414.001 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
Oregon Revised Statutes
Chapter 414 — Medical Assistance
341 sections414.002 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.003 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.004 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.005 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.006 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.007 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.008 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.009 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.010 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.011 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.012 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.013 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.014 [Repealed by 1953 c.378 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.015 [Repealed by 1953 c.30 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.016 [Repealed by 1953 c.30 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.017 [Repealed by 1953 c.30 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.018 Legislative intent; findings
It is the intention of the Legislative Assembly to achieve the goals of universal access to an adequate level of high quality health care at an affordable cost. The Legislative Assembly finds: A significant level of public and private funds is expended each year for the provision of health care to Oregonians; The state has a strong interest in assisting O…
414.019 [1993 c.815 §2; 1999 c.547 §4; 2005 c.22 §284; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.020 [Repealed by 1953 c.204 §9]repealed
No operative statutory text appears at this designation in the selected edition.
414.021 [1993 c.815 §3; 1995 c.727 §19; 1997 c.683 §14; 1999 c.547 §5; 2003 c.47 §1; 2003 c.784 §6; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.022 [1993 c.815 §29; 1995 c.806 §3; 1995 c.807 §4; 1999 c.835 §1; 2001 c.900 §100; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.023 [1993 c.815 §30; 1997 c.249 §128; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.024 [1993 c.815 §31; 1997 c.683 §15; 1999 c.547 §6; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.025 Definitions for ORS chapters 411, 413 and 414
As used in this chapter and ORS chapters 411 and 413, unless the context or a specially applicable statutory definition requires otherwise: “Alternative payment methodology” means a payment other than a fee-for-services payment, used by coordinated care organizations as compensation for the provision of integrated and coordinated health care and services. …
414.026 [2001 c.980 §2; renumbered 414.420 in 2005]renumbered
No operative statutory text appears at this designation in the selected edition.
414.027 [2001 c.980 §3; renumbered 414.422 in 2005]renumbered
No operative statutory text appears at this designation in the selected edition.
414.028 [Formerly 414.305; renumbered 414.426 in 2005]renumbered
No operative statutory text appears at this designation in the selected edition.
414.029 [2003 c.76 §1; renumbered 414.428 in 2005]renumbered
No operative statutory text appears at this designation in the selected edition.
414.030 [Repealed by 1953 c.204 §9]repealed
No operative statutory text appears at this designation in the selected edition.
414.031 [2003 c.784 §9; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.032 [1967 c.502 §4; 1985 c.747 §10; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.033 Expenditures for medical assistance authorized
The Oregon Health Authority may: Subject to the allotment system provided for in ORS 291.234 to 291.260, expend such sums as are required to be expended in this state to provide medical assistance. Expenditures for medical assistance include, but are not limited to, expenditures for deductions, cost sharing, enrollment fees, premiums or similar charges impo…
414.034 Acceptance of federal billing, reimbursement and reporting forms
The Oregon Health Authority shall accept federal Centers for Medicare and Medicaid Services billing, reimbursement and reporting forms instead of department billing, reimbursement and reporting forms if the federal forms contain substantially the same information as required by the department forms. Note: 414.034 was enacted into law by the Legislative Asse…
414.035 [1965 c.556 §1; repealed by 1967 c.502 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.036 [1983 c.415 §2; 1989 c.836 §1; 1991 c.753 §1; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.037 [1967 c.502 §5; repealed by 1975 c.509 §2 (414.038 enacted in lieu of 414.037)]repealed
No operative statutory text appears at this designation in the selected edition.
414.038 [1975 c.509 §§3,4 (enacted in lieu of 414.037); repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.039 [1985 c.747 §12; 1989 c.31 §1; 1991 c.66 §7; 1997 c.581 §23; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.040 [1953 c.204 §2; renumbered 414.810 and then 566.310]renumbered
No operative statutory text appears at this designation in the selected edition.
414.041 Simplified application process; outreach and enrollment
The Oregon Health Authority, under the direction of the Oregon Health Policy Board and in collaboration with the Department of Human Services, shall implement a streamlined and simple application process for the medical assistance and premium assistance programs administered by the Oregon Health Authority. The process must meet the requirements of ORS 411.40…
414.042 [1967 c.502 §6; 1971 c.503 §1; 1989 c.836 §20; 1991 c.66 §8; 1991 c.753 §2; 1993 c.815 §20; 1995 c.807 §2; 1997 c.581 §24; 2007 c.861 §21; 2009 c.595 §269; 2009 c.867 §42; renumbered 411.404 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.044 Notice to Department of Veterans’ Affairs of information regarding applications for health care coverage by uniformed service members and veterans; rules
As used in this section: “Uniformed service” means the Armed Forces of the United States, the Army National Guard or the Air National Guard when the member is engaged in active duty for training, inactive duty for training or full-time National Guard duty, the commissioned corps of the United States Public Health Service and any other category of persons de…
414.045 [1965 c.556 §3; repealed by 1967 c.502 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.047 [1967 c.502 §7; 1969 c.68 §8; 1971 c.779 §46; 1991 c.66 §9; 2003 c.14 §189; renumbered 411.400 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.049 [2003 c.810 §17; 2009 c.595 §272; renumbered 411.402 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.050 [1953 c.204 §2; renumbered 414.820 and then 566.320]renumbered
No operative statutory text appears at this designation in the selected edition.
414.051 [1979 c.296 §2; 1991 c.66 §10; 2009 c.595 §273; renumbered 411.459 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.055 [1965 c.556 §4; 1971 c.734 §45; 1971 c.779 §47; 1991 c.66 §11; renumbered 411.408 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.057 [1967 c.502 §8; 1971 c.779 §48; 1991 c.66 §12; renumbered 411.406 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.060 [1953 c.204 §3; renumbered 414.830 and then 566.330]renumbered
No operative statutory text appears at this designation in the selected edition.
414.065 Determination of health services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules
Consistent with ORS 414.690, 414.710, 414.712 and 414.766 and other statutes governing the provision of and payments for health services in medical assistance, the Oregon Health Authority shall determine, subject to such revisions as it may make from time to time and to legislative funding: The types and extent of health services to be provided to each elig…
414.066 Billing patient for services covered by medical assistance prohibited
A health care provider may not bill or solicit payment from a medical assistance applicant or recipient for services, except for copayments or other charges authorized by the Oregon Health Authority by rule. A health care provider that submits a claim for payment to the authority or a coordinated care organization shall wait to receive payment for at least …
414.067 Coordinated care organization assumption of costs; reports to Legislative Assembly
If the Oregon Health Authority or the Department of Human Services requires a coordinated care organization to provide a service, paid for out of the organization’s global budget, that was previously reimbursed by the authority or the department on a fee-for-service basis, the authority or the department must provide the organization with a statement of the …
414.070 [1953 c.204 §4; renumbered 414.840 and then 566.340]renumbered
No operative statutory text appears at this designation in the selected edition.
414.071 Timely payment for dental services
The Oregon Health Authority and the Department of Human Services shall approve or deny prior authorization requests for dental services not later than 30 days after submission thereof by the provider, and shall make payments to providers of prior authorized dental services not later than 30 days after receipt of the invoice of the provider. Note: 414.071 wa…
414.072 Prior authorization data and reports
As used in this section, “coordinated care organization” has the meaning given that term in ORS 414.025. The Oregon Health Authority shall compile and annually post to the authority’s website a report of the following information, in the aggregate, that was reported to the authority by coordinated care organizations regarding requests for prior authorizatio…
414.073 [1971 c.188 §2; 1991 c.66 §14; 2009 c.595 §277; renumbered 411.463 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.074 Timely prior authorization determinations for repair of complex rehabilitation technology
As used in this section, “complex rehabilitation technology” means manual or power wheelchair systems, adaptive seating systems, alternative positioning systems, adaptive strollers, standing frames, gait trainers or specifically designated options or accessories that are: Classified as durable medical equipment; and Individually configured for a specific i…
414.075 Payment of deductibles imposed under federal law
Medical assistance provided to any individual who is covered by the hospital insurance benefits or supplementary health insurance benefits, or either of them, as established by federal law, may include: The full amount of any deductible imposed with respect to such individual under the hospital insurance benefits; and All or any part of any deductible, cos…
414.080 [1953 c.204 §5; renumbered 414.850 and then 566.350]renumbered
No operative statutory text appears at this designation in the selected edition.
414.085 [1965 c.556 §10; 1991 c.66 §15; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.090 [1953 c.204 §6; renumbered 414.860 and then 566.360]renumbered
No operative statutory text appears at this designation in the selected edition.
414.095 Exemptions applicable to payments
Neither medical assistance nor amounts payable to vendors out of medical assistance funds are transferable or assignable at law or in equity and none of the money paid or payable under the provisions of this chapter is subject to execution, levy, attachment, garnishment or other legal process.
