reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0025 - Basic Flat Rate Payment (Basic Rate)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PAYMENT. SPD may authorize payment at the
			 basic rate if a Medicaid resident requires daily, intermittent licensed nurse
			 observation and continuous nursing care and has a physician's order for nursing
			 facility care. When determining the payment rate, SPD shall consider the
			 stability of the medical condition, the health care needs of the individual,
			 and the individual's ability to maintain themselves in a less restrictive
			 setting. An individual who qualifies for reimbursement at the basic rate must:
(a) Have chronic medical problems that are
			 stabilized but not cured and have a need for supervision in a structured
			 environment to maintain or restore stability and prevent
			 deterioration;
(b) Require
			 assistance for a combination of health care needs either because of a physical
			 or psycho-social disabling condition; or
(c) Have insufficient personal and community
			 resources available to provide for either section (1)(a) or (1)(b) of this
			 rule.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0027 - Complex Medical Add-On Payment Authorization

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PAYMENT. APD may provide payment for a
			 complex medical add-on (in addition to the basic rate) when the resident
			 requires one or more of the treatments, procedures, and services listed in OAR
			 411-070-0091, for the additional
			 licensed nursing services needed to meet the resident's increased needs.
(2) APD may pay the complex
			 medical add-on only as long as the resident's needs meet one or more of the
			 treatments, procedures, and services listed in OAR
			 411-070-0091 and the facility
			 maintains the required documentation.
(3) DOCUMENTATION. The licensed nursing staff
			 of the nursing facility must keep sufficient documentation pertinent to the
			 qualified complex medical add-on procedure codes in the resident's clinical
			 record to justify the complex medical add-on payment determination in
			 accordance with these rules (refer to OAR
			 411-070-0091) and must make it
			 available to APD upon request.
(4)
			 COMPLEX MEDICAL ADD-ONS PROHIBITED. APD may not provide complex medical add-on
			 payments for a facility with a waiver that allows a reduction of eight or more
			 hours per week from required licensed nurse staffing hours.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0029 - Pediatric Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The pediatric
			 rate shall be for those facilities meeting the criteria established in OAR
			 411-070-0452 as pediatric
			 nursing facilities or as self-contained pediatric units.
(2) The pediatric rate shall constitute the
			 total rate payable by SPD on behalf of the individual.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0033 - Post Hospital Extended Care Benefit

