410-146-0021 American Indian/Alaska Native (AI/AN) Provider Enrollment (1) This rule outlines the Division requirements for Indian Health Service (IHS) and Tribal 638 clinics to enroll as American Indian/Alaska Native (AI/AN) providers (refer to OAR 410-120-1260, Provider Enrollment). (2) An IHS or Tribal 638 clinic that operates a retail pharmacy provides durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) or provides targeted case management (TCM) services must enroll separately as a pharmacy, DMEPOS, or TCM provider. For specific information, refer to OAR chapter 410, division 121, Pharmaceutical Services program; OAR chapter 410, division 122, DMEPOS program; and OAR chapter 410, division 138, TCM program. (3) To enroll with the Division as an IHCP, a health center must be one of the following: (a) An IHS direct health care services facility established, operated, and funded by IHS; or (b) A Tribally-owned and operated facility funded by Title I or V of the Indian Self Determination and Education Assistance Act (Public Law 93-638) and is referenced throughout these rules as a “Tribal 638” provider: (A) A Tribal 638 facility that has administrative control, operation, and funding for health programs transferred to AI/AN tribal governments under a Title I contract with IHS; (B) A Tribal 638 facility that assumes autonomy for the provision of the tribe’s own health care services under a Title V compact with IHS. (4) Eligible IHS and Tribal 638 providers who want to enroll with the Division as an IHCP must submit the following information: (a) Completed Oregon Health Authority (Authority) provider enrollment forms with attachments; (b) A Tribal facility must submit documentation verifying they are a 638 provider: (A) A letter from IHS, applicable-Area Office or Central Office, indicating that the facility (identified by name and address) is a 638 facility; (B) A written assurance from the Tribe that the facility (identified by name and site address) is owned or operated by the Tribe or a Tribal organization with funding directly obtained under a 638 contract or compact. A copy of the relevant provision of the Tribe’s current 638 contract or compact must accompany the written assurance; (c) A copy of the clinic’s Division certification for a program of behavioral health services if someone other than a licensed psychiatrist, licensed clinical psychologist, licensed clinical social worker, psychiatric nurse practitioner, licensed professional counselor, or licensed marriage and family therapist is providing behavioral health services; (d) A copy of the clinic’s Division letter or licensure of approval if providing Substance Use Disorder (SUD) services; (e) A list of all Prepaid Health Plan (PHP) contracts; (f) A list of all practitioners contracted with or employed by the IHS or Tribal 638 facility including names, legacy Division provider numbers, National Provider Identifier (NPI) numbers, and associated taxonomy codes; and (g) A list of all clinics affiliated or owned by the IHS or Tribal 638 facility including business names, legacy Division provider numbers, National Provider Numbers (NPI) and associated taxonomy codes. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 42-2017, amend filed 10/03/2017, effective 10/03/2017 DMAP 37-2010, f. 12-15-10, cert. ef. 1-1-11 DMAP 46-2009, f. 12-15-09, cert. ef. 1-1-10 DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08 DMAP 19-2007, f. 12-5-07, cert. ef. 1-1-08 OMAP 62-2004, f. 9-10-04, cert. ef. 10-1-04 OMAP 59-2002, f. & cert. ef. 10-1-02