<p> Instruction Manual</p><p>Support Services Basic Supplement Criteria Inventory (BSCI)</p><p>DHS 0203IN Revision (3/11) Basic Supplement Criteria Inventory</p><p>Policy overview and general instructions</p><p>Definition...... 1 Description...... 1 Initial application...... 2 Review and reapplication...... 2 Loss of basic supplement funding...... 2 General instructions...... 3</p><p>Scoring the BSCI</p><p>Questions 1 – 5: Physical and health care supports 1. ADL needs...... 4-6 1.a. Assistance with Daily Living 1.b. Specialized Assistance Needs a) Meals by mouth over 30 minutes b) Perineal care c) Routine enema, digital stimulation or catheterization.</p><p>2. Physical mobility...... 4 2.a. Total dependence on others for all mobility 2.b. Mobility assistance at least 50% of the time 2.c. Total assistance is needed for transfers</p><p>3. Daytime supervision...... 5 3.a. Constant 3.b. Close supervision 3.c. Routine supervision 3.d. Periods longer than an hour </p><p>4. Medical support...... 5 4.a. Specialized task of nursing 4.b. Uncontrolled seizures of a prolonged nature 4.c. Insulin dependent diabetes 4.d. Other life threatening medical condition </p><p>5. Nighttime monitoring and care...... 6</p><p>DHS 0203IN (3/11) Page 2 of 14 Questions 6 – 12: Behavior support and supervision...... 6-8 6. Behaviors that harm self or others...... 6-7 6.a. Behaviors 6.b. Aggression requiring physical intervention 6.c. Injury requiring professional medical attention 6.d. Vulnerable people in the household</p><p>7. Destruction of structures...... 7 8. Damage of furnishings...... 7 8.a. Behavior within the last 3 months 8.b. Behavior within the last 6 months 9. Complex adaptation of routines...... 8 10. Adaptation of home ...... 8 11. Community limiting actions...... 8 12. History of public endangerment...... 8</p><p>Questions 13 – 16; caregiver needs and capacity...... 9-10 13. Single (non-paid) caregiver in-home...... 9 14. Limited caregiver capacity...... 9</p><p>15. Caregiver age...... 10 16. Caregiver responsibilities...... 10 16.a. Child(ren) under the age of 5. 16.b. Others with disabilities over the age of five.</p><p>Addendum: Rules applying to BSCI...... A-C 411-3400-020 Definitions...... A (3) Activities of Daily Living (9) Basic Benefit (10) Basic Supplement (11) Basic Supplement Inventory Criteria (12) Benefit Level (71) Social Benefit</p><p>411-340-0130 Using Support Service Funds to Purchase Supports...... A (1) Use of Support Service Funds in accordance with ISP...... A (2) Goods and services purchased with support service funds (3) Limits of Financial Assistance...... B (4) Exceptions to Basic Benefit Financial Limits (BSCI)</p><p>SPD –PT-10-048 Instruction Change for BSCI with Renewal Signature Page...... C</p><p>DHS 0203IN (3/11) Page 3 of 14 Basic Supplement Criteria Inventory</p><p>Definition: Per OAR411-340-0020 (10): The inventory identifies extraordinary long term needs impacting the health and safety of the individual that may not otherwise be considered in determining level of support need. The inventory gathers information regarding specific categories of information impacting the adequacy of supports for the customer’s individual needs as well as the caregiver’s ability to provide care. The inventory of the individual’s circumstances is completed and scored by the Brokerage providing services for annual support service funds in excess of the Basic Benefit. Long- term support needs are expected to persist the length of time the customer’s Individual Support Plan (ISP) is in effect. The care plan must be in effect a minimum of six (6) months. Description: Basic Supplement Criteria Inventory (BSCI) OAR 411-340-0020(11) defines Basic Supplement Criteria Inventory as “the written inventory of an individual’s circumstances that is completed and scored by the brokerage to determine whether the individual is eligible for a basic supplement.”</p><p>Basic supplement is “an amount of support services funds in excess of the basic benefit to which an individual may have access in order to purchase necessary supports based on demonstration of extraordinary long-term need on the Basic Supplement Criteria Inventory.” Long-term needs are expected to exist at least the duration, if not beyond, the length of time the customer’s Individual Support Plan is in effect and at a minimum of six (6) months. The Inventory asks 16 questions related to long-term health, physical management, behavior supports, caregiver circumstances and caregiver ability to provide care needed by the individual to be healthy and safe and to remain in his/her own home. A score of 60 or greater allows access to mid-level supplement funding benefit level. A score of 81 or greater allows access to the maximum allowable annual benefit level. Benefit levels are defined in the Annual Brokerage Plan Benefit Levels” document developed by Senior’s and People with Disabilities. The conditions and caregiver circumstances identified in the inventory must be identified in the individual’s person centered planning information, Goal Survey and Individual Support Plan. Evaluators are instructed to inform individuals and their families at the time of the assessment that if an individual qualifies for additional funding, those funds must be used to address the conditions and caregiver circumstances identified in the inventory to protect the health and safety of the individual. Basic Supplement funds cannot be used to supplant natural support or supports available from other sources.