. (d) “Elderly Person” or a “Person with a Disability” as defined in ORS 124.005.
31. (32) “Person-Centered Service Plan (PCSP)” means the written document prepared by the IQA service coordinator that details the supports, desired outcomes, activities, and resources required for an individual to achieve and maintain personal goals, health, and safety as described in OAR 410-173-0025. The PCSP must be completed and signed prior to the individual receiving HCBS. The PCSP is not satisfied by a document primarily prepared by a provider.
32. (33) "Professional Experience" means having verifiable work experience as a licensed or certified nurse, nursing assistant, medication aide, physician, or physical or occupational therapist or having received the professional development certificate from the Oregon Home Care Commission or other verifiable work experience from other states. The license or certificate must be current and in good standing.
33. (34) "Provider Enrollment Agreement" refers to the agreement between the Medicaid Division of the Oregon Health Authority and a qualified Medicaid provider to receive a provider number and deliver services for compensation.

34. (35) "Qualified Trainer" means a person who:

    1. (a) Has professional experience providing training to direct support workers, homecare workers, certified nursing assistants or other relevant caregivers with the necessary skills, knowledge and information to deliver competent, quality care, and is approved by the Authority;
    2. (b) Is designated by an Agency with Choice to conduct direct support worker training on behalf of the Agency with Choice, including, but not limited to, orientation, mandatory training and continuing education training required by these rules.
35. (36) “Self-directed Service Delivery Model” for the purpose of these rules means a model in which an individual is supported by an Agency with Choice that functions as the employer of direct support workers recruited by the individual or the Agency with Choice and provides financial management services and tasks in place of the individual. The individual chooses, trains and directs the tasks and work priorities of the direct support workers who will provide needed services and is considered a co-employer with the Agency with Choice.
36. (37) “Services and Supports” means those services defined as habilitation services and psychosocial rehabilitation services under OAR Chapter 410, Division 173 or personal care services under OAR 410-172-0776 as described in the individual’s person-centered service plan.
37. (38) "Subject Individual (SI)” means an individual person for whom an Agency with Choice must conduct a background check and the Background Check Unit (BCU) may conduct a criminal records and abuse check, and from whom BCU may require fingerprints for the purpose of conducting a national criminal records check. An SI includes all staff and volunteers working for or with an Agency with Choice.

Statutory/Other Authority

ORS 413.042 & Oregon Law 2024, Chapter 37

Statutes/Other Implemented

ORS 430.731 & Oregon Law 2024, Chapter 37

History

BHS 4-2026, adopt filed 04/30/2026, effective 04/30/2026