Stat. Auth.:ORS413.225 Stats. Implemented:ORS413.223 413.225 Hist.: Ph 10-2014, F. & Cert. Ef. 4-1-14


Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 

DIVISION 28
SCHOOL-BASED HEALTH CENTER
PROGRAM
333-028-0200
Purpose
The school-based health center (SBHC)
program supports communities in promoting the health and well-being of the school-age
population through the evidence-based best practice within a public health framework.
These rules (OAR 333-028-0200 through 333-028-0250) establish the procedure and
criteria the Oregon Health Authority shall use to certify, suspend and decertify
SBHCs. Certification of a SBHC by the SBHC state program is voluntary; an operating
clinic is free to choose not to participate in certification and still operate.
Only certified SBHCs are eligible for funding from the Oregon Health Authority.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14
333-028-0210
Definitions
(1) “Authority” means the
Oregon Health Authority.
(2) “Certification
year” means a one-year period beginning on July 1 and ending on June 30.
(3) “Electronic health
record (EHR)” means an electronic record of an individual’s health-related
information that conforms to nationally recognized interoperability standards and
that can be created, managed and consulted by authorized clinicians and staff across
more than one health care provider.
(4) “Electronic medical
record (EMR)” means a digital version of a paper chart that contains all of
the patient’s medical history from one practice. An EMR is mostly used by
providers for diagnosis and treatment.
(5) “Program”
means the Oregon Health Authority, Public Health Division, school-based health center
program.
(6) “School-based health
center” (SBHC) has the meaning given the term in ORS 413.225.
(7) “SBHC system”
is one or more SBHCs that operate under the same sponsoring agency.
(8) “Sponsoring agency”
is an entity that provides the following services for a SBHC or contracts with another
entity to provide one or more of the following:
(a) Funding;
(b) Staffing;
(c) Medical oversight;
(d) Liability insurance;
and
(e) Billing support.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14
333-028-0220
Certification Requirements
In order to be certified as a SBHC,
a SBHC must meet all requirements for certification in the following sections of
the 2014 SBHC Standards for Certification Manual, incorporated by reference.
(1) Sponsoring agency, section
B.1;
(2) Facility, section B.2;
(3) Hours of operation, section
C.1;
(4) Staffing, section C.2;
(5) Eligibility for services,
section C.3;
(6) Policies and procedures,
section C.4;
(7) Laboratory/Diagnostic
services, section D;
(8) Comprehensive Services,
section E.1;
(9) Equipment, section E.2;
(10) Medication, section
E.3;
(11) Data collection/reporting,
section F; and
(12) Billing, section G.
[ED. NOTE:
Tables referenced are not included in rule text. Click here for PDF copy of table(s).]
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223,
413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14; PH 9-2015(Temp), f. & cert. ef. 5-6-15 thru 11-1-15; PH 18-2015,
f. 9-30-15, cert. ef. 10-1-15
333-028-0230
Application and Certification Process
(1) An individual with legal authority
to act on behalf of the entity that administers a SBHC may apply for certification
of a SBHC by submitting a SBHC Certification Application to the Authority via electronic
mail to the program’s electronic mail address posted on the program’s
website or by mail to the mailing address posted on the program’s website,
www.healthoregon.org/sbhc. Instructions and criteria for submitting a SBHC Certification
Application is posted on the program’s website.
(2) An individual may submit
an application for more than one SBHC provided that each SBHC will be administered
by the same entity and each SBHC individually meets the certification requirements.
(3) The program shall review
the application within 30 days of receiving the application to determine whether
it is complete.
(4) If the program determines
that the application is not complete, it will be returned to the applicant for completion
and resubmission.
(5) If the program determines
that the application is complete it will be reviewed to determine if it meets certification
requirements described in OAR 333-028-0210. If the program determines that on the
face of the application and in reviewing any other applicable documents that the
SBHC meets the certification requirements the program shall:
(a) Inform the applicant
in writing that the application has been approved;
(b) Request the applicant
complete the program’s online Operational Profile forms prior to the on-site
verification review; and
(c) Schedule an on-site verification
review.
