Oregon Administrative Rules
Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES
Division 70 - NURSING FACILITIES/MEDICAID GENERALLY AND REIMBURSEMENT
Section 411-070-0452 - Pediatric Nursing Facilities
Universal Citation: OR Admin Rules 411-070-0452
Current through Register Vol. 63, No. 3, March 1, 2024
(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(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, 2023.
(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.
Statutory/Other Authority: ORS 410.070
Statutes/Other Implemented: ORS 410.070, OL 2011 ch. 630 & OL 2013 ch. 608
Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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