Or. Admin. Code § 410-133-0100
Current through Register Vol. 63, No. 12, December 1, 2024
Section 410-133-0100 - School Medical Provider RequirementsThe school medical provider is responsible to:
(1) Enroll as a school medical provider with the Authority in compliance with OARs: 410-120-0310 through 0350; 410-120-1260; and 943-120-0320.(2) Provide health services pursuant to the child or young adult's Individual Plan of Care (IPOC).(3) Ensure health services are provided by medically-qualified individuals in compliance with School-Based Health Services (SBHS) rules (OARs Division 410, Chapter 133).(4) Provide for appropriate medical supervision by licensed medically-qualified individuals consistent with each medically-qualified individual's respective scope of practice and licensing board requirements.(5) Document health services in writing as required in OARs 410-120-1360 and 410-133-0320.(6) Maintain and retain adequate medical and financial records, in compliance with OAR 410-120-1360, necessary to fully disclose the extent of the covered health services provided as part of the child or young adult's education record.(7) Document costs and establish a schedule of cost rates per discipline in accordance with SBHS OAR 410-133-0245.(8) Provide access, in compliance with OARs 410-120-1360, 410-120-1396, 410-120-1510, 943-120-0180, 943-120-0310, and 943-120-1505, for on-site review of the service-delivery location and education records of Medicaid-enrolled children or young adults if such records are directly related to payments for claims to the school medical provider for Medicaid-covered services specified on the child or young adult's IPOC. Such information must be provided to any state or federal agency responsible for administration or oversight of the Medicaid program.(9) Document any changes in the Medicaid-enrolled child or young adult's IPOC related to the provision of Medicaid-covered SBHS.(10) Make certain that SBHS are billed in accordance with OAR 410-120-0035 and SBHS OARs Chapter 410, Division 133.(11) Confirm each individual providing SBHS to Medicaid-enrolled children or young adults, as an employee or under contract with the school medical provider, is eligible to provide Medicaid services. The Authority shall not reimburse a school medical provider for a service provided by a medically-licensed individual who has defrauded or abused the Authority for items or services furnished by that individual. The Authority's Office of Program Integrity maintains a list of excluded providers on the State Medicaid Fraud Convictions website. The U.S. Department of Health and Human Services' Office of the Inspector General maintains, with monthly updates, a complete database of individuals and entities currently excluded from Federally funded health care programs.(12) Comply with all applicable provisions of OARs: Chapter 943, Division 120; Chapter 410, Division 120; and Chapter 410, Division 133.Or. Admin. Code § 410-133-0100
HR 39-1991, f. & cert. ef. 9-16-91; OMAP 31-1998, f. & cert. ef. 9-1-98; 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 28-2008(Temp), f. 6-30-08, cert. ef. 7-1-08 thru 12-28-08; DMAP 43-2008, f. 12-17-08, cert. ef. 12-28-08; 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 9/6/2024Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 414.065