Or. Admin. Code § 410-133-0060 - School-Based Health Services

(1) School-Based Health Services (SBHS) are health services provided in school settings, for which the school is responsible to provide in support of a child or young adult's education and which address health-related service needs and devices that help the individual child or young adult keep, learn, or improve skills and functioning that adversely affect individual educational performance.

(2) A School-Based Health Service is a health service provided to a Medicaid-enrolled child or young adult when:

(a) The health service is provided or supervised by an Authority-enrolled medically-qualified individual in a school setting;

(b) The education agency billing the health service is enrolled with the Authority as a school medical provider; and

(c) The child or young adult has an active, established, and documented IPOC that clearly identifies the necessary and appropriate health services recommended by a health care practitioner.

(3) SBHS that meet the requirements of sections (1) and (2) of this rule may include:

(a) Evaluation and assessment for SBHS;

(b) Care coordination and referrals;

(c) Assistive technology services;

(d) Audiology services;

(e) Behavioral health services;

(f) Dental services;

(g) Diagnostic, screening, preventive, developmental and rehabilitative services;

(h) Nursing services;

(i) Nurse Practitioner services;

(j) Occupational therapy services;

(k) Physical therapy services;

(l) Physician services;

(m) Specialized transportation services; and

(n) Speech-language pathology services.

(4) Medicaid-covered SBHS are not subject to Oregon's Medicaid program's HERC Prioritized List of Health Services when services are medically necessary and medically appropriate pursuant to a Medicaid-enrolled child or young adult's IPOC.

Notes

Or. Admin. Code § 410-133-0060

HR 39-1991, f. & cert. ef. 9-16-91; HR 22-1995, f. & cert. ef. 12-1-95; OMAP 38-1999, f. & cert. ef. 10-1-99; OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05; OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09; DMAP 33-2016, f. 6-29-16, cert. ef. 7/1/2016; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065