The rates are
determined annually and referred to as the Rebasing Year.
(a) The basic rate is based on the statements
received by the Department by October 31 for the fiscal reporting period ending
on June 30 of the previous year. For example, for the year beginning July 1,
2018, statements for the period ending June 30, 2017 are used. The Department
desk reviews or field audits these statements and determines the allowable
costs for each nursing facility. The costs include both direct and indirect
costs. The costs and days relating to pediatric beds and Ventilator Assisted
Program beds are excluded from this calculation. The Department only uses
financial reports of facilities that have been in operation for at least 180
days and are in operation as of June 30.
(b) For each facility, its allowable costs,
less the costs of its self-contained pediatric unit (if any), or the Ventilator
Assisted Program Unit, are inflated by the DRI Index, or its successor index.
The DRI table as published in the fourth quarter of the year immediately
preceding the beginning of the payment year will be used. Costs will be
inflated to reflect projected changes in the DRI Index from the mid-point of
the fiscal reporting period to the mid-point of the payment year (e.g., for the
July 1, 2018 rebase, the midpoint of the fiscal reporting period is December
31, 2016 and the mid-point of the payment year is December 31, 2018).
(c) For each facility, its allowable costs
per Medicaid day is determined using the allowable costs as inflated and
resident days, excluding pediatric and ventilator days as reported in the
(d) The facilities are
ranked from highest to lowest by the facility's allowable costs, per Medicaid
(e) The basic rate is
determined by ranking the allowable costs per Medicaid day by facility and
identifying the allowable cost per day at the applicable percentage. If there
is no allowable cost per day at the applicable percentage, the basic rate is
determined by interpolating the difference between the allowable costs per day
that are just above and just below the applicable percentage to arrive at a
basic rate at the applicable percentage. The applicable percentage for the
period beginning July 1, 2018 is at the 62nd percentile.
(2) Due to the COVID-19 pandemic, a temporary
10% increase to the basic rate has been authorized for nursing facilities for
services provided April 1, 2020 thru June 30, 2020.
(3) Due to the extraordinary expenses
incurred as a result of the COVID-19 pandemic, a 5% increase to the basic rate
has been authorized for nursing facilities for services provided January 1,
2021 thru March 31, 2022.
Department provides an augmented rate to nursing facilities who qualify under
the Quality and Efficiency Incentive Program as described in OAR 411-070-0437
An acquisition plan must be submitted to the Department on or after October 7,
2013 and on or before June 30, 2016. The purchasing operator must meet all
requirements in OAR 411-070-0437
(3) in order to receive the augmented rate. The
qualifying nursing facility is paid the augmented rate for each
Nursing facility bed capacity in Oregon shall be reduced by 1,500 beds by
December 31, 2015, except for bed capacity in nursing facilities operated by
the Department of Veteran's Affairs and facilities that either applied to the
Oregon Health Authority for a certificate of need between August 1, 2011 and
December 1, 2012, or submitted a letter of intent under ORS
between January 15, 2013 and January 31, 2013. An official bed count
measurement shall be determined and issued by the Department as of July 1, 2016
and each quarter thereafter if the goal of reducing the nursing facility bed
capacity in Oregon by 1,500 beds is not achieved.
(a) For the period beginning July 1, 2013 and
ending June 30, 2016, the Department shall reimburse costs as set forth in
section (1) of this rule at the 63rd percentile.
For each three-month period beginning on
or after July 1, 2016 and ending June 30, 2018, in which the reduction in bed
capacity in licensed facilities is less than the goal described in this
section, the Department shall reimburse costs at a rate not lower than the
percentile of allowable costs according to the following schedule:
(A) 63rd percentile for a reduction of 1,500
or more beds.
(B) 62nd percentile
for a reduction of 1,350 or more beds but less than 1,500 beds.
(C) 61st percentile for a reduction of 1,200
or more beds but less than 1,350 beds.
(D) 60th percentile for a reduction of 1,050
or more beds but less than 1,200 beds.
(E) 59th percentile for a reduction of 900 or
more beds but less than 1,050 beds.
(F) 58th percentile for a reduction of 750 or
more beds but less than 900 beds.
(G) 57th percentile for a reduction of 600 or
more beds but less than 750 beds.
(H) 56th percentile for a reduction of 450 or
more beds but less than 600 beds.
(I) 55th percentile for a reduction of 300 or
more beds but less than 450 beds.
(J) 54th percentile for a reduction of 150 or
more beds but less than 300 beds.
(K) 53rd percentile for a reduction of 1 to
(c) For the
period beginning July 1, 2018 and ending June 30, 2026, the Department shall
reimburse costs, as set forth in section (1) of this rule, at the 62nd
complex medical rate is 140% percent of the basic rate.
(7) The Ventilator Assisted Program rate is
235% of the established basic rate.
(8) The bariatric rate is 185% of the
established basic rate.
Or. Admin. R.
SPD 36-2004, f. 12-23-04,
cert. ef. 12-28-04; SPD 15-2007(Temp), f. & cert. ef. 9-10-07 thru 3-8-08;
SPD 2-2008, f. 2-29-08, cert. ef. 3-1-08; SPD 6-2009(Temp), f. & cert. ef.
7-1-09 thru 12-28-09; SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09; SPD
17-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SPD 22-2011, f.
10-7-11, cert. ef. 11-1-11; SPD 10-2012, f. 7-31-12, cert. ef. 8-1-12; SPD
37-2013(Temp), f. 10-4-13, cert. ef. 10-7-13 thru 4-5-14; SPD 39-2013(Temp), f.
10-4-13, cert. ef. 10-7-13 thru 4-5-14; APD 2-2014, f. 3-13-14, cert. ef.
4-1-14; APD 20-2014, f. & cert. ef. 7-1-14; APD 7-2016(Temp), f. 3-30-16,
cert. ef. 4-1-16 thru 9-27-16;
38-2016, f. 9-27-16, cert. ef.
17-2018, amend filed 06/28/2018, effective
9-2019, amend filed 01/31/2019, effective
2-2020, minor correction filed 02/13/2020, effective
2/13/2020; APD 8-2020, temporary amend filed
03/20/2020, effective 03/20/2020 through 09/15/2020; APD 25-2020, amend filed
06/23/2020, effective 07/01/2020;
28-2020, temporary amend filed 06/26/2020, effective
7/1/2020 through 12/27/2020;
36-2020, amend filed 09/02/2020, effective
9/4/2020; APD 11-2021, temporary
amend filed 03/09/2021, effective 03/12/2021 through 09/07/2021;
25-2021, amend filed 06/29/2021, effective
27-2021, temporary amend filed 06/30/2021, effective
7/1/2021 through 12/27/2021;
38-2021, amend filed 09/22/2021, effective
Statutory/Other Authority: ORS
Statutes/Other Implemented: ORS
OL 2003 ch. 736, OL 2007 ch. 780, OL 2009 ch. 827, OL 2011 ch. 630, OL 2013 ch.
608 & OL 2018 ch. 66