414.105 [1965 c.556 §12; 1967 c.502 §15; 1969 c.507 §2; 1971 c.334 §1; 1973 c.334 §1; part renumbered 416.280; 1975 c.386 §4; 1985 c.522 §4; 1991 c.66 §16; 1993 c.249 §5; 1995 c.642 §1; 2001 c.620 §5; 2001 c.900 §223; 2007 c.70 §191; 2009 c.595 §278; renumbered 416.350 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.106 [1995 c.642 §2; 2001 c.900 §224; 2009 c.595 §279; renumbered 416.351 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.107 [1991 c.753 §5a; 1993 c.815 §15; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.109 Oregon Health Plan Fund
The Oregon Health Plan Fund is established, separate and distinct from the General Fund. Interest earned by the Oregon Health Plan Fund shall be retained by the Oregon Health Plan Fund. Moneys in the Oregon Health Plan Fund are continuously appropriated to the Department of Human Services for the purposes of funding the maintenance and expansion of the numb…
414.115 Medical assistance by insurance or service contracts; rules
In lieu of providing one or more of the health care and services available under medical assistance by direct payments to providers thereof and in lieu of providing such health care and services made available pursuant to ORS 414.065, the Oregon Health Authority may use available medical assistance funds to purchase and pay premiums on policies of insurance,…
414.117 Premium assistance for health insurance coverage
Subject to funds available, the Oregon Health Authority may provide medical assistance in the form of premium assistance for the purchase of health insurance coverage provided by public programs or private insurance, including but not limited to medical assistance described in ORS 414.115. Note: 414.117 was enacted into law by the Legislative Assembly but w…
414.125 Rates on insurance or service contracts; requirements for insurer or contractor
Any payment of available medical assistance funds for policies of insurance or service contracts shall be according to such uniform area-wide rates as the Oregon Health Authority shall have established and which it may revise from time to time as may be necessary or practical, except that, in the case of a research and demonstration project entered into unde…
414.135 Contracts relating to direct providers of care and services
The Oregon Health Authority may enter into nonexclusive contracts under which funds available for medical assistance may be administered and disbursed by the contractor to direct providers of medical and remedial care and services available under medical assistance in consideration of services rendered and supplies furnished by them in accordance with the pr…
414.145 Implementation of ORS 414.115, 414.125 or 414.135
The provisions of ORS 414.115, 414.125 or 414.135 shall be implemented whenever it appears to the Oregon Health Authority that such implementation will provide comparable benefits at equal or less cost than provision thereof by direct payments by the authority to the providers of medical assistance, but in no case greater than the legislatively approved budg…
414.150 Purpose of ORS 414.150 to 414.153
It is the purpose of ORS 414.150 to 414.153 to take advantage of opportunities to: Enhance the state and local public health partnership; Improve the access to care and health status of women and children; and Strengthen public health programs and services at the local level. Note: 414.150 to 414.153 were enacted into law by the Legislative Assembly but …
414.151 [1991 c.337 §2; 1993 c.18 §100; 2001 c.900 §101; 2009 c.595 §285; renumbered 411.435 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.152 Duty of state agencies to work with local health departments
To capitalize on the successful public health programs provided by local health departments and the sizable investment by state and local governments in the public health system, state agencies shall encourage agreements that allow local health departments and other publicly supported programs to continue to be the providers of those prevention and health pr…
414.153 Services provided by local health departments
In order to make advantageous use of the system of public health care and services available through local health departments and other publicly supported programs and to ensure access to public health care and services through contract under ORS chapter 414, the state shall: Unless cause can be shown why such an agreement is not feasible, require and appro…
414.205 [1967 c.502 §18; 1981 c.825 §1; repealed by 1995 c.727 §48]repealed
No operative statutory text appears at this designation in the selected edition.
414.210 [1957 c.692 §1; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.211 Medicaid Advisory Committee
There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor. The committee shall be composed of: A physician licensed under ORS chapter 677; Two members of health care consumer groups that include Medicaid recipients; Two Medicaid recipients, one of whom shall be a person with a disability; The Dir…
414.215 [1967 c.502 §19; 1991 c.66 §21; repealed by 1995 c.727 §48]repealed
No operative statutory text appears at this designation in the selected edition.
414.220 [1957 c.692 §2; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.221 Duties of committee
The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on: Medical care, including mental health and alcohol and drug treatment and remedial care to be provided under ORS chapter 414; and The operation and administration of programs provided under ORS chapter 414. Note: See note under 41…
414.225 Oregon Health Authority to consult with committee
The Oregon Health Authority shall consult with the Medicaid Advisory Committee concerning the determinations required under ORS 414.065.
414.227 Application of public meetings law to advisory committees
ORS 192.610 to 192.705 apply to any meeting of an advisory committee with the authority to make decisions for, conduct policy research for or make recommendations to the Oregon Health Authority, the Oregon Health Policy Board or the Department of Human Services on administration or policy related to the medical assistance program operated under this chapter.…
414.229 [Formerly 414.751; 2011 c.602 §38; repealed by 2015 c.318 §56]repealed
No operative statutory text appears at this designation in the selected edition.
414.230 [1957 c.692 §5; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.231 Eligibility for Cover All People program; 12-month continuous enrollment; verification of eligibility
As used in this section: “Adult” means a person 19 years of age or older. “Child” means a person under 19 years of age. The Cover All People program is established to make affordable, accessible health care available to all residents in this state. The program provides medical assistance, funded in whole or in part by Title XIX of the Social Security Act,…
414.240 [1957 c.692 §3; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.241 Oregon Health Authority to administer bridge program
The Oregon Health Authority shall administer a bridge program to provide affordable health care coverage, improve the continuity of coverage and care for Oregonians and reduce health inequities for individuals who regularly enroll and disenroll in the medical assistance program due to fluctuations in their incomes. Note: 414.241 and 414.245 were enacted int…
414.245 Bridge Program Fund
The Bridge Program Fund is established in the State Treasury, separate and distinct from the General Fund, consisting of federal funds received by the Oregon Health Authority to administer the bridge program described in ORS 414.241. Moneys in the Bridge Program Fund are continuously appropriated to the Oregon Health Authority to carry out ORS 414.241. Note…
414.250 [1957 c.692 §4; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.260 [1957 c.692 §6; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.270 [1957 c.692 §7(1); repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.280 [1957 c.692 §7(2); repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.290 [1957 c.692 §7(3); repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.300 [1957 c.692 §8; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.305 [1969 c.507 §3; 1971 c.33 §1; 1977 c.384 §5; 1991 c.66 §23; 2001 c.900 §102; renumbered 414.028 in 2001]renumbered
No operative statutory text appears at this designation in the selected edition.
414.310 [1957 c.692 §9; 1961 c.130 §2; repealed by 1963 c.631 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.312 Oregon Prescription Drug Program
As used in ORS 414.312 to 414.318: “Pharmacy benefit manager” means an entity that negotiates and executes contracts with pharmacies, manages preferred drug lists, negotiates rebates with prescription drug manufacturers and serves as an intermediary between the Oregon Prescription Drug Program, prescription drug manufacturers and pharmacies. “Prescription …
414.314 Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees
An individual or entity described in ORS 414.312 (4) may apply to participate in the Oregon Prescription Drug Program. Participants shall apply on an application provided by the Oregon Health Authority. The authority may charge participants a nominal fee to participate in the program. The authority shall issue a prescription drug identification card to parti…
414.316 [2003 c.714 §3; 2007 c.697 §19; 2009 c.595 §293; repealed by 2015 c.318 §56]repealed
No operative statutory text appears at this designation in the selected edition.
