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 411-070-0350 - Management Fees

Current through Register Vol. 63, No. 7, July 1, 2024
Management fees are an allowable expense if they are necessary,
				reasonable, non-duplicative of facility personnel and functions, and documented
				by a binding contract with a non-related party defining the items, services,
				and activities provided. If the administrator or assistant administrator is
				supplied as part of the contract, the rules governing their compensation in
				these rules apply. Documentation demonstrating that the services were actually
				performed is required. Management fees paid to a related organization are
				subject to the rules governing related parties (OAR
				411-070-0335), chain operations
				(411-070-0340), and allocation of
				home office costs (411-070-0345). The allowable
				salary paid to the administrator and assistant administrator is included in the
				total facility management fee calculation. Total management fees for allowable
				management and supervisory services may not exceed the limits established for
				the administrator and the assistant administrator in
				411-070-0315 plus $5,000
				allowable for other management fees per year.
Publications: Publications referenced are available from the
				  agency.
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 411-070-0365 - Capital Assets

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 following costs must be capitalized and depreciated: Expenses for depreciable
			 assets with historical cost in excess of $1,000 per unit, or in aggregate, and
			 a useful life greater than one year from the date of purchase.
(2) Repair costs in excess of $1,000 on
			 equipment or buildings must be capitalized.
(3) The provider must maintain schedules of
			 capital assets and depreciation, on a straight line basis, to document amounts
			 on the Nursing Facility Financial Statement.
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 411-070-0370 - Depreciable Assets

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Tangible
			 assets of the following types in which a provider has an economic interest
			 through ownership are subject to depreciation:
(a) Buildings -- The basic structure or shell
			 and additions thereto;
(b) Building
			 Fixed Equipment -- Attachments to buildings, such as wiring, electrical
			 fixtures, plumbing, elevators, heating system, and air conditioning system. The
			 general characteristics of this equipment are:
(A) Affixed to the building and not subject
			 to transfer;
(B) A fairly long life
			 but shorter than the life of the building to which affixed.
(c) Movable Equipment -- Such
			 items as beds, wheelchairs, desks, vehicles, and other depreciable items. The
			 general characteristics of these equipment are:
(A) Capable of being moved;
(B) Subject to control and meeting the
			 definition of a capital asset.
(d) Land Improvements -- Such items as
			 paving, tunnels, underpasses, on-site sewer and water lines, parking lots,
			 shrubbery, fences, walls, etc. where replacement is the responsibility of the
			 provider;
(e) Leasehold
			 Improvements -- Betterments and additions made by the lessee to the leased
			 property that become the property of the lessor after the expiration of the
			 lease.
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 411-070-0375 - Depreciation Basis

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Purchase of a
			 Nursing Home:
(a) New Facility -- The
			 depreciation basis of a new facility must be the historical cost of building
			 the facility, including preparation for use, or the purchase price from an
			 unrelated organization not to exceed the fair market value, including
			 preparation for use, less salvage value;
(b) Ongoing Facility -- The depreciation
			 basis of the purchase of an ongoing facility from an unrelated organization is
			 limited to the lower of the following:
(A)
			 The allowable acquisition cost of such asset to the first owner of record on or
			 after July 18, 1984; or
(B) The
			 acquisition cost of such asset to the new owner.
(c) To properly provide for costs or
			 valuations of fixed assets, an appraisal by an appraisal expert will be
			 required if the provider has no historical cost records, or has incomplete
			 records of depreciable fixed assets, or purchases a facility without
			 designation of purchase price for the classification of assets acquired. The
			 appraisal is subject to the approval of the Department. In any case, the
			 Department may require such an appraisal to establish the fair market value of
			 the provider assets;
(d) If the
			 purchase is from a related organization, the cost basis is the lower of the
			 cost basis of the related organization or the cost basis as determined in
			 subsections (b) and (c) of this section, less depreciation as determined by the
			 provisions of these rules.
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 411-070-0385 - Depreciation Lives

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The provider
			 must use the "
Estimated Useful Lives of Depreciable Hospital
			 Assets
" Revised 2004 guidelines for asset lives when computing
			 depreciation.
(2) For assets not
			 covered by the guidelines and with costs of more than $1,000 per unit, or in
			 aggregate, the lives established by the provider are subject to approval by the
			 Department.
(3) Depreciation and
			 amortization schedules must be maintained.
(4) Depreciation expense is not allowed on
			 land.
(5) Depreciation and
			 amortization must be calculated on a straight line basis and prorated over the
			 estimated useful life of the asset.
Publications: Publications referenced are available from the
				  agency.
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 411-070-0400 - Equity

