justicedao/ipfs_state_laws huggingface dataset:
407-043-0020 Cooperative Relationship with Oregon Health Authority (1) The Department of Human Services (Department) will cooperate and collaborate with Oregon Health Authority (Authority) in order to effectively coordinate services to individuals, families and communities and realize operational efficiencies in the administration of services that can be shared between them (“shared services”). (2) In any Department rules, policies, or procedures that refer to the programs, functions, and duties that were formerly part of the Department that were transferred to the Authority, such reference shall be considered a reference to the Authority. (3) The Department acknowledges that the Authority is the state Medicaid agency and the state Children’s Health Insurance Program agency, authorized by state statute to administer the medical assistance program. The Authority is also responsible for facilitating outreach and enrollment efforts to connect eligible individuals with all available publicly funded health programs. (a) The Department and the Authority recognize that there are many points of interconnection between their programs and the individuals who receive services through these programs. In addition, there are areas of natural connection between the Department and the Authority based upon the former structure of the Department. (b) The Department shall continue to work cooperatively with the Authority in the administration of the medical assistance program, including determinations of eligibility and service need for medical assistance. The Authority has designated the Department as the operating agency for the home and community-based waivers and as an Organized Health Care Delivery System. (c) The Department and the Authority are authorized by state law to delegate to each other any duties, functions, and powers that they deem necessary for the efficient and effective operation of their respective functions. The Department and the Authority will work together to adopt rules to assure that medical assistance eligibility requirements, procedures, and determinations are consistent across both agencies. The Authority has authorized the Department to determine medical eligibility for medical assistance. Where that responsibility is given to the Department under ORS Chapter 411, the Department has delegated to the Authority the duties, functions and powers to make medical eligibility determinations in accordance with OAR 410-120-0006. (d) Where statute establishes duties and functions of the Department or the Authority in relation to medical assistance as a public assistance program, the Department and the Authority will cooperate in the effective administration of the program. Statutory/Other Authority: ORS 409.050 & 413.042 Statutes/Other Implemented: ORS 413.032 History: DHSD 12-2011, f. & cert. ef. 12-27-11 DHSD 3-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11
407-050-0000 Purpose These rules set forth parameters concerning who can make decisions and take action on behalf of individuals who are incapable of making their own Medicare Part D Decisions. The decisions and actions include choosing a Medicare Part D prescription drug plan or a Part C Medicare Advantage Plan and filing drug coverage exceptions and appeals, and pursuing grievances with Medicare Part C or D plan sponsors and the federal Centers for Medicare and Medicaid Services (CMS). These rules only pertain to those individuals who receive benefits or services, which are provided by, operated by, authorized or funded by Oregon Department of Human Services (Department). Those acting under the authority of this rule must do so with the express purpose of meeting the pharmaceutical and medical needs of the individual receiving the assistance. Statutory/Other Authority: ORS 409.050, 410.070, 410.090, 411.116, 426.500 & 430.640 Statutes/Other Implemented: ORS 409.010, 410.250, 410.280, 410.020, 411.060, 426.490 & 430.630 History: DHSD 4-2006, f. & cert. ef. 5-26-06 DHSD 1-2005(Temp), f. & cert. ef. 11-28-05 thru 5-26-06
407-070-0000 Race, Ethnicity, Language, and Disability Demographic Data Collection Standards (1) Pursuant to ORS 413.161, the Oregon Health Authority, in collaboration with the Oregon Department of Human Services, established uniform standards, based on local, statewide and national best practices, for the collection of data on race, ethnicity, preferred spoken and written languages and disability status. These standards are set forth in OAR 950-030-0000 to 950-030-0200 and 950-038-0010. (2) The Oregon Department of Human Services adopts and incorporates by reference the rules established in OAR 950-030-0000 to 950-030-0200 and 950-038-0010 for those matters related to data collection standards. Statutory/Other Authority: ORS 409.050 & 413.161 Statutes/Other Implemented: ORS 413.161 History: DHS 3-2023, minor correction filed 05/15/2023, effective 05/15/2023 DHSD 6-2015, f. 8-28-15, cert. ef. 9-1-15
407-100-0010 Purpose and Scope (1) OAR 407-100 establishes the Resilience Hubs and Networks Grant Program within the Oregon Department of Human Services (ODHS) Office of Resilience and Emergency Management (OREM). The Program offers grants to organizations or individuals who wish to develop, expand, or strengthen a Resilience Hub or Network in their community. (2) The purpose of the Resilience Hubs and Networks Grant Program is to empower communities to become more resilient. