justicedao/ipfs_state_laws huggingface dataset:
410-173-0075 Eligibility Criteria for HCBS Psychosocial Rehabilitation for Persons with Chronic Mental Illness (1) To be eligible for PSR services outlined in these rules, Individuals shall: (a) Be eligible for 1915(i) HCBS as outlined in OAR 410-173-0010 and (b) Have assessed needs for PSR requiring services and supports in the home and community; (2) Individuals determined eligible to receive PSR shall be provided the choice of services and supports, who provides those services and supports, and where those services and supports are provided to meet the Individual’s assessed needs. The Individual’s choice shall be reflected by their signature, or, if appropriate, the legal or authorized representative’s signature indicating informed consent. (3) These services cannot duplicate services received through other authorities-Medicaid, Medicare, or other medical coverage. Statutory/Other Authority: ORS 413.042, 426.495, 430.630 & 430.640 Statutes/Other Implemented: ORS 413.042, 426.495, 430.630 & 430.640 History: DMAP 42-2024, amend filed 02/14/2024, effective 02/29/2024 DMAP 46-2019, adopt filed 11/07/2019, effective 11/26/2019 DMAP 12-2019, temporary adopt filed 05/21/2019, effective 06/01/2019 through 11/27/2019
410-173-0085 Eligibility for Housing Support Services (1) To be eligible for Housing Support Services outlined in these rules, Individuals shall: (a) Be eligible for 1915(i) Housing Support Services be outlined in these rules or OAR 410-173-0010; (b) Have assessed needs for Housing Support Services as approved and documented in the PCSP; (c) Not have other resources to provide the same housing support services identified in the PSCP (2) Individuals determined eligible to receive Housing Support Services shall be provided the choice of services and supports, who provides those services and supports, and where those services and supports are provided to meet the individual’s assessed needs. The individual’s choice shall be reflected by their signature, or, if appropriate, the legal or authorized representative’s signature indicating informed consent. (3) These services cannot duplicate services received though other authorities. Statutory/Other Authority: ORS 413.042, 426.495, 430.630 & 430.640 Statutes/Other Implemented: ORS 413.042, 426.495, 430.630 & 430.640 History: DMAP 42-2024, adopt filed 02/14/2024, effective 02/29/2024
410-173-0090 Home Delivered Meals (1) 1915(i) home delivered meals shall be provided to eligible Individuals who are home bound, live in their own home, and are unable to complete meal preparation, to assist an Individual to remain in their own home and are intended to provide one (1) meal per day; (2) Home delivered meal services shall be provided in the following settings, as identified, and approved within the PCSP: (a) Community; or (b) Individuals own or family home. (3) Home delivered meals are not available to Individuals residing in a setting in which residential providers are responsible to provide meals. Statutory/Other Authority: ORS 410.070, ORS 411.060 & 411.070 Statutes/Other Implemented: ORS 410.070 History: DMAP 42-2024, adopt filed 02/14/2024, effective 02/29/2024
410-173-0095 Eligibility for Home Delivered Meals (1) To be eligible for 1915(i) home delivered meals and Individual must: (a) Be 1915(i) HCBS as outlined in OAR 410-173-0010 eligible; (b) Have assessed needs for Home Delivered Meals as documented and approved in the PCSP; (c) Be homebound and live in their own home; (d) Not have natural supports available that are willing and able to provide meal preparation services; (2) Individuals determined eligible to receive Home Delivered Meals shall be provided the choice of services and supports, who provides those services and supports, and where those services and supports are provided to meet the individual’s assessed needs. The Individual’s choice shall be reflected by their signature, the Individual’s legal or authorized representative’s, signature. (3) These services cannot duplicate services received though other authorities. Statutory/Other Authority: ORS 410.070, ORS 411.060 & 411.070 Statutes/Other Implemented: ORS 410.070 History: DMAP 42-2024, adopt filed 02/14/2024, effective 02/29/2024
410-173-0100 Provider Qualifications for Home Delivered Meals (1) To be in alignment with the provision of services, home delivered meal providers must have contracts with, or be, an Area Agency on Aging or AAA as defined in 411-002-0100(1). (2) The provider must be in compliance, during all stages of food service operation, with applicable federal, state, and local regulations, codes, and licensure requirements relating to fire, health, sanitation, safety, building and other provisions relating to the public health, safety, and welfare of meal patrons. (3) The provider must demonstrate that menu standards are developed to sustain and improve a participant’s health through the provision of safe and nutritious meals that are approved by a dietician. (4) Each provider must be an enrolled Medicaid provider approved to provide Medicaid home delivered meals. (5) The provider must ensure that all requirements in OAR 411-040-0035 through 411-040-0037 are met. (6) Providers must ensure that anyone who delivers meals: (a) Have passed a background check as defined in OAR 407-007-0275; or (b) Uses an approved carrier. (7) All requests for Medicaid home delivered meals received by the provider must be referred to the Department or the Medicaid AAA office for prior authorization. (8) Meal providers must not solicit program income or voluntary donations from Medicaid eligible participants. Statutory/Other Authority: ORS 410.070, ORS 411.060 & 411.070 Statutes/Other Implemented: ORS 410.070 History: DMAP 42-2024, adopt filed 02/14/2024, effective 02/29/2024
