reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 151 - Early and Periodic Screening, Diagnostic and Treatment › Section 410-151-0008 - EPSDT Beneficiary communication requirements

Current through Register Vol. 63, No. 7, July 1, 2024
The Authority and MCEs must notify EPSDT Beneficiaries and, as
				applicable, the EPSDT Beneficiary's parent or guardian, about services covered
				under EPSDT and how to access them, in accordance with a guidance document
				which became effective January 1, 2023 and is available at
https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Guidance.pdf
.
				The notice must comply with the criteria for written materials set forth in OAR
				410-141-3585  and be sent to EPSDT Beneficiaries and, as applicable, the EPSDT
				Beneficiary's parent or guardian in accordance with the following
				timelines:
(1) Within sixty (60) days
			 of an EPSDT Beneficiary enrolling in Oregon Health Plan (OHP)
			 coverage;
(2) Immediately following
			 birth for newborn infants; and
(3)
			 Annually for any EPSDT Beneficiary who has not undergone an EPSDT screening or
			 used other OHP services.
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: ORS
				  414.025,
				  414.065 &
				  414.150
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Community Violence Prevention services
			 are evidence-based, trauma-informed, supportive, and non-psychotherapeutic
			 services provided by a certified Violence Prevention Professional.
(2) Services are provided within or outside
			 of a clinical setting for the purpose of promoting improved health outcomes and
			 positive behavioral change, preventing injury, recidivism and reducing the
			 likelihood that individuals who are victims of community violence may commit or
			 promote violence themselves.
Statutory/Other Authority: Oregon Medicaid State Plan
				  Amendment, 42 C.F.R
				  440.130 (c), House Bill 4045
				  & 2022 Legislative Session
Statutes/Other Implemented: ORS
				  413.032,
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0005 - Violence Prevention Professional Certification Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
To be certified as a Violence Prevention Professional, an
				individual shall:
(1) Be employed by a
			 community-based organization who is enrolled with the Oregon Health Authority
			 as a Medicaid billing provider. The community-based organization must also be
			 affiliated with a licensed hospital in Oregon that authorizes the program to
			 provide community violence prevention services to individuals in the
			 hospital.
(2) Complete thirty-five
			 (35) hours of initial training on trauma informed care, de-escalation, conflict
			 mediation, retaliation prevention, case management, victim advocacy and patient
			 privacy with an Oregon Health Authority approved training and certification
			 program for violence prevention professionals in Oregon.
(3) Six (6) hours of Oregon Health Authority
			 approved continuing education every two (2) years that must include effects of
			 trauma and violence, trauma-informed care, case management and advocacy,
			 community violence prevention strategies and patient privacy (HIPAA, 45 CFR
			 parts 160 & 164)
(4) Have lived
			 experience, either as a victim of a violent injury as a result of community
			 violence or as someone closely impacted by community violence.
Statutory/Other Authority: Oregon Medicaid State Plan
				  Amendment, 42 C.F.R
				  440.130 (c), House Bill 4045
				  & 2022 Legislative Session
Statutes/Other Implemented: ORS
				  413.032,
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0015 - Community Violence Prevention Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All Community
			 Violence Prevention services provided by a community violence prevention
			 program shall be performed by a certified Violence Prevention
			 Professional.
(2) Community
			 Violence Prevention services performed by a certified Violence Prevention
			 Professional, shall be determined to be medically appropriate, medically
			 necessary and appropriate for the individual's age. Community Violence
			 Prevention services may include based on the individualized plan of care:
(a) Conflict mediation;
(b) Crisis intervention;
(c) Mentorship;
(d) Peer support and counseling;
(e) Case management;
(f) Referrals to certified or licensed health
			 care professionals or social service providers; or
(g) Screening services to victims' community
			 violence.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0020 - Documentation Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Plan of
			 Care shall include the individuals need for: safety planning, interest in
			 employment, housing, education, mental health and substance abuse treatment
			 services, gang affiliation, legal needs and history of injury within the last
			 six (6) months.
(2) Services
			 rendered must be documented and signed, electronically or wet, by the certified
			 Violence Prevention Professional rendering the service on each date of
			 service.
(3) The provider shall
			 maintain a record of each service provided to each eligible individual for each
			 date of service including, but not limited to:
(a) Name and Medicaid identification number
			 of individual receiving the service;
(b) Name and credentials of the certified
			 Community Violence Prevention professional;
(c) Date the service was provided;
(d) Description of each service provided to
			 the individual to address the psychosocial and safety needs of the client to
			 include coordination of all services and interventions as developed in the
			 individuals plan of care.
