OAR 410-148-0120: Reimbursement Limitations for Clients in a Nursing Facility

(1) The Division of Medical Assistance Programs (Division) will not reimburse for the following services/supplies for clients residing in a nursing facility: (a) Nursing service visits (including assessment visit). Refer to Aging and People with Disabilities (APD) administrative rule covering all-inclusive rate; (b) Supplies and items covered in the nursing facility All-inclusive rate. Refer to the Supplemental Information section of the Home Enteral/Parenteral Nutrition and IV Services provider website (http://www.oregon.gov/OHA/HSD/OHP/Pages/Policy-Home-EPIV.aspx) for a listing of those supplies and items; (c) Oral nutritional supplements that are in addition to consumption of food items or meals. (2) The Division will reimburse for the following: (a) Oral nutritional supplements are covered by the Division for nursing facility clients when medically appropriate, i.e., the client cannot consume food items or meals; (b) Tube fed enteral nutrition formula, when medically appropriate; (c) Patient controlled pump for pain control medication (CADD). [Publications: Publications referenced are available from the agency.]