OAR 410-146-0460: Compensation for Outstationed Eligibility Workers

(1) The Division may provide reasonable compensation for activities directly related to the receipt and initial processing of applications for individuals to apply for Medicaid at outstationed locations other than state offices. (2) The Division may provide reasonable compensation to eligible IHCPs for outreach activities performed by Outstationed Outreach Workers (OSOW) equal to 100 percent of direct costs. (3) IHCPs must submit a budget each December 1 to the Division for review of the clinic OSOW costs for approval before any OSOW compensation is made each January 1. (4) IHCPs must be compliant with OAR 410-120-0045 Applications for Medical Assistance at provider locations to be eligible for compensation under this rule. (5) For staff employed by a clinic and performing outreach activities at less than full time, the clinic must calculate the percent of time spent performing OSOW services and maintain adequate documentation to support the percentage of time claimed. The percent must be used to calculate personnel expenses incurred by an IHCP as outlined in section (7) of this rule and that are directly attributed to outreach activities performed by the employee. (6) Case management is excluded from OSOW reimbursement. If an OSOW also does case management, calculate the OSOW expense as outlined in section (5) above. (7) Direct cost expenses allowed for OSOW reimbursement: (a) Personnel costs for OSOWs: (A) Salary/wages; (B) Taxes; (C) Fringe benefits provided to OSOW; (D) Premiums paid by the IHCP for private health insurance. (b) Travel expenses incurred by the IHCP for the Division training on OSOW activities; (c) Phone bills, if a dedicated line. Otherwise an estimate of telephone usage and resulting costs; (d) Reasonable equipment necessary to perform outreach activities. A Tribal 638 provider reimbursed according to a cost-based rate may not include expenses for replacing equipment if the original cost of the equipment was reported on the cost statement when the clinic's initial cost-based encounter rate was calculated; (e) Rent or space costs. A Tribal 638 provider reimbursed according to a cost-based rate may not include rent or space costs if 100 percent of facility costs were reported on the cost statement when the clinic's initial cost-based encounter rate was calculated; (f) Reasonable office supplies necessary to perform outreach activities; and (g) Postage. (8) The Division excludes indirect costs relating to OSOW activities to Tribal 638 providers reimbursed according to a cost-based rate. Excluded indirect costs include and are not limited to the following: (a) Any costs included in the initial calculation of a Tribal 638 clinic's cost-based encounter rate; (b) Contracted interpretation services; (c) Administrative overhead costs; and (d) Operating expenses including utilities, building maintenance and repair, and janitorial services. (9) IHS and Tribal 638 facilities that have a Medicaid Administrative Match contract that includes outreach costs are not eligible for separate outreach payments. IHS and Tribal 638 facilities may not participate in the Medicaid Administrative Claiming (MAC) program if they are receiving OSOW compensation according to this rule.