OAR 410-133-0090: Payment

(1) Payment shall be made for school-based health services in accordance with OARs: 410-120-1340, 943-120-0350, and 410-133-0245. (2) Evaluation, re-evaluation, and assessment reimbursable time may include: (a) The time for evaluating and assessing a child or young adult’s school-based health service needs (cannot be delegated); (b) The time to prepare the written report, including obtaining and interpreting medical information to determine health-related needs or diagnosis or for the purpose of planning treatment. (3) Care coordination and referral reimbursable time may include: (a) The time for managing integration of, and access to, Medicaid-covered services for the child or young adult: (A) With a physician, community practitioner, community organization, the Authority, or the child or young adult’s parent/guardian or coordinated care organization (CCO); (B) To consult with or provide technical assistance to education agency staff, healthcare providers, or families; and (C) To provide training for non-supervisory level rendering providers performing health care activities. (b) The portion of a conference between interested parties and an SBHS-recognized provider for developing, reviewing, or revising a treatment plan or to establish, re-establish, or terminate a covered health service. (4) Direct assistance with selection, acquisition, or use of assistive technology reimbursable time may include: (a) An assistive technology assessment with one-to-one child or young adult contact time; (b) The time to prepare the required written report of the need, suitability, and benefits of the use of an assistive technology device or adaptive equipment; (c) Care coordination and consultation with the child or young adult’s healthcare practitioner, parent/guardian, and the Authority for the acquisition of a personal assistive technology device through the child or young adult’s Medicaid plan; and (d) Training or technical assistance provided to, or demonstrated with, the child or young adult which may include instructing on the use of an assistive technology device or adaptive equipment in the education setting with professionals (including individuals providing education and rehabilitation services) or the child or young adult’s family members, guardians, advocates, or authorized representative. (5) Interpreter services may be reimbursed when provided in accordance with OAR 410-120-0001. (6) Payment for school-based health services is through cost-sharing, a federal financial participation reimbursement that requires a public unit of government to pay the non-federal share pursuant to 42 CFR 433.51. (a) The education agency is responsible for paying the non-federal share for each payable school-based health service. (b) The non-federal share is calculated using the Federal Medical Assistance Percentage (FMAP) rates in effect during the quarter when the service is reimbursed. (c) Public funds may be considered as the state's (non-federal) share in claiming federal financial participation if the public funds: (A) Are transferred to the state agency from the public unit of government; (B) Are not federal funds, or are federal funds authorized by federal law to be used to match other federal funds; and (C) All sources are allowable under 42 CFR 433, Subpart B. (7) Before reimbursement, the Authority must receive the school medical provider’s corresponding non-federal share payment. (8) The Authority shall not be financially responsible for payment of any claim or service that the Centers for Medicare and Medicaid Services (CMS) disallows under Medicaid. If the Authority has previously paid the school medical provider any such claim, the school medical provider must reimburse the amount of the claim, less any amount previously paid for the non-federal share portion of that claim, to the Authority.