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OREGON YOUTH AUTHORITY







 

DIVISION 640
ADMINISTRATIVE MEDICAL EXAMINATIONS

 
416-640-0000
Purpose
The purpose of this rule is to describe the administrative medical examinations and reports authorized by the Oregon Youth Authority for youth in its custody who are or are potentially Medicaid-eligible (see OAR 416-610-0000 through OAR 416-610-0200 for discussion of Medicaid eligibility).
Stat. Auth.: ORS 422

Stats. Implemented: ORS 422

Hist.: OYA 3-1996, f. 6-26-96, cert. ef. 8-1-96
 
416-640-0010
Definitions
As used in this Division, the following definitions apply:
(1) Administrative Medical Examination: An examination, evaluation, and/or copies of medical records from a OMAP-enrolled medical provider for the purpose of casework planning.
(2) Medicaid: A federal and state-funded medical assistance program established by Title XIX of the Social Security Act. The Medicaid program pays for medical and remedial care provided to eligible Oregonians.
(3) OMAP: The Office of Medical Assistance Programs of the Oregon Department of Human Resources. OMAP is the state agency responsible for coordinating Oregon's Medicaid program.
(4) Substitute Care: An out-of-home placement directly supervised by the Oregon Youth Authority or other agency, including placement in a foster family home, group home, or other youth-caring institution. Substitute care does not include care in a detention facility or an Oregon Youth Authority youth correctional facility, youth accountability camp, work/study camp, or residential academy.
Stat. Auth.: ORS 422

Stats. Implemented: ORS 422

Hist.: OYA 3-1996, f. 6-26-96, cert. ef. 8-1-96
 
416-640-0020
Administrative Medical Examination Authorization
(1) Administrative Medical Examinations must be authorized by the local OYA
supervisor or designee prior to the medical service. Authorizations must done on a Form OMAP 729.
(2) Authorization for Administrative Medical Examinations will be made only to licensed medical service providers or polygraphers. The provider must be a licensed physician, psychiatrist, psychologist, registered clinical social worker, a licensed medical facility or other medical provider, or a licensed polygrapher enrolled by OMAP for participation in the Medicaid (Title XIX) Program. Providers must have an assigned active provider number from OMAP in order to receive payment for their services.
(3) Authorized amounts for Administrative Medical Examinations will be at the current OMAP-published rate for the fee code billed.
(4) Parents and any medical insurance available to the youth are resources for payment of examinations or evaluations.
Stat. Auth.: ORS 422

Stats. Implemented: ORS 422

Hist.: OYA 3-1996, f. 6-26-96, cert. ef. 8-1-96
 
416-640-0030
Administrative Medical Examination Payments
(1) Administrative Medical Examinations may be authorized for youth in OYA's care and custody who are eligible or are potentially eligible for Medicaid (Title XIX). Expenditures are federally-matchable and will be paid through OMAP. An Administrative Medical Examination expenditure includes any payment to a medical provider for a physical examination or psychological/psychiatric evaluation, a licensed polygrapher for polygraph testing, or copies of medical records in connection with:
(2) Casework planning for Medicaid-eligible youth in substitute care;
(3) Evaluation and/or testing of youth in their own homes to determine if a substitute care placement is the most appropriate case plan. Administrative Medical Examinations payments may be authorized whether or not substitute care placement is made; or
(4) Copies of hospital or medical records.
Stat. Auth.: ORS 422

Stats. Implemented: ORS 422

Hist.: OYA 3-1996, f. 6-26-96, cert. ef. 8-1-96

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