Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 133 - SCHOOL-BASED HEALTH SERVICES › Section 410-133-0200 - Not Covered Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Education-based costs normally incurred to operate a school and provide an
			 education are not covered for payment by the Authority.
(2) Health services and treatment not
			 documented on the Medicaid-eligible student's IEP or IFSP is not covered for
			 payment by the Authority under the School-Based Health Services (SBHS)
			 rules.
(3) Reviewing records
			 (exception: reviewing records as part of an evaluation to establish,
			 re-establish, or terminate a SBHS covered health service on a Medicaid-eligible
			 student's IEP or IFSP).
(4) Meeting
			 preparation.
(5) Health services
			 preparation including materials preparation.
(6) Report writing (exception: report writing
			 as part of preparation of initial evaluation and initial treatment plan to
			 establish a covered health service on a Medicaid-eligible student's IEP or
			 IFSP).
(7)
			 Correspondence.
(8) Treatment and
			 care coordination for an acute medical condition.
(9) Medication management not specific to
			 mental health related services listed in the IEP/IFSP.
(10) Purchase of an assistive technology
			 device is not covered through SBHS.
(11) Activities related to researching
			 student names, determining Medical Assistance Program eligibility status,
			 administrative activities such as data entry of billing claim forms, and travel
			 time by service providers.
(12)
			 Family therapy where the focus of treatment is the family.
(13) Routine health nursing services provided
			 to all students by school nurses and nursing intervention for acute medical
			 issues in the school setting, e.g., students who become ill or are
			 injured.
(14) Educational
			 workshops, training classes, and parent training workshops.
(15) Regular transportation services to and
			 from school.
(16) Vocational
			 services.
(17) Screening
			 services.
(18) Evaluation services
			 that are not performed by medically qualified staff within the scope of
			 practice to establish, re-establish, or terminate a covered SBHS under
			 IDEA.
(19) Service provided to
			 non-Medicaid students in a group, class, or school free of charge. If only
			 Medicaid-eligible students are charged for the service, the care is free, and
			 Medicaid will not reimburse for the service. The free care limitation does not
			 apply to health services provided as a result of an educational agency's
			 obligation to provide FAPE services, and the health service is identified on
			 the Medicaid-eligible student's IEP/IFSP. This means that school medical
			 providers may bill for covered health services provided to Medicaid-eligible
			 students under IDEA even though they may be provided to non-Medicaid-eligible
			 students for free as a part of FAPE.
(20) Any non-medical unit of time spent on
			 evaluations.
(21) Recreational
			 services.
(22) Early and Periodic
			 Screening, Diagnostic and Treatment (EPSDT) comprehensive examinations
			 described in OAR 410-130-0245  are not authorized to be provided by school
			 medical providers.
(23) Services
			 provided by an entity that employs an excluded provider. It is the obligation
			 of the education agency to utilize the excluded provider web site to check for
			 providers who have been excluded from receiving any monies affiliated with
			 Medicaid and Medicare service reimbursements.
(24) Covered health services listed on an IEP
			 or IFSP for those dates of service when the IEP/IFSP has lapsed.
(25) Covered health services that do not have
			 a current recommendation by medically qualified staff within the scope of
			 practice for the treatment provided as specified on the IEP or IFSP.
(26) Orientation and Mobility Training.
			 Services provided to blind or visually impaired students by qualified personnel
			 to enable those students to attain systematic orientation to and safe movement
			 within their environments in school, home, and community.
(27) Using a rubber stamp to authenticate any
			 entry for documentation of therapy provided to a student and billed to Medicaid
			 for reimbursement for SBHS.
(28)
			 Services provided by staff in an education setting licensed solely by the
			 Teacher Standards and Practices Commission (TSPC). It is not sufficient for a
			 state to use Department of Education provider qualifications for reimbursement
			 of Medicaid-covered health services provided in an education setting.
(29) Services provided by speech-language
			 pathology assistants in schools under the supervision of a speech-language
			 pathologist who do not meet the requirements for a speech pathologist described
			 in 410-133-0120  Medically Qualified Staff but instead holds either a basic,
			 initial, standard, or continuing license in speech impaired issued by the
			 Teacher Standards and Practices Commission and has obtained a permit from the
			 Oregon Board of Examiners for Speech-Language Pathology and Audiology to
			 supervise SLPA's in education settings under OAR 335-095-0055.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.065