</p><p>Initial application: An individual or their legal representative can make a request for BSCI at any time. The request should be documented and the BSCI is to be administered within 30 calendar days of the date of the request. The inventory must be administered by the Brokerage Director or an administrative designee who has completed training through Senior’s and People with Disabilities.</p><p>DHS 0203IN (3/11) Page 4 of 14 The Brokerage will send written notice of the results of the Inventory within 45 calendar days of the request. The written notice must include an offer to discuss the findings and information on the appeal rights and process. Appeal rights and process are found in OAR 411-340-0060. Information to complete the inventory should be obtained from 1) personal observation and interview, 2) interview with a family member or other person close to the individual and 3) record review. All methods should be used whenever possible. Settings to be considered in answering inventory questions include home, community and work but only those locations where Brokerage funds are used to provide support through the plan are applicable. Behaviors or circumstances that occur only at school cannot be used to score points on the inventory. Individuals entering Support Services from Children’s Intensive In-Home Supports (CIIS) and other funded services should not experience disruption in services. These individuals will immediately be eligible for administration of the basic Supplement Criteria Inventory. Reviews and reapplication: Annual review of the BSCI is required and must include a review of circumstance and resources to confirm continued need. Verification of the annual review is documented on the signature page of the Customer Goal Survey by the Personal Agent checking the box that the customer has Supplement to Base and by signing that the circumstances and resources have been reviewed. Circumstantial changes with potential implications for the existing benefit level will be referred for a new administration of the Basic Supplemental Criteria Inventory. Individuals who do not qualify for the Supplement to base funding may make a request for re- evaluation at any time. Loss of Basic Supplement Funding: In situations where changes may potentially impact eligibility to the Basic Supplement, the BSCI should be referred immediately for re-administration. If loss of eligibility does occur, the Brokerage will provide the individual and his/her legal representative with written notification of the action to be taken and the appeal rights as stated in OAR 411-340-0060. General instructions: Scoring of all items should be based on observable situations, reported functioning levels and available data. The comment section should be used to provide clear information of how the individual does or does not meet criteria for the given question. No points should be awarded when complete criteria is not met. Behaviors should be scored only once in the most appropriate category unless otherwise specified. Example: The behavior scored on #11 (Community limiting actions) should not be the same behavior which received points on question #6 (Self-injurious or aggressive behavior) or on #12 (History of public endangerment).</p><p>DHS 0203IN (3/11) Page 5 of 14 On multiple choice questions, pick the one item that best describes the individual’s circumstances. An exception is question #6, which allows scoring on more than one option to reach the maximum score of 15 points. The inventory is part of the customer’s program record and is to be completed in ink. Comments are to be recorded in the space provided in order to document information and provide the rationale for the score given. Copies of the completed Inventory are required to be maintained in the individual’s file and sent to the office of Senior’s and People with Disabilities. Inventories may be sent electronically.</p><p>Scoring the BSCI Questions 1 – 5: Physical and health care supports 1. ADL needs 1.a. Assistance with Daily Living: Each applicable ADL receives a score of 5 points for a total possible 20 points. ADLs are defined as requiring constant supervision to eat by mouth, bathe, toilet or dress. The caregiver must be able to intervene immediately and have no other responsibilities during the time. Do not double score for 1 and 4. 1.b. Specialized Assistance Needs: Each applicable item receives a score of 3 points. For inventories completed on or before 9/25/08 points can continue to be given for G, J and NG tube feeding. a) Special Positioning is necessary during or immediately after meals to prevent aspiration or reflux. Do not include positions most people would use to eat such as sitting upright or a position used by the person for most of the day. b) Full assistance to eat and/or drink by mouth means it is necessary to have continual hands on assistance throughout the feeding. c) The individual has complex dietary needs, ordered by a licensed professional requiring extraordinary effort and additional time by the caregiver to weigh, measure and monitor meals. d) The individual requires over 30 minutes to complete meals by mouth using full assistance. e) The individual refuses food and/or fluids on a regular basis to the point that medical intervention is necessary, requiring a physician visit or nurse evaluation for weight loss or potential dehydration. f) The individual requires perineal care and routine changes of incontinence products. The individual is incontinent of bowel and bladder throughout the day and night requiring extraordinary effort by the caregiver on a consistent basis. Do not score when occasional incontinence or enuresis occurs or when wiping only is needed. g) The individual requires routine enema, digital stimulation or catheterization at least weekly. Do not score when the condition is managed through medications, stool softeners, diet or supplements. 