justicedao/ipfs_state_laws huggingface dataset:
943-045-0000 Adult Abuse Investigations, Assessing Protective Services and Review of Abuse Findings for Mental Health Services The standards and procedures for the investigation of abuse, assessment for protective services and review of abuse findings are available at OAR chapter 419 as follows. (1) Effective September 1, 2017 for adult community mental health programs and mental health residential treatment services, including adult foster homes, in OAR chapter 419, division 110. (2) Effective April 13, 2018 for the state hospitals in OAR chapter 419, division 120. (3) Effective March 1, 2019 for requesting a contested case hearing in OAR 419-050-0000 and use of lay representatives in OAR 419-050-0010. (4) Effective January 1, 2020 for adult residential treatment services for a substance use disorder and recovery, and Oregon Department of Human Services review of substantiated abuse findings in OAR chapter 419, division 130. Statutory/Other Authority: ORS 179.040 & 413.042 Statutes/Other Implemented: ORS 179.390, 426.385, 427.031, 430.210 & 430.731 to 430.768 History: OHA 7-2023, minor correction filed 12/01/2023, effective 12/01/2023 OHA 3-2021, amend filed 06/22/2021, effective 06/22/2021 Suspended by OHA 2-2017(Temp), f. & cert. ef. 9-14-17 thru 2-28-18 OHA 28-2011, f. 12-1-11, cert. ef. 12-4-11 OHA 10-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-060-0000 Application These rules (OAR 943-060-0000 to 943-060-0120) govern public contracting of the Oregon Health Authority and are subject to ORS chapters 279A, 279B, and 279C. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 179.040, 279A.065, 413.033 & 413.042 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0020 Procurement Authority (1) The Authority may enter into contracts for the planning, erection, completion, and furnishing of new buildings and additions to its institutions, and may establish contracts for goods and services of all kinds necessary for the successful management and maintenance of the institutions within the Authority’s jurisdiction. The Authority may procure goods, services, personal services, construction materials, equipment, and supplies for the Authority’s institutions. The Authority may also make procurements in connection with the construction, demolition, exchange, maintenance, operation, and equipping of housing for persons with chronic mental illness. (2) The Director of the Authority may exercise all powers necessary to effectively and expeditiously carry out procurement functions. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 413.033 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0030 Contractor Requirements (1) No contract or other agreement for more than $1,000 may be entered into, renewed, or extended with any individual unless the individual certifies in writing, under penalty of perjury, that the individual is not in violation of any tax laws described in ORS 305.385. (2) A contractor who is a corporation, partnership, or who has an assumed business name shall be registered with the Oregon Secretary of State in accordance with ORS chapters 58, 60, 62, 63, 65, 67, 70, and 648. This registration is the obligation of the contractor, not the Authority. (a) Architects, engineers, and land surveyors shall be registered with the appropriate licensing boards under the provisions of ORS 671.020, 672.020, and 672.025. (b) The statutory requirements for contractors to register with the Oregon Secretary of State may be subject to a limited number of exceptions under federal law. For example, sole proprietors or national banks, when they contract with the Authority, are not subject to the registration requirement. (c) The contractor shall be registered at the time of the execution of the contract and thereafter. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 413.033 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0050 ORS 190 Agreements (1) The Authority, when it enters into an agreement under ORS 190.110, 190.420, or 190.485, or an agreement under ORS 190.112 or 660.342, shall post a summary of the agreement on an applicable electronic procurement system within the 30-day period immediately following the effective date of the agreement. (2) The summary shall include: (a) Names of the parties to the agreement; (b) Date of the agreement; (c) Subject matter of the agreement; and (d) The agency through which a person may obtain a copy of the agreement. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.014, 413.033 & 413.042 Statutes/Other Implemented: ORS 279A.140(2)(h) History: OHA 5-2012, f. & cert. ef. 8-1-12 OHA 1-2012(Temp), f. & cert. ef. 2-17-12 thru 8-14-12
943-060-0060 Contract Amendments The Authority may amend a contract without additional competition in any of the following circumstances: (1) The amendment is within the scope of the procurement as described in the solicitation documents, or if no solicitation documents, as described in the sole source notice or the approved special procurement or the contract, if any. The amendment is not within the scope of the procurement if the Authority determines that requested changes were not covered in the solicitation and would have likely increased competition or affected award of the contract. (2) These rules would otherwise permit the Authority to award a contract without competition for the goods or services to be procured under the amendment. (3) The amendment is necessary to comply with a change in law that affects performance of the contract. (4) The amendment results from renegotiation of the terms and conditions, including the contract price, are advantageous to the Authority, subject to all of the following conditions: (a) The goods or services to be provided under