justicedao/ipfs_state_laws huggingface dataset:
411-070-0087 Bariatric Criteria and Services (1) A Medicaid eligible individual qualifies for the bariatric reimbursement rate if the individual has a physician diagnosis of obesity with a BMI>40 and the individual meets the following criteria as defined in OAR chapter 411, division 015: (a) Two-person full assist with ambulation or transfers; and (b) Full assist in one of the following: cognition, eating or elimination. (2) If an individual meets the criteria documented in 411-070-0087, and the Department has authorized the bariatric rate, the facility must provide one (1) additional Certified Nursing Assistant (CNA), for each shift, above the licensing staffing standard in OAR 411-086-0100(5), for the third through fifth approved individuals for the bariatric rate. Another CNA is then required, for each shift, for every additional five (5) individuals receiving the bariatric rate. For example: (a) For the first two (2) approved individuals, the facility must meet the requirements in OAR 411-086-0100(3). (b) For three (3) to five (5) approved individuals, one CNA would be required above staffing standard, for each shift. (c) For six (6) to ten (10) approved individuals, two (2) CNAs would be required above staffing standard, for each shift. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 19-2023, amend filed 10/27/2023, effective 11/01/2023 APD 25-2020, adopt filed 06/23/2020, effective 07/01/2020
411-070-0100 Audit of Personal Incidental Funds (1) Records Available to Department. All account records and expenditure receipts for the resident's personal incidental funds must be available in the facility for audit and inspection by representatives of the Department of Human Services. (2) Department Audits. Audits of a provider's cost reports, financial records and other pertinent documents may be made by the Department to verify that the provider is complying with Federal regulations and State Administrative Rules regarding protection of residents' funds. Copies of the provider's records may be removed from the facility. (3) Discrepancies. Any discrepancies in the utilization of personal incidental funds brought to the attention of the case manager will be discussed with the facility. If the discrepancy cannot be resolved, the Department will assist the resident in finding an attorney to represent them or bring the situation to the attention of the local district attorney. (4) Abuse of Funds. Abuse of resident's personal incidental funds or failure to comply with SPD personal incidental funds policy will be considered by the Department in deciding if a provider's agreement will be continued or renewed. Statutory/Other Authority: ORS 410.070 & 414.065 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 6-1984, f. 7-20-84, cert. ef. 9-1-84 Renumbered from 461-017-0170 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-77 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0105 Resident Property Records (1) Current Records. The facility must maintain a current, written record for each resident that includes written receipts for all personal possessions deposited with the facility. (2) Availability. The property record must be available to the resident and the resident's representative. (3) Personal Property. The resident's private property must be clearly marked with his or her name. (4) Department Audit. These records are subject to the same audit criteria as all personal incidental funds in OAR 411-070-0100. (5) Removal from Facility. The Department may remove copies of these records from the facility. Statutory/Other Authority: ORS 410.070 & 414.065 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 6-1984, f. 7-20-84, cert. ef. 9-1-84 Renumbered from 461-017-0180 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-77 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0110 Temporary Absence from Facility (Bedhold) (1) SPD does not pay for holding a resident's bed when the individual is absent from the facility. (2) Personal incidental funds or payment from an individual's family may be used to hold a facility bed if there are no vacancies in the facility to which other residents of the same sex may be admitted and if there is no duplicate payment from SPD. Personal incidental funds may only be used if the resident so chooses. Statutory/Other Authority: ORS 410.070 & 414.065 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09 SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 9-1995, f. 8-31-95, cert. ef. 9-1-95 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 1-1987, f. & cert. ef. 4-13-87 SSD 13-1986(Temp), f. & cert. ef. 10-13-86 SSD 10-1986, f. & cert. ef. 7-1-86 SSD 8-1982, f. & cert. ef. 6-30-82 SSD 4-1982(Temp), f. 4-26-82, cert. ef. 5-1-82 Renumbered from 461-017-0190 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-77 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0115 Transfer of Residents (1) Prior Approval Required. A resident must not be transferred to another facility without prior approval by the resident, the attending physician, branch worker, and the facility's director of nursing services. Reassignment of rooms within the facility requires prior notice to the case manager. All transfers, both inter- and intra-facility, must be conducted in accordance with resident's rights as described in OAR chapter 411, division 085 and the transfer rules in OAR chapter 411, division 088. (2) Emergency Transfer. In an emergency, consultation with the