1. (1) School-Based Health Services (SBHS) rules:

   1. (a) Define Oregon’s fee-for-service Medicaid program administered by the Oregon Health Authority (Authority) to reimburse publicly funded education agencies for health services provided in education settings to Oregon’s Medicaid-enrolled children and young adults.
   2. (b) Define when Medicaid-covered services are reimbursable to education agencies.
   3. (c) Define the reimbursement methodology for services rendered in education settings.

   4. (d) Cite and align with federal and state requirements and limitations including:

      1. (A) Individuals with Disabilities Education Act (IDEA);
      2. (B) Section 504 of the Rehabilitation Act of 1973;
      3. (C) Title XIX and Title XXI of the Social Security Act;
      4. (D) Oregon Revised Statutes; and
      5. (E) Oregon Administrative Rules (OARs).

2. (2) These SBHS rules are to be used in conjunction with:

   1. (a) Medical Assistance Programs rules in OARs Chapter 410, Divisions 120 and 141;
   2. (b) The Authority provider rules in OARs Chapter 943, Division 120; and

   3. (c) Oregon Department of Education’s (ODE) rules in:

      1. (A) OARs Chapter 581, Divisions 15, 21, and 22; and
      2. (B) OARs Chapter 584, Divisions 220 and 245.
3. (3) Medicaid-enrolled children and young adults retain the ability to obtain services from any qualified Medicaid provider. These rules do not require Medicaid-enrolled children and young adults to receive their health services only from school medical providers.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

DMAP 65-2025, amend filed 08/29/2025, effective 08/29/2025
DMAP 121-2024, amend filed 09/06/2024, effective 09/06/2024
DMAP 33-2016, f. 6-29-16, cert. ef. 7-1-16
DMAP 19-2009, f. 6-12-09, cert. ef. 7-1-09
OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05
OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05
OMAP 31-2003, f. & cert. ef. 4-1-03
OMAP 15-2000, f. 9-28-00, cert. ef 10-1-00
OMAP 38-1999, f. & cert. ef. 10-1-99
HR 39-1991, f. & cert. ef. 9-16-91