Or. Admin. R. 410-148-0060
Current through Register Vol. 63, No. 8, August 1, 2024
Section 410-148-0060 - Authorization(1) The Division of Medical Assistance Programs (Division) requires authorization of payment for the following items or services:(a) All enteral/parenteral or IV infusion pumps. The provider is required to submit documentation with each request proving that other (non-pump) methods of delivery do not meet the client's medical need;(b) All nursing service visits, except the assessment nursing visit, associated with home enteral/parenteral nutrition or IV services;(c) All oral nutritional supplements;(d) All drugs and goods identified as requiring payment authorization in the Pharmaceutical Services administrative rules (chapter 410, division 121). Contact the Division's Pharmacy Benefit Manager to determine those items that require prior authorization.(2) The Division will approve payment for the above home enteral/parenteral nutrition and/or IV services entities when they are considered to be "medically appropriate."(3) The Division requires authorization of payment for those services that require authorization even though the client has other insurance that may cover the service. Authorization of payment is not required for Medicare covered services.(4) For services requiring authorization, providers must contact the Division's Medical Unit for authorization within five working days following initiation of services. Authorization will be given based on medical appropriateness, appropriateness of level of care given, cost and/or effectiveness.(5) How to obtain payment authorization: (a) The Division's Medical Unit is responsible for authorization for services for clients identified as Medically Fragile Children's Unit clients;(b) Contact the Division's Pharmacy Benefit Manager, prior authorization help desk to request oral nutrition supplements;(c) Contact the Division's Medical Unit to request all other authorization;(d) Payment authorization does not guarantee reimbursement.Or. Admin. R. 410-148-0060
PWC 818(Temp), f. 10-22-76, ef. 11-1-76; PWC 831, f. 2-18-77, ef. 3-1-77; PWC 869, f. 12-30-77, ef. 1-1-78; AFS 70-1981, f. 9-30-81, ef. 10-1-81; AFS 44-1982, f. 4-30-82 & AFS 52-1982, f. 5-28-82, ef. 5-1-82 for providers located in the geographical areas covered by the branch offices of North Salem, South Salem, Dallas, Woodburn, McMinnville, Lebanon, Albany and Corvallis, ef. 6-30-82 for remaining AFS branch offices; AFS 99-1982, f. 10-25-82, ef. 11-1-82; AFS 12-1984, f. 3-16-84, ef. 4-1-84; AFS 26-1984, f. & ef. 6-19-84; AFS 53-1985, f. 9-20-85, ef. 10-1-85; AFS 52-1986, f. & ef. 7-2-86; AFS 15-1987, f. 3-31-87, ef. 4-1-87; AFS 4-1989, f. 1-31-89, cert. ef. 2-1-89; AFS 56-1989, f. 9-28-89, cert. ef. 10-1-89, Renumbered from 461-016-0090; HR 26-1990, f. 8-31-90, cert. ef. 9-1-90, Renumbered from 461-016-0220; HR 9-1992, f. & cert. ef. 4-1-92; HR 26-1993, f. & cert. ef. 10-1-93; HR 3-1995, f. & cert. ef. 2-1-95; OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98; OMAP 29-2000, f. 9-29-00, cert. ef. 10-1-00; OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0680; OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03; OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03; DMAP 26-2008, f. 6-13-08, cert. ef. 7-1-08; DMAP 38-2011, f. 12-13-11, cert. ef. 1-1-12Publications: Publications referenced are available from the agency.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065