justicedao/ipfs_state_laws huggingface dataset:
411-070-0435 Appeals (1) The Department will send letters to a provider that inform the provider of any changes made by the Department from the provider Nursing Facility Financial Statement. A provider is entitled to an informal conference or a contested case hearing pursuant to ORS 183.413–183.470, as described in sections (2) or (3) of this rule, to protest the change(s). (2) The provider may request an informal conference, by notifying the Department in writing within 30 days of receipt of the letter from the Department that informs the provider of the change(s). The request for an informal conference must be postmarked within the 30-day limit and must state, specifically, the reason(s) for requesting the conference. At the informal conference, the provider may submit documentation and explain the basis for the provider's protest. Following the informal conference, the Department will notify the provider of its decision by mail. No judicial review is available following a decision from an informal conference. If the provider is not satisfied with the decision, the provider may request a contested case hearing pursuant to ORS 183.413–183.470 by notifying the Department in writing of the request for the hearing within 10 working days of the date of the decision letter from the informal conference. If a provider is not satisfied with the results from the contested case hearing, the provider may petition for judicial review pursuant to ORS 183.480–183.497. (3) As an alternative to section (2) of this rule, the provider may request a contested case hearing pursuant to ORS 183.413–183.470 by notifying the Department in writing that a contested case hearing is requested within 30 days of receipt of the letter from the Department that informs the provider of the change(s). The request for the contested case hearing must be postmarked within the 30-day limit and must state, specifically, the reason(s) for requesting the hearing. If a provider is not satisfied with the results from the contested case hearing, the provider may petition for judicial review pursuant to ORS 183.480–183.497. (4) If no request for an informal conference or contested case hearing is made within the specified time period, the most recent decision from the Department will automatically become a final order. (5) A provider may request documentation supporting the change(s) from the Department; however, a request for documentation does not toll the time period within which an informal conference or contested case must be requested. The Department will produce these work papers within 30 days of receipt for a written request. 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 6-1985, f. 5-31-85, cert. ef. 6-1-85 Renumbered from 461-017-0430 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
411-070-0436 Employee Retention Payment Reimbursement Program (1) ESTABLISHMENT. The Department establishes the Employee Retention Payment Reimbursement Program (Program). The Program is designed to promote the availability of nursing home level of care to Oregonians through the current direct-care workforce shortage. (2) FACILITY ELIGIBILITY. All licensed nursing facilities are eligible for participation in the Program, regardless of whether the facility is enrolled as a Medicaid provider. (3) VOLUNTARY. Participation in this program is highly encouraged by the Department but is not mandatory. (4) EMPLOYEE. For the purposes of this Program, an employee includes any employee whose regular worksite is at the location of the facility, regardless of whether the employee is part-time or full-time, hourly or salaried. Employee does not include contracted staff. (5) The Department will provide a one-time reimbursement to facilities that have issued a retention payment of $500 or more per employee and have properly submitted an approved claim form in the timeline provided. The maximum reimbursement will be $500 per employee, regardless of whether the facility has paid a higher retention payment, incurred additional administrative expenses, or incurred additional payroll-related expenses. (6) The reimbursement payment will be limited to employees who were employed continuously by the nursing facility from October 8, 2021 through November 15, 2021. The payment, from the nursing facility, will be provided to eligible employees after November 15, 2021, to ensure employees continued to be employed during the duration of the Program period. (7) CLAIM FORM. In order to receive reimbursement, nursing facilities must submit one claim form for the Program on a form adopted by the Department. The Department’s form will require the nursing facility to attest that all onsite employees were paid a minimum $500 retention payment, regardless of job classification. (8) TIMELINESS. Forms for the Employee Retention Payment Reimbursement Program must be submitted to the Department no earlier than December 1, 2021 and no later than December 31, 2021 in order to be eligible for reimbursement. Nursing facilities may only submit one claim form for reimbursement. (9) AUDIT. The Department may conduct audits and require verification of payment to qualifying employees at its discretion. (10) OVERPAYMENT. Nursing facilities are liable for refunding any overpayments to the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2022, adopt filed 03/29/2022, effective 04/01/2022 APD 45-2021, temporary adopt filed 10/14/2021, effective 10/15/2021 through 04/12/2022
