Or. Admin. Code § 410-133-0000

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-133-0000 - Purpose

(1) School-Based Health Services (SBHS) rules:

(a) Define Oregon's fee-for-service Medicaid program administered by the Oregon Health Authority (Authority) to reimburse publicly funded education agencies for health services provided in school settings to Oregon's Medicaid-enrolled children or young adults.

(b) Define when Medicaid-covered services rendered to Medicaid-enrolled children or young adults in school settings are reimbursable to education agencies.

(c) Define the reimbursement methodology for necessary and appropriate SBHS rendered to Medicaid-enrolled children or young adults in school settings.

(d) Cite and align with federal and state requirements and limitations for SBHS and Medicaid-covered services when provided to Medicaid-enrolled children or young adults in school settings, including:

(A) Individuals with Disabilities Education Act (IDEA);

(B) Section 504 of the Rehabilitation Act of 1973;

(C) Title XIX and Title XXI of the Social Security Act;

(D) Oregon Revised Statutes; and

(E) Oregon Administrative Rules (OARs).

(2) These SBHS rules are to be used in conjunction with:

(a) Medical Assistance Programs rules in OARs Chapter 410, Divisions 120 and 141;

(b) The Authority provider rules in OARs Chapter 943, Division 120; and

(c) Oregon Department of Education's (ODE) rules in OARs Chapter 581, Divisions 15, 21, and 22.

(3) Medicaid-enrolled children and young adults retain the ability to obtain services from any qualified Medicaid provider. These rules do not require Medicaid-enrolled children and young adults to receive their health services only from school medical providers.

Or. Admin. Code § 410-133-0000

HR 39-1991, f. & cert. ef. 9-16-91; OMAP 38-1999, f. & cert. ef. 10-1-99; OMAP 15-2000, f. 9-28-00, cert. ef 10-1-00; OMAP 31-2003, f. & cert. ef. 4-1-03; OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05; OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09; DMAP 33-2016, f. 6-29-16, cert. ef. 7/1/2016; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065