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The post hospital extended care benefit
			 (OAR 410-120-1210(4))
			 is an Oregon Health Plan benefit that consists of a stay of up to 20 days in a
			 nursing facility to allow discharge from hospitals.
(2) The post hospital extended care benefit
			 must be prior authorized by pre-admission screening for individuals not
			 enrolled in managed care.
(3) To
			 be eligible for the post hospital extended care benefit, the individual must
			 meet all of the following:
(a) Be receiving
			 Oregon Health Plan Plus or Standard, Fee-for-Service benefits;
(b) Not be Medicare eligible;
(c) Have a medically-necessary, qualifying
			 hospital stay consisting of:
(A) A DMAP-paid
			 admission to an acute-care hospital bed, not including a hold bed, observation
			 bed, or emergency room bed.
(B)
			 The stay must consist of three or more consecutive days, not counting the day
			 of discharge.
(d)
			 Transfer to a nursing facility within 30 days of discharge from the hospital;
(e) Need skilled nursing or
			 rehabilitation services on a daily basis for a hospitalized condition meeting
			 Medicare skilled criteria that may be provided only in a nursing facility
			 meaning:
(A) The individual is at risk of
			 further injury from falls, dehydration, or nutrition because of insufficient
			 supervision or assistance at home;
(B) The individual's condition requires daily
			 transportation to a hospital or rehabilitation facility by ambulance; or
(C) It is too far to travel to
			 provide daily nursing or rehabilitation services in the individual's home.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0035 - Complex Medical Add-On Effective Start and End Dates and Administrative Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective
			 Complex Medical Add-On Start and End Dates
(a) Complex Medical Add-On Start Date:
(A) Admission of any Medicaid resident whose
			 condition or service needs meet the criteria for a complex medical add-on
			 procedure code; or
(B) A current
			 Medicaid resident whose condition or service needs change and now meets the
			 criteria for a complex medical add-on procedure code. This includes a
			 readmission or return of a Medicaid resident following a leave of absence from
			 the nursing facility whose needs meet add-on criteria.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0040 - Client Screening, Assessment and Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) INTRODUCTION. All individuals who are
			 candidates for admission to a Medicaid-certified nursing facility must be
			 assessed to evaluate their service needs and preferences and must receive
			 information about community-based, alternative services, and resources that can
			 meet the individual's service needs and are safe, least restrictive, and
			 potentially less costly than comparable nursing facility services.
(2) PRE-ADMISSION SCREENING. A pre-admission
			 screening (PAS) as defined in OAR
			 411-070-0005 is required for
			 potentially Medicaid eligible individuals who are at risk for nursing facility
			 services.
(a) PAS includes:
(A) An assessment;
(B) The determination of an individual's
			 service eligibility for Medicaid-paid long term care or post-hospital extended
			 care services in a nursing facility;
(C) The identification of individuals who can
			 transition to community-based service settings;
(D) The provision of information about
			 community-based services and resources to meet the individual's needs;
			 and
(E) Transition planning
			 assistance as needed.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0043 - Pre-Admission Screening and Resident Review (PASRR)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) INTRODUCTION. PASRR was mandated by
			 Congress as part of the Omnibus Budget Reconciliation Act of 1987 and is
			 codified in Section 1919(e)(7) of the Social Security Act. Final regulations
			 are contained in 42 CFR, Part 483, subparts C through E. The purpose of PASRR
			 is to prevent the placement of individuals with mental illness or intellectual
			 or developmental disabilities in a nursing facility unless their medical needs
			 clearly indicate that they require the level of service provided by a nursing
			 facility. Categorical determination, as described in section (2) of this rule,
			 are groupings of individuals with mental illness or intellectual or
			 developmental disabilities who may be admitted to a nursing facility without a
			 PASRR Level II evaluation.
(2)
			 CATEGORICAL DETERMINATIONS.
(a) Exempted
			 hospital discharge:
(A) The individual is
			 admitted to the nursing facility directly from a hospital after receiving acute
			 inpatient care at the hospital; or
(B) The individual is admitted to the nursing
			 facility directly from a hospital after receiving care as an
			 observation-status; and
(C) The
			 individual requires nursing facility services for the condition for which he or
			 she received care in the hospital; and
(D) The individual's attending physician has
			 certified before admission to the facility that the individual is likely to
			 require nursing facility services for 30 days or less.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0045 - Facility Payments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PRIOR
			 AUTHORIZATION. The Department may reimburse a nursing facility for services
			 provided to a Department resident only if prior authorized after the Department
			 has participated in development of the placement plan and is satisfied that the
			 placement is justified and most suitable for the person according to the
			 Department care plan. The Department may not reimburse a nursing facility for
			 services rendered prior to the date of referral to the Department. A nursing
			 facility must verify that the local SPD/Type B AAA where the facility is
			 located is involved in the placement.
(2) The facility must confirm an individual's
			 financial eligibility for Medicaid payment of any nursing facility service with
			 the local office. Medicaid eligibility is based on the requirements outlined in
			 OAR chapter 461. The facility is responsible for collecting resident liability
			 from the resident or their responsible party.
(3) PAYMENT TO PROVIDER. Provider payments
			 will be made following the month of service. For billing, the Department will
			 mail Form SDS 483, Invoice and Payment Authorization, to each
			 facility.
(4) RESIDENT'S INCOME. A
			 resident's income, exclusive of the authorized allowance for personal
			 incidental needs and other prior authorized special needs, will be offset as a
			 credit against the established Department rate paid to that facility.
(5) REDUCED PAYMENT FOR ABUSE.
(a) If abuse of a resident, according to the
			 provisions of ORS 441.630 to
			 441.685, is substantiated by the
			 Department, the Department may reduce the payment for the resident(s) for the
			 month the abuse occurred, and until such time as the Department determines the
			 conditions leading to the abuse have been corrected.
(A) The facility will receive payment for
			 services provided for the resident as determined by the Department. This
			 determination will be based on the absence of appropriate services that
			 resulted in the substantiated abuse of a resident.
(B) The reduced payment may not be considered
			 a reduction in benefits for the resident.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0050 - Days Chargeable

