justicedao/ipfs_state_laws huggingface dataset:
410-142-0100 Election of Hospice Care (1) An individual who meets the eligibility requirements of OAR 410-142-0040 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative may file the election statement. (2) The election statement must include the following: (a) Identification of the particular hospice that will provide care to the individual; (b) The individual's or representative's acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care, as related to the individual's terminal illness; (c) Except for children (see 410-124-0110), acknowledgment that certain otherwise covered services are waived by the election. Election of a hospice benefit means that the Division of Medical Assistance Programs (Division) will only reimburse the hospice for those services included in the hospice benefit; (d) The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement; (e) The signature of the individual or representative. (3) Re-election of hospice benefits. If an election has been revoked in accordance with OAR 410-142-0160, the individual (or his or her representative if the individual is mentally or physically incapacitated) may at any time file an election, in accordance with this section, for any other election period that is still available to the individual. (4) File the election statement in the medical record. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11 OMAP 1-2003, f. 1-31-03, cert. ef. 2-1-03 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0110 Concurrent Care for Children (1) Under Section 2302 of the Affordable Care Act, Medicaid or Children’s Health Insurance Program (CHIP) eligible children are eligible to receive curative treatment upon the election of the hospice benefit. (2) The criteria for receiving hospice services does not change for children eligible for Medicaid and CHIP programs. However these children may now receive hospice services without forgoing any other service to which the child is entitled under Medicaid for treatment of the terminal condition. (3) All other eligibility, coverage, and hospice rules for the Division of Medical Assistance Programs apply. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11
410-142-0120 Duration of Hospice Care (1) An eligible individual may elect to receive hospice care during one or more of the following election periods: (a) An initial 90-day period; (b) A subsequent 90-day period; (c) An unlimited number of subsequent 60-day periods. (2) An election to receive hospice care will be considered to continue through the initial election period and through the subsequent election periods without a break in care as long as the individual: (a) Remains in the care of a hospice; and (b) Does not revoke the election under the provisions of OAR 410-142-0160. (3) For the duration of an election of hospice care, an individual waives all rights to the Division of Medical Assistance Programs (Division) payments for the following services: (a) Hospice care provided by a hospice other than the hospice designated by the individual, unless provided under arrangements made by the designated hospice; (b) Any covered services related to the treatment of the terminal condition for which hospice care was elected or a related condition, or services equivalent to hospice care. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0140 Changing the Designated Hospice (1) An individual or representative may change, once in each election period, the designation of the particular hospice from which hospice care will be received. (2) The change of the designated hospice is not a revocation of the election for the period in which it is made. (3) To change the designation of hospice programs, the individual or representative must file, with the hospice from which care has been received and with the newly designated hospice, a statement that includes the following: (a) The name of the hospice from which the individual has received care and the name of the hospice from which he or she plans to receive care; (b) The date the change is to be effective. (4) The statement shall be kept on file in the medical record. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 16-1995, f. & cert. ef. 8-1-95 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0160 Revoking the Election of Hospice Care (1) An individual or representative may revoke the individual's election of hospice care at any time during an election period. (2) Revocation Procedure: To revoke the election of hospice care, the individual or representative must file with the Hospice a statement to be placed in the medical record that includes the following information: (a) A signed statement that the individual or representative revokes the individual's election for coverage of hospice care for the remainder of that election period; (b) The date that the revocation is to be effective. (An individual or representative may not designate an effective date earlier than the date that the revocation is made.) (3) An individual, upon revocation of the election of coverage of hospice care for a particular election period: (a) Is no longer covered for hospice care; (b) Resumes eligibility for all covered services as before the election to hospice; and (c) May at any time elect to receive hospice coverage for any other hospice election periods he or she is eligible to receive, in accordance with OAR 410-142-0120. