1. (1) Oregon’s School-Based Health Services (SBHS) program does not cover or reimburse for:

   1. (a) Services that are not provided and documented by SBHS-recognized providers within their respective scope of practice and in compliance with their respective board rules, OAR 410-120-1360, and OAR 410-133-0120;
   2. (b) Unplanned services in lieu of planned services when an IPOC is required by IDEA, Section 504 of the Rehabilitation Act of 1973, or the provider’s scope of practice;
   3. (c) Record reviews as a stand-alone service;
   4. (d) Meeting preparation;
   5. (e) Report writing as a stand-alone service;
   6. (f) Correspondence (e.g., copying, mailing, etc.);
   7. (g) Purchase of an assistive technology device or software;
   8. (h) Activities related to determining Medicaid eligibility and enrollment status, administrative activities, and travel time by SBHS-recognized providers;
   9. (i) Educational workshops, training classes, and parent training workshops;
   10. (j) Regular transportation services to and from school;
   11. (k) Vocational services;
   12. (l) Services provided to non-Medicaid children or young adults;
   13. (m) Services provided by an entity that employs an excluded provider; or
   14. (n) Planned services performed on a date of service for which the child or young adult’s IPOC has lapsed.
2. (2) Education-based costs normally incurred to operate a school and provide an education are not covered for Medicaid reimbursement by the Authority.

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 53-2003, f. 8-13-03 cert. ef. 9-1-03
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 21-1995, f. & cert. ef. 12-1-95
HR 39-1991, f. & cert. ef. 9-16-91