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Independent Choices Program (ICP)

Oregon Administrative Rules

OAR 411-030-0100 In-Home Services - Independent Choices Program

Tools

Program Descriptions & Brochures

Forms

ICP Forms Processing Chart (Updated Sept. 15, 2022)
ICP Participation Agreement Form DHS 2876
Representative Agreement
Payment Coupon for Workers' Benefit Fund Assessment
Notice of Eligibility and Responsibility Form APD 0541
Notice of ICP Payment Ending Form SDS 0540ICP
ICP Benefit Calculation 2 Week Authorization Form SDS 0546IC2Wk
ICP Employee Provider(s) Information Form APD 0548
ICP Provider and ICP Representative Background Check Application
Workers Compensation Consent and Agreement Form APD 0353
ICP Request for Direct Deposit Form DHS 7262I (Updated Oct. 19, 2022)

Budget and Payroll Forms and Samples

ICP Budget Worksheet Print Version
ICP Budget Worksheet Digital Version *Does it for you!
ICP Budget Worksheet Instructions
ICP Budget Worksheet Example
Six Month Budget Review Checklist
Six Month Budget Review Process
Budget Monitoring Review Letter *To be printed on local office letterhead)
Six Month Budget Review Coming Due Letter *To be printed on local office letterhead
ICP Proration Tool for Initial Month Cash Benefit Payment

Acumen - Customer Service Phone #:(866) 235-4745 / Email: Enrollment@Acumen2.net

Acumen Referral Form
Acumen Training Material Link
ICP Participant Letter with EVV Information *To be printed on local office letterhead
Acumen Referral Fact Sheet
Acumen EVV FAQs Brochure
Acumen FAQs
Acumen Introduction Power Point Material
Acumen Introduction Webinar Recording with Audio
Acumen Trifold Brochure
Acumen Request for Vendor Payment/Reimbursement Form
Acumen OR ICP Payment Payroll & Time Entry Schedule 07/2022 - 06/2023
Acumen ICP Employer Enrollment Forms
- OR ICP Acumen Authorization for Auto Withdrawal
- ICP Employer EVV Only 'Good to Go Notification' *FYI only-Acumen sends out when enrollment is completed
- ICP Employer EVV Only 'Welcome Letter' *FYI only-Acumen sends out when enrollment is completed
- ICP Employer 'How to Approve/Review Time in the Web Portal' *FYI only-Acumen sends out when enrollment is completed
- ICP Employer EVV Email Template *FYI only-Acumen sends out when enrollment is completed
- ICP EVV Only Reason Codes and Verification Letter
- ICP Payroll and EVV Reason Codes and Verification Letter
Acumen ICP Provider Enrollment Forms *FYI only-Acumen will work with ICP providers to complete forms

ICP Employee Provider EVV Only 'Good to Go Notification' *FYI only-Acumen sends out when enrollment is completed
ICP Employee Provider 'Time Entry Instructions' *FYI only-Acumen sends out when enrollment is completed
ICP Employee Provider EVV Only 'Time Entry Report Schedule' 07/2022 - 06/2023 *FYI only-Acumen sends out when enrollment is completed

ICP FAQ Podcasts (Note: Please listen to the Podcast in Firefox or Microsoft Edge)

Resources & Checklists

Web Links

For ICP information, please contact Christine Maciel, ICP Policy Analyst at: Christine.C.Maciel@dhsoha.state.or.us or icp.spd@odhsoha.oregon.gov

Transmittals

Transmittal #	Date	Title
APD-IM-22-006	01/26/22	Info: ICP Acumen Payroll Fund Withdrawal Date Change
APD-AR-21-069	12/15/21	Action: Independent Choices Program (ICP) Benefit Calculation Form Updated Due to Wage Increase, SUTA Tax Rate Change, and Pay-In Change Effective 01/01/2022
APD-IM-21-070	08/02/21	Info: Independent Choices Program (ICP) Training: Module Series Release
APD-AR-21-042	07/29/21	Action: ONE and ICP
APD-AR-21-039	07/16/21	Action: EDMS Update: Scanning HCW and ICP-PSW documents to EDMS
SS-PT-21-011	07/07/21	Policy: Oregon Minimum Wage Increase for 2021 Update
APD-IM-21-053	06/17/21	Info: ONE System Modifications (MRP Payments)
APD-IM-21-052	06/16/21	Info: Employee Providers of ICP Participants
APD-PT-21-002	03/16/21	Policy: VDQ Certification Requirement
APD-IM-21-025	03/15/21	Info: OHCC Conditional Certifications
APD-IM-21-024	03/15/21	Info: OregonSaves Benefit for Homecare Workers and Personal Care Attendants
APD-IM-21-007	01/25/21	Info: Weekly Update for CM Tools Website (ICP SUTA Rate Change) (01/11/21-01/22/21)
APD-IM-21-003	01/14/21	Info:COVID-19 Vaccine Informational Flyer Sent to Homecare Workers, Personal Care Attendants, and Individuals Who Receive Medicaid/Oregon Project Independence In-Home Services
APD-IM-20-136	12/11/20	Info: ICP Participants and Providers Online EVV Trainings Offered by Acumen
APD-IM-20-131	12/09/20	Info:New Worker Training Series for Homecare and Personal Support Workers Now Available Statewide
APD-IM-20-124	11/19/20	Info: URGENT - Changes to Independent Choices and Special Needs Payments when Cases Converted to ONE at Wave 1
APD-IM-20-094	08/18/20	Info: Mandatory Training for Homecare and Personal Support Workers – Carewell SEIU 503 Training Begins Voluntary Pilot
APD-AR-20-068	07/06/20	Action: Independent Choices Program (ICP) Work to Prepare for Electronic Visit Verification (EVV)
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-PT-19-013	03/29/19	Policy: Independent Choices Program (ICP) Tax Requirements When Spouse is Paid Provider
OPAR-IM-18-002	04/24/18	Info: CMU Client Direct Deposit Procedure Changes
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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