Or. Admin. R. 410-172-0630 – Medically Appropriate

(1) In addition to the definition of medically appropriate in OAR 410-120-0000 for behavioral health services, “medically appropriate” means the services and supports required to diagnose, stabilize, care for, and treat a behavioral health condition.
(2) The Division shall make payment for medically appropriate behavioral health services when the services or supports are:
1. (a) Rendered by a provider whose training, credentials, or license is appropriate to treat the identified condition and deliver the service;
2. (b) Based on the standards of evidence-based practice, and the services provided are appropriate and consistent with the diagnosis identified in the behavioral health assessment;
3. (c) Provided in accordance with an individualized service plan and appropriate to achieve the specific and measurable goals identified in the service plan;
4. (d) Not provided solely for the convenience of the recipient, the recipient’s family, or the provider of the services or supplies;
5. (e) Not provided solely for recreational purposes;
6. (f) Not provided solely for research and data collection;
7. (g) Not provided solely for the purpose of fulfilling a legal requirement placed on the recipient.

ORS 413.042 & 430.640

ORS 413.042, 414.025, 414.065, 430.640, 430.705 & 430.715