OAR 410-172-0730
Payment Limitations for Behavioral Health Services

(1) Services shall be subject to periodic utilization review to determine medical appropriateness.
(2) If a review reveals that a recipient received less than active treatment, payment may not be allowed under these rules and prior authorization may be cancelled.
(3) The Division may make no payment for services if the Division or designee has determined the service is not medically appropriate.
(4) Residential treatment services are provided to Medicaid Title XIX eligible individuals in facilities with 16 or fewer beds. Payment is excluded for individuals in “institutions of mental diseases” (IMD) who are over age 18 and under age 65. IMDs are defined in 42 CFR 435.1010.
(5) For residential facilities, the Division shall pay for the day of admission but may not pay for the day of transfer or discharge.
(6) Medicaid may not reimburse costs associated with room and board for recipients residing in Authority licensed residential treatment programs.

Source: Rule 410-172-0730 — Payment Limitations for Behavioral Health Services, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-172-0730.

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 410-172-0730’s source at or​.us