Current through Register Vol. 63, No. 7, July 1, 2024
Equity is not an allowable expense for reimbursement but must
				be reported. Equity capital is the net worth of the provider (owner's equity in
				the net assets as determined under these rules), adjusted for those assets and
				liabilities that are not related to the provision of resident care:
(1) Generally accepted accounting principles
			 are to be used unless otherwise specified in these rules for computing owner's
			 equity.
(2) Assets and liabilities
			 not related to providing resident care are not includable in the provider's
			 equity capital.
(3) Loans from
			 owners or related entities are considered as invested equity capital of the
			 provider.
(4) Owner's equity in
			 assets leased from related entities is includable in the equity capital of a
			 proprietary provider.
(5) Goodwill
			 is not includable as part of owner's equity.
(6) Invested funds that are diverted to
			 income producing activities that are not resident related for more than six
			 months will not be included as part of owner's equity.
(7) Amounts deposited in a funded
			 depreciation account and the earnings on deposits are not included in equity
			 capital. Interest earned on these funds is not offset against interest
			 expense.
(8) Land, buildings, and
			 other assets acquired in anticipation of expansion are not includable in equity
			 capital. Construction-in-process and liabilities related to such construction
			 are not includable in equity capital.
(9) Prepaid premiums on life insurance
			 carried by a provider on officers and key employees, where the provider is
			 designated as the beneficiary, are not included when computing equity capital.
(10) The costs of noncompetitive
			 agreements are not includable in equity capital.
(11) The amount deposited and the earnings on
			 self-insurance reserve funds are not includable in equity capital.
(12) When an asset is totally or partially
			 destroyed by a casualty, the unrecovered loss is not included in equity
			 capital.
(13) Working capital,
			 defined as the difference between current assets and current liabilities, must
			 be adjusted by any amount considered to be excessive for the necessary and
			 proper operation of resident care activities. The excessive amount will not be
			 included in equity capital.
(14)
			 The cash surrender value of insurance is not includable in equity
			 capital.
(15) Imputed salaries for
			 proprietors will be offset in computing the equity capital.
(16) Any portion of an acquisition cost,
			 incurred on or after July 18, 1984, that exceeds the depreciable basis is not
			 includable in the owner's equity calculation.
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 411-070-0415 - Offset Income

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Income is
			 offset against expenses unless specifically excluded in section (2) of this
			 rule. If an adjustment is for a revenue producing activity representing a
			 non-allowable cost, the revenue must be offset against the appropriate expense
			 if the revenue is less than 2 percent of the total provider expense (sum of
			 cost areas). Where the revenue is greater than 2 percent of the total provider
			 expense (sum of cost areas), costs must be allocated to this area as described
			 in OAR 411-070-0430, Allocation
			 Methods.
(2) Income items that may
			 not be offset are:
(a) Ancillary income and
			 charges for routine services or supplies that are included in the bundled rate
			 but charged to other residents (except as required in OAR
			 411-070-0359(3));
(b) Grants, unless designated for paying a
			 specific operating cost; and
(c)
			 Donations, unless designated for paying a specific operating cost.
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 411-070-0417 - Treatment of Complex Medical Add-Ons

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The complex medical add-on reflects the
			 additional costs of providing skilled nursing services for certain residents
			 due to their needs.
(2) The complex
			 medical add-on is added to the basic rate.
(3) When calculating per resident day care
			 compensation cost, the treatment of the complex medical add-on is as follows:
(a) The allowable care compensation costs for
			 both the basic rate and the complex medical add-on are divided by total basic
			 rate resident days.
(b) Revenue
			 from the complex medical add-on received for eligible individuals is divided by
			 the number of Medicaid basic rate resident days.
(c) The per resident day amounts computed in
			 section (3)(a) of this rule are reduced by the per Medicaid resident day
			 amounts computed in section (3)(b) of this rule. The result is defined as care
			 compensation per resident day and shall be used in determining the prospective
			 base rate.
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 411-070-0420 - Base Year Cost Finding

