OAR 411-070-0035
Complex Medical Add-On Effective Start and End Dates and Administrative Review


(1)

Effective Complex Medical Add-On Start and End Dates

(a)

Complex Medical Add-On Start Date:

(A)

Admission of any Medicaid resident whose condition or service needs meet the criteria for a complex medical add-on procedure code; or

(B)

A current Medicaid resident whose condition or service needs change and now meets the criteria for a complex medical add-on procedure code. This includes a readmission or return of a Medicaid resident following a leave of absence from the nursing facility whose needs meet add-on criteria.

(b)

Complex Medical Add-On End date — For a resident whose condition or service needs meet a complex medical add-on procedure code, the complex medical add-on is effective only until the last date the resident’s condition or need continues to meet complex medical add-on procedure code criteria.

(2)

ADMINISTRATIVE REVIEW. If a provider disagrees with the decision of APD’s Complex Medical Add-On Coordinator to make or deny an adjustment in the complex medical add-on payment for a Medicaid resident, the provider may request from APD an administrative review of the decision. The provider must submit its request for review in writing within 30 days of receipt of the notice to make or deny the adjustment. The provider must submit documentation, as requested by APD, to substantiate its position. APD shall notify the provider in writing of its informal decision within 45 days of APD’s receipt of the provider’s request for review. APD’s informal decision shall be an order in other than a contested case and subject to review pursuant to ORS 183.484 (Jurisdiction for review of orders other than contested cases).

(3)

OVERPAYMENT FOR COMPLEX MEDICAL ADD-ONS. APD shall collect monies that were overpaid to a facility for any period APD determines the resident’s condition or service needs did not meet the criteria for the complex medical add-on, or determines the facility did not maintain the required documentation.

Source: Rule 411-070-0035 — Complex Medical Add-On Effective Start and End Dates and Administrative Review, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-070-0035.

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 411-070-0035’s source at or​.us