Or. Admin. Code § 411-018-0010 - Certification Process
(1) A long-term
care facility seeking certification as an essential community provider
long-term care facility must make written application to the Department. The
application must include:
(a) The name under
which the facility is licensed;
(b)
The facility's Medicaid provider number, if the facility has a Medicaid
contract;
(c) The mailing address
of the facility;
(d) The county in
which the facility is located;
(e)
The name and address of a contact person at the facility;
(f) Information about facility residency
during the previous calendar year to include:
(A) A monthly count of resident days paid for
or accrued by Medicaid;
(B) A
monthly count of resident days paid for or accrued by Medicare;
(C) A monthly count of resident days that
would have been paid by Medicaid except for the availability of Medicare
payment;
(D) A monthly count of
resident days paid privately by facility residents or their families;
and
(E) A monthly count of resident
days paid through any other payment source; and
(g) A statement of the average calendar year
Medicaid eligible residency rate. The average Medicaid eligible residency rate
is the sum of all monthly days paid by or accrued to Medicaid plus all monthly
days that would have been paid by Medicaid except for the availability and use
of another source of payment divided by the total of all monthly days paid
through or accrued to all payment sources including Medicaid. The percent
calculated will be rounded up by the third decimal place.
(2) The Department will make a suggested
application form available to facilities upon request. Facilities are not
required to use the suggested application form to apply for certification;
however, no application for certification may be considered complete until all
information listed in section (1) of this rule is received.
(3) Applications must be delivered to Seniors
and People with Disabilities, Research, Planning and Rate Setting, 500 Summer
Street NE-E18, Salem, OR 97301-1074.
(4) The earliest date on which the Department
will accept an application for certification is January 2 of the calendar year
following the year for which the Certification is sought.
(5) Application will be considered complete
on the date received by the Department if all required information is
included.
(6) The Department must
audit and review applications submitted by facilities to ensure accuracy of the
information provided and will issue Certification if the average Medicaid
eligible residency rate during the preceding calendar year is:
(a) 50 percent or more in a nursing facility,
assisted living facility or residential care facility; or
(b) 60 percent or more in an adult foster
home.
(7) The Department
must issue a notice of Certification within 15 business days following receipt
of the completed application if it is determined the facility meets the
required Medicaid eligible residency rate in section (6)(a) or (6)(b) of this
rule.
(8) The Certification issued
by the Department will include information required by the local taxing
districts for submitting Certifications.
(9) The Certification must be mailed to the
mailing address supplied by the facility.
(10) The Certification issued by the
Department only applies to the single licensed facility for which Certification
is requested.
Notes
Stat. Auth.: ORS 410.070
Stats. Implemented: ORS 307.808 - 307.815, 443.888 & 410.070
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