1. (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. (2) The post hospital extended care benefit must be prior authorized by pre-admission screening for individuals not enrolled in managed care.

3. (3) To be eligible for the post hospital extended care benefit, the individual must meet all of the following:

   1. (a) Be receiving Oregon Health Plan benefit;
   2. (b) Not be Medicare eligible;

   3. (c) Have a medically-necessary, qualifying hospital stay consisting of:

      1. (A) A Medicaid-paid admission to an acute-care hospital bed, not including a hold bed, observation bed, or emergency room bed.
      2. (B) The stay must consist of three or more consecutive days, not counting the day of discharge.
   4. (d) Transfer to a nursing facility within 30 days of discharge from the hospital;

   5. (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:

      1. (A) The individual is at risk of further injury from falls, dehydration, or nutrition because of insufficient supervision or assistance at home;
      2. (B) The individual's condition requires daily transportation to a hospital or rehabilitation facility by ambulance; or
      3. (C) It is too far to travel to provide daily nursing or rehabilitation services in the individual's home.
4. (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. (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

Statutory/Other Authority

ORS 410.070 & 414.065

Statutes/Other Implemented

ORS 410.070 & 414.065

History

APD 11-2026, amend filed 06/18/2026, effective 06/24/2026
APD 21-2025, temporary amend filed 12/26/2025, effective 01/01/2026 through 06/29/2026
SPD 44-2013, f. 12-13-13, cert. ef. 12-15-13
SPD 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13
SPD 15-2009, f. 11-30-09, cert. ef. 12-1-09
SPD 4-2005, f. & cert. ef. 4-19-05