2021 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 414 - Medical Assistance

Section 414.034 - Acceptance of federal billing, reimbursement and reporting forms. - Note: 414.034 was enacted into law by the Legislative Assembly...

Section 414.041 - Simplified application process; outreach and enrollment. - (2) In developing the simplified application process, the authority shall...

Section 414.044 - Notice to Department of Veterans’ Affairs of information regarding applications for health care coverage by uniformed service members and veterans; rules. - (a) "Uniformed service" means the Armed Forces of the United...

Section 414.065 - Determination of health care and services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules. - (A) The types and extent of health care and services...

Section 414.066 - Billing patient for services covered by medical assistance prohibited. - (2)(a) A health care provider that submits a claim for...

Section 414.067 - Coordinated care organization assumption of costs; reports to Legislative Assembly. - (2) If the authority or the department requires a coordinated...

Section 414.071 - Timely payment for dental services. - Note: 414.071 was enacted into law by the Legislative Assembly...

Section 414.072 - Prior authorization data and reports. - (2) The Oregon Health Authority shall compile and annually post...

Section 414.075 - Payment of deductibles imposed under federal law. - (1) The full amount of any deductible imposed with respect...

Section 414.109 - Oregon Health Plan Fund. - (2) Moneys in the Oregon Health Plan Fund are continuously...

Section 414.115 - Medical assistance by insurance or service contracts; rules. - assistance. Notwithstanding other specific provisions, the use of available medical...

Section 414.117 - Premium assistance for health insurance coverage. - Note: 414.117 was enacted into law by the Legislative Assembly...

Section 414.125 - Rates on insurance or service contracts; requirements for insurer or contractor. - (2) No premium or other periodic charge on any policy...

Section 414.135 - Contracts relating to direct providers of care and services. - (1) To make all payments under this chapter promptly but...

Section 414.145 - Implementation of ORS 414.115, 414.125 or 414.135. - (2) When determining comparable benefits at equal or less cost...

Section 414.150 - Purpose of ORS 414.150 to 414.153. - (1) Enhance the state and local public health partnership; (2)...

Section 414.152 - Duty of state agencies to work with local health departments. - Note: See note under 414.150.

Section 414.153 - Services provided by local health departments. - (1) Unless cause can be shown why such an agreement...

Section 414.211 - Medicaid Advisory Committee. - (2) The committee shall be composed of: (a) A physician...

Section 414.221 - Duties of committee. - (1) Medical care, including mental health and alcohol and drug...

Section 414.227 - Application of public meetings law to advisory committees. - (2) Subsection (1) of this section applies only to advisory...

Section 414.231 - Eligibility for Cover All People program; 12-month continuous enrollment; verification of eligibility. - (a) "Adult" means a person 19 years of age or...

Section 414.312 - Oregon Prescription Drug Program. - (a) "Pharmacy benefit manager" means an entity that negotiates and...

Section 414.314 - Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees. - (2) The authority shall provide a mechanism to calculate and...

Section 414.318 - Prescription Drug Purchasing Fund. - Note: See note under 414.312.

Section 414.320 - Rules. - (1) Issuing prescription drug identification cards to individuals and entities...

Section 414.325 - Prescription drugs; use of legend or generic drugs; prior authorization; rules. - (a) "Legend drug" means any drug requiring a prescription by...

Section 414.326 - Supplemental rebates from pharmaceutical manufacturers. - (2) The authority may participate in a multistate prescription drug...

Section 414.327 - Electronically transmitted prescriptions; rules. - Note: 414.327 was enacted into law by the Legislative Assembly...

Section 414.328 - Synchronization of prescription drug refills. - (2) Each coordinated care organization shall implement a synchronization policy...

Section 414.329 - Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules. - (a) Identification of the Part D classes of drugs for...

Section 414.330 - Legislative findings on prescription drugs. - (1) The cost of prescription drugs in the medical assistance...

Section 414.332 - Policy for Practitioner-Managed Prescription Drug Plan. - (1) Oregonians have access to the most effective prescription drugs...

Section 414.334 - Practitioner-Managed Prescription Drug Plan for medical assistance program. - (2) In adopting the plan, the authority shall consider recommendations...

