These videos give an overview of the various Home and Community-Based Services (HCBS) available in Oregon for providers who want to learn how to start or operate an HCBS agency in the state. Each video explains the purpose of the service, provider requirements, licensing process, and how the program functions. Use these videos to better understand the responsibilities, standards, and steps involved in becoming or working with approved HCBS providers in Oregon. Explore each section to find the service that best matches your goals or area of interest.
Respite Care
RESPITE CARE SERVICES PROVIDER IN OREGON
DELIVERING TEMPORARY RELIEF TO CAREGIVERS WHILE ENSURING SAFE, COMPASSIONATE SUPPORT FOR INDIVIDUALS WITH SPECIAL NEEDS
Respite Care Services in Oregon are Medicaid-funded supports that provide short-term, substitute care for individuals with disabilities, chronic conditions, or age-related needs — allowing primary caregivers to take a break from their caregiving responsibilities. These services help prevent caregiver burnout and promote the health and safety of both the caregiver and the person receiving care. Respite is delivered in-home, at a certified provider’s site, or in the community and is authorized through Oregon Medicaid (Oregon Health Plan), including HCBS Waivers and the K Plan.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities (DD)
Role: Authorizes and coordinates respite care services through local APD or CDDP (Community Developmental Disabilities Programs).
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan (OHP), oversees Medicaid operations, and ensures waiver compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Oversees federal standards for respite care under HCBS authorities like 1915(c) and 1915(k).
Agency: Oregon Secretary of State (SOS) – Corporation Division
Role: Registers businesses and maintains corporate filings for provider entities.
2. RESPITE CARE SERVICES OVERVIEW
Respite Care allows caregivers of individuals with significant support needs to rest, travel, or attend to personal matters while ensuring the individual continues to receive proper care.
Approved providers may offer:
In-Home Respite: Temporary support delivered at the individual’s residence.
Out-of-Home Respite: Care in a provider's certified home, foster care, or community setting.
Facility-Based Respite (optional): Short stays in licensed adult foster homes or residential care settings.
Planned or Emergency Respite: Scheduled relief or crisis-response options.
Personal Support & Monitoring: Assistance with ADLs, medication reminders, and supervision.
Documentation: Progress notes, care logs, and Medicaid billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your entity with the Oregon Secretary of State.
Secure an EIN from the IRS and obtain a Type 2 NPI.
Enroll as a Medicaid provider through the Oregon Health Plan Provider Portal.
If providing services to individuals with developmental disabilities, become certified through ODHS-DD.
If offering out-of-home care, comply with adult foster home or residential licensing through ODHS.
Carry appropriate liability and workers’ compensation insurance.
Develop a Respite Care Services Policy & Procedure Manual based on service type and target population.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity and acquire EIN, NPI, and insurance.
Step 2: Complete Medicaid enrollment via OHP’s Provider Portal.
Step 3: For DD respite, work with your local CDDP to gain certification and connect with case management entities.
Step 4: If applicable, apply for adult foster home licensing through APD.
Step 5: After approval, begin coordinating with service coordinators and accepting clients.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmation
Insurance certificates (liability, workers’ comp)
ODHS-DD or APD respite provider certification (as applicable)
Respite Services Policy Manual covering:
Intake and service planning
Emergency protocols and backup staffing
Personal care and medication assistance guidelines
Incident reporting and documentation templates
Participant rights and caregiver consent forms
Quality assurance procedures and recordkeeping
Medicaid billing and EVV tools
6. STAFFING REQUIREMENTS
Role: Respite Care Provider / Direct Support Professional (DSP)
Requirements: ODHS-approved; background check; experience with ADLs and behavioral support (if applicable).
Role: Program Supervisor / Coordinator
Requirements: Oversight of documentation, staff scheduling, and training. Strong understanding of DD/APD service systems.
Role: RN or Licensed Practitioner (optional)
Requirements: For respite clients with skilled care needs or nursing oversight.
All staff must complete:
CPR/First Aid and abuse reporting training
HIPAA and participant confidentiality modules
EVV and documentation procedures
Emergency preparedness and behavior support (if applicable)
Annual re-certification and performance evaluation
7. MEDICAID WAIVER PROGRAMS
Respite Care Services are available through:
K Plan (Community First Choice 1915(k)) – allows flexible in-home respite for OHP members with support needs.
APD Waiver Services – for seniors and adults with physical disabilities.
IDD Waivers (DD Services) – for individuals with intellectual or developmental disabilities.
Children’s Waiver and Medically Fragile Waivers – for families caring for children with special needs.
OHP State Plan Respite – for short-term support under specific eligibility.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Creation
Timeline: 1–2 months
Phase: Medicaid Enrollment & Certification
Timeline: 2–3 months
Phase: Staff Hiring & Required Trainings
Timeline: 30–60 days
Phase: Referral Coordination & Service Activation
Timeline: Begin as soon as authorization is received from local case management offices or DD brokerages.
9. CONTACT INFORMATION
Oregon Department of Human Services (ODHS)
Website: https://www.oregon.gov/DHS
ODHS – Developmental Disabilities Services
Website: https://www.oregon.gov/dhs/DD
Oregon Health Authority (OHA)
Website: https://www.oregon.gov/oha
Oregon Health Plan Provider Portal
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON RESPITE CARE SERVICES PROVIDER
WCG helps Oregon providers launch fully compliant respite care programs with:
Scope of Work:
Business registration and Medicaid enrollment navigation
ODHS and DD respite provider certification assistance
Customized Respite Policy & Procedure Manual
Staff training guides and credentialing templates
EVV setup, billing support, and documentation systems
Emergency response plans and quality assurance templates
Partnership development with case managers and family networks
Residential Care
RESIDENTIAL SUPPORT SERVICES PROVIDER IN OREGON
CREATING SAFE, STABLE, AND PERSON-CENTERED LIVING ENVIRONMENTS FOR OREGONIANS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
Residential Support Services in Oregon are Medicaid-funded programs that provide 24/7 or intermittent care and supervision to individuals with intellectual and developmental disabilities (IDD) in community-based residential settings. These services are designed to support individuals in achieving independence, building life skills, and participating in their communities, while ensuring health and safety in a home-like environment. Residential support is authorized through Oregon’s HCBS Waivers and K Plan under the Oregon Health Plan (OHP).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Office of Developmental Disabilities Services (ODDS)
Role: Oversees certification, funding, and oversight of residential service providers in coordination with Community Developmental Disabilities Programs (CDDPs).
Agency: Oregon Health Authority (OHA)
Role: Administers Oregon Health Plan, processes Medicaid enrollment, and ensures compliance with Medicaid service rules.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures state Medicaid residential services meet federal waiver standards.
Agency: Oregon Secretary of State (SOS)
Role: Handles business registration and legal formation of provider agencies.
2. RESIDENTIAL SUPPORT SERVICES OVERVIEW
These services support individuals in licensed or certified residential settings such as group homes, foster homes, supported living apartments, or individualized community settings.
Approved providers may deliver:
24-Hour Residential Services: Full-time supervision, skill development, and ADL support in group homes or staffed residences.
Supported Living Services: Assistance for individuals living independently or with roommates in community apartments or homes.
Host Homes/Adult Foster Care (AFH): Care provided in a family-like setting by certified providers.
Daily Living Support: Help with bathing, cooking, dressing, shopping, and household management.
Community Integration: Outings, recreational activities, and participation in public life.
Medication Assistance & Health Monitoring: Medication administration, monitoring, and documentation.
Behavior Support Implementation: Plan implementation and data collection (if BSP is in place).
Documentation & Medicaid Billing: Progress notes, ISP tracking, incident reports, and shift logs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider via the Oregon Health Plan Provider Portal.
Apply for certification through ODDS and your local CDDP (required for group homes, supported living, and foster care).
Complete required inspections (for licensed homes) and health/safety compliance.
Maintain general liability, workers’ comp, and property insurance.
Develop a Residential Support Services Policy & Procedure Manual based on Oregon Administrative Rules (OARs).
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and obtain EIN, NPI, and insurance.
Step 2: Complete ODDS certification process through your local CDDP.
Step 3: Enroll as a Medicaid provider through OHA’s portal.
Step 4: Prepare your home/facility for walkthrough inspection (if applicable).
Step 5: Submit documentation, pass background checks, and receive service authorization.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
Certification and licensing (group home, supported living, or AFH)
Insurance coverage documents
Residential Support Services Policy & Procedure Manual including:
Resident rights and grievance protocols
ADL support routines and personal care standards
Medication assistance and health monitoring
Emergency procedures and evacuation plans
Staffing requirements and training guidelines
ISP implementation and documentation templates
Incident reporting and quality improvement systems
Medicaid billing forms and daily shift logs
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP) / Residential Caregiver
Requirements: Background check, CPR/First Aid, ODDS core training, and understanding of ISP/BSP implementation.
Role: Program Coordinator / House Manager
Requirements: Supervises daily operations, oversees ISP delivery, and ensures compliance.
Role: RN / Medical Consultant (optional)
Requirements: Licensed; may assist with medication delegation, training, or complex care oversight.
All staff must complete:
Abuse reporting and safety training
HIPAA and confidentiality modules
Individual Support Plan (ISP) implementation
Documentation and incident tracking
Annual competency reviews and in-service training
7. MEDICAID WAIVER PROGRAMS
Residential Support Services in Oregon are provided under:
Comprehensive Waiver (IDD): Covers 24-hour residential, supported living, and behavioral supports.
Support Services Waiver (IDD): Includes flexible residential supports for individuals in non-licensed housing.
K Plan (1915(k)): Supports ADL/IADL assistance in community living arrangements.
Children’s DD Waiver: Includes family and foster care-based residential services.
Adult Foster Homes (AFH) & Host Homes: May be covered under HCBS Waiver if certified by ODDS.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Preparation
Timeline: 1–2 months
Phase: ODDS Certification & Medicaid Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Background Checks & Training
Timeline: 30–60 days
Phase: Facility Readiness & Client Referral Coordination
Timeline: Begins once certification and approval are complete
9. CONTACT INFORMATION
Oregon Department of Human Services – ODDS Residential Services
Website: https://www.oregon.gov/dhs/DD
Oregon Health Authority – Medicaid Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON RESIDENTIAL SUPPORT PROVIDER
WCG helps providers in Oregon open high-quality, person-centered residential programs for individuals with IDD, from group homes to supported living models.
Scope of Work:
Business formation, Medicaid enrollment, and ODDS certification support
Facility readiness checklists and compliance walkthroughs
Custom Residential Policy & Procedure Manual
Staff onboarding materials, training plans, and credentialing trackers
ISP delivery templates and shift documentation forms
Incident reporting systems and audit preparation
Referral partnership development with brokerages and case managers
Supported Employment
SUPPORTED EMPLOYMENT SERVICES PROVIDER IN OREGON
EMPOWERING INDIVIDUALS WITH DISABILITIES TO ACHIEVE MEANINGFUL, COMPETITIVE EMPLOYMENT THROUGH CUSTOMIZED SUPPORT
Supported Employment Services in Oregon are Medicaid-funded and state-supported programs that assist individuals with intellectual and developmental disabilities (IDD) or other barriers in preparing for, securing, and maintaining competitive, integrated employment. These services are person-centered and focus on helping individuals find jobs that match their interests and abilities while providing the support they need to succeed. Supported Employment is authorized through Oregon’s HCBS Waivers, the K Plan, and Vocational Rehabilitation (VR) partnerships, all coordinated under the Oregon Health Plan (OHP).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Office of Developmental Disabilities Services (ODDS)
Role: Coordinates long-term Supported Employment Services for individuals with IDD through local Community Developmental Disabilities Programs (CDDPs).
Agency: Oregon Vocational Rehabilitation (VR) Services
Role: Provides short-term job readiness and placement services; transitions to long-term support through ODDS.
