Current through Register Vol. 60, No. 12, December 1, 2021
The School Medical (SM) provider is responsible to:
(1) Enroll with the Authority's Division,
Medical Assistance Programs to provide health services and comply with all the
requirements in the Authority's provider rules OAR chapter 943 division 120,
General Rules OAR chapter 410 division 120, and SBHS 410-133-0140 in these
rules, applicable to enrollment as a provider.
(2) Provide health services pursuant to the
Medicaid-eligible student's Individualized Education Program (IEP) or
Individualized Family Service Plan (IFSP) for special education under OAR
chapter 581, division 15.
Provide health services using medically qualified staff (see 410-133-0120
Medically Qualified Staff in these rules).
(4) Provide appropriate medical supervision
by licensed medically qualified staff consistent with their licensing board
(5) Document health
services in writing as required in OAR 410-133-0320.
(6) Maintain adequate medical and financial
records as part of the Medicaid-eligible student's education record necessary
to fully disclose the extent of the covered health services provided.
(7) Make the records required by these rules
and specifically OAR 410-133-0320 available for a period of seven years from
the date of payment.
costs and establish a schedule of cost rates per discipline in accordance with
access for on-site review of IDEA Medicaid-eligible students' education records
directly related to payments for claims to the SM provider for Medicaid covered
health related services specified on an IEP or IFSP and furnish such
information to any state or federal agency responsible for administration or
oversight of the medical assistance program as the state or federal agency may
from time to time request in compliance with OAR 943-120-0310.
(10) Document any changes in the
Individualized Education Program/Individualized Family Service Plan (IEP/IFSP)
related to the provision of Medicaid covered health services under School-Based
Health Services (SBHS).
that SBHS services billed are billed in accordance with OAR 410-120-0035,
reflect covered health services, and do not reimburse for non-covered education
services or administrative activities.
(12) Retain the full payment amount for
Medicaid-covered services provided.
(13) Utilize procedures to confirm that all
individuals providing health services to Medicaid-eligible students, whether as
employees or under contract with the SM provider, are eligible to provide
Medicaid services and are not excluded from providing Medicaid services.
Exclusion means the Authority will not reimburse an SM provider (allied agency)
who employs a medically licensed individual who has defrauded or abused the
Authority for items or services furnished by that individual. (See OAR
410-120-1400 Provider Sanctions, OAR 410-133-0120 Medically Qualified Staff,
and 410-133-0200 Not Covered Services.).
(14) Comply with all applicable provisions of
the Authority's rules chapter 943 division 120 and the Division General Rules
Chapter 410 division 120, including rules related to the use of billing
providers. If the SM provider seeks to submit claims to the Authority
electronically, it must comply with the applicable provisions of the
Department's Electronic Data Interchange (EDI) rules for EDI transactions OAR
Chapter 943 Divsion120. EDI does not include electronic transmission by web
Or. Admin. R.
HR 39-1991, f. & cert.
ef. 9-16-91; OMAP 31-1998, f. & cert. ef. 9-1-98; OMAP 53-2003, f. 8-13-03
cert. ef. 9-1-03; 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 43-2008, f. 12-17-08, cert. ef. 12-28-08;
DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09;
33-2016, f. 6-29-16, cert. ef.
Stat. Auth.: ORS
Stats. Implemented: ORS