(e)
			 Description of outcomes, including the individual's responsiveness to services
			 and any change in the frequency of: emergency room visits, retaliatory
			 violence, arrest and acute stress and post-traumatic stress disorder.
(f) Document referrals to other identified
			 services and supports, including referrals to entities completing eligibility
			 assessments.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0025 - Eligibility Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be eligible
			 to receive Community Violence Prevention services performed by a certified
			 Violence Prevention Professional the individual shall:
(a) be enrolled in the Oregon Health
			 Plan;
(b) have a history of injury
			 sustained because of an act of community violence;
(c) received a recommendation for services by
			 a physician or other qualified licensed practitioner of the healing arts within
			 the practitioner's scope of practice under the state law; and
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 152 - Community Violence Prevention Services › Section 410-152-0030 - Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Community Violence Prevention Services
			 are not covered for individuals:
(a) Solely
			 treated for intimate partner violence;
(b) Identified as a family member, friend, or
			 associate of the individual receiving the service, and does not meet
			 eligibility requirements described in OAR 410-152-0040
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 160 - LAW ENFORCEMENT LIABILITY ACCOUNT (LEMLA) › Section 410-160-0000 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purposes of OAR 410-160-0000  through 410-160-0100, the
				following definitions shall apply:
(1)
			 LEMLA means the Law Enforcement Medical Liability Account.
(2) LEMLA Patient means a person who has
			 suffered injuries related to law enforcement activity.
(3) Injuries Related to Law Enforcement
			 Activity means injuries sustained prior to booking, citation in lieu of arrest
			 or release instead of booking that occur during and as a result of efforts by a
			 law enforcement officer to restrain or detain, or to take or retain custody of,
			 the individual. Whether injuries related to law enforcement activity have
			 occurred shall be determined by the law enforcement agency.
(4) Release Date means the date the LEMLA
			 patient was released from actual physical custody, as determined by the law
			 enforcement agency.
(5) Cost of
			 Such Services means "usual charge" as defined in OAR 410-120-0000.
(6) Hospital means a hospital as defined in
			 OAR 410-120-0000.
(7) Overpayment
			 means payment made by LEMLA to a claimant in excess of the amount due for the
			 covered services and items billed.
(8) Claimant means a Medicaid
			 provider.
(9) Medicaid Provider
			 means a provider who has been issued a provider number by the Division and is
			 not currently subject to sanction by the Division.
(10) Prior Payment Amount means the total of
			 all payments received by the claimant from all other sources, including the
			 LEMLA patient, prior to submitting a LEMLA claim.
(11) LEMLA Claim Amount means the total cost
			 of such services provided to a LEMLA patient that are directly connected to
			 injuries related to law enforcement activity. It shall not include any charges
			 for services provided to a LEMLA patient for a preexisting disease or
			 condition, or services that are unrelated to the "injuries related to law
			 enforcement activities."
Stat. Auth.: ORS 413-042, ORS
				  414.065
Stats. Implemented: ORS
				  414.805 -- ORS
				  414.815
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 160 - LAW ENFORCEMENT LIABILITY ACCOUNT (LEMLA) › Section 410-160-0100 - Process and Procedure

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 purpose of the Law Enforcement Medical Liability Account (LEMLA) is to provide
			 a fund to reimburse a claimant for emergency medical services provided to a
			 LEMLA patient.
(2) The time limit
			 for submitting claims to LEMLA is one year after the date of injury. If a
			 claimant has been paid by a LEMLA patient's insurer or health care contractor
			 and the LEMLA patient's insurer or health care contractor subsequently demands
			 return of the payment, a claimant must bill LEMLA not later than 180 days from
			 the date of the demand letter or one year from the date of injury, whichever is
			 later.
(3) The Division shall
			 process all claims received in accordance with the following procedures:
(a) The claim shall be date stamped on the
			 date received by LEMLA;
(b) The
			 Division shall review each claim submitted to verify that the claim contains
			 all of the following required information:
(A)
			 The LEMLA claim form, with the following information:
(i) Certification by an authorized
			 representative of the law enforcement agency involved with an injury that the
			 injury is related to law enforcement activity;
(ii) The release date, if any, as determined
			 by the law enforcement agency. If the LEMLA patient has not yet been released,
			 state that on the LEMLA claim form;
(iii) LEMLA patient's name;
(iv) Prior payment amount;
(v) Date of injury;
(vi) Claimant's Medicaid provider
			 number;
(vii) Claimant's
			 name;
(viii) LEMLA claim
			 amount;
(ix) Cause or nature of
			 injury.