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan and Medicaid provider enrollment.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance for employment-related services under 1915(c) waivers and 1915(k) Community First Choice Option.
Agency: Oregon Secretary of State (SOS)
Role: Registers provider businesses operating in Oregon.
2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW
Supported Employment Services are tailored to the individual's goals and may occur in various settings, including community-based jobs, self-employment, or micro-enterprises.
Approved providers may offer:
Discovery & Career Exploration: Identify client strengths, interests, and employment potential.
Job Development & Placement: Resume building, job matching, applications, and interview coaching.
Job Coaching: On-site assistance to help individuals adjust to work and perform duties effectively.
Ongoing Job Support: Periodic check-ins and interventions to maintain employment.
Small Group Supported Employment (optional): Group employment settings with supervision.
Self-Employment Support: Guidance on developing and sustaining a business.
Documentation & Progress Tracking: Service plans, coaching logs, employer communication, and billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the Oregon Health Plan Provider Portal.
Apply for certification as a Supported Employment provider through ODDS and/or your local CDDP.
Partner with Oregon VR for referral and funding coordination.
Carry general liability and workers’ comp insurance.
Develop a Supported Employment Services Policy & Procedure Manual that aligns with Oregon Employment First standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register business entity and acquire EIN/NPI and insurance.
Step 2: Enroll through the OHA Medicaid Provider Portal.
Step 3: Apply for ODDS certification and complete local onboarding with your CDDP or brokerage.
Step 4: Coordinate with Oregon VR to be added as a community partner.
Step 5: Begin receiving referrals and service authorizations.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance coverage verification
ODDS Provider Enrollment Approval
Supported Employment Services Policy Manual including:
Discovery and employment planning protocols
Job coaching and workplace support strategies
Emergency and safety policies for job sites
Progress note templates and time logs
HIPAA and participant rights policies
Employer engagement standards and outreach logs
Quality assurance metrics and service reviews
Billing records and documentation forms
6. STAFFING REQUIREMENTS
Role: Employment Specialist / Job Coach
Requirements: Experience in workforce development or disability services; background check required; training in person-centered employment planning.
Role: Program Supervisor / Employment Coordinator
Requirements: Oversees employment services, ensures data accuracy, supervises coaching staff.
Role: Transition Specialist (optional)
Requirements: Supports youth and school-aged individuals entering the workforce.
All staff must complete:
Employment First core competencies
Job development and placement strategies
Documentation and Medicaid billing training
Workplace safety and employer engagement training
Annual reviews and skill assessments
7. MEDICAID WAIVER PROGRAMS
Supported Employment Services are available under:
Comprehensive Waiver (IDD): Long-term job support and coaching services.
Support Services Waiver (IDD): Employment supports for individuals living independently or with families.
K Plan (1915(k)): Covers employment-related supports for those needing ongoing job coaching.
Vocational Rehabilitation (VR): State-funded short-term job readiness and placement services prior to waiver-funded supports.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Creation
Timeline: 1–2 months
Phase: Medicaid & ODDS Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Network Building & Service Launch
Timeline: Begins upon authorization and CDDP or VR case manager referral
9. CONTACT INFORMATION
Oregon Department of Human Services – ODDS Employment Services
Website: https://www.oregon.gov/dhs/DD/Pages/employment.aspx
Oregon Vocational Rehabilitation Services
Website: https://www.oregon.gov/dhs/EMPLOYMENT/VR
Oregon Health Authority – Medicaid Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON SUPPORTED EMPLOYMENT PROVIDER
WCG supports Supported Employment providers in Oregon with all the tools needed to launch high-impact, compliant job support programs for individuals with disabilities.
Scope of Work:
Business registration, OHA/ODDS enrollment, and VR partnership setup
Employment Policy Manual creation and coaching documentation tools
Discovery and ISP-aligned service templates
Employer engagement protocols and referral tracking tools
Credentialing logs, safety planning, and job site readiness checklists
Medicaid billing system setup and compliance guidance
Partnership strategies for schools, VR, and local employers
Personal Care
PERSONAL CARE SERVICES PROVIDER IN OREGON
DELIVERING COMPASSIONATE, CLIENT-CENTERED SUPPORT TO MAINTAIN INDEPENDENCE AND DIGNITY FOR OREGONIANS IN THEIR HOMES AND COMMUNITIES
Personal Care Services (PCS) in Oregon are Medicaid-funded supports that assist eligible individuals with daily living tasks such as bathing, dressing, mobility, eating, and medication reminders. These services are aimed at helping older adults, people with disabilities, and individuals with chronic conditions live safely in their homes and avoid institutional care. PCS are authorized under Oregon’s Medicaid program, Oregon Health Plan (OHP), and through Home and Community-Based Services (HCBS) waivers and the State Plan Personal Care Option.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD)
Role: Administers and authorizes PCS for eligible OHP recipients, including through local APD and Area Agency on Aging (AAA) offices.
Agency: Oregon Health Authority (OHA)
Role: Oversees the Medicaid program (OHP), contracts with coordinated care organizations (CCOs), and ensures federal compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon’s Medicaid State Plan and waiver services comply with federal regulations.
Agency: Oregon Secretary of State (SOS) – Corporation Division
Role: Registers new business entities and maintains business compliance.
2. PERSONAL CARE SERVICES OVERVIEW
PCS in Oregon are provided in the client’s home or community setting and support daily functioning, reduce hospitalization risks, and promote dignity.
Approved providers may deliver:
Assistance with Activities of Daily Living (ADLs): Bathing, dressing, eating, toileting, and ambulation.
Instrumental ADLs (IADLs): Light housekeeping, meal preparation, laundry, and shopping.
Medication Reminders: Non-skilled cueing and monitoring for medication compliance.
Protective Supervision: Ensuring safety for individuals with cognitive impairments.
Escort to Appointments: Support for accessing health and community resources.
Documentation and Progress Notes: Daily service logs, care plans, and billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an Employer Identification Number (EIN) from the IRS and a National Provider Identifier (NPI).
Enroll with Oregon Medicaid through the Oregon Health Plan Provider Portal.
If employing skilled staff (e.g., RNs), ensure licensing through Oregon State Board of Nursing (OSBN).
Secure general liability and workers’ compensation insurance.
Develop a Personal Care Services Policy & Procedure Manual aligned with APD standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your LLC or corporation and obtain EIN/NPI.
Step 2: Submit a Medicaid provider application via the Oregon Health Plan Provider Portal.
Step 3: Pass background checks and submit ownership and staffing details.
Step 4: Receive approval and begin coordinating with local APD/AAA offices.
Step 5: Accept referrals and begin delivering authorized PCS services.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI documentation
Insurance certificates
Staff rosters and credentialing logs
PCS Policy & Procedure Manual including:
Care planning and service protocols
ADL/IADL service delivery procedures
Documentation templates and standards
Incident reporting and participant safety procedures
Privacy, dignity, and HIPAA compliance policies
Medicaid billing protocols
6. STAFFING REQUIREMENTS
Role: Personal Support Worker (PSW) / Personal Care Aide (PCA)
Requirements: DHS-approved, background-checked, and trained in ADL support.
Role: Program Coordinator / Supervisor
Requirements: Experience managing care services; oversees documentation and staff compliance.
Role: Registered Nurse (optional for oversight or skilled support)
Requirements: Licensed through OSBN; supports medication management or advanced care needs.
All staff must complete:
Orientation on rights, dignity, and autonomy
Documentation and electronic visit verification (EVV) training
Abuse reporting and elder protection education
Annual refresher and skills validation
7. MEDICAID WAIVER PROGRAMS
Personal Care Services in Oregon are available through:
Oregon K Plan (State Plan Personal Care Option) – provides services under the Community First Choice Option (1915(k)).
Aging & People with Disabilities (APD) HCBS Waivers – for seniors and adults with physical disabilities.
Developmental Disabilities Waivers – for individuals with intellectual/developmental disabilities (IDD).
Children's Waiver and Medically Fragile Waivers – for youth needing in-home support.
Oregon Health Plan (OHP) Standard PCS – for qualifying members needing short- or long-term support.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Preparation
Timeline: 1–2 months
Phase: Medicaid Enrollment & Background Checks
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing, & Training
Timeline: 30–60 days
Phase: Referral Readiness & Service Launch
Timeline: Services may begin once provider approval and local referral connections are established.
9. CONTACT INFORMATION
Oregon Department of Human Services (ODHS)
Website: https://www.oregon.gov/DHS
Oregon Health Authority (OHA)
Website: https://www.oregon.gov/oha
Oregon Health Plan Provider Portal
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON PERSONAL CARE SERVICES PROVIDER
WCG empowers PCS providers in Oregon to launch sustainable, compliant home care programs with:
Scope of Work:
Business registration and Medicaid provider enrollment assistance
Custom Oregon PCS Policy Manual development
Staff credentialing trackers and EVV onboarding
Care plan templates, shift logs, and billing forms
Participant rights documents and grievance protocols
Referral network building with APD/AAA case managers
Audit readiness guides and quality improvement plans
Specialized Medical Equipment
SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN OREGON
DELIVERING ACCESS TO CRITICAL DEVICES THAT SUPPORT INDEPENDENCE, SAFETY, AND QUALITY OF LIFE FOR MEDICAID BENEFICIARIES
Specialized Medical Equipment (SME) Services in Oregon are Medicaid-funded supports that provide individuals with disabilities or chronic medical conditions access to essential devices that support health, mobility, communication, and safety in the home and community. These services include the assessment, purchase, delivery, customization, and repair of equipment such as hospital beds, mobility devices, adaptive aids, and environmental modifications. SME is available under the Oregon Health Plan (OHP) and through HCBS waivers and the K Plan (1915(k)).
1. GOVERNING AGENCIES
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan, oversees Medicaid provider enrollment, and authorizes funding for medical equipment and devices.
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Coordinates SME services through local APD offices or Community Developmental Disabilities Programs (CDDPs).
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon’s Medicaid SME coverage meets federal guidelines under HCBS and State Plan options.
Agency: Oregon Secretary of State (SOS)
Role: Registers businesses operating in Oregon, including Durable Medical Equipment (DME) providers.
Agency: Oregon Board of Pharmacy (if applicable)
Role: Licenses providers dispensing certain medical devices with medical or pharmaceutical components.
2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW
SME Services include the provision of medical and adaptive equipment that is not typically covered under standard Medicaid benefits but is deemed necessary to increase independence or reduce institutional care needs.
Approved providers may deliver:
Needs Assessment & Device Selection: Reviewing individual support needs and recommending appropriate equipment.
Procurement & Delivery: Ordering and delivering Medicaid-authorized equipment (e.g., shower chairs, Hoyer lifts, respiratory equipment).
Installation & Setup: Ensuring devices are functional and safe for use in home environments.
Customization: Modifying devices to meet individual specifications.
Training & Instruction: Teaching individuals and caregivers to use equipment correctly.
Maintenance & Repairs: Replacing worn parts and repairing broken devices.
Documentation & Billing: Service records, equipment logs, delivery receipts, and Medicaid billing templates.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll with Oregon Medicaid through the OHP Provider Portal as a DME or SME provider.
If dispensing certain devices, secure licensure with the Oregon Board of Pharmacy.
Obtain national accreditation (e.g., CHAP, ACHC, or The Compliance Team) if required.
Carry general liability and workers’ compensation insurance.
Develop a Specialized Medical Equipment Services Policy & Procedure Manual in line with Medicaid and accreditation standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register business entity and secure EIN/NPI and insurance.
Step 2: Complete Medicaid provider enrollment through OHA.
Step 3: Apply for DME accreditation (if needed) and Board of Pharmacy licensure.
Step 4: Submit service documentation and equipment inventory processes.
