OAR 410-138-0390: Targeted Case Management Retroactive Payments

(1) Providers may submit claims retroactively for services provided to the targeted populations described in OAR 410-138-0020(2) if the claims meet the following criteria: (a) Services were provided less than 12 months prior to the date of first claim submission and were provided on or after the date indicated in the rule listed above and were allowable services in accordance with OAR 410-138-0007; (b) The maximum number of units billed does not exceed the maximum allowed under each TCM program. (c) The case manager was appropriately licensed or certified and met all current requirements for case managers at the time the service was provided, as described in the provider requirements rule OAR 410-138-0060 appropriate for the TCM program; (d) Documentation regarding provider qualifications and the services that the provider retroactively claims shall have been available at the time the services were performed. (2) The Division may not allow duplicate payments to be made to the same or different providers for the same service for the same client, nor will payment be allowed for services for which third parties are liable to pay (see also OAR 410-138-0005). (3) Reimbursement is subject to all rules and laws pertaining to federal financial participation.