Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 133 - SCHOOL-BASED HEALTH SERVICES › Section 410-133-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) School-Based
			 Health Services (SBHS) rules describe the Medicaid covered services available
			 to Medicaid-eligible students receiving health services on a fee-for-service
			 basis when "Necessary and Appropriate" and within the limitations established
			 by the Medical Assistance Program and these rules, consistent with the
			 requirements of the Individuals with Disabilities Education Act (IDEA). These
			 rules are to be used in conjunction with the General Rules governing the Health
			 Systems Division, Medical Assistance Programs (Division) (OAR 410 division 120)
			 and the Oregon Health Plan (OHP) rules (OAR 410 division 141). The School-Based
			 Health Services rules are also a user's manual designed to assist the
			 Educational Agency (EA) in matching state and federal funds for Oregon's
			 Medicaid-eligible students with disabilities.
(2) The Oregon Administrative Rules (OARs) in
			 Chapter 581, division 15 for the Oregon Department of Education (ODE) outline
			 Oregon's program to meet the federal provisions of the IDEA. These SBHS rules
			 define Oregon's fee-for-service program to reimburse publicly funded education
			 agencies for the health services provided under the IDEA to Oregon's
			 Medicaid-eligible children.
(3) The
			 Department of Human Services (Department), The Oregon Health Authority
			 (Authority), and ODE recognize the unique intent of health services provided
			 for Medicaid-eligible students with disabilities in the special education
			 setting. The School-Based Health Services rules address the health aspects of
			 special education services that are covered by Medicaid or the Children's
			 Health Insurance Program (CHIP).
(4) The Authority endeavors to furnish School
			 Medical (SM) providers with up-to-date billing, procedural information, and
			 guidelines to keep pace with program changes and governmental requirements. The
			 Authority does so by providing information on its website.
(5) Enrolled School-Based Health Services
			 providers are responsible to maintain current publications provided by the
			 Authority and the Division and to comply with the OARs in effect on the date of
			 service the health service is provided.
(6) In order for the Authority to reimburse
			 for health services provided in the school, the health services must be
			 included as a covered service under the Oregon Health Plan (OHP). There is no
			 benefit category in the Medicaid statute titled "school health services" or
			 "early intervention services." These rules do not create a new category of
			 health benefits for this fee-for-service program.
(7) These rules describe health services that
			 are covered services for Medicaid-eligible students, which are authorized and
			 provided consistent with these rules.
(8) Medicaid-eligible students retain the
			 ability to obtain services from any qualified Medicaid provider that undertakes
			 to provide services to them. These rules do not require a Medicaid-eligible
			 student to receive their health services solely from school medical
			 providers.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.065