Or. Admin. R. 411-070-0033 - Post Hospital Extended Care Benefit
(1) The post hospital extended care benefit
(OAR 410-120-1210(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.
(3) 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;
(c) 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.
(B)
The stay must consist of three or more consecutive days, not counting the day
of discharge.
(d)
Transfer to a nursing facility within 30 days of discharge from the hospital;
(e) 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
meaning:
(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.
(4) The
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
this rule.
(5) Individuals
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
411-015-0100 or 411-320-0080.
Notes
Stat. Auth.: ORS 410.070 & 414.065
Stats. Implemented: 410.070 & 414.065
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