justicedao/ipfs_state_laws huggingface dataset:
431-121-2030 Preferred Drug List (1) The Administrator shall consider any PDL developed and recommended by OHPR that identifies preferred choices of prescription drugs within therapeutic classes for particular diseases and conditions, including generic alternatives, for use in the OPDP by participating programs. (2) The OPDP shall develop a PDL that participating programs may choose to adopt for beneficiaries of their prescription drug benefit program. The PDL shall include the most effective prescription drugs at the lowest possible prices, taking into account negotiated price discounts and rebates available to the OPDP, while allocating and distributing the operational costs of the OPDP. (3) If a participating program uses the PDL developed by the OPDP, it must be used in conjunction with that participating program’s benefit plan including all pharmacy management programs the participating program has or adopts. (4) OPDP shall make the PDL available to individuals enrolled in the OPDP. Statutory/Other Authority: ORS 414.320 Statutes/Other Implemented: ORS 414.312 - 414.320 History: Renumbered from 410-121-2030, OPDP 1-2015, f. & cert. ef. 2-18-15 DMAP 10-2012, f. 3-6-12, cert. ef. 3-13-12 Renumbered from 409-030-0030 by DMAP 1-2011, f. 2-10-11, cert. ef. 3-1-11 OHP 3-2009, f. & cert. ef. 10-1-09 OHP 1-2004, f. & cert. ef. 9-24-04
431-121-2050 Enrollment (1) Participating programs, other than the DCP, shall enroll for participation through the designated entity chosen by the OPDP to administer the participating program’s enrollment and claims processing. (a) Eligibility for members of a participating program shall be maintained electronically between the participating program and designated entity. (b) Participating programs or designated entities shall issue identification cards to members at initial enrollment and renewal, and between those times as needed. (2) Residents of Oregon who do not have prescription drug coverage or who are underinsured for prescription drug coverage may be individually enrolled by the designated entity. (a) The designated entity shall issue identification cards to members. (b) Individuals who are eligible for Medicare Part D prescription drug coverage may participate in the program. (3) The OPDP may charge a nominal fee to participate in the program. Statutory/Other Authority: ORS 414.320 Statutes/Other Implemented: ORS 414.312 - 414.320 History: Renumbered from 410-121-2050, OPDP 1-2015, f. & cert. ef. 2-18-15 DMAP 10-2012, f. 3-6-12, cert. ef. 3-13-12 Renumbered from 409-030-0050 by DMAP 1-2011, f. 2-10-11, cert. ef. 3-1-11 OHP 3-2009, f. & cert. ef. 10-1-09 OHP 3-2007, f. & cert. ef. 8-3-07 OHP 2-2007(Temp), f. & cert. ef. 5-16-07 thru 11-6-07 OHP 2-2006(Temp), f. & cert. ef. 11-28-06 thru 5-23-07 OHP 1-2004, f. & cert. ef. 9-24-04
431-121-2065 Contracted Services (1) The Administrator may procure goods and services to perform any of the functions of OPDP. (2) The Administrator shall delegate procurement authority to the Authority’s designated Procurement Officer for OPDP goods and services, except as the Administrator determines to retain such authority in a particular case and as otherwise provided in section (4) of this rule. (3) The Administrator shall act as the Authority’s representative for each contract. The Administrator may delegate in writing the representative's responsibilities to a designee. The agency's representative may participate with the Authority’s designated Procurement Officer in all aspects of procurement. (4) OPDP's mechanism for and administration of the enrollment of participating groups shall not constitute procurements subject to this rule. Statutory/Other Authority: ORS 414.312 Statutes/Other Implemented: ORS 414.312, 414.314, 414.316 & 414.318 History: Renumbered from 410-121-2065, OPDP 1-2015, f. & cert. ef. 2-18-15 DMAP 10-2012, f. 3-6-12, cert. ef. 3-13-12 Renumbered from 409-030-0065 by DMAP 1-2011, f. 2-10-11, cert. ef. 3-1-11 OHP 6-2010, f. 9-23-10, cert. ef. 10-1-10 OHP 2-2010(Temp), f. 4-20-10, cert. ef. 4-21-10 thru 10-17-10 OHP 3-2009, f. & cert. ef. 10-1-09 OHP 3-2007, f. & cert. ef. 8-3-07
436-001-0003 Purpose and Applicability of these Rules (1) Rules related to rulemaking. OAR 436-001-0005 through 436-001-0009 establish supplemental procedures for rulemaking under ORS chapter 183 and apply to all division rulemaking on or after the date the rules are effective. (2) Rules related to hearings. OAR 436-001-0019 through 436-001-0296 establish supplemental procedures for hearings on matters within the director’s jurisdiction. (a) In general, the rules of the Workers’ Compensation Board in OAR chapter 438 apply to the conduct of hearings, unless these rules provide otherwise. (b) Except for OAR 436-001-0030, these rules do not apply to hearings requested under ORS 656.740. (c) These rules do not apply to hearings on reconsideration orders issued under ORS 656.268. (d) These rules apply to hearings held on or after the date the rules are effective. (3) Rules related to attorney fees. OAR 436-001-0400 through 436-001-0440 apply to attorney fees under ORS 656.262(11) and (12), 656.268(6)(c), 656.277(1)(b), 656.383(1), and 656.385(1). These rules