1. (1) An Agency with Choice's Licensee assumes full legal, financial, and overall responsibility for the Agency with Choice's operation and contractual obligations. Any violations by Agency with Choice owners, Direct Support Workers, other staff, or representatives are attributable to the Agency with Choice and against the Agency with Choice’s license.
2. (2) An Agency with Choice must not assign administrative or supervisory functions of the Agency with Choice to another entity.
3. (3) When Medicaid is the source of payment for the services provided by the Agency with Choice, the Medicaid service payment is considered payment in full for all services provided by the Agency with Choice.
4. (4) All Agency with Choice records must be kept separate and distinct from other business entities.
5. (5) All Direct Support Workers are covered under labor laws, including the Fair Labor Standards Act.
6. (6) An Agency with Choice must ensure services are made available to any Individual who chooses this service option, in alignment with the Medicaid Statewide operations requirement outlined in Section 1902 (a)(1) of the Social Security Act and 42 CFR Part 431. This requirement mandates that a state’s Medicaid program must operate uniformly across the state. Agency with Choice must have the capacity to meet the needs of Individuals through responsive communication, proactive recruitment, staffing, and retention of Direct Support Workers, and must be able to serve statewide.
7. (7) All Agency with Choice employees, Direct Support Workers, and Administrators must carry identification indicating their name and the Agency with Choice employer.
8. (8) An Agency with Choice Direct Support Worker may accompany an Individual anywhere if requested by the Individual. The Direct Support Worker must document all Services and Supports provided to the Individual on a daily basis through the EVV system.

9. (9) Agency with Choice must establish a process for:

   1. (a) Identifying, analyzing, and correcting any of the following events:

      1. (A) Abuse as defined in OAR 411-020-0002;
      2. (B) Serious injury resulting in hospitalization, urgent care or emergency room treatment;
      3. (C) Medication errors or discrepancies;
      4. (D) Missing person when a member's whereabouts are unknown;
      5. (E) Law enforcement contact;
      6. (F) Unexpected death.
   2. (b) Ensuring the immediate reporting of any allegations of events listed in (a) or any other violation of the Individual’s rights must be made to the Individuals Case Manager and Adult Protective Services;
   3. (c) Notifying the Individual’s Case Manager, as applicable, of any known change in the Individual’s health, behavior, environment and related events as defined in (a);
   4. (d) Ensuring Direct Support Workers maintain confidentiality of personally identifiable information of the Individual and addressing allegations of release of confidential information;
   5. (e) Provide standardized training to Direct Support Workers as defined in OAR 411-039-0120;
   6. (f) Retain a personnel record for each Direct Support Worker;
   7. (g) Provide other administrative and employment-related supports; and
   8. (h) An Agency with Choice must provide equitable and non-discriminatory services to all Individuals, regardless of race, color, religion, national origin, age, sex, sexual orientation, gender identity, disability, or any other protected status under state and federal law.

10. (10) An Agency with Choice must:

    1. (a) Maintain a Drug-Free Workplace;
    2. (b) Report any Abuse, harassment, restrain or hospitalization, emergency room visits and urgent care visits and deaths.
    3. (c) Involve Direct Support Workers employed by the Agency with Choice served by the Agency with Choice in the development of and decision-making about work processes, performance standards, quality improvement strategies, training, retention, technology use, and workplace safety;
    4. (d) Minimize the impact of the loss of pay and work hours for Direct Support Workers resulting from the hospitalization or death of an Individual or the dismissal of the Direct Support Worker by the Individual;
    5. (e) Engage and work closely with Individuals to design and implement Agency with Choice Services by appointing Individuals to an advisory board, using focus groups of Individuals, or employing other methods approved by the Department to engage with Individuals effectively;
    6. (f) Enhancing the role of Direct Support Workers as members of the Individual’s service team, as desired and approved by the Individual, or their Authorized Representative; and
    7. (g) Complying with other requirements as prescribed by the Department, and by rule.