Section 414.337 - Limitation on rules regarding Practitioner-Managed Prescription Drug Plan. - Note: 414.337 was enacted into law by the Legislative Assembly...

Section 414.351 - Definitions for ORS 414.351 to 414.414. - (1) "Compendia" means those resources widely accepted by the medical...

Section 414.353 - Committee established; membership. - (2) The Director of the Oregon Health Authority shall appoint...

Section 414.354 - Meetings; advisory committees; public notice and testimony. - (2) A committee member is not entitled to compensation but...

Section 414.356 - Executive session. - (a) Reviewing the prescribing or dispensing practices of individual physicians...

Section 414.359 - Mental Health Clinical Advisory Group. - (a) The efficacy of the drug; (b) The cost of...

Section 414.361 - Committee to advise and make recommendations on drug utilization review standards and interventions; preferred drug list. - (a) Adoption of rules to implement ORS 414.351 to 414.414...

Section 414.364 - Intervention approaches. - (1) Information disseminated to prescribers and pharmacists to ensure that...

Section 414.369 - Prospective drug use review program. - (1) Therapeutic duplication. (2) Drug-drug interactions, including serious interactions with...

Section 414.371 - Retrospective drug use review program. - (1) Guidelines established by the Oregon Health Authority that are...

Section 414.372 - Pharmacy lock-in program; rules. - (A) Uses three or more pharmacies in a six-month period;...

Section 414.381 - Annual reports; educational materials; procedures to protect confidential information. - (1) Publish an annual report, as described in ORS 414.382....

Section 414.382 - Requirements for annual report. - (a) An overview of the activities of the Pharmacy and...

Section 414.414 - Use and disclosure of confidential information. - (2) The staff of the committee may have access to...

Section 414.426 - Payment of cost of medical care for institutionalized persons. - Note: 414.426 was enacted into law by the Legislative Assembly...

Section 414.428 - Coverage for American Indian and Alaska Native beneficiaries. - (a) The Oregon Health Authority receives 100 percent federal medical...

Section 414.430 - Access to dental care for pregnant women; rules. - (a) Emergency dental services; (b) Urgent dental services; (c) Routine...

Section 414.432 - Reproductive health services for noncitizens. - (2) The authority shall provide the medical assistance for pregnant...

Section 414.500 - Findings regarding medical assistance for persons with hemophilia. - Note: 414.500 to 414.530 were enacted into law by the...

Section 414.510 - Definitions. - (2) "Hemophilia services" means a program for medical care, including...

Section 414.520 - Hemophilia services. - Note: See note under 414.500.

Section 414.530 - When payments not made for hemophilia services. - Note: See note under 414.500.

Section 414.532 - Definitions for ORS 414.534 to 414.538. - (1) "Medical assistance" has the meaning given that term in...

Section 414.534 - Treatment for breast or cervical cancer; eligibility criteria for medical assistance; rules. - (a) Is found by a provider to be in need...

Section 414.536 - Presumptive eligibility for medical assistance for treatment of breast or cervical cancer. - (2) The period of time a woman may receive medical...

Section 414.538 - Prohibition on coverage limitations; priority to low-income women. - (2) In establishing eligibility requirements for medical assistance under ORS...

Section 414.540 - Rules. - Note: See note under 414.532.

Section 414.550 - Definitions for ORS 414.550 to 414.565. - (1) "Cystic fibrosis services" means a program for medical care,...

Section 414.555 - Findings regarding medical assistance for persons with cystic fibrosis. - Note: See note under 414.550.

Section 414.560 - Cystic fibrosis services. - (2) No member of the review committee shall be held...

Section 414.565 - When payments not made for cystic fibrosis services. - Note: See note under 414.550.

Section 414.570 - System established. - (2) The Oregon Health Authority shall seek input from groups...

Section 414.572 - Coordinated care organizations; rules. - (a) Have demonstrated experience and a capacity for managing financial...

Section 414.575 - Community advisory councils. - (a) Include representatives of the community and of each county...

Section 414.577 - Community health assessment and adoption of community health improvement plan; rules. - (2) The coordinated care organization shall post the health improvement...

Section 414.578 - Community health improvement plan. - (a) Working with programs developed by the Early Learning Council,...

