(1)Compliance with documentation standards in this rule and completion of mandatory Department forms is intended to ensure communication between case managers and home and community-based care providers.
(2)The documentation requirements in this rule do not replace or substitute for the documentation requirements in the:
(a)Medicaid Provider Rules governing provider requirements as described in OAR chapter 407, division 120, Provider Rules, MMIS Provider Enrollment and Claiming; Contractor Audits, Appeals and Post Payment Recoveries;
(b)Medicaid General Rules under OAR chapter 410, division 120 as applicable; and
(c)Licensing or Medicaid Program rules governing the home and community-based care provider, as applicable.
(3)Behavior consultants are expected to complete mandatory Department forms for support services provided under 411-046-0140 (Behavior Support Services).
(4)Use of alternative, but equivalent forms, may be approved by the Department using the exceptions process under 411-046-0220 (Exceptions to Rules) or as defined in supplemental or specific needs setting contracts or individuals who receive Behavior Support Services as part of their monthly service rate.
(5)Mandatory forms must be sent to the case manager before or at the time of submission of invoices or before receipt of the monthly Medicaid service rate.
(a)Documentation must support the services billed and adhere to the timeframes noted in this rule and on the mandatory forms.
(b)Claims will not be paid until the mandatory forms are submitted to the individual’s case manager and the documentation noted in 411-046-0170 (Documentation)(2) is completed.
(6)Behavior Support Service providers are expected to maintain a written record of all services provided to, and for, an individual and an individual’s caregiver.
(a)The record must include copies of all documentation provided to the:
(B)Home and community-based care contractor; and
(C)Behavior consultant or provider maintained to meet 411-046-0170 (Documentation)(2)(a)–(c).
(b)The record must be retained until the behavior consultant no longer provides services to the individual, at which time, the behavior consultant or the agency must provide a copy of any part of the record that was not previously provided to the case manager.
(c)The behavior consultant or agency must retain the original record, following HIPAA practices, for a period of seven years.
(d)All documentation must be provided in HIPAA secure format.
Rule 411-046-0170 — Documentation,