Nursing facilities must meet the following conditions in order
to receive payment under Title XIX (Medicaid):
(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
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
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
, 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
for any bed occupied by or held for any resident who is found eligible for
Medicaid until the bed is vacated by:
death of the resident; or
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
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
CIVIL RIGHTS, MEDICAID DISCRIMINATION.
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
(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
(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
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.
Or. Admin. R.
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
Stats. Implemented: ORS