Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 133 - SCHOOL-BASED HEALTH SERVICES › Section 410-133-0040 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the definitions in OAR 410-120-0000, the
				following definitions apply to these rules:
(1) "Adapted vehicle" means a vehicle
			 specifically designed or modified to transport passengers with
			 disabilities.
(2) "Adequate
			 recordkeeping" means in addition to General Rules OAR 410-120-0000, Definitions
			 and 410-120-1360, Requirements for Financial, Clinical, and Other Records,
			 documentation in the student's educational record and on the Individualized
			 Education Plan (IEP) or Individualized Family Service Plan (IFSP) showing the
			 necessary and appropriate health services provided to the student detailed in
			 the School-Based Health Services (SBHS) administrative rules (410-133-0000  and
			 410-133-0320).
(3) "Agent" means a
			 third party or organization that contracts with a provider, allied agency, or
			 Prepaid Health Plan (PHP) to perform designated services in order to facilitate
			 a transaction or conduct other business functions on its behalf. Agents include
			 billing agents, claims clearinghouses, vendors, billing services, service
			 bureaus, and accounts receivable management firms. Agents may also be clinics,
			 group practices, and facilities that submit billings on behalf of providers but
			 the payment is made to a provider, including the following: an employer of a
			 provider, if a provider is required as a condition of employment to turn over
			 his fees to the employer; the facility in which the service is provided, if a
			 provider has a contract under which the facility submits the claim; or a
			 foundation, plan, or similar organization operating an organized health care
			 delivery system, if a provider has a contract under which the organization
			 submits the claim. Agents may also include electronic data transmission
			 submitters.
(4) "Assessment" means
			 a process of obtaining information to determine if a student qualifies for or
			 continues to qualify for the Division covered school-based health
			 services.
(5) "Assistive technology
			 service" means services provided by medically qualified staff within the scope
			 of practice under state law with training and expertise in the use of assistive
			 technology (see 410-133-0080  Coverage and 410-133-0200  Not Covered Services in
			 these rules).
(6) "Audiologist"
			 means a licensed audiologist within the scope of practice as defined by state
			 or federal law who meet the standards of licensing or certification for the
			 health service provided as described in OAR 410-133-0120  Medically Qualified
			 Staff.
(7) "Audiology" means
			 assessment of children with hearing loss; determination of the range, nature,
			 and degree of hearing loss, including the referral for medical or other
			 professional attention for restoration or rehabilitation due to hearing
			 disorders; provision of rehabilitative activities, such as language restoration
			 or rehabilitation, auditory training, hearing evaluation and speech
			 conversation, and determination of the child's need for individual
			 amplification; obtaining and interpreting information; and coordinating care
			 and integrating services relative to the student receiving services.
(8) "Authority" means the Oregon Health
			 Authority. (Please see General Rules 410-120-0000  Acronyms and
			 Definitions.)
(9) "Billing agent or
			 billing service" means a third party or organization that contracts with a
			 provider to perform designated services in order to facilitate an Electronic
			 Data Interchange (EDI) transaction on behalf of the provider. Also see
			 definition for Electronic Data Interchange (EDI) Submitter.
(10) "Billing Provider (BP)" means a person,
			 agent, business, corporation, clinic, group, institution, or other entity that
			 submits claims to and receives payment from the Division on behalf of a
			 performing provider and has been delegated the authority to obligate or act on
			 behalf of the performing provider. (See the Department-wide Support Services
			 (DWSS) administrative rules in, chapter 407, division 120 Provider Rules, and
			 the Division's General Rules OAR 410-120-1260  and SBHS OAR
			 410-133-0140.)
(11) "Billing time
			 limit" means the period allowed to bill services to the Division, see General
			 Rules OAR 410-120-1300, Timely Submission of Claims. In general, those rules
			 require initial submission within 12 months of the date of service or 18 months
			 for resubmission.
(12) "Centers for
			 Medicare and Medicaid Services (CMS)" means the federal regulatory agency for
			 Medicaid programs.
(13)
			 "Certification." See "licensure."
(14) "Children's Health Insurance Program
			 (CHIP)" means a federal and state funded portion of the Oregon Health Plan
			 (OHP) established by Title XXI of the Social Security Act and administered in
			 Oregon by the Authority and the Division.
(15) "Clinical Social Work Associate (CSWA)"
			 means a person working toward Licensed Clinical Social Worker (LCSW) licensure
			 in compliance with Division 20, Procedure for Certification of Clinical Social
			 Work Associates and Licensing of Licensed Clinical Social Workers, OAR Chapter
			 877 division 020.
(16) "Coordinated
			 care" means services directly related to covered school-based health services
			 (SBHS) specified in the individualized education program (IEP) or
			 individualized family service plan (IFSP), performed by medically qualified
			 staff, and allowed under OAR 410-133-0080  Coverage to manage integration of
			 those health services in an education setting. Coordinated care includes the
			 following activities:
(a) Conference. The
			 portion of a conference in a scheduled meeting between medically qualified
			 staff and interested parties to develop, review, or revise components of
			 school-based health services provided to a Medicaid-eligible student to
			 establish, re-establish, or terminate a Medicaid covered health service on a
			 Medicaid-eligible student's Individualized Education Program (IEP) or
			 Individualized Family Service Plan (IFSP); or to develop, review, or revise
			 components of a health service currently provided to a Medicaid-eligible
			 student to determine whether or not those covered health services continue to
			 meet the student's needs as specified on the student's IEP or IFSP;
(b) Consultation. Performed by medically
			 qualified staff within the scope of practice providing technical assistance to
			 or conferring with special education providers, physicians, and families to
			 assist them in providing a covered health service for Medicaid-eligible
			 students related to a specific health service and health service goals and
			 objectives in the individualized education program (IEP) or individualized
			 family service plan (IFSP);
(c)
			 Physician coordinated care. Meeting or communication with a physician in
			 reference to oversight of care and treatment provided for a health service
			 specified on a Medicaid-eligible student's individualized education program
			 (IEP) or individualized family service plan (IFSP).