1. (1) HCBS In-Home Personal Care (IHPC) are direct services that are authorized using a person-centered planning process that allow an eligible individual the opportunity to direct their services and supports. The direct services assist an individual to accomplish ADL/IADL tasks, as defined in OAR 410-173-0005, in home settings and the broader community to the same degree as individuals who do not require services and supports to remain in their home and community. IHPC do not include services that assist an individual with the acquisition, retention, and improvement of the skills needed to accomplish ADL/IADL tasks.

2. (2) Individuals exercise Employer Authority in HCBS IHPC services by:

   1. (a) Identifying their own candidate for employment;
   2. (b) Screening otherwise qualified candidates for the ability to meet the individual’s needs; and
   3. (c) Hiring, supervising, directing, and discharging employees enrolled as Personal Care Attendants as per these rules and OAR 410-172-0800.
3. (3) The Authority may terminate a IHPC provider per these rules and OAR 410-172-0820.  Grounds for termination include, but are not limited to, violations of provider standards, failure to meet performance expectations, and breaches of contractual obligations.

4. (4) ADLs include eating, bathing, dressing, toileting, maintaining continence, mobility and transferring:

   1. (a) Eating includes assisting the individual in feeding or fluid intake by any means from a receptacle into the body, including monitoring to prevent choking or aspiration;
   2. (b) Bathing includes assisting the individual with cleansing the body, washing hair, and using assistive devices when necessary to get in and out of the bathtub or shower;
   3. (c) Dressing includes assisting the individual with putting on, fastening, and taking off all items of clothing, braces, and artificial limbs, including obtaining and replacing items from their storage area in the immediate environment;
   4. (d) Toileting includes assisting the individual in getting to and from, on and off, the toilet, commode, or bedpan for elimination of feces and urine. This includes cleansing after elimination and adjusting clothing as necessary or requested;
   5. (e) Maintaining Continence includes reminders to use the toilet or commode, developing a continence schedule, assisting the individual with external cleansing of Foley catheter, emptying urinals, emptying bedside commode, emptying catheter drainage bag, maintenance bowel care, changing and replacing incontinence products, including colostomy or ileostomy bags;
   6. (f) Transferring includes assisting the individual with mobility, transfers, and repositioning by any means, including use of an assistive device and turning or adjusting padding for physical comfort or pressure relief and encouraging or assisting with range of motion exercises.

5. (5) IADLs capture more complex life activities and include personal hygiene, light housework, laundry, meal preparation, shopping, using electronic communication devices, medication management and money management:

   1. (a) Personal hygiene includes performing or assisting the individual with activities required to keep one’s desired appearance, secure or fasten clothing, comb/brush hair, nail care, foot care, skin care, menstrual care, mouth care and oral hygiene, etc;
   2. (b) Light housework includes performing or assisting the individual with housekeeping tasks necessary to maintain the individual in a healthy and safe living environment;
   3. (c) Laundry includes performing or assisting the individual with laundering or cleaning of clothing, bedding, and other linens;
   4. (d) Meal preparation includes performing or assisting the individual with healthy meal planning and preparation, ensuring special diets are followed;
   5. (e) Shopping includes performing or assisting the individual in planning for and purchasing of essential items including clothing, groceries, prescribed medication, hygiene products and basic household necessities;
   6. (f) Using the telephone or other electronic communication devices includes performing or assisting the individual in arranging necessary appointments and making desired phone calls using a telephone, smart phone, tablet or other similar electronic device for communication purposes, including entering the phone number and connecting to secure telecommunication platforms;

   7. (g) Medication assistance includes helping the individual with oral medications prescribed for the individual by a licensed medical professional, which are ordinarily self-administered described below:

      1. (A) Administering medication;
      2. (B) Supervision or cueing to ensure the individual is taking medication as prescribed;
      3. (C) Documenting and monitoring any notable side effects;
      4. (D) Refilling prescriptions; and

      5. (E) Assisting with use, maintenance, and cleaning of in-home medical equipment authorized by a licensed medical professional, including:

         1. (i) Monitoring the individual’s condition;
         2. (ii) Ordering and maintaining necessary supplies;
         3. (iii) Use, maintenance, and cleaning of in-home medical equipment must be performed by PCA in compliance with manufacturers guidelines; and
         4. (iv) PCA must have received prior training and education from an RN, when applicable, in how to correctly perform these tasks;
   8. (h) Money Management includes performing or assisting the individual with budgeting, making payments for monthly expenses and use of personal funds for desired items and activities.
6. (6) Personal care services may be required due to cognitive impairments that prevent an individual from knowing when or how to carry out ADL/IADL tasks. In such cases, personal assistance may include cueing along with supervision to ensure the individual performs the task properly.