Section 414.581 - Tribal Advisory Council established; membership; terms. - (a) Serve as a channel of communication between the coordinated...

Section 414.584 - Meetings of coordinated care organization governing body to be open to public; recording and taking of minutes required. - (a) Be open to the public; (b) Provide an opportunity...

Section 414.590 - Coordinated care organization contracts; terms and amendments; 60 days’ advance notice; refusal to renew. - (a) "Benefit period" means a period of time, shorter than...

Section 414.591 - Coordinated care organization contracts; financial reporting; rules. - (2) The authority shall execute contracts with coordinated care organizations...

Section 414.592 - Requirements for contracts between authority and providers; alignment with behavioral quality health metrics and incentives. - (1) Contracts between the Oregon Health Authority and coordinated care...

Section 414.593 - Reporting and public disclosure of expenditures by coordinated care organizations. - (a) "Coordinated care organization" has the meaning given that term...

Section 414.595 - External quality reviews of coordinated care organizations; limits on documentation and reporting requirements. - (a) "Coordinated care organization" has the meaning given that term...

Section 414.598 - Alternative payment methodologies. - (a) Reimburse providers on the basis of health outcomes and...

Section 414.605 - Consumer and provider protections. - (a) Must be encouraged to be an active partner in...

Section 414.607 - Use and disclosure of member information; access by member to personal health information. - (2) A member of a coordinated care organization must have...

Section 414.609 - Network adequacy; member transfers. - (2) A member may transfer from one organization to another...

Section 414.611 - Transfer of 500 or more members of coordinated care organization. - (a) The members’ provider has contracted with the receiving organization...

Section 414.613 - Discrimination based on scope of practice prohibited; appeals; rules. - (2) An organization may establish an internal review process for...

Section 414.619 - Coordination between Oregon Health Authority and Department of Human Services. - (2) The authority and the department may delegate to each...

Section 414.628 - Innovator agents. - (2) Innovator agents must observe the meetings of the community...

Section 414.631 - Mandatory enrollment in coordinated care organization; exemptions. - (2) Subsections (1) and (4) of this section do not...

Section 414.632 - Services to individuals who are dually eligible for Medicare and Medicaid. - (2) An individual who is dually eligible for Medicare and...

Section 414.638 - Metrics and scoring subcommittee; identification of outcome and quality measures and benchmarks. - (a) Three members at large; (b) Three individuals with expertise...

Section 414.654 - Persons served by prepaid managed care health services organizations; funding of health information technology. - (A) A geographic area of the state that a coordinated...

Section 414.655 - Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. - (a) A community health worker. (b) A personal health navigator....

Section 414.665 - Traditional health workers utilized by coordinated care organizations; rules. - (a) A community health worker. (b) A personal health navigator....

Section 414.669 - Payment for doula services. - Note: Sections 6 and 8, chapter 281, Oregon Laws 2017,...

Section 414.686 - Health assessments for foster children. - (2) If a child has not received an initial health...

Section 414.688 - Commission established; membership. - (a) "Practice of pharmacy" has the meaning given that term...

Section 414.689 - Members; meetings. - (2) A majority of the members of the commission constitutes...

Section 414.690 - Prioritized list of health services. - (2) The commission shall actively solicit public involvement through a...

Section 414.694 - Commission review of covered reproductive health services. - Note: 414.694 was enacted into law by the Legislative Assembly...

Section 414.695 - Medical technology assessment. - (a) "Medical technology" means medical equipment and devices, medical or...

Section 414.698 - Comparative effectiveness of medical technologies. - (2) The commission shall develop or identify and shall disseminate...

Section 414.701 - Commission may not rely solely on comparative effectiveness research. - Note: See note under 414.695.

Section 414.706 - Persons eligible for medical assistance; rules. - (1) Is receiving a category of aid; (2) Would be...

Section 414.710 - Services not subject to prioritized list. - (1) Nursing facilities, institutional and home- and community-based waivered services...

Section 414.712 - Health services for certain eligible persons. - (1) Ombudsman services for individuals who receive medical assistance under...

Section 414.717 - Palliative care program; rules. - (a) "Interdisciplinary team" means a group composed of the following...