branch worker is waived. However, the branch worker must be notified by the facility of the resident's transfer at the earliest possible opportunity. (3) Noncompliance. Failure on the part of the facility administration to comply with this rule can constitute a basis for withholding payment for care of the resident involved. Statutory/Other Authority: ORS 410.070, 414.065 & 441.357 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 20-1990, f. & cert. ef. 10-4-90 Renumbered from 461-017-0200 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-77 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0120 Discharge of Residents When the attending physician indicates that the resident does not, or in the future will not, require long-term care, facility authorities must report this fact to the branch office no later than the first branch office working day following the physician's notification. Upon request, the branch office will assist the resident, facility, relatives, or guardian in developing plans and arrangements for discharge placement. Resident's refusal to be discharged will relieve the Department of responsibility for payment. Statutory/Other Authority: ORS 410.070 & 414.065 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 Renumbered from 461-017-0210 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-7 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0125 Medicare, (Title XVIII) SPD shall pay on behalf of eligible individuals the coinsurance rate established under Medicare, Part A, Hospital Care, for care rendered from the 21st day through the 100th day of care in a Medicare certified nursing facility. SPD shall pay the appropriate rate as described in these rules for care beyond the 100th day. Payment shall be subject to documentation required for the rate. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09 SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 14-1990, f. 6-29-90, cert. ef. 7-1-90 SSD 4-1990(Temp), f. 1-12-90, cert. ef. 1-15-90 SSD 7-1989, f. & cert. ef. 5-1-89 Renumbered from 461-017-0220 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 58-1981, f. & cert. ef. 9-1-81 PWC 859, f. 10-31-77, cert. ef. 11-1-77 PWC 847(Temp), f. & cert. ef. 7-1-77
411-070-0130 Medicaid Payment in Hospitals (1) SWING BED ELIGIBILITY. To be eligible to receive a Medicaid payment under this rule, a hospital must: (a) Have approval from the Centers for Medicare and Medicaid Services (CMS) to furnish skilled nursing facility services as a Medicare swing-bed hospital; (b) Have a Medicare provider agreement for acute care; and (c) Have a current signed Health Services Division (HSD) provider agreement to receive Medicaid payment for swing-bed services. (2) SERVICES PROVIDED. The daily Medicaid rate shall be for the services outlined in OAR 411-070-0085 (Bundled Rate). (3) COMPLIANCE WITH MEDICAID REQUIREMENTS. Hospitals receiving Medicaid payment for swing-bed services must comply with state and federal rules and statutes that affect long-term care facilities as outlined in the facility's provider agreement with HSD. (4) ADMISSION OF MEDICAID ELIGIBLE INDIVIDUALS TO INTERMEDIATE CARE FACILITY (ICF). Prior to determination of Medicaid eligibility in the ICF swing bed, the APD case manager must coordinate with the hospital for continued Medicaid services and payment. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 & 414.065 History: APD 42-2024, amend filed 07/09/2024, effective 07/12/2024 SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09 SPD 1-2007, f. 3-12-07, cert. ef. 3-13-07 SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 7-1988, f. & cert. ef. 7-1-88
411-070-0140 Hospice Services (1) CONTRACT. (a) The Department enters into a contract (provider agreement) to reimburse Medicare certified hospice providers in Oregon for services provided in Medicaid certified nursing facilities under the following conditions: (A) The Medicare-certified hospice provider must have a written contract with the nursing facility; and (B) A copy of the completed contract must be made available to the Department upon request. (b) The hospice provider must have a completed, written contract (provider agreement) with the Department for nursing facility-based hospice services prior to being determined eligible for reimbursement. (2) REIMBURSEMENT. (a) The Department pays the hospice provider a rate equal to 100 percent of the rate that the nursing facility would otherwise receive. (b) The hospice provider is solely responsible for reimbursing the nursing facility. (c) Reimbursement for services provided under this rule is available only if the recipient of such services is Medicaid-eligible, Medicare hospice eligible, and been found to need nursing facility services through the Pre-Admission Screening process. Statutory/Other Authority: ORS 410.070 & 414.065 Statutes/Other Implemented: ORS 410.070 & 414.065 History: SPD 35-2013, f. & cert. ef. 10-1-13 SPD 9-2013(Temp), f. 4-29-13, cert. ef. 5-1-13 thru 10-28-13 SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 13-1993, f. 12-30-93, cert. ef. 1-1-94
411-070-0302 Filing of Revised Financial Statements (1) Revised Nursing Facility Financial Statements may only be filed with prior written authorization from the Department. (2) An amended report must be postmarked within six months of the end of the fiscal reporting period. Statutory/Other Authority: ORS 414.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 8-1994, f. & cert. ef. 12-1-94 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 8-1991, f. & cert. ef. 4-1-91 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 6-1985, f. 5-31-85, ef. 6-1-85
