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The Oregon Administrative Rules contain OARs filed through August 15, 2014
 
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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.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 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.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 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 2013 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.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 413.225
Hist.: PH 15-2013, f.12-26-13, cert. ef. 1-1-14

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.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 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.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 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.: 2013 OL Ch. 683
Stats. Implemented: 2013 OL Ch. 683 & ORS 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 413.225
Stats. Implemented: 2013 OL Ch. 683, ORS 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 413.225
Stats. Implemented: 2013 OL Ch. 683, ORS 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: 2013 OL Ch. 683, ORS 413.225
Hist.: PH 10-2014, f. & cert. ef. 4-1-14

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