Or. Admin. Code § 410-133-0090 - Payment Requirements

(1) Payment shall be made for School-Based Health Services (SBHS) in accordance with OARs: 410-120-1340, 943-120-0350, and 410-133-0245.

(2) SBHS provided pursuant to a child or young adult's Individual Plan of Care (IPOC) shall be reimbursed through cost-sharing. Cost-sharing is a federal financial participation reimbursement that requires a public unit of government to pay the non-federal share pursuant to 42 CFR 433.51:

(a) The education agency is responsible for paying the non-federal share for each payable school-based health service.

(b) The non-federal share is calculated using the Federal Medical Assistance Percentage (FMAP) rates in effect during the quarter when the service is reimbursed.

(c) Pursuant to 42 CFR 433.51, public funds may be considered as the state's (non-federal) share in claiming federal financial participation if the public funds meet the following conditions:

(A) The public funds are transferred to the state agency from the public unit of government;

(B) The public funds are not federal funds, or they are federal funds authorized by federal law to be used to match other federal funds; and

(C) All sources of funds must be allowable under 42 CFR 433 Subpart B.

(3) Before reimbursement, the Authority must receive the school medical provider's corresponding non-federal share payment.

(4) The Authority shall not be financially responsible for payment of any claim or service that the Centers for Medicare and Medicaid Services (CMS) disallows under Medicaid. If the Authority has previously paid the school medical provider any such claim, the school medical provider must reimburse the amount of the claim, less any amount previously paid for the non-federal share portion of that claim, to the Authority.

Notes

Or. Admin. Code § 410-133-0090

HR 39-1991, f. & cert. ef. 9-16-91; HR 41-1992, f. 12-31-92, cert. ef. 1-1-93; OMAP 31-1998, f. & cert. ef. 9-1-98; OMAP 88-2003(Temp), f. & cert. ef. 12-15-03 thru 5-15-04; OMAP 4-2004, f. 1-23-04, cert. ef. 2-1-04; 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 28-2008(Temp), f. 6-30-08, cert. ef. 7-1-08 thru 12-28-08; DMAP 32-2008(Temp), f. & cert. ef. 10-2-08 thru 3-27-09; DMAP 43-2008, f. 12-17-08, cert. ef. 12-28-08; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065