Oregon Health Authority (OHA) has adopted newly updated School-Based Health Services (SBHS) Oregon Administrative Rules (OARs), effective September 6, 2024. Rule changes focused on alignment with State Plan Amendment (SPA) 19-0001 School-Based Health Services – Technical Revisions – Approved 5/18/2023. 

Please see the new SBHS OARs (Chapter 410, Division 133), which include the following changes: 

• Individual Plan of Care (new term and new rule 410-133-0050)
  • Created "Individual Plan of Care (IPOC)" to encompass Medicaid requirements for all individualized plans (IEP/IFSP and other plans) prescribing SBHS-covered services.
  • Defined the IPOC to include required elements according to CMS' Delivering Services in School-Based Settings, May 2023 guide.
• Education agency (EA) definition
  • EA definition now includes public school districts, Early Intervention/Early Childhood Special Education (EI/ECSE) contractors and subcontractors, education service districts (ESDs), and state institutions providing educational services or transition services, that are also considered a local unit of government pursuant to 42 CFR 433.51.
  • EAs included in the definition are allowed to bill for SBHS provided all requirements are met.
• Documentation
  • Deleted restrictive SBHS-specific documentation requirements.
  • Added documentation requirements in alignment with medically-qualified individuals' respective board rules and CMS' Delivering Services in School-Based Settings, May 2023 guide.
• Covered Services
  • Expanded covered services beyond those pursuant to the Individuals with Disabilities Education Act (IDEA).
  • Added Medicaid-covered service categories, and recognized medically-qualified individuals, allowed per the CMS-approved SPA including:
    • Behavioral health;  
    • Dental services; and
    • Diagnostic, screening, preventive, developmental, and rehabilitative services.
  • Aligned covered SBHS-services with:
    • Medicaid-covered services;
    • Respective licensing board rules and requirements; and
    • CMS' Delivering Services in School-Based Settings, May 2023 guide.
• Behavioral Health
  • Added behavioral health supports and treatment as SBHS-covered services in alignment with Medicaid-covered services.
  • Added SBHS-recognized providers that may provide behavioral health supports and treatment in alignment with respective board rules. 

Please join Oregon Department of Education (ODE) and OHA for the Fall 2024 Webinar Series: Oregon School-Based Health Services (SBHS) Medicaid Program Expansion. The first webinar of the series, Oregon SBHS Medicaid Expansion: New Services and Practitioners to Support More Students, is scheduled for September 23, 2024, and you can register here. This webinar will introduce recent expansions to the program, focusing on updates to the Oregon Administrative Rules (OARs). Additionally, the session will cover the OHA and ODE initiatives to provide enhanced technical assistance and support to schools. 

Thank you, education partners, for your participation and valuable input during OHA’s engagement opportunities! We look forward to engaging with you further as we continue to expand and implement the SBHS (School Medicaid) program. 

If you have questions about SBHS OARs or this memorandum, please contact: Jennifer.R.Smith@oha.oregon.gov.