OAR 411-070-0033: Post Hospital Extended Care Benefit

(1) The post hospital extended care benefit (OAR 410-120-1210(4)) is an Oregon Health Plan benefit that consists of a stay of up to one hundred (100) days in a nursing facility to allow discharge from hospitals. (2) The post hospital extended care benefit must be prior authorized by pre-admission screening for individuals not enrolled in managed care. (3) To be eligible for the post hospital extended care benefit, the individual must meet all of the following: (a) Be receiving Oregon Health Plan benefit; (b) Not be Medicare eligible; (c) Have a medically-necessary, qualifying hospital stay consisting of: (A) A Medicaid-paid admission to an acute-care hospital bed, not including a hold bed, observation bed, or emergency room bed. (B) The stay must consist of three or more consecutive days, not counting the day of discharge. (d) Transfer to a nursing facility within 30 days of discharge from the hospital; (e) Need skilled nursing or rehabilitation services on a daily basis for a hospitalized condition meeting Medicare skilled criteria that may be provided only in a nursing facility meaning: (A) The individual is at risk of further injury from falls, dehydration, or nutrition because of insufficient supervision or assistance at home; (B) The individual's condition requires daily transportation to a hospital or rehabilitation facility by ambulance; or (C) It is too far to travel to provide daily nursing or rehabilitation services in the individual's home. (4) The individual may qualify for another one hundred (100) day post-hospital extended care benefit only if the individual has been out of a hospital and has not received skilled nursing care for 60 consecutive days in a row and meets all the criteria in this rule. (5) Individuals eligible for the one hundred (100) day post-hospital extended care benefit are not eligible for long term care nursing facility or Medicaid home and community-based services unless the individual meets the eligibility criteria in OAR 411-015-0100 or OAR 411-320-0080