414.318 Prescription Drug Purchasing Fund
The Prescription Drug Purchasing Fund is established separate and distinct from the General Fund. The Prescription Drug Purchasing Fund shall consist of moneys appropriated to the fund by the Legislative Assembly and moneys received by the Oregon Health Authority for the purposes established in this section in the form of gifts, grants, bequests, endowments …
414.320 Rules
The Oregon Health Authority shall adopt rules to implement and administer ORS 414.312 to 414.318. The rules shall include but are not limited to establishing procedures for: Issuing prescription drug identification cards to individuals and entities that participate in the Oregon Prescription Drug Program; and Enrolling pharmacies in the program. Note: See…
414.324 Prohibition on requiring prior authorization or step therapy for human immunodeficiency virus drugs
As used in this section: “Prior authorization” has the meaning given that term in ORS 743B.001. “Step therapy” has the meaning given that term in ORS 743B.001. Notwithstanding ORS 414.325, the Oregon Health Authority and a coordinated care organization may not require prior authorization or step therapy for drugs prescribed for a medical assistance recipi…
414.325 Prescription drugs; use of legend or generic drugs; prior authorization; rules
As used in this section: “Legend drug” means any drug requiring a prescription by a practitioner, as defined in ORS 689.005. “Urgent medical condition” means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the development of more serious medical problems. A licensed practitioner may prescribe such d…
414.326 Supplemental rebates from pharmaceutical manufacturers
The Oregon Health Authority shall negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates that are in addition to the discount required under federal law to participate in the medical assistance program. The authority may participate in a multistate prescription drug purchasing pool for the purpose of negotiating suppl…
414.327 Electronically transmitted prescriptions; rules
The Oregon Health Authority shall adopt rules permitting a practitioner to communicate prescription drug orders by electronic means directly to the dispensing pharmacist. Note: 414.327 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Rev…
414.328 Synchronization of prescription drug refills
As used in this section, “synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently. Each coordinated care organization shall implement a synchronization policy for the dispensing of prescription drugs to members of the organiza…
414.329 Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules
Notwithstanding ORS 414.591, 414.631 and 414.688 to 414.745, the Oregon Health Authority shall adopt rules modifying the prescription drug benefits for persons who are eligible for Medicare Part D prescription drug coverage and who receive prescription drug benefits under the state medical assistance program or Title XIX of the Social Security Act. The rules…
414.330 Legislative findings on prescription drugs
The Legislative Assembly finds that: The cost of prescription drugs in the medical assistance program is growing and will soon be unsustainable; The benefit of prescription drugs when appropriately used decreases the need for other expensive treatments and improves the health of Oregonians; and Providing the most effective drugs in the most cost-effective…
414.332 Policy for Practitioner-Managed Prescription Drug Plan
It is the policy of the State of Oregon that a Practitioner-Managed Prescription Drug Plan will ensure that: Oregonians have access to the most effective prescription drugs appropriate for their clinical conditions; Decisions concerning the clinical effectiveness of prescription drugs are made by licensed health practitioners, are informed by the latest pe…
414.334 Practitioner-Managed Prescription Drug Plan for medical assistance program
The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best possible price. In adopting the plan, the authority shall consider recommendations o…
414.336 [2003 c.810 §22; repealed by 2009 c.827 §14]repealed
No operative statutory text appears at this designation in the selected edition.
414.337 Limitation on rules regarding Practitioner-Managed Prescription Drug Plan
The Oregon Health Authority may not adopt or amend any rule that requires a prescribing practitioner to contact the authority to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug list for that class of drugs adopted under ORS 414.334, unless otherwise author…
414.338 [2001 c.869 §1; 2009 c.595 §301; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.340 [2001 c.869 §3; 2005 c.381 §15; repealed by 2009 c.263 §1]repealed
No operative statutory text appears at this designation in the selected edition.
414.342 [2001 c.869 §4; repealed by 2009 c.263 §1]repealed
No operative statutory text appears at this designation in the selected edition.
414.344 [2001 c.869 §10; repealed by 2009 c.263 §1]repealed
No operative statutory text appears at this designation in the selected edition.
414.346 [2001 c.869 §8; repealed by 2009 c.263 §1]repealed
No operative statutory text appears at this designation in the selected edition.
414.348 [2001 c.869 §6; 2005 c.22 §285; repealed by 2009 c.263 §1]repealed
No operative statutory text appears at this designation in the selected edition.
414.350 [1993 c.578 §1; 2009 c.595 §302; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.351 Definitions for ORS 414.351 to 414.414
As used in ORS 414.351 to 414.414: “Compendia” means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources: The American Hospital Formulary Service drug information. The United States Pharmacopeia drug information. The American Medical Association drug evaluations. Peer-reviewed medica…
414.353 Committee established; membership
There is created an 11-member Pharmacy and Therapeutics Committee responsible for advising the Oregon Health Authority on the implementation of the retrospective and prospective programs and on the Practitioner-Managed Prescription Drug Plan. The Director of the Oregon Health Authority shall appoint the members of the committee, who shall serve at the pleas…
414.354 Meetings; advisory committees; public notice and testimony
Except as provided in ORS 414.356, the Pharmacy and Therapeutics Committee shall operate in accordance with ORS chapter 192. The committee shall annually elect a chairperson from the members of the committee. A committee member is not entitled to compensation but is entitled to reimbursement for actual and necessary travel expenses incurred in connection wi…
414.355 [1993 c.578 §2; 2009 c.595 §303; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.356 Executive session
Notwithstanding ORS 192.610 to 192.705, the Pharmacy and Therapeutics Committee shall meet in an executive session for purposes of: Reviewing the prescribing or dispensing practices of individual physicians or pharmacists; Discussing drug use review data pertaining to individual physicians or pharmacists; Reviewing profiles of individual patients; or Rev…
414.359 Mental Health Clinical Advisory Group
The Mental Health Clinical Advisory Group is established in the Oregon Health Authority. The Mental Health Clinical Advisory Group shall develop evidence-based algorithms for mental health treatments, including treatments with mental health drugs based on: The efficacy of the drug; The cost of the drug; Potential side effects of the drug; A patient’s pro…
414.360 [1993 c.578 §6; 2003 c.70 §1; 2009 c.595 §304; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.361 Committee to advise and make recommendations on drug utilization review standards and interventions; preferred drug list
The Pharmacy and Therapeutics Committee shall advise the Oregon Health Authority on: Adoption of rules to implement ORS 414.351 to 414.414 in accordance with ORS chapter 183. Implementation of the medical assistance program retrospective and prospective programs as described in ORS 414.351 to 414.414, including the type of software programs to be used by t…
414.364 Intervention approaches
In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following: Information disseminated to prescribers and pharmacists to ensure that they are aware of the duties and powers of the Pharmacy and Therapeutics Committee. Written, oral or electronic reminders of recipient-specific or drug-specific information that are des…
414.365 [1993 c.578 §7; 2009 c.595 §305; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.369 Prospective drug use review program
The prospective drug use review program must use guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee. The program must ensure that prior to the prescription being filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug…
414.370 [1993 c.578 §8; 2003 c.70 §2; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.371 Retrospective drug use review program
The retrospective drug use review program must use: Guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee; and The mechanized drug claims processing and information retrieval system to analyze claims data on drug use against explicit predetermined standards that are based on c…
414.372 Pharmacy lock-in program; rules
If necessary to avoid overutilization by a recipient of medical assistance, the Oregon Health Authority may restrict, for 18 months or less, the recipient’s pharmacy choices for filling and refilling prescriptions to a mail order pharmacy that contracts with the authority, a retail pharmacy selected by the recipient and a specialty pharmacy selected by the r…
414.375 [1993 c.578 §13; 2009 c.595 §306; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.380 [1993 c.578 §12; 2009 c.595 §307; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.381 Annual reports; educational materials; procedures to protect confidential information
In addition to the duties described in ORS 414.361, the Pharmacy and Therapeutics Committee shall do the following subject to the approval of the Director of the Oregon Health Authority: Publish an annual report, as described in ORS 414.382. Publish and disseminate educational information to prescribers and pharmacists regarding the committee and the drug …
414.382 Requirements for annual report
The annual report required under ORS 414.381 (1) is subject to public comment prior to its submission to the Director of the Oregon Health Authority and must include the following: An overview of the activities of the Pharmacy and Therapeutics Committee and the prospective and retrospective programs; A summary of interventions made, including the number of…
414.385 [1993 c.578 §11; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.390 [1993 c.578 §10; 2009 c.595 §308; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.395 [1993 c.578 §14; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.400 [1993 c.578 §4; 2001 c.900 §103; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.410 [1993 c.578 §5; 2009 c.595 §309; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.414 Use and disclosure of confidential information
Information collected under ORS 414.351 to 414.414 that identifies an individual is confidential and may not be disclosed by the Pharmacy and Therapeutics Committee, the retrospective program or the Oregon Health Authority to any person other than a health care provider appearing on a recipient’s medication profile. The staff of the committee may have acces…
414.415 [1993 c.578 §9; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.420 [Formerly 414.026; 2009 c.595 §309a; renumbered 411.443 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.422 [Formerly 414.027; renumbered 411.445 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.424 [2005 c.494 §2; 2007 c.70 §193; 2009 c.414 §1; renumbered 411.439 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.426 Payment of cost of medical care for institutionalized persons
The Oregon Health Authority is hereby authorized to pay the cost of care for patients in institutions operated under ORS 179.321 under the medical assistance program established by ORS chapter 414. Note: 414.426 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action…
414.428 Coverage for American Indian and Alaska Native beneficiaries
An individual who is eligible for or receiving medical assistance, as defined in ORS 414.025, pursuant to a demonstration project under section 1115 of the Social Security Act and who is an American Indian and Alaska Native beneficiary shall receive the same package of health services as individuals described in ORS 414.706 (1), (2) and (3) if: The Oregon H…
414.430 Access to dental care for pregnant medical assistance recipients; rules
The Oregon Health Authority shall prescribe by rule appropriate time frames within which a pregnant medical assistance recipient whose medical assistance is reimbursed on a fee-for-service basis and who needs general or specialty dental care must have the opportunity to be seen, or referred for, and provided: Emergency dental services; Urgent dental servic…
414.432 Reproductive health services for noncitizens
The Oregon Health Authority shall administer a program to reimburse the cost of medically appropriate services, drugs, devices, products and procedures described in ORS 743A.067, for individuals who can become pregnant and who would be eligible for medical assistance if not for 8 U.S.C. 1611 or 1612. The authority shall provide the medical assistance for pr…
414.434 Eligibility for individuals under age 26 who have aged out of foster care in Oregon or another state
Medical assistance shall be provided to an individual who: Is at least 18 years of age and not older than 25 years of age; Resides in this state; Was in foster care in the custody of any state on the date the individual attained 18 years of age; and Was enrolled in medical assistance in this state or another state while in foster care.
