OAR 309-015-0007: General Conditions of Eligibility and Treatment

In order for payment to be made by the Division, the following conditions must be met: (1) Medicaid-eligible age. The patient must be eligible for Medicaid benefits, be aged 65 or over, aged 20 or under, or aged 21 and receiving services at the time of reaching age 21. (2) Written plan of care. A professionally developed written plan of care for each patient will describe treatment objectives and prescribe an integrated program of appropriate therapy activities and experiences designed to improve the patient’s condition to the extent that inpatient care is no longer necessary. (3) Unemancipated minor consultation. If the patient is under 18 years of age and not emancipated, the facility shall consult with the parent(s), legal guardian or others into whose care or custody the person will be released following discharge. The consultation shall be documented in the hospital records. (4) Conformance with these rules. The Division has determined that admission and care of the patient who is eligible for Medicaid benefits is in accordance with these rules and regulations as evidenced by the hospital record. (5) Service provider requirements. The service provider must meet all requirements for participation under OAR 309-015-0010.