Or. Admin. R. 411-346-0250 - Foster Provider Eligibility for Medicaid Service Payment
(1) A foster
provider must have an approved prior authorization for services in the
Department's electronic payment and reporting system prior to entering a claim
for a day of service. The prior authorization includes the dates of authorized
services and the funding amount allocated for the services.
(2) A foster provider may only enter a claim
for a day of service when:
(a) A child sleeps
in the child foster home overnight; or
(b) A child does not sleep in the child
foster home overnight, but intends to return to the child foster home, and the
foster provider was responsible for and provided an accumulated period of eight
hours for the primary care, support, safety, and well-being of the child,
including any of the following:
(A) Providing
intermittent physical support or care.
(B) Providing stand-by support with the
ability to respond in person within the response times agreed upon by the ISP
team.
(C) Being responsible to
communicate reciprocally within the response times agreed upon by the ISP team
based on a child's identified support need and as documented in the child's
most current ISP.
(3) A foster provider is not eligible to
enter a claim for a day of service when a child:
(a) Has been admitted to an acute care
hospital unless the child's ISP authorizes attendant care for the child in an
acute care hospital and the day of service criteria in section (2)(b) of this
rule is met. An ISP may only authorize attendant care for a child who has been
admitted to an acute care hospital when the support is not a duplication of
service that the hospital provides and the child has one of the following:
(A) Challenging behavior that interferes with
getting medical care. The challenging behavior must require specific training
or experience to support and must be able to be mitigated by the foster
provider to an extent that medical care is improved.
(B) An inability to independently communicate
with hospital staff that interferes with getting medical care. This must not be
solely due to limited or emerging English proficiency.
(C) Support with one or more activities of
daily living that may only be adequately met by someone familiar with the
child.
(b) Has been
admitted to a nursing facility;
(c)
Has been admitted to a mental health facility;
(d) Is held in detention or jail;
or
(e) Is outside the United
States.
(4) PROGRESS
NOTES. A foster provider must maintain and keep current progress notes
regarding the delivery of foster care services. Progress notes must demonstrate
the supports provided to a child are consistent with, and within the scope of,
the supports authorized in the child's ISP.
(a) At a minimum, progress notes must include
all of the following:
(A) Child's
name.
(B) Dates the supports were
provided.
(C) Description of the
supports provided.
(b)
Progress notes must support each claim a foster provider submits in the
Department's electronic payment and reporting system.
Notes
Statutory/Other Authority: ORS 409.050, 427.104, 430.662 & 443.835
Statutes/Other Implemented: ORS 409.010, 427.007, 427.101, 427.104, 430.215, 430.610, 430.662 & 443.830-443.836
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