414.436 Oregon Health Authority to review rules and contracts to ensure timely access to services for individuals under 21 years of age
The Oregon Health Authority shall review, and amend as needed, current administrative rules and contracts to ensure that individuals receiving medical assistance who are under 21 years of age have timely access to the services described in subsection (2) of this section. The services described in subsection (1) of this section shall include: The medically …
414.440 [2011 c.207 §1; 2013 c.640 §1; renumbered 411.447 in 2013]renumbered
No operative statutory text appears at this designation in the selected edition.
414.500 Findings regarding medical assistance for persons with hemophilia
The Legislative Assembly finds that there are citizens of this state who have the disease of hemophilia and that hemophilia is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended upon termination of employment. The Legislative Assembly further finds that there is a need …
414.510 Definitions
“Eligible individual” means a resident of the State of Oregon over the age of 20 years. “Hemophilia services” means a program for medical care, including the cost of blood transfusions and the use of blood derivatives. Note: See note under 414.500.
414.520 Hemophilia services
Within the limit of funds expressly appropriated and available for medical assistance to hemophiliacs, hemophilia services under ORS 414.500 to 414.530 shall be made available to eligible persons as recommended by the Medical Advisory Committee of the Oregon Chapter of the National Hemophilia Foundation. Note: See note under 414.500.
414.530 When payments not made for hemophilia services
Payments under ORS 414.500 to 414.530 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.500 to 414.530 is intended to limit in any way state participation in any federal program for medical care of person…
414.532 Definitions for ORS 414.534 to 414.538
As used in ORS 414.534 to 414.538: “Medical assistance” has the meaning given that term in ORS 414.025. “Provider” has the meaning given that term in ORS 743B.001. Note: 414.532 to 414.540 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Or…
414.534 Treatment for breast or cervical cancer; eligibility criteria for medical assistance; rules
The Oregon Health Authority shall provide medical assistance, as defined in ORS 414.025, to a woman who: Is found by a provider to be in need of treatment for breast or cervical cancer; Meets the eligibility criteria for the Oregon Breast and Cervical Cancer Program prescribed by rule by the authority; Does not otherwise have creditable coverage, as defin…
414.536 Presumptive eligibility for medical assistance for treatment of breast or cervical cancer
If the Department of Human Services or the Oregon Health Authority determines that a woman likely is eligible for medical assistance under ORS 414.534, the department or the authority shall determine her to be presumptively eligible for medical assistance until a formal determination on eligibility is made. The period of time a woman may receive medical ass…
414.538 Prohibition on coverage limitations; priority to low-income women
The Department of Human Services and the Oregon Health Authority may not impose income or resource limitations or a prior period of uninsurance on a woman who otherwise qualifies for medical assistance under ORS 414.534 or 414.536. In establishing eligibility requirements for medical assistance under ORS 414.534, the department and the authority shall give …
414.540 Rules
The Oregon Health Authority shall adopt rules necessary for the implementation and administration of ORS 414.534 to 414.538. Note: See note under 414.532. (Cystic Fibrosis)
414.550 Definitions for ORS 414.550 to 414.565
As used in ORS 414.550 to 414.565: “Cystic fibrosis services” means a program for medical care, including the cost of prescribed medications and equipment, respiratory therapy, physical therapy, counseling services that pertain directly to cystic fibrosis related health needs and outpatient services including physician, physician associate, naturopathic phy…
414.555 Findings regarding medical assistance for persons with cystic fibrosis
The Legislative Assembly finds that there are citizens of this state who have the disease of cystic fibrosis and that cystic fibrosis is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended upon termination of employment. The Legislative Assembly further finds that there …
414.560 Cystic fibrosis services
Within the limit of funds expressly appropriated and available for medical assistance to individuals who have cystic fibrosis, cystic fibrosis services under ORS 414.550 to 414.565 shall be made available by the Services for Children with Special Health Needs to eligible individuals as recommended by the review committee. The review committee shall consist o…
414.565 When payments not made for cystic fibrosis services
Payments under ORS 414.550 to 414.565 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.550 to 414.565 is intended to limit in any way state participation in any federal program for medical care of person…
414.570 System established
There is established the Oregon Integrated and Coordinated Health Care Delivery System. The system shall consist of state policies and actions that make coordinated care organizations accountable for care management and provision of integrated and coordinated health care for each organization’s members, primarily managed within fixed global budgets, by provi…
414.572 Coordinated care organizations; rules
The Oregon Health Authority shall adopt by rule the qualification criteria and requirements for a coordinated care organization and shall integrate the criteria and requirements into each contract with a coordinated care organization. Coordinated care organizations may be local, community-based organizations or statewide organizations with community-based pa…
414.575 Community advisory councils
A coordinated care organization must have a community advisory council to ensure that the health care needs of the consumers and the community are being addressed. The council must: Include representatives of the community and of each county government served by the coordinated care organization, but consumer representatives must constitute a majority of th…
414.577 Community health assessment and adoption of community health improvement plan; rules
As used in this section: “Local mental health authority” has the meaning given that term in ORS 430.630. “Local planning committee” has the meaning given that term in ORS 430.306. A coordinated care organization shall collaborate with local public health authorities, community mental health programs, local planning committees and hospitals located in area…
414.578 Community health improvement plan to address health of children and youth
A community health improvement plan adopted by a coordinated care organization and its community advisory council in accordance with ORS 414.577 shall include a component for addressing the health of children and youth in the areas served by the coordinated care organization including, to the extent practicable, a strategy and a plan for: Working with progr…
414.581 Tribal Advisory Council established; membership; terms
The Tribal Advisory Council is established. The duties of the council are to: Serve as a channel of communication between the coordinated care organizations and Indian tribes in this state regarding the health of tribal communities; and Oversee the tribal liaisons in each coordinated care organization, described in ORS 414.572 (2)(r), and work with coordin…
414.584 Meetings of coordinated care organization governing body to be open to public; recording and taking of minutes required
Meetings of a governing body of a coordinated care organization in which substantive decisions are made final must: Be open to the public; Provide an opportunity for members of the public to provide written or oral testimony; and Include the minutes or other record of the previous meeting of the governing body. A coordinated care organization shall give …
414.590 Coordinated care organization contracts; terms and amendments; 60 days’ advance notice; refusal to renew
As used in this section: “Benefit period” means a period of time, shorter than the contract term, for which specific terms and conditions in a contract between a coordinated care organization and the Oregon Health Authority are in effect. “Renew” means an agreement by a coordinated care organization to amend the terms or conditions of an existing contract …
414.591 Coordinated care organization contracts; financial reporting; rules
The Oregon Health Authority shall use, to the greatest extent possible, coordinated care organizations to provide fully integrated physical health services, chemical dependency and mental health services and oral health services. This section, and any contract entered into pursuant to this section, does not affect and may not alter the delivery of Medicaid-f…
414.592 Requirements for contracts between authority and providers; alignment with behavioral quality health metrics and incentives
Notwithstanding ORS 414.590: Contracts between the Oregon Health Authority and coordinated care organizations or individual providers for the provision of behavioral health services must align with the quality metrics and incentives developed by the Behavioral Health Committee under ORS 413.017 and contain provisions that ensure that: Individuals have easy…
414.593 Reporting and public disclosure of expenditures by coordinated care organizations
As used in this section: “Coordinated care organization” has the meaning given that term in ORS 414.025. “Medical assistance” has the meaning given that term in ORS 414.025. “Related party” means an entity that: Provides administrative services or financing to a coordinated care organization directly or through one or more unrelated parties; and Is asso…
414.595 External quality reviews of coordinated care organizations; limits on documentation and reporting requirements
As used in this section: “Coordinated care organization” has the meaning given that term in ORS 414.025. “Subcontractor” means an entity that contracts with a coordinated care organization to provide health care, dental care, behavioral health care or other services to medical assistance recipients enrolled in the coordinated care organization. The Oregon…