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 34-2000, f. 9-29-00, cert. ef. 10-1-00 HR 16-1995, f. & cert. ef. 8-1-95 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0180 Plan of Care A written plan of care must be established and maintained for each individual admitted to a hospice program, and the care provided to an individual must be in accordance with the plan: (1) Establishment of Plan. The plan is established by the attending physician, the medical director or physician designee and interdisciplinary group prior to providing care. (2) Content of Plan. The plan must include an assessment of the individual’s needs and identification of the services including the management of discomfort and symptom relief. It must state in detail the scope and frequency of services needed to meet the patient’s and family’s needs. (3) Review of Plan. The plan must be reviewed and updated, at intervals specified in the plan, by the attending physician, the medical director or physician designee and interdisciplinary group. These reviews must be documented. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 9-1994, f. & cert. ef. 2-1-94
410-142-0200 Interdisciplinary Group The hospice must designate an interdisciplinary group or groups composed of individuals who provide or supervise the care and services offered by the hospice: (1) Composition of group. The hospice must have an interdisciplinary group or groups composed of or including at least the following individuals who are employees of the hospice, or, in the case of a doctor, be under contract with the hospice: (a) A doctor of medicine or osteopathy; (b) A registered nurse; (c) A social worker; (d) A pastoral or other counselor. (2) Role of interdisciplinary group. Members of the group interact on a regular basis and have a working knowledge of the assessment and care of the patient/family unit by each member of the group. The interdisciplinary group is responsible for: (a) Participation in the establishment of the plan of care; (b) Provision or supervision of hospice care and services; (c) Periodic review and updating of the plan of care for each individual receiving hospice care; and (d) Establishment of policies governing the day-to-day provision of hospice care and services. (3) If a hospice has more than one interdisciplinary group, it must document in advance the group it chooses to execute the functions described in section (2) of this rule; (4) Coordinator. The hospice must designate a registered nurse to coordinate the implementation of the plan of care for each patient. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11 OMAP 1-2003, f. 1-31-03, cert. ef. 2-1-03 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0220 Requirements for Coverage To be covered, hospice services must meet the following requirements: (1) They must be reasonable and necessary for the palliation or management of the terminal illness as well as related conditions. (2) The individual must elect hospice care in accordance with OAR 410-142-0100 and a plan of care must be established as set forth in 410-142-0180 before services are provided. (3) The services must be consistent with the plan of care. (4) A certification that the individual is terminally ill must be completed as set forth in OAR 410-142-0060. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 9-1994, f. & cert. ef. 2-1-94
410-142-0225 Signature Requirements (1) The Division of Medical Assistance Programs (Division) requires practitioners to sign for services they order. This signature shall be handwritten or electronic, (or facsimiles of original written or electronic signatures for terminal illness for hospice) and it must be in the client’s medical record. (2) The ordering practitioner is responsible for the authenticity of the signature. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11 OMAP 37-2006, f. 12-15-06, cert. ef. 1-1-07
410-142-0260 Hospice Level of Care (1) Each day of hospice care is classified into one of five levels of care. The level of care determines the payment for each day of hospice benefit: (a) Routine Home Care. A routine home care day is a day on which a patient who has elected to receive hospice care is in a place of residence and is not receiving continuous home care; (b) Continuous Home Care. A continuous home care day is a day on which a patient who has elected to receive hospice care is not in an inpatient facility and receives hospice care consisting predominantly of nursing care on a continuous basis at home. Home health aid or homemaker services or both may also be provided on a continuous basis. Continuous home care is only furnished during brief periods of crisis as necessary to maintain the terminally ill individual at home. Nursing care must be provided by a registered nurse or a licensed practical nurse and a nurse must be providing care for more than half of the period of care. A minimum of eight hours of care must be provided during a 24-hour day, which begins and ends at midnight. When fewer than 8 hours of nursing care are required, the services are covered as routine home care rather than continuous home care; (c) In-Home Respite Care. An in-home respite care day is a day on which short-term in-home care is provided to the patient only when necessary to relieve the family members or other persons caring for the patient at home. Respite care may be provided only on an occasional basis and may not be reimbursed for more than five consecutive days at a time. In-home respite care will be provided at the level necessary to meet the patient's need, with a minimum of