Or. Admin. Code § 411-018-0010

Current through Register Vol. 63, No. 12, December 1, 2024

Section 411-018-0010 - Certification Process

(1) A long-term care facility seeking certification as an essential community provider long-term care facility must make written application to the Department. The application must include:

(a) The name under which the facility is licensed;

(b) The facility's Medicaid provider number, if the facility has a Medicaid contract;

(c) The mailing address of the facility;

(d) The county in which the facility is located;

(e) The name and address of a contact person at the facility;

(f) Information about facility residency during the previous calendar year to include:

(A) A monthly count of resident days paid for or accrued by Medicaid;

(B) A monthly count of resident days paid for or accrued by Medicare;

(C) A monthly count of resident days that would have been paid by Medicaid except for the availability of Medicare payment;

(D) A monthly count of resident days paid privately by facility residents or their families; and

(E) A monthly count of resident days paid through any other payment source; and

(g) A statement of the average calendar year Medicaid eligible residency rate. The average Medicaid eligible residency rate is the sum of all monthly days paid by or accrued to Medicaid plus all monthly days that would have been paid by Medicaid except for the availability and use of another source of payment divided by the total of all monthly days paid through or accrued to all payment sources including Medicaid. The percent calculated will be rounded up by the third decimal place.

(2) The Department will make a suggested application form available to facilities upon request. Facilities are not required to use the suggested application form to apply for certification; however, no application for certification may be considered complete until all information listed in section (1) of this rule is received.

(3) Applications must be delivered to Seniors and People with Disabilities, Research, Planning and Rate Setting, 500 Summer Street NE-E18, Salem, OR 97301-1074.

(4) The earliest date on which the Department will accept an application for certification is January 2 of the calendar year following the year for which the Certification is sought.

(5) Application will be considered complete on the date received by the Department if all required information is included.

(6) The Department must audit and review applications submitted by facilities to ensure accuracy of the information provided and will issue Certification if the average Medicaid eligible residency rate during the preceding calendar year is:

(a) 50 percent or more in a nursing facility, assisted living facility or residential care facility; or

(b) 60 percent or more in an adult foster home.

(7) The Department must issue a notice of Certification within 15 business days following receipt of the completed application if it is determined the facility meets the required Medicaid eligible residency rate in section (6)(a) or (6)(b) of this rule.

(8) The Certification issued by the Department will include information required by the local taxing districts for submitting Certifications.

(9) The Certification must be mailed to the mailing address supplied by the facility.

(10) The Certification issued by the Department only applies to the single licensed facility for which Certification is requested.

Or. Admin. Code § 411-018-0010

SDSD 11-1999, f. 12-30-99 cert. ef. 1-1-00; SDSD 7-2000, f. 12-29-00 cert. ef. 1-1-01; SPD 17-2005, f. & cert. ef. 12-12-05

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 307.808 - 307.815, 443.888 & 410.070