(B) Attached to
			 the LEMLA form, the following information:
(i)
			 Documentation that demonstrates the claimant has billed the LEMLA patient or
			 the LEMLA patient's insurer or health care contractor for the charges or
			 expenses owed to the claimant and that the claimant has made a reasonable
			 effort to collect from the LEMLA patient or the LEMLA patient's insurer or
			 health care contractor;
(ii) A copy
			 of the hospital or provider billing document that shows the usual charge and
			 date of service.
(c) The Division shall reject claims that do
			 not contain all of the information required in subsection (3)(b) of this rule;
(d) The Division shall review the
			 documentation of reasonable collection effort. If 45 days have not elapsed
			 since the claimant billed the LEMLA patient or the LEMLA patient's insurer or
			 health care contractor, the claim may be rejected;
(e) The Division shall review the date of
			 injury. If the date stamped on the claim under subsection (3)(a) of this rule
			 is more than one year after the date of injury, the claim shall be rejected.
			 The one-year time limit may not apply if the provisions of section (2) of this
			 rule apply with regards to an insurer or health care contractor demanding
			 repayment of a previously paid claim.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0000 - Basis and Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules
			 (OAR chapter 410, division 165) govern the Oregon Health Authority (Authority),
			 Health Systems Division (Division), Medicaid Electronic Health Record (EHR)
			 Incentive Program. The Medicaid EHR Incentive Program provides incentive
			 payments consistent with federal law concerning such payments to eligible
			 providers participating in the Medicaid program who adopt, implement, upgrade,
			 or successfully demonstrate meaningful use of certified EHR technology and who
			 are qualified by the program.
(2)
			 The Medicaid EHR Incentive Program is implemented pursuant to:
(a) The American Reinvestment and Recovery
			 Act of 2009,
			 Pub.
			 L. No. 111-5,
			 section
			 4201;
(b) The Centers for Medicare and Medicaid
			 Services (CMS) federal regulation  42 CFR Part 495  (2010, 2012, 2014, and 2015)
			 pursuant to the Social Security Act sections 1903(a)(3)(F) and
			 1903(t);
(c) The Division's General
			 Rules program, OAR chapter 410, division 120;
(d) The Authority's Provider Rules, OAR
			 chapter 943, division 120.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0020 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 410-165-0010 through
				410-165-0140:
(1) "Acceptance
			 Documents" means written evidence supplied by a provider demonstrating that the
			 provider met Medicaid EHR Incentive Program eligibility criteria or
			 participation requirements according to standards specified by the
			 Division.
(2) "Acute Care Hospital"
			 means a healthcare facility including, but not limited to, a critical access
			 hospital with a Centers for Medicare and Medicaid Services' (CMS) certification
			 number (CCN) that ends in 0001-0879 or 1300-1399 and where the average length
			 of patient stay is 25 days or fewer.
(3) "Adopt, Implement, or Upgrade" means:
(a) Acquire, purchase, or secure access to
			 certified EHR technology capable of meeting meaningful use
			 requirements;
(b) Install or
			 commence utilization of certified EHR technology capable of meeting meaningful
			 use requirements; or
(c) Expand the
			 available functionality of certified EHR technology capable of meeting
			 meaningful use requirements at the practice site, including staffing,
			 maintenance, and training or upgrade from existing EHR technology to certified
			 EHR technology.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0060 - Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) There are three
			 categories of eligibility criteria:
(a)
			 Eligible professionals;
(b)
			 Eligible professionals practicing predominately in a FQHC or RHC; and
(c) Eligible hospitals.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0080 - Meaningful Use

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An eligible
			 provider shall demonstrate being a meaningful EHR user as prescribed by
			 42
			 CFR 495.4 (2010, 2012, 2015, 2016, 2017, and
			 2018),
			  42
			 CFR 495.6  (2010, 2012, and 2014),
			   42 CFR
			 495.8   (2010, 2012, and 2014),
			 42
			 CFR 495.20 (2015),
			 42
			 CFR 495.22 (2015, 2016, and 2017),
			 42
			 CFR 495.24 (2015, 2016, 2017, and 2018), and
			 42 CFR
			 495.40 (2015, 2016, 2017, and 2018):
(a) For eligible providers demonstrating
			 meaningful use under the program in Stage 1 prior to December 15, 2015, to
			 comply with
			 42 CFR
			 495.8, the State of Oregon requires the
			 eligible provider to satisfy the objective "Capability to submit electronic
			 data to immunization registries or immunization information systems and actual
			 submission in accordance with applicable law and practice;"
(b) For eligible hospitals:
(A) If CMS deems an eligible hospital to be a
			 meaningful EHR user for the Medicare EHR Incentive Program for a program year,
			 the eligible hospital is automatically deemed to be a meaningful EHR user for
