OAR 410-172-0630
Medically Appropriate

(1)

In addition to the definition of medically appropriate in OAR 410-120-0000 (Acronyms and Definitions) for behavioral health services, “medically appropriate” means the services and supports required to diagnose, stabilize, care for, and treat a behavioral health condition.

(2)

The Division shall make payment for medically appropriate behavioral health services when the services or supports are:

(a)

Rendered by a provider whose training, credentials, or license is appropriate to treat the identified condition and deliver the service;

(b)

Based on the standards of evidence-based practice, and the services provided are appropriate and consistent with the diagnosis identified in the behavioral health assessment;

(c)

Provided in accordance with an individualized service plan and appropriate to achieve the specific and measurable goals identified in the service plan;

(d)

Not provided solely for the convenience of the recipient, the recipient’s family, or the provider of the services or supplies;

(e)

Not provided solely for recreational purposes;

(f)

Not provided solely for research and data collection;

(g)

Not provided solely for the purpose of fulfilling a legal requirement placed on the recipient.

Source: Rule 410-172-0630 — Medically Appropriate, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-172-0630.

410‑172‑0600
Acronyms and Definitions 410‑172‑0610
Provider Enrollment 410‑172‑0620
Documentation Standards 410‑172‑0630
Medically Appropriate 410‑172‑0640
Behavioral Health Services Fee Schedule 410‑172‑0650
Prior Authorization 410‑172‑0660
Rehabilitative Behavioral Health Services 410‑172‑0670
Substance Use Disorder Treatment Services 410‑172‑0680
Residential Treatment Services for Children 410‑172‑0690
Admission Procedure for Residential Treatment Services for Children 410‑172‑0695
Intensive In-Home Behavioral Health Treatment Services for Youth (IIHBT) 410‑172‑0705
Residential Rate Standardization 410‑172‑0710
Residential Personal Care 410‑172‑0720
Prior Authorization and Re-Authorization for Residential Treatment 410‑172‑0730
Payment Limitations for Behavioral Health Services 410‑172‑0745
Exception Criteria for Facial Gender Confirmation Surgery (FGCS) 410‑172‑0760
Applied Behavior Analysis 410‑172‑0770
Individual Eligibility for Applied Behavioral Analysis Treatment 410‑172‑0780
Behavioral Health Personal Care Attendant Program 410‑172‑0790
Eligibility for Behavioral Health Personal Care Attendant Services 410‑172‑0800
Personal Care Attendant Employer-Employee Relationship 410‑172‑0810
Personal Care Attendant Qualifications 410‑172‑0820
Provider Termination 410‑172‑0830
Personal Care Attendant Service Assessment, Authorization, and Monitoring 410‑172‑0840
Personal Care Attendant Payment Limitations 410‑172‑0850
Telemedicine for Behavioral Health 410‑172‑0860
Billing for Dual Eligible Individuals
Last Updated

Jun. 8, 2021

Rule 410-172-0630’s source at or​.us