410-173-0110 Eligibility for HCBS-In-Home Personal Care (1) To be eligible for IHPC services outlined in these rules, individuals shall: (a) Be eligible for 1915(i) HCBS as outlined in these rules and OAR 410-173-0010; (b) Have assessed needs for ADL’s and IADL’s as documented in the PCSP; (c) Require assistance as documented and approved in the PCSP in two (2) areas of IADLs as outlined in these rules due to the symptoms of a behavioral health condition; (d) Lack natural supports to consistently provide HCBS IHPC services; (e) Access one or more 1915(i) services at least one time every 30 days. (2) These services cannot duplicate services received through other authorities-Medicaid, Medicare, or other medical coverage. (3) Individuals determined eligible to receive IHPC services shall be provided the choice of services and supports, who provides those services and supports, and where those services and supports are provided to meet the individual’s assessed needs. The individual’s choice shall be reflected by their signature, or, if appropriate, the legal or authorized representative’s signature indicating informed consent. Statutory/Other Authority: ORS 413.042, 426.495, 430.610 & 430.630 Statutes/Other Implemented: ORS 413.042, 426.495, 430.610 & 430.630 History: DMAP 80-2025, adopt filed 10/28/2025, effective 10/28/2025
410-174-0000 Purpose and Scope (1) These rules establish processes and procedures for traditional health workers and the programs and organizations they work for to receive enhanced payment for delivering culturally and linguistically specific physical health related services to patients on the Oregon Health Plan. (2) These rules apply to organizations, programs and individuals that are reimbursed through OHP's fee schedule for physical health related services. (3) These rules do not apply to organizations, programs and individuals that are reimbursed outside OHP’s fee schedule such as but not limited to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Care Providers (IHCPs), because such organizations, programs and individuals are already reimbursed at a clinic-specific encounter rate. (4) All providers of health services are encouraged to provide culturally and linguistically specific services if they have that expertise whether or not a provider qualifies for enhanced payments through this program. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 48-2025, adopt filed 06/03/2025, effective 07/01/2025
410-174-0001 Definitions (1) “ Culturally and linguistically specific services” means quality health care or health care related services that are designed specifically for a distinct minoritized cultural community, developed based on the languages used and the cultural values of a distinct minoritized cultural community and designed to elevate their voices and experiences, and that aim to enhance emotional safety, belonging and a shared collective cultural experience for healing and promotion of health among the distinct cultural community. (2) “Culturally and linguistically specific services organization” means an organization providing outpatient care or a community-based organization, group or association providing culturally and linguistically specific health care or health related services, or both, in its entirety as evidenced by its organizational mission. (3) “Culturally and linguistically specific services program” means a division or associated component of an organization that provides culturally and linguistically specific health care or health related services, or both, as evidenced by the program’s mission, that exists within the subset of services provided by an organization whose mission may, but is not required to, focus on a distinct minoritized cultural community. (4) “Culturally and linguistically specific traditional health worker provider” means a traditional health worker enrolled with OHA as an Oregon Health Plan (OHP) provider and deemed eligible by OHA to receive enhanced payments for culturally and linguistically specific services. (5) “Minoritized cultural community” is a community that has experienced historical and contemporary discrimination and oppression primarily on the basis of race, ethnicity, gender identity, sexual and affectional orientation, ability status, and/or migration history. (6) “OHA” means the Oregon Health Authority. (7) “Provider” is an individual, or entity enrolled with OHA’s Medicaid program and authorized to bill for Medicaid eligible services. (8) “These rules” means OAR 410-174-0000 to 410-174-0040 (9) “Traditional health worker” means ORS 414.665 and OAR 950, Division 60. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 48-2025, adopt filed 06/03/2025, effective 07/01/2025