			 the program for the same program year;
(B) An eligible hospital deemed to be a
			 meaningful EHR user by CMS for a program year does not have to meet the
			 requirements specified in section (1)(a) for the program for the same program
			 year.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0100 - Participation and Incentive Payments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To qualify for an incentive payment, an
			 eligible provider shall meet the Program eligibility criteria and participation
			 requirements for each year the eligible provider applies:
(a) An eligible provider shall meet the
			 eligibility criteria for each program year of:
(A) Type of eligible provider;
(B) Patient volume minimum; and
(C) Certified EHR technology adoption,
			 implementation, or upgrade requirements in the first year of participation and
			 meaningful use requirements in subsequent years, or meaningful use requirements
			 in all years of participation.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0120 - Appeals

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The appeals
			 process for the Program is governed by
			 42
			 CFR 495.370 and the Authority's Provider
			 Appeals Rules in chapter 410, division 120.
(2) Pursuant to
			 42 CFR
			 495.312 and
			 42
			 CFR 495.370, the Authority may have CMS
			 conduct the audits and handle any subsequent appeals of whether eligible
			 hospitals are meaningful EHR users.
(3) A provider who applies for a Medicaid EHR
			 incentive payment may appeal the Program's decision. Appeals are governed by
			 the Division's Provider Appeal Rules OAR chapter 410, division 120. The
			 provider's appeal shall note the specific reason for the appeal, due to one or
			 more of the following issues:
(a) An
			 incentive payment;
(b) An incentive
			 payment amount;
(c) A provider
			 eligibility determination;
(d) The
			 demonstration of adopting, implementing, or upgrading; or
(e) Meaningful use eligibility other than a
			 meaningful use eligibility issue where CMS handles the appeal, as provided in
			 section (2) of this rule.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 165 - OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM › Section 410-165-0140 - Oversight and Audits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 provider who qualifies for a Medicaid Electronic Health Record (EHR) incentive
			 payment under the Program is subject to audit or other post-payment review
			 procedures pursuant to OAR 943-120-1505.
(2) The Authority and the Department of Human
			 Services may recover overpayments from the person or entity who received an
			 incentive payment from the Program.
(3) As authorized in
			 42 CFR
			 495.312, the Authority designates CMS to
			 conduct audits on hospitals' meaningful use attestations through program year
			 2014. For program year 2015 and later, the Authority and the Department of
			 Human Services shall conduct these audits.
(4) The person or entity who received a
			 Medicaid EHR incentive overpayment must repay the amount specified within 30
			 calendar days from the mailing date of written notification of the overpayment
			 as prescribed by OAR 943-120-1505.
Tables referenced are not included in rule text.
Click here for PDF copy of
				  table(s)
.
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: ORS
				  413.042 &
				  414.033
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0000 - Administration of the Behavior Rehabilitation Services (BRS) Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All BRS
			 contractors shall, and ensure that their BRS providers, comply with the Medical
			 Assistance programs rules in OAR Chapter 410, Division 120.
(2) All BRS contractors shall, and ensure
			 that their BRS providers, comply with the BRS program general rules in OAR
			 Chapter 410, Division 170.
(a) BRS
			 contractors shall, and ensure that their BRS providers, comply with OAR Chapter
			 413, Division 095 to provide services or placement-related activities to BRS
			 clients who receive prior authorization from the Department of Human
			 Services;
(b) BRS contractors
			 shall, and ensure that their BRS providers, comply with OAR Chapter 416,
			 Division 335 to provide services or placement-related activities to BRS clients
			 who receive prior authorization from the Oregon Youth Authority.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0010 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of the Behavior Rehabilitation Services (BRS)
				Program is to remediate the BRS client's debilitating psychosocial, emotional,
				and behavioral disorders by providing such services as behavioral intervention,
				counseling, and skills-training. Services are delivered in a way that
				integrates a gender-responsive, culturally-sensitive, trauma-informed, and
				age-appropriate or developmentally-appropriate approach. These rules describe
				the general program requirements for the BRS program, prior authorization
				process, services and placement-related activities, BRS contractor and BRS
				provider requirements, reimbursement rates, and compliance and oversight
				activities.
