Or. Admin. R. 410-133-0100 - School Medical Provider Requirements

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.
(3) 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 requirements.
(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.
(8) Document costs and establish a schedule of cost rates per discipline in accordance with OAR 410-133-0245.
(9) Provide 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).
(11) Assure 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 portal.


Or. Admin. R. 410-133-0100
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; DMAP 33-2016, f. 6-29-16, cert. ef. 7-1-16

Stat. Auth.: ORS 413.042 & 414.065

Stats. Implemented: ORS 413.042 & 414.065

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