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 provider must report its gross costs and must make reclassifications and
			 adjustments to costs as provided in these rules. This process will determine
			 net allowable costs on the Nursing Facility Financial Statement that includes a
			 uniform chart of accounts provided by the Department. The gross costs and
			 revenues must agree with the statement of earnings and expenses or profit and
			 loss statement of the provider. Revenues are to be reported in the same manner
			 as costs on the Nursing Facility Financial Statement. The provider must also
			 use the balance sheet provided to report its gross assets, gross liabilities,
			 and gross equity, make reclassifications and adjustments as provided by these
			 rules.
(2) The per diem costs of
			 care must be used to determine each provider's allowable per diem costs and
			 must be effective for the same period as covered by the Nursing Facility
			 Financial Statement.
(3) The per
			 diem costs of each facility will be used to establish the basic rate on July 1
			 of each odd numbered year.
(4)
			 Costs, revenues, assets, liabilities, and owner's equity attributable from a
			 home office or regional office to a provider under OAR
			 411-070-0345 will be included on
			 the Nursing Facility Financial Statement in the Home Office column. The home
			 office financial data must be reconcilable to the home office financial
			 statements and records.
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 411-070-0425 - Resident Days

Current through Register Vol. 63, No. 7, July 1, 2024
The provider must keep census records on all
				residents.
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 411-070-0430 - Allocation Methods

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The provider
			 must use the allocation methods designated on the NFFS: COST -- ALLOCATION
			 METHOD:
(a) Property -- Resident Days or
			 Square Footage.
(b) Administrative
			 and General -- Resident Days.
(c)
			 Other Operating Support -- Resident Days.
(d) Food -- Resident Days.
(e) Direct Care Compensation -- Actual Cost
			 or Resident Days.
(f) Direct Care
			 Supplies -- Actual Cost or Resident Days.
(g) Ventilator Assisted Program Expense --
			 Actual Cost or Resident Days.
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 411-070-0435 - Appeals

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
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 411-070-0436 - Employee Retention Payment Reimbursement Program

Current through Register Vol. 63, No. 7, July 1, 2024
(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
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 411-070-0438 - Enhanced Wage Add-on Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 ESTABLISHMENT. The Department establishes the Enhanced Wage Add-on Program
			 (Program). The Program is designed to support nursing facilities with retention
			 of Certified Nursing Assistants (CNAs) by paying a starting wage of $17 per
			 hour for all Certified Nursing Assistants (CNAs), with an increase to $17.50
			 per hour by the second year of the 2021-2023 biennium (July 1, 2022).
(2) The Department will provide additional
			 compensation to nursing facilities who meet the criteria contained in paragraph
			 (3). Such compensation shall be an add-on of 4% of the daily Medicaid nursing
			 facility rate during the effective dates of the Program. A nursing facility may
			 be eligible to apply between October 1, 2021 and June 30, 2023.
(3) CRITERIA. Criteria must be met in order
			 for a nursing facility to be eligible for the Enhanced Wage Add-on Program. The
			 nursing facility shall submit documentation supporting that it provides a
			 starting wage of $17 per hour or more for all CNAs, escalating up to $17.50 per
			 hour or more by the second year of the 2021-2023 biennium (July 1, 2022).
			 Sufficient documentation shall be submitted to the Department with the required
			 form referenced in paragraph (5) and shall include at least one of the
			 following:
(a) A copy of a collective
			 bargaining agreement or addendums with such provisions;
(b) Amended policies that includes the wages
			 for CNAs during the period of the Program;
(c) Notification to CNAs of wages during the
			 period of the Program; or
(d)
			 Payroll records demonstrating rates of pay for CNAs equal to or higher than
			 $17.50 per hour.
(e) Written
			 communication to staff with wage criteria that includes reference to the
			 Legislature establishing a wage add-on to Medicaid rates for the purpose of
			 supporting caregiver wages in partnership with the Oregon Department of Human
			 Services, the Oregon Health Care Association, SEIU Local 503, and other senior
			 care advocates.
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 411-070-0437 - Quality and Efficiency Incentive Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) ESTABLISHMENT. Effective October 7, 2013
			 through June 30, 2016, the Department establishes the Quality and Efficiency
			 Incentive Program (Program) in order to implement Enrolled House Bill 2216
			 (Chapter 608, 2013 Oregon Laws) and Enrolled Senate Bill 1585 (2016). The
			 Program is designed to reimburse quality nursing facilities that voluntarily
			 reduce bed capacity that increases occupancy levels and enhances efficiency
			 with the goal of slowing the growth of system-wide costs. The Department may
			 provide additional compensation to nursing facilities who qualify for the
			 legislatively approved Program. Such compensation may not exceed $9.75 per
			 resident day and may not exceed four years from the date of eligibility.
			 Eligibility to participate in this Program sunsets on June 30, 2016.
(2) CAPACITY REDUCTION DISCUSSIONS. If two or
			 more providers wish to initiate discussions concerning reduction of bed
			 capacity in a community, the providers must notify the Department. The notice
			 must identify the community and state that the parties wish to discuss
			 reduction of bed capacity in that market pursuant to the Program.
(a) Upon receipt of a notice to discuss
			 reduction of bed capacity, the Department shall review the notice and either
			 approve or disapprove the proposed preliminary discussion. The Department shall
			 approve the preliminary discussion if the community is one in which the
			 proposed capacity reduction is consistent with the goals of the Program.
(b) If the Department approves the
			 preliminary discussion, the Department shall notify the providers who requested
			 approval and shall schedule a meeting at which a Department representative
			 shall be made available to supervise the discussion. Providers in the affected
			 market may attend the meeting and may discuss capacity reduction for that
			 market under the supervision of the Department.
(c) The Department shall determine the time,
			 place, and mechanism to discuss the reduction of bed capacity. The discussions
			 may be held in-person or by means of conference call, video conference, or such
			 other means that allow for each participant to hear and be heard by the other
			 participant at the same time.
(d)
			 Notice to the Department is not required for two providers who wish to discuss
			 a specific transfer of bed capacity.
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 411-070-0439 - COVID-19 Emergency Response Incentive Program

