ORS Chapter 414 — Medical Assistance

ORS 414.153. Services provided by local health departments. In order to make advantageous use of the system of public health care and services available through local health departments and other publicly supported programs and to ensure access to public health care and services through contract under ORS chapter 414, the state shall: (1) Unless cause can be shown why such an agreement is not feasible, require and approve agreements between coordinated care organizations and publicly funded providers for authorization of payment for point of contact services in the following categories: (a) Immunizations; (b) Sexually transmitted infections; and (c) Other communicable diseases; (2) Allow members of coordinated care organizations to receive from fee-for-service providers: (a) Family planning services; (b) Human immunodeficiency virus and acquired immune deficiency syndrome prevention services; and (c) Maternity case management if the Oregon Health Authority determines that a coordinated care organization cannot adequately provide the services; (3) Encourage and approve agreements between coordinated care organizations and publicly funded providers for authorization of and payment for services in the following categories: (a) Maternity case management; (b) Well-child care; (c) Prenatal care; (d) School-based clinics; (e) Health care and services for children provided through schools and Head Start programs; and (f) Screening services to provide early detection of health care problems among low income women and children, migrant workers and other special population groups; and (4) Recognize the responsibility of counties under ORS 430.620 to operate community mental health programs by requiring a written agreement between each coordinated care organization and the local mental health authority in the area served by the coordinated care organization, unless cause can be shown why such an agreement is not feasible under criteria established by the Oregon Health Authority. The written agreements: (a) May not prevent coordinated care organizations from contracting with other public or private providers for mental health or chemical dependency services; (b) Must include agreed upon outcomes; and (c) Must describe the authorization and payments necessary to maintain the mental health safety net system and to maintain the efficient and effective management of the following responsibilities of local mental health authorities, with respect to the service needs of members of the coordinated care organization: (A) Management of children and adults at risk of entering or who are transitioning from the Oregon State Hospital or from residential care; (B) Care coordination of residential services and supports for adults and children; (C) Management of the mental health crisis system; (D) Management of community-based specialized services, including but not limited to supported employment and education, early psychosis programs, assertive community treatment or other types of intensive case management programs and home-based services for children; and (E) Management of specialized services to reduce recidivism of individuals with mental illness in the criminal justice system. [1991 c.337 4; 1993 c.592 1; 2009 c.595 286; 2011 c.602 24; 2015 c.27 42; 2015 c.736 60; 2015 c.798 4; 2019 c.280 8] Note: See note under