411-070-0464 Final Report (1) FINAL REPORTS. When a provider agreement is terminated for any reason, the provider must submit final reports in accordance with OAR 411-070-0300. Full payment for the month during which the provider agreement is terminated will not be made by the Department until final reports are received and desk reviewed. The Department will initially pay the provider the excess by which the payment for the month in which the provider agreement is terminated exceeds the maximum amount the Department can penalize a provider under OAR 411-070-0300(2)(c). The remainder of the payment must be made by the Department after receipt and desk review of final reports. (2) Settlement rates based on Nursing Facility Financial Statements submitted for the period that ends June 30, 1997 must be calculated as defined by these rules as they existed on June 30, 1997. 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 SSD 8-1991, f. & cert. ef. 4-1-91 SSD 5-1985, f. & ef. 5-1-85
411-071-0000 Purpose (1) The purpose of Private Admission Assessment is to ensure that non-Medicaid eligible individuals applying for or considering admission to a Medicaid certified nursing facility receive information regarding appropriate service and placement alternatives. (2) These rules establish procedures and requirements for admission assessment of non-Medicaid eligible individuals applying for or considering admission to a Medicaid certified nursing facility as required in ORS 410.505 to 410.545. The admission assessment includes mandatory services necessary to comply with the federal pre-admission screening requirements established by the Health Care Financing Administration. It also provides optional information regarding appropriate care settings and services, including nursing facilities and community-based options such as adult foster care, assisted living, residential care, in-home services, and other community-based services. (3) These rules establish a certification process for programs henceforth called “certified programs,” to perform admission assessments to individuals seeking admission to nursing facilities with a Medicaid contract, These rules establish standards for assessments performed by certified programs, local Area Agencies on Aging and Department personnel. Recommendations made during the admission assessment are not binding. Each individual has the right to choose from any of the long-term care options available. Statutory/Other Authority: ORS 410.505 - 410.545 Statutes/Other Implemented: ORS 410.030 & 410.510 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0010 Assessment Requirements (1) An admission assessment must be provided prior to admission for all non-Medicaid eligible individuals applying as new admissions to a Medicaid certified nursing facility except as provided in OAR 411-071-0015. The admission assessment must occur no more than 90 days prior to the date of admission. (2) Admission assessments are to be performed by certified programs. (3) If the assessment is performed by personnel from a certified program, such personnel must make a good faith effort to determine whether the individual receiving the assessment is or appears to be Medicaid eligible based on a review of optional income and asset information provided by the individual. If the individual appears to be Medicaid eligible or may become Medicaid eligible within 60 days, the certified program must contact and coordinate with the local Area Agency on Aging/Seniors and People with Disabilities unit to provide further assessment services. Statutory/Other Authority: ORS 410.505 - 410.545 Statutes/Other Implemented: ORS 410.510 & 410.520 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0015 Exemptions (1) The criteria under which an individual is exempted must be clearly indicated on the form designated by the Department. (2) An exemption from the full assessment process may be granted for an individual who meets one of the following criteria: (a) An individual seeking temporary admission to a nursing facility from a hospital and meets all of the following criteria as certified by the attending physician: (A) Seeks admission directly from a hospital, or within 30 days of discharge from the hospital, after receiving acute inpatient care at the hospital; and (B) Requires nursing facility services for the condition for which he or she received care in the hospital; and (C) Requires nursing facility services for 30 days or less. (b) An individual has a medical prognosis with life expectancy of 30 days or less; (c) An individual seeking temporary admission for respite services with expected length of stay of 30 days or less; (d) A resident of a continuing care retirement community who is seeking admission to a Medicaid certified nursing facility that is part of the same continuing care retirement community; or (e) An individual certified by the attending physician that he/she must be admitted from the community or hospital emergency room without delay due to a serious and immediate threat to the individual's health and safety. (3) The assessment must be completed and signed by a certified program, the attending physician, or a professional medical staff person working directly under the supervision of the attending physician for individuals admitted under an exemption criteria. (4) An individual admitted to a nursing facility under an exemption under subsections (2)(a), (b), or (c) of this rule must receive an assessment within 7 days after the 30th day of admission. (5) An individual temporarily admitted to a nursing facility under subsection (2)(e) of this rule must receive an assessment within seven days from the date of admission. (6) No assessment or exemption is required for: (a) An individual returning to a nursing facility after having entered a hospital from the same nursing facility; or (b) An individual transferring from one Oregon nursing facility to another Oregon nursing facility with or without an intervening hospital stay. