Or. Admin. R. 411-070-0085 - Bundled Rate
(1) PURPOSE. The
nursing facility rate established for a facility is a bundled rate and includes
all services, supplies and facility equipment required for services.
(2) SERVICES AND SUPPLIES.
(a) The following services and supplies
required to provide services in accordance with each resident's care plan are
included in the bundled rate:
(B) All support services and supplies
associated with the required nursing services;
(C) All activity services, supplies and
staffing as defined in OAR 411-086-0230;
(D) All social services, supplies and
staffing as defined in OAR 411-086-0240;
(E) All dietary services, supplies and
staffing as defined in OAR 411-086-0250;
(F) All professional consultant
services;
(G) All services of the
facility medical director;
(H)
Management of resident funds, including purchase of items;
(I) Room and board, including:
(i) Special diets and non-pumped food
supplements; and
(ii) Laundry,
whether performed by the facility staff or an outside provider, including
laundering and marking of resident's personal clothing and
bedding;
(J)
Miscellaneous services and supplies, including:
(i) Items stocked by the facility in gross
supply and administered individually on physician's order;
(ii) Items owned or rented by the facility
that are utilized by individual residents but are reusable and are routinely
expected to be available in a nursing facility;
(iii) Shaves, haircuts, supplies and shampoos
as required for grooming and cleanliness, whether performed by facility staff
or by an outside provider; and
(iv)
Transportation provided in vehicles that are owned or leased by the facility or
by any person who holds an ownership interest in the facility.
(b) Items included
within the bundled rate must meet all of the following criteria:
(A) Item(s) are medically
appropriate;
(B) Item(s) are most
effective and least costly means to meet the individuals' needs; and
(C) Item(s) are allowed in the state
plan.
(c) The Oregon
Health Plan will continue to provide coverage for specified items and equipment
in accordance with OAR chapter 410, division 122. No entitlement to any item is
created for any resident in a nursing facility based solely on the listing of
an item in OAR chapter 410, division 122, as potentially included in the
nursing facility bundled rate. Oregon Health Plan limits on duration, scope
and/or frequency of provision of the item(s) may not apply to the bundled rate
if the facility needs to provide the item(s) in excess of the limits in order
to meet resident needs. Nursing facilities are not required to purchase all
specified codes, forms, sizes or varieties of the items listed in OAR chapter
410, division 122, so long as the residents' service needs are met. Nursing
facilities are not required to honor individual preferences for specific types
of equipment and supplies.
(d) The
bundled rate pays for all equipment and supplies, unless the item(s) is
specified as not paid for by the bundled rate. Equipment and supplies paid for
in the bundled rate include:
(A) Oxygen and
oxygen equipment, including concentrators, unless the oxygen provided exceeds
1,000 liters in a 24-hour period;
(B) Glucose monitors and diabetic
equipment;
(C) Nebulizers and
nebulizer supplies;
(D) Ostomy
supplies;
(E) Urological
supplies;
(F) Resident lifts except
as specified in Appendix A to this rule;
(G) Toilet supplies, except as specified in
Appendix A to this rule;
(H)
Miscellaneous supplies;
(I)
Surgical dressings;
(J)
Incontinence supplies;
(K) All
medically necessary wheelchairs and wheelchair accessories except:
(i) As specified in Appendix A to this rule;
or
(ii) If at the time of admission,
the individual's expected length of stay in the nursing facility is 30 days or
less as confirmed on a written statement from the individual's attending
physician, and the individual has a physician's order for the same wheelchair
for on-going use in the individual's home and meets Department of Medical
Assistance Programs (DMAP) criteria for a tilt-in-space wheelchair;
(L) Suction pumps and supplies;
(M) Tracheostomy
supplies;
(N) Canes and
crutches;
(O) Standing and
positioning aides;
(P)
Walkers;
(Q) Hospital beds, except
as specified in Appendix A to this rule or if an exception need exists as
determined by the DMAP prior authorization process;
(R) Pressure reducing support services,
except as specified in Appendix A to this rule;
(S) Hospital bed accessories, except as
specified in Appendix A to this rule;
(T) Bath supplies; and
(U) Over the counter medications as defined
in Appendix B to this rule.
(e) The following services and supplies are
NOT included in the bundled rate:
(A) Therapy
services provided to residents by outside providers;
(B) Medical services by physicians or other
practitioners other than the services required by OAR 411-086-0200;
(C) Radiology services, laboratory services
and podiatry services;
(D)
Transportation for residents to and from medical services in vehicles that are
not owned or leased by the facility or by any person who holds an ownership
interest in the facility;
(E)
Biologicals (e.g., immunization vaccines);
(F) Hyperalimentation ;
(G) Prescription pharmaceuticals;
or
(H) Ventilators.
Notes
Stat. Auth.: ORS 414.065 & 410.070
Stats. Implemented: ORS 410.070 & 414.065
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