Current through Register Vol. 63, No. 7, July 1, 2024
The Department will pay for the day of admission but not for
				the day of discharge, transfer, or death except as provided for in OAR
				411-070-0110. When the day of
				admission is the same as the day of discharge, the Department will only pay for
				one day.
Stat. Auth.: ORS
				  410.070 &
				  414.065
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0075 - Rates - Facilities in Oregon

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The daily rate of payment for Oregon facilities will be the basic
			 rate.
(2) A nursing facility may
			 receive payment for complex medical rate if all of the criteria in OAR
			 411-070-0091 is met.
(3) A nursing facility may receive payment
			 for the ventilator assisted program rate if all of the criteria in OAR
			 411-070-0092 is met.
(4) A nursing facility may receive the
			 pediatric rate if all of the criteria in OAR
			 411-070-0452 is met.
(5) A nursing facility may receive the
			 bariatric rate if all of the criteria in OAR
			 411-070-0087 is met.
Statutory/Other Authority: ORS
				  410.070
Statutes/Other Implemented: ORS
				  410.070,
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0080 - Out-of-State Rates

Current through Register Vol. 63, No. 7, July 1, 2024
Out-of-state facilities in areas contiguous to Oregon shall be
				paid for eligible individuals who are receiving temporary care while
				alternative placement in Oregon is being located. Payment shall be made at the
				facility's Medicaid rate established by the state in which the facility is
				located, or the maximum rate paid to Oregon nursing facilities for a comparable
				payment level, whichever is less. The maximum rate for out-of-state purposes is
				Oregon's basic rate plus the complex medical add-on, if determined to be
				appropriate, or the pediatric rate, if warranted. The facility must submit a
				copy of the Assurance and Compliance (HHS 690), certifying its compliance with
				the Civil Rights Act of 1964. The facility must also submit their current
				approved nursing facility Medicaid rate to SPD. An Oregon resident shall be
				returned to Oregon when proper placement may be made and it is feasible to do
				so.
Forms referenced are available from the
				  agency.
Stat. Auth.: ORS
				  414.070
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0085 - Bundled Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PURPOSE. The
			 nursing facility rate established for a facility is a bundled rate and includes
			 all services, supplies and facility equipment required for services.
(2) SERVICES AND SUPPLIES.
(a) The following services and supplies
			 required to provide services in accordance with each resident's care plan are
			 included in the bundled rate:
(A) All nursing
			 services defined in OAR
			 411-086-0110 through
			 411-086-0160;
(B) All support services and supplies
			 associated with the required nursing services;
(C) All activity services, supplies and
			 staffing as defined in OAR
			 411-086-0230;
(D) All social services, supplies and
			 staffing as defined in OAR
			 411-086-0240;
(E) All dietary services, supplies and
			 staffing as defined in OAR
			 411-086-0250;
(F) All professional consultant
			 services;
(G) All services of the
			 facility medical director;
(H)
			 Management of resident funds, including purchase of items;
(I) Room and board, including:
(i) Special diets and non-pumped food
			 supplements; and
(ii) Laundry,
			 whether performed by the facility staff or an outside provider, including
			 laundering and marking of resident's personal clothing and
			 bedding;
(J)
			 Miscellaneous services and supplies, including:
(i) Items stocked by the facility in gross
			 supply and administered individually on physician's order;
(ii) Items owned or rented by the facility
			 that are utilized by individual residents but are reusable and are routinely
			 expected to be available in a nursing facility;
(iii) Shaves, haircuts, supplies and shampoos
			 as required for grooming and cleanliness, whether performed by facility staff
			 or by an outside provider; and
(iv)
			 Transportation provided in vehicles that are owned or leased by the facility or
			 by any person who holds an ownership interest in the facility.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0087 - Bariatric Criteria and Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0091 - Complex Medical Add-On Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) LICENSED NURSING SERVICES. If a Medicaid
			 resident qualifies for payment at the basic rate and if the resident's
			 condition or service needs are determined to meet one or more of the
			 procedures, routines, or services listed in this rule, and the nursing facility
			 maintains documentation per OAR
			 411-070-0027, APD may pay a
			 complex medical add-on payment (in addition to the basic rate) for the
			 additional licensed nursing services needed to meet the resident's increased
			 needs.
(a) Medication Procedures.
(A) M-1 -- Administration of medication, at
			 least daily, requiring skilled observation and judgment for necessity, dosage,
			 and effect, for example new anticoagulants. (This category is limited to
			 non-routine subcutaneous injections and does not include insulin, or the
			 infrequent adjustments of current medications). The facility must maintain a
			 daily nursing note.
(B) M-2 --
			 Intravenous injections or infusions, heparin locks used daily or continuously
			 for hydration or medication. The facility must maintain a daily nursing note.
			 For total parenteral nutrition (TPN) the facility must maintain daily
			 documentation on a flow sheet and must maintain a weekly nursing
			 note.
(C) M-4 -- Intramuscular
			 medications for unstable condition used at least daily. The facility must
			 maintain a daily nursing note.
(D)
			 M-5 -- External infusion pumps used at least daily. This does not include
			 external infusion pumps when the resident is able to self bolus. The facility
			 must maintain a daily nursing note.
(E) M-6 -- Hypodermoclysis - daily or
			 continuous use. The facility must maintain a daily nursing note.
(F) M-7 -- Peritoneal dialysis, daily, and
			 Hemodialysis, at least 2-3 times a week for in-house dialysis. This does not
			 include residents who can do their own exchanges. The facility must maintain a
			 daily nursing note.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0092 - Ventilator Assisted Program - Medicaid Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PAYMENT- A Medicaid eligible individual
			 qualifies for the Ventilator Assisted Program reimbursement rate if the:
(a) Individual meets the criteria described
			 in section (2) of this rule; and
(b) The Nursing facility providing the
			 ventilator services maintains an active endorsement pursuant to OAR chapter
			 411, division 90.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0095 - Resident Funds

