Or. Admin. Code § 411-016-0190

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-016-0190 - [Effective until 11/26/2024] Long Term Care Community Nursing Services and Provider Qualifications

(1) Individuals with health-related needs as assessed by the Services Case Manager are eligible for long term care community nursing services as described in Oregon Administrative Rule chapter 411, division 048.

(2) For the purposes of these rules, the term case manager used in chapter 411, division 048 is synonymous with the term Services Case Manager used in these rules.

(3) Long Term Care Community Nursing Services must be prior authorized by the Services Case Manager.

(4) Limitations:

(a) Services Case managers may not prior authorize long term care community nursing services that duplicate nursing services provided by Medicare or other Medicaid programs for which the individual is eligible.

(b) Long term care community nursing services do not include:

(A) Nursing activities used for other functions such as protective service investigations, pre-admission screenings, eligibility determinations, licensing inspections, case manager assessments, or corrective action activities. This limitation does not include authorized care coordination as defined in OAR 411-048-0160 (Definitions).

(B) Reimbursement for direct hands-on nursing as defined in OAR 411-048-0160 (Definitions).

(5) An exception to section (3)(b) of this rule may be requested as described in OAR 411-048-0250 (Exceptions).

(6) Long Term Care Community Nursing Services providers must:

(a) Provide the services and use the practices and procedures described in OAR 411-048-0180; and

(b) Follow the Communication and Notification Practices in OAR 411-048-0190; and

(c) Comply with the Additional Documentation requirements in OAR 411-048-0200; and

(d) Meet the provider qualifications in OAR 411-048-0210; and

(e) Meet orientation requirements in OAR 411-048-0240.

(7) All billing and claims must comply with:

(a) OAR 407-120-0330 (Billing Procedures) and 407-120-0340 (Claim and PHP Encounter Submission); and

(b) OAR chapter 410, division 120 as applicable; and

(c) The Long Term Care Community Nursing Procedure Codes and Payment Authorization Guidelines posted at https://www.oregon.gov/odhs/providers-partners/ltccn/Pages/resources.aspx#billing

(8) Compensation for long term care community nursing services shall be defined in the Department's rate schedule in OAR 411-027-0170 or through a contract with the Department. The Department may adjust rates in underserved areas to assure that individuals have access to long term care community nursing services.

(9) The Department may grant exceptions as described in OAR 411-048-0250 to Long Term Care Community Nursing Services for OPI-M participants.

Or. Admin. Code § 411-016-0190

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065