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.520 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0025 Recommendations for Placement/Prohibition on Conflict of Interest (1) If the individual chooses to have long-term care information provided by a certified program, the certified program must provide information about appropriate care settings and services. (2) A certified program must not recommend placement to a specific nursing facility, assisted living facility, residential care facility or adult foster home in which it has a financial interest. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.525 & 410.530 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0027 Confidentiality of Assessment Information (1) Any records, forms, or information collected during the assessment process that identify an individual by name or address must be confidential and subject to the Department's rules on confidentiality set forth in OAR 411, division 005. (2) Certified programs must not release information obtained during the assessment process to any person or entity not authorized by law to receive such information without the written consent of the individual or the individual's legal guardian. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0030 Assessment Fees A certified program must not charge an individual for any portion of the assessment. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.515, 410.525 & 410.530 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0035 Certification Process (1) Any hospital, agency, program, or Area Agency on Aging must obtain certification from the Department before providing admission assessment services. (2) The certification issued to a program is not valid for use by any other program. (3) Certification is valid for the length of the contract unless revoked or suspended by the Department. Statutory/Other Authority: ORS 410.505 - 410.545 Statutes/Other Implemented: ORS 410.530 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0040 Application Process (1) Application for certification must be submitted in writing on a form provided by the Department. The application must include but not be limited to: (a) The name, address, phone number and other descriptive information about the applicant; (b) A statement of the applicant's experience in performing functional assessments and knowledge of long term care resources in the area to be served by the applicant. This statement must demonstrate, to the satisfaction of the Department, the ability of the applicant to perform admission assessments; (c) Information and supporting documentation regarding qualifications and training of personnel performing assessments, as required by the Department; (d) Examples of informational materials provided to individuals receiving admission assessments; (e) Information pertaining to the program's financial interests in nursing facilities, assisted living facilities, residential care facilities and adult foster homes; and (f) A signed and dated statement from the applicant stating that the applicant will comply with the requirements of ORS 410.505 to 410.545 and these rules. (2) The application will not be considered complete until all the required information is received by the Department. (3) After receipt of the completed application materials, the Department will investigate the information submitted and consult with the local Area Agency on Aging/Seniors and People with Disabilities unit and health care providers who have worked with the applicant to determine compliance with these rules. (4) If the Department determines after review of the completed application that the applicant does not meet the requirements for certification, the Department must issue a written notice to the applicant citing the deficiencies in the application. If the applicant fails to correct the deficiencies within the time frames specified by the Department, the application may be denied. If denied, the applicant is entitled to a hearing as defined in ORS Chapter 183. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.530 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 1-1994, f. 3-11-94, cert. ef. 3-15-94 SSD 5-1992, f. & cert. ef. 7-7-92 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0043 Qualifications for Personnel Performing Admission Assessments (1) Except as provided in section (2) of this rule, all persons performing admission assessments shall meet one of the following criteria: (a) Be a registered nurse licensed by the State of Oregon; (b) Have a master of social work degree from an accredited institution of higher education; or (c) Have a bachelor’s degree from an accredited institution of higher education and have experience in gerontology, health care, long-term care, or other relevant human services. (2) Any applicant or Certified Program may request that the Division allow an employee who meets the following conditions to perform admission assessments: (a) The employee for whom the exception is being requested works directly under the supervision of someone qualifying under section (1) of this rule; and (b) One or more of the following apply: (A) The employee has at least one year of experience performing functions substantially similar to admission assessments; (B) The employee has other work or educational experiences that provide clear and convincing evidence of the person’s ability to perform admission assessments. