OAR 411-346-0250: Child Foster Provider Eligibility for Medicaid Service Payment

(1) A foster provider must have an approved prior authorization for services in the Department’s electronic payment and reporting system prior to entering a claim for a day of service. The prior authorization includes the dates of authorized services and the funding amount allocated for the services. (2) A foster provider may only enter a claim for a day of service when: (a) A child sleeps in the child foster home overnight; or (b) A child does not sleep in the child foster home overnight, but intends to return to the child foster home, and the foster provider was responsible for and provided an accumulated period of eight hours for the primary care, support, safety, and well-being of the child, including any of the following: (A) Providing intermittent physical support or care. (B) Providing stand-by support with the ability to respond in person within the response times agreed upon by the ISP team. (C) Being responsible to communicate reciprocally within the response times agreed upon by the ISP team based on a child’s identified support need and as documented in the child’s most current ISP. (3) A foster provider is not eligible to enter a claim for a day of service when a child: (a) Has been admitted to an acute care hospital unless the child’s ISP authorizes attendant care for the child in an acute care hospital and the day of service criteria in section (2)(b) of this rule is met. An ISP may only authorize attendant care for a child who has been admitted to an acute care hospital when the support is not a duplication of service that the hospital provides and the child has one of the following: (A) Challenging behavior that interferes with getting medical care. The challenging behavior must require specific training or experience to support and must be able to be mitigated by the foster provider to an extent that medical care is improved. (B) An inability to independently communicate with hospital staff that interferes with getting medical care. This must not be solely due to limited or emerging English proficiency. (C) Support with one or more activities of daily living that may only be adequately met by someone familiar with the child. (b) Has been admitted to a nursing facility. (c) Has been admitted to a mental health facility. (d) Is held in detention or jail. (4) PROGRESS NOTES. A foster provider must maintain and keep current progress notes regarding the delivery of foster care services. Progress notes must demonstrate the supports provided to a child are consistent with, and within the scope of, the supports authorized in the child’s ISP. (a) At a minimum, progress notes must include all of the following: (A) Child’s name. (B) Dates the supports were provided. (C) Description of the supports provided. (b) Progress notes must support each claim a foster provider submits in the Department’s electronic payment and reporting system.