Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Active
			 Treatment" means implementation of a professionally developed and supervised
			 plan of care that is in effect within 14 days of admission and designed to
			 achieve the patient's discharge at the earliest possible time. Custodial care
			 is not active treatment.
(2)
			 "Actual Costs" means all legitimate Medicaid expenditures. Since Oregon's
			 Addictions and Behavioral Health Division utilizes Medicare cost finding
			 principles, actual costs must be the same as "Medicaid Allowable Costs" as
			 defined in this rule.
(3)
			 "Allowable Costs" means the costs applicable to the provision of psychiatric
			 inpatient services as described in OAR
			 309-015-0050(3).
			 They are derived using the Medicare cost finding principles located in the
			 Medicare Provide Reimbursement Manual.
(4) "Annual Cost Report" means a financial
			 report submitted to the Medicare/Medicaid Fiscal Intermediary by a hospital, on
			 forms provided by the Fiscal Intermediary. This report details the actual
			 revenues and expenses of the hospital during the latest fiscal
			 period.
(5) "Base Year" means July
			 1, 1981 through June 30, 1982.
(6)
			 "Basic Health Program" means Section 1331 of the Affordable Care Act, which the
			 state calls "OHP Bridge - Basic Health Program."
(7) "Disproportionate Share Adjusted Medicaid
			 Rate" (DSR) means the weighted average Medicaid per diem rate (interim,
			 year-end settlement or final settlement) for disproportionate share hospitals.
			 This rate does not include the disproportionate share payment of uncompensated
			 costs of participating hospital programs as provided in these rules.
(8) "Disproportionate Share Costs" means
			 costs that are reimbursable under federal disproportionate share statutes and
			 regulations. These costs are limited to costs of participating hospital
			 programs which have not already been reimbursed by Medicare, Medicaid,
			 insurance, or the patient's own resources.
(9) "Disproportionate Share Hospital" means a
			 psychiatric hospital which has a low-income utilization rate exceeding 25
			 percent as described in OAR
			 309-015-0035(5).
(10) "Disproportionate Share Payment" means
			 the payment made quarterly to reimburse participating hospital programs for
			 disproportionate share costs. This payment is subject to recalculation at the
			 time of each year-end or final settlement payment.
(11) "Distinct Program" means a specialized
			 inpatient psychiatric treatment program with unique admission standards
			 approved by the Division. If a participating psychiatric hospital has a
			 specialized program based upon patient age or medical condition, contains 50 or
			 more beds, has a nursing staff specifically assigned to the program which has
			 experience or training in working with the specialized population, and has
			 record keeping systems adequate to separately account for expenditures and
			 revenue to that program relative to the entire hospital, the Division may
			 approve it as a distinct program.
(12) "Division" means the Addictions and
			 Behavioral Health Division of the Oregon Health Authority.
(13) "Fiscal Intermediary" means:
(a) Blue Cross of Oregon for Medicare, Parts
			 A and B; and
(b) Division for
			 Medicaid services provided under the provisions of this rule;
(c) The Division's Assistant Administrator
			 for Administrative Services, is the designated Fiscal Intermediary.