apply to orders issued on or after the date the rules are effective, regardless of the date the claim was filed or closed. (4) General provisions. OAR 436-001-0500 applies to any refund or credit processed by the director on or after the date the rule is effective, regardless of the date the payment was received. (5) Procedural waiver. The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.262, ORS 656.268, ORS 656.277, ORS 656.383, ORS 656.385, ORS 656.704 & ORS ch. 183 History: WCD 6-2022, amend filed 07/05/2022, effective 09/01/2022 WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 3-2012(Temp), f. 6-13-12, cert. ef. 7-1-12 thru 12-27-12 WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 1-2006, f. 1-13-06, cert. ef. 1-17-06 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96 Reverted to WCD 9-1992, f. & cert. ef. 5-22-92 WCD 6-1995(Temp), f. & cert. ef. 7-14-95 WCD 9-1992, f. & cert. ef. 5-22-92
436-001-0004 Definitions (1) Unless a term is defined in these rules or the context otherwise requires, the definitions of ORS chapter 656 and ORS 183.310 are incorporated by reference and made a part of these rules. (2) For the purpose of these rules: (a) “ Administrative law judge ” means an administrative law judge appointed by the Workers’ Compensation Board, as defined in OAR 438-005-0040. (b) “ Board ” means the Workers’ Compensation Board and includes its Hearings Division. (c) “ Delivered ” means physical delivery to the division’s Salem office during regular business hours. (d) “ Director ” means the director of the Department of Consumer and Business Services or the director’s designee. (e) “ Division ” means the Workers’ Compensation Division of the Department of Consumer and Business Services. (f) “ Filed ” means mailed, faxed, emailed, delivered, or otherwise submitted to the division in a method allowable under these rules. (g) “ Final order ” means a final, written action of the director. (h) “ Mailed ” means addressed to the last known address, with sufficient postage and placed in the custody of the U.S. Postal Service. (i) “ Party ” refers to a party to the hearing and may include, but is not limited to, a worker, an employer, an insurer, a self-insured employer, a managed care organization, a medical provider, or the division. (j) “ Proposed and final order ” means an order subject to revision by the director that becomes final unless exceptions are timely filed or the director issues a notice of intent to review the proposed and final order. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 & ORS 183 History: WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96 Suspended by WCD 17-1995(Temp), f. & cert. ef. 11-2-95 WCD 6-1995(Temp), f. & cert. ef. 7-14-95 WCD 9-1992, f. & cert. ef. 5-22-92
436-001-0005 Model Rules For Rulemaking The Model Rules for Rulemaking, OAR 137-001-0005 through 137-001-0100, in effect on Jan. 1, 2008, adopted by the Oregon Department of Justice under ORS 183.341, are adopted as the rules of procedure for rulemaking actions of the division. [ NOTE: The full text of the Model Rules is available from the Department of Justice, the Workers’ Compensation Division, or on the Oregon State Archives website at https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=281 .] Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 183.325 - 183.410 History: WCD 2-2023, minor correction filed 09/18/2023, effective 09/18/2023 WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 1-2006, f. 1-13-06, cert. ef. 1-17-06 WCD 1-2005, f. & cert. ef. 1-14-05 WCD 3-2004, f. 3-5-04, cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96 WCD 6-1995(Temp), f. & cert. ef. 7-14-95, Suspended by WCD 17-1995(Temp), f. & cert. ef. 11-2-95 WCD 9-1992, f. & cert. ef. 5-22-92 WCD 3-1986, f. & cert. ef. 5-15-86 WCD 1-1985, f. & cert. ef. 5-1-85, Renumbered from 436-090-0110 thru 436-090-0180 WCD 2-1982, f. 1-20-82, cert. ef. 1-21-82 WCD 3-1978, f. & cert. ef. 3-6-78 WCD 5-1977(Temp), f. & cert. ef. 11-7-77
436-001-0009 Notice of Division Rulemaking (1) Except when adopting a temporary rule, the division will give prior public notice of the proposed adoption, amendment, or repeal of any rule by: (a) Publishing notice of the proposed rulemaking action in the Secretary of State’s Oregon Bulletin at least 21 days before the effective date of the rule; (b) Notifying interested people and organizations on the division’s notification lists of proposed rulemaking actions under ORS 183.335; and (c) Providing notice to legislators as required by ORS 183.335(15). (2) A person or organization may elect to receive email or hard-copy notification of proposed rulemaking actions of the division. (a) A person or organization may elect to subscribe to the division’s email notification service at https://service.govdelivery.com/accounts/ORDCBS/subscriber/new. (b) A person or organization may elect to receive hard-copy notification by sending a request in writing, including the person or organization’s full name and mailing address, to the following address: Rules Coordinator Workers’ Compensation Division P.O. Box 14480 Salem, OR 97309-0405 Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 183.335 & 84.022 History: WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06, Renumbered from 436-001-0000 WCD 3-2004, f. 3-5-04, cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 9-1992, f. & cert. ef. 5-22-92 WCD 3-1986, f. & cert. ef. 5-15-86 WCD 4-1978, f. & cert. ef. 3-6-78, Renumbered from 436-090-0505 WCD 4-1977(Temp), f. & cert. ef. 11-7-77 WCB 16-1975, f. & cert. ef. 10-20-75
