OAR 413-095-0040: Prior Authorization for the BRS Program; Appeal Rights

(1) BRS program eligibility. (a) The Department may provide prior authorization for the BRS program for a child who: (A) Meets the requirements in OAR 410-170-0040(2)(a)(A) to (C); and (B) Is in the care or custody of the Department or one of the federally recognized Oregon tribes. (b) Notwithstanding subsection (1)(a) of this rule, the Department may provide prior authorization for the BRS program for a child who: (A) Meets the requirements in OAR 410-170-0040(2)(a)(B) through (E); (B) Is eligible for state-funded medical assistance under Title XIX and General Assistance Medical Eligibility, OAR 413-100-0400 through 413-100-0530; and (C) Is in the care or custody of the Department or one of the federally recognized Oregon tribes. (2) Appeal rights. (a) When a child is in the care or custody of the Department or a federally recognized Oregon tribe and is denied prior authorization for the BRS program under subsection (1)(a) of this rule, the child is entitled to notice and contested case hearing rights under OAR 410-120-1860 to 410-120-1865. The contested case hearing will be provided by the Authority (see OAR 410-120-1860(1)) and conducted by the Office of Administrative Hearings (see ORS 183.635). (b) When a child in the care or custody of the Department and enrolled in the Oregon Health Plan is denied prior authorization for the BRS program under subsection (1)(b) of this rule, the child is entitled to notice and contested case hearing rights under OAR 413-010-0500 to 413-010-0535. The contested case hearing will be provided by the Department and conducted by the Office of Administrative Hearings (see ORS 183.635). (3) Qualified Residential Treatment Program eligibility. (a) A BRS client or child must have a QRTP assessment, conducted in compliance with OAR 413-070-1090, recommending placement in a QRTP. The assessment must be completed prior to or within 30 days of the child’s or BRS client’s placement in a QRTP (b) When a BRS client or child does not receive a recommendation by the Qualified Individual for a QRTP placement, the BRS client or child must transition out of the BRS contractor’s program within 30 days if placed prior to the completion of the QRTP Assessment.