1. (1) Professional Ambulatory services provided by IHCP include Medical, Diagnostic, Screening, Dental, Vision, Physical Therapy, Occupational Therapy, Podiatry, Behavioral Health, Substance Use Disorder, Maternity Case Management, Speech, Hearing, and Home Health services.

2. (2) Providers must use the following guidelines in conjunction with all individual program-specific Division administrative rules to determine service coverage and limitations for OHP clients according to their benefit packages:

   1. (a) American Indian/Alaska Native (AI/AN) Services administrative rules (OAR 410 division 146),
   2. (b) General Rules (OAR 410 division 120);
   3. (c) OHP Administrative Rules (OAR 410-141-0480, 410-141-0500, and 410-141-0520), and
   4. (d) The Health Evidence Review Commission’s (HERC) Prioritized List of Health Services (List).
3. (3) IHS and Tribal 638 facilities may be reimbursed for covered professional services provided within the scope of the clinic and within the individual practitioner’s scope of license or certification. See also AI/AN OAR 410-146-0085.
4. (4) The date of service determines the appropriate version of the AI/AN Services Rules, General Rules, and the HERC Prioritized List that IHCPs should use to determine coverage.

Statutory/Other Authority

ORS 413.042 & ORS 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 42-2017, amend filed 10/03/2017, effective 10/03/2017
DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08
DMAP 19-2007, f. 12-5-07, cert. ef. 1-1-08
OMAP 16-2005, f. 3-11-05, cert. ef. 4-1-05
OMAP 49-2004, f. 7-28-04 cert. ef. 8-1-04
OMAP 68-2003, f. 9-12-03, cert. ef. 10-1-03
OMAP 3-2003, f. 1-31-03, cert. ef. 2-1-03
OMAP 59-2002, f. & cert. ef. 10-1-02
OMAP 45-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 6-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 25-2000, f. 9-28-00, cert. ef. 10-1-00
OMAP 2-1999, f. & cert. ef. 2-1-99