Medicaid Reimbursement

Manzanita Building
1212 NE 5th St.
Redmond, OR 97756
Phone: 541-923-4889

Carole Wolfe

Secretary

541-693-5706
carole.wolfe@hdesd.org

Theresa Layman

Business Supervision - Special Programs

541-693-5612
theresa.layman@hdesd.org


The High Desert Education Service District is currently participating in two Medicaid reimbursement programs and in the planning stages to implement a third program:

  • Medicaid Administrative Claiming (MAC)
  • School Based Health Services (SBHS)
  • Targeted Case Management

Medicaid Administrative Claiming (MAC)

This program reimburses our districts and the High Desert Education Service District for time spent by staff on issues related to connecting children and families to Oregon Health Plan or other health services. Revenue generated by this program supports the Family Access Network (FAN) (link) in all districts in Deschutes County and nursing services in Crook County. 

School Based Health Services (SBHS)

Medically qualified staff bill for reimbursement for services provided to Medicaid eligible children such as:  Occupational Therapy, Physical Therapy, Speech Therapy and Nursing services.  School districts are also permitted to bill for transportation reimbursement to and from the medical service that the child receives according to their IEP (Individualized Education Plan) or IFSP (Individualized Family Service Plan).

HDESD manages a billing consortium whereby school districts pool funds to provide the following consortium services: electronic billing submission, information distribution and training for providers and local district billing clerks.

Participation in School Based Health Services Reimbursement Billing is required by Oregon Department of Education (ODE) for students who qualify for Early Intervention and Early Childhood Special Education programs funded by the legislature at an appropriated level which includes anticipated Medicaid revenue.

Targeted Case Management

Targeted Case Management is Medicaid reimbursement for case management services provided by Early Intervention/Early Childhood Special Education (EI/ECSE).  EI/ECSE staff manage the coordination of services between programs and agencies for children who are eligible for EI/ECSE services according to Federal and State rules and regulations.

The High Desert Education Service District provides Medicaid billing services to help school districts receive reimbursement for health and human services provided within the schools. Reimbursable services include Occupational Therapy, Physical Therapy, Speech Therapy and Nursing services. In addition, school-based Family Access Network (FAN) programs receive reimbursement for time spent linking students with health services such as Oregon Health Plan.

Currently in the planning stages, the Medicaid Targeted Case Management Reimbursement Program provides reimbursement to Early Intervention/Early Childhood Special Education programs for the coordination of services between programs and agencies.