7. (7) Services outside the ADL/IADL in section (5) above are not eligible for payment. Payment may not be made by the Authority to a PCA or an IHCA for any of the following excluded services:

   1. (a) Shopping for entertainment purposes or non-essential items;
   2. (b) Social companionship;
   3. (c) Day care, partial hospitalization, respite or baby-sitting services; or
   4. (d) Yard work, gardening, or home repair.
8. (8) Limited assistance with a consumer’s in-home animals is permitted only when directly related to an assessed ADL or IADL need and documented in the task list or service agreement.
9. (9) Personal care services can be provided on a continuing basis or on episodic occasions.
10. (10) Delegated nursing tasks by a Registered Nurse (RN) under Oregon’s Nurse Practice Act may be considered personal care services when the RN provides appropriate training and delegation of the listed nursing tasks in accordance with the Oregon Nurse Practice Act (OAR Chapter 851 Division 047).

11. (11) IHPC services shall be provided in the following settings, as identified within the PCSP:

    1. (a) Community
    2. (b) Individual’s own home, defined as a private residence where the individual resides independently, with a roommate, or in a shared housing arrangement;
    3. (c) Individual’s family home, defined as a private residence where the individual resides with family members;
12. (12) IHPC services must be captured using an Electronic Visit Verification (EVV) system to meet the 21st Century Cures Act.

13. (13) IHPC shall be provided by the following provider types:

    1. (a) Personal care attendant as described in OAR 410-172-0776 through 410-172-0840; or

    2. (b) In-home care agency who:

       1. (A) Meet licensing standards as described in OAR Chapter 333, Division 536; and
       2. (B) Are classified as comprehensive as described in OAR 333-536-0007(1)(d).

14. (14) Levels of assistance for determining IHPC service plan hours:

    1. (a) "Minimal Assistance" means an individual can perform the majority of an activity but requires some assistance from another person. Even with assistive devices, the individual requires assistance of another person for a task at least one day each week totaling four (4) days per month. This means hands-on assistance, cueing, or stand-by presence during the activity;
    2. (b) "Substantial Assistance" means an individual can perform only a small portion of the tasks that comprise an activity without assistance from another person. The individual requires assistance with a task at least daily;
    3. (c) "Full Assistance" means an individual needs assistance from another person through all tasks of an activity every time the activity is attempted. Even with assistive devices, the individual is unable to accomplish any tasks without the assistance of another person. This means the individual needs hands-on assistance of another person through all tasks of the activity, every time the activity is attempted.

15. (15) Maximum service period hours for ADL services:

    1. (a) The planning process uses the following maximum hours limitations for each service period for ADL tasks. Maximum hours in each assistance level are not guaranteed. Hours authorized must be based on the service needs of an individual as determined by the IQA during the person-centered service planning process;

    2. (b) For in-home benefit plans the following maximums apply:

       1. (A) Eating:

          1. (i) Minimal assistance, three (3) hours;
          2. (ii) Substantial assistance, nine (9) hours;
          3. (iii) Full assistance, fourteen (14) hours;

       2. (B) Dressing (including grooming):

          1. (i) Minimal assistance, two (2) hours;
          2. (ii) Substantial assistance, seven (7) hours;
          3. (iii) Full assistance, nine (9) hours;

       3. (C) Bathing:

          1. (i) Minimal assistance, five (5) hours;
          2. (ii) Substantial assistance, seven (7) hours;
          3. (iii) Full assistance, twelve (12) hours;

       4. (D) Mobility and transferring:

          1. (i) Minimal assistance, five (5) hours;
          2. (ii) Substantial assistance, seven (7) hours;
          3. (iii) Full assistance, twelve (12) hours;

       5. (E) Toileting and maintaining continence (bowel, and bladder):

          1. (i) Minimal assistance, five (5) hours;
          2. (ii) Substantial assistance, nine (9) hours;
          3. (iii) Full assistance, fourteen (14) hours;

       6. (F) Cognition:

          1. (i) Minimal assistance, three (3) hours;
          2. (ii) Substantial assistance, six (6) hours;
          3. (iii) Full assistance, twelve (12) hours.
          4. (c) PCSP hours for ADLs may only be authorized for an individual if the individual requires assistance (minimal, substantial, or full assist) from another person in the tasks associated with the activity of daily living as determined by a service assessment applying the parameters in this rule.
          5. (d) The IQA may authorize fewer hours than the maximum number of hours in any or all ADL tasks based on their assessment of the individual’s unmet need. The IQA must document the reason for authorizing fewer hours than the maximum number of hours allowed. The IQA may authorize fewer hours than the maximum for any of the following defined reasons:
       7. (A) Reduced frequency or duration of an ADL need;
       8. (B) Durable medical equipment or home modification reduces need for assistance;
       9. (C) Individual preference;
       10. (D) Natural supports as defined in OAR 410-173-0005;
       11. (E) Provided or funded by another agency.
    3. (e) For households with two or more eligible individuals, each individual's ADL service needs must be considered separately.

