OAR 309-035-0120: Contracts and Rates

(1) A provider receiving Medicaid reimbursement for services provided, must enroll with OHA’s Medicaid Provider Enrollment program or enter into a contract with the local CMHP, statewide coordinated care organizations, the Division, or other Division-approved party. Enrollment or contracting does not guarantee that any number of residents eligible for Division funded services will be referred to or maintained in the program. (2) The provider must specify in a fee policy and procedure rates for all services and the procedures for collecting payments from residents and payees. The fee policy and procedures must describe the schedule of rates, conditions under which rates may be changed, acceptable methods of payment, and the policy on refunds at the time of residency transfer or discharge: ( a) For residents whose services are funded by the Division, reimbursement for services shall be made according to the rate schedule outlined in Behavioral Health Rate Schedule or the contract. Room and board payments for residents receiving Social Security benefits or public assistance shall be in accordance with rates determined by the Division; (b) For residents paying privately, the program must enter into a signed agreement with the resident, and, if applicable, the resident’s legal representative, if applicable. This agreement must include but is not limited to a description of the services to be provided, the schedule of rates, conditions under which the rates may be changed, and policy on refunds at the time of residency transfer or discharge; and (c) Before increasing rates or modifying payment procedures, the program must provide a 30-day advance notice of the change to all residents, representatives, payees, guardians, or conservators.