the amended contract are the same as the goods or services to be provided under the current contract; (b) The Authority determines that, with all things considered, the amended contract is at least as favorable to Authority as the unamended contract; and (c) The amended contract does not have a total term greater than allowed in the solicitation documents, if any, or if no solicitation documents, as described in the sole source notice or the approved special procurement, if any, after combining the initial and extended terms. (5) The Authority may amend a contract, awarded from a solicitation, beyond its authorized term subject to the following conditions: (a) The goods and services provided under the additional term must be reasonably related to the original contract's solicitation; (b) Circumstances, basis, and term requested for extension amendment are outlined by program staff; and (c) The DPO approves the term extension. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 279A.050, 279A.065(5), 279A.070, 279A.140 & 413.033 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0070 Payment Authorization for Cost Overruns for Services Contracts (1) Payments on contracts for trade or personal services that exceed the maximum contract consideration (cost overruns) require approval of the DPO in accordance with section (2) of this rule. If the aggregated value of the contract, including cost overruns, exceeds $150,000, the cost overrun may also require approval from the Department of Justice under OAR 137-045-0010 to 137-045-0090. (2) The Authority may grant approval of the payment of a cost overrun if: (a) The original contract was duly executed and, if required, approved by the Attorney General; (b) Payments relate to services that were provided during the term of the contract; (c) The cost overrun is not associated with any change in the statement of work of the original contract; (d) The cost overrun arose from extraordinary circumstances or conditions encountered in the course of contract performance that were not reasonably anticipated at the time of the original contract or the most recent amendment, if any. Such circumstances include but are not limited to emergencies arising in the course of the contract that require prompt action to protect the work already completed, compliance with official or judicial commands or directives issued during contract performance, or a need to ensure that the purpose of the contract will be realized; (e) The cost overrun was incurred in good faith, results from the good faith performance by the contractor, and is not greater than the prescribed hourly rate or the reasonable value of the additional work or performance rendered; and (f) The aggregated value of the contract, including the cost overrun, and the contract’s objective are within the Authority’s procurement authority and the Authority has funds available for payment under the contract. (3) The Authority shall prepare a written report that describes the Authority's discovery of the cost overrun, the reasons for the cost overrun, and the Authority’s satisfaction of the conditions set forth in section (2) of this rule. The Authority shall maintain the report in its procurement file and make the report available upon request. (4) The DPO approves, in writing, the payment of the overrun or such portion of the overrun amount as the DPO determines may be paid consistent with the conditions of this rule. If the DPO has signed the contract, or has immediate supervisory responsibility over performance of the contract, the DPO shall designate an alternate delegate to grant or deny written approval of payment. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 279A.050 & 279A.065 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0080 Purchases Through Federal Programs (1) The Authority may purchase goods and services under the federal programs identified in ORS 279A.180 without competitive sealed bidding, competitive sealed proposals, or other competition required under ORS 279B.050 to 279B.085, provided that the Authority has federal authorization to purchase through the program. (2) To purchase through a federal program, the DPO shall document in the contract file that: (a) The acquisition meets the Authority’s requirements; (b) The price and other terms of the acquisition are advantageous to Authority; and (c) Required preference programs, outlined in OAR 943-060-0090(2)(a)-(d), were considered. (3) The Authority may add to its contract such contract terms and conditions as required by state statutes or rules if such additions do not conflict with the federal program’s contract terms and conditions, including but not limited to prompt payment requirements, additional commercial terms, and conflict resolution. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 279A.180 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0090 Buy Decision (1) “Buy decision” means the decision to buy goods and services through socio-economic programs, agreements, or the open market. (2) The Authority shall make its buy decision in the priority order set forth in sections (a) through (d). If a higher priority source satisfies a procurement, the Authority shall procure through that higher priority source and shall not elect to procure through a lower priority source. (a) Surplus property. Promotes the efficient use of existing resources (OAR 125-050-0100 to 125-050-0400). (b) Qualified rehabilitation facilities (QRFs). Assists individuals with disabilities through gainful employment (ORS 279.835 to 279.855 and OAR 125-055-0005 to 125-055-0045). (c) Inmate labor (Oregon Constitution, Article I, section 41). (d) Statewide price agreements. Promotes economy and efficiency through volume and strategic purchases. (3) Section (2) of this rule does not apply to ORS 190 agreements that promote the use of existing state resources, including an interagency agreement, intergovernmental agreement, interstate agreement, international agreement, or tribal agreement. The Authority may elect to use an ORS 190 agreement at any time. (4) If sections (2) and (3) of this rule do not apply, the Authority may procure goods and services through the open market, using the methods provided under the public contracting code, related rules, and policies. (5) The Authority shall award a contract for goods and services by one of the following seven sourcing methods in accordance with the public procurement code and related rules: (a) Competitive sealed bidding under ORS 279B.055; (b) Competitive sealed proposals under ORS 279B.060; (c) Small procurement under ORS 279B.065; (d) Intermediate procurement under ORS 279B.070; (e) Sole-source procurement under ORS 279B.075; (f) Emergency procurement under ORS 279B.080; or (g) Special procurement under ORS 279B.085. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 279B.050 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-060-0120 Grant Authority If the Authority is a grant recipient or grantor in an agreement, the definition of grant in ORS 279A.010 determines if the agreement is subject to the public procurement code and these rules. If the grantor or the Authority has substantial involvement in the program or activity of the Authority, the agreement is not a grant. Statutory/Other Authority: ORS 179.040, 279A.065, 279A.070, 413.033 & 413.042 Statutes/Other Implemented: ORS 279A.025 History: OHA 5-2012, f. & cert. ef. 8-1-12
943-120-0110 Purpose (1) These rules establish requirements applicable to providers, CCOs, PHPs, and allied agencies that want to conduct electronic data transactions with the Authority. These rules govern the conduct of all web portal or EDI transactions with the Authority. These rules only apply to services or items that are paid for by the Authority. If the service or item is paid for by a plan or an allied agency, these rules do not apply. (2) These rules establish the Authority's electronic data transaction requirements for purposes of the Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d–1320d-8, Public Law 104-191, sec. 262 and sec. 264, and the implementing standards for electronic transactions rules. Where a federal HIPAA standard has been adopted for an electronic data transaction, this rule implements and does not alter the federal standard. (3) These rules establish procedures that must be followed by any provider, CCO, PHP, or allied agency in the event of a security or privacy incident, regardless of whether the incident is related to the use of an electronic data transaction. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 7-2012, f. 10-9-12, cert. ef. 10-10-12 OHA 4-2012(Temp), f. & cert. ef. 7-12-12 thru 1-6-13 OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0112 Scope and Sequence of Electronic Data Transmission Rules (1) The Authority communicates with and receives communications from its providers, CCOs, PHPs, and allied agencies using a variety of methods appropriate to the services being provided, the nature of the entity providing the services, and constantly changing technology. These rules describe some of the basic ways that the Authority will exchange data electronically. Additional details may be provided in the Authority's access control rules, provider-specific rules, or the applicable contract documents. (2) Access to eligibility information about covered individuals may occur using one or more of the following methods: (a) Automated voice response, via a telephone; (b) Web portal access; (c) EDI submitter access; or (d) Point of sale (POS) for pharmacy providers. (3) Claims for which the Authority is responsible for payment or encounter submissions made to the Authority may occur using one or more of the following methods: (a) Paper, using the form specified in the provider specific rules and supplemental billing guidance. Providers may submit paper claims, except that pharmacy providers are required to use the POS process for claims submission, and CCOs and PHPs must use the 837 electronic formats; (b) Web portal access; (c) EDI submitter access; or (d) POS for pharmacy providers. (4) Authority informational updates, provider record updates, depository for CCO or PHP reports, or EDT as specified by the Authority for contract compliance. (5) Other Authority network and information system access is governed by specific program requirements, which may include but is not limited to IUP access. Affected providers, CCOs, PHPs, and allied agencies shall be separately instructed about the access and requirements. Incidents are subject to these rules. (6) Providers and allied agencies that continue to use only paper formats for claims transactions are only subject to the confidentiality and security rule, OAR 943-120-0170. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 7-2012, f. 10-9-12, cert. ef. 10-10-12 OHA 4-2012(Temp), f. & cert. ef. 7-12-12 thru 1-6-13 OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0114 Provider Enrollment Agreement (1) When a provider applies to enroll, the application form will include information about how to participate in the web portal for use of DDE and automated voice response (AVR) inquiries. The enrollment agreement shall include a section describing the process that will permit the provider, once enrolled, to participate in DDE over the Internet using the secure Authority web portal. This does not include providers enrolled through the use of the DMAP 3108 Managed Care Plan and FFS Non Paid Provider Application. CCOs and PHPs shall receive the information described in this rule, along with PINs and other information required for access. (2) When the provider number is issued by the Authority, the provider will also receive two PINs: one that may be used to access the web portal and one that may be used for AVR. (a) If the PINs are not activated within 60 days of issuance, the Authority will initiate a process to inactivate the PIN. If the provider wants to use PIN-based access to the web portal or AVR after deactivation, the provider must submit an update form to obtain another PIN. (b) Activating the PIN will require Internet access and the provider must supply security data that will be associated with the use of the PIN. (c) Providers, CCOs, and PHPs using the PIN must protect the confidentiality and security of the PIN pursuant to OAR 943-120-0170. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 7-2012, f. 10-9-12, cert. ef. 10-10-12 OHA 4-2012(Temp), f. & cert. ef. 7-12-12 thru 1-6-13 OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0116 Web Portal Submitter (1) Any provider, CCO, or PHP activating their web portal access for web portal submission may be a web portal submitter. The provider will be referred to as the web portal submitter when functioning in that capacity, and shall be required to comply with these rules governing web portal submitters. (2) The authorized signer of the provider enrollment agreement shall be the individual who is responsible for the provider's, CCO’s, or PHP’s DDE claims submission process. (a) If a provider, CCO, or PHP submits their own claims directly, the provider, CCO, or PHP will be referred to as the web portal submitter when functioning in that capacity and shall be required to comply with these rules. (b) If a provider, CCO, or PHP uses an agent or clinic to submit DDE claims using the Authority's web portal, the agent or clinic will be referred to as the web portal submitter when functioning in that capacity and shall be required to comply with these rules. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 7-2012, f. 10-9-12, cert. ef. 10-10-12 OHA 4-2012(Temp), f. & cert. ef. 7-12-12 thru 1-6-13 OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0130 Trading Partner as EDI Submitter — EDI Transactions (1) A trading partner may be an EDI submitter. Registered trading partners that also qualify as an EDI submitter may submit their own EDI transactions directly to the Authority. A trading partner will be referred to as an EDI submitter when functioning in that capacity and will be required to comply with applicable EDI submitter rules, except as provided in section (3) of this rule. (2) Authorization and Registration Designating Trading Partner as EDI Submitter. Before acting as an EDI submitter, a trading partner must designate in the application for application that they are an EDI submitter who is authorized to send and receive data transmissions in the performance of EDI transactions. A trading partner must complete the "Trading Partner Application for Authorization to Submit EDI Transactions" and the "EDI Submitter Information" required in the application. A trading partner must also submit the EDI registration form identifying them as an EDI submitter. A trading partner must notify the Authority of any material changes in the information no less than ten days prior to the effective date of the change. (3) EDI Submitter Certification Conditions. Where a trading partner is acting as its own EDI submitter, the trading partner is not required to submit the EDI submitter certification conditions in the application for authorization applicable to agents. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0150 Testing — EDI Transactions (1) When a trading partner or authorized EDI submitter registers an EDI transaction with the Authority, the Authority may require testing before authorizing the transaction. Testing may include third party and business-to-business testing. An EDI submitter must be able to demonstrate its capacity to send and receive each transaction type for which it has registered. The Authority will reject any EDI transaction if an EDI submitter either refuses or fails to comply with the Authority testing requirements. (2) The Authority may require EDI submitters to complete compliance testing at an EDI submitter's expense for each transaction type if either the Authority or an EDI submitter has experienced a change to hardware or software applications by entering into business-to-business testing. (3) When third party and/or business-to-business testing is completed to the Authority's satisfaction, the Authority will notify an EDI submitter that it will register and accept the transactions in the production environment. This notification authorizes an EDI submitter to submit the registered EDI transactions to the Authority for processing and response, as applicable. If there are any changes in the trading partner or EDI submitter authorization, profile data or EDI registration information on file with the Authority, updated information must be submitted to the Authority as required in OAR 943-120-0190. (4) Testing will be conducted using secure electronic media communications methods. (5) An EDI submitter may be required to re-test with the Authority if the Authority format changes or if the EDI submitter format changes. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
943-120-0165 Pharmacy Point of Sale Access Pharmacy providers who electronically bill pharmaceutical claims must participate in and submit claims using the POS system, except as provided in OAR 410-121-0150. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemented: ORS 413.042 & 414.065 History: OHA 26-2011, f. 10-31-11, cert. ef. 11-1-11 OHA 13-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11