436-001-0023 Other Filings and Submissions (1) Except as provided in section (3) of this rule, any filing, motion, request, document, or correspondence filed or submitted in a matter within the director’s jurisdiction must be filed or submitted: (a) To the division before the dispute is referred to the board; (b) To the administrative law judge after the dispute is referred to the board but before the administrative law judge issues a proposed and final order; and (c) To the division after the administrative law judge issues a proposed and final order, unless it is a request for correction of errors in the proposed and final order under OAR 436-001-0246(7). (2) A copy of any filing, motion, request, document, or correspondence must be sent to the other parties, or their legal representatives, at the same time it is filed or submitted to the division or administrative law judge. (3) A party must notify the division and the other parties of any changes in the party’s mailing address or legal representation. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06
436-001-0027 Timeliness; Calculation of Time (1) Timeliness of any document required by these rules to be filed or submitted to the division is determined as follows: (a) If a document is mailed, it will be considered filed on the date it is postmarked. (b) If a document is faxed or emailed, it must be received by the division by 11:59 p.m. Pacific Time to be considered filed on that date. (c) If a document is delivered, it must be delivered during regular business hours to be considered filed on that date. (2) The date and time of receipt for electronic filings is determined under ORS 84.043. (3) Time periods allowed for a filing or submission to the division are calculated in calendar days. The first day is not included. The last day is included unless it is a Saturday, Sunday, or legal holiday. In that case, the period runs until the end of the next day that is not a Saturday, Sunday, or legal holiday. Legal holidays are those listed in ORS 187.010 and 187.020. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06
436-001-0170 Duties and Powers of the Administrative Law Judge (1) The administrative law judge may conduct the hearing in any manner consistent with these rules that will achieve substantial justice. (2) Unless provided otherwise by statute or rule and except as stated in section (3) of this rule, any order issued by an administrative law judge regarding a matter within the director’s jurisdiction is a proposed and final order subject to review by the director under OAR 436-001-0246. (3) When appropriate, the administrative law judge may issue an interim order. An interim order is not subject to review by the director under OAR 436-001-0246. (4) The administrative law judge may dismiss requests for hearing as provided in OAR 436-001-0296. (5) When appropriate, the administrative law judge may remand a dispute to the director for further administrative action. (6) The administrative law judge may consolidate matters in which there are common parties or common issues of law or fact. (7) The administrative law judge may separate matters to promote efficient disposition of the matters. (8) Consolidation of matters under section (6) of this rule or under ORS 656.704(3)(c) is only for the purpose of hearing. The administrative law judge must issue a separate order for matters other than those concerning a claim. (9) On the motion of a party, the division, or the administrative law judge, the administrative law judge may continue a hearing to allow the presentation of oral or written legal argument by the Department of Justice. (10) The administrative law judge may send the division a written question regarding which rules or statutes apply to a matter, or regarding the division’s interpretation of the rules and statutes. If the administrative law judge sends such a question, the administrative law judge must provide a written summary of the context in which the question arises, provide a reasonable time for the division to respond, and send a copy to all parties. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96 Suspended by WCD 17-1995(Temp), f. & cert. ef. 11-2-95 WCD 6-1995(Temp), f. & cert. ef. 7-14-95 WCD 9-1992, f. & cert. ef. 5-22-92
