OAR 411-070-0033
Post Hospital Extended Care Benefit
(1)
The post hospital extended care benefit (OAR 410-120-1210 (Medical Assistance Benefit Packages and Delivery System)(4)) is an Oregon Health Plan benefit that consists of a stay of up to 20 days in a nursing facility to allow discharge from hospitals.(2)
The post hospital extended care benefit must be prior authorized by pre-admission screening for individuals not enrolled in managed care.(3)
To be eligible for the post hospital extended care benefit, the individual must meet all of the following:(a)
Be receiving Oregon Health Plan Plus or Standard, Fee-for-Service benefits;(b)
Not be Medicare eligible;(c)
Have a medically-necessary, qualifying hospital stay consisting of:(A)
A DMAP-paid admission to an acute-care hospital bed, not including a hold bed, observation bed, or emergency room bed.(B)
The stay must consist of three or more consecutive days, not counting the day of discharge.(d)
Transfer to a nursing facility within 30 days of discharge from the hospital;(e)
Need skilled nursing or rehabilitation services on a daily basis for a hospitalized condition meeting Medicare skilled criteria that may be provided only in a nursing facility meaning:(A)
The individual is at risk of further injury from falls, dehydration, or nutrition because of insufficient supervision or assistance at home;(B)
The individual’s condition requires daily transportation to a hospital or rehabilitation facility by ambulance; or(C)
It is too far to travel to provide daily nursing or rehabilitation services in the individual’s home.(4)
The individual may qualify for another 20 day post-hospital extended care benefit only if the individual has been out of a hospital and has not received skilled nursing care for 60 consecutive days in a row and meets all the criteria in this rule.(5)
Individuals eligible for the 20 day post-hospital extended care benefit are not eligible for long term care nursing facility or Medicaid home and community-based services unless the individual meets the eligibility criteria in OAR 411-015-0100 (Eligibility for Nursing Facility or Medicaid Home and Community-Based Services) or 411-320-0080 (Application and Eligibility Determination).
Source:
Rule 411-070-0033 — Post Hospital Extended Care Benefit, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-070-0033.