16. (16) Maximum service period hours for IADL services:

    1. (a) The planning process uses the following limitations for time allotments for IADL tasks. Maximum hours in each assistance level are not guaranteed. Hours authorized must be based on the unmet service needs of an individual as determined by the IQA during the person-centered service planning process:

       1. (A) Medication Services:

          1. (i) Minimal assistance, one (1) hour;
          2. (ii) Substantial assistance, two (2) hours;
          3. (iii) Full assistance, five (5) hours;

       2. (B) Personal Hygiene:

          1. (i) Minimal assistance, five (5) hours;
          2. (ii) Substantial assistance, seven (7) hours;
          3. (iii) Full assistance, twelve (12) hours;

       3. (C) Meal Preparation:

          1. (i) Minimal assistance:

             1. (I) Breakfast, one (1) hour;
             2. (II) Lunch, one (1) hour;
             3. (III) Supper, two (2) hours;

          2. (ii) Substantial assistance:

             1. (I) Breakfast, two (2) hours;
             2. (II) Lunch, two (2) hours;
             3. (III) Supper, three (3) hours;

          3. (iii) Full assistance:

             1. (I) Breakfast, five (5) hours;
             2. (II) Lunch, five (5) hours;
             3. (III) Supper, six (6) hours;
             4. (D) Shopping:
          4. (i) Minimal assistance, one (1) hour;
          5. (ii) Substantial assistance, two (2) hours;
          6. (iii) Full assistance, three (3) hours;

       4. (E) Housekeeping and Laundry:

          1. (i) Minimal assistance, two (2) hours;
          2. (ii) Substantial assistance, five (5) hours;
          3. (iii) Full assistance, nine (9) hours;
    2. (b) When two or more individuals eligible for IADL task hours live in the same household, the assessed need in medication management and transportation must be authorized separately. Payment is made for the individual with the highest of the allotments in meal preparation, shopping, and housekeeping and laundry and a total of two (2) additional IADL hours per service period for each additional individual to allow for the specific IADL needs of the other Individuals.
    3. (c) Service plan hours for IADL tasks may only be authorized for an individual if the individual requires assistance (minimal, substantial, or full assist) from another person in that IADL task as determined by a service assessment applying the parameters in these rules. Hours authorized must incorporate the frequency and the duration of the tasks within each instrumental activity of daily living. For housekeeping, the size of the home may be used to reduce the hours. For meal preparation, hours must be reduced if an individual is receiving Medicaid home delivered meals.

    4. (d) The IQA may authorize fewer hours than the maximum number hours in any or all IADLs based on their assessment of the individual's unmet need. The IQA must document the reason for authorizing fewer hours than the maximum hours. The IQA may reduce hours for any of the following reasons:

       1. (A) Reduced frequency or duration of an IADL need;
       2. (B) Durable medical equipment or home modification reduces need for assistance;
       3. (C) Individual preference;
       4. (D) Natural supports;
       5. (E) Provided by or funded by another agency;
       6. (F) Small living space.
17. (17) When one or more eligible individuals are living in the same household and receiving in-home services, the total number of hours authorized for ADLs and IADLs may not exceed 24 hours within any 24-hour period in the same household unless an exception is granted as described in these rules.
18. (18) A single PCA is limited to 16 hours of awake care during a 24-hour work period.
19. (19) All PCAs are limited to 60 hours per week unless the individual has received a “Weekly Cap” exception.

20. (20) In an emergency or unanticipated situation where the PCA must provide critical care to ensure the health or safety of the individual and the IQA is unavailable to provide prior authorization, the following shall be permitted if the PCA or individual notifies the IQA within two (2) business days of the date the additional hours were first:

    1. (a) Worked to meet an ADL need totaling more than the hours established by section (17) of this rule;
    2. (b) Worked to meet an ADL need that exceeds the total amount authorized by the IQA on the service plan authorization; or
    3. (c) Totaling more than the hours established by section (17)(a) of this rule if an unanticipated need arises that requires the PCA to remain awake to provide necessary ADL care.
21. (21) A provider may not receive payment from the Authority for more than the total amount authorized by the Authority on the service plan authorization form under any circumstances. All service payments must receive prior authorization by the IQA. This section shall be waived if the criteria in section (18) of this rule are met.
22. (22) The IQA must assess and utilize as appropriate, natural supports, cost-effective assistive devices, durable medical equipment, housing accommodations, and alternative service resources as described in this rule that may reduce the need for paid assistance.
23. (23) The Authority may authorize paid in-home services only to the extent necessary to supplement potential or existing resources within an individual's natural supports system.
24. (24) Payment by the Authority for Medicaid IHPC services are only made for the tasks described in this rule as ADL or IADL tasks. Services must be authorized to meet the needs of an eligible individual and may not be provided to benefit an entire household.

Statutory/Other Authority

ORS 409.050, 413.042, 413.085, 414.025, 426.495, 427.104 & 430.662

Statutes/Other Implemented

ORS 409.050, 413.042, 413.085, 414.025, 426.495, 427.007, 430.610, 430.620 & 430.662 – 430.670

History

DMAP 80-2025, adopt filed 10/28/2025, effective 10/28/2025