1. (1) Enrollment with the Authority is subject to and in compliance with OAR 410-120-1260 and 943-120-0320.
2. (2) Education agencies must be enrolled as a school medical provider with the Authority to bill and receive reimbursement for Medicaid-covered.
3. (3) Supervisory-level rendering providers providing or supervising services in education settings, for which the education agency intends to seek Medicaid reimbursement, must be enrolled with the Authority.
4. (4) Authority-enrolled providers must submit updates to the Authority within thirty (30) calendar days of the change under the EDMS Coversheet (MSC 3970). Changes include address, contact information, NPI, and Federal Tax Identification Number (TIN), when applicable.

5. (5) Authority Medicaid provider enrollment process:

   1. (a) For an education agency enrolling as a school medical provider, complete and submit a school medical provider enrollment application including the EDMS Coversheet, all required Oregon Medicaid forms, and the Provider Enrollment Attachment; or
   2. (b) For supervisory-level rendering providers, complete and submit a provider enrollment application including the EDMS Coversheet and all required Oregon Medicaid forms.
   3. (c) Required forms are unique to each provider and are available on the Oregon Health Plan Provider Enrollment website.
   4. (d) The school medical provider may submit completed enrollment forms on behalf of supervisory-level rendering providers that are employed by the school medical provider.

   5. (e) Upon submission of a provider enrollment application, the Authority shall:

      1. (A) Enroll a school medical provider or supervisory-level rendering provider that has satisfied the provider enrollment criteria;
      2. (B) Notify the applicant if information is missing or invalid; or
      3. (C) Deny enrollment if Authority provider enrollment criteria are not satisfied.
      4. (D) Upon enrollment, notify the contact listed on the provider enrollment application of the enrolled, assigned Medicaid Identification number.
6. (6) Revalidation of Authority-enrolled providers is subject to and in compliance with OAR 410-120-1260.
7. (7) Termination of provider enrollment is subject to and in compliance with OAR 410-120-1260.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 413.042

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
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