Current through Register Vol. 60, No. 12, December 1, 2021
Non-contiguous area hospitals are out-of-state hospitals
located more than 75 miles outside the Oregon border. Contiguous area hospitals
are out-of state hospitals located less than 75 miles outside the Oregon
border. Unless such hospitals have an agreement with the Division of Medical
Assistance Programs (Division) regarding reimbursement for specialized
services, these hospitals will be reimbursed as follows:
(1) Laboratory, diagnostic and therapeutic
radiology, nuclear medicine, CT scans, MRI services, other imaging services,
and maternity case management services will be reimbursed under a Division fee
schedule.
(2) All other outpatient
services will be reimbursed at 50 percent of billed charges. There is no cost
settlement.
(3) Notwithstanding
subsections (1)-(2) of this rule, this subsection becomes effective for dates
of service on and after January 1, 2006, but will not be operative as the basis
for payments until the Division determines all necessary federal approvals have
been obtained. Non-contiguous area hospitals are out-of-state hospitals located
more than 75 miles outside the Oregon border. Contiguous area hospitals are
out-of-state hospitals located less than 75 miles outside the Oregon border.
Unless such hospitals have an agreement with the Division regarding
reimbursement for specialized services, these hospitals will be reimbursed as
follows:
(a) Clinical laboratory services
will be reimbursed under a Division fee schedule;
(b) All other outpatient services will be
reimbursed at 50 percent of billed charges. There is no cost
settlement.
(4) The
National Drug Code (NDC) must be included on the electronic (837I) and paper
(UB 04) claims for physician administered drug codes required by the Deficit
Reduction Act of 2005.
Notes
Or. Admin. R.
410-125-0181
AFS 14-1980, f. 3-27-80,
ef. 4-1-80; AFS 57-1980, f. 8-29-80, ef. 9-1-80; AFS 18-1982(Temp), f. &
ef. 3-1-82; AFS 60-1982, f. & ef. 7-1-82; Renumbered from 461-015-0120(5);
AFS 37-1983(Temp), f. & ef. 7-15-83; AFS 1-1984, f. & ef. 1-9-84; AFS
45-1984, f. & ef. 10-1-84; AFS 6-1985, f. 1-28-85, ef. 2-1-85; AFS 52-1985,
f. 9-3-85, ef. 10-1-85; AFS 46-1986(Temp), f. 6-25-86, ef. 7-1-86; AFS 61-1986,
f. 8-12-86, ef. 9-1-86; AFS 33-1987(Temp), f. & ef. 7-22-87; AFS 46-1987,
f. & ef. 10-1-87; AFS 62-1987(Temp), f. 12-30-87, ef. 1-1-88; AFS 12-1988,
f. 2-10-88, cert. ef. 6-1-88; AFS 26-1988, f. 3-31-88, cert. ef. 4-1-88; AFS
47-1988(Temp), f. 7-13-88, cert. ef. 7-1-88; AFS 63-1988, f. 10-3-88, cert. ef.
12-1-88; AFS 7-1989(Temp), f. 2-17-89, cert. ef. 3-1-89; AFS 15-1989(Temp), f.
3-31-89, cert. ef. 4-1-89; AFS 36-1989(Temp), f. & cert. ef. 6-30-89; AFS
37-1989(Temp), f. 6-30-89, cert. ef. 7-1-89; AFS 45-1989, f. & cert. ef.
8-21-89; AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89; AFS 72-1989, f. &
cert. ef. 12-1-89, Renumbered from 461-015-0124; HR 18-1990(Temp), f. 6-29-90,
cert. ef 7-1-90; HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from
461-015-0540; HR 31-1990(Temp), f. & cert. ef. 9-11-90; HR 2-1991, f. &
cert. ef. 1-4-91; HR 15-1991(Temp), f. & cert. ef. 4-8-91; HR
28-1991(Temp), f. & cert. ef. 7-1-91; HR 32-1991(Temp), f. & cert. ef.
7-29-91; HR 53-1991, f. & cert. ef. 11-18-91, Renumbered from 410-125-0780;
OMAP 13-2003, f. 2-28-03, cert. ef. 3-1-03; OMAP 58-2003, f. 9-5-03, cert. ef.
10-1-03; OMAP 90-2003, f. 12-30-03 cert. ef. 1-1-04; OMAP 16-2004(Temp), f.
& cert. ef. 3-15-04 thru 8-15-04; OMAP 27-2004, f. 4-22-04 cert. ef.
5-1-04; OMAP 73-2005, f. 12-29-05, cert. ef. 1-1-06; OMAP 17-2006, f. 6-12-06,
cert. ef. 7-1-06; DMAP 39-2008, f. 12-11-08, cert. ef.
1-1-09
Stat. Auth.: ORS
413.042
Stats. Implemented: ORS
414.065
