Or. Admin. Code § 410-133-0200

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

Section 410-133-0200 - Services Not Covered

(1) Oregon's School-Based Health Services (SBHS) program does not cover or reimburse for:

(a) Services that are not specified on the child or young adult's Individual Plan of Care (IPOC);

(b) Services that are not provided and documented by medically-qualified individuals within their respective scope of practice and in compliance with their respective board rules and OAR 410-120-1360;

(c) Record reviews as a stand-alone service;

(d) Meeting preparation;

(e) Report writing as a stand-alone service;

(f) Correspondence (e.g., copying, mailing, etc.);

(g) Medication management not specific to health services on the child or young adult's IPOC;

(h) Purchase of an assistive technology device;

(i) Activities related to determining Medicaid eligibility and enrollment status, administrative activities, and travel time by service providers;

(j) Routine health nursing services provided to all children or young adults by school nurses;

(k) Educational workshops, training classes, and parent training workshops;

(l) Regular transportation services to and from school;

(m) Vocational services;

(n) Services provided free-of-charge to non-Medicaid children or young adults;

(o) Services provided by an entity that employs an excluded provider;

(p) Covered health services performed on a date of service for which the child or young adult's IPOC has lapsed; or

(q) Covered health services that do not have a current written recommendation.

(2) Education-based costs normally incurred to operate a school and provide an education are not covered for Medicaid reimbursement by the Authority.

Or. Admin. Code § 410-133-0200

HR 39-1991, f. & cert. ef. 9-16-91; HR 21-1995, f. & cert. ef. 12-1-95; 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 53-2003, f. 8-13-03 cert. ef. 9-1-03; 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