411-070-0305 Accounting and Record Keeping (1) Nursing Facility Financial Statements are to be prepared in conformance with generally accepted accounting principles and the provisions of these rules. The Department has the option to prescribe and interpret these rules in conformance with generally accepted accounting principles. (2) Financial Statements must be filed using the accrual method of accounting except governmental facilities using the cash method of accounting may file reports using the cash method. (3) The provider must maintain, for a period of not less than three years following the date of submission of the Nursing Facility Financial Statement, financial and statistical records that are accurate and in sufficient detail to substantiate the cost data reported. If there are unresolved audit questions at the end of this three-year period, the records must be maintained until the questions are resolved. The records must be maintained in a condition that can be audited for compliance with generally accepted accounting principles and provisions of these rules. (4) Expenses reported as allowable costs must be adequately documented in the financial records of the provider or they will be disallowed. (5) The Department will maintain each required Nursing Facility Financial Statement submitted by a provider for three years following the date of submission of the report. In the event there are unresolved audit questions at the end of this three year period, the statements will be maintained until such questions are resolved. (6) The records of the provider must be available for review by authorized personnel of the Department and of the U.S. Department of Health and Human Services during normal business hours at a location in the State of Oregon specified by the provider. (7) Accrued expenses that are forgiven by a creditor will be considered as income to the facility and offset against expenses in the subsequent period. Accruals that are settled at less than full value will have the forgiven amount considered as income and offset against expenses. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 8-1991, f. & cert. ef. 4-1-91 Renumbered from 461-017-0305 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 29-1979, f. 8-30-79, cert. ef. 9-1-79 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78
411-070-0310 Auditing (1) All Nursing Facility Financial Statements are subject to desk review and analysis within six months after proper completion and filing. (2) The desk review will determine, to the extent possible: (a) That the provider has properly included its costs on the Nursing Facility Financial Statement in accordance with generally accepted accounting principles and the provisions of these rules; and (b) That the provider has properly applied the cost finding method specified by the Department to its allowable costs determined in subsection (2)(a) of this rule; and (c) Whether further auditing of the provider's financial and statistical records is needed. (3) All filed Nursing Facility Financial Statements are subject to a field audit, normally to be completed within one year from the date of filing. (4) The field audit will, at a minimum, be sufficiently comprehensive to verify that in all material respects: (a) Generally accepted accounting principles and the provisions of these rules have been adhered to; and (b) Reported data are in agreement with supporting records; and (c) The Nursing Facility Financial Statement is reconcilable to the appropriate IRS report and payroll tax reports. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 Renumbered from 461-017-0310 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78
411-070-0315 Maximum Allowable Compensation of Administrator and Assistant Administrator (1) The maximum compensation of a full-time (40 hours per week) licensed administrator to a nursing facility may be allowable at the lower of compensation actually received or the maximum allowable administrator compensation amount determined annually using the calculation in section (4) of this rule. (2) The maximum compensation of not more than one full-time (40 hours per week) assistant administrator to a nursing facility with at least 80 licensed beds may be allowable at the lower of compensation actually received or seventy-five percent of the allowable administrator compensation for the number of licensed beds in the nursing facility. The Department will not allow the cost of an assistant administrator in a facility with less than 80 beds. (3) If either of the above individuals works less than 40 hours in the average week, allowable compensation must be the lower of actual compensation received or the maximum allowable administrator compensation determined annually based on the calculation in section (4) of this rule, multiplied by the percentage of 40 hours worked in the average week. The provider must maintain adequate records to demonstrate time actually spent. (4) The maximum allowable administrator compensation may be adjusted each year and will be effective as of January 1 each year. The rates must be established using the gross allowable compensation in Account 411 (Administrator Compensation) of the Nursing Facility Financial Statement for non-owner administrators. The applicable compensation amounts will be inflated by the U.S. CPI from the mid point of each facility's fiscal year to July 1. The 75th percentile of each bed-size category, 1–49, 50–79, 80–99, 100 and over, will be the ceiling for each grouping. (5) When a single individual serves as the administrator of both a nursing facility and a hospital, the salary will be pro-rated to both functions. The nursing facility portion will then be compared to the pro-rated share of the allowable administrator compensation to determine the amount to be included as allowable. Statutory/Other Authority: ORS 414.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 8-1994, f. & cert. ef. 12-1-94 SSD 2-1985, f. & cert. ef. 3-5-85 Renumbered from 461-017-0315 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78
