Or. Admin. Code § 410-146-0021

Current through Register Vol. 64, No. 1, January 1, 2025

Section 410-146-0021 - American Indian/Alaska Native (AI/AN) Provider Enrollment

(1) This rule outlines the Division requirements for Indian Health Service (IHS) and Tribal 638 clinics to enroll as American Indian/Alaska Native (AI/AN) providers (refer to OAR 410-120-1260, Provider Enrollment).

(2) An IHS or Tribal 638 clinic that operates a retail pharmacy provides durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) or provides targeted case management (TCM) services must enroll separately as a pharmacy, DMEPOS, or TCM provider. For specific information, refer to OAR chapter 410, division 121, Pharmaceutical Services program; OAR chapter 410, division 122, DMEPOS program; and OAR chapter 410, division 138, TCM program.

(3) To enroll with the Division as an IHCP, a health center must be one of the following:

(a) An IHS direct health care services facility established, operated, and funded by IHS; or

(b) A Tribally-owned and operated facility funded by Title I or V of the Indian Self Determination and Education Assistance Act ( Public Law 93-638) and is referenced throughout these rules as a "Tribal 638" provider:

(A) A Tribal 638 facility that has administrative control, operation, and funding for health programs transferred to AI/AN tribal governments under a Title I contract with IHS;

(B) A Tribal 638 facility that assumes autonomy for the provision of the tribe's own health care services under a Title V compact with IHS.

(4) Eligible IHS and Tribal 638 providers who want to enroll with the Division as an IHCP must submit the following information:

(a) Completed Oregon Health Authority (Authority) provider enrollment forms with attachments;

(b) A Tribal facility must submit documentation verifying they are a 638 provider:

(A) A letter from IHS, applicable-Area Office or Central Office, indicating that the facility (identified by name and address) is a 638 facility;

(B) A written assurance from the Tribe that the facility (identified by name and site address) is owned or operated by the Tribe or a Tribal organization with funding directly obtained under a 638 contract or compact. A copy of the relevant provision of the Tribe's current 638 contract or compact must accompany the written assurance;

(c) A copy of the clinic's Division certification for a program of behavioral health services if someone other than a licensed psychiatrist, licensed clinical psychologist, licensed clinical social worker, psychiatric nurse practitioner, licensed professional counselor, or licensed marriage and family therapist is providing behavioral health services;

(d) A copy of the clinic's Division letter or licensure of approval if providing Substance Use Disorder (SUD) services;

(e) A list of all Prepaid Health Plan (PHP) contracts;

(f) A list of all practitioners contracted with or employed by the IHS or Tribal 638 facility including names, legacy Division provider numbers, National Provider Identifier (NPI) numbers, and associated taxonomy codes; and

(g) A list of all clinics affiliated or owned by the IHS or Tribal 638 facility including business names, legacy Division provider numbers, National Provider Numbers (NPI) and associated taxonomy codes.

Or. Admin. Code § 410-146-0021

OMAP 59-2002, f. & cert. ef. 10-1-02; OMAP 62-2004, f. 9-10-04, cert. ef. 10-1-04; DMAP 19-2007, f. 12-5-07, cert. ef. 1-1-08; DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08; DMAP 46-2009, f. 12-15-09, cert. ef. 1-1-10; DMAP 37-2010, f. 12-15-10, cert. ef. 1-1-11; DMAP 42-2017, amend filed 10/03/2017, effective 10/3/2017

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065