Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 133 - SCHOOL-BASED HEALTH SERVICES › Section 410-133-0090 - Public Education Agency School Medical Provider Payment Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
These rules are designed to assist the public Education Agency
				(EA) School Medical (SM) provider in matching state and federal funds for
				services defined by Section 1915(g) of the Social Security Act, 42 USC |
				1396n(g) and are to be used in conjunction with the Division of Medical
				Assistance Programs (Division) General Rules (chapter 410 division 120).
(1) Payment will be made in accordance with
			 Department of Human Services Provider Rules Chapter 407 Division 120 and
			 Division General Rules Chapter 410 Division 120 to the enrolled School Medical
			 (SM) provider with the Oregon Health Authority (Authority), also termed
			 Department, meeting the requirements set forth in the provider enrollment
			 agreement for those covered health services provided by medically qualified
			 staff working within the scope of their practice. Medically qualified staff
			 must meet the qualifications as outlined in OAR 410-133-0120  Medically
			 Qualified Staff.
(2) Signing the
			 school medical provider enrollment agreement sets forth the relationship
			 between the State of Oregon, the Authority, and the SM provider and constitutes
			 agreement by the SM provider to comply with all applicable rules of the
			 Authority, the Division, and federal and state laws or regulations. (See OARs
			 chapter 407 division120 and Division General Rules chapter 410 division
			 120).
(3) The school medical (SM)
			 provider will bill for covered services provided to Medicaid-eligible students
			 in accordance with Authority chapter 407 division 120 Provider rules, the
			 Division rules chapter 410 division 120 and these School-Based Health Services
			 (SBHS) rules. Payments will be made through the Medicaid Management Information
			 System (MMIS) and the SM provider must retain the full payment for the covered
			 services provided. The SM provider must have a Trading Partner Agreement (TPA)
			 with the Authority prior to submission of electronic transactions.
(4) School-based health services (SBHS)
			 authorized under these rules is a cost-sharing Federal Financial Participation
			 (FFP) matching program in which the Education Agency (EA) SM provider that is a
			 public entity unit of government, is responsible for paying the non-federal
			 matching share of the amount of the SBHS claims, calculated using the Federal
			 Medical Assistance Percentage (FMAP) rates in effect during the quarter when
			 the SBHS claims will be paid:
(a) The unit of
			 government public education agency SM provider's share means the public funds
			 share of the Medicaid payment amount. Pursuant to
			 42 CFR
			 433.51, public funds may be considered as the
			 State's share in claiming federal financial participation (FFP) if the public
			 funds meet the following conditions:
(A) The
			 public funds are transferred to the Authority from public entities that are
			 units of government;
(B) The public
			 funds are not federal funds or they are federal funds authorized by federal law
			 to be used to match other federal funds;
(C) All sources of funds must be allowable
			 under
			 42 CFR
			 433.51 Subpart B;