OAR 410-147-0400: Compensation for Outstationed Outreach Activities

(1) This rule provides reasonable compensation for activities directly related to the receipt and initial processing of applications for individuals, including low-income pregnant women and children, to apply for Medicaid at outstation locations other than state offices. (2) A federally qualified health center (FQHC) eligible in accordance with OAR 410-120-0045, will be eligible for compensation under this rule. (3) ‘‘Initial processing’’ includes the following activities: (a) Taking applications; (b) Assisting applicants in completing the application; (c) Providing information as outlined in OAR 410-120-0045; (d) Obtaining required documentation to complete processing of the application; (e) Ensuring that the information contained on the application form is complete; and (f) Conducting any necessary interviews. (4) “Initial processing” does not include evaluating the information contained on the application and the supporting documentation or making a determination of eligibility or ineligibility. (5) At locations that are infrequently used by the designated low-income eligibility groups, the Division may use the following resources: (a) Volunteers, provider or contractor employees; or (b) Its own eligibility staff, or (c) Telephone assistance by: (A) The FQHC as outlined in section (12); or (B) Prominently displaying a notice that includes the telephone number for the state OHP Application Center or the local branch office that applicants may call for assistance. (6) Eligible FQHCs may be able to receive reasonable compensation for outreach activities performed by Outstationed Outreach Workers (OSOW) that is equal to 100% of direct costs. (7) Allowable direct cost expenses for OSOW reimbursement include: (a) Travel expenses incurred by the FQHC for Division training on OSOW activities; (b) Phone bills, if a dedicated line is used. Otherwise an estimate of telephone usage and resulting costs; (c) OSOW personnel costs: (A) Wages shall be the lesser of: (i) Wages reported by the FQHC; or (ii) Wages paid by the State of Oregon to an employee of the state providing enrollment assistance to individuals applying for OHP; (iii) Wage reimbursement may not exceed the highest salary issued by the State of Oregon to a Human Services Specialist 2; (B) Taxes; (C) Fringe benefits provided to OSOW; (D) Premiums paid by the FQHC for private health insurance. (d) Reasonable costs for equipment necessary to perform outreach activities, which does include expenses for replacing equipment if the original equipment cost was reported on the cost statement when the clinic’s initial PPS encounter rate was calculated; (e) Rent or space costs only if 100% of facility costs were not reported on the cost statement when the clinic’s initial PPS encounter rate was calculated; (f) Reasonable office supplies necessary to perform outreach activities; and (g) Postage. (8) The Division may not include indirect costs in the OSOW reimbursement rate. Indirect costs include but are not limited to the following: (a) Any costs included in the initial calculation of a clinic’s PPS encounter rate; (b) Contracted interpretation services; (c) Administrative overhead costs; (d) Supervision costs; and (e) Operating expenses including utilities, building maintenance and repair, and janitorial services. (9) Clinics must submit to the Division a cost statement for the preceding calendar year between October 1, and October 31, of each year for Division review and approval of the clinic’s OSOW direct costs. (10) If a clinic fails to submit the OSOW cost statement by October 31 of the required year, the clinic may not be eligible for reimbursement of OSOW costs as of January 1 for the following year. (11) Any change to the OSOW rate, based on the October cost statement submission, shall be effective January 1 of the following year; The Division shall make payment to the clinic for the reviewed and accepted OSOW costs in four equal installments at the beginning of each calendar quarter; January 1, April 1, July 1, and October 1. (12) Clinic locations with limited operating hours, or that limit access to the general public during their regular operating hours must calculate the actual time an OSOW meets face-to-face with the general public for receipt and the initial processing of applications. For example, if a clinic employs an OSOW at a satellite school-based health center (SBHC), and the SBHC can only be accessed by the general public outside of the school’s normal hours of operation, use the percent of time an OSOW is available to meet face-to-face with potential applicants when reporting compensation as outlined in section (11)(c) of this rule. (a) Clinics must display a notice in a prominent place that advises potential applicants when an OSOW will be available; (b) The notice must include a telephone number that applicants may call for assistance. (13) For staff employed by a clinic and performing outreach activities at less than full time, the clinic must calculate the percentage of time spent performing OSOW activities and maintain adequate documentation to support the time claimed. The percentage must be used to calculate personnel expenses incurred by an FQHC that are directly attributed to outreach activities performed by the employee. Outreach activities: (a) May include assisting individuals with completing applications for other Department of Human Services (Department) and Authority-administered programs where eligibility is determined by staff at local branch offices; (b) Does not include assisting individuals with applying for non-Department and non-Authority-administered programs. (14) A clinic shall not claim reimbursement for costs associated with personnel positions where 100% of costs were included in the FQHC’s PPS encounter rate calculation. (15) A Public Health Department designated as an FQHC or a School Based Health Center (SBHC) within the scope of an FQHC designation cannot participate in the Medicaid Administrative Claiming (MAC) program.