OAR 410-133-0060
Health Services
(1)
A School-based Health Service is a health service for a Medicaid-eligible student that meets the coverage requirements in OAR 410-133-0080 (Coverage) and that:(a)
Addresses physical or mental disabilities and health-related service needs and devices that help the child or student keep, learn, or improve skills and functioning that adversely affects the child or student’s educational performance; and(b)
Is identified in a student’s Individualized Education Program (IEP) or the Individualized Family Service Plan (IFSP); and(c)
Is recommended by a physician or other licensed health care practitioner within the scope of practice under state law.(2)
School-based health services that meet the requirements of section (1) of this rule may include:(a)
Physical Therapy Evaluations and Treatments that include assessing, preventing, or alleviating movement dysfunction and related functional problems, obtaining and interpreting information, and coordinating care and integrating services relative to the student receiving treatments such as:(A)
Neuromotor or neurodevelopmental assessment;(B)
Assessing and treating problems related to musculo-skeletal status;(C)
Gait, balance, and coordination skills;(D)
Oral motor assessment;(E)
Adaptive equipment assessment;(F)
Gross and fine motor development;(G)
Observation of orthotic devices; and(H)
Prosthetic training.(b)
Occupational Therapy Evaluations and Treatments that include assessing, improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation; improving ability to perform tasks for independent functioning when functions are lost or impaired; preventing through early intervention initial or further impairment or loss of function; obtaining and interpreting information; coordinating care; and integrating services relative to the student receiving services such as:(A)
Neuromuscular and musculo-skeletal status (muscle strength and tone, reflex, joint range of motion, postural control, endurance);(B)
Gross and fine motor development;(C)
Feeding or oral motor function;(D)
Adaptive equipment assessment;(E)
Prosthetic or orthotic training;(F)
Neuromotor or neurodevelopmental assessment;(G)
Gait, balance, and coordination skills.(c)
Speech Evaluation and Therapy Treatments that include assessment of children with speech and language disorders, diagnosis and appraisal of specific speech or language disorders, referral for medical and other professional attention necessary for the rehabilitation of speech-language disorders, provision of speech-language services for the prevention of communicative disorders, obtaining and interpreting information, coordinating care and integrating services relative to the student receiving services such as:(A)
Expressive language;(B)
Receptive language;(C)
Auditory processing, discrimination, perception and memory;(D)
Vocal quality;(E)
Resonance patterns;(F)
Phonological;(G)
Pragmatic language;(H)
Rhythm or fluency; and(I)
Feeding and swallowing assessment.(d)
Audiological Evaluation and Services that include assessment of children with hearing loss; determination of the range, nature, and degree of hearing loss, including the referral for medical or other professional attention for restoration or rehabilitation due to hearing disorders; provision of rehabilitative activities such as language restoration or rehabilitation, auditory training, hearing evaluation and speech conversation; and determination of the child’s need for individual amplification; obtaining and interpreting information; coordinating care and integrating services relative to the student receiving services such as:(A)
Auditory acuity (including pure tone air and bone conduction), speech detection, and speech reception threshold;(B)
Auditory discrimination in quiet and noise;(C)
Impedance audiometry, including tympanometry and acoustic reflex;(D)
Central auditory function;(E)
Testing to determine the child’s need for individual amplification;(F)
Auditory training; and(G)
Training for the use of augmentative communication devices.(e)
Nurse Evaluation and Treatment Services that include assessments, treatment services, and supervision of delegated health care services provided to prevent disease, disability, other health conditions or their progression, prolong life, and promote physical and mental health and efficiency. This includes any medical or remedial services recommended by a physician or other licensed health care practitioner within the scope of practice under state law for maximum reduction of physical or mental disability and restoration of a recipient to his or her best possible functional level. The RN is responsible for periodic supervision for services provided to coordinating care and integrating nursing tasks and services that can be performed in the educational setting such as:(A)
Monitoring patient’s seizure activity for breathing patterns, onset/duration of seizure, triggers/auras, level of consciousness, support after seizure, administering medication as ordered;(B)
Monitoring and providing treatment for high and low blood sugar, checking urine keytones, blood glucose testing, carbohydrate calculations, assisting with insulin administration;(C)
Ventilator Care, suctioning, and equipment management;(D)
Tracheotomy care, changing dressings, emergency trach replacement, suctioning, changing “nose”, and providing humidification as necessary;(E)
Catheterization, assisting with or performing procedure for catheterization, monitor urinary tract infections, and performing skin integrity checks;(F)
Gastrostomy tube feeding, administering tube feedings per physician order, monitoring skin status around the tube, and emergency treatment for button dislodgement;(G)
Medication pumps, e.g., insulin pump, calculate carbohydrate amounts in food/snacks, provide insulin bolus per physician order, emergency disconnect procedure and monitoring blood sugar; and(H)
Medication management, e.g., monitoring signs and symptoms for medication administration, administering medications, observing for side effects.(f)
Mental Health Evaluation and Treatment Services that include assessment and treatment services provided by or under the supervision and direction of a psychiatrist, psychologist, a mental health nurse practitioner, or by a social worker qualified and licensed to deliver the service and who may provide care coordination and integration for services relative to the student for outpatient mental health services received in the educational setting to prevent disease, disability, other health conditions or their progression, to prolong life and promote physical and mental health and efficiency. This includes any medical or remedial services recommended by a physician or other licensed health care practitioner within the scope of practice under state law for maximum reduction of physical or mental disability and restoration of a recipient to his or her best possible functional level, such as:(A)
Mental health assessment;(B)
Psychological testing (non-educational cognitive and adaptive testing);(C)
Assessment of motor language, social, adaptive, and cognitive functioning by standardized developmental instruments;(D)
Behavioral health counseling and therapy; and(E)
Psychotherapy (group/individual).(3)
Services for physical, occupational, and speech therapy, hearing, nursing, and mental health services must be recommended as set out and provided by medically-qualified individuals as defined in OAR 410-133-0120 (Medically Qualified Staff).(4)
Medicaid covered services and treatments are considered as a covered service in accordance with Oregon’s Medicaid program’s Prioritized List of Health Services to recipients receiving services pursuant to an IEP/IFSP eligible under Individuals with Disabilities Education Act in the educational setting. The above-listed therapy services and treatments are examples of services that may be provided to eligible recipients in an educational setting under the Oregon Medicaid program. The current Prioritized List of services can be found on the Health Evidence Review Commission’s (HERC) web site.
Source:
Rule 410-133-0060 — Health Services, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-133-0060.