OAR 410-146-0000
Foreword

(1) The Health Systems Division (Division) American Indian/Alaska Native (AI/AN) Oregon Administrative Rules are designed to assist the following providers to prepare claims for services provided to clients with Medical Assistance Program coverage:

(a) Indian Health Service (IHS) facilities; and

(b) Tribal 638 facilities, defined as Tribally-operated health care clinics owned or operated by a Tribe or Tribal organization with funding authorized by Title I or Title V of the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended), and recognized by the Centers for Medicare and Medicaid Services (CMS) under the 1996 Memorandum of Agreement (MOA);

(2) Indian Health Care Providers (IHCP) not designated an IHS or Tribal 638 facility should refer to Oregon Health Plan (OHP) General Rules (OAR 410 division 120) and other applicable program-specific rules to enroll and operate as any other provider type recognized under the state plan.

(3) CMS does not recognize Urban Indian Health Program (UIHP) clinics as eligible for reimbursement of services under the MOA. UIHP Clinics should refer to:

(a) Federally Qualified Health Centers (FQHC) and Rural Health Clinics administrative Rules (OAR 410 division 147) to enroll as a FQHC if the clinic is an urban Indian organization under the Indian Health Care Improvement Act, Public Law 94-437; or

(b) OHP General Rules (OAR 410 division 120) and other applicable program-specific rules to enroll and operate as any other provider type recognized under the state plan.

(4) The AI/AN administrative rules include important information about general program policy, provider enrollment, maintenance of financial records, special programs, and billing. Unless specifically directed by the AI/AN rules, do not use other Division administrative rules to determine appropriate action.

(5) OHP-enrolled IHCP must use the OHP General Rules (OAR 410 division 120) and the OHP Administrative Rules (OAR 410 Division 141) as directed in the AI/AN rules and in conjunction with applicable program-specific rules including the AI/AN administrative rules.

(6) The Health Evidence Review Commission’s Prioritized List of Health Services defines the Division’s Medicaid-covered services. For more information, refer to the OHP Administrative Rules (OAR 410-141-0520).

Source: Rule 410-146-0000 — Foreword, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-146-0000.

410‑146‑0000
Foreword 410‑146‑0020
Memorandum of Agreement Reimbursement Methodology 410‑146‑0021
American Indian/Alaska Native (AI/AN) Provider Enrollment 410‑146‑0040
ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes 410‑146‑0060
Prior Authorization 410‑146‑0075
Client Copayments 410‑146‑0080
Professional Ambulatory Services 410‑146‑0085
Encounter and Recognized Practitioners 410‑146‑0086
Multiple Encounters 410‑146‑0100
Vaccines for Children 410‑146‑0120
Maternity Case Management Services 410‑146‑0130
Modifiers 410‑146‑0160
Administrative Medical Examinations and Reports 410‑146‑0200
Pharmacy 410‑146‑0220
Death With Dignity 410‑146‑0240
Transportation 410‑146‑0440
Prepaid Health Plan Supplemental Payments 410‑146‑0460
Compensation for Outstationed Eligibility Workers

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OAR 410-146-0000 Foreword

OAR 410-146-0000
Foreword