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 411-070-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless the context indicates otherwise, the following
				definitions and the definitions in OAR
				411-085-0005 apply to the rules
				in OAR chapter 411, division 070:
(1)
			 "Accrual Method of Accounting" means a method of accounting where revenues are
			 reported in the period they are earned, regardless of when they are collected,
			 and expenses are reported in the period they are incurred, regardless of when
			 they are paid.
(2) "Active
			 Treatment" means the implementation of an individualized care plan developed
			 under and supervised by a physician and other qualified mental health
			 professionals that prescribes specific therapies and activities.
(3) "Activities of Daily Living" means
			 activities usually performed in the course of a normal day in an individual's
			 life such as eating, dressing, grooming, bathing, personal hygiene, mobility
			 (ambulation and transfer), elimination (toileting, bowel, and bladder
			 management), and cognition and behavior.
(4) "Aging and People with Disabilities
			 (APD)" means the program area of Aging and People with Disabilities, within the
			 Department of Human Services.
(5)
			 "Alternative Services" mean individuals or organizations offering services to
			 persons living in a community other than a nursing facility or
			 hospital.
(6) "Area Agency on Aging
			 (AAA)" means the Department of Human Services designated agency charged with
			 the responsibility to provide a comprehensive and coordinated system of
			 services to seniors and individuals with disabilities in a planning and service
			 area. For the purpose of these rules, the term Area Agency on Aging is
			 inclusive of both Type A and Type B Area Agencies on Aging as defined in ORS
			 410.040 and described in ORS
			 410.210 to
			 410.300.
(7) "Augmented Rate" means the additional
			 compensation to a nursing facility who qualifies for the Quality and Efficiency
			 Incentive Program described in OAR
			 411-070-0437. The augmented rate
			 is a daily rate of $9.75 and is in addition to the rate a nursing facility
			 would otherwise receive. The Department may pay the augmented rate to a
			 qualifying facility for a period not to exceed four years from the date the
			 facility purchases bed capacity under the Quality and Efficiency Incentive
			 Program.
(8) "Bariatric rate" means
			 a rate paid for a Medicaid resident of a nursing facility if the resident meets
			 the criteria described in OAR
			 411-070-0087.
(9) "Basic Flat Rate Payment" and "Basic
			 Rate" means the statewide standard payment rate for all long-term services
			 provided to a Medicaid resident of a nursing facility, except for services
			 reimbursed through another Medicaid payment source. The "Basic Rate" is the
			 bundled payment rate, unless the resident qualifies for the complex medical
			 rate, the ventilator assisted program rate, the bundled pediatric rate or the
			 bariatric rate (instead of the basic rate).
(10) "Bi-PAP" means bi-level positive airway
			 pressure/spontaneous timed.
(11)
			 "Behavioral Health" means the program within the Health Systems Division (HSD)
			 within the Oregon Health Authority (OHA), responsible for addictions and mental
			 health services.
(12) "Capacity"
			 means licensed nursing beds multiplied by number of days in
			 operation.
(13) "Case Manager"
			 means a Department of Human Services or Area Agency on Aging employee who
			 assesses the service needs of an applicant, determines eligibility, and offers
			 service choices to the eligible individual. The case manager authorizes and
			 implements the service plan and monitors the services delivered.
(14) "Cash Method of Accounting" means a
			 method of accounting where revenues are recognized only when cash is received,
			 and expenditures for expense and asset items are not recorded until cash is
			 disbursed for them.
(15)
			 "Categorical Determinations" mean the provisions in the Code of Federal
			 Regulations (42 CFR
			 483.130) for creating categories that
			 describe certain diagnoses, severity of illness, or the need for a particular
			 service that clearly indicates that admission to a nursing facility is normally
			 needed or that the provision of specialized services is not normally needed.
(a) Membership in a category may be made by
			 the evaluator only if existing data on the individual is current, accurate, and
			 of sufficient scope.
(b) An
			 individual with mental illness or developmental disabilities may enter a
			 nursing facility without a PASRR Level II evaluation if criteria of a
			 categorical determination are met as described in OAR
			 411-070-0043(2)(a)
			 - (2)(c).