414.598 Alternative payment methodologies
The Oregon Health Authority shall encourage coordinated care organizations to use alternative payment methodologies that: Reimburse providers on the basis of health outcomes and quality measures instead of the volume of care; Hold organizations and providers responsible for the efficient delivery of quality care; Reward good performance; Limit increases …
414.605 Consumer and provider protections
The Oregon Health Authority shall adopt by rule safeguards for members enrolled in coordinated care organizations that protect against underutilization of services and inappropriate denials of services. In addition to any other consumer rights and responsibilities established by law, each member: Must be encouraged to be an active partner in directing the m…
414.607 Use and disclosure of member information; access by member to personal health information
The Oregon Health Authority shall ensure the appropriate use of member information by coordinated care organizations, including the use of electronic health information and administrative data that is available when and where the data is needed to improve health and health care through a secure, confidential health information exchange. A member of a coordi…
414.609 Network adequacy; member transfers
A coordinated care organization that contracts with the Oregon Health Authority must maintain a network of providers, including but not limited to addiction treatment providers, sufficient in numbers and areas of practice and geographically distributed in a manner to ensure that the health services provided under the contract are reasonably accessible to mem…
414.610 [1983 c.590 §1; 1985 c.747 §8; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.611 Transfer of 500 or more members of coordinated care organization
The Oregon Health Authority may approve the transfer of 500 or more members from one coordinated care organization to another coordinated care organization if: The members’ provider has contracted with the receiving organization and has stopped accepting patients from or has terminated providing services to members of the transferring organization; and Mem…
414.613 Discrimination based on scope of practice prohibited; appeals; rules
A coordinated care organization may not discriminate with respect to participation in the organization or coverage against any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. This section does not require that an organization contract with any health care provider willing to abide by …
414.615 [Formerly 414.640; 2017 c.356 §34; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.618 [Formerly 414.630; 2014 c.45 §39; 2017 c.356 §35; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.619 Coordination between Oregon Health Authority and Department of Human Services
The Oregon Health Authority and the Department of Human Services shall cooperate with each other by coordinating actions and responsibilities necessary to implement the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. The authority and the department may delegate to each other any duties, functions or powers that the…
414.620 [1983 c.590 §2; 1985 c.747 §2; 2011 c.602 §2; 2015 c.798 §10; renumbered 414.570 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.625 [2011 c.602 §4; 2012 c.8 §20; 2013 c.535 §3; 2015 c.798 §11; 2017 c.101 §25; 2017 c.273 §6; 2017 c.429 §1; 2017 c.489 §§1,14; 2018 c.49 §§3,4; 2019 c.358 §§7,8; 2019 c.364 §§1,2; 2019 c.478 §§57,58; 2019 c.529 §§6,7; renumbered 414.572 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.627 [2012 c.8 §13; 2013 c.535 §§4,5; 2017 c.82 §1; 2019 c.529 §8; renumbered 414.575 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.628 Innovator agents
Upon the request of a coordinated care organization, the Oregon Health Authority shall assign to the coordinated care organization one employee of the authority, called an innovator agent, to act as the single point of contact between the coordinated care organization and the authority. The innovator agent must be available to the organization on a day-to-da…
414.629 [2013 c.598 §1; 2015 c.402 §3; 2019 c.529 §10; renumbered 414.578 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.630 [1983 c.590 §3; 1991 c.66 §24; 2003 c.794 §275; 2009 c.595 §317; 2011 c.602 §40; renumbered 414.618 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.631 Mandatory enrollment in coordinated care organization; exemptions
Except as provided in subsections (2), (3), (4) and (5) of this section and ORS 414.632 (2), a person who is eligible for or receiving health services must be enrolled in a coordinated care organization to receive the health services for which the person is eligible. For purposes of this subsection, Medicaid-funded long term care services do not constitute h…
414.632 Services to individuals who are dually eligible for Medicare and Medicaid
Subject to the Oregon Health Authority obtaining any necessary authorization from the Centers for Medicare and Medicaid Services, coordinated care organizations that meet the criteria adopted under ORS 414.572 are responsible for providing covered Medicare and Medicaid services, other than Medicaid-funded long term care services, to members who are dually el…
414.635 [2011 c.602 §§8,9; 2012 c.8 §5; 2013 c.27 §1; 2017 c.618 §4; 2019 c.364 §3; renumbered 414.605 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.637 [2014 c.55 §6; renumbered 414.772 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.638 [2011 c.602 §10; 2012 c.8 §21; 2015 c.389 §10; 2023 c.584 §13; renumbered 413.022 in 2023]renumbered
No operative statutory text appears at this designation in the selected edition.
414.640 [1983 c.590 §4; 1991 c.66 §25; 2003 c.794 §276; 2009 c.595 §318; renumbered 414.615 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.645 [2011 c.417 §2; 2015 c.27 §43; renumbered 414.609 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.646 [2012 c.80 §4; 2012 c.80 §5; renumbered 414.613 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.647 [2011 c.417 §3; 2013 c.234 §1; 2015 c.27 §44; renumbered 414.611 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.650 [1983 c.590 §7; 1987 c.660 §19; 1989 c.513 §1; 1991 c.66 §26; repealed by 1995 c.727 §48]repealed
No operative statutory text appears at this designation in the selected edition.
414.651 [Formerly 414.725; 2015 c.792 §6; 2019 c.478 §59; renumbered 414.591 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.652 [2013 c.535 §2; 2015 c.799 §1; 2016 c.79 §1; 2018 c.49 §5; 2019 c.478 §60; 2019 c.529 §9; renumbered 414.590 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.653 [2011 c.602 §5; 2015 c.798 §12; 2017 c.489 §4; renumbered 414.598 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.654 Persons served by prepaid managed care health services organizations; funding of health information technology
The Oregon Health Authority shall continue to contract with one or more prepaid managed care health services organizations, as defined in ORS 414.025, that are in compliance with contractual obligations owed to the state or local government on July 27, 2015, and that serve: A geographic area of the state that a coordinated care organization has not been cer…
414.655 Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations
The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. Each coordinated care organization shall implement, to the maximum extent feasible, patient centered primary care homes and behavioral health homes, including developing capacity for …
414.660 [1983 c.590 §5; 1985 c.747 §3; 1991 c.66 §27; 2009 c.11 §57; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.661 [2015 c.552 §1; renumbered 414.595 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.665 Traditional health workers utilized by coordinated care organizations; rules
As used in this section, “traditional health worker” includes any of the following: A community health worker. A personal health navigator. A peer wellness specialist. A peer support specialist. A doula. A tribal traditional health worker. In consultation with the Traditional Health Workers Commission established under ORS 413.600, the Oregon Health A…
414.667 Definitions for ORS 414.667 to 414.671
As used in ORS 414.667 to 414.671: “Doula” has the meaning given that term in ORS 414.025. “Lactation counselor” has the meaning given that term in ORS 676.665. “Lactation educator” has the meaning given that term in ORS 676.665.
414.668 Access to services provided by doulas, lactation counselors and lactation educators
In determining the types and extent of health care and services to be provided to medical assistance recipients under ORS 414.065, the Oregon Health Authority and a coordinated care organization shall ensure that recipients have access to services provided by doulas, lactation counselors and lactation educators. The services described in subsection (1) of t…
414.669 Payment for doula, lactation counselor and lactation educator services
The Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall in each even-numbered year review, and revise if necessary, any rates of reimbursement in the state medical assistance program for doulas. When reviewing and revising rates of reimbursement, the authority shall consider factors including retention of doulas and…
414.670 [1983 c.590 §6; 1985 c.747 §3a; 1991 c.66 §28; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.671 Report on status of doulas
No later than September 15 of each even-numbered year, the Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall report on the status of doulas in this state, in the manner provided in ORS 192.245, to the interim committees of the Legislative Assembly related to health. The report described in subsection (1) of this …
414.672 Tribal-based practices for mental health and substance abuse prevention, counseling and treatment
A medical assistance program shall consider tribal-based practices for mental health and substance abuse prevention, counseling and treatment services for members who are Native American or Alaska Native as equivalent to evidence-based practices for purposes of meeting standards of care and shall reimburse for those tribal-based practices.
