OAR 411-070-0025: Basic Flat Rate Payment (Basic Rate)

(1) PAYMENT. SPD may authorize payment at the basic rate if a Medicaid resident requires daily, intermittent licensed nurse observation and continuous nursing care and has a physician's order for nursing facility care. When determining the payment rate, SPD shall consider the stability of the medical condition, the health care needs of the individual, and the individual's ability to maintain themselves in a less restrictive setting. An individual who qualifies for reimbursement at the basic rate must: (a) Have chronic medical problems that are stabilized but not cured and have a need for supervision in a structured environment to maintain or restore stability and prevent deterioration; (b) Require assistance for a combination of health care needs either because of a physical or psycho-social disabling condition; or (c) Have insufficient personal and community resources available to provide for either section (1)(a) or (1)(b) of this rule. (2) DOCUMENTATION. The professional nursing staff of the nursing facility must keep sufficient documentation in the resident's clinic record to justify the basic rate payment determination in accordance with these rules and must make it available to SPD upon request.