410-174-0010 Culturally and Linguistically Specific Services Organization (1) In order to qualify for enhanced payments for culturally and linguistically specific services provided by traditional health workers as an organization, the organization must: (a) Be enrolled as a provider and reimbursed through OHP’s fee schedule for physical health services; (b) Submit a complete Traditional Health Worker Culturally and Linguistically Specific Services application to OHA; (c) Demonstrate the ability to serve a minoritized cultural community; and (d) Have traditional health workers working with or being immersed in the same distinct minoritized community being served; or (e) Have a history of at least one year experience primarily serving the specified minoritized cultural community being served. (2) To demonstrate the ability to serve a minoritized cultural community under section (1)(c) of this rule an organization must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective health and wellbeing. (b) Knowledge of specific health inequities documented in the minoritized cultural community being served, which may be addressed by the organization. (c) A practice of supporting and affirming cultural and language practices for the community being served, such as but not limited to: (A) Health and safety beliefs, or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Sacred beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of the organization’s established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information. (3) The information required to be provided under section (1)(b) through (e) and (2) of this rule must include documentation of the organization’s culturally specific focus demonstrated in a mission statement, vision statement, or other public-facing document. Supporting information can also include but is not limited to: (a) Documentation detailing policies and procedures. (b) Documentation of staff training requirements and any resulting certifications. (c) A narrative that details the organization or program’s strategic plan or history and experience, including specific examples, without identifying any individual clients. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 48-2025, adopt filed 06/03/2025, effective 07/01/2025
410-174-0020 Culturally and Linguistically Specific Services Program Qualifications (1) In order to qualify for enhanced payments for culturally and linguistically specific services provided by traditional health workers as a program, the program must: (a) Be enrolled as a provider and reimbursed through OHP’s fee schedule for physical health services; (b) Submit a complete Culturally and Linguistically Specific Services Traditional Health Worker application to OHA. (c) Demonstrate the ability to serve a minoritized cultural community; and (d) Have traditional health worker staff working with or being immersed in the same minoritized community being served; or (e) Ensure traditional health worker staff have a history of at least one year experience primarily serving the specified cultural community being served. (2) To demonstrate the ability to serve a minoritized cultural community under (1) (c) of this rule, a program must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective health and wellbeing. (b) Knowledge of specific health inequities documented in the minoritized cultural community being served, which may be addressed by the program. (c) A practice of supporting and affirming cultural and language practices of the minoritized cultural community being served, such as but not limited to: (A) Health and safety beliefs, or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Sacred beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional disparities in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of the program’s established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information. (3) The information required to be provided under section (1)(b) through (e) and (2) of this rule must include documentation of the program’s culturally specific focus demonstrated in a mission statement, vision statement, or other public-facing document. Supporting information can also include but is not limited to: (a) Documentation detailing policies and procedures. (b) Documentation of staff training requirements and any resulting certifications. (c) A narrative that details the program’s strategic plan or history and experience, including specific examples, without identifying any individual clients. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 48-2025, adopt filed 06/03/2025, effective 07/01/2025