414.679 [2011 c.602 §12; 2015 c.389 §11; 2019 c.280 §9; renumbered 414.607 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.685 [2011 c.602 §15; 2017 c.17 §34; renumbered 414.619 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.686 Health assessments for foster children
A coordinated care organization shall provide an initial health assessment on any child enrolled in the coordinated care organization who is in the custody of the Department of Human Services no later than 60 days after the date that the Oregon Health Authority notifies the coordinated care organization that the child has been taken into the department’s cus…
414.688 Commission established; membership
As used in this section: “Practice of pharmacy” has the meaning given that term in ORS 689.005. “Retail drug outlet” has the meaning given that term in ORS 689.005. The Health Evidence Review Commission is established in the Oregon Health Authority, consisting of 13 members appointed by the Governor in consultation with professional and other interested o…
414.689 Members; meetings
The Health Evidence Review Commission shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers the commission determines necessary for the performance of the functions of the offices. A majority of the members of the commission constitutes a quorum for the transaction of business. The commission s…
414.690 Prioritized list of health services
The Health Evidence Review Commission shall regularly solicit testimony and information from stakeholders representing consumers, advocates, providers, carriers and employers in conducting the work of the commission. The commission shall actively solicit public involvement through a public meeting process to guide health resource allocation decisions that i…
414.694 Commission review of covered reproductive health services
The Health Evidence Review Commission shall review the coverage described in ORS 743A.067 (2) and, no later than November 1 of each even-numbered year, report to the interim committees of the Legislative Assembly related to health any recommended changes to the coverage described in ORS 743A.067 (2) based upon the latest clinical research. Note: 414.694 was…
414.695 Medical technology assessment
As used in this section and ORS 414.698: “Medical technology” means medical equipment and devices, medical or surgical procedures and techniques used by health care providers in delivering medical care to individuals, and the organizational or supportive systems within which medical care is delivered. “Medical technology assessment” means evaluation of the…
414.698 Comparative effectiveness of medical technologies
The Health Evidence Review Commission shall conduct comparative effectiveness research of medical technologies selected in accordance with ORS 414.695. The commission may conduct the research by comprehensive review of the comparative effectiveness research undertaken by recognized state, national or international entities. The commission may consider eviden…
414.701 Commission to rely on range of research; research referencing quality of life in general measure under limited circumstances
As used in this section, “peer-reviewed medical literature” has the meaning given that term in ORS 414.690. The Health Evidence Review Commission, in ranking health services or developing guidelines under ORS 414.690 or in assessing medical technologies under ORS 414.698, and the Pharmacy and Therapeutics Committee, in considering a recommendation for a dru…
414.704 Advisory committee
The Health Evidence Review Commission shall consult with an advisory committee in determining priorities for mental health care and chemical dependency. The advisory committee shall include mental health and chemical dependency professionals who provide inpatient and outpatient mental health and chemical dependency care.
414.705 [1989 c.836 §2; 1991 c.753 §4; 2003 c.735 §1; 2003 c.810 §7; repealed by 2011 c.602 §§64,70]repealed
No operative statutory text appears at this designation in the selected edition.
414.706 Persons eligible for medical assistance; rules
Within available funds and subject to the rules of the Oregon Health Authority, medical assistance shall be provided to an individual who is a resident of this state and who: Is receiving a category of aid; Would be eligible for a category of aid but is not receiving a category of aid; Is required by federal law to be included in the state’s medical assis…
414.707 [2003 c.735 §4; 2009 c.595 §319; 2009 c.867 §44; 2011 c.602 §42; 2011 c.720 §143; repealed by 2013 c.688 §98]repealed
No operative statutory text appears at this designation in the selected edition.
414.708 [2003 c.735 §11; 2005 c.381 §16; 2007 c.70 §194; 2009 c.595 §320; 2011 c.720 §144; repealed by 2013 c.688 §98]repealed
No operative statutory text appears at this designation in the selected edition.
414.709 Adjustment of population of eligible persons in event of insufficient resources prohibited
If insufficient resources are available during a biennium, the population of eligible persons receiving health services may not be reduced below the population of eligible persons approved and funded in the legislatively adopted budget for the Oregon Health Authority for the biennium.
414.710 Services not subject to prioritized list
The following services are not subject to ORS 414.690: Nursing facilities, institutional and home- and community-based waivered services funded through the Department of Human Services; and Services to children who are wards of the Department of Human Services by order of the juvenile court and services to children and families for health care or mental he…
414.712 Health services for certain eligible persons
The Oregon Health Authority shall provide health services under ORS 414.591, 414.631 and 414.688 to 414.745 to eligible persons who are determined eligible for medical assistance as defined in ORS 414.025. The Oregon Health Authority shall also provide the following: Ombudsman services for individuals who receive medical assistance under ORS 411.706 and for…
414.715 [1989 c.836 §4; 1991 c.753 §12; 2009 c.469 §1; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.717 Palliative care program; rules
As used in this section: “Interdisciplinary team” means a group composed of the following individuals who are trained or certified in palliative care: A case manager who is a registered nurse licensed under ORS 678.010 to 678.415; A medical social worker; and A physician or other primary care provider. “Palliative care services” includes: Palliative ca…
414.719 Housing navigation services and social determinants of health; rules
The Oregon Health Authority shall adopt by rule requirements for coordinated care organizations to provide housing navigation services and address the social determinants of health through care coordination. Note: 414.719 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislat…
414.720 [1989 c.836 §4a; 1991 c.753 §6; 1991 c.916 §2a; 1993 c.754 §1; 1993 c.815 §19; 1997 c.245 §2; 2003 c.735 §10; 2003 c.810 §8; 2009 c.595 §324; 2011 c.545 §48; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.721 [2009 c.867 §16; 2009 c.828 §50; repealed by 2015 c.70 §18]repealed
No operative statutory text appears at this designation in the selected edition.
414.722 Post-hospital extended care benefit
As used in this section: “Coordinated care organization” and “medical assistance” have the meanings given those terms in ORS 414.025. “Post-hospital extended care benefit” means short-term medical assistance provided for an individual’s stay in a skilled nursing facility to allow the individual to discharge from a hospital. “Skilled nursing facility” has …
414.723 Telemedicine services; rules
As used in this section: “Audio only” means the use of audio telephone technology, permitting real-time communication between a health care provider and a patient for the purpose of diagnosis, consultation or treatment. “Audio only” does not include: The use of facsimile, electronic mail or text messages. The delivery of health services that are customar…
414.725 [1989 c.836 §6; 1991 c.753 §8; 2003 c.14 §194; 2003 c.735 §13; 2003 c.794 §277; 2003 c.810 §4; 2005 c.806 §8; 2007 c.458 §1; 2009 c.595 §325; 2009 c.795 §3; 2011 c.602 §26; renumbered 414.651 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.726 Requirement to use certified or qualified health care interpreters; reimbursement; rules
As used in this section: “Certified health care interpreter” has the meaning given that term in ORS 413.550. “Qualified health care interpreter” has the meaning given that term in ORS 413.550. The Oregon Health Authority shall adopt rules to ensure that a coordinated care organization, in accordance with ORS 414.572 (2)(e), and any other health care provi…
414.727 [1997 c.642 §2; 1999 c.546 §2; 2005 c.806 §2; 2009 c.595 §326; 2013 c.688 §79; repealed by 2015 c.792 §14]repealed
No operative statutory text appears at this designation in the selected edition.
414.728 Reimbursement of rural hospitals on fee-for-service basis
For services provided on a fee-for-service basis to persons who are entitled to receive medical assistance, the Oregon Health Authority shall reimburse Type A and Type B hospitals and rural critical access hospitals, as described in ORS 442.470 and identified by the Office of Rural Health as rural hospitals, fully for the cost of covered services based on th…
414.730 [1989 c.836 §7; 1995 c.79 §209; 2005 c.22 §286; 2011 c.720 §148; renumbered 414.704 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.735 Reduction in scope of health services in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers
If insufficient resources are available during a contract period: The population of eligible persons determined by law may not be reduced. The reimbursement rate for providers and plans established under the contractual agreement may not be reduced. In the circumstances described in subsection (1) of this section, reimbursement shall be adjusted by reduci…
414.736 [2003 c.810 §2; 2009 c.595 §329; 2009 c.867 §47; 2009 c.886 §6; 2011 c.417 §4; 2011 c.602 §45; 2011 c.720 §150; 2013 c.688 §80; 2015 c.3 §46; 2015 c.27 §45; 2015 c.792 §7; 2015 c.798 §13; 2017 c.273 §7; 2017 c.618 §7; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.737 [2003 c.810 §3; 2007 c.751 §8; 2009 c.595 §§330,331; 2011 c.602 §§27,28; renumbered 414.631 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.738 [2003 c.810 §5; 2009 c.595 §332; 2015 c.318 §23; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.739 [2003 c.810 §5a; 2009 c.595 §333; 2015 c.318 §24; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.740 [2003 c.810 §6; 2009 c.595 §334; 2012 c.8 §26; 2013 c.688 §81; 2015 c.3 §47; 2015 c.798 §14; 2017 c.273 §8; 2017 c.618 §8; repealed by 2011 c.602 §§64,70; 2012 c.8 §23 and 2015 c.792 §2]repealed
No operative statutory text appears at this designation in the selected edition.
414.741 [2003 c.810 §9; 2009 c.595 §335; repealed by 2011 c.720 §228]repealed
No operative statutory text appears at this designation in the selected edition.
414.742 Payment for mental health drugs
The Oregon Health Authority may not establish capitation rates or global budgets that include payment for mental health drugs. The authority shall reimburse pharmacy providers for mental health drugs only on a fee-for-service payment basis.