Statutory/Other Authority: ORS
				  413.042 &
				  414.065
Statutes/Other Implemented: ORS
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0020 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to terms used in OAR Chapter
				410, Division 170.
(1) "Accreditation"
			 as defined in OAR 413-095-0000(2)  means:
(a)
			 An endorsement certifying that the BRS program meets all of the rigorous
			 guidelines for service and quality established by any of the following
			 entities:
(A) The Commission on Accreditation
			 of Rehabilitation Facilities (CARF); or
(B) The Joint Commission on Accreditation of
			 Healthcare Organizations (JCAHO); or
(C) The Council on Accreditation (COA);
			 or
(D) An independent, not for
			 profit accrediting organization approved by the U.S. Department of Health and
			 Human Services.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0030 - BRS Contractor and BRS Provider Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The BRS contractor shall ensure that its
			 BRS providers meet the following minimum requirements:
(a) Have the necessary current and valid
			 licenses, approvals, or certifications required by federal or state law or
			 regulations for the entity and its staff to operate a BRS program;
(b) Have a license to operate a child-caring
			 agency;
(c) Comply with the
			 provider enrollment requirements in OAR 410-120-1260;
(d) Comply with all applicable provisions of
			 ORS
			 418.205 to 4138.327, OAR 413, Division 215, and any other federal and state laws and
			 regulations governing child-caring agencies that apply to the type of BRS
			 program being operated;
(e) Comply
			 with the requirements in OAR 410-120-1380(1)(c)(J)  for excluding individuals
			 and entities from being subcontractors if they are found on the listed
			 exclusion list; and
(f) Have a
			 contract or agreement with an agency or, as applicable, a BRS contractor to
			 provide services and placement-related activities to the BRS client.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0040 - Prior Authorization for the BRS Program; Hearing Rights

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The BRS program
			 requires prior authorization from the agency in accordance with the Authority's
			 rules, the general BRS program rules, and applicable agency-specific BRS
			 program rules. A referral by an LPHA or agency to the Authority for prior
			 authorization of the BRS program is not a prior authorization.
(2) Prior Authorization Criteria for the BRS
			 program:
(a) The Authority shall provide
			 prior authorization for the BRS program to an individual who:
(A) Is enrolled in the Oregon Health Plan
			 (OHP), is eligible for Oregon's Medicaid or CHIP program, and is eligible for
			 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services,
			 according to the procedures established by the Authority;
(B) Has a determination by a designated LPHA
			 that the BRS program is medically appropriate to meet the individual's medical
			 needs;
(C) Is not receiving
			 residential mental health or residential developmental disability services from
			 another governmental unit or entity;
(D) Is a child; and
(E) Does not have a current prior
			 authorization for the BRS program for the requested time period from OYA or the
			 Department.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0050 - Program Referrals and Admission to BRS Provider

Current through Register Vol. 63, No. 7, July 1, 2024
(1) After the BRS client receives prior
			 authorization for the BRS program, the agency shall refer the BRS client for
			 admission to one or more BRS contractors or BRS providers that provide the
			 appropriate BRS type of care.