Current through Register Vol. 63, No. 7, July 1, 2024
							¿
(1) ESTABLISHMENT. The Department establishes
			 the COVID Response Incentive Program (Program). The Program is designed to
			 support nursing facilities in adopting employment policies that protect
			 employees during the COVID-19 pandemic.
(2) The Department will provide additional
			 compensation to nursing facilities who meet the criteria contained in paragraph
			 (3). Such compensation shall be 2.5% of their Medicaid Resident Revenue for
			 services provided during the effective dates of the Program. A facility may be
			 eligible for any continuous 90-day period between May 1, 2020 and September 30,
			 2020.
(3) CRITERIA. All three of
			 the following criteria must be met in order for a nursing facility to be
			 eligible for the incentive payment.
(a)
			 Increased paid time off: The nursing facility must demonstrate that it
			 increased paid time off for workers who become sick with COVID-19 or for
			 individuals who are being asked to quarantine by their employer or medical
			 professional or who are waiting for test results. Employees receiving paid time
			 off due to COVID-19 illness must receive pay equal to their regular hourly
			 compensation for scheduled work shifts. Sufficient evidence must be submitted
			 with the required claim form referenced in paragraph (5) and may include:
(A) For facilities with collective bargaining
			 agreements, a copy of any collective bargaining agreements or addendums with
			 such provisions if changes were made;
(B) A letter to all staff stating that this
			 protection has been granted;
(C)
			 Amended staff policies or handbooks; or
(D) Copies of payroll records showing paid
			 time off for ill employees.
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 411-070-0442 - Calculation of the Basic Rate, Complex Medical Rate, Bariatric Rate and Ventilator Assisted Program Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 rates are determined annually and referred to as the Rebasing Year.
(a) The basic rate is based on the statements
			 received by the Department by October 31 for the fiscal reporting period ending
			 on June 30 of the previous year. For example, for the year beginning July 1,
			 2018, statements for the period ending June 30, 2017 are used. The Department
			 desk reviews or field audits these statements and determines the allowable
			 costs for each nursing facility. The costs include both direct and indirect
			 costs. The costs and days relating to pediatric beds and Ventilator Assisted
			 Program beds are excluded from this calculation. The Department only uses
			 financial reports of facilities that have been in operation for at least 180
			 days and are in operation as of June 30.
(b) For each facility, its allowable costs,
			 less the costs of its self-contained pediatric unit (if any), or the Ventilator
			 Assisted Program Unit, are inflated by the DRI Index, or its successor index.
			 The DRI table as published in the fourth quarter of the year immediately
			 preceding the beginning of the payment year will be used. Costs will be
			 inflated to reflect projected changes in the DRI Index from the mid-point of
			 the fiscal reporting period to the mid-point of the payment year (e.g., for the
			 July 1, 2018 rebase, the midpoint of the fiscal reporting period is December
			 31, 2016 and the mid-point of the payment year is December 31, 2018).
(c) For each facility, its allowable costs
			 per Medicaid day is determined using the allowable costs as inflated and
			 resident days, excluding pediatric and ventilator days as reported in the
			 statement.
(d) The facilities are
			 ranked from highest to lowest by the facility's allowable costs, per Medicaid
			 day.
(e) The basic rate is
			 determined by ranking the allowable costs per Medicaid day by facility and
			 identifying the allowable cost per day at the applicable percentage. If there
			 is no allowable cost per day at the applicable percentage, the basic rate is
			 determined by interpolating the difference between the allowable costs per day
			 that are just above and just below the applicable percentage to arrive at a
			 basic rate at the applicable percentage. The applicable percentage for the
			 period beginning July 1, 2018 is at the 62nd percentile.
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 411-070-0452 - Pediatric Nursing Facilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 PEDIATRIC NURSING FACILITY.
(a) A pediatric
			 nursing facility is a licensed nursing facility at least 50 percent of whose
			 residents entered the facility before the age of 14 and all of whose residents
			 are under the age of 21.
(b) A
			 nursing facility that meets the criteria of subsection (1)(a) of this section
			 is reimbursed as follows:
(A) The pediatric
			 rate is a prospective rate and is not subject to settlement. The Department
			 uses financial reports of facilities that have been in operation for at least
			 180 days and are in operation as of June 30.
(B) The facility specific pediatric cost per
			 resident day is inflated as described in OAR
			 411-070-0442(1)(b).
			 The Oregon Medicaid pediatric days are multiplied by the inflated facility
			 specific cost per resident day for each pediatric facility. The totals are
			 summed and divided by total Oregon Medicaid days to establish the weighted
			 average cost per pediatric resident day. The rebase relationship percentage of
			 93 percent is applied to the weighted average cost to determine the pediatric
			 rate.
(c) Due to the
			 COVID-19 pandemic, a temporary 10% increase to the pediatric rate has been
			 authorized for nursing facilities for services provided April 1, 2020 thru June
			 30, 2020.
(d) Due to the
			 extraordinary expenses incurred as a result of the COVID-19 pandemic, a 5%
			 increase to the pediatric rate has been authorized for nursing facilities for
			 services provided January 1, 2021 thru June 30, 2023.
(e) Even though pediatric facilities are
			 reimbursed in accordance with subsection (1)(b) of this section, pediatric
			 facilities must comply with all requirements relating to the timely submission
			 of Nursing Facility Financial Statements.
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 411-070-0464 - Final Report

