The school medical provider is responsible to:

1. (1) Enroll as a school medical provider with the Authority in compliance with OARs: 410-120-1260 and 943-120-0320.
2. (2) Ensure school-based health services are provided by SBHS-recognized providers in compliance with School-Based Health Services (SBHS) rules (OARs Division 410, Chapter 133) and OARs 410-120-1260, 410-120-1396, and 410-120-1510.
3. (3) Document, maintain, and retain credentials and qualifications records for each rendering provider, staff or contractor, providing services in the district in compliance with OAR 410-120-1260. Documentation must state the process by which the school medical provider checked, and periodically re-checked, the Medicaid provider exclusion list to confirm that each rendering provider is eligible to provide health services to Medicaid-enrolled children and young adults.
4. (4) Confirm each rendering provider, as an employee or under contract with the school medical provider, is eligible to provide Medicaid services. The Authority’s Office of Program Integrity maintains a list of excluded providers on the State Medicaid Fraud Convictions website. The U.S. Department of Health and Human Services’ Office of the Inspector General maintains, with monthly updates, a complete database of individuals and entities currently excluded from Federally funded health care programs.
5. (5) Ensure rendering providers providing services in education settings document each service in compliance with their respective board rules and OAR 410-120-1360 and OAR 410-133-0320.
6. (6) Provide for appropriate medical supervision consistent with each rendering provider’s respective scope of practice and board requirements.
7. (7) Maintain and retain adequate medical and financial records, in compliance with OAR 410-120-1360, necessary to fully disclose the extent of the covered health services provided as part of the child or young adult’s education record.
8. (8) Document, and submit to the Authority, costs in accordance with OAR 410-133-0245.
9. (9) Provide access for on-site review of the service-delivery location and education records of Medicaid-enrolled children or young adults if such records are directly related to payments for claims to the school medical provider for Medicaid-covered services. Such information must be provided to any state or federal agency responsible for administration or oversight of the Medicaid program.
10. (10) Document any changes related to the provision of Medicaid-covered services.
11. (11) Make certain that services are billed in accordance with OAR 410-120-0035 and SBHS OARs Chapter 410, Division 133.
12. (12) Comply with all applicable provisions of OARs: Chapter 943, Division 120; Chapter 410, Division 120; and Chapter 410, Division 133.

Statutory/Other Authority

ORS 413.042, OAR 410-120-1360, 410-120-1396, 410-120-1510, 943-120-0180, 943-120-0310 & 943-120-1505

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
DMAP 43-2008, f. 12-17-08, cert. ef. 12-28-08
DMAP 28-2008(Temp), f. 6-30-08, cert. ef. 7-1-08 thru 12-28-08
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 53-2003, f. 8-13-03 cert. ef. 9-1-03
OMAP 31-1998, f. & cert. ef. 9-1-98
HR 39-1991, f. & cert. ef. 9-16-91