Or. Admin. Code § 411-070-0010 - Conditions for Payment
Nursing facilities must meet the following conditions in order to receive payment under Title XIX (Medicaid):
(1) CERTIFICATION.
(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
beds.
(c) 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
Program;
(B) Request 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
411-088-0060, 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 initiated;
(C) Retain certification for any bed occupied
by or held for any resident who is found eligible for Medicaid until the bed is
vacated by:
(i) The death of the resident;
or
(ii) The 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
(E) 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 facility.
(2) CIVIL RIGHTS, MEDICAID DISCRIMINATION.
(a) 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 this rule.
(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 charges.
(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 regulation.
(3) PROVIDER 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.
Notes
Stat. Auth.: ORS 410.070 & 414.065
Stats. Implemented: ORS 410.070 & 414.065
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