Senior and Disability Services

ORS 410.851
Policy on patient-based reimbursement system for long term care facilities

  • rules


The Legislative Assembly finds and declares that patients admitted to and cared for by long term care facilities in Oregon are more impaired than in the past. In keeping with the traditional commitment of the State of Oregon to the care and protection of its citizens who are frail or elderly or who have disabilities, as expressed in ORS 410.010 (State policy for seniors and people with disabilities), the Legislative Assembly declares that a patient-based reimbursement system emphasizing quality incentives is appropriate for long term care facilities. Such a system would reward long term care facilities for outcomes, such as maintaining or improving a patient’s condition, and meet the legitimate costs of caring for patients.


As used in this section, “patient-based reimbursement” means reimbursement for direct patient care according to the needs of the patient, based on multiple levels of patient health, functioning and impairment.


A patient-based reimbursement system does not require the Department of Human Services to assess each patient and reimburse long term care facilities according to the constantly changing conditions of the patients except for changes between skilled and intermediate levels of care which shall result in prompt readjustment of rates.


The department shall establish by rule definitions of levels of care and the payment rates for the patient-based reimbursement system. The rates shall be designed to maintain and enhance access to community-based care services.


Notwithstanding ORS 410.555 (Submission of changes to Medicaid reimbursement system to council), the department, in cooperation with representatives of community-based care providers, shall implement policies that offer incentives to providers for entering into Medicaid contracts with the department and that enable a patient, to the greatest extent possible, to remain in the residential setting offering the scope of services that best meets the patient’s needs. [1987 c.523 §2 (enacted in lieu of 410.850); 2007 c.70 §186; 2008 c.18 §11; 2011 c.201 §10]
Chapter 410

Notes of Decisions

Agency rules making placement of handicapped and elderly persons factor of their primary service needs and providing for different residential facilities to accommodate persons with different needs were consistent with provisions of this chapter in effect at time petitioner, who was mentally retarded, was refused placement at facility which primarily served elderly. Dempsey v. Senior Services Division, 92 Or App 163, 758 P2d 367 (1988)


Last accessed
Jun. 26, 2021