(2)
			 The agency shall provide the BRS contractor or, as applicable, the BRS provider
			 with the following documents in the BRS client's referral packet:
(a) Information identifying the individual or
			 entity with legal authority over the BRS client, which may be the BRS client's
			 parent, guardian, or legal custodian;
(b) Any prior evaluations, assessments, or
			 other documents that provide background information about the BRS client or
			 that support the need for the BRS client's current level of services;
			 and
(c) The caseworker's case plan
			 describing necessary services or similar planning form for the BRS
			 client.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0060 - Discharge from the BRS Contractor or BRS Provider

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Planned discharge initiated by the BRS
			 contractor, BRS provider, or the agency:
(a)
			 Initiated by the BRS contractor or BRS provider:
(A) The BRS contractor shall, and require
			 that its BRS providers, notify the caseworker in writing as soon as reasonably
			 practicable regarding its intent to initiate the planned discharge of the BRS
			 client from its program;
(B)
			 Following notification, the BRS contractor or BRS provider and caseworker shall
			 meet to discuss the case. If a discharge date can be agreed upon, the BRS
			 client shall be discharged on that date. If they cannot agree, the caseworker
			 shall remove the BRS client from the program within 30 days from the original
			 written notice to the caseworker, resulting in the BRS client's planned
			 discharge.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0070 - BRS Service Planning

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Initial
			 Service Plan (ISP):
(a) A BRS contractor that
			 provides services and placement-related activities in a Shelter, Independent
			 Living program, Enhanced Structure Independent Living program, Proctor Care,
			 Proctor Enhanced Services, Assessment and Evaluation, Basic Residential, Basic
			 Rehabilitation, Intensive Residential, Intensive Rehabilitation, or Intensive
			 Behavioral Support program shall, and require that its BRS providers:
(A) Ensure that a social service staff member
			 completes a written ISP within two business days of the BRS client's admission
			 to its program;
(B) Provide an
			 opportunity for the following individuals to participate in developing the BRS
			 client's ISP, including but not limited to the BRS client, the BRS client's
			 family, fictive kin, social service staff, the BRS client's caseworker, and any
			 other significant individuals involved with the BRS client;
(C) Obtain and maintain documentation that
			 the individuals listed in section (1)(a)(B) of this rule were provided with the
			 opportunity to participate in developing the ISP;
(D) Obtain written approval of the ISP prior
			 to its implementation from the caseworker and, as applicable and appropriate,
			 the BRS client and the BRS client's parent, guardian, or legal custodian;
			 and
(E) Provide the services
			 identified in the ISP during the first 45 days in the BRS provider's program or
			 until the MSP is written.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0080 - Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The BRS
			 contractor shall, and require that its BRS provider, provide services to the
			 BRS client in accordance with the BRS client's service plan.
(2) BRS contractor staff shall, and require
			 that its BRS provider, staff structure and directly supervise all
			 services.
(3) Types of Services:
(a) Milieu Therapy:
(A) The BRS contractor shall, and require
			 that its BRS provider, provide the BRS client structured activities and planned
			 interventions designed to normalize psycho-social development, promote safety,
			 stabilize environment, and assist in responding in developmentally appropriate
			 ways;
(B) The program's staff shall
			 monitor the BRS client in these activities, which include developmental,
			 recreational, academic, rehabilitative, or other productive work;
(C) Milieu therapy occurs in concert with one
			 of the other types of services. Because milieu therapy must occur in concert
			 with another BRS service, the BRS contractor may not and shall ensure that its
			 BRS provider does not count milieu therapy in the number of hours of BRS
			 services provided to the BRS client per week.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0090 - BRS Types of Care

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Shelter,
			 Community Step-Down, and Independent Living Program:
(a) The BRS contractor or BRS provider may
			 use either a residential care model or proctor care model for these BRS types
			 of care;
(b) The BRS contractor
			 providing one of these BRS types of care shall, and require that its BRS
			 provider, ensure that a minimum of six hours of services are available per week
			 to each BRS client as follows:
(A) One hour
			 of individual counseling or individual skills-training provided by social
			 service staff; and
(B) Five hours
			 of any combination of individual or group counseling, crisis counseling,
			 skills-training, or parent training.
(c) The BRS client is placed in a shelter
			 type of care as a short-term intervention to develop necessary
			 skills;
(d) The BRS client is
			 placed in a community step-down type of care from a higher BRS level of care
			 following a thorough Assessment and Evaluation Report and when the BRS client
			 requires only six BRS hours of service but the same level of BRS structure and
			 support;
(e) The BRS client placed
			 in an independent living program type of care requires a structured, supervised
			 setting prior to transitioning to a supported community placement or living
			 independently.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0110 - Billing and Payment for Services and Placement-Related Activities

Current through Register Vol. 63, No. 7, July 1, 2024
Effective July 1, 2023:
(1) The BRS contractor is compensated for a
			 billable care day (service and placement-related activities rates) on a
			 fee-for-service basis, except as otherwise provided for in these rules. The
			 Authority does not make payments for any calendar day that does not meet the
			 definition of a billable care day under this rule.
(2) Billable care day rates are provided in
			 the "BRS Rates Table," dated July 1, 2023, which is adopted as Exhibit 1 and
			 incorporated by reference into this rule. The BRS Rates Table is available at
http://www.oregon.gov/oha/HSD/OHP/Pages/Policy-BRS.aspx
.
			 A printed copy may be obtained from the agency. BRS contractors not meeting the
			 QRTP requirements will be paid at the non-QRTP rate.