Step 5: Begin accepting referrals and authorizations from APD/DD case managers.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI documentation
Accreditation and/or licensure (Board of Pharmacy, if applicable)
Insurance certificates
SME Services Policy & Procedure Manual, including:
Equipment procurement, delivery, and installation protocols
Client training and instruction procedures
Maintenance and repair documentation
HIPAA and participant rights safeguards
Equipment inventory and tracking logs
Incident reporting and recall procedures
Medicaid billing and documentation templates
Safety and infection control procedures
6. STAFFING REQUIREMENTS
Role: Equipment Technician / Delivery Specialist
Requirements: Background check; trained in device setup, client interaction, and maintenance.
Role: Program Coordinator / Fulfillment Manager
Requirements: Manages orders, vendor relations, scheduling, and Medicaid documentation.
Role: Clinical Consultant (optional)
Requirements: May be an OT, PT, or RN who evaluates equipment needs and trains clients (required for some HCBS services).
All staff must complete:
HIPAA and safety training
Equipment-specific handling and infection control
Documentation and Medicaid compliance education
Annual performance and protocol reviews
7. MEDICAID WAIVER PROGRAMS
Specialized Medical Equipment Services are available through:
K Plan (1915(k)) – includes SME necessary to support ADLs/IADLs and independence.
APD HCBS Waivers – equipment for aging adults or those with physical disabilities.
Comprehensive & Support Services Waivers (IDD) – includes SME for home and community integration.
Children’s DD Waiver – adaptive equipment for in-home or school use.
State Plan DME Benefit (via Prior Authorization) – covers standard medical equipment (wheelchairs, hospital beds, etc.).
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Accreditation
Timeline: 2–4 months (longer if DME accreditation required)
Phase: Equipment Sourcing & Staff Training
Timeline: 30–60 days
Phase: Referral Network Setup & Service Activation
Timeline: Begins once authorizations and contracts are in place
9. CONTACT INFORMATION
Oregon Health Authority (OHA)
Website: https://www.oregon.gov/oha
Oregon Department of Human Services (ODHS)
Website: https://www.oregon.gov/dhs
Oregon Medicaid Provider Portal
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
Oregon Board of Pharmacy
Website: https://www.oregon.gov/pharmacy
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON SME PROVIDER
WCG helps DME and SME providers in Oregon develop high-compliance programs that deliver critical medical equipment to Medicaid members across the state.
Scope of Work:
Business formation, Medicaid enrollment, and equipment licensing support
SME Policy Manual development and delivery tracking tools
Equipment request forms, training protocols, and service documentation templates
Staff credentialing systems and fulfillment workflows
Accreditation navigation (CHAP, ACHC, TCT)
Medicaid billing system setup and claim readiness support
Partnership-building with APD, DD, and hospital discharge teams
Home & Community-Based Services
HOME AND COMMUNITY-BASED SERVICES (HCBS) PROVIDER IN OREGON
DELIVERING PERSON-CENTERED SUPPORT THAT ENABLES OREGONIANS TO THRIVE IN THEIR HOMES AND COMMUNITIES
Home and Community-Based Services (HCBS) in Oregon are Medicaid-funded supports that help individuals with disabilities, chronic illnesses, or aging-related needs live independently in their homes and actively participate in their communities. These services cover a wide range of medical, social, and personal care supports and are designed to reduce institutionalization and promote quality of life. HCBS is administered under Oregon’s Medicaid program, the Oregon Health Plan (OHP), through a combination of waivers, the K Plan (1915(k)), and the State Plan.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Authorizes HCBS services via local offices, Community Developmental Disabilities Programs (CDDPs), and Area Agencies on Aging (AAAs).
Agency: Oregon Health Authority (OHA)
Role: Oversees Medicaid administration, provider enrollment, and HCBS plan compliance through the Oregon Health Plan.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight of HCBS waivers and the K Plan to ensure compliance with Medicaid rules.
Agency: Oregon Secretary of State (SOS)
Role: Registers new business entities and maintains corporate compliance.
2. HCBS SERVICES OVERVIEW
HCBS encompass a broad range of services designed to support individuals with varying needs — from daily personal care to advanced behavioral, nursing, or habilitative support.
Approved providers may offer:
Personal Care Assistance: Help with bathing, grooming, dressing, and toileting.
Homemaker and Chore Services: Housekeeping, laundry, meal preparation, and home upkeep.
Skilled Nursing Services: Medication management, wound care, and monitoring of health conditions.
Habilitation and Life Skills Training: Teaching ADLs, communication, and independent living skills.
Behavioral Support Services: Assessment, plan development, and behavior coaching.
Respite Care: Temporary relief for caregivers while maintaining client safety and routine.
Adult Day Services: Supervision, social activities, and health checks in structured settings.
Employment Services: Job coaching, discovery, and workplace support.
Transportation Services: Access to medical appointments, work, and community events.
Assistive Technology and Environmental Modifications: Equipment and home adjustments to promote safety and accessibility.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll with Oregon Medicaid via the OHA Provider Portal.
Apply for service-specific approval or certification through ODHS/DD/APD.
Secure any required health, behavioral, or facility licenses based on services provided.
Maintain liability and workers’ compensation insurance.
Develop a Home and Community-Based Services Policy & Procedure Manual tailored to your service scope.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your LLC or nonprofit and secure EIN/NPI and insurance.
Step 2: Enroll with OHA as a Medicaid provider.
Step 3: Apply for program-specific approval (e.g., for DD, APD, behavioral health, or nursing).
Step 4: Undergo staff background checks, training, and compliance verifications.
Step 5: Begin accepting referrals from APD, CDDPs, brokerages, or case management entities.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (general, workers’ comp, malpractice if applicable)
ODHS or APD/DD service approval
HCBS Policy & Procedure Manual including:
Care planning and service delivery protocols
Staff training and supervision policies
Client rights and grievance processes
Emergency preparedness and safety procedures
HIPAA and documentation standards
Incident reporting and quality assurance systems
Medicaid billing forms and visit verification (EVV) templates
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP) / Personal Support Worker (PSW)
Requirements: Background check; trained in ADL/IADL assistance, safety, and documentation.
Role: Program Coordinator / Supervisor
Requirements: Manages day-to-day operations, ensures compliance, and oversees care quality.
Role: RN / LPN / Behavioral Consultant (optional based on service type)
Requirements: Active Oregon licensure; provides skilled care or clinical oversight.
All staff must complete:
HIPAA and client rights training
Emergency procedures and abuse reporting
Service-specific skills training (e.g., medication administration, ISP implementation)
Annual competency reviews and continuing education
7. MEDICAID WAIVER PROGRAMS
HCBS services in Oregon are delivered through:
K Plan (Community First Choice, 1915(k)): Broad in-home and community supports for individuals with functional needs.
Comprehensive Waiver (IDD): Intensive supports including employment, habilitation, and behavioral services.
Support Services Waiver (IDD): More flexible support for individuals living independently or with family.
Children’s Waiver Programs: Supports for medically fragile and developmentally delayed children.
APD HCBS Waivers: In-home, adult foster, and community support for seniors and physically disabled adults.
State Plan Services (OHP): Standard Medicaid offerings that may overlap with HCBS depending on medical need.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Creation
Timeline: 1–2 months
Phase: Medicaid Enrollment & Certification
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Coordination & Service Activation
Timeline: Begins upon case management referral and service authorization
9. CONTACT INFORMATION
Oregon Department of Human Services – HCBS Division
Website: https://www.oregon.gov/dhs
Oregon Health Authority – Medicaid Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Oregon DD Services
Website: https://www.oregon.gov/dhs/DD
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON HCBS PROVIDER
WCG empowers new and expanding HCBS providers in Oregon with everything they need to launch sustainable, person-centered programs that meet Medicaid standards.
Scope of Work:
Business registration, OHA enrollment, and ODHS service approval
Tailored HCBS Policy & Procedure Manual creation
Staff onboarding materials and credentialing trackers
Documentation templates for ISP, care planning, EVV, and incident tracking
Medicaid billing guidance and compliance systems
Referral strategies and networking with APD, CDDPs, and support coordinators
Quality assurance tools and audit readiness planning
Habilitation Services
HABILITATION SERVICES PROVIDER IN OREGON
SUPPORTING SKILL-BUILDING, COMMUNITY INTEGRATION, AND INDEPENDENT LIVING FOR OREGONIANS WITH DEVELOPMENTAL DISABILITIES
Habilitation Services in Oregon are Medicaid-funded supports that help individuals with intellectual and developmental disabilities (IDD) acquire, retain, and improve daily living skills. Unlike rehabilitation (which focuses on restoring lost skills), habilitation focuses on developing new skills in communication, mobility, socialization, self-care, and community living. These services are a cornerstone of Oregon’s HCBS (Home and Community-Based Services) waiver programs and the K Plan (Community First Choice Option), all authorized under the Oregon Health Plan (OHP).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Developmental Disabilities Services (DDS)
Role: Oversees approval, funding, and oversight of habilitation services delivered through local Community Developmental Disabilities Programs (CDDPs).
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan and manages Medicaid provider enrollment and compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance for habilitative services under HCBS waiver programs and 1915(k) authorities.
Agency: Oregon Secretary of State (SOS)
Role: Registers provider organizations as legal business entities in Oregon.
2. HABILITATION SERVICES OVERVIEW
Habilitation Services help individuals with IDD develop meaningful skills that promote autonomy, integration, and personal growth.
Approved providers may deliver:
Community Habilitation: Support for participation in community activities, public transportation use, and social skill-building.
In-Home Habilitation: Daily living skills training such as hygiene, cooking, money management, and safety awareness.
Supported Employment (optional): Job coaching and skill development for competitive employment (if authorized).
Adaptive Skill Development: Instruction in communication, personal responsibility, and emotional regulation.
Recreation and Socialization Support: Access to inclusive activities and opportunities for peer engagement.
Care Planning & Documentation: Individual support plans, data collection, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider via the Oregon Health Plan Provider Portal.
Become a certified DD service provider through ODHS/DDS in collaboration with the local CDDP.
Carry general liability and workers’ compensation insurance.
Develop a Habilitation Services Policy & Procedure Manual aligned with Oregon Medicaid and DDS requirements.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Form your LLC or nonprofit and obtain EIN/NPI and insurance.
Step 2: Apply for Medicaid enrollment through OHA’s Provider Portal.
Step 3: Complete ODHS/DDS application process and background checks.
Step 4: Meet training requirements and submit your policies and program materials.
Step 5: After certification, begin coordinating with the local CDDP and accepting client referrals.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
Insurance certificates (liability, workers’ comp)
DDS Provider Certification (via local CDDP)
Habilitation Services Policy & Procedure Manual including:
Individual Support Plan development guidelines
Community inclusion and skill-building protocols
Behavior and safety planning (if applicable)
Staff training and supervision policies
HIPAA compliance and participant rights materials
Data collection and documentation templates
Quality assurance and incident reporting systems
Medicaid billing and service tracking forms
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP) / Habilitation Specialist
Requirements: Background check; trained in person-centered planning, ADL/IADL skill-building, and safety practices.
Role: Program Coordinator / Supervisor
Requirements: Manages client schedules, supervises DSPs, ensures compliance with ISP goals and Medicaid regulations.
Role: Behavior Support Consultant (optional)
Requirements: Assists in supporting individuals with behavioral needs; must hold appropriate licenses/certifications.
All staff must complete:
ODHS core competency training for DSPs
First Aid/CPR and abuse reporting certification
HIPAA and rights training
ISP goal tracking and documentation training
Annual recertification and performance evaluation
7. MEDICAID WAIVER PROGRAMS
Habilitation Services in Oregon are funded through:
Comprehensive Waiver (for IDD): Full-service habilitation supports including community inclusion and skill development.
Support Services Waiver (for IDD): Tailored services for adults living in their own homes or with family.
Children’s DD Waiver: In-home and community habilitation for children with IDD.