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each Medicaid
			 resident is allowed a monthly amount for personal incidental needs. For
			 purposes of this rule, personal incidental funds (PIFs) include monthly
			 payments as allowed and previously accumulated resident savings.
(2) FACILITY RESPONSIBILITY.
(a) The facility must not charge for items
			 included in the bundled rate or for other items or services for which funding
			 can be provided through the Medicaid agency or another non-resident
			 source.
(b) The facility must hold,
			 safeguard and account for a resident's funds if he or she requests such
			 management; or if the case manager requests on Form SDS 0542 that the facility
			 perform such management.
(c) The
			 facility must maintain a record of the request by the resident, case manager or
			 resident representative on Form SDS 0542, covering all funds it holds or
			 manages for residents.
(d) The
			 facility must manage resident funds in a manner in the resident's best
			 interest.
(A) The facility must not charge
			 the resident for holding, disbursing, safeguarding, accounting for, or
			 purchasing from resident funds. Charges for these services are included in the
			 Nursing Facility Financial Statement, Form SPD 35 or 35A and are considered
			 allowable costs reimbursable through the bundled rate.
(B) The cost for items charged to resident
			 funds must not be more than the actual purchase price charged by an unrelated
			 supplier.
(C) The facility may not
			 charge SPD residents or other sources for items or services furnished if all
			 residents receiving such items or services are not charged. Charges must be for
			 direct, identifiable services or supplies furnished to individual residents. A
			 periodic "flat" charge for routine items, such as beverages, cigarettes, etc.,
			 is not allowed. Charges must be made only after services are performed or items
			 are delivered.
(D) The facility
			 must keep any funds received from a resident for holding, safeguarding and
			 accounting separate from the facility's funds.
(E) The nursing facility may request
			 technical assistance from SPD/Type B AAA staff, however, responsibility for
			 managing resident funds in the resident's best interest remains with the
			 facility.
(F) When a facility is a
			 resident's representative payee, it must fulfill its duties as representative
			 payee in accordance with applicable federal regulations and state regulations
			 that define those duties.
(G)
			 Facilities holding resident funds must be insured to cover all amounts held in
			 trust.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0100 - Audit of Personal Incidental Funds

