OAR 410-173-0045: Service Reimbursement Documentation Standards

(1) All Providers rendering 1915(i) HCBS are required to maintain records that fully support the extent of services (i.e. scope, amount, and duration) for which payment is requested and provide the records to either or both the Division and IQA upon request. (2) All records shall comply with documentation standards set out in OAR 410-120-1360 and 410-172-0620. For the purpose of clarity, all documentation of services provided must include all of the following: (a) The name of the Individual receiving 1915(i) HCBS; (b) The Medicaid Identification Number of the Individual receiving 1915(i) HCBS; (c) The name of the provider rendering1915(i) HCBS; (d) Type of service and supports provided, which must be identified and described in the PCSP and all of the following relating to the type of service provided; (e) Date of service; (f) Start time of each service; and (g) End time of each service. (3) All providers shall also document how the services and supports relate to identified goals and objectives outlined in the PCSP. (4) Providers shall document how the services and supports addressing the following HCBS qualities: (a) Employment and volunteer opportunities; (b) Individual choice of community activities and community access; (c) Access to and control of personal resources; and (d) Strategies identified in the PCSP to ensure the health and safety of the individual or others. (5) All Medicaid 1915(i) HCBS provided in a person’s own, or family home must be documented or otherwise verified using an Electronic Visit Verification (EVV) system, as required under Section 1903 of the Social Security Act. EVV systems shall electronically verify the following information at the time the service is occurring: (a) Type of service performed; (b) Individual receiving the service; (c) Date and location of the service; (d) Individual providing the service; and (e) Time the service begins and ends. (6) The information that all providers must include in their records, including the individual’s records, shall be appropriate in quality and quantity to meet the professional standards applicable to the provider and any additional, applicable standards for documentation that are identified in OAR Chapters 410 and 309, the Medicaid provider enrollment agreement submitted to OHA, and any other applicable contracts.