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
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 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.505 -
				  410.545
Stats. Implemented: ORS410.030 &
				  410.510
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0010 - Assessment Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.505 -
				  410.545
Stats. Implemented: ORS410.510 &
				  410.520
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0015 - Exemptions

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0020 - Assessment Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Department must develop and provide to certified programs an assessment
			 instrument to be used for all admission assessments.
(2) The admission assessment must consist of:
(a) Information necessary to comply with
			 federal pre-admission screening requirements as established by the Centers for
			 Medicare Services;
(b)
			 Recommendations regarding appropriate care settings and services based on the
			 individual's personal, family, and community support system, discussion of the
			 individual's lifestyle preferences and goals, and other information. An
			 individual or the individual's representative must indicate on the assessment
			 form provided by the Department whether the individual has received information
			 about care options or does not want the information. An individual may not be
			 required to receive this information. Documentation by non-hospital based
			 programs must be on the form designated by the Department. Hospital based
			 programs must document information regarding appropriate care settings and
			 services in their own discharge planning documents for all individuals
			 assessed.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0025 - Recommendations for Placement/Prohibition on Conflict of Interest

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.525 &
				  410.530
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0027 - Confidentiality of Assessment Information

Current through Register Vol. 63, No. 7, July 1, 2024
(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 chapter 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.
Stat. Auth.: ORS
				  410.535
Stats. Implemented: ORS410.505 -
				  410.545
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0030 - Assessment Fees

Current through Register Vol. 63, No. 7, July 1, 2024
A certified program must not charge an individual for any
				portion of the assessment.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.515,
				  410.525 &
				  410.530
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0035 - Certification Process

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.505 -
				  410.545
Stats. Implemented: ORS410.530
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0040 - Application Process

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0043 - Qualifications for Personnel Performing Admission Assessments

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0045 - Issuance of the Certificate for Private Admission Assessment

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  410.535
Stats. Implemented: ORS410.505 -
				  410.545
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 71 - PRIVATE ADMISSION ASSESSMENT › Section 411-071-0050 - Contracts, Reimbursements, and Certification Fees

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  410.070
Stats. Implemented: ORS
				  410.515,
				  410.530 &
				  410.535