K Plan (1915(k)): Includes personal support and habilitation services for individuals eligible under the Community First Choice option.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & DDS Certification
Timeline: 2–3 months
Phase: Staff Hiring, Training, and Background Checks
Timeline: 30–60 days
Phase: Referral Coordination & Service Activation
Timeline: Begins as soon as approved and connected with local CDDPs
9. CONTACT INFORMATION
Oregon Department of Human Services – Developmental Disabilities Services (DDS)
Website: https://www.oregon.gov/dhs/DD
Oregon Health Authority (OHA)
Website: https://www.oregon.gov/oha
Oregon Health Plan Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON HABILITATION SERVICES PROVIDER
WCG guides habilitation providers in Oregon to establish fully compliant, person-centered service programs for individuals with developmental disabilities.
Scope of Work:
Business formation, Medicaid enrollment, and DDS provider certification
Habilitation Services Policy Manual development
ISP and skill-tracking documentation templates
Staff credentialing logs and training checklists
Risk mitigation and safety planning materials
Referral-building strategies and CDDP partnership support
Billing system setup and audit readiness protocols
Adult Health
ADULT HEALTH SERVICES PROVIDER IN OREGON
DELIVERING INTEGRATED MEDICAL AND PERSONAL SUPPORT SERVICES TO PROMOTE WELL-BEING AND INDEPENDENCE FOR ADULTS ACROSS OREGON
Adult Health Services in Oregon are Medicaid-funded supports that address the complex medical, functional, and supportive care needs of adults with disabilities, chronic conditions, and age-related limitations. These services aim to help individuals maintain their health and independence in their homes or community settings, and they are provided through the Oregon Health Plan (OHP), K Plan (1915(k)), and several Home and Community-Based Services (HCBS) waivers administered by the Oregon Department of Human Services (ODHS).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD)
Role: Manages and authorizes adult health services through local APD offices and Area Agencies on Aging (AAAs).
Agency: Oregon Health Authority (OHA)
Role: Oversees Medicaid provider enrollment and policy compliance through the Oregon Health Plan (OHP).
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon’s Medicaid and HCBS programs meet federal regulations and guidelines.
Agency: Oregon Secretary of State (SOS)
Role: Registers provider businesses and manages corporate compliance.
2. ADULT HEALTH SERVICES OVERVIEW
Adult Health Services include both skilled and non-skilled care delivered in the client’s home or community, with a focus on chronic condition management, daily assistance, and preventative care.
Approved providers may deliver:
Skilled Nursing Services: Medication administration, wound care, health monitoring, and chronic disease management.
Personal Care Services: Assistance with activities of daily living (ADLs), such as bathing, toileting, and dressing.
Health Monitoring: Routine vitals, symptoms tracking, and health documentation.
Medication Management: Administration, reminders, and medication education.
Nutrition Assistance: Meal planning, feeding support, and special diet preparation.
Therapeutic Services (optional): Physical, occupational, or speech therapy as authorized.
Care Coordination: Development and implementation of individualized care plans.
Adult Day Health (optional): Daytime supervision, wellness checks, and social engagement in licensed settings.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll with Oregon Medicaid via the OHA Provider Portal.
If providing skilled services, acquire licensure for home health or nursing through the Oregon State Board of Nursing (OSBN) or Oregon Health Authority (OHA).
Obtain necessary facility licensing if operating an adult day health center.
Maintain general liability, workers’ comp, and malpractice insurance (if applicable).
Develop an Adult Health Services Policy & Procedure Manual in alignment with OARs and Medicaid standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity and acquire EIN, NPI, and insurance.
Step 2: Submit your Medicaid provider application via the Oregon Health Plan Provider Portal.
Step 3: For skilled services or facilities, apply for licensure through OHA or OSBN.
Step 4: Complete readiness review, staff onboarding, and documentation submission.
Step 5: Receive approval and begin accepting service authorizations and referrals.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (general, workers’ comp, malpractice if applicable)
State-issued healthcare facility licenses (if required)
Adult Health Services Policy & Procedure Manual including:
Care plan development and review procedures
Medication management and safety protocols
Personal care delivery and documentation guidelines
HIPAA compliance and client rights statements
Incident reporting and risk mitigation plans
Quality assurance processes and review schedules
Medicaid billing forms, logs, and EVV records
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN) / Clinical Supervisor
Requirements: Active Oregon nursing license; responsible for clinical oversight, care planning, and staff training.
Role: Certified Nursing Assistant (CNA) / Home Health Aide / Personal Care Aide
Requirements: Background check, CPR/First Aid, relevant certification or training per service model.
Role: Program Coordinator
Requirements: Supervises service delivery, compliance tracking, and staff performance.
Role: Therapists (optional)
Requirements: Licensed PT, OT, or SLP if providing therapeutic services.
All staff must complete:
HIPAA and confidentiality training
Abuse prevention and incident reporting
Documentation and Medicaid compliance modules
Annual performance reviews and refresher training
7. MEDICAID WAIVER PROGRAMS
Adult Health Services are delivered through:
K Plan (1915(k)): In-home nursing and personal care support for individuals with ADL/IADL needs.
APD HCBS Waivers: Provide skilled and unskilled services for older adults and individuals with physical disabilities.
State Plan Home Health Benefit: Skilled services prescribed by a physician and authorized through OHP.
Living Choices & Transition Services: For adults leaving institutional settings who need care in the community.
Children’s Medically Fragile Programs (if applicable): Home health services for individuals aging out of pediatric systems.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Clinical Licensing
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Activation & Service Delivery
Timeline: Begins once authorizations and contracts are approved
9. CONTACT INFORMATION
Oregon Health Authority – Medicaid Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Oregon Department of Human Services – Aging and People with Disabilities (APD)
Website: https://www.oregon.gov/dhs
Oregon State Board of Nursing (OSBN)
Website: https://www.oregon.gov/osbn
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON ADULT HEALTH SERVICES PROVIDER
WCG helps providers across Oregon launch fully compliant, client-centered Adult Health Service programs by offering:
Scope of Work:
Business formation, Medicaid enrollment, and OSBN/OHA licensure navigation
Custom Adult Health Policy & Procedure Manual development
Staff onboarding plans, credentialing trackers, and compliance logs
Medication documentation templates and shift note systems
EVV setup and Medicaid billing support
Referral network building with hospitals, case managers, and APD offices
Audit readiness planning and incident response documentation
Assistive Technology
ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN OREGON
ENABLING GREATER INDEPENDENCE, ACCESSIBILITY, AND SAFETY FOR OREGONIANS THROUGH INNOVATIVE TECHNOLOGY SOLUTIONS
Assistive Technology (AT) Services in Oregon are Medicaid-funded supports that provide individuals with disabilities or chronic conditions access to devices, equipment, and technology-related services that increase functional independence in their daily lives. These services include both the provision of AT devices (e.g., mobility aids, communication tools, environmental controls) and the customization, training, or maintenance of those devices. AT Services are authorized through the Oregon Health Plan (Medicaid) and delivered under multiple Home and Community-Based Services (HCBS) waivers and the K Plan (Community First Choice Option).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities (DD)
Role: Approves and authorizes AT services via local service coordinators or case managers.
Agency: Oregon Health Authority (OHA)
Role: Oversees Oregon Medicaid (OHP) and manages provider enrollment, funding, and compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon’s Medicaid HCBS and K Plan services meet federal standards, including assistive technology provisions.
Agency: Oregon Secretary of State (SOS)
Role: Registers provider businesses operating in Oregon.
2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW
AT Services help individuals acquire, retain, or improve their ability to perform daily activities at home or in the community. Services can include device procurement, customization, repair, installation, and user training.
Approved providers may deliver:
Device Selection & Procurement: Identifying and ordering AT that meets the client’s functional needs.
Installation & Setup: Ensuring devices are safely and properly configured in the home or community setting.
Customization & Programming: Modifying AT for individual preferences (e.g., voice commands, mobility access).
Training & Coaching: Teaching individuals and caregivers how to use AT effectively.
Repair & Maintenance: Troubleshooting, replacing parts, and servicing equipment.
Environmental Accessibility Solutions: Smart home devices, switches, alarms, and remote controls for safety and independence.
Documentation & Reporting: Progress notes, equipment logs, service plans, and billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider via the Oregon Health Plan Provider Portal.
Meet ODHS/DD approval requirements for AT service vendors.
Carry general liability and workers’ comp insurance.
Develop an Assistive Technology Services Policy & Procedure Manual aligned with Oregon Medicaid expectations.
If operating as a Durable Medical Equipment (DME) provider, you may also require accreditation (e.g., through CHAP or ACHC) and licensing via the Oregon Board of Pharmacy (for some devices with medical components).
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your LLC or corporation and obtain EIN/NPI and insurance.
Step 2: Complete provider enrollment through the OHP Provider Portal.
Step 3: Submit required documentation, including service types, coverage areas, and qualifications.
Step 4: Coordinate with ODHS/APD or DD to become an approved AT provider for relevant waivers.
Step 5: Start accepting client referrals and authorizations from service coordinators.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI documentation
Liability and workers’ compensation insurance
AT Policy & Procedure Manual, including:
AT assessment and recommendation process
Device tracking and inventory systems
Installation and safety guidelines
Client and caregiver training protocols
Incident and service failure reporting
Maintenance, warranty, and replacement procedures
Billing and documentation templates
HIPAA compliance and participant rights safeguards
6. STAFFING REQUIREMENTS
Role: Assistive Technology Specialist / Technician
Requirements: Background check, technical knowledge in AT and DME; may require certifications (e.g., RESNA ATP credential preferred).
Role: Program Coordinator / Service Planner
Requirements: Coordinates services, ensures compliance, oversees billing and staff supervision.
Role: Licensed Clinical Professional (optional, for evaluations)
Requirements: OT, PT, or Speech-Language Pathologist (SLP) licensed in Oregon; often required for AT assessments.
All staff must complete:
HIPAA, client safety, and documentation training
Equipment-specific onboarding and safety protocols
Emergency planning, environmental modification awareness
Annual review and credentialing updates
7. MEDICAID WAIVER PROGRAMS
Assistive Technology is authorized under:
K Plan (Community First Choice, 1915(k)) – broad AT access for individuals needing ADL/IADL supports.
APD Waivers – for seniors and adults with physical disabilities needing environmental or mobility supports.
DD Waivers (e.g., Comprehensive and Support Services Waivers) – includes AT for individuals with IDD.
Children’s Waiver & Medically Fragile Services – includes pediatric AT such as speech devices and accessible toys.
State Plan OHP Coverage (limited) – for medically necessary durable equipment when prescribed.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & DD/APD Approval
Timeline: 2–3 months
Phase: Equipment Sourcing, Staff Onboarding & Training
Timeline: 30–60 days
Phase: Referral Network Building & Service Activation
Timeline: Begins once authorizations are issued by case managers or service coordinators.
9. CONTACT INFORMATION
Oregon Department of Human Services (ODHS)
Website: https://www.oregon.gov/DHS
ODHS – Developmental Disabilities Services
Website: https://www.oregon.gov/dhs/DD
Oregon Health Authority (OHA)
Website: https://www.oregon.gov/oha
Oregon Health Plan Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON ASSISTIVE TECHNOLOGY PROVIDER
WCG helps AT providers in Oregon launch and scale with full compliance and technical guidance.
Scope of Work:
Business registration, Medicaid enrollment, and policy manual support
DD/APD vendor certification assistance
AT service documentation templates and device tracking logs
Staff credentialing systems and EVV onboarding
Referral pipeline building and partnership development
Medicaid billing setup, quality assurance, and audit preparation
Behavioral Health
BEHAVIORAL SUPPORT SERVICES PROVIDER IN OREGON
PROMOTING SAFETY, STABILITY, AND SKILL-BUILDING FOR INDIVIDUALS THROUGH STRUCTURED BEHAVIORAL INTERVENTIONS
Behavioral Support Services in Oregon are Medicaid-authorized interventions that help individuals with intellectual or developmental disabilities (IDD), mental health conditions, or challenging behaviors achieve greater independence and stability in their homes and communities. These services include functional assessments, behavior support planning, staff training, and ongoing monitoring. Behavioral supports are critical components of Oregon’s Home and Community-Based Services (HCBS) waivers and the K Plan (Community First Choice Option), coordinated through the Oregon Health Plan (OHP).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Developmental Disabilities Services (DDS)
Role: Authorizes Behavioral Support Services via local Community Developmental Disabilities Programs (CDDPs).
