OAR 410-155-0010: Eligibility Criteria and Service Requirements

The purpose of this rule is to establish the processes, standards, and obligations required to be followed or met in administering and delivering Reentry FCAA Services, identified below. (1) Reentry FCAA Services must be provided to FCAA-Covered Youth in accordance with Section 5121 of the Federal Consolidated Appropriations Act of 2023 (CAA, 2023) (P.L. 117-328). (2) The Authority shall monitor Correctional Facility delivery of Reentry FCAA Services in the Pre-Release Period. (3) The Oregon Health Plan (OHP) shall cover Reentry FCAA Services provided in the Post-Release Period. (4) The Authority or the Managed Care Entity (MCE) must document when they receive notice (from sources such as ODHS, the Authority, Correctional Facilities, OHP application assisters) of an FCAA-Covered Youth’s release from a Correctional Facility. (5) OHA payment to MCEs for FCAA Reentry Services as defined in OAR 410-155-0000(5) and in the CCO Reentry Guidance Document is included in the Global Budget. (6) The Authority or the MCE shall provide the following Reentry FCAA Services in the Post-Release Period: (a) Screening and Diagnostic Services shall be provided within one (1) week, or as soon as practicable, after the FCAA-Covered Youth’s release from a Correctional Facility by a Medicaid-enrolled physician (MD or DO), nurse practitioner, licensed physician assistant, or other licensed health professional. (A) Services must meet Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) standards as defined in OAR 410-151-0004, 410-151-0040 for screening exams and OAR 410-151-0004(1) for diagnostic services. (B) Screening Services, in accordance with requirements in Section 1905(r)(1)-(4) of the Social Security Act (42 U.S.C §§ 301-1307), must include, at a minimum: comprehensive health and developmental history, including assessment of both physical and mental health development, comprehensive unclothed physical examinations, appropriate vision and hearing test, appropriate laboratory tests, and dental screening services. (C) Diagnostic services, in accordance with section 1905(r)(5) of the SSA, must include diagnosis of defects in vision and hearing, dental care, and appropriate immunizations. (D) For FCAA-Covered Youth enrolled in the Children’s Health Insurance Program (CHIP), benefit must include similar screening and diagnostic services, but only to the extent such services would normally be covered for a non-incarcerated youth. (E) For FCAA-Covered Youth 21 years of age and older, services must be provided based on reasonable standards of medical and dental practice. (F) If efforts to deliver screening or diagnostic services are unsuccessful, or if the FCAA-Covered Youth declines to receive these services, the MCE or as applicable, the Authority must document: (i) That the MCE or as applicable, the Authority made at least two (2) attempts to conduct outreach to the FCAA-Covered Youth, including identifying the specific attempts and barriers to outreach; and (ii) The FCAA-Covered Youth’s reasons for rejecting screening and diagnostic services to the maximum extent feasible. (G) The MCE or as applicable, the Authority must conduct outreach to the FCAA-Covered Youth to facilitate the delivery of screening and diagnostic services within the timeframe stated above in 6(a). (H) The MCE or as applicable, the Authority is responsible for documenting, and maintaining such documentation, that FCAA-Covered Youth have been provided with screening and diagnostic services. (b) Reentry Targeted Case Management (TCM) as defined in OAR 410-138-0000 shall be provided within the Post-Release Period by a Medicaid-enrolled Post-Release Case Manager as defined in OAR 410-155-0000. (c) Reentry TCM must include the following activities: (A) Completion of the Reentry Health Risk Assessment (Reentry HRA) that includes: (i) The Post-Release Case Manager must complete the Reentry HRA with the FCAA-Covered Youth within thirty (30) days of the FCAA-Covered Youth’s release from a Correctional Facility; and (ii) The Reentry HRA shall be developed with and agreed upon by the FCAA-Covered Youth, the FCAA-Covered Youth’s guardian, or both, as applicable, and documented in the FCAA-Covered Youth’s health records. (iii) The Reentry HRA must include all of the following elements: (I) Taking FCAA-Covered Youth’s history and gathering available information from other sources such as family members, medical providers, social workers, Correctional Facility where the FCAA-Covered Youth was incarcerated, including from any assessments completed by the Correctional Facility, and educators (if necessary), to form a complete assessment of the FCAA-Covered Youth; and (II) Screening for medical, mental, substance use, housing and other