1. (1) A Medicaid eligible individual qualifies for the bariatric reimbursement rate if the individual has a physician diagnosis of obesity with a BMI>40 and the individual meets the following criteria as defined in OAR chapter 411, division 015:

   1. (a) Two-person full assist with ambulation or transfers; and
   2. (b) Full assist in one of the following: cognition, eating or elimination.

2. (2) If an individual meets the criteria documented in 411-070-0087, and the Department has authorized the bariatric rate, the facility must provide one (1) additional Certified Nursing Assistant (CNA), for each shift, above the licensing staffing standard in OAR 411-086-0100(5), for the third through fifth approved individuals for the bariatric rate. Another CNA is then required, for each shift, for every additional five (5) individuals receiving the bariatric rate. For example:

   1. (a) For the first two (2) approved individuals, the facility must meet the requirements in OAR 411-086-0100(3).
   2. (b) For three (3) to five (5) approved individuals, one CNA would be required above staffing standard, for each shift.
   3. (c) For six (6) to ten (10) approved individuals, two (2) CNAs would be required above staffing standard, for each shift.

Statutory/Other Authority

ORS 410.070

Statutes/Other Implemented

ORS 410.070

History

APD 19-2023, amend filed 10/27/2023, effective 11/01/2023
APD 25-2020, adopt filed 06/23/2020, effective 07/01/2020