OAR 413-095-0060
Billing and Payment for Services and Placement-Related Activities
(1)
Billable care day:(a)
The BRS contractor is compensated for billable care day services and placement-related activities rates on a fee-for-service basis in accordance with OAR 410-170-0110 (Billing and Payment for Services and Placement-Related Activities).(b)
The BRS contractor may include overnight home visits and transitional visits by the BRS client to a hosting placement in its billable care days. The BRS contractor must:(A)
Receive prior approval for the home visit or transitional visit to a hosting placement from the Department;(B)
Ensure that the home visit or transitional visit is in support of the goals related to transition in the BRS client’s most current service plan; and(C)
Not exceed eight calendar days of any combination of home visits or transitional visits in a month as billable care days. Transitional visits have the same restrictions and requirements as home visits as indicated in OAR 410-170-0110 (Billing and Payment for Services and Placement-Related Activities).(c)
The Department will reimburse the sending placement or BRS provider at the BRS rate for the BRS type of care listed in the contract. Hosting placement will be reimbursed at the absent rate for the BRS level of care in the contract or the equivalent foster care rate.(2)
Absent day:(a)
The BRS contractor is compensated for an absent day at the absent day rate in order to hold a BRS program placement for a BRS client with the prior approval of the BRS client’s caseworker and with authorization from the contract administrator.(b)
The BRS contractor is compensated at an absent day rate when the BRS contractor is a hosting placement for a transitional visit, unless the hosting placement is a foster home.(c)
Notwithstanding OAR 410-170-0110 (Billing and Payment for Services and Placement-Related Activities)(4), the BRS contractor may request prior approval from the BRS client’s caseworker and contract administrator to be reimbursed for more than eight but no more than 14 calendar days of home visits and transitional visits in a month for a BRS client. However, any additional days of home visits approved under this rule will be paid at the absent day rate.(d)
To claim reimbursement for an absent day, the BRS contractor is required to submit the DHS absent day authorization form to the contract administrator within 30 days from the dates for which the BRS contractor is requesting absent day payment.(3)
The BRS contractor may only be reimbursed for the BRS type of care authorized in the contract with the Department.(4)
Invoice form:(a)
The BRS contractor must submit to the Department a monthly invoice in a format acceptable to the Department, on or after the first day of the month following the month in which services and placement-related activities were provided to the BRS client. The monthly invoice must specify the number of billable care days and absent days for each BRS client in that month.(b)
The BRS contractor must provide upon request, in a format approved by the Department, written documentation of each BRS client’s location for each day claimed as a billable care day and an absent day.
Source:
Rule 413-095-0060 — Billing and Payment for Services and Placement-Related Activities, https://secure.sos.state.or.us/oard/view.action?ruleNumber=413-095-0060.