Office of Developmental Disabilities Services / Notification of Planned Action
This Notice amends a previous notice.
Date of notice: / Effective date of planned action:
Individual’s date of birth: / Individual’s prime number:
City: / State: / ZIP code:
Legal guardian’s name(if applicable):
The purpose of this Notification is to inform you of the planned action below.The planned action is based on Oregon Administrative Rulesand the records listed in this Notification. If you disagree with thedecision, you have the right to request a hearing,as provided in ORS chapter 183 and OAR 411-318-0025.For informationon how to request a hearing and the hearing process, see Parts 1–4 on the following pages.
If you have questions, if your situation changes, or if you have relevant records not included below, please contact the person at this agency:
Notification completed by: / Select oneServices CoordinatorPersonal AgentEligibility SpecialistProgram Manager / Other:
Name: / Phone:
Your request for services from the DHS Developmental Disabilities Program has been denied.
Your current services will not change, but yourspecific request for has been denied.
Your services are going to be select onereducedsuspendedterminatedvoluntarily reducedvoluntarily suspendedvoluntarily terminated.
Specific services involved: Attendant Care and Skills Training.
Reason for Action
After reviewing the following Oregon Administrative Rules and the records listed below, DHS is taking this action becauseA review of data has showed that service levels determined by the Adult Needs Assessment (ANA) version C functional needs assessment exceeded the number of hours required for an individual to live independently in the community. In response to the legislative direction to the Department found in the 2016 Legislative Session SB5701A Budget Note to align service levels with the needs of individuals and to incorporate appropriate limits. The service level that is determined is based on data that showed service levels determined by the ANA-C exceeded the number of hours required for an individual to live independently. The Department now uses the ANA-D needs assessment that allocates fewer hours for individuals in your situation.
A functional needs assessment was performed on MM/DD/YYYY. This assessment found you to be eligible for yyy hours of Attendant Care/Skills Training. You were previously authorized to receive xxx hours of Attendant Care/Skills Training. The Department has determined on the basis of your functional needs assessment on MM/DD/YYYY that your current amount of xxx hours of Attendant Care and Skills Training exceed what you need to live independently in a community-based setting, and that you only need yyy hours to live independently in a community-based setting. Your service plan is being reduced from XXX to YYY hours per month, effective MM/DD/YYYY..
Relevant Oregon Administrative Rules
The planned action is based on the following OAR(s) (include subsections):
943-001-0020(3); 411-450-0060 (7)(b); 411-450-0020 (2),(3), (14),(21); 411-415-0070 (1)(b)
Oregon Administrative Rules can be found on the website of the Oregon Office of the Secretary of State.
Records Used in the Decision
Typeof record/report/evaluation/ Author
mm/dd/yyyy / ANA-D
Other information and comments:
You have the right to review these records. You can request the records by contacting the person listed on page 1.
Notice of Hearing Rights
- You have the right to challenge this decision by requesting a contested case hearing.Hearings are held by an Administrative Law Judge and the Office of Administrative Hearings, which is independent from DHS. If you want a hearing, you must request a hearing within 90 calendar daysof the date of this Notification.If you are being denied services, see Parts 1, 2 and 4 (below). If your services will be reduced, suspended or terminated, see Parts 1 – 4 (below).
You can request to have an informal discussionabout this Notificationby contacting the local officewhere you receive services (Brokerage, CIIS or CDDP).Aninformal discussionwill not affect your right to a hearing.If you verballyrequest a hearing during the informal discussion, the person you are speaking with can request a hearing for you. If you choose to have an informal discussion, the deadline to request a hearing does not change.
Note to military personnel: Active duty service members have a right to stay these proceedings under the federal service members Civil Relief Act. For more information, you may contact the Oregon State Bar (1-800-452-8260), the Oregon Military Department (1-800-452-7500) or find the nearest military legal assistance office here: (SB125).Part 1 — How do I ask for a hearing?
Ways to request a hearing:
- Fill out an Administrative Hearing Request Form(SDS 0443DD)and send itto: Oregon Developmental Disability Services (ODDS), Attn: Administrative Specialist, 500 Summer St., E-09, Salem OR 97301; or
- Fax an Administrative Hearing Request Form(SDS 0443DD)to503-373-7274; or
- Make a verbal request for a hearing by speaking directly with the person listed on Page 1,your caseworker, or a DHS or ODDS employee.
You can request theform from: / at:
or follow this link:
If you need help filling out this form, call:
at: / .
DHS must receive your request for a hearing within 90 calendar days from the date of this Notification(in the upper left corner on Page 1).If your services are being reduced, suspended, or terminated, you can continue to receive services until a hearing is held and a final order is issued. To receive services until a final order is issued, request a hearing before the ‘effective date of planned action’ on this Notification. See Part 3 for more information on continuing services.
Part 2 — What are my hearing rights?
- What happens after I request a hearing?
- Who can help with my hearing?
- What happens if there is no hearing?
Part 3 — How can I keep getting benefits/services until my hearing?
(This applies only if you currently receive services from the Developmental Disabilities Programand this Notification will terminate, reduce or suspend your services.)
You can ask that your services remain the same until the hearing decision (continuing services). You must request a hearingby the ‘effective date of planned action’ on this Notification in order to receive continuing services.
You may also receive continuing services if you request a hearing and select “yes”on the Hearing Request Form (SDS 0443DD); youmust do thiswithin 10 business days after the effective date of planned action.
If you elect to receive continuing services and you lose the hearing, you may be asked to payfor the services you receive between the effective date of planned action and the date of the Final Order. If you do not want to receive continuing services, select “no” on the Hearing Request Form (SDS 0443DD).
Part 4 — Can I request to have a hearing within five working days?
You may have the right to an “expedited hearing” (within five (5) working days), if you are denied a medical service that creates an immediate, serious threat to your life or health, or if DHS denied your request to continue to receive services until your hearing.
You must request an expedited hearing on the Hearing Request Form (SDS 0443DD).The Department of Human Services (DHS) and the Oregon Health Authority (OHA) do not discriminate against anyone. This means that DHS/OHA will help all who qualify and will not treat anyone differently because of age, race, gender, color, national origin, religion, political beliefs, disability or sexual orientation. If you believe DHS or OHA treated you differently for any of these reasons, you may file a complaint with the Governor’s Advocacy Office by calling 1-800-442-5238, or contacting the office at: Governor’s Advocacy Office, 500 Summer Street NE, E-17, Salem, OR 97301.
Page 1 of 5SDS 0947 (12/2014)