410-174-0030 Culturally and Linguistically Specific Services Individual Traditional Health Worker Qualifications (1) In order to qualify for enhanced payments for culturally and linguistically specific traditional health worker services, an individual must: (a) Be enrolled as a provider and reimbursed through OHP’s fee schedule for physical health services. (b) Be a Traditional Health Worker. (c) Submit a complete Traditional Health Worker Culturally and Linguistically Specific Services application. ( d ) Demonstrate the ability to serve a minoritized cultural community. (2) To demonstrate the ability to serve a particular minoritized community under (1) (c) of this rule, an individual must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective health and wellbeing. (b) Knowledge of specific social/physical health inequities documented in the minoritized cultural community being served, which may be addressed by the culturally and linguistically specific services of the individual; (c) A practice of supporting and affirming cultural and language practices for the minoritized cultural community being served, such as but not limited to: (A) Health and safety beliefs or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Sacred beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of the individual’s established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information; and (e) Have extensive experience working with or being immersed in the same minoritized cultural community being served; or (f) Have a history of at least one year of experience primarily serving a specified minoritized cultural community. (3) The information required to be provided under section (1)(b) and (c) and (2) of this rule can include, but is not limited to: (a) A resume or curriculum vitae detailing academic credentials, relevant course work, work history, or certifications; or (b) A narrative that details the individual’s professional history and experience, including specific examples, without identifying clients. Statutory/Other Authority: ORS 413.042 & ORS 414.065 Statutes/Other Implemented: ORS 414.065 History: DMAP 48-2025, adopt filed 06/03/2025, effective 07/01/2025
410-200-0010 Overview. These rules, OAR 410-200-0010 through 410-200-0510, describe eligibility requirements for the Health Systems Division (HSD) Medical Programs. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706 History: DMAP 94-2024, amend filed 05/29/2024, effective 06/01/2024 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0125 Acting on Reported Changes (1) When an HSD Medical Program beneficiary or an individual authorized to act on the beneficiary’s behalf reports a change that may affect eligibility, the Agency shall promptly redetermine eligibility before reducing or ending medical benefits. (2) The Agency may send an RFI to request additional information or verification related to the reported change. (3) If a beneficiary remains eligible as a result of a redetermination due to a reported change, a new 12-month eligibility period is not established; the original renewal date is maintained. (4) If the Authority has information about anticipated changes in a beneficiary’s circumstances that may affect eligibility, it shall redetermine eligibility at the appropriate time based on the changes. Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706 History: DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 24-2016, f. & cert. ef. 6-2-16 DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0130 Retroactive Medical (1) The Authority may evaluate for retroactive medical eligibility for all HSD Medical Programs, except retroactive eligibility for OHP Bridge - Basic Health Program is not permitted. (2) The Authority shall evaluate for retroactive medical eligibility for the three calendar months preceding the month in which the Date of Request was established for the following individuals: (a) Applicants requesting HSD Medical Programs who have unpaid medical bills or received donated medical services that may have been covered by Oregon Medicaid/CHIP; and (b) Deceased individuals who have unpaid medical bills or received donated medical services that may have been covered by Oregon Medicaid/CHIP, who may have been eligible for Medicaid covered services had they, or someone acting on their behalf, applied. (3) If eligible for retroactive medical, the individual’s eligibility shall not start earlier than the date indicated by OAR 410-200-0115 Effective Dates. (4) The Authority reviews each month individually for retroactive medical eligibility. (5) If an individual is determined to be eligible for retroactive medical eligibility, the period of retroactive eligibility shall be approved for months in which an individual received coverage during a Hospital Presumptive Eligibility period (OAR 410-200-0105), unless the retroactive benefits may be a reduction in benefit-level compared to the Hospital Presumptive Eligibility benefits. Statutory/Other Authority: ORS 411.402, 411.404 & 414.534 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 414.025, 414.231, 414.534, 414.536 & 414.706 History: DMAP 94-2024, amend filed 05/29/2024, effective 06/01/2024 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 24-2016, f. & cert. ef. 6-2-16 DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14