(3) Billable Care Day:
(a) For purposes of computing a billable care
			 day, the BRS client must be in the direct care of the BRS contractor or BRS
			 provider at 11:59 p.m. of that day, be on runaway status as defined in this
			 rule or be on an authorized home or transitional visit in accordance with
			 section (4) of this rule;
(b) A
			 billable care day does not include any day where the BRS client is in
			 detention, an inpatient in a hospital, or has not yet entered or is discharged
			 from the BRS contractor's or BRS provider's program;
(c) A billable care day does not include any
			 day in which a BRS client is on runaway status and the BRS contractor or BRS
			 provider was responsible for less than an accumulated period of 8 hours for the
			 primary care, support, safety, and well-being of the BRS client.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 170 - BEHAVIOR REHABILITATION SERVICES PROGRAM GENERAL RULES › Section 410-170-0120 - Compliance Reviews and Sanctions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The BRS contractor shall cooperate and
			 ensure its BRS providers cooperate with program compliance reviews or audits
			 conducted by any federal or state or local governmental agency or entity
			 related to the BRS program.
(2) The
			 Authority or agency or both shall conduct compliance reviews periodically,
			 including but not limited to review of documentation and onsite
			 inspections.
(3) If the Authority
			 determines that the BRS contractor is not in compliance with its contract to
			 provide BRS services or placement-related activities, including but not limited
			 to non-compliance with state or federal law or regulation, then the Authority
			 may:
(a) Provide technical
			 assistance;
(b) Require the BRS
			 contractor working with its BRS provider to develop and implement a corrective
			 action plan;
(c) Pursue any or all
			 remedies authorized under the contract;
(d) Pursue any other remedy authorized by
			 state or federal law; or
(e) Pursue
			 any combination of the above.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0000 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  413.042,
				  414.025,
				  414.065,
				  430.640,
				  430.705 &
				  430.715
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0600 - Acronyms and Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Activity of
			 Daily Living (ADLs)" means those personal and functional activities required by
			 an individual for continued well-being, that are essential for health and
			 safety. ADLs include eating, bathing, dressing, toileting, transferring
			 (including mobility and ambulation) and maintaining continence.
(2) "Adult" means an individual 18 years of
			 age or older or an emancipated minor. An individual with Medicaid eligibility
			 who needs services specific to children, adolescents, or young adults in
			 transition shall be considered a child until age 21 for the purposes of these
			 rules. Adults who are between the ages of 18 and 21 who are considered children
			 for purposes of these rules shall have all rights afforded to adults as
			 specified in these rules.
(3) "ASAM
			 PPC" means the most current publication of the American Society of Addiction
			 Medicine Patient Placement Criteria for the Treatment of Substance-related
			 Disorders, which is a clinical guide used in matching individuals to
			 appropriate levels of care.
(4)
			 "Authority" means the Oregon Health Authority, the agency established in ORS
			 413 that administers the funds for Titles XIX and XXI of the Social Security
			 Act, or its designee. It is the single state agency for the administration of
			 the medical assistance program under ORS 414. For purposes of these rules, the
			 agencies under the authority of the Oregon Health Authority are the Public
			 Health Division, Health Systems Division, External Relations, Health Policy and
			 Analytics, Fiscal and Operations, Office of Equity and Inclusion, and the
			 Oregon State Hospital.
(5)
			 "Authorized Representative" means any adult with longstanding involvement in
			 assuring the individual's health and safety, appointed to participate in the
			 service planning process, and is:
(a) Chosen
			 and appointed by the individual or their legal representative, if
			 applicable;
(b) Not a paid provider
			 of Home and Community Based Services (HCBS) and supports or personal care
			 services;
(c) Authorized, in
			 writing or other method that clearly indicates consenting choice, by the
			 individual or legal representative, if applicable, to serve as the individuals
			 representative in connection with the provision of funded supports;
			 and
(d) Responsible to act as the
			 authorized representative until the individual or legal representative, if
			 applicable, modifies the authorization or notifies the agency that the
			 authorized representative is no longer authorized to act on their
			 behalf.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0610 - Provider Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Providers shall be enrolled with the Division as a behavioral health provider.
			 Paid providers of behavioral health services shall possess a current and valid
			 license, letter, or certificate.
(2) Providers shall provide services within
			 the scope of professional standards and practice defined by the providers
			 licensing board or certifying organization.
(3) Providers shall meet all requirements in
			 OAR 410-120-1260  (Medical Assistance Programs Provider Enrollment), OAR
			 943-120-0310  (Provider Requirements), and OAR 943-120-0320  (Provider
			 Enrollment).