(6) If a SBHC does not meet
certification requirements in their certification application, the Authority may
choose one of the following actions:
(a) The program may deny
SBHC certification if the SBHC does not meet the requirements of these rules. The
program will provide the applicant with a clear description of reasons for denial
based on the certification requirements in the denial letter. An applicant may request
that the program reconsider the denial of SBHC certification. A request for reconsideration
must be submitted in writing to the program within 90 days of the date of the denial
letter and must include a detailed explanation of why the applicant believes the
program’s decision is in error along with any supporting documentation. The
program shall inform the applicant in writing whether it has reconsidered its decision;
or
(b) The program may approve
the applicant’s SBHC certification based on an agreed upon timeline for a
corrective action plan for the non-compliant requirements. The site must submit
a waiver to the program that includes an explanation of the non-compliant requirements,
a plan for corrective action and date for meeting compliance.
(7) Once a SBHC is certified,
the certification status is effective for the following certification year.
(8) A certified SBHC must
renew its certification no later than October 1 each year via the program’s
online Operational Profile forms in order to remain certified.
(9) The program will notify
SBHCs of their certification renewal status by November 1 each year.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14
333-028-0240
Verification
(1) The program shall conduct one on-site
verification review of each approved SBHC within one year of application approval
to determine compliance with SBHC certification requirements.
(2) After the initial on-site
verification review, the program shall conduct an on-site verification review every
two years for a representative sample of certified SBHCs in each SBHC system.
(3) A SBHC will be notified,
in writing, no less than 30 days before its scheduled verification review.
(4) A SBHC must permit program
staff access to the site’s place of business during the review.
(5) The verification review
must include, but is not limited to:
(a) Review of documents,
policies and procedures, and records;
(b) Review of electronic
medical record systems, review of electronic health records systems, and review
of practice management systems;
(c) Review of data reports
from electronic systems or other patient registry and tracking systems;
(d) Interviews with practice
management, clinical and administrative staff;
(e) On-site observation of
practice staff with at a minimum two patients, with the consent of the patient;
and
(f) On-site observation of
patient environment and physical environment.
(6) Following a review, program
staff may conduct an exit interview with SBHC representative(s). During the exit
interview the program staff shall:
(a) Inform the SBHC representative(s)
of the preliminary findings of the review; and
(b) Give the SBHC representatives(s)
a reasonable opportunity to submit additional facts or other information to the
program staff in response to the findings.
(7) Within two weeks of the
on-site visit program staff must prepare and provide the SBHC with a written report
of the findings from the on-site review.
(8) If no certification deficiencies
are found during the review, the program shall issue written findings to the SBHC
indicating no deficiencies were found.
(9) If certification deficiencies
are found during the on-site review, the program may take action in compliance with
OAR 333-028-0250.
(10) The program may conduct
a review of a certified SBHC without prior notice of any or all selected certification
requirements for compliance and perform a verification on-site review of a certified
SBHC if the program is made aware of issues of compliance from any source.
(11) At any time, a SBHC
may request an administrative review of compliance, which includes one on-site visit.
The review will be considered a “no penalty” review with the exception
of gross violation or negligence that may require site closure or temporary suspension
of services.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14
333-028-0250
Compliance
(1) A SBHC must notify the program within
20 days of any change that brings the SBHC out of compliance with the certification
requirements. A SBHC must submit a waiver to the program that includes an explanation
of the non-compliant requirement, a plan for corrective action and date for meeting
compliance.
(2) The program will review
the waiver request and inform the SBHC of approval or denial of the waiver within
two weeks of submission.
(3) If the waiver is approved
the SBHC must comply with certification requirements by the proposed date of compliance.
(4) If a waiver is denied;
a SBHC does not come into compliance by the date of compliance stated on the waiver;
or a SBHC is out of compliance with certification requirements and has not submitted
a waiver, based on the program’s discretion, the program may:
(a) Require the SBHC to complete
an additional waiver with an updated plan for corrective action and updated date
for meeting compliance; or
(b) Require the SBHC to complete
a waiver to satisfy the requirements in section (1) of this rule; or
(c) Issue a written warning
with a timeline for corrective action; or
(d) Issue a letter of non-compliance
with the notification of a suspension or decertification status.
