OAR 411-070-0452
Pediatric Nursing Facilities

(1)

PEDIATRIC NURSING FACILITY.

(a)

A pediatric nursing facility is a licensed nursing facility at least 50 percent of whose residents entered the facility before the age of 14 and all of whose residents are under the age of 21.

(b)

A nursing facility that meets the criteria of subsection (1)(a) of this section is reimbursed as follows:

(A)

The pediatric rate is a prospective rate and is not subject to settlement. The Department uses financial reports of facilities that have been in operation for at least 180 days and are in operation as of June 30.

(B)

The facility specific pediatric cost per resident day is inflated as described in OAR 411-070-0442 (Calculation of the Basic Rate, Complex Medical Rate, Bariatric Rate and Ventilator Assisted Program Rate)(1)(b). The Oregon Medicaid pediatric days are multiplied by the inflated facility specific cost per resident day for each pediatric facility. The totals are summed and divided by total Oregon Medicaid days to establish the weighted average cost per pediatric resident day. The rebase relationship percentage of 93 percent is applied to the weighted average cost to determine the pediatric rate.

(c)

Due to the COVID-19 pandemic, a temporary 10% increase to the pediatric rate has been authorized for nursing facilities for services provided April 1, 2020 thru June 30, 2020.

(d)

Due to the extraordinary expenses incurred as a result of the COVID-19 pandemic, a 5% increase to the pediatric rate has been authorized for nursing facilities for services provided January 1, 2021 thru June 30, 2021.

(e)

Even though pediatric facilities are reimbursed in accordance with subsection (1)(b) of this section, pediatric facilities must comply with all requirements relating to the timely submission of Nursing Facility Financial Statements.

(2)

LICENSED NURSING FACILITY WITH A SELF-CONTAINED PEDIATRIC UNIT.

(a)

A nursing facility with a self-contained pediatric unit is a licensed nursing facility that provides services for pediatric residents (individuals under the age of 21) in a separate and distinct unit within or attached to the facility with staffing costs separate and distinct from the rest of the nursing facility. All space within the pediatric unit must be used primarily for purposes related to the services of pediatric residents and alternate uses may not interfere with the primary use.

(b)

A nursing facility that meets the criteria of subsection (2)(a) of this section is reimbursed for pediatric residents served in the pediatric unit as described in section (1) of this rule.

(c)

Licensed nursing facilities with a self-contained pediatric unit must comply with all requirements relating to the timely submission of Nursing Facility Financial Statements and must file a separate attachment, on forms prescribed by the Department, related to the costs of the self-contained pediatric unit.

Source: Rule 411-070-0452 — Pediatric Nursing Facilities, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-070-0452.

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 411-070-0452’s source at or​.us