Or. Admin. Code § 410-147-0020 - Professional Ambulatory Services
(1)
Providers must use the following rules in conjunction with all individual
program rules to determine service coverage and limitations for Oregon Health
Plan (OHP) clients according to their benefit packages: Medical, EPSDT,
Diagnostic, Dental, Vision, Physical Therapy, Occupational Therapy, Podiatry,
Mental Health, Alcohol and Chemical Dependency, Maternity Case Management,
Speech, Hearing, and Home Health services are governed by the Federally
Qualified Health Center (FQHC) and Rural Health Clinic (RHC) rules (OAR 410
division 147), General Rules (410 division 120), OHP Administrative Rules
(410-141-0480,
410-141-0500, and
410-141-0520), and the Health
Services Commission's (HSC) Prioritized List of Health Services (List), and the
Oregon Health Authority (Authority) rules related to Provider Enrollment and
Claiming (943-0120-300 through 0380).
(2) Federally Qualified Health Centers
(FQHCs) and Rural Health Clinics (RHCs) are eligible for reimbursement of
covered professional services provided within the scope of the clinic and
within the individual practitioner's scope of license or certification. See
also OAR 410-147-0120(6).
For the purposes of this rule, a clinic's "scope" refers to authorization or
certification to provide services if required:
(a) For FQHCs only, services must be provided
in accordance with the FQHC's scope as approved by the Health Resources and
Services Administration (HRSA) Notice of Grant Award Authorization;
and
(b) Both FQHCs and RHCs must
provide services within the scope of the Addictions and Mental Health Division
(AMH) certification for the facility, if required. See OAR
410-147-0320(3) and
(5).
(3) The date of service determines the
appropriate version of the FQHC and RHC rules, General Rules, and HSC
Prioritized List to determine coverage.
Notes
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
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