1. (1) Private duty nursing providers shall obtain prior authorization (PA) for all services.

2. (2) Providers shall request PA as follows (see the Private Duty Nursing Services Supplemental Information booklet for contact information):

   1. (a) For individuals served by the MFC), from the Department‘s MFC Program;
   2. (b) For clients enrolled in the fee-for-service (FFS) Medical Case Management (MCM) program, from the MCM contractor;
   3. (c) For members enrolled in a coordinated care organization (CCO) or prepaid health plan (PHP), from the CCO or the PHP;
   4. (d) For all other clients, from the Division.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

DMAP 45-2015, f. & cert. ef. 8-25-15
DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08
OMAP 93-2003, f. 12-30-03 cert. ef. 1-1-04
OMAP 16-2000, f. 9-28-00, cert. ef. 10-1-00
OMAP 7-1999, f. 3-4-99, cert. ef. 4-1-99
HR 6-1997, f. & cert. ef. 2-19-97
HR 9-1991, f. 1-28-91, cert. ef. 3-1-91, Renumbered from 461-019-0210
AFS 40-1984, f. 9-18-84, ef. 10-1-84
AFS 22-1984(Temp), f. & ef. 5-1-84
AFS 14-1984(Temp), f. & ef. 4-2-84
AFS 9-1983, f. 2-17-83, ef. 3-2-83
AFS 52-1982, f. 5-28-82, ef. 6-30-82
AFS 43-1982, f. 4-29-82, ef. 5-1-82
PWC 799, f. & ef. 6-1-76
PWC 759, f. 9-5-75, ef. 10-1-75
PWC 681, f. & ef. 7-17-74