Or. Admin. Code § 410-127-0060
Current through Register Vol. 63, No. 11, November 1, 2024
Section 410-127-0060 - Reimbursement and Limitations(2) The Division recalculates its home health services rates every other year. The Division shall reimburse home health services at a level of 74 percent of Medicare costs reported on the audited, most recently accepted or submitted Medicare Cost Reports prior to the rebase date and pending approval from the Centers for Medicare and Medicaid Services (CMS), and, if indicated, legislative funding authority.(3) The Division shall request the Medicare Cost Reports from home health agencies with a due date and shall recalculate potential rates based on the Medicare Cost Reports received by the requested due date. The home health agency shall submit requested cost reports by the date requested.(4) The Division reimburses only for services that are medically appropriate.(5) Limitations: (a) Limits of covered services: (A) Skilled nursing visits are limited to two visits per day with payment authorization;(B) All therapy services are limited to one visit or evaluation per day for physical therapy, occupational therapy, or speech-language pathology services. Therapy visits require payment authorization;(C) Home health aide services are limited to those ordered by a physician, included in the plan of care, permitted to be performed under state law, consistent with home health aide training, and under the direction of a registered nurse or licensed therapist familiar with the client and the client's plan of care. These services must not duplicate other Medicaid-paid personal care services.(D) The Division shall authorize home health visits for clients with uterine monitoring only for medical problems that could adversely affect the pregnancy and are not related to the uterine monitoring;(E) Medical supplies must be billed at acquisition cost, and the total of all medical supply revenue codes may not exceed $50 per day. Only supplies that are used during the visit or the specified additional supplies used for current client/caregiver teaching or training purposes as medically appropriate are billable. Client visit notes must include documentation of supplies used during the visit or supplies provided according to the current plan of care;(F) Durable medical equipment must be obtained by the client by prescription through a durable medical equipment provider.(b) Services not covered: (A) Service not medically appropriate;(B) A service for a diagnosis that does not appear on a line of the Prioritized List of Health Services that has been funded by the Oregon Legislature (OAR 410-141-0520);(C) Medical social worker service;(D) Registered dietician counseling or instruction;(F) Fetal non-stress testing;(G) Respiratory therapist service;(I) Psychiatric nursing service.Or. Admin. Code § 410-127-0060
PWC 682, f. 7-19-74, ef. 8-11-74; PWC 798, f. & ef. 6-1-76; PWC 854(Temp), f. 9-30-77, ef. 10-1-77 thru 1-28-78; Renumbered from 461-019-0420 by Chapter 784, Oregon Laws 1981 & AFS 69-1981, f. 9-30-81, ef. 10-1-81; SSD 4-1983, f. 5-4-83, ef. 5-5-83; SSD 10-1990, f. 3-30-90, cert. ef. 4-1-90; HR 28-1990, f. 8-31-90, cert. ef. 9-1-90, Renumbered from 411-075-0010; HR 14-1992, f. & cert. ef. 6-1-92; HR 15-1995, f. & cert. ef. 8-1-95; OMAP 19-2000, f. 9-28-00, cert. ef. 10-1-00; OMAP 77-2003, f. & cert. ef. 10.1.03; DMAP 16-2007, f. 12-5-07, cert. ef. 1-1-08; DMAP 33-2010, f. 12-15-10, cert. ef. 1-1-11; DMAP 22-2011(Temp), f. 7-29-11, cert. ef. 8-1-11 thru 1-25-12; DMAP 39-2011, f. 12-15-11, cert. ef. 1-1-12; DMAP 29-2013, f. & cert. ef. 6-27-13; DMAP 2-2018, amend filed 01/10/2018, effective 01/10/2018; DMAP 46-2018, minor correction filed 05/25/2018, effective 5/25/2018; DMAP 4-2020, amend filed 02/24/2020, effective 2/25/2020Statutory/Other Authority:ORS 413.042
Statutes/Other Implemented:ORS 414.065