Or. Admin. R. 411-070-0010 - Conditions for Payment

Nursing facilities must meet the following conditions in order to receive payment under Title XIX (Medicaid):

(1) CERTIFICATION.
(a) The facility must be in compliance with Title XIX federal certification requirements.
(b) Except as provided in section (1)(c) of this rule, all beds in the facility must be certified as nursing facility beds.
(c) A facility choosing to discontinue compliance with section (1)(b) of this rule may elect to gradually withdraw from Medicaid certification but must comply with all of the following:
(A) Notify SPD in writing within 30 days of the certification survey that it elects to gradually withdraw from the Medicaid Program;
(B) Request Medicaid reimbursement for any resident who resided in the facility, or who was eligible for right of return under OAR 411-088-0050 or right of readmission under OAR 411-088-0060, on the date of the notice required by this rule. If it appears the resident may be eligible within 90 days, such request may be initiated;
(C) Retain certification for any bed occupied by or held for any resident who is found eligible for Medicaid until the bed is vacated by:
(i) The death of the resident; or
(ii) The transfer or discharge of the resident pursuant to the transfer rules in OAR chapter 411, division 088.
(D) All Medicaid recipients exercising rights of return or readmission under the transfer rules must be permitted to occupy a Medicaid certified bed; and
(E) Notify in writing all persons applying for admission subsequent to notification of gradual withdrawal that, should the person later become eligible for Medicaid assistance, that reimbursement would not be available in that facility.
(2) CIVIL RIGHTS, MEDICAID DISCRIMINATION.
(a) The facility must meet the requirements of Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973.
(b) The facility must not discriminate based on source of payment. The facility must not have different standards of transfer or discharge for Medicaid residents except as required to comply with this rule.
(c) The facility must accept Medicaid payment as payment in full. The facility must not require, solicit, or accept payment, the promise of payment, a period of residence as a private pay resident, or any other consideration as a condition of admission, continued stay, or provision of care or service from the resident, relatives, or any one designated as a "responsible party".
(d) No applicant may be denied admission to a facility solely because no family member, relative, or friend is willing to accept personal financial liability for any of the facility's charges.
(e) The facility may not request or require a resident, relative, or "responsible party" to waive or forego any rights or remedies provided under state or federal law, rule, or regulation.
(3) PROVIDER AGREEMENT, FACILITY PAYMENT.
(a) The facility must sign a formal provider agreement with SPD.
(b) The facility must file a NFFS with SPD within 90 days after the end of its fiscal year.
(c) The facility must bill SPD in accordance with established rules and guidelines.

Notes

Or. Admin. R. 411-070-0010
PWC 847(Temp), f. & ef. 7-1-77; PWC 859, f. 10-31-77, ef. 11-1-77; Renumbered from 461-017-0020, AFS 69-1981, f. 9-30-81, ef. 10-1-81; SSD 12-1986, f. 9-26-86, ef. 10-1-86; SSD 20-1990, f. & cert. ef. 10-4-90; SSD 17-1991(Temp), f. & cert. ef. 9-13-91; SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06; SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09

Stat. Auth.: ORS 410.070 & 414.065

Stats. Implemented: ORS 410.070 & 414.065

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