Or. Admin. Code § 410-133-0245 - Cost Determination and Payment

(1) The Authority shall make cost determinations for the purposes of School-Based Health Service (SBHS) payment rates based on annual cost determinations submitted by education agencies.

(2) Cost determinations for each education agency shall:

(a) Be based upon prior year's annual audited costs and the Oregon Department of Education's (ODE) approved current year indirect rate.

(b) Establish an hourly rate and a per-minute increment rate for the current calendar year for each covered SBHS discipline (e.g., physical therapy and nursing, as separate disciplines, shall each have a separate rate).

(3) An education agency shall not bill for more than the rate prescribed by the Authority's cost determination.

(4) Data for cost determinations shall be submitted in a format prescribed by the Authority and in accordance with Oregon's Medicaid State Plan approved by the Centers for Medicare and Medicaid Services (CMS).

(5) Cost determinations shall be completed for each covered service discipline.

(6) Transportation costs shall be reimbursed when:

(a) The need for medically necessary and appropriate specialized transportation is documented in the Medicaid-eligible child or young adult's Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP);

(b) The transportation is provided in a specially adapted vehicle that has been physically adjusted or designed to meet the needs of the individual child or young adult under Individuals with Disabilities Education Act (IDEA) to accommodate the child or young adult's specified health need; and

(c) A separate school-based health service, other than transportation, is specified on the child or young adult's IEP or IFSP and provided and reimbursed on that day.

(7) Costs for telehealth technologies used to provide SBHS are included in the cost for each service discipline and are not billed separately.

Notes

Or. Admin. Code § 410-133-0245

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 19-2020, temporary amend filed 04/09/2020, effective 04/09/2020 through 10/05/2020; DMAP 56-2020, amend filed 10/02/2020, effective 10/5/2020; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065