Or. Admin. Code § 411-073-0080

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

Section 411-073-0080 - Denial of Payment for New Admissions

(1) When Imposed. The Division may deny payment for new Medicaid admissions:

(a) When there are widespread deficiencies constituting no actual harm, but with a potential for more than minimal harm;

(b) When there is at least one deficiency constituting actual harm to a resident;

(c) When the Division finds that the facility is not in substantial compliance three months after the last day of a survey in which the facility was found to not be in substantial compliance;

(d) When the Division finds substandard quality of care on the last three consecutive standard surveys;

(e) When there is immediate jeopardy; or

(f) In any other situation under which a category 2 remedy is required or optional in Exhibit 1.

(2) Required Action. When the Division determines that there is cause pursuant to section (1) of this rule, the Division shall deny payment for new Medicaid admissions.

(3) Resumption of Payment. The Division may resume payment for new admissions when the facility achieves substantial compliance and is capable of remaining in substantial compliance as determined by HCFA or the Division.

Or. Admin. Code § 411-073-0080

SSD 11-1995, f. 9-29-95, cert. ef. 10-1-95

Stat. Auth.: ORS 410.070

Stats. Implemented: ORS 410.070