OAR 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 (Right to Return from Hospital) or right of readmission under 411-088-0060 (Right to Readmission), 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.

Source: Rule 411-070-0010 — Conditions for Payment, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-070-0010.

411‑070‑0000
Purpose
411‑070‑0005
Definitions
411‑070‑0010
Conditions for Payment
411‑070‑0015
Denial, Termination or Non-Renewal of Provider Agreement
411‑070‑0020
On-Site Reviews
411‑070‑0025
Basic Flat Rate Payment (Basic Rate)
411‑070‑0027
Complex Medical Add-On Payment
411‑070‑0028
Bariatric Authorization and Payment
411‑070‑0029
Pediatric Rate
411‑070‑0033
Post Hospital Extended Care Benefit
411‑070‑0035
Complex Medical Add-On Effective Start and End Dates and Administrative Review
411‑070‑0040
Screening, Assessment, and Resident Review
411‑070‑0043
Pre-Admission Screening and Resident Review (PASRR)
411‑070‑0045
Facility Payments
411‑070‑0050
Days Chargeable
411‑070‑0075
Rates - Facilities in Oregon
411‑070‑0080
Out-of-State Rates
411‑070‑0085
Bundled Rate
411‑070‑0087
Bariatric Criteria and Services
411‑070‑0091
Complex Medical Add-On Services
411‑070‑0092
Ventilator Assisted Program - Medicaid Payment
411‑070‑0095
Resident Funds
411‑070‑0100
Audit of Personal Incidental Funds
411‑070‑0105
Resident Property Records
411‑070‑0110
Temporary Absence from Facility (Bedhold)
411‑070‑0115
Transfer of Residents
411‑070‑0120
Discharge of Residents
411‑070‑0125
Medicare, (Title XVIII)
411‑070‑0130
Medicaid Payment in Hospitals
411‑070‑0140
Hospice Services
411‑070‑0300
Filing of Financial Statement
411‑070‑0302
Filing of Revised Financial Statements
411‑070‑0305
Accounting and Record Keeping
411‑070‑0310
Auditing
411‑070‑0315
Maximum Allowable Compensation of Administrator
411‑070‑0320
Consultants
411‑070‑0330
Owner Compensation
411‑070‑0335
Related Party Transactions
411‑070‑0340
Chain Operations
411‑070‑0345
Allocation of Home Office and Regional Office Costs
411‑070‑0350
Management Fees
411‑070‑0359
Allowable Costs
411‑070‑0365
Capital Assets
411‑070‑0370
Depreciable Assets
411‑070‑0375
Depreciation Basis
411‑070‑0385
Depreciation Lives
411‑070‑0400
Equity
411‑070‑0415
Offset Income
411‑070‑0417
Treatment of Complex Medical Add-Ons
411‑070‑0420
Base Year Cost Finding
411‑070‑0425
Resident Days
411‑070‑0430
Allocation Methods
411‑070‑0435
Appeals
411‑070‑0437
Quality and Efficiency Incentive Program
411‑070‑0439
COVID-19 Emergency Response Incentive Program
411‑070‑0442
Calculation of the Basic Rate, Complex Medical Rate, Bariatric Rate and Ventilator Assisted Program Rate
411‑070‑0452
Pediatric Nursing Facilities
411‑070‑0464
Final Report
411‑070‑0465
Uniform Chart of Accounts
411‑070‑0470
Nursing Assistant Training and Competency Evaluation Programs Request for Reimbursement
Last Updated

Jun. 8, 2021

Rule 411-070-0010’s source at or​.us