Or. Admin. Code § 411-070-0130

Current through Register Vol. 64, No. 1, January 1, 2025

Section 411-070-0130 - Medicaid Payment in Hospitals

(1) SWING BED ELIGIBILITY. To be eligible to receive a Medicaid payment under this rule, a hospital must:

(a) Have approval from the Centers for Medicare and Medicaid Services (CMS) to furnish skilled nursing facility services as a Medicare swing-bed hospital;

(b) Have a Medicare provider agreement for acute care; and

(c) Have a current signed Health Services Division (HSD) provider agreement to receive Medicaid payment for swing-bed services.

(2) SERVICES PROVIDED. The daily Medicaid rate shall be for the services outlined in OAR 411-070-0085 (Bundled Rate).

(3) COMPLIANCE WITH MEDICAID REQUIREMENTS. Hospitals receiving Medicaid payment for swing-bed services must comply with state and federal rules and statutes that affect long-term care facilities as outlined in the facility's provider agreement with HSD.

(4) ADMISSION OF MEDICAID ELIGIBLE INDIVIDUALS TO INTERMEDIATE CARE FACILITY (ICF). Prior to determination of Medicaid eligibility in the ICF swing bed, the APD case manager must coordinate with the hospital for continued Medicaid services and payment.

Or. Admin. Code § 411-070-0130

SSD 7-1988, f. & ef. 7-1-88; SSD 20-1990, f. & cert. ef. 10-4-90; SSD 6-1993, f. 6-30-93, cert. ef. 7-1-93; SSD 1-1997, f. 6-30-97, cert. ef. 7-1-97; SPD 9-2006, f. 1-26-06, cert. ef. 2-1-06; SPD 1-2007, f. 3-12-07. & cert. ef. 3-13-07; SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09; APD 42-2024, amend filed 07/09/2024, effective 7/12/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.070 & 414.065