1. (1) In order to receive public funds, an Agency with Choice must be licensed as an Agency with Choice and must be enrolled with the Authority as a Medicaid provider.
2. (2) An Agency with Choice must meet all requirements in OAR 410-120-1260 (Provider Enrollment), OAR 943-120-0310 (Provider Requirements), and OAR 943-120-0320 (Provider Enrollment) for the Authority.

3. (3) To receive payment for services, the Agency with Choice must utilize a Authority-approved Electronic Visit Verification system (EVV), as specified in OAR 410-172-0776, to verify the following details at the time of service for visits:

   1. (a) Date of service;
   2. (b) Start and end time;
   3. (c) Type of service;
   4. (d) Location of service;
   5. (e) The name of the direct support worker providing the service; and
   6. (f) The name of individual receiving services.
4. (4) Agency with Choice must submit claims for reimbursement to the Division and pay direct support workers for authorized hours worked and billed in accordance with the Electronic Visit Verification requirements. All claims must be submitted no later than 12 months from the date of service. Per 42 CFR §424.44, time limits for filing claims, any claims submitted after 12 months from the date of service will not be eligible for reimbursement.
5. (5) The Agency with Choice must withhold, file, and pay income taxes and all employment-related taxes, including but not limited to, workers’ compensation premiums and unemployment taxes. The Agency with Choice must also verify the qualifications of each direct support workers as required by Oregon and Federal Laws.

6. (6) The Agency with Choice shall be reimbursed:

   1. (a) Only for approved and authorized hours and services delivered to an Individual based on the individual’s person-centered service planning.
   2. (b) Only at the Authority’s approved hourly rate for services.
   3. (c) Request for reimbursement of community transportation must not include mileage for an employee commuting to and from the Individual's home.
   4. (d) To provide community transportation services, the direct support worker must maintain valid driver’s license, current vehicle registration and necessary auto insurance. Proof must be available upon the request of the Authority. Mileage must be prior authorized in the person-centered service plan.
7. (7) The Agency with Choice must comply with OAR 410-120-1510, OAR 461-195-0601 and the requirements therein for prompt reporting of fraud, waste, and abuse in the Medicaid program. Information on how to report may always be found online: https://www.oregon.gov/oha/FOD/PIAU/Pages/Report-Fraud.aspx.
8. (8) The Agency with Choice must provide a copy of all information and documents as requested by the Authority.
9. (9) The Agency with Choice must cooperate with all review activities required by the Authority, including but not limited to providing access to records, staff, and service documentation related to the delivery of Agency with Choice Services.

Statutory/Other Authority

ORS 413.042 & Oregon Law 2024, Chapter 37

Statutes/Other Implemented

ORS 430.731 & Oregon Law 2024, Chapter 37

History

BHS 4-2026, adopt filed 04/30/2026, effective 04/30/2026