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