2. Physical mobility Definition: The level of assistance needed by others to physically move from one place to another by walking, scooting, wheelchair use walker or other modalities. Points are received for either a or b, whichever best describes the level of need and independence of the individual. Points are received for c only when the need for total assistance for transfers is documented. DHS 0203IN (3/11) Page 6 of 14 2.a. Score 10 points when the individual has total dependence on others for all mobility and requires at least one other person to prevent falls/injury and/or to move a wheelchair. 2.b. Score 7 points when the individual requires assistance at least 50% of the time, may take a few steps or move wheelchair for short distances but there is a history of falls when not and has a history of falls when support is not present. 2.c. When total assistance is needed for transfers, add 3 point if weight is between 60 – 149 or add 7 points if weight is 150 or more.</p><p>3. Daytime supervision Definition: The person is within sight or hearing of the caregiver at all times and the caregiver must be in the same structure. Supervision is required on a daily basis and is necessary due to health and safety issues, to insure the individual is not a danger to self or others, or to prevent damage to surroundings. 3.a. Constant Supervision: score 15 points when supervision is required on a continual basis, outside of normal sleeping hours. The caregiver can rarely leave the room and only for two to three minute intervals. The caregiver must be able to intervene immediately.  OR  3.b. Close Supervision: Score 10 points when caregiver needs to have line of sight or audible proximity to the individual. The individual can be left alone for a maximum of 15 minutes while the caregiver is in another room but caregiver cannot leave the premises.  OR  3.c. Routine Supervision: Score 5 points when the caregiver must have constant knowledge of where the individual is and how he/she is doing. The person can be left alone in a separate room for up to one hour.  OR  3.d. When the person can be left for periods longer than an hour no score is given. 4. Medical support Definition: Medical support refers to life threatening conditions that require a level of extraordinary supervision and support on a frequent and ongoing basis throughout the day to maintain health. The individual is under a physician’s care for the medical condition and requires assistance to monitor and manage the condition, access and to access medical care. Without this frequent treatment and monitoring in the home, the individual is at imminent risk of death. Do not score:  For conditions controlled by the administration of medications.  For conditions that received points in question 1.  Examples of non-qualifying conditions include chronic high blood pressure, high cholesterol, checking coumadin levels, use of an epi-pen and other conditions that do not require frequent and routine caregiver intervention to maintain health. Score only one option listed for a maximum of 15 points regardless of how many statements apply. 4.a. Specialized Task of Nursing: Individual requires feeding through a G, J or NG tube or a specialized task of nursing. Examples include suctioning through a tracheotomy or ventilator care. DO NOT SCORE: tasks the individual can complete him/herself.  OR </p><p>DHS 0203IN (3/11) Page 7 of 14 4.b. Uncontrolled seizures of a prolonged nature within the last 12 months requiring constant supervision to maintain safety. The seizure affects the entire body for longer than 5 minutes before recovery begins and requires treatment by a physician, the need for oxygen, treatment of an injury or emergency service.  OR  4.c. Insulin dependent diabetes requiring glucose monitoring at least once a day. The individual is unable to monitor independently and there is no one living in the home able to manage the insulin.  OR  4.d. Other Life Threatening Medical Condition requiring on-going, intense, monitoring and care. See the definition above before awarding points for this item.</p><p>5. Nighttime monitoring and care Score a maximum of 10 points when due to the person’s disability, intervention is required at least once per might and results in less than 5 hours of uninterrupted sleep between 11 PM and 5 AM for 3 or more nights each week. Interventions may include positioning, medication administration, tube feeding, or behavior management. Clarification of disability related: kicking the blankets off at night would not normally be scored, except where the individual is unable to regulate body temperature due to a disability and intervention is required. A maximum of 57 points is possible for questions 2 – 5.</p><p>Questions 6 – 12: Behavior support and supervision Criterion in this section should not be scored more than one time. Do not score behaviors that received points in Question 11 or 12.