Or. Admin. R. 411-048-0230

Current through Register Vol. 63, No. 8, August 1, 2024

Section 411-048-0230 - Compensation and Billing

(1) All long term care community nursing services must be authorized by an individual's case manager using Department approved forms provided by the Department prior to the delivery of long term care community nursing services.

(2) All billing and claims must comply with:

(a) OAR 407-120-0330 and 407-120-0340;

(b) OAR chapter 410, divisions 120 and 173 as applicable; and

(c) The Long Term Care Nursing Procedure Codes and Payment Authorization Guidelines posted at https://www.oregon.gov/odhs/providers-partners/ltccn/Pages/resources.aspx#billing

(3) Compensation for long term care community nursing services in OAR 411-048-0180 shall be defined in the Department's rate schedule. The Department may adjust rates in underserved areas to assure that individuals have access to long term care community nursing services.

(4) Payment for non-Medicaid covered services must be prior authorized by the Department and billed on Department approved invoices.

(a) Rates for non-Medicaid services shall be determined by the Department but may not exceed the rate noted on the Department's rate schedule.

(b) The Department makes payment for non-Medicaid covered services within 45 days of receipt of the completed invoice.

Or. Admin. R. 411-048-0230

SPD 8-2013, f. & cert. ef. 4-15-13; APD 18-2023, amend filed 10/13/2023, effective 11/1/2023

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.070