OAR 411-070-0452: Pediatric Nursing Facilities

(1) PEDIATRIC NURSING FACILITY. (a) A pediatric nursing facility is a licensed nursing facility at least 50 percent of whose residents entered the facility before the age of 14 and all of whose residents are under the age of 21. (b) A nursing facility that meets the criteria of subsection (1)(a) of this section is reimbursed as follows: (A) The pediatric rate is a prospective rate and is not subject to settlement. The Department uses financial reports of facilities that have been in operation for at least 180 days and are in operation as of June 30. (B) The facility specific pediatric cost per resident day is inflated as described in OAR 411-070-0442(1)(b). The Oregon Medicaid pediatric days are multiplied by the inflated facility specific cost per resident day for each pediatric facility. The totals are summed and divided by total Oregon Medicaid days to establish the weighted average cost per pediatric resident day. The rebase relationship percentage of 93 percent is applied to the weighted average cost to determine the pediatric rate. (c) Due to the COVID-19 pandemic, a temporary 10% increase to the pediatric rate has been authorized for nursing facilities for services provided April 1, 2020 thru June 30, 2020. (d) Due to the extraordinary expenses incurred as a result of the COVID-19 pandemic, a 5% increase to the pediatric rate has been authorized for nursing facilities for services provided January 1, 2021 thru June 30, 2023. (e) Even though pediatric facilities are reimbursed in accordance with subsection (1)(b) of this section, pediatric facilities must comply with all requirements relating to the timely submission of Nursing Facility Financial Statements. (2) LICENSED NURSING FACILITY WITH A SELF-CONTAINED PEDIATRIC UNIT. (a) A nursing facility with a self-contained pediatric unit is a licensed nursing facility that provides services for pediatric residents (individuals under the age of 21) in a separate and distinct unit within or attached to the facility with staffing costs separate and distinct from the rest of the nursing facility. All space within the pediatric unit must be used primarily for purposes related to the services of pediatric residents and alternate uses may not interfere with the primary use. (b) A nursing facility that meets the criteria of subsection (2)(a) of this section is reimbursed for pediatric residents served in the pediatric unit as described in section (1) of this rule. (c) Licensed nursing facilities with a self-contained pediatric unit must comply with all requirements relating to the timely submission of Nursing Facility Financial Statements and must file a separate attachment, on forms prescribed by the Department, related to the costs of the self-contained pediatric unit.