Current through Register Vol. 60, No. 12, December 1, 2021
Effective for dates of service on or after November 17, 2005, physician and
other practitioner services provided by practitioners affiliated with a public
academic medical center that meets the following eligibility standards shall be
eligible for a supplemental teaching practitioner's payment for these services
provided to eligible Medicaid recipients and paid for directly on a
fee-for-service basis, subject to subsections (3) and (4) of this rule. This
supplemental payment shall be equal to the difference between the Medicare
allowable and Medicaid reimbursement received.
Eligible academic medical centers must
(a) The hospital must be located within
the State of Oregon (border hospitals are excluded); and
(b) The hospital provides a major medical
teaching program, defined as a hospital with more than 200 residents or
under this rule shall be made only to the eligible academic medical centers in
accordance with the terms of an intergovermental agreement between the eligible
academic medical center and Division of Medical Assistance Programs (Division).
Such payments may be made quarterly, but shall be at least paid annually, at
the end of each federal fiscal year. Calculation of the payment amount will be
based on the annual difference between the practitioners' Medicare allowable
and the Medicaid allowable payments to eligible practitioners for the Medicaid
claims paid during the most recently completed state fiscal year. Services
included are physician and other practitioners' services with RVU weights and
physician-administered drugs. The RVU rates used for the payment calculation
are the Division fee established in rule for the date of service payment
(4) Allowable Medicaid
payments including this supplemental payment remain subject to OAR
410-125-0220(12) and 410-130-0225. For purposes of this rule, the allowable
Medicaid payments used to calculate the supplemental payment shall be limited
to the services that are billed fee-for-service to the Division on the
electronic 837P or the paper CMS-1500, and as to which the physician or
practitioner is receiving no reimbursement from the eligible academic medical
center and the cost of their service is not reported as a direct medical
education cost on the Medicare and the Division cost report.
Or. Admin. R.
OMAP 33-2006, f. 8-31-06,
cert. ef. 9-1-06; OMAP 43-2006, f. 12-15-06, cert. ef.
Stat. Auth.: ORS