HOME AND COMMUNITY-BASED SERVICES (HCBS) PROVIDER IN OREGON

Fatumata Kaba
Oct 6
4 min read

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 encompasses 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

Oregon Home and Community-Based Services Provider

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: