Or. Admin. Code § 410-172-0860

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-172-0860 - Billing for Dual Eligible Individuals

(1) As described in OAR 410-120-1280 (8), when an individual has both Medicare and coverage through Medicaid, providers shall make reasonable efforts to obtain payment from other resources including Medicare or other Third Party Liability (TPL).

(2) In accordance with OAR 410-120-1280 (f), OAR 410-141-0420, and OAR 410-141-3420, behavioral health providers may bill the Division directly and may not be required to bill Medicare under the following circumstances:

(a) For behavioral health services that are never covered by Medicare or another insurer;

(b) For behavioral health services that are not covered when rendered by the following provider types:

(A) Qualified Mental Health Professional (non-licensed) as defined in OAR 309-019-0105;

(B) Qualified Mental Health Associate as defined in OAR 309-019-0105;

(C) Professional Counselor or Marriage and Family Therapist licensed by the Oregon Board of Licensed Professional Counselors and Therapists;

(D) Certified Peer Support Specialist as defined in OAR 950-060-0010;

(E) Recovery Assistant;

(F) Certified Alcohol and Drug Counselor.

Or. Admin. Code § 410-172-0860

DMAP 32-2015, f. 6-24-15, cert. ef. 6/26/2015; DMAP 106-2024, minor correction filed 06/11/2024, effective 6/11/2024

Statutory/Other Authority: ORS 413.042 & 430.640

Statutes/Other Implemented: ORS 413.042, 414.025, 414.065, 430.640, 430.705 & 430.715