</p><p>6. Behaviors that harm self or others Definition: The intensity of behaviors must be severe enough that injury is expected and intervention is required. The actions must significantly impact family functioning as well as the ability of the individual to interact with family, friends and in the community. The ISP must address the behaviors. The plan must reflect consultation or other methods to address behaviors when formal and/or informal behavior management techniques do not keep the individual safe. Do not score:  Self-stimulating behavior that is self regulated or is not reasonably expected to cause injury.  Mouthing objects that are not dangerous or not expected to be swallowed.  Injuries from running tripping, falling or occasionally picking at skin. 6.a. Score points across any of the 5 options that apply for a maximum of 15 points: 15 points for daily behaviors, 10 points for weekly behaviors, 3 points for monthly behaviors and 2 points if behavior occurred within the last 6 months.</p><p>Intentional body, head or limb banging against walls or floors, slapping, hitting poking, cutting/hitting self with objects, placement of foreign objects into body orifices where it is reasonable to assume injury will occur.</p><p>DHS 0203IN (3/11) Page 8 of 14  Darting away without regard for personal safety, requiring, caregiver to hold onto the individual outside the home.  Consumption of non-edible objects, pebbles, string, buttons, plaster, etc. requiring intervention to protect the individual via environmental sweeps and constant vigilance.  Hyperphagia, diagnosed by a physician, that is overwhelming, difficult to control, involves food foraging and compulsive eating, is not controlled by environmental adaptations and requires a focused effort to protect the individual with constant vigilance.  Physical aggression toward others of a nature that is likely to cause significant physical injury. Aggression may include biting, hitting, kicking, head butting, throwing or swinging objects. Hair pulling that causes damage to the scalp, removes several hairs at a time or requires special intervention to release may be scored. Do not score:  Non-physical aggression including verbal threats, or threatening gestures.  Scratches, pinches, bumps, jabs, accidents and /or other unintentional actions. 6.b. Aggression requiring physical intervention for intentional actions within the last 3 months to prevent physical injury. Score 3 points for weight of 60 – 149, score 5 points for weight of 150 or more. 6.c. Injury requiring professional medical attention: Behaviors must be of an intensity likely to cause significant permanent damage as documented by a physician. The behavior is expected to cause catastrophic injury such as ingesting certain objects, pulling out permanent teeth, banging one’s head on hard or sharp surfaces, gouging eyes and/or cutting ones self. Score 6 points when the behavior has occurred within the last 12 months and resulted in a visit to the doctor or emergency room within 24 hours of the incident by the individual or another person. In limited situations where emergency services were needed but not accessed due to circumstances, points may be scored. Examples: Injuries requiring immediate professional medical attention may include fractures, cuts requiring stitches, loss of consciousness due to a head injury, injury to the abdomen, or major burns, damage to the eyes or ears. Sprains and strains that require specific care according to professional medical orders on maintaining bandages, limiting activity or follow-up care may be scored as a major injury when such instructions prevent the exacerbation of the injury. 6.d. Vulnerable people in the household: Vulnerable people are individuals who are unable to defend themselves, have medical conditions that make minor injuries serious or cannot move away from aggressive behavior. Score 5 points for vulnerable people living in the household who are targeted by the individual. Do not score: If the caregiver is paid to provide care and supervision of the vulnerable person though foster care, childcare or Support Services.</p><p>7. Destruction of structures Definition:</p><p>DHS 0203IN (3/11) Page 9 of 14  Destruction is sufficient damage to require repair or replacement because the item is no longer usable. Destruction does not include normal wear, tear, aging or accidents such as a wheelchair bumping into walls.  Structures include windows, walls, carpeting, molding, linoleum, subflooring and built in cabinetry, etc, within a home, community or work setting. Score 6 points if, in the last 6 months, intentional behavior by the individual has destroyed structures within the home, community or work setting. The damage and cause must be listed in the comments.</p><p>8. Damage of furnishings Definition:  Damage is due to intentional behavior and not a result of normal wear and tear, accidents and/or misuse.  Furnishings include appliances, fixtures, window coverings, screens, televisions, VCRs stereos, computers showers, couches, tables, chairs, workbenches, cars, carpet, toilets and tools within a home community or work setting. 8.a. Score 3 points if due to intentional behavior within the last 3 months, furnishings have been damaged. 8.b. Score 2 points if due to intentional behavior within the last 6 months, furnishings have been damaged. 