Or. Admin. R. 410-148-0120 - Reimbursement Limitations for Clients in a Nursing Facility

(1) The Division of Medical Assistance Programs (Division) will not reimburse for the following services/supplies for clients residing in a nursing facility:

(a) Nursing service visits (including assessment visit). Refer to Aging and People with Disabilities (APD) administrative rule covering all-inclusive rate;

(b) Supplies and items covered in the nursing facility All-inclusive rate. Refer to the Supplemental Information section of the Home Enteral/Parenteral Nutrition and IV Services provider website (http://www.oregon.gov/OHA/HSD/OHP/Pages/Policy-Home-EPIV.aspx) for a listing of those supplies and items;

(c) Oral nutritional supplements that are in addition to consumption of food items or meals.

(2) The Division will reimburse for the following:

(a) Oral nutritional supplements are covered by the Division for nursing facility clients when medically appropriate, i.e., the client cannot consume food items or meals;

(b) Tube fed enteral nutrition formula, when medically appropriate;

(c) Patient controlled pump for pain control medication (CADD).

Notes

Or. Admin. R. 410-148-0120

HR 26-1993, f. & cert. ef. 10-1-93; HR 34-1993(Temp), f. & cert. ef. 12-1-93; HR 11-1994, f. 2-25-94, cert. ef. 2-27-94; OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0730; OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03; OMAP 15-2004, f. 3-11-04, cert. ef. 4-1-04; DMAP 64-2018, minor correction filed 05/25/2018, effective 5/25/2018

Publications: Publications referenced are available from the agency.

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065