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Oregon Administrative Rules

Division 125

Or. Admin. R. ch. 410, div. 125

Hospital Services

Oregon Health Authority

0000Determining When the Patient Has Medical Assistance 0020Retroactive Eligibility 0030Hospital Hold 0040Title XIX/Title XXI Clients 0041Non-Title XIX/XXI Clients 0045Coverage and Limitations 0050Client Copayments 0080Inpatient Services 0085Outpatient Services 0086Prior Authorization for FCHP/MHO Clients 0090Inpatient Rate Calculations — Type A, Type B, and Critical Access Oregon Hospitals 0095Hospitals Providing Specialized Inpatient Services 0101Hospital-Based Nursing Facilities and Medicaid Swing Beds 0102Medically Needy Clients 0103Medicare Clients 0115Non-Contiguous Area Out-of-State Hospitals — Effective for services rendered on or after October 1, 2003 0120Transportation To and From Medical Services 0121Contiguous Area Out-of-State Hospitals 0124Retroactive Authorization 0125Free-Standing Inpatient Psychiatric Facilities 0140Prior Authorization Does Not Guarantee Payment 0141DRG Rate Methodology 0142Graduate Medical Education Reimbursement for Public Teaching Hospitals 0146Supplemental Reimbursement for Public Academic Teaching University Medical Practitioners 0150Disproportionate Share 0155Upper Limits on Payment of Hospital Claims 0162Hospital Transformation Performance Program 0165Transfers and Reimbursement 0170Death Occurring on Day of Admission 0175Hospitals Providing Specialized Outpatient Services 0180Public Rates 0181Non-Contiguous and Contiguous Area Out-of-State Hospitals — Outpatient Services 0190Outpatient Rate Calculations — Type A, Type B, and Critical Access Oregon Hospitals 0195Outpatient Services In-State DRG Hospitals 0200Time Limitation for Submission of Claims 0201Independent ESRD Facilities 0210Third Party Resources and Reimbursement 0220Services Billed on the Electronic 837I or on the Paper UB-04 and Other Claim Forms 0221Payment in Full 0230Qualified Directed Payments 0360Definitions and Billing Requirements 0400Discharge 0401Definitions: Emergent, Urgent, and Elective Admissions 0410Readmission 0450Provider Preventable Conditions 0550X-Ray or EKG Procedures Furnished in Emergency Room 0600Non-Contiguous Out-of-State Hospital Services 0620Special Reports and Exams and Medical Records 0640Third Party Payers — Other Resources, Client Responsibility and Liability 0641Medicare 0720Adjustment Requests 1020Filing of Cost Statement 1040Accounting and Record Keeping 1060Fiscal Audits 1070Type A and Type B Hospitals 1080Documentation 2000Access to Records 2020Post Payment Review 2030Recovery of Payments 2040Provider Appeals — Administrative Review 2060Provider Appeals — Hearing Request 2080Administrative Errors