health-related social needs (HRSN), functional needs, and strengths and support needs. (iv) The Post-Release Case Manager is responsible for all Reentry HRA documentation, including documentation of: (I) At least one face-to-face or telehealth encounter/assessment with the FCAA-Covered Youth by the Post-Release Case Manager. This encounter must include either direct screening and/or assessments in accordance with subsection (a) above, or review with the FCAA-Covered Youth of any prior assessments through prior medical record review and other documentation review with identification of new or resolved needs or the documentation of no new additional needs. This could occur over multiple visits/encounters, as needed. (II) Reentry goals and objectives based on the Reentry HRA. This can be included as part of the same documentation of the Reentry HRA or can be a separate document. This must be developed with and informed by the FCAA-Covered Youth. (v) If efforts to have a meeting are unsuccessful, or if the FCAA-Covered Youth declines to participate in the development of the Reentry HRA but the FCAA-Covered Youth is eligible to receive Reentry FCAA Services and wishes to accept these services, they are still entitled to receive the Reentry FCAA Services as medically appropriate. In all such circumstances, the MCE or as applicable, the Authority must document: (I) That the Post-Release Case Manager made efforts to have one or more meetings with the FCAA-Covered Youth, including identifying the specific attempts and barriers to having the meetings; and (II) The FCAA-Covered Youth’s reasons for not participating in the Reentry HRA to the maximum extent feasible. (B) Completion of the Reentry Care Plan (RCP) (i) The Post-Release Case Manager must complete the Reentry Care Plan with the FCAA-Covered Youth within thirty (30) days of the FCAA-Covered Youth’s release from a Correctional Facility. (ii) The Reentry Care Plan must be developed with and agreed upon by the FCAA-Covered Youth, the FCAA-Covered Youth’s guardian, or both, as applicable, and documented in the FCAA-Covered Youth’s health records. (iii) Post-Release Case Managers must ensure the Reentry Care Plan includes all elements required in OAR 410-141-3870, with the additional elements listed below in (I)-(III), based on information collected through the HRA: (I) Specifies the goals and actions needed to address the medical, mental, substance use, housing and other HRSN, functional needs, and strengths and support needs of the FCAA-Covered Youth such as developing safe decision-making skills or building relationships. (II) Includes referral and related activities such as scheduling appointments for the FCAA-Covered Youth, and working with the FCAA-Covered Youth’s (or the FCAA-Covered Youth’s authorized health care decision maker) and others to develop those goals. (III) Identifies a course of action to respond to the goals and proposed actions of the FCAA-Covered Youth. (iv) If efforts to have a meeting are unsuccessful, or if the FCAA-Covered Youth declines to participate in the development of the Reentry Care Plan, but the FCAA-Covered Youth wishes to accept Reentry FCAA Services, they are still entitled to receive the Reentry FCAA Services in the Post-Release Period as medically appropriate. In all such circumstances, the MCE or as applicable, the Authority must document: (I) That the Post-Release Case Manager made efforts to have one or more meetings with the FCAA-Covered Youth, including identifying the specific attempts and barriers to having the meetings; (II) The FCAA-Covered Youth’s reasons for not participating in the Reentry Care Plan to the maximum extent feasible. (C) The MCE or as applicable, the Authority is responsible for documenting, and maintaining such documentation, that FCAA-Covered Youth have been provided with Reentry TCM services. (D) Completion of the Reentry Warm Handoff within thirty (30) days of a FCAA-Covered Youth’s release from a Correctional Facility if the FCAA-Covered Youth received Reentry TCM in the pre-release period and was assigned a Pre-Release Case Manager. To complete a Reentry Warm Handoff with the Pre-Release Case Manager, the Post-Release Case Manager must: (i) Reach out to Correctional Facility and request relevant health information; and (ii) Conduct the Reentry Warm Handoff meeting, either in-person or via telehealth, with the FCAA-Covered Youth and the Pre-Release Case Manager, unless the FCAA-Covered Youth refuses to participate. (iii) During the Reentry Warm Handoff, the Pre-Release Case Manager and/or the Correctional Facility must share correctional health records and any other information related to the FCAA-Covered Youth’s care, with the Post-Release Case Manager as appropriate and necessary for the care of the FCAA-Covered Youth.