Agency: Oregon Health Authority (OHA) – Health Systems Division
Role: Oversees Medicaid compliance and provider enrollment for mental/behavioral health professionals.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance for all Medicaid-funded behavioral support under HCBS and 1915(k) authorities.
Agency: Oregon Secretary of State (SOS) – Corporation Division
Role: Handles business registration for new provider organizations.
2. BEHAVIORAL SUPPORT SERVICES OVERVIEW
These services are designed to reduce challenging behaviors and increase adaptive skills using person-centered, evidence-based practices. Services are individualized based on each person’s behavioral needs and support environment.
Approved providers may deliver:
Functional Behavioral Assessments (FBA): Evaluations of behavior triggers, patterns, and environmental influences.
Behavior Support Plan (BSP) Development: Creating structured plans with proactive strategies, reinforcement systems, and crisis interventions.
Staff & Caregiver Training: Equipping support teams to implement BSPs consistently and safely.
Plan Monitoring & Modification: Ongoing adjustments based on data and client progress.
Direct Behavior Consultation: One-on-one coaching, modeling, or skill-building with individuals and staff.
Crisis Planning: Development of individualized protocols to prevent and respond to behavioral emergencies.
Documentation & Reporting: Daily service logs, progress updates, and Medicaid billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the OHA Provider Portal.
If providing DD Behavioral Services, become certified through ODHS/DD.
For mental/behavioral health professionals, licensing is required through the appropriate Oregon board (e.g., LPC, LCSW, BCBA).
Carry professional liability and workers’ comp insurance.
Develop a Behavioral Support Services Policy & Procedure Manual aligned with Oregon Medicaid and DDS guidelines.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Establish your business entity and acquire EIN, NPI, and insurance.
Step 2: Apply for Medicaid enrollment through the OHA Provider Portal.
Step 3: If serving DD clients, apply for approval through ODHS/DD and connect with local CDDPs.
Step 4: Submit professional credentials and provider background materials.
Step 5: Once authorized, begin receiving referrals and authorizations from support coordinators.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business license
EIN and NPI confirmations
Professional licenses (e.g., BCBA, LCSW, LPC, psychologist)
Liability and workers’ compensation insurance
Behavioral Support Services Policy & Procedure Manual including:
FBA protocols and plan development standards
Crisis and de-escalation procedures
Documentation tools and shift notes
Client rights, confidentiality, and consent policies
Staff training requirements and monitoring systems
Data collection forms and outcome measurement
HIPAA compliance and quality assurance protocols
Medicaid billing formats and compliance checks
6. STAFFING REQUIREMENTS
Role: Behavior Consultant / Behavior Support Professional
Requirements: Advanced degree (master’s or doctoral level); licensed/certified (e.g., BCBA, LCSW, LPC); background check required.
Role: Direct Support Professional (optional)
Requirements: Trained in BSP implementation, crisis prevention, and documentation.
Role: Clinical Supervisor / Program Coordinator
Requirements: Oversees behavior plans, supervises staff, ensures compliance with Medicaid and DDS rules.
All staff must complete:
Person-centered planning training
Functional behavior support principles
HIPAA and client rights education
Abuse prevention and incident reporting
Data collection and documentation protocols
Annual recertification and skills reviews
7. MEDICAID WAIVER PROGRAMS
Behavioral Support Services are authorized under:
Comprehensive & Support Services Waivers (for IDD) – includes BSP development, training, and ongoing consultation.
K Plan (1915(k)) – behavioral services for individuals with high support needs.
Children’s DD Waiver – for families managing behavioral needs at home or school.
Mental Health Wraparound Services – for youth involved in child welfare or juvenile systems.
State Plan Mental Health Services – via coordinated care organizations (CCOs), if licensed professionals are enrolled.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Certification
Timeline: 2–3 months
Phase: Staff Hiring, Licensing & Training
Timeline: 30–60 days
Phase: Referral Coordination & Activation
Timeline: Begins upon approval and connection with case management entities or schools
9. CONTACT INFORMATION
Oregon Department of Human Services – Developmental Disabilities Services (DDS)
Website: https://www.oregon.gov/dhs/DD
Oregon Health Authority – Health Systems Division
Website: https://www.oregon.gov/oha/HSD
Oregon Medicaid Provider Portal (OHA)
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON BEHAVIORAL SUPPORT SERVICES PROVIDER
WCG helps behavior support providers in Oregon design ethical, person-centered services that meet all Medicaid and state standards.
Scope of Work:
Medicaid enrollment, ODHS/DD certification, and policy manual development
Behavior plan templates, data collection tools, and consent forms
Staff credentialing trackers and training outlines
Crisis management procedures and incident response logs
Referral networking with schools, case managers, and CDDPs
Medicaid documentation and audit preparation systems
Quality assurance systems to track outcomes and compliance
Home Modification
HOME MODIFICATION SERVICES PROVIDER IN OREGON
ENHANCING ACCESSIBILITY, FUNCTIONALITY, AND SAFETY THROUGH STRUCTURAL ADAPTATIONS FOR OREGONIANS RECEIVING MEDICAID
Home Modification Services in Oregon are Medicaid-funded supports that allow individuals with disabilities, aging-related conditions, or chronic illnesses to remain safely in their homes by adapting their living environment. These services are essential for promoting independence and preventing institutional placement. Authorized under the Oregon Health Plan (OHP), K Plan (1915(k)), and HCBS Waivers, modifications range from simple safety enhancements to complex construction projects.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Authorizes home modifications through service coordinators and case managers. Coordinates funding approval through local CDDPs, brokerages, and APD offices.
Agency: Oregon Health Authority (OHA)
Role: Oversees Medicaid provider enrollment, funding rules, and program compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and ensures that Oregon’s HCBS programs meet Medicaid standards.
Agency: Oregon Secretary of State (SOS)
Role: Registers and certifies businesses operating in Oregon.
Agency: Oregon Construction Contractors Board (CCB)
Role: Licenses residential and commercial contractors performing structural work.
2. HOME MODIFICATION SERVICES OVERVIEW
These services allow clients to live in a more accessible, safer, and functional home environment, tailored to their physical and health-related needs.
Approved providers may deliver:
ADA Accessibility Modifications: Ramps, widened doors, handrails, and barrier removal.
Bathroom and Kitchen Adaptations: Roll-in showers, grab bars, lowered counters, faucet and cabinet modifications.
Flooring and Threshold Adjustments: Anti-slip flooring, smooth transitions, and level entryways.
Environmental Controls: Installation of switches, smart home tech, alarms, and visual/auditory enhancements.
Structural Enhancements: Stair lifts, ceiling track systems, porch lifts, and emergency exits.
Home Assessments and Estimates: On-site evaluations, contractor coordination, and cost reviews.
Post-Completion Monitoring: Ensuring that modifications meet client needs and Medicaid requirements.
Documentation: Service authorization records, estimates, completion forms, and Medicaid billing logs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain EIN and Type 2 NPI.
Enroll with Oregon Medicaid via the OHA Provider Portal.
Apply as an approved vendor through local CDDPs, APD, or brokerages.
If performing physical construction, obtain contractor licensure via the Oregon Construction Contractors Board (CCB).
Maintain liability insurance, workers’ compensation, and bonding (if applicable).
Develop a Home Modification Services Policy & Procedure Manual tailored to Medicaid guidelines and construction best practices.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your LLC or corporation, secure EIN and NPI.
Step 2: Enroll in the Oregon Health Plan as a Medicaid provider.
Step 3: Apply for vendor status through APD, CDDP, or brokerage offices.
Step 4: If applicable, obtain CCB licensing and verify subcontractor credentials.
Step 5: Submit policy manual, sample estimates, and service flow documentation.
Step 6: Begin receiving service referrals and project authorizations.
5. REQUIRED DOCUMENTATION
Articles of Incorporation
EIN and NPI confirmation
CCB license and bonding documents (for construction)
Business insurance certificates (general liability and workers’ comp)
Medicaid vendor enrollment confirmation
Home Modification Policy & Procedure Manual including:
Assessment and site visit procedures
Safety and ADA compliance standards
Project timeline estimates and authorization process
Change order policies and billing reconciliation
Post-completion review protocols
Client consent forms and complaint resolution processes
HIPAA compliance and privacy safeguards
6. STAFFING REQUIREMENTS
Role: Home Modification Specialist / Project Manager
Requirements: Experience with accessibility design and Medicaid-funded adaptations.
Role: Licensed Contractor / Subcontractor
Requirements: CCB license, construction experience, and background clearance.
Role: Administrative Coordinator
Requirements: Oversees referral intake, billing, vendor logs, and client records.
All staff must complete:
HIPAA and client confidentiality training
Medicaid billing documentation and EVV logging (if applicable)
ADA design standards education (recommended)
Safety and injury prevention procedures
Annual credential renewals and training refreshers
7. MEDICAID WAIVER PROGRAMS
Home Modification Services are available through:
K Plan (1915(k)): Covers accessibility-related modifications to support ADL/IADL performance.
Comprehensive & Support Services Waivers (IDD): Funds home adaptations that allow individuals with IDD to remain at home.
APD HCBS Waivers: For seniors and adults with physical disabilities.
Children’s DD Waiver: Provides home modifications for medically fragile or mobility-limited youth.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Vendor Approval
Timeline: 2–3 months
Phase: CCB Licensing & Contractor Credentialing
Timeline: 30–60 days
Phase: Referral Activation & Project Fulfillment
Timeline: Begins once service authorizations are issued by case managers
9. CONTACT INFORMATION
Oregon Health Authority – Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Oregon Department of Human Services (ODHS)
Website: https://www.oregon.gov/dhs
Oregon Construction Contractors Board (CCB)
Website: https://www.oregon.gov/ccb
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON HOME MODIFICATION PROVIDER
WCG helps providers establish compliant, well-documented home modification programs designed to meet the accessibility needs of Medicaid recipients in Oregon.
Scope of Work:
Business formation, CCB licensing, and Medicaid enrollment
Home Modification Policy & Procedure Manual development
Contractor and vendor credentialing workflows
Authorization tracking tools and estimate templates
Medicaid billing documentation and audit prep materials
Referral relationship building with APD, CDDPs, and brokerages
Project monitoring, satisfaction surveys, and compliance logs
Nursing Facility Transition
NURSING FACILITY TRANSITION SERVICES PROVIDER IN OREGON
SUPPORTING INDIVIDUALS IN SAFELY RETURNING TO COMMUNITY LIVING WITH DIGNITY, CHOICE, AND COMPREHENSIVE SUPPORT
Nursing Facility Transition (NFT) Services in Oregon are Medicaid-funded supports designed to help individuals residing in nursing homes or institutional settings move back into the community. These services assist with care planning, housing navigation, home setup, and coordination of home and community-based services (HCBS). NFT is delivered through Oregon’s Medicaid programs — primarily the Oregon Health Plan (OHP) — under the K Plan (1915(k)), HCBS Waivers, and specialized transition initiatives such as Oregon’s Money Follows the Person (MFP) program.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD)
Role: Manages transition planning, funding approval, and coordination through local offices and transition coordinators.
Agency: Oregon Health Authority (OHA)
Role: Oversees Medicaid administration, provider enrollment, and quality compliance under the Oregon Health Plan.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for transition programs and ensures compliance with Money Follows the Person and HCBS rules.
Agency: Oregon Secretary of State (SOS)
Role: Registers provider businesses operating in Oregon.
