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* 1. AAA:

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* 2. Branch Office Number where case is currently held:

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* 3. Sample/Random Number (NOT PRIME):

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* 4. OPI Case Manager / Service Coordinator Name (who is assigned to the case):

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* 5. Reviewer's Name and Phone Number:

OPI CAPS Assessment in OACCESS
(OAR 411-032-0020 1) a) C; OAR 411-032-002- 2) d) B)

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* 6. What is the individual's SPL? (1-18 or 99)

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* 7. What month was the current OPI assessment completed.
(OAR 411-032-0020 1) a) C - OAR 411-032-0020 2) d) B)

OPI Client Details in CAPS/OACCESS

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* 8. Does the consumer have at least one diagnosis on diagnosis list in CAPS client details?
(OAR 411-032-0020 (2)b)

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* 9. Comments regarding OPI Client Details in CAPS

OPI Case Narration/OACCESS

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* 10. Does narration verify that the CAPS was completed face-to-face in the consumer's home?
(OAR 411-015-0008 1) f & g)

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* 11. Was the narration completed at the time of contact/activity, or within 3 business days?
(Agreed-upon professional standard and used in training)

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* 12. Comments regarding OPI Case Narration

OPI Service Plan in CAPS/OACCESS

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* 13. DO NOT ANSWER THIS QUESTION
PLEASE GO TO QUESTION 14 TO CONTINUE

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* 14. The paid OPI services in the service plan are:
(check all that apply)

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* 15. Are the needs identified in the CAPS assessment addressed in the service plan?
(AR 17-041, OAR 411-032-0010 1) c, d, e and OAR 411-031-0015 1) a)

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* 16. Are Natural Supports identified  in the Service Plan?
(OAR 411-032-0001 3), 4)
If yes go to question 16

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* 17. Are Natural Supports identified with tasks in the Service Plan?
(OAR 411-032-0001 3), 4)

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* 18. Comments regarding the OPI Service Plan

OACCESS OAA Services Tab Information

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* 19. Do the OPI services in the service plan correspond with the services listed on the OACCESS OAA SVC/FCSP tab (or in the approved alternate program for RAIN/SPR reporting)?
(See Detail, Provider OAR 411-032-0015 3) C) IJ.)

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* 20. Are units displayed for current OPI services? (any dates for the past 13 months)
(See Detail, Provider Qualifier/Units OAR 411-032-0015 3) C) IJ.)

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* 21. Comments regarding the OACCESS OAA Services Tab Information

OPI Form Review

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* 22. If the approved OPI service plan includes a HCW, is the Workers' Comp agreement (354) signed by consumer and complete?
OAR 411-032-0010-1) d, e

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* 23. Is the current (dated in the past 12 months) OPI Service Agreement (0287L) signed by both the consumer and OPI Case Manager/Service Coordinator?
(OAR 411-032-0020 2) e) A, B; AR 13-005)

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* 24. Is the OPI fee determination (0287K) current and signed by both the consumer and OPI Case Manager/Service Coordinator within the past 12 months?
(OAR 411-032-0044 1, 2; AR 13-005)

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* 25. Is the OPI Risk Tool (0287J) or the version in the Care Tool current and complete in the past 12 months?
(AR 13-005)

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* 26. If a HCW or in-home care agency are listed as OPI providers on the case, is there a signed in-home service plan (546N) for the HCW and/or in-home agency for the time period?
(OAR 411-032-0010 1) c, d, e)

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* 27. If the service plan includes a HCW, is the CEP Program Participation Agreement or representative Choice Form (737) signed? (only required since December 2015)
(PT 15-013, AR 17-041, OAR 411-032-0010 1) d, e)

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* 28. Comments regarding overall OPI form review for this client.

Thank you for completing the monitoring review for this OPI consumer.

T