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.