1. (1) The Division shall make payment for medically appropriate and medically necessary goods, supplies, and services for home enteral/parenteral nutrition and IV therapy on written order or prescription.

   1. (a) The order or prescription must be dated and signed by a licensed prescribing practitioner. The order shall be legible and specify the service required, the ICD-10-CM diagnosis code(s), the route of administration, the amounts prescribed, and the length of time needed.
   2. (b) The prescription or written practitioner’s order must be retained on file by the provider of service for the period of time specified in the Division's General Rules.
   3. (c) A nutritional assessment performed by a registered dietitian or the treating practitioner and a new prescription are required once a year for ongoing services.
   4. (d) Also covered are services for subcutaneous, epidural and intrathecal injections requiring pump or gravity delivery.
2. (2) All claims for enteral/parenteral nutrition and IV services require a valid ICD-10-CM diagnosis code. It is the provider's responsibility to obtain the actual diagnosis code(s) from the prescribing practitioner. Reimbursement shall be made according to covered services on funded lines of the Health Services Commission's Prioritized List of Health Services, and these rules.
3. (3) The Division shall cover one initial nursing service visit to assess the home environment and appropriateness of enteral/parenteral nutrition or IV services in the home setting when recommended by the treating practitioner to establish the client's treatment plan. This nursing service visit for assessment purposes does not require prior authorization.
4. (4) Nursing service visits, except the assessment nursing visit, specific to this Home Enteral/Parenteral and IV services program are provided in the home or an Ambulatory Infusion Suite of the Home Infusion Therapy Provider (AIS) and shall be reimbursed by the Division only when prior authorized, and performed by a person who is licensed by the Oregon State Board of Nursing to practice as a Registered Nurse. All registered nurse delegated or assigned nursing care tasks must comply with the Oregon State Board of Nursing, Nurse Practitioner Act and Administrative Rules regulating the practice of nursing.
5. (5) Payment for services identified in the Home Enteral/Parenteral Nutrition and IV Services provider rules shall be made only when provided in the client's place of residence.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

DMAP 116-2024, amend filed 08/09/2024, effective 08/09/2024
DMAP 51-2015, f. 9-22-15, cert. ef. 10-1-15
DMAP 11-2007, f. 6-14-07, cert. ef. 7-1-07
OMAP 64-2004, f. 9-10-04, cert. ef. 10-1-04
OMAP 15-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03
OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0640
OMAP 29-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98
HR 3-1995, f. & cert. ef. 2-1-95
HR 26-1993, f. & cert. ef. 10-1-93
HR 9-1992, f. & cert. ef. 4-1-92
HR 26-1990, f. 8-31-90, cert. ef. 9-1-90, Renumbered from 461-016-0290
AFS 56-1989, f. 9-28-89, cert. ef. 10-1-89