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The Oregon Administrative Rules contain OARs filed through June 15, 2014
 
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DEPARTMENT OF HUMAN SERVICES,
VOCATIONAL REHABILITATION SERVICES

 

DIVISION 75

RATES OF PAYMENT -- MEDICAL 

582-075-0010

General Policy

(1) The Office of Vocational Rehabilitation Services (OVRS) does not have the authority to reimburse vendors for the cost of goods and services if OVRS has not authorized payment prior to the provision of goods and services. OVRS shall reject all charges without such prior authorization.

(2) Except as provided in subsection (3) of this rule and OAR 582-075-0030, the amount that OVRS shall pay vendors for previously authorized medical or psychological services shall be the lesser of the following:

(a) The lowest fee that the vendor charges the general public or other state agencies for the service; or

(b) One of the following prescribed fees:

(A) The maximum fee prescribed by the Workers' Compensation Schedule.

(B) For medical, psychological, laboratory, and other services not governed by that schedule, OVRS shall pay the amount derived by applying the cost ratio between that schedule and the Division of Medical Assistance Program (DMAP) Schedule to the fee prescribed by the DMAP schedule.

(3) With prior written approval by the Field Services Manager, OVRS may exceed the fee prescribed by subsection (2) of this rule when financial or human considerations outweigh the difference in cost.

Stat. Auth.: ORS 344.530(2)
Stats. Implemented: ORS 344.511 - 344.690
Hist.: VRD 1-1991, f. 1-14-91, cert. ef. 3-1-91; VRD 4-1993, f. & cert. ef. 11-1-93; VRD 6-1997, f. 12-31-97, cert. ef. 1-1-98; VRS 5-2004, f. & cert. ef. 8-5-04

582-075-0020

Definitions

(1) "Brief narrative," as used in division 075, means a document from a treating vendor that summarizes client treatment to date and current status; responds briefly to 3-5 specific questions posed by OVRS, if any; and is usually one or two pages.

(2) "Complete narrative," as used in division 075, means a document from a treating vendor that describes an extended client history, addresses six or more specific topics, and is usually three or more pages.

(3) "Vendor, " as used in division 075, means an entity that provides goods and/or services at the request of OVRS.

Stat. Auth.: ORS 344.530(2)
Stats. Implemented: ORS 344.511 - 344.690
Hist.: VRD 1-1991, f. 1-14-91, cert. ef. 3-1-91; VRD 4-1993, f. & cert. ef. 11-1-93; VRD 1-1997(Temp), f. 5-8-97, cert. ef. 6-15-97; OAR 582-075-0020(Temp) suspended by VRD 2-1997(Temp), f. 6-13-97, cert. ef. 6-15-97; VRD 6-1997, f. 12-31-97, cert. ef. 1-1-98; VRS 5-2004, f. & cert. ef. 8-5-04

582-075-0030

Medical Evidence of Record (MER) and Narrative Charges

(1) OAR 582-075-0010(2) and (3) do not govern payment for Medical Evidence of Record and Narratives.

(2) OVRS payment for existing medical records shall not exceed the lesser of the following:

(a) The lowest fee that the vendor charges the general public or other state agencies for the service; or

(b) When the invoice itemizes the number of pages copied and provided:

(A) $18.00 for ten or fewer pages;

(B) $0.25 per page for pages 11 to 20;

(C) $0.10 per page for pages greater than 21; and

(D) A total maximum payment of $22.50.

(c) When the invoice does not itemize the number of pages copied and provided, a total maximum payment of $18.00.

(3) Additional payment will not be made for second or subsequent requests when the information to be provided was available to the vendor when the original request was processed.

(4) Integrated records will be paid as a single record request.

(5) When OVRS receives copies of existing medical records within 7 days from the date recorded on the OVRS record request, OVRS shall pay the vendor an additional $5.00. Time shall be measured from the date of the OVRS written request to the date that OVRS electronically receipts the copies or receives them in the rehabilitation services local office.

(6) When OVRS and a vendor enter a public contract for the contractor to obtain existing medical records on behalf of OVRS and perform additional related services:

(a) The contract governs payment to the contractor;

(b) The fee schedule prescribed by subsection (2) governs the contractor's payment to those from whom the contractor obtains the medical records.

(c) No bonus, as prescribed by subsection (5) of this rule shall be paid by OVRS or by the contractor.

(7) When purchasing a brief narrative, OVRS shall pay the amount billed up to a maximum payment of $35.00.

(8) When purchasing a complete narrative, OVRS shall pay the amount billed up to a maximum payment of $75.00.

(9) A supplier of records under this rule is not entitled to any payments if the supplier fails to provide the records requested within a specific deadline identified in the letter requesting the records, and OVRS is not able to make use of the records as a result.

Stat. Auth.: ORS 344.530(2)
Stats. Implemented: ORS 344.511 - 344.690
Hist.: VRD 1-1991, f. 1-14-91, cert. ef. 3-1-91; VRD 4-1993, f. & cert. ef. 11-1-93; VRD 1-1997(Temp), f. 5-8-97, cert. ef. 6-15-97; OAR 582-075-0030(Temp) suspended by VRD 2-1997(Temp), f. 6-13-97, cert. ef. 6-15-97; VRD 6-1997, f. 12-31-97, cert. ef. 1-1-98; VRS 5-2004, f. & cert. ef. 8-5-04

582-075-0040

Limitations of Payments

The vendor shall accept the fees prescribed by division 75 as payment in full. If a vendor's usual and customary fee for a service exceeds the fee prescribed by division 75, the client and/or his or her family shall not be liable to the vendor for any portion of a vendor's usual and customary fee unless the client and/or his or her family agrees in writing to assume the additional charges. Without such explicit agreement, the vendor must accept the OVRS payment, including any client copayment, as payment in full.

Stat. Auth.: ORS 344.530(2)
Stats. Implemented: ORS 344.511 - 344.690
Hist.: VRD 6-1997, f. 12-31-97, cert. ef. 1-1-98; VRS 5-2004, f. & cert. ef. 8-5-04

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