(4) Providers shall
			 not be included on any US Office of Inspector General Exclusion
			 lists.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  413.042,
				  414.025,
				  414.065,
				  430.640,
				  430.705, &
				  430.715
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0620 - Documentation Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OHP
			 providers shall maintain records that fully support the extent of services for
			 which payment has been requested and provide the records to the Division upon
			 request.
(2) All records shall
			 document the specific service provided, the number of services comprising the
			 service provided, the extent of the service provided, the dates on which the
			 service was provided, and the individual who provided the service.
(3) Clinical records shall document the
			 recipient's diagnosis and the medical need for the service.
(4) The record shall be annotated each time a
			 service is provided and be signed or initialed by the individual providing the
			 service.
(5) Information contained
			 in the record shall be appropriate in quality and quantity to meet the
			 professional standards applicable to the provider and any additional standards
			 for documentation found in these rules, other Division rules, and pertinent
			 contracts.
(6) For AMH certified
			 providers, in addition to meeting the requirements in this rule, clinical
			 documentation for behavioral health services shall also comply with the
			 requirements in OAR 309-019-0135  through OAR 309-019-0140, and clinical
			 documentation standards for substance use disorder services shall comply with
			 OAR 309-018-0140  through OAR 309-018-0150.
Stat. Auth.: ORS
				  413.042,
				  430.640,
				  430.705, &
				  430.715
Stats. Implemented: ORS
				  414.025,
				  414.065, &
				  430.640
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0630 - Medically Appropriate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In
			 addition to the definition of medically appropriate in OAR 410-120-0000  for
			 behavioral health services, "medically appropriate" means the services and
			 supports required to diagnose, stabilize, care for, and treat a behavioral
			 health condition.
(2) The Division
			 shall make payment for medically appropriate behavioral health services when
			 the services or supports are:
(a) Rendered by
			 a provider whose training, credentials, or license is appropriate to treat the
			 identified condition and deliver the service;
(b) Based on the standards of evidence-based
			 practice, and the services provided are appropriate and consistent with the
			 diagnosis identified in the behavioral health assessment;
(c) Provided in accordance with an
			 individualized service plan and appropriate to achieve the specific and
			 measurable goals identified in the service plan;
(d) Not provided solely for the convenience
			 of the recipient, the recipient's family, or the provider of the services or
			 supplies;
(e) Not provided solely
			 for recreational purposes;
(f) Not
			 provided solely for research and data collection;
(g) Not provided solely for the purpose of
			 fulfilling a legal requirement placed on the recipient.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0660 - Rehabilitative Behavioral Health Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Rehabilitative behavioral health services means medical or remedial services
			 recommended by a licensed medical practitioner or other licensed practitioner
			 to reduce impairment to an individuals functioning associated with the symptoms
			 of a mental disorder or substance use disorder and are intended to restore
			 functioning to the highest degree possible.
(2) Remedial rehabilitative behavioral health
			 services shall be recommended by a licensed practitioner of the healing arts as
			 described in parts 4(c-h) and 5(a-d) within the scope of their practice under
			 state law.
(3) Rehabilitative
			 behavioral health services that include medical services shall be recommended
			 by and provided under ongoing oversight of a licensed medical practitioner as
			 described in part 4(a-b) of this rule within the scope of their practice under
			 state law.
(4) Rendering providers
			 of rehabilitative behavioral health services shall meet one of the following
			 qualifications:
(a) Physician or Physician
			 Assistant licensed in the State of Oregon;
(b) Advanced Practice Nurse including
			 Clinical Nurse Specialist and Certified Nurse Practitioner licensed by the
			 Oregon Board of Nursing;
(c)
			 Psychologist licensed by the Oregon Board of Psychology;
(d) Professional Counselor or Marriage and
			 Family Therapist licensed by the Oregon Board of Licensed Professional
			 Counselors and Therapists;
(e)
			 Clinical Social Worker licensed by the Oregon Board of Licensed Social
			 Workers;
(f) Licensed Master Social
			 Worker licensed by the Oregon Board of Licensed Social Workers as described in
			 OAR 877-015-0105;
(g) Licensed Psychologist Associate granted
			 independent status as described in OAR
			 858-010-0039;
(h) Licensed Occupational Therapist licensed
			 by the Oregon Occupational Therapy Licensing Board;
(i) Organizational certificate of approval
			 issued by the Health Systems Division (Division) as described in OAR
			 309-012-0130 through
			 309-012-0220.