9. Complex adaptation of routines Definition: The need for extensive, complex adaptive routines that consume a significant amount of time throughout the day to prevent aggression or self injurious behavior. Normal daily routines of the family and caregiver are significantly altered to accommodate the individual’s actions. Score 5 points for complex adaptation to routines in response to behaviors where actions would result in injury to self or others without the adaptations. Explain the need and the adaptations in the comments. Do not score for medical or physical adaptations. 10. Adaptation of home Definition: Adaptation of the home must relate directly to identifiable, intentional actions by the individual which risk the safety of self or others. Score 5 points when adaptation of the home is required for the safety of self or others. Explain the need and adaptation in the comments. Examples include locked windows/doors, safety glass, secure fencing, furniture secured to the wall or floor. Do not score for medical or physical adaptations. 11. Community limiting actions Definition: Behaviors that profoundly affect the individual’s or family functioning in the community including screaming, high pitched vocalizations lasting at least 15 minutes or more that are audible to others in the home or community, obsessive-compulsive behavior, smearing feces, touching others inappropriately, or undressing in public.</p><p>DHS 0203IN (3/11) Page 10 of 14 Score 5 points if within the last 3 months, behaviors have profoundly interfered with or limited access to the community or have made it difficult for others to come to the home. Explain how the behaviors are limiting in the comments. Do not score:  For sounds that are easily ignored  If the individual has skills allowing them to be safe in public  If the individual walks away from supervision but looks to see if he/she is being watched or returns independently.  For medical conditions that limit community access such as seizures or one who easily fatigues.  12. History of public endangerment Score 10 points if intentional actions present a clear and present danger to others in the community. Examples include repeated police involvement, stalking, sexual aggression, exposure of genitals, touching self sexually in public, physical assault, intentional arson, use of weapons, gang involvement, etc. A maximum of 60 points is possible for questions 6 – 12.</p><p>Questions 13 – 16: Caregiver needs and capacity</p><p>These questions are based on the primary caregiver‘s need for relief and their capacity and capability to provide care to the family member with a developmental disability. Definition: The primary caregiver is a person in the home, in an unpaid capacity, who performs the majority of the tasks related to care and support of the individual with developmental disabilities. They must be 18 years of age or older with the physical and cognitive capability to provide the care. Paid caregiver is a person who is paid with Support Service funds, including the ADL Supplement. There is an exception for inventories finalized on or before September 26, 2008 where caregivers paid only with the ADL Supplement were scored as non-paid caregivers. This scoring may continue until there is a break in Basic Supplement funding. This impacts questions 13, 14, and 16. 13. Single (non-paid) caregiver in-home Definition  A single caregiver is someone who does not have any other family member within their adult family unit, living within the home capable of providing back up support.  Back up support is someone, 18 years of age, within the adult family unit who is capable of providing relief while the caregiver goes to the store, and/or may provide relief in the evenings or on weekends.  A family member is a husband, wife, domestic partner, natural parent, adoptive parent, child, sibling, adopted child stepparent, stepchild, step-brother, step-sister, father-in-law, mother-in- law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent, grandchild, aunt, uncle, adult niece, nephew, or first cousin.</p><p>DHS 0203IN (3/11) Page 11 of 14 Score 8 points when only one person in the home is physically and cognitively capable of providing needed support. Do not score if there is another adult family member within the family unit capable of providing care.</p><p>14. Limited caregiver capacity Definition: The health and safety of the person with disabilities is at risk or the quality of care may be inadequate.</p><p>Score 20 points when due to the primary caregiver’s long-term (six months or more) illness, disability, size or strength, the primary caregiver is not capable of meeting the physical management, care or supervision needs of the individual and without additional support the individual may not be able to continue to live in the home. Comments must specify the caregiver limitation and how it affects health and safety of the individuals. If the disability of the caregiver is not clear, proof such as a doctor’s statement may be required. Do not score:  If the caregiver is a paid provider  If limitation of caregiver capacity is based on age</p><p>15. Caregiver age Score 10 points if primary caregiver age is 65 to 74. Score 15 points if primary caregiver age is 75 or older.</p><p>16. Caregiver responsibilities Definition: The primary caregiver is responsible for the care, supervision and/or assistance with daily living of one or more individuals due to their youth or disability. 16.a. Score points 5 points for each child under the age of 5. 16.b. Score 10 points for each individual with disabilities over the age of five. Do not score  For individuals for whom the caregiver receives payment through Support Service funds, public or private childcare, foster care or other paid supports.  