An Oregon Medicaid Agency Supporting Individuals with Intellectual and Developmental Disabilities

Section 5C

Meeting Health and Medical Needs of Customers

Eligibility for Medical Advocacy

The company will only provide medical management or advocacy services if the service agreement so stipulates with a goal for medical management or if the CDDP agrees that communication services include medical management. As a Community Living provider, we only work with customers who practice self-medication.


Company staff may not administer medications to customers. They may remind customers about medication schedules as indicated on labels or through physician’s printed orders. They may also assist the customer in setting medications out in a system that will help the customer know how and when to take each medication. This will be based on the customer’s preferences.

Where such assistance is provided, company staff will assure the customer that each medication has been approved by a qualified medical professional. Staff may recommend that the customer not take a medication if an imminent risk of physical harm is present and only as long as the imminent threat exists.

Medical Appointments

Company staff may attend medical, dental, and mental health appointments and participate in the appointments for the sake of medical advocacy. This may include asking medical providers to provide simpler descriptions of symptoms, treatments, and instructions. It may also include helping customers express themselves in terms of symptoms, actions taken, and other information requested by providers.

If customers do not want medical advocacy during an appointment, the company employee should not assist the customer in attending appointments. The employee may help the customer arrange for medical transportation, but should not bill for time sitting in a waiting room while the customer is with a medical provider. There may be exceptions to this depending on the customer’s needs, but the employee shall seek guidance from the company leadership team whenever a customer insists on the employee being at the medical facility but not in attending the appointments.

During times in an exam room when customers are being asked to dress or undress, the employee should step outside unless the customer requests the employee remain in the room during dressing/undressing or when it is part of the customers’ goals to have assistance with dressing/undressing.

Medical Transportation

Mileage for medical transportation is not billable and the employee must choose between:

  1. Not billing for mileage, or
  2. Arranging for medical transportation or public transportation.

When other activities are planned during the same employee/customer session as a medical appointment, the employee should subtract the miles it takes to attend medical appointments from total mileage being billed and note the fact in the customer’ progress notes.

Medical Advice

While working as a DSP for the company, employees are not allowed to give medical advice, even when the employee is qualified to do so. Medical advice should only be given to the customer by a qualified medical provider.

Where medical providers do not provide adequate informed consent to customers regarding risks, benefits, any experimental nature of treatment, and full understanding of treatment, employees should encourage the medical provider to be more precise regarding informed consent.

Employees should assure the customer that the customer has the right to decline any treatment or choose from available treatment options. Employee involvement in that choice is limited to helping the customer understand the recommendations of the medical provider in the professional’s presence. For individuals who are incapable of making such choices, as predetermined by ISPs and service agreements, the employee shall defer to an alternate decision maker such as a parent or guardian.

Employees should not assist customers in behavior that is contrary to a doctor’s orders. For example, if a doctor says that a customer is lactose intolerant and the customer wants to go to the store to buy milk, the employee should decline to assist with it, recognizing that the customer has the right to ignore the advice. An alternative would be to tell the customer to ask a family member to help with that or take public transportation to the store.

Medical Advocacy Readiness

For each customer, employees who first provide services to the customer, must compile a list phone numbers of doctors, nurses, health insurance representatives, appointment lines, and advice lines. This list should be kept in the customer’s home near the phone or easily accessible. The employee should not keep the list on an unsecured mobile device. It may be kept in the customer’s contract page on the Company’s proprietary billing and progress notes system. This will require the employee to communicate the information the employee’s lead via phone call or secured email.

hindi hd