(5) A SBHC that had been
decertified may be reinstated after reapplying for certification.
(6) A SBHC with its certification
status suspended may have its suspension lifted once the program determines that
compliance with certification requirements has been achieved satisfactorily.
(7) If there are updates
to the current rules that require a SBHC to make any operational changes, the program
will allow the SBHC until the beginning of the next certification year or a minimum
of 90 days to come into compliance.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 15-2013, f.12-26-13,
cert. ef. 1-1-14
333-028-0260
Funding Criteria for Certified SBHCs
(1) The program is required, under ORS
413.225 to provide funds for the expansion and continuation of certified school-based
health centers.
(2) A SBHC that is certified
by the program is eligible for funding by the program.
(3) Funding for a certified
SBHC may be provided, but is not limited to being provided, to:
(a) A local public health
authority, as that is defined in ORS 431.260;
(b) A sponsoring agency;
or
(c) A coordinated care organization,
or governmental entity or person that can demonstrate a significant interest and
involvement in assisting and coordinating with SBHCs.
(4) Funding award amounts
will be primarily based on the number of certified SBHCs in the county and legislatively
approved budget. The program may take into consideration other factors such as the
quality of the health care services, clients served, and population needs.
(5) Funding for certified
SBHCs shall be awarded for up to two years. Fund awards are renewable based on the
certification renewal process per OAR 333-028-0220.
(6) Funding for a certified
SBHC may be suspended or discontinued at the program’s discretion if a certified
SBHC is out of compliance with certification requirements and the program has issued
a suspension notice under OAR 333-028-0250(4).
(7) The program must discontinue
funding of an SBHC that has been decertified.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 10-2014, f. &
cert. ef. 4-1-14
333-028-0270
Funding Criteria for SBHC Planning
Communities
(1) The program is required to direct
funds to communities planning for certified school-based health centers and will
do so through a competitive grant proposal process for one or two year planning
grants.
(2) Any of the following
entities may be eligible to apply for planning grant funds on behalf of their community:
(a) A local public health
authority;
(b) A school or school district;
(c) A coordinated care organization
as that is defined in ORS 414.025;
(d) Medical, dental or mental
health organizations; or
(e) A governmental entity
or person that can demonstrate a significant interest and involvement in establishing,
assisting or coordinating with SBHCs.
(3) The program will specify
in its published request for proposals which entities within a community are eligible
for that specific grant award.
(4) Planning grant applicants
will be evaluated on elements outlined in the request for proposal, which must include
but is not limited to an evaluation of community need and readiness for a SBHC.
(5) The grant amount awarded
shall be determined based on number of awarded applicants and legislatively approved
budget.
(6) Funding for planning
communities shall be awarded for up to two years.
Stat. Auth.: ORS 413.223
Stats. Implemented: ORS 413.223, 413.225
Hist.: PH 10-2014, f. &
cert. ef. 4-1-14
333-028-0280
Funding Criteria for Incentive Funds
(1) The program shall award grant funding
to communities with certified SBHCs through a competitive grant proposal process
in order to incentivize:
(a) Increasing the number
of SBHCs as state-recognized patient-centered primary care homes as that is defined
in ORS 414.025;
(b) Improve coordination
of care of patients served by coordinated care organizations and SBHCs; and
(c) Improve the effectiveness
of the delivery of health services through SBHCs to children who qualify for medical
assistance.
(2) Any entity or person
described in OAR 333-028-0270(2) may apply for funding and the program will specify
in its published request for proposals which entities within a community are eligible
for that specific grant award.
(3) The program will evaluate
applicants based on elements outlined in the request for proposals, which must include
but is not limited to an evaluation of whether the person or entity has the qualifications
to accomplish one or more of the activities described in subsections (1)(a) through
(c) of this rule.
(4) Funding awards shall
be determined based on number of awarded applicants and legislatively approved budget.
(5) Funding for the incentive
grants shall be awarded for up to two years.
Stat. Auth.: ORS 413.225
Stats. Implemented: ORS 413.223 413.225
Hist.: PH 10-2014, f. &
cert. ef. 4-1-14

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