Or. Admin. Code § 411-304-0200 - Claim Reimbursement Requirements for Independent and Agency Providers of Professional Behavior Services

(1) Claim reimbursement is required for all professional behavior services delivered to an individual.

(2) A behavior professional must maintain true and accurate information for claims, including the written documents and an invoice attesting the hours were delivered as billed. All invoices must be made available upon request by the case management entity, the Department, or their designees. An invoice for professional behavior services already delivered is required to be submitted to the Department accompanying any request for an exception to the Expenditure Guidelines.

(3) Payment for periodic or ongoing maintenance of the PBSP must:

(a) Meet the delivery of service requirements contained in these rules;

(b) Be prior authorized by the case management entity;

(c) Have the need for maintenance identified in an individual's ISP, or Annual Plan for family support services, and the ongoing maintenance is identified as a chosen service; and

(d) Only be paid when a progress note for the maintenance has been submitted by the behavior professional to the case management entity. The progress note must identify progress toward, or reason for regress from, the desired outcomes as identified in an individual's ISP, Annual Plan for family support services, or Service Agreement, as applicable. The progress note must include all of the following for each service delivered:

(A) Date of service.

(B) Who provided the service.

(C) Location of where the service was provided.

(D) Length of time required for the service, including start and end times.

(E) Description of the service delivered.

(F) People present when the service was delivered.

Notes

Or. Admin. Code § 411-304-0200

APD 28-2017, adopt filed 11/30/2017, effective 12/1/2017; APD 5-2018, minor correction filed 02/21/2018, effective 2/21/2018; APD 32-2022, amend filed 06/26/2022, effective 7/1/2022

Statutory/Other Authority: ORS 409.050, 427.104 & 430.662

Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.610 & 430.662