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070 &
				  414.065
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0105 - Resident Property Records

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070 &
				  414.065
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0110 - Temporary Absence from Facility (Bedhold)

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070 &
				  414.065
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0115 - Transfer of Residents

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070,
				  414.065 &
				  441.357
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0120 - Discharge of Residents

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  410.070 &
				  414.065
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0125 - Medicare, (Title XVIII)

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070 &
				  414.065
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0130 - Medicaid Payment in Hospitals

Current through Register Vol. 63, No. 7, July 1, 2024
(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 provider agreement with SPD to receive Medicaid payment for swing-bed
			 services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0140 - Hospice Services

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0300 - Filing of Financial Statement

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The provider must file annually with the Department, Financial Audit Unit, the
			 Nursing Facility Financial Statement (NFFS) covering actual costs based on the
			 facility's fiscal reporting period for the period ending June 30. A NFFS must
			 be filed for other than a year only when necessitated by termination of a
			 provider agreement with the Department, or by a change in ownership, or when
			 directed by the Department. Financial reports containing up to 15 months of
			 financial data are accepted for the reasons above or with the Department's
			 permission prior to filing.
(2) A
			 NFFS is due on or before October 31 or within three months of a change of
			 ownership or withdrawal from the program.
(a)
			 A NFFS must be postmarked on or before the due date to be considered timely. An
			 extension may not be obtained.
(b)
			 A penalty is assessed and collected when a NFFS is not postmarked within the
			 due date. The amount of the penalty is $5 per licensed nursing facility bed per
			 day for each State of Oregon business day the NFFS is late. The total penalty
			 may not exceed $50,000 per fiscal reporting period. For purposes of this
			 section, the number of licensed nursing facility beds is the number of beds
			 licensed on the last day of the fiscal reporting period that the facility
			 failed to submit a NFFS.
(c) The
			 Department may assess interim penalties and deduct the amount of the interim
			 penalties from the next Medicaid payment payable to the facility. Each interim
			 penalty is the amount of the penalty that has accrued under subsection (2)(b)
			 of this section to the date of assessment, and has not already been assessed as
			 an interim penalty.
(d) A facility
			 may request an informal conference or contested case hearing pursuant to ORS
			 183.413 through
			 183.470 within 30 days of
			 receiving a letter from the Department informing the facility of assessment of
			 an interim penalty or a penalty under this rule. OAR
			 411-070-0435 applies to such
			 requests and sets forth the procedures to be followed. If no request for an
			 informal conference or contested case hearing is made within 30 days of
			 receiving such a letter, the interim penalty or penalty becomes final in all
			 respects, including liability for payment of and the amount of the interim
			 penalty or penalty.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0302 - Filing of Revised Financial Statements

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  414.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0305 - Accounting and Record Keeping

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0310 - Auditing

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0315 - Maximum Allowable Compensation of Administrator and Assistant Administrator

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  414.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0320 - Consultants

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0335 - Related Party Transactions

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0340 - Chain Operations

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT › Section 411-070-0345 - Allocation of Home Office and Regional Office Costs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The initial step in the allocation of
			 home office and regional office costs is direct allocation of all allowable
			 costs directly attributable to a particular nursing facility (such as
			 construction interest, salary where the administrator of a nursing facility in
			 the chain is paid directly by the home office, etc.) or non-nursing facility
			 activity.
(2) Other allowable costs
			 must appropriately be allocated among the providers (and to any non-provider
			 activities in which the home office or regional office may be engaged) on the
			 basis of beds, resident days, or other bases, whichever most equitably
			 allocates such costs. Revenues are not generally appropriate for distributing
			 these costs. Where possible, allocation of costs are to be based on function
			 and, consequently, the bases of allocation may appropriately be different, say
			 for accounting costs and for personnel costs. Where the home office or regional
			 office incurs costs for activities not related to resident care in the chain's
			 participating providers, the allocation basis must provide for all allocation
			 of costs such as rent, administrative salaries, other general overhead costs,
			 organization costs, etc., that are attributable to non-resident care as well as
			 resident care activities.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.070