414.743 Payment to noncontracting hospital by coordinated care organization; rules
Except as provided in subsection (2) of this section, a coordinated care organization that does not have a contract with a hospital to provide inpatient or outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745 must, using Medicare payment methodology, reimburse the noncontracting hospital for services provided to a member of the orga…
414.744 [2003 c.810 §13; repealed by 2009 c.595 §1204]repealed
No operative statutory text appears at this designation in the selected edition.
414.745 Liability of health care providers and plans
Any health care provider or plan contracting to provide services to the eligible population under ORS 414.591, 414.631 and 414.688 to 414.745 shall not be subject to criminal prosecution, civil liability or professional disciplinary action for failing to provide a service which the Legislative Assembly has not funded or has eliminated from its funding pursua…
414.746 [2009 c.867 §15; 2009 c.828 §49; 2011 c.602 §48; 2013 c.608 §11; repealed by 2013 c.608 §12]repealed
No operative statutory text appears at this designation in the selected edition.
414.747 [2003 c.810 §15; renumbered 414.326 in 2011]renumbered
No operative statutory text appears at this designation in the selected edition.
414.750 [1989 c.836 §18; 1991 c.753 §11; 2009 c.595 §340; repealed by 2013 c.688 §98]repealed
No operative statutory text appears at this designation in the selected edition.
414.751 [1997 c.683 §35; 2001 c.69 §2; 2009 c.595 §341; renumbered 414.229 in 2009]renumbered
No operative statutory text appears at this designation in the selected edition.
414.755 Payment for hospital services
The Oregon Health Authority shall establish fee-for-service reimbursement rates for inpatient hospital services provided by hospitals that receive Medicare reimbursement on the basis of diagnostic related groups as follows: For the period from October 1, 2009, through September 30, 2013, at the same rate paid by Medicare on the date of the service. For the…
414.756 Payments to Oregon Health and Science University
The Oregon Health Authority shall ensure that the Oregon Health and Science University receives net reimbursement of at least 87 percent but no more than 100 percent of the university’s costs of providing services that are paid for, in whole or in part, with Medicaid funds. Net reimbursement means all Medicaid payments less any amount that is transferred by …
414.760 Payment for patient centered primary care home and behavioral health home services
The Oregon Health Authority shall provide reimbursement in the state’s medical assistance program for services provided by patient centered primary care homes and behavioral health homes. If practicable, efforts to align financial incentives to support patient centered primary care homes and behavioral health homes for enrollees in medical assistance program…
414.761 Payment for bilateral cochlear implants, hearing aids and hearing assistive technology systems for minors
Notwithstanding ORS 414.065 and 414.690, a coordinated care organization and the Oregon Health Authority shall provide to medical assistance recipients who are 18 years of age or younger the devices and services described in ORS 743A.140 and 743A.141.
414.762 Payment for child abuse assessment
As used in this section: “Child abuse assessment” has the meaning given that term in ORS 418.782. “Children’s advocacy center” has the meaning given that term in ORS 418.782. “Forensic interview” has the meaning given that term in ORS 418.782. The Oregon Health Authority shall reimburse a children’s advocacy center for the services the center provides: …
414.763 Payment for dispensing of 12-month supply of prescription contraceptives
As used in this section, “prescription contraceptive” means a drug or device that requires a prescription and is approved by the United States Food and Drug Administration to prevent pregnancy. In determining the extent of prescription drugs to be provided in medical assistance, in accordance with ORS 414.065, the Oregon Health Authority shall ensure paymen…
414.764 Payment for services provided by pharmacy or pharmacist
The Oregon Health Authority may reimburse a pharmacist or pharmacy for any health service: Provided to a medical assistance recipient who is not enrolled in a coordinated care organization or a prepaid managed care health services organization; That is within the lawful scope of practice of a pharmacist; and If the authority determines the service is with…
414.765 Periodic surveys of pharmacists regarding costs of dispensing prescription drugs
Every three years, the Oregon Health Authority shall: Conduct a survey of retail pharmacy providers that are enrolled as Medicaid providers in the state medical assistance program to determine the costs of the providers for dispensing prescription drugs; and If the survey indicates a change is needed in the professional dispensing fee reimbursement, submit…
414.766 Behavioral health treatment; rules
Notwithstanding ORS 414.065 and 414.690, a coordinated care organization must provide behavioral health services to its members that include but are not limited to all of the following: For a member who is experiencing a behavioral health crisis: A behavioral health assessment; and Services that are medically necessary to transition the member to a lower …
414.767 Survey of medical assistance recipients regarding experience with behavioral health care and services
The Oregon Health Authority shall contract with a third-party vendor to survey medical assistance recipients about their experiences with behavioral health care and services using a standardized survey tool. Note: 414.767 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislat…
414.768 [2017 c.281 §3; renumbered 414.669 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.769 Payment for gender-affirming treatment; rules
As used in this section, “gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence between the individual’s gender identity and the individual’s sex assignment at birth. Notwithstanding ORS 414.065 and 414.690, medical assistance prov…
414.770 Participants in clinical trials
As used in this section: “Approved clinical trial” has the meaning given that term in ORS 743A.192. “Routine health care”: Means the types and extent of health care and services that the Oregon Health Authority requires to be provided in medical assistance in accordance with ORS 414.065. Does not include: The drug, device or service being tested in an a…
414.771 Payment for certain registered nurse services without order from primary care provider
The Oregon Health Authority may not require a primary care provider to order a covered care management service, as listed in the schedule developed under subsection (2) of this section, as a condition of reimbursing the costs of the service when: The service is provided to a medical assistance recipient by a registered nurse licensed under ORS 678.010 to 67…
414.772 Limits on use of step therapy
As used in this section, “step therapy” means a drug protocol in which the cost of a prescribed drug is reimbursed only if the patient has first tried a specified drug or series of drugs. A coordinated care organization that requires step therapy shall make easily accessible to any provider who is reimbursed by the organization, directly or through a risk-b…
414.773 Certain conditions on reimbursement of claims for behavioral health services prohibited; assignment of CCO member to primary care provider
A claim for reimbursement for a behavioral health service or a physical health service provided to a medical assistance recipient may not be denied by the Oregon Health Authority or a coordinated care organization on the basis that the behavioral health service and physical health service were provided on the same day or in the same facility, unless required…
414.774 Payment for private duty nursing services for medically fragile children; rules
At least once each biennium, the Oregon Health Authority shall conduct a nursing market study for the purpose of determining the appropriate Medicaid reimbursement rates for providers of private duty nursing for medically fragile children. No later than July 1 each year, the authority shall seek approval from the Centers for Medicare and Medicaid Services t…
414.775 Payment for COVID-19 testing and treatment
Notwithstanding ORS 414.065 and 414.690, medical assistance provided to a member of a coordinated care organization or a medical assistance recipient who is not enrolled in a coordinated care organization shall include the testing and treatment, as described in ORS 689.662, performed or provided by a pharmacist.
414.776 Payment for behavioral health services provided by licensed art therapists, licensed certified art therapists and provisional licensed art therapists
As used in this section, “licensed art therapist,” “licensed certified art therapist” and “provisional licensed art therapist” have the meanings given those terms in ORS 681.740. The Oregon Health Authority and a coordinated care organization shall provide reimbursement in the state’s medical assistance program for the cost of behavioral health services pro…
414.780 Coordinated care organization reporting of data to assess compliance with mental health parity requirements; annual assessment
As used in this section: “Behavioral health coverage” means mental health treatment and services and substance use disorder treatment or services reimbursed by a coordinated care organization. “Coordinated care organization” has the meaning given that term in ORS 414.025. “Mental health treatment and services” means the treatment of or services provided t…
414.781 Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services
The Oregon Health Authority shall reimburse the cost of co-occurring mental health and substance use disorder treatment services paid for on a fee-for-service basis at an enhanced rate based on: Existing reimbursement codes used for co-occurring disorder treatments; Clinical complexity; and The education level of the provider. Note: 414.781 and 414.782 w…
414.782 Reimbursement to ensure access to addiction treatment statewide
The Oregon Health Authority, with the advice of stakeholders and the Alcohol and Drug Policy Commission, may establish minimum rates of reimbursement paid by the authority or coordinated care organizations to addiction treatment providers to ensure medical assistance recipients’ access, without delay, to all modalities of addiction treatment within each geog…
414.805 Liability of individual for medical services received while in custody of law enforcement officer
An individual who receives medical services while in the custody of a law enforcement officer is liable: To the provider of the medical services for the charges and expenses therefor; and To the Oregon Health Authority for any charges or expenses paid by the authority out of the Law Enforcement Medical Liability Account for the medical services. A person …
414.807 Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury
When charges and expenses are incurred for medical services provided to an individual for injuries related to law enforcement activity and subject to the availability of funds in the account, the cost of such services shall be paid by the Oregon Health Authority out of the Law Enforcement Medical Liability Account established in ORS 414.815 if the provider o…
414.810 [Formerly 414.040; renumbered 566.310]renumbered
No operative statutory text appears at this designation in the selected edition.