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0020 Definitions The following definitions apply to OAR 407-100: (1) “Awardee” means a Resilience Hubs and Networks Grant Program applicant that is selected for a grant award. (2) “Department” means the Oregon Department of Human Services. (3) “Grant Agreement” means the document agreed to and signed by Awardee and Oregon Department of Human Services (ODHS) that describes the terms and conditions required by the ODHS Office of Resilience and Emergency Management to issue the grant award. (4) “Grant Applicant” means an organization or individual who submits an application to the Resilience Hubs and Networks Grant Program. (5) “Oregon Buys” means a web-based eProcurement system that automates the State of Oregon's procurement process. (6) “Resilience Hub” means a physical facility that is operated, managed, or supported by one or more local residents, local governments, tribal governments, public schools, community-based organizations, faith-based organizations, nonprofit organizations, or nongovernmental organizations and that: (a) Supports the needs of community members or tribal communities, facilitates gathering and communication, distributes resources and otherwise enhances quality of life within a community; (b) Serves as a central point for gathering, information sharing, and coordination in response to a disruption in the community; (c) Enhances the ability of a community to respond to and recover from a disruption in a community; (d) Is positioned, operated and resourced on a day-to-day basis to provide community resources, including but not limited to food, water, information exchange, electronic charging stations, basic medical supplies and equipment proportionate to the size of the community’s population and needs; (e) Supports community cache sites and other support for community members who shelter in place; (f) Can provide child care, training, food distribution and other services that can help a community respond to unmet social needs to prepare for, respond to and recover from disasters; (g) Can provide, or can be retrofitted to provide, heating, cooling, air filtration and weather protection, and; (h) Accommodates individuals with accessibility needs. (7) "Resilience Network” means an association of facilities, organizations, resource providers, or service providers outside of a physical Resilience Hub facility that collectively serve the purposes of a Resilience Hub. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0030 Eligibility Individuals or organizations in Oregon are eligible to apply for the Resilience Hubs and Networks Grant Program. In accordance with ORS 409.760, the Oregon Department of Human Services (ODHS), Office of Resilience and Emergency Management (OREM) encourages grant applications that describes activities that: (1) Supports the needs of community members or tribal communities, facilitates gathering and communication, distributes resources and otherwise enhances quality of life within a community; (2) Serves as a central point for gathering, information sharing, and coordination in response to a disruption in the community; (3) Enhances the ability of a community to respond to and recover from a disruption in a community; (4) Support a Resilience Hub that is positioned, operated and resourced on a day-to-day basis to provide community resources, including but not limited to food, water, information exchange, electronic charging stations, basic medical supplies and equipment proportionate to the size of the community’s population and needs; (5) Supports community cache sites and other support for community members who shelter in place; (6) Can provide child care, training, food distribution and other services that can help a community respond to unmet social needs to prepare for, respond to, and recover from disasters; (7) Can provide, or can be retrofitted to provide, heating, cooling, air filtration and weather protection, and; (8) Accommodates individuals with accessibility needs. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0040 Evaluation Criteria Individuals or organizations may apply for grants by submitting an application that must include: (1) A description of the purposes for which grant moneys will be expended; (2) A plan for implementing specific strategies to build resilience in a community; (3) A description of additional resources available for purposes of the Resilience Hub or Network; (4) A description of the project’s ability to serve vulnerable populations and communities traditionally underrepresented in the public process, including communities of color, communities experiencing lower incomes, tribal communities, rural communities, coastal communities, communities with limited infrastructure, seniors, youth, and persons with disabilities; and any other information required by the Oregon Department of Human Services (ODHS). Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0050 Technical Review Process (1) Applications will be scored on objective criterion and subjective essay questions, which will be combined to calculate a combined total score. The applications combined total score will be used to inform funding decisions. (2) Objective score rubric: The objective score will be based upon the physical address submitted in the application. That score will be derived from that physical address’ location within the Center for Disease Control (CDC) Social Vulnerability Index Map (SVI), and the Environmental Protection Agencies’ (EPA) Environmental Justice (EJ) Screen map. Based on the CDC’s SVI map, an application will receive a score commensurate with that location’s SVI rating; if a location has the highest SVI rating, then that application will receive the highest score in that category. (3) Subjective essay scoring rubric: Applicants will be required to answer the short-answer essay questions. A review panel will read the applicants’ essays and apply scores to each answer based on the subjective essay scoring rubric. The total of the essays’ scores will be added to the total objective score to produce an application’s final total score. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0060 Funding Decision Awards may be funded in-whole or in-part. