OAR 410-133-0245
Cost Determination and Payment
(1)
The Oregon Health Authority (Authority) will make rate determinations for the purposes of payment under OAR 410-133-0220 (Billing and Payment) based on annual cost determinations submitted by local education agencies (EA’s).(2)
Cost determinations will:(a)
Be based on the EA’s prior year’s annual audited costs;(b)
Establish an hourly and 15-minute increment rate for the current year billed;(c)
Use the current year Oregon Department of Education (ODE)-approved indirect rate for the EA;(3)
An EA shall not bill for more than its prior year’s annual audited cost incurred during the previous year. There will be no required annual cost settlement for each EA, although the Authority may conduct reviews or audits of cost reports.(4)
Data for cost determinations shall be submitted in a format prescribed by the Authority and in accordance with Oregon’s State Plan approved by the Centers for Medicare and Medicaid Services (CMS).(5)
Cost determinations shall be completed for each service discipline eligible for Medicaid billing. If an EA does not receive a confirmation from the Authority indicating costs have been received and accepted, the EA may not submit payment requests for those services. Costs for services include: Nursing, Occupational Therapy, Physical Therapy, Speech Language Pathology, Audiology, Psychological, Delegated Health Care, and Clinical Social Work. The Authority’s acceptance of the cost calculations submitted by the SBHS provider for rates per discipline based upon the School-Based Health Services’ (SBHS) provider’s previous year’s audited costs and, if applicable, the current years indirect rates does not imply or validate the accuracy of the data submitted.(6)
Transportation costs for Medicaid-eligible children will be reimbursed when the Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) for the Medicaid eligible child documents the need for necessary and appropriate transportation. Transportation cost reimbursement rates are based on the EA’s prior year’s audited costs for special education transportation and will be submitted in a format prescribed by the Department and in accordance to Oregon’s State Plan approved by the Centers for Medicare and Medicaid Services (CMS).(7)
Costs for telehealth technologies used to provide SBHS health related services are included in the cost for each service discipline and are not billed separately.
Source:
Rule 410-133-0245 — Cost Determination and Payment, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-133-0245.