411-070-0320 Consultants (1) Costs for direct care and dietitian consultant services to the staff of the facility will be allowed. (2) No other consultant costs will be allowed. (3) Payment for treatment and evaluation provided directly to an individual resident by medical providers will not be paid by Seniors and People with Disabilities Division. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 8-1991, f. & cert. ef. 4-1-91 SSD 20-1990, f. & cert. ef. 10-4-90 SSD 6-1985, f. 5-31-85, cert. ef. 6-1-85 Renumbered from 461-017-0320 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 2-1980, f. 1-18-80, cert. ef. 2-1-80 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78
411-070-0335 Related Party Transactions (1) Costs applicable to services and supplies furnished to a provider by organizations related to the provider by common ownership or control are allowable at the lower of cost excluding profits and markups to the related party or charge to the facility. Such costs are allowable to the extent that they relate to resident care, are reasonable, ordinary, and necessary, and are not in excess of those costs incurred by a prudent cost-conscious buyer. Documentation of costs to related parties (including those identified in OAR 411-070-0330(10) must be made available at time of audit. If documentation is not available, such payments to or for the benefit of the related organization will be non-allowable costs. (2) An exception is provided to the general rule in section (1) of this rule applicable to related organizations. The exception applies if the provider demonstrates by convincing evidence to the satisfaction of the Department: (a) That the supplying organization is a separate legal entity; and (b) That a substantial part of the supplying organization's business activity, of the type carried on with the provider, is transacted with other organizations not related to the provider and the supplier by common ownership or control and there is an open, competitive market. Prices paid by the provider may not be in excess of what would be paid by a prudent cost conscious buyer. (3) If the provider takes the position that an exception as stated in section (2) of this rule applies, then the provider must: (a) Make available the books and records of the related organization to SPD auditors; and (b) Maintain a receiving report signed by personnel of the nursing facility for services or supplies furnished by the related organization. (4) Rental expense paid to related organizations for facilities may be allowable to the extent the rental does not exceed the related organization's costs of owning (e.g., depreciation, interest on a mortgage) or leasing the assets, computed in accordance with the provisions of these rules. The exception listed in section (2) of this rule does not apply to rental expense paid for facilities. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 6-1995, f. 6-30-95, cert.ef. 7-1-95 SSD 8-1994, f. & cert. ef. 12-1-94 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 8-1991, f. & cert. ef. 4-1-91 Renumbered from 461-017-0335 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78
411-070-0340 Chain Operations (1) A chain organization consists of a group of two or more health care facilities that are owned, leased, or through any other device controlled by one business entity. This includes not only proprietary chains but also chains operated by various religious and other charitable organizations. (2) Although the home office of a chain is normally not a provider in itself, it may furnish to the individual provider central administration or other service such as centralized accounting, purchasing, personnel, or management services. Only the home office's actual cost of providing such services is includable in the provider's allowable costs under the program. (3) Home office costs that are not otherwise allowable costs when incurred directly by the provider are not allowable as home office costs to be allocated to providers. Where the home office is a mere holding company and provides no services related to resident care, no costs of the home office are allowable to the providers in the chain or single facility. (4) Where an owner receives compensation from the home office for services to the facility, the compensation is allowable only to the extent that it is related to resident care and to the extent that it is reasonable as defined under owner's compensation. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06 SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93 SSD 18-1991, f. 9-27-91, cert. ef. 10-1-91 SSD 14-1991(Temp), f. 6-28-91, cert. ef. 7-1-91 Renumbered from 461-017-0340 by Ch. 784, OL 1981 & AFS 69-1981, f. 9-30-81, cert. ef. 10-1-81 AFS 19-1978, f. & cert. ef. 5-1-78 PWC 866(Temp), f. 12-30-77, cert. ef. 1-1-78