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Independent Choices Program (ICP)

Oregon Administrative Rules

OAR 411-030-0100

Tools

ICP Worker Guide

ICP Participant Handbook

ICP Letter to Participants Explaining Discontinuing Requirement to Return Cash Benefit

Program Descriptions & Brochures

Forms

ICP Forms Processing Chart (Updated 05/15/2020)

ICP Participation Agreement (English) Form DHS 2876

Representative Agreement

Payment Coupon for Workers' Benefit Fund Assessment

Notice of Eligibility and Responsibility (English) Form APD 0541

Notice of ICP Payment Ending (English) Form SDS 0540ICP

ICP Benefit Calculation 2 Week Authorization (English) Form SDS 0546IC2Wk

ICP Employee Provider(s) Information (English) Form APD 0548

Workers Compensation Consent and Agreement (English) Form APD 0353

ICP Request for Direct Deposit (DHS 7262I)

Budget and Payroll Forms and Samples

Budget Worksheet Print Version (Updated 11/06/2019)
Budget Worksheet Digital Version (Updated 11/06/2019)
Budget Worksheet Instructions
Completed Budget Worksheet - Sample
Six Month Budget Review Checklist

Coding for ICP

Acumen -- NEW

Acumen Referral Form (Updated 07/06/2020)
ICP Participant Letter with EVV Information (New 06/29/2020)
Acumen Referral Fact Sheet (Updated 07/02/2020)
Acumen EVV FAQs Brochure (New 07/02/2020)
Acumen FAQs (New 12/13/2019)
Acumen Introduction Power Point Material
Acumen Introduction Webinar Recording with Audio
Acumen Trifold Brochure
Acumen Request for Vendor Payment/Reimbursement Form
Acumen ICP Employer Forms (FYI only - Acumen will work with ICP participants to complete enrollment forms.)
Acumen ICP Provider Forms (FYI only - Acumen will work with ICP providers to complete forms.)

Resources & Checklists

Web Links

For ICP information, please contact Christine Maciel, ICP Policy Analyst at (541) 471-3830, email at: Christine.C.Maciel@dhsoha.state.or.us or icp.spd@dhsoha.state.or.us

Transmittals

Transmittal #	Date	Title
APD-IM-20-071	07/02/20	Info: Carewell SEIU 503 CARES PTO benefit - Expanded Leave Benefit
APD-AR-20-066	07/01/20	Action: Independent Choices Program (ICP) Benefit Calculation Form Updated Due to Wage Increase Effective 07/01/2020
APD-AR-19-056	12/20/19	Action: Independent Choices Program (ICP) Benefit Calculation Form Updated Due to Wage Increase and Wage Increase and WBF Rate Change for 2020
APD-IM-19-017	03/29/19	Info: New Fiscal Intermediary 'Acumen' for Independent Choices Program (ICP) Participants (Voluntary Program)
APD-PT-19-013	03/29/19	Policy: Independent Choices Program Cash Benefit Requirement Change
APD-IM-19-016	03/28/19	Info: Changes to the APD Receipting Solutions (APDRS)
APD-IM-19-006	01/23/19	Info: Independent Choices Program 2019 Taxes
OPAR-IM-18-002	04/24/18	Info: CMU Client Direct Deposit Procedure Changes
APD-IM-18-028	03/26/18	Info: Independent Choices Benefit Calculation form updated due to wage increase for 2018
APD-IM-17-095	12/29/17	Info: No new Independent Choices Program Benefit Calculation form needed
APD-AR-17-060	09/22/17	Action: Updated Independent Choices Benefit Calculation form due to Live-in Services closing and two week authorizations
APD-IM-17-053	07/14/17	Info: Letter for Individuals Currently Receiving Live-in Services
APD-AR-17-037	06/26/17	Action: Independent Choices Benefit Calculation form updated due to wage increase for 2017
APD-PT-17-019	06/15/17	Policy: In-Home Services Live-in Option Closure
APD-AR-17-002	01/19/17	Info: Independent Choices Benefit Calculation form updated due to wage increase for 2017satt
APD-IM-16-105	11/17/16	Info: UPDATED Direct Deposit form (DHS 7262i)
APD-AR-16-064	08/31/16	Action: In-home Service Options brochure
APD-AR-16-047	07/01/16	Action: Independent Choices Benefit Calculation form updated due to minimum wage increase
APD-PT-16-020	05/26/16	Policy: Homecare workers acting as consumer representatives *(Corrected)*
APD-IM-15-115	12/28/15	Info: UPDATED Independent Choices Benefit Calculation form (546ic)
APD-AR-15-076	12/23/15	Action: Indepenedent Choices Benefit Calculation form updated due to wage increase and tax rate changes for 2016
APD-PT-15-025	07/28/15	Policy: New Authorization Criteria for Live-in/Shift Services under the In-Home Services Program, Including the Independent Choices Program and Spousal Pay Program
APD-AR-14-076	12/24/14	Action: Independent Choices Benefit Calculation form updated due to wage increase and tax rate changes
SPD-AR-10-118	12/20/10	Action: Independent Choices Benefit Calculation Form Update and Workers' Compensation Forms
SPD-AR-10-117	12/20/10	Action: Workers' Compensation Consent and Agreement Form (SDS 0353)
SPD-IM-10-069	09/07/10	Action:Worker's Compensation Insurance for employee providers in the Independent Choices Program

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