Or. Admin. Code § 410-147-0280
Current through Register Vol. 63, No. 12, December 1, 2024
Section 410-147-0280 - Drugs(1) As defined by the Division of Medical Assistance Programs (DMAP), a valid FQHC or RHC encounter excludes pharmaceutical or biologicals not generally provided during a clinic visit. Refer to OAR 41-147-0120 DMAP Encounter and Recognized Practitioners. (a) Because DMAP includes the costs of drugs or medication treatments administered by a clinic to treat a client during an office visit in the PPS all-inclusive encounter rate for the office visit, providers cannot bill separately for the costs of the drugs or treatments;(b) Prescriptions are not included in the PPS encounter rate. To bill for filled prescriptions, the FQHC or RHC's qualified enrolled pharmacy must bill DMAP using its pharmacy provider number.(2) Clinics may directly bill DMAP using their clinic provider number for contraceptive supplies and contraceptive medications only for: (a) Clients enrolled in a Prepaid Health Plan (PHP): Clinics must bill the PHP first. If the PHP will not reimburse for the contraceptive supply or contraceptive medication, then the clinic can bill DMAP fee-for-service at the clinic's acquisition cost. See also OAR 410-130-0585, Family Planning Services;(b) Fee-for-service clients: Clinics can directly bill DMAP fee-for-service at the clinic's acquisition cost for contraceptive supplies and contraceptive medications. See also OAR 410-130-0585, Family Planning Services.(3) Refer to OAR 410 division 121, Pharmaceutical Services Program Rulebook for specific information.Or. Admin. Code § 410-147-0280
OMAP 19-1999, f. & cert. ef. 4-1-99; OMAP 35-1999, f. & cert. ef. 10-1-99; OMAP 20-2000, f. 9-28-00, cert. ef. 10-1-00; OMAP 21-2000, f. 9-28-00, cert. ef 10-1-00; OMAP 8-2001, f. 3-30-01, cert. ef. 4-1-01; OMAP 19-2001, f. 3-30-01, cert. ef. 4-1-01; OMAP 37-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 42-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 39-2002, f. 9-13-02, cert. ef. 9-15-02; OMAP 62-2002, f. & cert. ef. 10-1-02, Renumbered from 410-128-0600; OMAP 63-2002, f. & cert. ef. 10-1-02, Renumbered from 410-135-0240; OMAP 71-2003, f. 9-15-03, cert. ef. 10-1-03; OMAP 27-2006, f. 6-14-06, cert. ef. 7-1-06; DMAP 25-2008, f. 6-13-08, cert. ef. 7-1-08Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065