Or. Admin. Code § 410-130-0605

Current through Register Vol. 63, No. 10, October 1, 2024

Section 410-130-0605 - Newborn Nurse Home Visiting Services

(1) Definitions.

(a) "Comprehensive newborn nurse home visit" has the meaning described in OAR 333-006-0010 a 333-006-0120;

(b) "HSD" means the Oregon Health Authority's Health Systems Division;

(c) "Public Health" means the Oregon Health Authority's Public Health Division;

(d) "Eligible Client" means an individual who is found eligible for Medicaid or the Children's Health Insurance Program (CHIP) by the Oregon Health Authority (Authority) at the time the services are furnished;

(e) "Oregon Health Plan (OHP)" means the Medicaid program in Oregon that is known as the OHP and governed by a series of laws passed by the Oregon Legislature with the intention of providing universal access to healthcare to Oregonians. OHP is also governed by many federal laws;

(f) "Newborn Nurse Home Visiting Program (NNHV)" has the meaning described in OAR 333-006-0010. The program provides services to Medicaid-eligible newborns and their families. The program is governed by Public Health, Division 6, OAR 333-006-0000 to 333-006-333-006-0160. "Newborn Nurse Home Visiting Program" and "Universally Offered Newborn Nurse Home Visiting Program" are synonymous and may be used interchangeably;

(g) "Newborn nurse home visits" means home visits provided under the Newborn Nurse Home Visiting Program.

(2) Purpose. The primary purpose of providing Newborn Nurse Home Visiting services is to support healthy child development and strengthen families. Newborn nurse home visits are a component of the services provided to families with newborns as part of the Newborn Nurse Home Visiting Program.

(3) Governing Rules. This rule is to be used in conjunction with Newborn Nurse Home Visiting Program (NNHV) Rules 333-006-0000 to 333-006-333-006-0160, Targeted Case Management (TCM) rules OAR 410-138-0000 through 410-138-0390, OAR 410-130-0605, and the HSD's General Rules chapter 410, Division 120.

(4) Eligibility Requirements. The services may be provided to Medicaid eligible infants 0 through 6 months of age. Members must be an eligible client enrolled in OHP on the date of service. NNHV is a carveout from the CCO benefit.

(5) Providers Requirements. Newborn Nurse Home Visiting providers must be enrolled with HSD on the date of service. To be enrolled a provider a must be certified by the Authority according to OAR 333-006-0070.

(6) A comprehensive newborn nurse home visit:

(a) Must meet the requirements described in OAR 333-006-0120. Medical services provided include a comprehensive caregiver (if applicable) and newborn physical nursing assessment as well as standardized anticipatory and supportive guidance;

(b) May include an assessment of family strengths, risks, and needs and referrals for identified interventions or community resources are provided in coordination with the targeted case management requirements described in OAR 410-138-0000 through 410-138-0390;

(c) For Newborn Nurse home visiting services for births with multiples (twins, triplets, etc.) additional newborns may be reimbursed at a reduced case rate;

(d) Is a requirement for OAR 410-130-0605(7).

(7) the Authority will reimburse newborn nurse home visits using a bundled case rate. To be eligible for reimbursement newborn nurse home visits:

(a) Must include at a minimum a comprehensive newborn nurse home visit meeting the requirements of OAR 333-006-0120 and 410-130-0605(6);

(b) May include up to two follow up support visits.

(8) Reimbursement may be made for one (1) support visit prior to the comprehensive visit:

(a) This pre-comprehensive visit may be provided if the nurse home visitor determines the family has immediate postpartum needs within two weeks of birth;

(b) A pre-comprehensive visit may be billed separately from the case rate if meeting the requirements of a support home visit described in OAR 333-006-0120.

(9) The provision of services shall be documented in the client's medical record by the Home visitor who provides home visits under the Newborn Nurse Home Visiting Program. The client's record shall include the dates of service, and a description of services provided.

(10) Requests for reimbursement for home visits under the Newborn Nurse Home Visiting Program shall:

(a) Use CPT 99502 with modifier 32 for one time for a comprehensive visit case rate. This service may be provided over 1-3 home visits;

(b) Use CPT 99502 with modifier TT for one time for a comprehensive visit case rate for each additional baby for births with multiples (twins, triplets, etc.);

(c) Use CPT 99502 with modifier TD one time for a pre-comprehensive visit;

(d) Claim only one comprehensive visit case rate per newborn;

(e) Claim only one pre-comprehensive visit per delivery.

(11) Only an enrolled provider under the Newborn Nurse Home Visiting Program, provider type 64/519, may be the billing provider for home visits under the Newborn Nurse Home Visiting Program.

(12) Newborn Nurse Home Visiting rates are based on the current published fee schedule.

Or. Admin. Code § 410-130-0605

DMAP 55-2021, temporary adopt filed 12/29/2021, effective 1/1/2022 through 6/25/2022; DMAP 58-2022, adopt filed 06/21/2022, effective 6/22/2022

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065