Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 133 - SCHOOL-BASED HEALTH SERVICES › Section 410-133-0100 - School Medical Provider Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  413.042 &
				  414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065