OAR 410-172-0630: Medically Appropriate

(1) In addition to the definition of medically appropriate in OAR 410-120-0000 for behavioral health services, “medically appropriate” means the services and supports required to diagnose, stabilize, care for, and treat a behavioral health condition. (2) The Division shall make payment for medically appropriate behavioral health services when the services or supports are: (a) Rendered by a provider whose training, credentials, or license is appropriate to treat the identified condition and deliver the service; (b) Based on the standards of evidence-based practice, and the services provided are appropriate and consistent with the diagnosis identified in the behavioral health assessment; (c) Provided in accordance with an individualized service plan and appropriate to achieve the specific and measurable goals identified in the service plan; (d) Not provided solely for the convenience of the recipient, the recipient’s family, or the provider of the services or supplies; (e) Not provided solely for recreational purposes; (f) Not provided solely for research and data collection; (g) Not provided solely for the purpose of fulfilling a legal requirement placed on the recipient.