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: Renumbered from 411-071-0065, SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0045 Issuance of the Certificate for Private Admission Assessment Within 60 days of receipt of a completed application, the Department must issue a Certificate for Private Admission Assessment to the applicant if the applicant meets all the requirements of ORS 410.505 to 410.545 and these rules. The Certificate must indicate the name, address and telephone number of the program and the name of the owner and/or manager of the program. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0050 Contracts, Reimbursements, and Certification Fees (1) Certified programs eligible for reimbursement must enter into a contract with the Department regarding provision of admission assessment services. Certified hospital programs that only provide inpatient admission assessment services and are not eligible for reimbursement must enter into an agreement with the Department regarding provision of assessment services. (2) The maximum fee a certified program may charge to the Department for the admission assessment will be $ $140 for all assessments, including those performed on an outpatient basis by hospitals that are certified programs. (3) Each certified program that has a contract with the Department must pay an annual certification fee to the Department of $200. Fee payments must be received by the Department within 60 days of the date the invoice was issued, unless other specific arrangements have been approved by the Department. Failure to pay fees in a timely fashion may be cause for suspension of reimbursement payments and/or suspension or revocation of a program's certification. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.515, 410.530 & 410.535 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 14-1993, f. 12-30-93, cert. ef. 1-1-94 SSD 5-1992, f. & cert. ef. 7-7-92 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0055 Renewal (1) At least 30 days prior to the expiration of the Certificate for Private Admission Assessment, a reminder notice and renewal application shall be sent by the Division to the certified program. Submittal of a renewal application and the certification fee prior to the expiration date will keep certification in effect until the Division takes action. If the renewal application and fee are not submitted prior to the expiration date, the program shall no longer be considered certified by the Division. (2) In making its renewal decision, the Division may investigate any information in the renewal application and evaluate past performance upon consultation with area agencies on aging/SPD units. The Division may refuse to renew the certification if the renewal application does not meet the requirements of these rules. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: SSD 3-1991, f. & cert. ef. 2-1-91
411-071-0060 Exceptions (1) A certified program may make written request to the Department for an exception from the provisions of these rules. An exception may be granted if the certified program proves to the Department by clear and convincing evidence that such an exception is in compliance with ORS 410.505 to 410.545 and the federal criteria for pre-admission assessment, and will not jeopardize the health, safety, and welfare of the individuals receiving the admission assessment. (2) Exceptions will be granted in writing and reviewed at each renewal period. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0070 Orientation Requirement (1) Management and supervisory personnel responsible for the admission assessment activities of the program applying for certification must participate in orientation or training sessions conducted by the Department. (2) All personnel of the certified program, who will be performing admission assessments, must participate in the earliest available orientation or training session conducted by or approved by the Department on the admission assessment process, the forms designated by the Department and the continuum of long term care options available. Statutory/Other Authority: ORS 410.535 Statutes/Other Implemented: ORS 410.505 - 410.545 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SSD 22-1990, f. & cert. ef. 10-15-90
411-071-0075 Record Keeping Certified programs must maintain records for three calendar years of the following materials: (1) Completed assessment forms for each individual assessed; (2) Personnel records for all employees engaged in performing admission assessments; (3) Billing and financial records required by the program's contract with the Department; and (4) Any other information as required by the Department and necessary for the implementation and enforcement of ORS 410.505 to 410.595 and these rules. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.530 & 410.535 History: SPD 30-2004, f. 8-27-04, cert. ef. 9-1-04 SDSD 1-1998, f. 1-30-98, cert. ef. 2-1-98 SSD 3-1991, f. & cert. ef. 2-1-91