Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0695 - Intensive In-Home Behavioral Health Treatment Services for Youth (IIHBT)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) IIBHT services as described in OAR
			 309-019-0167 are intended as an
			 outcome-based, transitional, and episodic period of care to provide service and
			 supports in a natural environment that allows the individual and their family
			 or caregivers to successfully remain or reintegrate into their home, in school
			 and community.
(2) Participation in
			 IIBHT services shall not be contingent upon successful completion of, or
			 participation in, any other behavioral health treatment services.
(3) A Youth and Family shall not be required
			 to participate in other services or supports, including Wraparound, to receive
			 IIBHT.
(4) Youth may be eligible
			 for IIBHT services in congregate care settings such as Behavioral
			 Rehabilitation Services or Developmental Disability Group Homes.
(5) Youth are considered for IIBHT services
			 without regard to race, ethnicity, gender, gender identity, gender
			 presentation, sexual orientation, religion, creed, national origin, age,
			 intellectual and/or developmental disability, IQ score, or physical
			 disability.
(6) Prior to delivering
			 any IIBHT service, IIBHT providers shall meet all qualifications,
			 credentialing, or licensing standards and competencies described in OAR
			 309-019-0125, and OARs
			 950-060-0000 through 0160, and
			 supervision requirements described in OAR
			 309-019-0130, OAR
			 309-019-0167, or as required by
			 a licensing or certification board.
(7) To be eligible for IIBHT services, Youth
			 ages zero through 20 years of age shall be determined by the Department of
			 Human Services (Department) to meet Title XIX Medicaid eligibility criteria.
			 The Department shall complete Title XIX Medicaid eligibility determinations
			 according to OAR chapter 461, division 135, division 140, and division 155
			 rules, and OAR chapter 410 division 200 and division 120 rules.
(8) IIBHT services providers shall document
			 services as described in OAR
			 410-120-1360 and OAR 410-0620.
			 The Division may consider incomplete or insufficient documentation as required
			 by OAR 410-172-0620 as non-existent
			 records and recoup payments.
(9)
			 IIBHT services providers shall retain clinical records for seven years and
			 financial and other records for at least five years as described in
			 410-120-1360 Requirements for
			 Financial, Clinical and Other Records. The Division may consider incomplete or
			 insufficient documentation above as non-existent records and recoup
			 payments.
(10) Qualified IIBHT
			 services providers shall work with all providers and the youth and their family
			 to provide transition planning as described in OAR
			 309-019-0167.
(11) The Division shall reimburse authorized
			 IIBHT services that are medically appropriate as described in OAR
			 410-172-0630 and identified on
			 the behavioral health fee schedule described in OAR
			 410-172-0640. Providers shall:
(a) Comply with Medicaid billing and payment
			 rules described in OAR
			 410-120-1280 through
			 1340;
(b) Comply with prior
			 authorization described in OAR
			 410-172-0650; and
(c) Comply with behavioral health program
			 rules described in OAR chapter 309 division 019.