OAR 411-070-0027
Complex Medical Add-On Payment


(1)

PAYMENT. APD may provide payment for a complex medical add-on (in addition to the basic rate) when the resident requires one or more of the treatments, procedures, and services listed in OAR 411-070-0091 (Complex Medical Add-On Services), for the additional licensed nursing services needed to meet the resident’s increased needs.

(2)

APD may pay the complex medical add-on only as long as the resident’s needs meet one or more of the treatments, procedures, and services listed in OAR 411-070-0091 (Complex Medical Add-On Services) and the facility maintains the required documentation.

(3)

DOCUMENTATION. The licensed nursing staff of the nursing facility must keep sufficient documentation pertinent to the qualified complex medical add-on procedure codes in the resident’s clinical record to justify the complex medical add-on payment determination in accordance with these rules (refer to OAR 411-070-0091 (Complex Medical Add-On Services)) and must make it available to APD upon request.

(4)

COMPLEX MEDICAL ADD-ONS PROHIBITED. APD may not provide complex medical add-on payments for a facility with a waiver that allows a reduction of eight or more hours per week from required licensed nurse staffing hours.

Source: Rule 411-070-0027 — Complex Medical Add-On Payment, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-070-0027.

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 411-070-0027’s source at or​.us