eight hours of care provided in a 24-hour day, which begins and ends at midnight. Home health aide/CNA or homemaker services or both may be utilized for providing in-home respite care; (d) Inpatient Respite Care. An inpatient respite care day is a day on which short-term inpatient care is provided to the patient only when necessary to relieve the family members or other persons caring for the patient at home. Respite care may be provided only on an occasional basis and may not be reimbursed for more than five consecutive days at a time. Payment for the sixth, and any subsequent days, is to be made at the routine home care rate. Respite care may not be provided when the hospice patient is a nursing home resident; (e) General Inpatient Care. A general inpatient care day is a day on which a hospice patient receives care in an inpatient facility for pain control, acute or chronic symptom management, or other procedures which cannot be managed or provided in any other setting. (2) Inpatient care must be provided by a facility that has an agreement with the hospice: (a) A hospice capable of providing inpatient care; (b) A hospital; or (c) A nursing facility. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 58-2002, f. & cert. ef. 10-1-02 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0280 Recipient Benefits An individual who has elected to receive hospice care remains entitled to receive other services not included in the hospice benefit. These services are subject to the same rules as for non-hospice clients. Typical services used that are not covered by the hospice benefit include: (1) Attending physician care (e.g. office visits, hospital visits, etc.); (2) Medical transportation; (3) Any services, drugs or supplies for a condition other than the recipient's terminal illness or a related condition (e.g. broken leg, pre-existing diabetes). Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 36-2010, f. 12-15-10, cert. ef. 1-1-11 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0380 Death With Dignity (1) Death with dignity services are defined in the Division of Medical Assistance Programs (Division) Medical-Surgical Services and Pharmaceutical Services program rules. (2) All death with dignity services must be billed directly to Division, even if the client is in a prepaid health plan (PHP). (3) Death with dignity services are not included in the hospice care per diem payment. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 43-2005, f. 9-2-05, cert. ef. 10-1-05 OMAP 34-2000, f. 9-29-00, cert. ef. 10-1-00 OMAP 40-1999, f. & cert. ef. 10-1-99
410-144-0000 Purpose These rules outline the requirements for participation in three different Workforce Development programs for supplemental payment through Medicaid which were enacted by the Oregon legislature under Senate Bill 800 (Enrolled 2021 Regular Session), House Bill 3396 (Enrolled 2023 Regular Session), House Bill 4002 (Enrolled 2024 Regular Session) and House Bill 2024 (Enrolled 2025 Regular Session). The Essential Workforce Healthcare Program (EWHP), the Essential Workforce Development Program (EWDP) also known as CareWorks Supplemental Payment program, and the United We Heal Supplemental Payment Program (UWHP) were established with the goal of developing certain segments of the healthcare workforce in this State. Eligible employers that participate in an EWHP, EWDP, or UWHP may be eligible to receive supplemental Medicaid payments by supporting the recruitment, retention and development of health care professionals through programs approved by the legislature such as providing health care benefits; on-the-job training; apprenticeship and mentorship opportunities; increased wages and better health care benefits, and improved workplace safety standards to the employees of their facilities in accordance with the rules in this Division 144. Statutory/Other Authority: ORS 410.070 & 413.042 Statutes/Other Implemented: ORS 414.033, 735.520, OL 2021 ch. 595, HB 2024 (2025), HB 4002 (2024), HB 3396 (2023) & SB 800 (2021) History: DMAP 83-2025, amend filed 11/24/2025, effective 12/01/2025 DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023
410-144-0010 Eligibility (1) Requirements for an employer to be eligible to participate in the Essential Workforce Health Care Program include that the employer shall: (a) Have a signed memorandum of understanding with the Oregon Health Authority (Authority) that specifies how the supplemental payments must be used; (b) Agree to participate in evidence-based workforce and quality of care improvements ; and (c) Annually report quality and other metrics. (2) Requirements for a qualified nursing facility to participate in the Essential Workforce Development Program include that the facility shall: (a) Have a signed memorandum of understanding with the Authority that specifies how the supplemental payments must be used to support training health care workers; (b) Annually report workforce development metrics; (c) Be a participating provider in the Oregon medical assistance program; (d) Have received a Medicaid payment for a nursing facility claim for services provided during the effective dates of payment; (e) Be a privately-owned nursing facility; and (f) Participate in a labor-management training trust that supports the development of health care professionals during the effective dates. (3) Requirements for a behavioral health care provider to participate in the United We Heal Supplemental Payment Program include that the provider shall: (a) Have a signed memorandum of understanding with the Authority that specifies how the supplemental payments must be used to access apprenticeship and training programs and opportunities to increase the available behavioral health care workforce; (b) Annually report apprenticeship and training metrics; (c) Have received a Medicaid payment for a behavioral health care provider claim for services provided during the effective dates of payment; and (d) Participate in a labor-management training trust that supports the recruitment, retention and development of behavioral health care professionals during the effective dates. Statutory/Other Authority: ORS 410.070 & 413.042 Statutes/Other Implemented: ORS 410.070, 414.033, OL 2021 ch. 595, HB 2024 (2025), HB 4002 (2024), HB 3396 (2023) & SB 800 (2021) History: DMAP 83-2025, amend filed 11/24/2025, effective 12/01/2025 DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023
410-144-0020 Memorandum of Understanding All participating employers that receive a supplemental payment under these programs shall sign a Memorandum of Understanding with the Authority. The Memorandum of Understanding shall document the requirements and responsibilities for using the supplemental payments to provide employee recruitment, retention and development support as appropriate to the program through some of the following: increased wages, better health care benefits, improved workplace safety standards, on-the-job training, apprenticeship opportunities, educational opportunities and/or other approved programs that support the development of health care professionals, including medical technicians, certified nursing assistants, phlebotomists, pre-apprentices, apprentices, Certified Alcohol and Drug Counselors (CADC), Qualified Mental Health Associates (QMHA), and/or Qualified Mental Health Professionals (QMHP). Statutory/Other Authority: ORS 410.070 & 413.042 Statutes/Other Implemented: ORS 410.070, 414.033, OL 2021 ch. 595, HB 2024 (2025), HB 4002 (2024), HB 3396 (2023) & SB 800 (2021) History: DMAP 83-2025, amend filed 11/24/2025, effective 12/01/2025 DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023
410-144-0025 Use of Supplemental Payments Participating employers who receive supplemental payments under the EWH P, EWD P, or UWH P must use the supplemental payments as outlined in this rule and as further detailed in the MOU entered into with the Authority. (1) Payments under Essential Workforce Health Care Program must be used to provide health care benefits to employees of the participating facilities through the Essential Workforce Health Care Fund (EWHF). (2) Participating employers use of the supplemental payments are subject to the requirements established by the Essential Workforce Health Care Fund (EWHF). (3) Payments under Essential Workforce Development Program (CareWorks) must be used to provide apprenticeships, on-the-job training, and other approved programs to employees of the participating facilities through an Eligible Labor Management Training Trust. (4) Qualified nursing facility’s use of the supplemental payments are subject to the requirements established by an Eligible Labor Management Training Trust. (5) Payments under United We Heal Supplemental Payment Program must be used to provide recruitment, retention and development opportunities such as increases in wages, better health care benefits, and improved workplace safety standards; pre-apprenticeships, apprenticeships, and on-the-job training; and other approved programs to employees of the participating providers through an Eligible Labor Management Training Trust. (6) Eligible Behavioral Health Care Providers use of the supplemental payments is subject to the requirements established by an Eligible Labor Management Training Trust. Statutory/Other Authority: ORS 410.070 & 413.042 Statutes/Other Implemented: ORS 410.070, 414.033, OL 2021 ch. 595, HB 2024 (2025), HB 4002 (2024), HB 3396 (2023) & SB 800 (2021) History: DMAP 83-2025, amend filed 11/24/2025, effective 12/01/2025 DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023
410-144-0030 Evidence-based Workforce and Quality of Care Improvements Participating employers in Essential Workforce Health Care Program must participate in evidence-based workforce and quality of care improvements, including all of the requirements in this rule. (1) Workforce input into benefit design; (2) Quantitative and qualitative reporting on impact of health care benefit on workforce; (3) Retention strategies for workforce; and (4) Others as mutually agreed upon by the Authority and participating employers. Statutory/Other Authority: ORS 410.070 & 413.042 Statutes/Other Implemented: ORS 410.070, 414.033 & OL 2021 ch. 595 History: DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023
410-144-0060 Oversight All payments authorized for these Programs are subject to audit at the discretion of the Authority. The Authority will terminate payments if the provider fails to abide by or violates the terms of their signed MOU. A provider may request a contested case proceeding to challenge a termination. Statutory/Other Authority: ORS 410.070, 413.042 & 410.120 Statutes/Other Implemented: ORS 410.070, 414.033 & OL 2021 ch. 595 History: DMAP 41-2025, amend filed 04/29/2025, effective 05/01/2025 DMAP 33-2025, amend filed 03/21/2025, effective 03/23/2025 DMAP 123-2024, temporary amend filed 09/25/2024, effective 09/25/2024 through 03/23/2025 DMAP 52-2023, adopt filed 06/30/2023, effective 06/30/2023