(a) "Emergency medical services" means the services provided by emergency medical services providers to an individual experiencing a medical emergency in order to:
(A) Assess, treat and stabilize the individual’s medical condition; or
(B) Prepare and transport the individual by ground to a medical facility.
(b) "Emergency medical services provider" or "provider" means an entity that employs individuals who are licensed by the Oregon Health Authority under ORS chapter 682 to provide emergency medical services and that is owned or operated by a local government, a state agency or a federally recognized Indian tribe.
(c) "Federal financial participation" means the portion of medical assistance expenditures for emergency medical services that are paid or reimbursed by the Centers for Medicare and Medicaid Services in accordance with the state plan for medical assistance.
(d) "Local government" has the meaning given that term in ORS 174.116.
(2) Upon request, an emergency medical services provider that has entered into a provider agreement with the authority or a contract with a coordinated care organization is eligible to receive Medicaid supplemental reimbursement from the authority or coordinated care organization for the cost of providing emergency medical services to a medical assistance recipient. The Medicaid supplemental reimbursement shall be added to the payment by the authority or coordinated care organization for the emergency medical services as permitted by the Centers for Medicare and Medicaid Services.
(3)(a) Except as provided in paragraph (b) of this subsection, the Medicaid supplemental reimbursement paid to an emergency medical services provider shall be equal to the amount of federal financial participation received by the authority for the provider’s cost for the emergency medical services.
(b) The Medicaid supplemental reimbursement paid to a provider under this section may not exceed the provider’s actual costs for the emergency medical services, determined in accordance with standards established by the authority, less the amount of reimbursement that the provider is eligible to receive from all public and private sources.
(4) An emergency medical services provider shall make readily available to the authority documentation, data and certifications, as prescribed by the authority, necessary to establish that the emergency medical services expenditures qualify for federal financial participation and to calculate the amount of Medicaid supplemental reimbursement that is due.
(5)(a) Except as provided in paragraph (b) of this subsection, the authority shall modify the method for calculating or paying the Medicaid supplemental reimbursement if modification is necessary to ensure that emergency medical services expenditures qualify for federal financial participation.
(b) This section does not authorize the payment of Medicaid supplemental reimbursement to an emergency medical services provider if the provider has not entered into a provider agreement with the authority, or a contract with a coordinated care organization, to serve medical assistance recipients.
(c) If the Centers for Medicare and Medicaid Services approves the implementation of this section and later revokes its approval or expresses its intent to revoke or refuse to renew its approval, the authority shall report the fact at the next convening of the interim or regular session committees of the Legislative Assembly related to health care.
(6) General Fund moneys may not be used to implement this section. As a condition of receiving Medicaid supplemental reimbursement, an emergency medical services provider must enter into and comply with an agreement with the authority to reimburse the authority for the costs of administering this section. [2016 c.34 §2; 2021 c.623 §4]
Structure 2021 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 413 - Oregon Health Authority
Section 413.006 - Establishment of Oregon Health Policy Board.
Section 413.007 - Composition of board.
Section 413.008 - Chairperson; quorum; meetings.
Section 413.011 - Duties of board.
Section 413.016 - Authority of board to establish advisory and technical committees.
Section 413.032 - Establishment of Oregon Health Authority.
Section 413.033 - Oregon Health Authority director.
Section 413.036 - Use of abuse and neglect reports for screening subject individuals; rules.
Section 413.037 - Administering oaths; depositions; subpoenas.
Section 413.038 - Service of notice by regular mail.
Section 413.041 - Persons authorized to represent parties in contested cases.
Section 413.046 - Right to courteous, fair and dignified treatment; grievances.
Section 413.071 - Authorization to request federal waivers.
Section 413.072 - Public process required if waiver of federal requirement involves policy change.
Section 413.083 - Dental director; duties; rules.
Section 413.084 - State School Nursing Consultant; duties.
Section 413.101 - Oregon Health Authority Fund.
Section 413.105 - Deposit of reimbursements received for medical assistance expenditures.
Section 413.109 - Acceptance and expenditures of funds received from private sources.
Section 413.121 - Oregon Health Authority Special Checking Account.
Section 413.125 - Revolving fund.
Section 413.129 - Aggregation of warrants and payments.
Section 413.135 - Combining and eliminating accounts.
Section 413.151 - Setoff of liquidated and delinquent debts.
Section 413.162 - Reports to Legislative Assembly on collection of data under ORS 413.161.
Section 413.164 - Collection and reporting of data by health care providers and insurers; rules.
Section 413.166 - Grants for data collection; rules.
Section 413.167 - Reports to Legislative Assembly.
Section 413.171 - Sharing of data with Department of Human Services; rules.
Section 413.175 - Prohibition on disclosure of information; exceptions.
Section 413.195 - Disclosure of information about cremated or reduced remains.
Section 413.223 - School-based health centers; certification; best practices; rules.
Section 413.231 - Recruitment of primary care providers.
Section 413.234 - Supplemental payments to emergency services providers.
Section 413.235 - Emergency services intergovernmental transfer program.
Section 413.246 - Information provided to retired physicians and health care providers.
Section 413.248 - Physician Visa Waiver Program; rules; fees.
Section 413.250 - Statewide Health Improvement Program.
Section 413.256 - Regional health equity coalitions.
Section 413.257 - Experimental, prototype health care of tomorrow.
Section 413.259 - Patient centered primary care home program and behavioral health home program.
Section 413.260 - Patient centered primary care and behavioral health home delivery models.
Section 413.270 - Advisory council; membership; duties.
Section 413.271 - Palliative care information and resources.
Section 413.300 - Definitions for ORS 413.300 to 413.308, 413.310 and ORS chapter 414.
Section 413.301 - Health Information Technology Oversight Council.
Section 413.303 - Council chairperson; quorum; meetings.
Section 413.308 - Duties of council.
Section 413.310 - Oregon Health Information Technology program; fees; rules.
Section 413.430 - Functions of Director of Oregon Health Authority regarding health professionals.
Section 413.435 - Administrative requirements for students in clinical training.
Section 413.450 - Continuing education in cultural competency.
Section 413.500 - Women, Infants and Children Program; rules; civil penalties.
Section 413.520 - Gambling addiction programs in Oregon Health Authority; advisory committee.
Section 413.522 - Problem Gambling Treatment Fund.
Section 413.550 - Definitions for ORS 413.550 to 413.559.
Section 413.552 - Legislative findings and policy on health care interpreters.
Section 413.554 - Oregon Council on Health Care Interpreters.
Section 413.556 - Testing, qualification and certification standards for health care interpreters.
Section 413.560 - Moneys received credited to account in Oregon Health Authority Fund.
Section 413.561 - Agencies or boards with enforcement authority.
Section 413.570 - Pain Management Commission; duties; staffing.
Section 413.572 - Additional duties of commission.
Section 413.574 - Membership of commission.
Section 413.580 - Pain Management Fund.
Section 413.582 - Acceptance of contributions.
Section 413.600 - Traditional Health Workers Commission.
Section 413.610 - Purpose of Compact of Free Association Premium Assistance Program.
Section 413.611 - Definitions.