1. (1) In order to receive public funds, an Agency with Choice must be licensed as an Agency with Choice and must be enrolled with the Department as a Medicaid provider.
2. (2) An Agency with Choice must meet all requirements in OAR 411-033-0030 (Provider Enrollment Requirements) for the Department.

3. (3) To receive payment for services, the Agency with Choice must utilize a Department-approved Electronic Visit Verification system (EVV), as specified in OAR 411-033-0010, to verify the following details at the time of service for visits:

   1. (a) Date of service;
   2. (b) Start and end time;
   3. (c) Type of service;
   4. (d) Location of service;
   5. (e) The name of the Direct Support Worker providing the service; and
   6. (f) The name of Individual receiving services.
4. (4) Agency with Choice must submit claims for reimbursement to the Department and pay Direct Support Workers for Authorized hours worked and billed in accordance with the Electronic Visit Verification requirements. All claims must be submitted no later than 12 months from the date of service. Per 42 CFR 424.44, time limits for filing claims, any claims submitted after 12 months from the date of service will not be eligible for reimbursement.
5. (5) The Agency with Choice must withhold, file, and pay income taxes and all employment-related taxes, including but not limited to, workers’ compensation premiums and unemployment taxes. The Agency with Choice must also verify the qualifications of each Direct Support workers as required by Oregon and Federal Laws.

6. (6) The Agency with Choice shall be reimbursed:

   1. (a) Only for approved and authorized hours and services delivered to an Individual based on the Individual’s Person-Centered Service Planning.
   2. (b) Only at the Department’s approved hourly rate for services.
   3. (c) Request for reimbursement of community transportation must not include mileage for an employee commuting to and from the Individual's home.
   4. (d) To provide community transportation services, the Direct Support Worker must maintain valid driver’s license, current vehicle registration and necessary auto insurance. Proof must be available upon the request of the Department. Mileage must be prior authorized in the Person-Centered Service Plan.
7. (7) The Agency with Choice must comply with OAR 411-020-0100, OAR 411-020-0105, and OAR 410-120-1510 and the requirements therein for prompt reporting of fraud, waste, and Abuse in the Medicaid program. Information on how to report may always be found online: https://www.oregon.gov/oha/FOD/PIAU/Pages/Report-Fraud.aspx.
8. (8) The Agency with Choice must provide a copy of all information and documents as requested by the Department.
9. (9) The Agency with Choice must cooperate with all review activities required by the Department, including but not limited to providing access to records, staff, and service documentation related to the delivery of Agency with Choice Services.

Statutory/Other Authority

Or Laws 2024, ch. 37

Statutes/Other Implemented

ORS 124.050 & Or Laws 2024, ch. 37

History

APD 17-2025, adopt filed 12/10/2025, effective 12/15/2025