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0070 Grant Agreement Conditions (1) Awards may not be used as pass-through funds to be distributed as a grant to other organizations; grant awards will be issued directly to the individual or organization that will be using the awarded resources. (a) However, if an organization is designated to apply for the grant on behalf of other organizations, then the organization can apply for funding or equipment and then pass it to another organization only if application includes: (A) The name(s) of the other organization(s) to whom you intend to pass the funding or equipment; and (B) A letter of support from those partner organization(s), which includes information regarding what the funding or equipment will be used for. (b) In addition to the items listed below in section (3) of this rule, an awardee's final report must also include: (A) Documentation that proves the funding or equipment was delivered to the organization(s) named in the application; and (B) Documentation that proves the funding or equipment was used for the purposes as stated in that application and grant agreement. (2) Awardees will be required to register in Oregon Buys to establish and store the grant agreement and to receive their funding award. (3) Awardees will be required to submit a report within 365 days after grant agreement is signed by all parties and entered into Oregon Buys, which describes: (a) How funds were allocated; (b) How the resource impacted the community; (c) How the existence of the new resource was communicated to the community; and (d) Submission of photographs of the new resource(s). Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-100-0080 Waiver and Periodic Review of Rules The Oregon Department of Human Services (ODHS) Office of Resilience and Emergency Management (OREM) may waive the requirements of these rules for individual grant applications unless required by statute, when doing so will result in more efficient or effective implementation of the Resilience Hubs and Networks Grant Program. Any waiver must be in writing and included in the grant file to which the waiver applies. The administrative rules for monitoring grants may be periodically reviewed by the ODHS Office of Resilience and Emergency Management staff and revised as necessary and appropriate. Statutory/Other Authority: ORS 409.760 & ORS 409.050 Statutes/Other Implemented: ORS 409.760 History: DHS 9-2024, adopt filed 07/10/2024, effective 07/10/2024 DHS 6-2024, temporary adopt filed 01/16/2024, effective 01/16/2024 through 07/13/2024
407-120-0110 Purpose (1) These rules establish requirements applicable to providers, PHPs, and allied agencies that want to conduct electronic data transactions with the Department. These rules govern the conduct of all web portal or EDI transactions with the Department. These rules only apply to services or items that are paid for by the Department. 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 Department’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, 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 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: Renumbered from 410-001-0110, DHSD 1-2008, f. & cert. ef. 2-1-08 DMAP 30-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08 OMAP 55-2003, f. & cert. ef. 8-22-03 OMAP 25-2003(Temp), f. & cert. ef. 3-21-03 thru 9-8-03
407-120-0112 Scope and Sequence of Electronic Data Transmission Rules (1) The Department communicates with and receives communications from its providers, 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 Department will exchange data electronically. Additional details may be provided in the Department'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 Department is responsible for payment or encounter submissions made to the Department 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 PHPs are required to use the 837 electronic formats; (b) Web portal access; (c) EDI submitter access; or (d) POS for pharmacy providers. (4) Department informational updates, provider record updates, depository for PHP reports, or EDT as specified by the Department for contract compliance. (5) Other Department network and information system access is governed by specific program requirements, which may include but is not limited to IUP access. Affected providers, PHPs, and allied agencies will 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 407-120-0170. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DHSD 13-2011, f. & cert. ef. 12-27-11 DHSD 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11 DHSD 1-2008, f. & cert. ef. 2-1-08 DHSD 13-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08
407-120-0114 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 will include a section describing the process that will permit the provider, once enrolled, to participate in DDE over the Internet using the secure Department web portal. This does not include providers enrolled through the use of the DMAP 3108 Managed Care Plan and FFS Non Paid Provider Application. (2) When the provider number is issued by the Department, 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 Department 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 using the PIN are responsible for protecting the confidentiality and security of the PIN pursuant to OAR 407-120-0170. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DHSD 13-2011, f. & cert. ef. 12-27-11 DHSD 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11 DHSD 1-2008, f. & cert. ef. 2-1-08 DHSD 13-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08
407-120-0116 Web Portal Submitter (1) Any provider 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 DDE claims submission process. (a) If a provider submits their own claims directly, 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. (b) If a provider uses an agent or clinic to submit DDE claims using the Department’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 governing web portal submitters. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DHSD 1-2008, f. & cert. ef. 2-1-08 DHSD 13-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08
407-120-0130 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 Department. 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 Department 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 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: Renumbered from 410-001-0130, DHSD 1-2008, f. & cert. ef. 2-1-08 DMAP 30-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08 OMAP 55-2003, f. & cert. ef. 8-22-03 OMAP 25-2003(Temp), f. & cert. ef. 3-21-03 thru 9-8-03