Section 414.719 - Housing navigation services and social determinants of health; rules. - Note: 414.719 was enacted into law by the Legislative Assembly...

Section 414.723 - Telemedicine services; rules. - (a)(A) "Audio only" means the use of audio telephone technology,...

Section 414.726 - Requirement to use certified or qualified health care interpreters; reimbursement; rules. - (a) "Certified health care interpreter" has the meaning given that...

Section 414.735 - Reduction in scope of health services in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers. - (a) The population of eligible persons determined by law may...

Section 414.743 - Payment to noncontracting hospital by coordinated care organization; rules. - (2)(a) If a coordinated care organization does not have a...

Section 414.755 - Payment for hospital services. - (1) For the period from October 1, 2009, through September...

Section 414.756 - Payments to Oregon Health and Science University. - Note: The amendments to 414.756 by section 18, chapter 2,...

Section 414.760 - Payment for patient centered primary care home and behavioral health home services. - (2) The authority shall require each coordinated care organization, to...

Section 414.762 - Payment for child abuse assessment. - (a) "Child abuse assessment" has the meaning given that term...

Section 414.764 - Payment for services provided by pharmacy or pharmacist. - (a) Provided to a medical assistance recipient who is not...

Section 414.766 - Behavioral health treatment; rules. - (a) For a member who is experiencing a behavioral health...

Section 414.767 - Survey of medical assistance recipients regarding experience with behavioral health care and services. - Note: 414.767 was enacted into law by the Legislative Assembly...

Section 414.770 - Participants in clinical trials. - (a) "Approved clinical trial" has the meaning given that term...

Section 414.772 - Limits on use of step therapy. - (2) A coordinated care organization that requires step therapy shall...

Section 414.780 - Coordinated care organization reporting of data to assess compliance with mental health parity requirements; annual assessment. - (a) "Behavioral health coverage" means mental health treatment and services...

Section 414.781 - Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services. - (1) Existing reimbursement codes used for co-occurring disorder treatments; (2)...

Section 414.782 - Reimbursement to ensure access to addiction treatment statewide. - Note: See note under 414.781. Note: Sections 3, 4, 21...

Section 414.805 - Liability of individual for medical services received while in custody of law enforcement officer. - (a) To the provider of the medical services for the...

Section 414.807 - Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury. - (b) When a law enforcement agency involved with an injury...

Section 414.815 - Law Enforcement Medical Liability Account; limited liability; rules; report. - (2) The liability of the Law Enforcement Medical Liability Account...

Section 414.853 - Definitions. - (1) "Charity care" means costs for providing inpatient or outpatient...

Section 414.855 - Hospital assessment; rates; rules. - (2) Each assessment shall be reported on a form prescribed...

Section 414.857 - Reduction in rate required by federal law. - Note: 414.857 is repealed January 2, 2031, and applies to...

Section 414.863 - Refund of hospital assessment; right to contested case hearing. - (2) Any hospital that is aggrieved by an action of...

Section 414.865 - Audits. - Note: 414.865 is repealed January 2, 2031, and applies to...

Section 414.867 - Deposit of assessments collected to Hospital Quality Assurance Fund. - Note: 414.867 is repealed January 2, 2031, and applies to...

Section 414.869 - Establishment of Hospital Quality Assurance Fund. - (2) Amounts in the Hospital Quality Assurance Fund are continuously...

Section 414.871 - Applicability of hospital assessment. - Note: See second note under 414.853. Note: Sections 12 (1)...

Section 414.880 - Managed care organization assessment; rate. - (a) "Managed care organization" means: (A) A coordinated care organization...

Section 414.882 - Refund of managed care organization assessment; right to contested case hearing. - (2) Any managed care organization that is aggrieved by an...

Section 414.884 - Applicability of managed care organization assessment. - Note: See note under 414.880.

Section 414.900 - Hospital assessment; penalties. - (2) Penalties imposed under this section shall be collected by...

Section 414.902 - Managed care organization assessment; penalties. - (2) Any penalty imposed under this section is in addition...

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2021 Oregon Revised Statutes Volume : 11 - Juvenile Code, Human Services Chapter 414 - Medical Assistance

2021 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 414 - Medical Assistance