2. NURSING FACILITY TRANSITION SERVICES OVERVIEW
NFT Services are designed to help eligible Medicaid beneficiaries transition from institutional care to independent or supported living settings. Providers work closely with discharge planners, case managers, and families to support a safe and sustainable move.
Approved providers may deliver:
Transition Planning & Coordination: Collaborating with facilities and case managers to develop a step-by-step discharge and support plan.
Housing Search & Setup: Identifying appropriate housing options, assisting with applications, and arranging utilities.
One-Time Transition Supports: Purchasing basic furnishings, appliances, and supplies to establish a new home.
Caregiver Training & Family Support: Educating caregivers on service needs, medication management, and safety.
Linkage to HCBS Services: Referring to providers for personal care, homemaker services, nursing, or behavioral supports.
Follow-Up Monitoring: Checking in post-transition to ensure stability and service access.
Documentation: Service plans, purchase logs, visit notes, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the OHA Provider Portal.
Apply for approval as a transition service provider through ODHS/APD.
Carry general liability and workers’ compensation insurance.
Develop a Nursing Facility Transition Policy & Procedure Manual based on state transition standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register business and secure EIN, NPI, and insurance.
Step 2: Apply for Medicaid enrollment via OHP’s Provider Portal.
Step 3: Contact ODHS/APD for transition service approval and staff background checks.
Step 4: Submit your policy manual, transition protocols, and documentation templates.
Step 5: Once approved, coordinate with transition coordinators and begin receiving referrals.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmation
Insurance certificates
ODHS/APD approval
Nursing Facility Transition Policy & Procedure Manual, including:
Discharge and housing planning workflows
Emergency preparedness protocols
Service delivery and documentation guidelines
Staff training policies and coordination checklists
Consent forms and participant rights policies
Item purchase logs and transition tracking forms
Medicaid billing forms and follow-up visit logs
6. STAFFING REQUIREMENTS
Role: Transition Coordinator / Case Manager
Requirements: Background check; training in Medicaid HCBS, housing navigation, and client-centered planning.
Role: Program Supervisor
Requirements: Oversees service quality, monitors outcomes, and liaises with facilities and ODHS.
Role: Support Aides (optional)
Requirements: Assist with move-in setup, shopping, and home preparation.
All staff must complete:
HIPAA and confidentiality training
Abuse prevention and incident reporting
Medicaid documentation protocols
Housing support and safety training
Annual performance reviews and continuing education
7. MEDICAID WAIVER PROGRAMS
NFT Services are funded under:
K Plan (1915(k)) – includes transition planning and one-time setup costs.
APD Waivers – for seniors and adults with physical disabilities transitioning to HCBS.
IDD Waivers (Comprehensive and Support Services) – for individuals with IDD transitioning from institutional or foster care settings.
Money Follows the Person (MFP) Program – special funding initiative for those in facilities 60+ days.
State Plan Medicaid (limited) – may cover basic transition coordination services.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Preparation
Timeline: 1–2 months
Phase: Medicaid Enrollment & ODHS Transition Approval
Timeline: 2–3 months
Phase: Staff Hiring & Training
Timeline: 30–60 days
Phase: Coordination & Referral Readiness
Timeline: Services begin once referral relationships and housing contacts are established
9. CONTACT INFORMATION
Oregon Department of Human Services – APD Transition Services
Website: https://www.oregon.gov/dhs
Oregon Health Authority – Medicaid Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS) – MFP Resources
Website: https://www.medicaid.gov/medicaid/ltss/money-follows-person/index.html
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON NURSING FACILITY TRANSITION PROVIDER
WCG supports NFT providers in Oregon by helping them build high-impact, compliant programs that reconnect individuals with community life.
Scope of Work:
Business registration, OHP enrollment, and ODHS onboarding
Transition services policy manual and discharge workflow templates
Housing coordination forms, shopping checklists, and move-in protocols
Staff credentialing tools and training plans
Medicaid documentation templates and billing forms
Referral-building strategies with facilities and discharge planners
Post-transition monitoring logs and quality tracking systems
Community Integration
COMMUNITY INTEGRATION SERVICES PROVIDER IN OREGON
SUPPORTING SOCIAL INCLUSION, SKILL DEVELOPMENT, AND MEANINGFUL PARTICIPATION IN COMMUNITY LIFE FOR INDIVIDUALS WITH DISABILITIES
Community Integration Services in Oregon are Medicaid-funded supports that promote full participation in everyday community activities for individuals with intellectual and developmental disabilities (IDD), physical disabilities, or aging-related limitations. These services are a core component of Oregon’s Home and Community-Based Services (HCBS) Waivers and the K Plan (1915(k)) under the Oregon Health Plan (OHP). Community integration focuses on helping individuals build relationships, access resources, and engage in volunteer, recreational, educational, or cultural opportunities.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Developmental Disabilities Services (DDS), Aging and People with Disabilities (APD)
Role: Approves and monitors providers, authorizes services through local CDDPs, brokerages, or APD case managers.
Agency: Oregon Health Authority (OHA)
Role: Oversees Medicaid enrollment and ensures services comply with the Oregon Health Plan (OHP) standards.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon’s waiver and K Plan services meet federal Medicaid guidelines.
Agency: Oregon Secretary of State (SOS)
Role: Registers legal entities operating as providers in Oregon.
2. COMMUNITY INTEGRATION SERVICES OVERVIEW
These services help individuals connect with and actively participate in their communities. Supports are tailored to individual goals and designed to reduce isolation, build social capital, and foster greater independence.
Approved providers may deliver:
Community Mapping & Access Planning: Identifying resources and activities aligned with individual interests.
Social Skills Development: Coaching on communication, interaction, and navigating public settings.
Volunteer & Civic Engagement: Assisting with finding and maintaining volunteer roles.
Recreational Activities: Support to attend cultural events, parks, fitness centers, or faith-based activities.
Travel Training: Teaching individuals how to use public transportation or navigate travel routes.
Safety & Independence Coaching: Guidance on street safety, social boundaries, and emergency preparedness.
Documentation & Progress Tracking: Activity logs, outcome tracking, and Medicaid-compliant reporting.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain EIN from the IRS and a Type 2 NPI.
Enroll with Oregon Medicaid through the OHA Provider Portal.
Apply for approval through ODHS/DD or APD, depending on your service population.
Maintain general liability insurance and workers’ compensation coverage.
Develop a Community Integration Services Policy & Procedure Manual in compliance with Oregon Administrative Rules (OARs).
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and secure EIN/NPI and insurance.
Step 2: Apply as a Medicaid provider via the OHA Provider Portal.
Step 3: Submit a vendor application to your local CDDP, brokerage, or APD office.
Step 4: Complete required background checks and staff training certifications.
Step 5: Once approved, begin receiving service authorizations and referrals.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI documentation
Liability and workers’ compensation insurance
ODHS/DD or APD vendor approval
Community Integration Policy & Procedure Manual including:
Activity planning and risk assessment procedures
Transportation and supervision policies
Participant choice and rights documentation
Daily documentation forms and service logs
Emergency protocols and safety guidelines
HIPAA compliance and grievance reporting
Medicaid billing templates and progress tracking tools
6. STAFFING REQUIREMENTS
Role: Community Integration Specialist / Direct Support Professional (DSP)
Requirements: Background check, training in person-centered planning, safety, and communication strategies.
Role: Program Coordinator
Requirements: Oversees staffing, schedules, documentation, and compliance.
All staff must complete:
Abuse prevention and mandatory reporting training
HIPAA and confidentiality modules
Activity safety and behavior support training (as needed)
Annual training updates and documentation refreshers
7. MEDICAID WAIVER PROGRAMS
Community Integration Services are authorized through:
Comprehensive Waiver (IDD): Includes extensive community-based supports for individuals with complex needs.
Support Services Waiver (IDD): For individuals living independently or with families.
K Plan (1915(k)): Covers ADL/IADL-related community access for eligible participants.
APD Waivers: Community-based supports for aging adults and individuals with physical disabilities.
Children’s DD Waiver: Community participation supports for youth with developmental disabilities.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & ODHS Approval
Timeline: 2–3 months
Phase: Staff Hiring, Background Checks & Training
Timeline: 30–60 days
Phase: Service Activation & Referral Coordination
Timeline: Begins once vendor status is confirmed and referrals are received
9. CONTACT INFORMATION
Oregon Department of Human Services – DD & APD Programs
Website: https://www.oregon.gov/dhs
Oregon Health Authority – Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON COMMUNITY INTEGRATION PROVIDER
WCG helps new Community Integration providers in Oregon develop robust, person-centered programs that connect individuals with meaningful opportunities in the community.
Scope of Work:
Business registration and Medicaid enrollment support
Custom Community Integration Policy & Procedure Manual
Activity tracking forms, progress notes, and outcome logs
Staff onboarding materials and credentialing checklists
Risk mitigation plans and transportation safety policies
Referral development with case managers and community partners
Audit readiness systems and documentation quality assurance
Adult Family Home
ADULT FAMILY HOME SERVICES PROVIDER IN OREGON
PROVIDING PERSONALIZED, ROUND-THE-CLOCK SUPPORT IN A SAFE, FAMILY-LIKE ENVIRONMENT FOR ADULTS WITH DISABILITIES OR AGE-RELATED NEEDS
Adult Family Home Services in Oregon offer Medicaid-funded residential support in a small, community-based home setting for adults with intellectual and developmental disabilities (IDD), physical disabilities, or age-related conditions. These services are delivered by certified providers in their own homes or designated residences, offering an alternative to institutional care. Services are designed to promote independence, inclusion, and health while maintaining a nurturing, family-like atmosphere. Adult Family Homes are authorized under Oregon’s HCBS Waivers and the K Plan (1915(k)) through the Oregon Health Plan (OHP).
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Certifies and oversees Adult Family Homes through local APD offices and Community Developmental Disabilities Programs (CDDPs).
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan and Medicaid enrollment systems.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Medicaid-funded residential services meet federal HCBS requirements.
Agency: Oregon Secretary of State (SOS)
Role: Handles legal registration of provider entities operating in Oregon.
2. ADULT FAMILY HOME SERVICES OVERVIEW
These services offer 24/7 individualized care, supervision, and skill-building in a home with one or more residents, typically limited to five or fewer individuals per home.
Approved providers may deliver:
Personal Care Support: Assistance with bathing, dressing, grooming, eating, and toileting.
Medication Administration: Prompting, administering, and documenting medication use.
Meal Preparation & Nutrition: Planning, cooking, and accommodating special dietary needs.
Health Monitoring: Observing health changes and coordinating with healthcare providers.
Community Engagement: Supporting access to community events, religious services, or day programs.
Habilitation & Skill Development: Teaching daily living skills and supporting behavioral goals.
Documentation: Daily notes, incident logs, ISP tracking, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Be at least 21 years old and reside in Oregon.
Complete required training through ODHS or DDS depending on target population.
Submit an application for Adult Foster Home or Host Home certification.
Pass a background check and home inspection.
Maintain general liability and homeowners/renters insurance.
Develop a Resident Care and Services Policy & Procedure Manual aligned with state and federal standards.
For Host Homes (serving IDD clients), additional requirements may include enhanced behavior training and coordination with Support Service Brokerages.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your business entity with the Oregon Secretary of State (if billing Medicaid as a business).
Step 2: Complete the Adult Foster Home or Host Home application through ODHS or DDS.
Step 3: Undergo pre-service training, background checks, and CPR/First Aid certification.
Step 4: Pass home inspection and environmental safety review.
Step 5: Receive certification and begin receiving client referrals from case managers or brokerages.
