1. Program Definition and Services

Specialized Medical Equipment (SME) Services in Oregon provide short-term support to children and adults with intellectual/developmental disabilities and chronic conditions. The program aims to help maintain individuals with disabilities in the community, averting the need for long-term services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Needs Assessment, Device Selection, Procurement, Delivery, and Customization of adaptive aids)
• Residential Personal Care: Supervision and care in a licensed residential, community-based setting (Equipment Installation, Safety Setup, Caregiver Device Training, Maintenance, and Product Repairs)

2. Regulations

The program is governed by the following regulations:

• Oregon Administrative Rules (OAR) Chapter 411, Division 435 (Ancillary Services: Assistive Devices, Technology, and Specialized Supplies)
• Oregon Administrative Rules (OAR) Chapter 411, Division 016 (Special Medical Equipment and Supplies Guidelines)
• Oregon Administrative Rules (OAR) Chapter 410, Division 122 (Durable Medical Equipment and Medical Supplies Rules)
• Federal 1915(c) and 1915(k) Community First Choice (K Plan) Medicaid Authorities

3. Licensing or Certification

Providers must be certified by the Oregon Department of Human Services (ODHS) or enrolled as an approved Durable Medical Equipment (DME) vendor and follow all Home and Community-Based Services (HCBS) requirements.

4. Responsible State Agency

The Oregon Health Authority (OHA) and the Oregon Department of Human Services (ODHS) Office of Developmental Disabilities Services (ODDS) are responsible for reviewing applications and certifying specialized medical equipment services providers.

5. Application Process

The application process is conducted through the electronic Oregon Health Authority (OHA) Provider Portal. Providers must submit forms online to initiate the application process.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state safety and operational rules
• Agency policies and procedures
• Staff qualifications and training records
• Proof of general and professional liability insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact their regional office for detailed information on current processing timeframes.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their business entity and secure necessary federal identification numbers.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access details are sent to qualified applicants once preliminary paperwork is reviewed.

10. Additional Notes

• Providers must ensure that intensive care settings meet all state accessibility and environmental safety guidelines
• In-Home Personal Care must be provided directly by the certified agency's employed personnel
• All direct care staff must conduct mandatory background clearances and fingerprinting screenings
• Providers must maintain detailed records of face-to-face services for Medicaid documentation and billing

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Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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