For individuals for whom the caregiver receives payment through Social Security Administration or an Adoptive Subsidy.</p><p>DHS 0203IN (3/11) Page 12 of 14 </p><p>Addendum 1 </p><p>Rules applying to BSCI</p><p>411-340-0020 Definitions (Amended 7/1/2010) As used in OAR chapter 411, division 340:</p><p>(3) "Activities of Daily Living (ADL)" mean those self-care activities that must be accomplished by an individual for continued well-being including mobility, dressing and grooming, bathing and personal hygiene, toileting, bowel and bladder care, and eating. (9) "Basic Benefit" means the type and amount of support services available to each eligible individual, specifically: (a) Access to the brokerage services listed in OAR 411-340-0120(1); and if required (b) Access to an amount of support services funds used to assist with the purchase of supports listed in OAR 411-340-0130(6). Either: (A) An amount when an individual is a Medicaid recipient and is eligible for, and has chosen to receive, services available through the Support Services Waiver; or (B) An amount of the state's General Fund when an individual is either not eligible for Medicaid or Medicaid waiver services or does not otherwise receive Medicaid benefits. (10) "Basic Supplement" means an amount of support services funds in excess of the basic benefit to which an individual may have access in order to purchase necessary supports based on demonstration of extraordinary long-term need on the Basic Supplement Criteria Inventory, Form DHS 0203. (11) "Basic Supplement Criteria Inventory (Form DHS 0203)" means the written inventory of an individual's circumstances that is completed and scored by the brokerage to determine whether the individual is eligible for a basic supplement. (12) "Benefit Level" means the total annual amount of support service funds for which an individual is eligible. The benefit level includes the basic benefit and any exceptions to the basic benefit financial limits. (71) "Social Benefit" means a service or financial assistance solely intended to assist an individual with a developmental disability to function in society on a level comparable to that of a person who does not have such a developmental disability. 411-340-0130 Using Support Services Funds to Purchase Supports (Amended 7/1/2010) (1) A brokerage may use support services funds to assist individuals to purchase supports in accordance with an ISP when: (a) Supports are necessary for an individual to live in the individual's own home or in the family home; (b) Cost-effective arrangements for obtaining the required supports, applying public, private, formal, and informal resources available to the eligible individual are specified in the ISP; (2) Goods and services purchased with support services funds on behalf of individuals are provided only as social benefits. </p><p>DHS 0203IN (3/11) Page 13 of 14 (3) Limits of financial assistance. Assistance with purchase of individual supports in any plan year is limited to the individual's annual benefit level.</p><p>(4) Exceptions to basic benefit financial limits. Exceptions to the basic benefit annual support services fund limit may be only as follows. (a) Individuals with extraordinary long-term need as demonstrated by a score of 60 or greater on the Basic Supplement Criteria Inventory (Form DHS 0203) may have access to a basic supplement in order to purchase necessary supports. (A) For Medicaid recipients choosing services under the Support Services Waiver, the basic supplement must result in a plan year cost that is not greater than the individual cost limit. (B) For individuals who are not Medicaid recipients choosing services under the Support Services Waiver, the basic supplement must result in a plan year cost that is not greater than the state's General Fund contribution to the individual cost limit, calculated according to the Medicaid match rate current at the beginning of the plan year, and adjusted annually to correspond to changes in the Medicaid match rates. (C) The brokerage director, or a designee from brokerage management and administration, must administer the Basic Supplement Criteria Inventory only after receiving Division-approved training. The brokerage director or designee must score basic supplement criteria according to written and verbal instruction received from the Division. (D) The trained brokerage director or a designee from a brokerage’s management or administration must administer the Basic Supplement Criteria Inventory within 30 calendar days of the documented request of the individual or the individual's legal representative. (E) The brokerage director or designee must send written notice of findings regarding eligibility for a basic supplement to the individual and the individual's legal representative within 45 calendar days of the written request for a basic supplement. This written notice must include: (i) An offer for the individual and the individual's legal representative to discuss the findings in person with the director and with the individual's personal agent in attendance if desired; (ii) A notice of the complaint process under OAR 411-340-0060; and (iii) A notice of planned action. (F) Annual ISP reviews for recipients of the basic supplement must include a review of circumstances and resources to confirm continued need according to the instructions included with the Basic Supplement Criteria Inventory.</p><p>DHS 0203IN (3/11) Page 14 of 14</p>