5. REQUIRED DOCUMENTATION
Completed ODHS Adult Foster Home or DDS Host Home application
CPR/First Aid and pre-service training certificates
Insurance policies (homeowner/renter and liability)
Background check clearance
Resident Care and Services Policy & Procedure Manual including:
Daily routines and support protocols
Medication administration and health tracking
Menu planning and special diet accommodation
Fire safety and emergency evacuation plans
Documentation forms (logs, shift notes, incident reports)
Client rights and grievance processes
Infection control and universal precautions
Billing forms and Medicaid service tracking
6. STAFFING REQUIREMENTS
Role: Adult Family Home Provider
Requirements: Must reside in or oversee the home; complete all required training and certifications.
Role: Alternate Caregiver / Backup Staff (if applicable)
Requirements: Approved by ODHS or DDS; background checked; trained in core care tasks.
All staff or household members age 18+ must complete:
Background checks and abuse prevention training
HIPAA and client confidentiality education
Training in resident rights and person-centered care
Emergency response and fire safety planning
7. MEDICAID WAIVER PROGRAMS
Adult Family Home Services in Oregon are supported through:
APD HCBS Waivers: For older adults and individuals with physical disabilities needing 24-hour residential care.
K Plan (1915(k)): Covers in-home and residential supports for individuals with ADL/IADL needs.
Comprehensive Waiver (IDD): Includes Host Home settings for individuals with intellectual or developmental disabilities.
Support Services Waiver (IDD): Can support individuals receiving Host Home services through brokerages.
Children’s Waiver Programs: In specific cases, foster-style care for youth aging into adult services.
8. TIMELINE TO LAUNCH
Phase: Training, Certification Application, and Home Preparation
Timeline: 1–2 months
Phase: Background Checks, Home Inspection & Compliance Review
Timeline: 1–2 months
Phase: Medicaid Enrollment & Documentation Setup
Timeline: 1 month
Phase: Client Matching & Service Start
Timeline: Begins once certification and referral connections are in place
9. CONTACT INFORMATION
Oregon Department of Human Services – APD & DDS
Website: https://www.oregon.gov/dhs
ODHS – Adult Foster Home Licensing Info
Website: https://www.oregon.gov/dhs/Pages/foster-home-licensing.aspx
Oregon Health Authority – Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON ADULT FAMILY HOME PROVIDER
WCG supports new providers in creating warm, compliant, and high-quality Adult Family Homes across Oregon.
Scope of Work:
Business registration and ODHS/Host Home certification support
Pre-inspection checklists and home readiness walkthroughs
Custom Resident Services Policy & Procedure Manual
Staff and alternate caregiver training trackers
Medicaid documentation templates and care log forms
Referral networking with brokerages, CDDPs, and APD case managers
Ongoing compliance guidance and audit preparation tools
Case Management
CASE MANAGEMENT SERVICES PROVIDER IN OREGON
COORDINATING INDIVIDUALIZED SUPPORTS TO HELP OREGONIANS NAVIGATE MEDICAID WAIVER SERVICES AND ACHIEVE THEIR PERSONAL GOALS
Case Management Services in Oregon are Medicaid-funded supports that assist individuals with disabilities, chronic conditions, and aging-related needs in accessing, coordinating, and monitoring their Home and Community-Based Services (HCBS). Case managers play a central role in person-centered planning, service referrals, and ensuring that individuals receive the right care at the right time. These services are integral to Oregon’s Medicaid programs — including the Oregon Health Plan (OHP), the K Plan, and various HCBS Waivers.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Authorizes and oversees Medicaid case management functions through Area Agencies on Aging (AAAs), Community Developmental Disabilities Programs (CDDPs), and brokerages.
Agency: Oregon Health Authority (OHA)
Role: Administers Medicaid enrollment, quality monitoring, and care coordination systems through the Oregon Health Plan (OHP).
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight of case management services under 1915(c) and 1915(k) authorities.
Agency: Oregon Secretary of State (SOS)
Role: Handles legal registration for case management provider entities.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Management helps individuals understand their options, access services, and remain safely supported at home or in the community. Services are person-centered and include ongoing communication with providers, families, and care teams.
Approved providers may deliver:
Assessment & Eligibility Determination: Functional needs assessments, documentation, and service planning.
Individual Support Plan (ISP) Development: Creating and updating person-centered service plans.
Service Authorization & Referral: Connecting individuals to HCBS providers and ensuring authorizations are in place.
Monitoring & Follow-Up: Ongoing contact with the participant to ensure service effectiveness and safety.
Crisis Planning & Problem-Solving: Responding to urgent needs and coordinating temporary interventions.
Record-Keeping & Reporting: Case notes, progress updates, and Medicaid documentation.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the Oregon Health Plan Provider Portal.
Apply for certification as a case management entity through ODHS (required for operating as a CDDP, brokerage, or contracted entity).
Carry professional liability and workers’ compensation insurance.
Develop a Case Management Policy & Procedure Manual in alignment with Oregon Administrative Rules (OARs) and CMS guidance.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and acquire EIN, NPI, and insurance.
Step 2: Enroll as a Medicaid provider through OHA’s Provider Portal.
Step 3: Submit an application for ODHS/DD or APD case management certification (depending on population served).
Step 4: Provide resumes, credentials, and training records for qualified staff.
Step 5: After approval, begin receiving referrals or entering into service coordination contracts.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (liability and workers’ comp)
Case Management Policy & Procedure Manual including:
Assessment protocols and eligibility verification
ISP development workflows
Referral and authorization tracking
Risk mitigation and emergency protocols
Participant rights and consent procedures
Documentation standards and progress note templates
Incident reporting and grievance resolution
Quality assurance and utilization review policies
6. STAFFING REQUIREMENTS
Role: Case Manager / Service Coordinator
Requirements: Bachelor’s degree in social work, human services, or related field; experience with Medicaid programs and person-centered planning; background check.
Role: Program Supervisor / Quality Coordinator
Requirements: Oversees caseload distribution, documentation quality, and training; often holds an advanced degree or clinical license.
Role: Administrative Support (optional)
Requirements: Manages intake paperwork, records management, and communication logs.
All staff must complete:
ODHS-required core training
HIPAA and participant confidentiality training
Person-centered planning and documentation procedures
Mandatory reporter and abuse prevention training
Annual training updates and supervisory evaluations
7. MEDICAID WAIVER PROGRAMS
Case Management Services are authorized through:
K Plan (1915(k)): Ongoing case management for individuals with significant functional needs.
Comprehensive & Support Services Waivers (IDD): Includes ISP planning, service monitoring, and outcomes tracking.
APD HCBS Waivers: For older adults and people with physical disabilities needing coordinated in-home support.
Children’s DD Waiver: Case coordination for children with intellectual and developmental disabilities.
Money Follows the Person (MFP): Transition case management for individuals leaving nursing facilities.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & ODHS Certification
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Partnerships & Case Assignment
Timeline: Begins upon certification and case management contract approval
9. CONTACT INFORMATION
Oregon Department of Human Services – Case Management Oversight
Website: https://www.oregon.gov/dhs
Oregon Health Authority – Medicaid Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON CASE MANAGEMENT PROVIDER
WCG helps launch high-integrity, compliant case management organizations that support individuals across Oregon’s Medicaid HCBS programs.
Scope of Work:
Business formation, Medicaid enrollment, and ODHS certification navigation
Case Management Policy & Procedure Manual development
ISP templates, service tracking tools, and contact logs
Staff onboarding checklists and training records
Referral-building strategies with CDDPs, brokerages, and APD offices
Medicaid documentation templates and audit preparation guides
Incident reporting and client satisfaction tracking systems
Transportation Services
TRANSPORTATION SERVICES PROVIDER IN OREGON
HELPING MEDICAID MEMBERS ACCESS HEALTH CARE, WORK, AND COMMUNITY LIFE THROUGH SAFE, RELIABLE TRANSPORTATION SOLUTIONS
Transportation Services in Oregon are Medicaid-funded supports that enable individuals with disabilities, chronic health conditions, and other mobility limitations to attend medical appointments, day programs, work, and other community-based activities. These services are a key component of Home and Community-Based Services (HCBS) and are available through Oregon’s Medicaid program, the Oregon Health Plan (OHP). Providers may deliver both Non-Emergency Medical Transportation (NEMT) and community-based HCBS transportation as authorized by the individual’s plan of care.
1. GOVERNING AGENCIES
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan and oversees Non-Emergency Medical Transportation (NEMT) brokers and Medicaid billing systems.
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Authorizes community-based transportation under HCBS Waivers and the K Plan; partners with local Community Developmental Disabilities Programs (CDDPs) and case managers.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for Medicaid-funded transportation programs.
Agency: Oregon Secretary of State (SOS)
Role: Handles business registration and compliance for transportation providers.
Agency: Oregon Department of Transportation (ODOT)
Role: May regulate vehicle inspections, driver safety standards, and other transportation compliance requirements.
2. TRANSPORTATION SERVICES OVERVIEW
Transportation services help individuals access necessary medical, therapeutic, vocational, and community services — promoting independence and inclusion.
Approved providers may deliver:
Non-Emergency Medical Transportation (NEMT): Rides to Medicaid-covered appointments coordinated through regional brokers.
Community Transportation (HCBS): Transportation to employment, day programs, or community activities as part of an Individual Support Plan (ISP).
One-Way or Round-Trip Services: With scheduled or on-demand routing, based on care plan needs.
Door-to-Door or Curb-to-Curb Support: Based on the participant’s mobility and support level.
Accompanied Transportation (if authorized): Staff or family member rides along to assist during transport.
Driver Support & Documentation: Logging mileage, pick-up/drop-off times, and incident reporting for Medicaid billing.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your transportation business with the Oregon Secretary of State.
Obtain EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid transportation provider via the OHA Provider Portal.
Secure approval through ODHS/DD or APD for HCBS community-based transport.
Meet vehicle and driver requirements set by OHA, ODOT, or contracted brokers.
Obtain commercial auto insurance, general liability, and workers’ comp.
Develop a Transportation Services Policy & Procedure Manual compliant with Medicaid and safety guidelines.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your company and secure EIN/NPI and insurance.
Step 2: Enroll with Oregon Medicaid as an NEMT or HCBS transportation provider.
Step 3: Coordinate with the regional NEMT broker or request approval through local CDDPs or case managers.
Step 4: Complete driver background checks, safety training, and vehicle inspections.
Step 5: Begin accepting ride requests or referrals once authorized.
5. REQUIRED DOCUMENTATION
Business license and Articles of Incorporation
EIN and NPI documentation
Vehicle registration, inspection reports, and insurance certificates
Driver background checks, DMV records, and training logs
Transportation Services Policy & Procedure Manual, including:
Routing and scheduling procedures
Emergency protocols and client safety guidelines
Medicaid documentation and billing templates
HIPAA and confidentiality training for drivers
Vehicle maintenance and cleanliness logs
Passenger rights and incident reporting forms
6. STAFFING REQUIREMENTS
Role: Transportation Driver
Requirements: Valid driver’s license; clean driving record; background check; CPR/First Aid and HIPAA training.
Role: Dispatcher / Scheduler (optional)
Requirements: Manages ride coordination, route efficiency, and client communication.
Role: Program Coordinator / Compliance Manager
Requirements: Oversees Medicaid documentation, billing, and quality control.
All staff must complete:
HIPAA and confidentiality training
Passenger assistance and lift/ramp operation (if applicable)
Defensive driving and incident response procedures
Annual training updates and vehicle safety reviews
7. MEDICAID WAIVER PROGRAMS
Transportation Services are funded through:
K Plan (Community First Choice, 1915(k)): Community-based rides for individuals with ADL/IADL needs.
Comprehensive & Support Services Waivers (IDD): Includes community integration and employment-related transport.
APD HCBS Waivers: In-home and community transport for aging adults and individuals with physical disabilities.
State Plan NEMT Benefit: Administered through OHA-contracted brokers for Medicaid-covered appointments.
