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Oregon Health Authority

Post-Hospital Extended Care (PHEC)

20-Day Skilled Nursing Benefit

The Oregon Health Plan (OHP) covers up to 20 days in a nursing facility following hospitalization. This benefit is for OHP members ages 21 and older who:

  • Do not qualify for Medicare,
  • Completed an OHP-covered inpatient stay of three or more days at an acute care hospital,
  • Meet Medicare's skilled nursing care criteria, and
  • Can transfer to the nursing facility within 30 days of discharge from the hospital.

Members must have a condition that requires daily skilled care at a nursing facility, such as:

  • Risk of falling, dehydration, or malnutrition,
  • Need for daily transportation by ambulance to a hospital or rehabilitation facility, or
  • Not living in an area where they can get skilled care at home.

To access this benefit, fee-for-service (open card) members must complete a pre-admission screening.

Pre-Admission Screening Process

The Level I Pre-Admission Screening and Resident Review (PASRR):

  • Ensures members qualify for the PHEC benefit, and
  • Screens for mental illness and intellectual or developmental disability.

A Level I review determines if the member qualifies for skilled nursing facility placement due to: 

  • Discharge from a hospital after receiving acute inpatient care,
  • Discharge from a hospital after post-treatment observation referred by their attending physician,
  • Needing end-of-life care, or
  • Certain emergency situations.

Other Ways People Can Qualify for Nursing Facility Care

Level II PASRR reviews determine if people need special services or nursing facility care due to a mental illness or intellectual/developmental disability.

People receiving long-term services and supports through the Oregon Department of Human Services (ODHS) Aging and People with Disabilities Program can also access nursing facility care. They do not need a qualifying hospitalization and can stay more than 20 days.

Resources

PHEC Benefit Summary

PHEC Section of 2024 CCO Contract

Related Rules

OHP Oregon Administrative Rules (OARs):

ODHS OARs:

Questions? 

Call your local ODHS Aging and Disabilities Services Office.