11. (11) An Agency with Choice must have a disclosure statement which must be signed by the Individual or the Authorized Representative when the Individual is accepted to receive services. The disclosure statement must include:

    1. (a) A statement must be included that the Agency with Choice will not bill the Individual for any additional services;
    2. (b) A description of services provided and how they will be provided, including a discussion regarding staffing availability, coordination, and support for creation of a backup plan;
    3. (c) A description of the Individual’s or the Authorized Representative regarding their role as co-employer;
    4. (d) Agency with Choice and Individual's rights and responsibilities;
    5. (e) An Agency with Choice must not include any provision in the disclosure statement that affect Individual's rights or the Agency with Choice liability for negligence. The Individual or Authorized Representative has a duty to supervise the Direct Support Worker consistent with the Service Plan;
    6. (f) A description of the qualifications and training requirements necessary for Direct Support Workers providing Services and Supports as required by OAR 411-039-0130(3) of these rules;
    7. (g) Procedures for contacting the Agency with Choice Administrator or Administrator's designee during all of the hours which services are provided;
    8. (h) A clear statement indicating the disclosure statement must be made available to the Individual or the Authorized Representative in an alternate format at the Individual's or the Authorized Representative’s request;
    9. (i) A copy of the Individual’s rights as defined in OAR 411-039-0160;
    10. (j) The disclosure statement must not include language or referring to "buy outs" or "finder's fees” nor shall it include any language that limits Individuals from their full access to other Medicaid services; and
    11. (k) The policy for Individual reimbursement for stolen, broken or misappropriated property or funds.

12. (12) An Agency with Choice must provide each Individual with a written notice of the Individual's rights as a part of the disclosure statement, prior to furnishing Services and Supports to an Individual. The Individual’s rights notice must also include:

    1. (a) Procedures for filing a Grievance, Complaint or Formal Complaint with the Agency with Choice;
    2. (b) Procedures for filing a Grievance, Complaint or Formal Complaint with the Department, along with the telephone number and contact information of the Department; and
    3. (c) Notice of the Individual’s rights and responsibilities as co-employer of the Direct Support Worker, as outlined in these rules.

13. (13) An Agency with Choice must incorporate the notice specified in subsection language below into its current nondiscrimination policy and written materials. The notice must also be included wherever the policy or materials are posted. The notice must state:

    "(Name of AwC) does not discriminate and does not permit discrimination, including, but not limited to, bullying, Abuse or harassment, based on an Individual’s actual or perceived sexual orientation, gender identity, gender expression or human immunodeficiency virus status, or based on an Individual’s association with another Individual on account of the other Individual’s actual or perceived sexual orientation, gender identity, gender expression or human immunodeficiency virus status. If you believe you have experienced this kind of discrimination, you may file a Complaint with the Oregon Department of Human Services.”

14. (14) An Agency with Choice must assist an Individual in planning for Direct Support Worker unplanned, and planned absences or similar situations which call for replacement workers, consistent with the Individual’s choice of Direct Support Workers to provide the services.

15. (15) An Agency with Choice must have in place a process to receive and respond to a Grievance, Complaint or Formal Complaint, submitted by an Individual about the services provided to the Individual, by a Direct Support Worker. An investigation must start no later than 5 business days from the date of the Grievance, Complaint or Formal Complaint of the allegation(s) contained therein and must finalize the response within 30 days.

    1. (a) For allegations that could reasonably be expected to result in harm to the Individual, investigations must start within 24 hours. Investigations must be completed no later than 15 days from the date the investigation started. Findings and mitigation strategies must be reported to the Department.
    2. (b) Agency with Choice must notify the Department of all Complaints and Formal Complaints within 45 days of receiving the Complaint, or Formal Complaint.
16. (16) The Department has authority to examine Individuals’ records as part of the Departments regulation and evaluation of the Agency with Choice.

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