(1)School-Based Health Services (SBHS) rules describe the Medicaid covered services available to Medicaid-eligible students receiving health services on a fee-for-service basis when “Necessary and Appropriate” and within the limitations established by the Medical Assistance Program and these rules, consistent with the requirements of the Individuals with Disabilities Education Act (IDEA). These rules are to be used in conjunction with the General Rules governing the Health Systems Division, Medical Assistance Programs (Division) (OAR 410 division 120) and the Oregon Health Plan (OHP) rules (OAR 410 division 141). The School-Based Health Services rules are also a user’s manual designed to assist the Educational Agency (EA) in matching state and federal funds for Oregon’s Medicaid-eligible students with disabilities.
(2)The Oregon Administrative Rules (OARs) in Chapter 581, division 15 for the Oregon Department of Education (ODE) outline Oregon’s program to meet the federal provisions of the IDEA. These SBHS rules define Oregon’s fee-for-service program to reimburse publicly funded education agencies for the health services provided under the IDEA to Oregon’s Medicaid-eligible children.
(3)The Department of Human Services (Department), The Oregon Health Authority (Authority), and ODE recognize the unique intent of health services provided for Medicaid-eligible students with disabilities in the special education setting. The School-Based Health Services rules address the health aspects of special education services that are covered by Medicaid or the Children’s Health Insurance Program (CHIP).
(4)The Authority endeavors to furnish School Medical (SM) providers with up-to-date billing, procedural information, and guidelines to keep pace with program changes and governmental requirements. The Authority does so by providing information on its website.
(5)Enrolled School-Based Health Services providers are responsible to maintain current publications provided by the Authority and the Division and to comply with the OARs in effect on the date of service the health service is provided.
(6)In order for the Authority to reimburse for health services provided in the school, the health services must be included as a covered service under the Oregon Health Plan (OHP). There is no benefit category in the Medicaid statute titled “school health services” or “early intervention services.” These rules do not create a new category of health benefits for this fee-for-service program.
(7)These rules describe health services that are covered services for Medicaid-eligible students, which are authorized and provided consistent with these rules.
(8)Medicaid-eligible students retain the ability to obtain services from any qualified Medicaid provider that undertakes to provide services to them. These rules do not require a Medicaid-eligible student to receive their health services solely from school medical providers.
Rule 410-133-0000 — Purpose,