436-001-0225 Scope of Review/Limitations on the Record (1) Except for the matters listed in sections (2) and (3) of this rule and unless otherwise provided by statute or administrative rule: (a) The administrative law judge reviews all matters within the director’s jurisdiction de novo; and (b) New evidence may be admitted and considered. (2) In medical service and medical treatment disputes under ORS 656.245, 656.247(3)(a), and 656.327, and managed care disputes under ORS 656.260(16), the administrative law judge may modify the director’s order only if it is not supported by substantial evidence in the record or if it reflects an error of law. New evidence or issues may not be admitted or considered. (3) In vocational assistance disputes under ORS 656.340, new evidence may be admitted and considered. Under ORS 656.340(16), the administrative law judge may modify the director’s order only if it: (a) Violates a statute or rule; (b) Exceeds the director’s statutory authority; (c) Was made upon unlawful procedure; or (d) Was characterized by abuse of discretion or clearly unwarranted exercise of discretion. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.245, 656.247, 656.260, 656.327, 656.340 & 656.704 History: WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 7-2012, f. 11-16-12, cert. ef. 12-28-12 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96
436-001-0240 The Record (1) Not more than 30 days after referring a request for hearing to the board, the division will provide the parties and the administrative law judge with copies of all documents in the director’s record. (2) Not less than 28 days before the hearing, or within seven days of receipt of the director’s record, whichever is later, the insurer or self-insured employer must provide the other parties legible copies of all documents, from the director’s record, that the insurer or self-insured employer will rely on at hearing. The documents must be numbered and indexed as provided in OAR 438-007-0018(1). (3) Not less than 14 days before the hearing, or within seven days of receipt of the insurer’s or self-insured employer’s documents and index, whichever is later, the other parties must provide legible copies of any additional documents, from the director’s record, that they will rely on at hearing. The documents must be numbered and indexed as provided in OAR 438-007-0018(2). (4) The parties may include with their documents and indexes documents that are not included in the director’s record only if new evidence is allowed under OAR 436-001-0225. (5) Before or at the hearing, the parties must submit their documents and indexes to the administrative law judge as provided in OAR 438-007-0018 or as otherwise required by the administrative law judge. (6) Unless withdrawn, all documents offered by a party will be included in the hearing file, whether or not they are admitted into the evidentiary record by the administrative law judge. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 1-2019, amend filed 03/11/2019, effective 04/01/2019 WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06 WCD 3-2004, f. 3-5-04 cert. ef. 4-1-04 WCD 8-1998, f. 8-10-98, cert. ef. 9-15-98 WCD 7-1996, f. & cert. ef. 2-12-96 Suspended by WCD 17-1995(Temp), f. & cert. ef. 11-2-95 WCD 6-1995(Temp), f. & cert. ef. 7-14-95 WCD 9-1992, f. & cert. ef. 5-22-92
436-001-0252 Stay of Director and Administrative Review The director may stay director review, administrative review, or referral of a matter if there is another pending matter concerning a claim that may affect the outcome of the matter within the director’s jurisdiction. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06
436-001-0259 Ex Parte Communication An ex parte communication is an oral or written communication to the director during director review of the matter not made in the presence of all parties to the dispute, concerning a fact in issue, but does not include communication from division staff or the Department of Justice about legal issues or facts in the record. Ex parte communications received during director review will be promptly disclosed to all parties, and the parties will be allowed a reasonable opportunity to respond. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 & OL 2005 & Ch. 26 History: WCD 9-2015, f. 12-10-15, cert. ef. 1-1-16 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06
436-001-0296 Settlements and Dismissals (1) If, after a request for hearing is filed but before a proposed and final order is issued, an agreement under ORS 656.236 or 656.289(4) is approved that resolves all issues in the matter within the director’s jurisdiction, the administrative law judge may issue a proposed and final order dismissing the request for hearing. (2) If, after a request for hearing is filed but before a proposed and final order is issued, the parties reach agreement on all issues in the matter within the director’s jurisdiction, the administrative law judge may issue a proposed and final order approving the agreement and dismissing the request for hearing. (3) If the matter within the director’s jurisdiction is consolidated with matters concerning a claim and the parties reach agreement on all issues in the matter within the director’s jurisdiction before issuance of a proposed and final order, the administrative law judge may issue a proposed and final order approving the agreement and dismissing the request for hearing. (4) Notwithstanding OAR 436-001-0170(2), the administrative law judge may issue a final order of dismissal when the requesting party withdraws the request for hearing and no cross-request for hearing has been filed. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.704 History: WCD 4-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 1-2008, f. 6-13-08, cert. ef. 7-1-08 WCD 7-2005, f. 10-20-05, cert. ef. 1-2-06