Children’s Waivers: May include transport to school-based or therapeutic services.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Broker/Agency Approval
Timeline: 2–3 months
Phase: Driver Hiring, Training & Vehicle Inspection
Timeline: 30–60 days
Phase: Referral Readiness & Ride Coordination
Timeline: Begins once authorizations or contracts are in place
9. CONTACT INFORMATION
Oregon Health Authority – NEMT & Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
ODHS – Aging and People with Disabilities
Website: https://www.oregon.gov/dhs
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
Local NEMT Brokers (e.g., RideToCare, LogistiCare/ModivCare)
Find contact details via https://www.oregon.gov/oha
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON TRANSPORTATION PROVIDER
WCG equips transportation providers in Oregon with the tools, training, and compliance systems needed to launch and grow Medicaid-funded transportation programs.
Scope of Work:
Business registration, Medicaid enrollment, and broker/vendor application support
Custom Transportation Policy & Procedure Manual
Driver hiring templates, credentialing trackers, and training protocols
Vehicle inspection checklists and maintenance logs
Medicaid trip log templates and billing documentation
Referral-building strategies with case managers and broker networks
Emergency procedures and incident documentation systems
Home Health
HOME HEALTH CARE SERVICES PROVIDER IN OREGON
DELIVERING SKILLED NURSING AND THERAPEUTIC CARE TO OREGONIANS IN THE COMFORT OF THEIR HOMES
Home Health Care Services in Oregon are Medicaid-funded medical services provided to individuals who require skilled nursing or therapy care at home due to illness, injury, or disability. These services are aimed at avoiding or reducing institutional care, supporting recovery, and promoting independence. Home Health Care is reimbursed through the Oregon Health Plan (OHP) and may also be delivered under the K Plan (1915(k)) and certain HCBS Waivers for eligible individuals.
1. GOVERNING AGENCIES
Agency: Oregon Health Authority (OHA)
Role: Oversees Oregon Health Plan, Medicaid reimbursement for home health services, and provider enrollment.
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD)
Role: Coordinates referrals and service authorization for Medicaid-eligible adults with medical needs at home.
Agency: Oregon State Board of Nursing (OSBN)
Role: Licenses and regulates nursing staff involved in home health service delivery.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Oregon's Medicaid program complies with federal standards for skilled home care.
Agency: Oregon Secretary of State (SOS)
Role: Registers businesses and legal entities offering home health care.
2. HOME HEALTH CARE SERVICES OVERVIEW
These services involve clinical care prescribed by a physician and delivered in the client’s residence. Providers must meet strict clinical and regulatory standards.
Approved providers may deliver:
Skilled Nursing Services: Wound care, catheter care, IV therapy, health assessments, and disease management.
Home Health Aide Services: Basic personal care under RN supervision, including bathing, dressing, and hygiene.
Physical Therapy (PT): Mobility improvement and rehabilitation after surgery or injury.
Occupational Therapy (OT): Skill development for activities of daily living (ADLs).
Speech Therapy (ST): Communication improvement and swallowing support.
Medical Social Services: Counseling, crisis support, and resource navigation (if authorized).
Care Coordination: Documentation, case review, and communication with the primary care provider.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN and a Type 2 NPI.
Apply for Medicaid provider enrollment through the OHA Provider Portal.
Secure a Home Health Agency License from OHA’s Health Care Regulation and Quality Improvement (HCRQI) section.
Meet staff licensure and accreditation requirements (ACHC, CHAP, or Joint Commission recommended).
Maintain liability, malpractice, and workers’ compensation insurance.
Develop a Home Health Care Policy & Procedure Manual that complies with federal and state standards.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Form your business and obtain EIN, NPI, and appropriate insurance.
Step 2: Apply for your Home Health Agency License through OHA-HCRQI.
Step 3: Submit a Medicaid provider application via the Oregon Health Plan Provider Portal.
Step 4: Complete agency inspection, policy review, and credentialing process.
Step 5: Begin accepting referrals once approved and authorized.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
OHA-issued Home Health Agency License
Accreditation certificate (if obtained)
Proof of insurance coverage (liability, workers’ comp, malpractice)
Home Health Care Services Policy & Procedure Manual including:
Nursing and therapy care delivery protocols
Infection control and universal precautions
Medication management and administration policies
Staff supervision and evaluation systems
Emergency preparedness and disaster plans
HIPAA compliance and client rights materials
Physician order tracking and visit documentation
Medicaid billing formats and progress notes
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN) / Case Manager
Requirements: Active Oregon nursing license; oversees care plans, performs assessments, and supervises aides.
Role: Home Health Aide (HHA)
Requirements: Certification or competency evaluation; works under RN supervision; trained in ADL support.
Role: Physical, Occupational, or Speech Therapist
Requirements: Licensed in Oregon; provides therapy per physician order and plan of care.
Role: Medical Social Worker (if applicable)
Requirements: Licensed MSW; provides supportive counseling and social service coordination.
All staff must complete:
HIPAA and patient rights training
CPR/First Aid and infection control education
Documentation, visit logging, and billing compliance training
Annual skills verification and continuing education
7. MEDICAID WAIVER PROGRAMS
Home Health Services are authorized through:
State Plan Home Health Benefit: Requires physician order and prior authorization for eligible OHP members.
K Plan (1915(k)): May cover additional personal care and nursing support needs.
APD HCBS Waivers: For individuals needing skilled home care to avoid nursing facility placement.
Children’s and Medically Fragile Waivers: Covers pediatric home nursing and therapy services.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Development
Timeline: 1–2 months
Phase: OHA Licensing & Medicaid Enrollment
Timeline: 3–4 months (may vary depending on licensing inspections)
Phase: Staff Hiring, Credentialing & Accreditation (optional)
Timeline: 30–60 days
Phase: Service Launch & Referral Network Building
Timeline: Begins once licensure and Medicaid approval are complete
9. CONTACT INFORMATION
Oregon Health Authority – Health Care Regulation and Quality Improvement (HCRQI)
Website: https://www.oregon.gov/oha
Oregon Health Authority – Medicaid Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Oregon State Board of Nursing (OSBN)
Website: https://www.oregon.gov/osbn
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON HOME HEALTH CARE PROVIDER
WCG assists Home Health providers in Oregon with launching high-quality, clinically compliant programs that meet the demands of Medicaid and home-based patient care.
Scope of Work:
Business formation, OHA licensure, and Medicaid enrollment
Custom Home Health Policy & Procedure Manual creation
Credentialing systems and staff documentation logs
Nursing visit templates, physician order tracking, and billing tools
Referral development with hospitals, physicians, and case managers
Audit readiness materials and compliance review checklists
Meal & Nutrition
MEAL AND NUTRITION SERVICES PROVIDER IN OREGON
DELIVERING NUTRITIOUS MEALS AND DIETARY SUPPORT TO PROMOTE HEALTH, INDEPENDENCE, AND QUALITY OF LIFE FOR OREGONIANS AT HOME AND IN THE COMMUNITY
Meal and Nutrition Services in Oregon are Medicaid-funded supports that ensure individuals with disabilities, chronic illnesses, or age-related conditions receive appropriate nutrition to support their health and independence. These services may include meal planning, preparation, delivery, and dietary counseling based on the individual's medical needs and functional limitations. Services are authorized through the Oregon Health Plan (OHP), the K Plan (1915(k)), and various HCBS Waivers.
1. GOVERNING AGENCIES
Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)
Role: Authorizes nutrition-related services through local case managers, CDDPs, or brokerages.
Agency: Oregon Health Authority (OHA)
Role: Administers the Oregon Health Plan and processes Medicaid provider enrollment.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance of Medicaid-funded nutrition services under 1915(c) and 1915(k) authorities.
Agency: Oregon Secretary of State (SOS)
Role: Handles business registration for new meal service or dietary support providers.
2. MEAL AND NUTRITION SERVICES OVERVIEW
These services support individuals who cannot safely or consistently prepare nutritious meals themselves due to disability, chronic illness, or age-related conditions.
Approved providers may deliver:
Meal Preparation: Cooking meals in-home for clients, following dietary guidelines or doctor’s orders.
Meal Delivery (Home-Delivered Meals): Providing hot or frozen meals to clients unable to shop or prepare food.
Menu Planning: Creating customized meal plans that meet the individual’s dietary needs and cultural preferences.
Nutrition Education: Teaching clients or caregivers how to maintain healthy diets and prevent malnutrition.
Dietary Counseling (optional): One-on-one sessions with a registered dietitian for clients with complex dietary conditions.
Documentation: Meal logs, dietary assessments, delivery confirmations, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the Oregon Health Plan Provider Portal.
If offering therapeutic diets or nutrition counseling, secure credentials as a licensed Dietitian/Nutritionist through the Oregon Board of Licensed Dietitians.
For meal production or delivery, comply with Oregon Health Authority food safety regulations (including commercial kitchen requirements if applicable).
Maintain general liability and workers’ compensation insurance.
Develop a Meal and Nutrition Services Policy & Procedure Manual consistent with OHA and ODHS expectations.
4. OREGON PROVIDER ENROLLMENT PROCESS
Step 1: Register your business, obtain EIN, NPI, and proper insurance.
Step 2: Apply for Medicaid provider enrollment through OHA’s portal.
Step 3: Submit documentation of food safety compliance and licensure (if applicable).
Step 4: Become an approved vendor with local case management entities (CDDPs, APD, or brokerages).
Step 5: Begin receiving referrals and service authorizations.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Food handler’s license or kitchen certification (as applicable)
Dietitian or nutritionist license (for clinical services)
Insurance certificates
Meal and Nutrition Policy & Procedure Manual including:
Meal planning and preparation protocols
Menu development and dietary modification procedures
Delivery, tracking, and client safety checks
Food storage, handling, and sanitation practices
Client rights and cultural dietary accommodations
Documentation templates and billing forms
HIPAA compliance and confidentiality safeguards
Emergency preparedness and missed delivery plans
6. STAFFING REQUIREMENTS
Role: Meal Preparer / Delivery Driver
Requirements: Food handler’s permit; background check; trained in safe food transport and client interaction.
Role: Registered Dietitian / Nutritionist (optional)
Requirements: Oregon licensure; provides clinical nutrition assessments and education.
Role: Program Coordinator / Scheduler
Requirements: Manages menus, delivery routes, documentation, and client communication.
All staff must complete:
HIPAA and abuse prevention training
Food safety and sanitation education
Emergency response and client safety protocols
Cultural competency and disability awareness training
7. MEDICAID WAIVER PROGRAMS
Meal and Nutrition Services are available through:
K Plan (1915(k)): Covers in-home meal preparation and sometimes home-delivered meals.
APD HCBS Waivers: Provides meals for older adults or those with physical disabilities who cannot prepare food.
Comprehensive & Support Services Waivers (IDD): Offers in-home meal prep and training on independent nutrition.
Children’s DD Waiver: May include nutrition education and caregiver meal assistance.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & Food Safety Certification
Timeline: 2–3 months
Phase: Staff Hiring, Licensing & Route Setup
Timeline: 30–60 days
Phase: Referral Coordination & Meal Service Launch
Timeline: Begins upon approval and authorization
9. CONTACT INFORMATION
Oregon Health Authority – Medicaid Provider Enrollment
Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx
Oregon Department of Human Services – APD & DD Services
Website: https://www.oregon.gov/dhs
Oregon Health Authority – Food Safety Program
Website: https://www.oregon.gov/oha/PH/HealthyEnvironments/FoodSafety
Oregon Board of Licensed Dietitians
Website: https://www.oregon.gov/oha
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON MEAL & NUTRITION PROVIDER
WCG helps new Meal and Nutrition Service providers in Oregon build compliant, efficient programs that meet the dietary needs of vulnerable populations.
Scope of Work:
Business registration and Medicaid enrollment assistance
Food safety certification guidance and commercial kitchen setup
Customized Meal and Nutrition Policy & Procedure Manual
Meal delivery tracking logs and route planning templates
Dietitian credentialing support and documentation systems
Referral-building strategies with CDDPs, brokerages, and APD offices
Medicaid billing systems and compliance checklists
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.