414.815 Law Enforcement Medical Liability Account; limited liability; rules; report
The Law Enforcement Medical Liability Account is established separate and distinct from the General Fund. Interest earned, if any, shall inure to the benefit of the account. The moneys in the Law Enforcement Medical Liability Account are appropriated continuously to the Oregon Health Authority to pay expenses in administering the account and paying claims ou…
414.820 [Formerly 414.050; renumbered 566.320]renumbered
No operative statutory text appears at this designation in the selected edition.
414.821 [2001 c.898 §1; 2003 c.14 §196; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.823 [2001 c.898 §2; 2003 c.14 §197; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.825 [2001 c.898 §3; 2003 c.14 §198; repealed by 2013 c.365 §9 and 2013 c.640 §16]repealed
No operative statutory text appears at this designation in the selected edition.
414.826 [2009 c.867 §30; 2011 c.700 §1; 2013 c.681 §49; 2015 c.3 §48; repealed by 2013 c.365 §9 and 2013 c.640 §16]repealed
No operative statutory text appears at this designation in the selected edition.
414.827 [2001 c.898 §4; 2003 c.14 §199; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.828 [2009 c.867 §31; 2013 c.681 §50; repealed by 2013 c.365 §9 and 2013 c.640 §16]repealed
No operative statutory text appears at this designation in the selected edition.
414.829 [2001 c.898 §5; 2003 c.14 §200; repealed by 2003 c.684 §13 and 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.830 [Formerly 414.060; renumbered 566.330]renumbered
No operative statutory text appears at this designation in the selected edition.
414.831 [2001 c.898 §5a; 2003 c.14 §201; 2003 c.684 §6; 2005 c.744 §37; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.833 [2001 c.898 §6; 2003 c.14 §202; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.834 [2001 c.898 §7; 2003 c.14 §203; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.835 [2001 c.898 §8; 2003 c.14 §204; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.837 [2001 c.898 §10; 2003 c.14 §205; repealed by 2003 c.735 §5]repealed
No operative statutory text appears at this designation in the selected edition.
414.839 [2001 c.898 §11; 2003 c.14 §206; 2003 c.684 §7; 2003 c.735 §9; 2009 c.595 §344a; 2009 c.867 §38; 2013 c.365 §2; 2013 c.681 §51; renumbered 414.117 in 2019]renumbered
No operative statutory text appears at this designation in the selected edition.
414.840 [Formerly 414.070; renumbered 566.340]renumbered
No operative statutory text appears at this designation in the selected edition.
414.841 [Formerly 735.720; 2011 c.70 §1; 2011 c.700 §2; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.842 [Formerly 735.722; 2011 c.70 §2; 2011 c.700 §6; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.844 [Formerly 735.724; 2011 c.70 §3; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.846 [Formerly 735.726; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.848 [Formerly 735.728; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.850 [Formerly 414.080; renumbered 566.350]renumbered
No operative statutory text appears at this designation in the selected edition.
414.851 [Formerly 735.730; 2011 c.700 §4; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.852 [Formerly 735.731; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.853 Definitions
As used in ORS 414.853 to 414.869 and 414.900: “Charity care” means costs for providing inpatient or outpatient care services free of charge or at a reduced charge because of the indigence or lack of health insurance of the patient receiving the care services. “Contractual adjustments” means the difference between the amounts charged based on the hospital’…
414.854 [Formerly 735.732; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.855 Hospital assessment; rates; rules
An assessment is imposed on the net inpatient revenue and net outpatient revenue of each hospital in this state. The assessment shall be imposed at a rate determined by the Director of the Oregon Health Authority by rule that is the director’s best estimate of the rate needed to fund the services and costs identified in ORS 414.869. The rate of assessment sh…
414.856 [Formerly 735.733; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.857 Reduction in rate required by federal law
Notwithstanding ORS 414.855, the Director of the Oregon Health Authority shall reduce the rate of assessment imposed under ORS 414.855 (1) to the maximum rate allowed under federal law if the reduction is required to comply with federal law. Note: 414.857 is repealed January 2, 2038, and applies to net revenues earned by hospitals during the period specifie…
414.858 [Formerly 735.734; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.860 [Formerly 414.090; renumbered 566.360]renumbered
No operative statutory text appears at this designation in the selected edition.
414.861 [Formerly 735.736; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.862 [Formerly 735.738; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.863 Refund of hospital assessment; right to contested case hearing
Any hospital that has paid an amount that is not required under ORS 414.853 to 414.869 and 414.900 may file a claim for refund with the Oregon Health Authority. Any hospital that is aggrieved by an action of the authority or by an action of the Director of the Oregon Health Authority taken pursuant to subsection (1) of this section shall be entitled to noti…
414.864 [Formerly 735.740; 2011 c.70 §4; repealed by 2013 c.681 §65 and 2013 c.640 §21]repealed
No operative statutory text appears at this designation in the selected edition.
414.865 Audits
The Oregon Health Authority may audit the records of any hospital in this state to determine compliance with ORS 414.853 to 414.869 and 414.900. The authority may audit records at any time for a period of five years following the date an assessment is due to be reported and paid under ORS 414.855. Note: 414.865 is repealed January 2, 2038, and applies to ne…
414.866 [Formerly 735.750; 2011 c.70 §5; repealed by 2013 c.681 §65, 2013 c.640 §21 and 2013 c.688 §98]repealed
No operative statutory text appears at this designation in the selected edition.
414.867 Deposit of assessments collected to Hospital Quality Assurance Fund
Amounts collected by the Oregon Health Authority from the assessments imposed under ORS 414.855 shall be deposited in the Hospital Quality Assurance Fund established under ORS 414.869. Note: 414.867 is repealed January 2, 2038, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 20…
414.868 [Formerly 735.752; 2011 c.70 §6; repealed by 2013 c.681 §65, 2013 c.640 §§20,21, 2013 c.688 §98 and 2013 c.698 §42]repealed
No operative statutory text appears at this designation in the selected edition.
414.869 Establishment of Hospital Quality Assurance Fund
The Hospital Quality Assurance Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Hospital Quality Assurance Fund shall be credited to the Hospital Quality Assurance Fund. Amounts in the Hospital Quality Assurance Fund are continuously appropriated to the Oregon Health Authority for the purpose of:…
414.870 [Formerly 735.754; repealed by 2013 c.681 §65, 2013 c.640 §21 and 2013 c.688 §98]repealed
No operative statutory text appears at this designation in the selected edition.
414.871 Applicability of hospital assessment
ORS 414.853 to 414.869 and 414.900 apply to net inpatient revenues and net outpatient revenues earned by hospitals during a period beginning July 1, 2019, and ending the earlier of December 31, 2032, or the date on which the assessment no longer qualifies for federal financial participation under Title XIX or XXI of the Social Security Act. [2003 c.736 §10; …
414.872 [Formerly 735.756; repealed by 2013 c.681 §65, 2013 c.640 §§20,21, 2013 c.688 §98 and 2013 c.698 §42]repealed
No operative statutory text appears at this designation in the selected edition.
414.880 Managed care organization assessment; rate
As used in this section and ORS 414.882 and 414.902: “Managed care organization” means: A coordinated care organization as defined in ORS 414.025; and A prepaid managed care health services organization as defined in ORS 414.025. “Premium equivalent” means the payments made to the managed care organization by the Oregon Health Authority for providing hea…
414.882 Refund of managed care organization assessment; right to contested case hearing
A managed care organization that has paid an amount that is not required under ORS 414.880 may file a claim for refund with the Oregon Health Authority. Any managed care organization that is aggrieved by an action of the authority taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing und…
414.884 Applicability of managed care organization assessment
ORS 414.880, 414.882 and 414.902 apply to any payments made to a managed care organization by the Oregon Health Authority for the period beginning January 1, 2020, and ending December 31, 2032. [2017 c.538 §12; 2019 c.2 §10; 2025 c.4 §9] Note: 414.884 is repealed January 2, 2038. See section 10, chapter 4, Oregon Laws 2025. Note: Section 11, chapter 4, Ore…
414.900 Hospital assessment; penalties
A hospital that fails to file a report or pay an assessment under ORS 414.855 by the date the report or payment is due shall be subject to a penalty of up to $500 per day of delinquency. The total amount of penalties imposed under this section for each reporting period may not exceed five percent of the assessment for the reporting period for which penalties…
414.902 Managed care organization assessment; penalties
If a managed care organization fails to timely pay an assessment under ORS 414.880, the Oregon Health Authority shall impose a penalty on the managed care organization of up to $500 per day of delinquency. The total amount of penalties imposed under this section for a calendar quarter may not exceed five percent of the assessment due for that calendar quarte…