The post hospital extended care benefit
(4)) is an Oregon Health Plan benefit that consists of a stay
of up to 20 days in a nursing facility to allow discharge from hospitals.
(2) The post hospital extended
care benefit must be prior authorized by pre-admission screening for
individuals not enrolled in managed care.
To be eligible for the post hospital
extended care benefit, the individual must meet all of the following:
(a) Be receiving Oregon Health Plan Plus or
Standard, Fee-for-Service benefits;
(b) Not be Medicare eligible;
Have a medically-necessary, qualifying
hospital stay consisting of:
(A) A DMAP-paid
admission to an acute-care hospital bed, not including a hold bed, observation
bed, or emergency room bed.
The stay must consist of three or more consecutive days, not counting the day
Transfer to a nursing facility within 30 days of discharge from the hospital;
Need skilled nursing or
rehabilitation services on a daily basis for a hospitalized condition meeting
Medicare skilled criteria that may be provided only in a nursing facility
(A) The individual is at risk of
further injury from falls, dehydration, or nutrition because of insufficient
supervision or assistance at home;
(B) The individual's condition requires daily
transportation to a hospital or rehabilitation facility by ambulance; or
(C) It is too far to travel to
provide daily nursing or rehabilitation services in the individual's home.
individual may qualify for another 20 day post-hospital extended care benefit
only if the individual has been out of a hospital and has not received skilled
nursing care for 60 consecutive days in a row and meets all the criteria in
eligible for the 20 day post-hospital extended care benefit are not eligible
for long term care nursing facility or Medicaid home and community-based
services unless the individual meets the eligibility criteria in OAR
Or. Admin. R.
SPD 4-2005, f. & cert.
ef. 4-19-05; SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09; SPD 14-2013(Temp), f.
& cert. ef. 7-1-13 thru 12-28-13; SPD 44-2013, f. 12-13-13, cert. ef.
Stat. Auth.: ORS