justicedao/ipfs_state_laws huggingface dataset:
ORS Chapter 414 — Medical Assistance

ORS 414.628. Innovator agents. (1) Upon the request of a coordinated care organization, the Oregon Health Authority shall assign to the coordinated care organization one employee of the authority, called an innovator agent, to act as the single point of contact between the coordinated care organization and the authority. The innovator agent must be available to the organization on a day-to-day basis to facilitate the exchange of information between the coordinated care organization and the authority. The organization may provide a work space to enable the agent to be colocated at a site of the coordinated care organization if practical. (2) Innovator agents must observe the meetings of the community advisory councils and report on the meetings to the authority. (3) Not less than once every calendar quarter, all of the innovator agents must meet in person to discuss the ideas, projects and creative innovations planned or undertaken by their assigned coordinated care organizations. (4) The innovator agent shall be made available by the authority for a period of four years beginning on the date that the coordinated care organization first contracts with the authority to be a coordinated care organization. Upon the request of the coordinated care organization, the authority may extend the period. [2012 c.8 14] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.630. [1983 c.590 3; 1991 c.66 24; 2003 c.794 275; 2009 c.595 317; 2011 c.602 40; renumbered
ORS Chapter 414 — Medical Assistance

ORS 414.631. Mandatory enrollment in coordinated care organization; exemptions. (1) Except as provided in subsections (2), (3), (4) and (5) of this section and ORS 414.632 (2), a person who is eligible for or receiving health services must be enrolled in a coordinated care organization to receive the health services for which the person is eligible. For purposes of this subsection, Medicaid-funded long term care services do not constitute health services. (2) Subsections (1) and (4) of this section do not apply to: (a) A person who is a noncitizen and who is eligible only for labor and delivery services and emergency treatment services; (b) A person who is an American Indian and Alaska Native beneficiary; (c) An individual described in ORS 414.632 (2) who is dually eligible for Medicare and Medicaid and enrolled in a program of all-inclusive care for the elderly; and (d) A person whom the Oregon Health Authority may by rule exempt from the mandatory enrollment requirement of subsection (1) of this section, including but not limited to: (A) A person who is also eligible for Medicare; (B) A woman in her third trimester of pregnancy at the time of enrollment; (C) A person under 19 years of age who has been placed in adoptive or foster care out of state; (D) A person under 18 years of age who is medically fragile and who has special health care needs; (E) A person receiving services under the Medically Involved Home-Care Program created by ORS 417.345 (1); and (F) A person with major medical coverage. (3) Subsection (1) of this section does not apply to a person who resides in an area that is not served by a coordinated care organization or where the organizations provider network is inadequate. (4) In any area that is not served by a coordinated care organization but is served by a prepaid managed care health services organization, a person must enroll with the prepaid managed care health services organization to receive any of the health services offered by the prepaid managed care health services organization. (5) As used in this section, American Indian and Alaska Native beneficiary means: (a) A member of a federally recognized Indian tribe; (b) An individual who resides in an urban center and: (A) Is a member of a tribe, band or other organized group of Indians, including those tribes, bands or groups whose recognition was terminated since 1940 and those recognized now or in the future by the state in which the member resides, or who is a descendant in the first or second degree of such a member; (B) Is an Eskimo or Aleut or other Alaska Native; or (C) Is determined to be an Indian under regulations promulgated by the United States Secretary of the Interior; (c) A person who is considered by the United States Secretary of the Interior to be an Indian for any purpose; or (d) An individual who is considered by the United States Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian health care services, including as a California Indian, Eskimo, Aleut or other Alaska Native.
ORS Chapter 414 — Medical Assistance

ORS 414.632. Services to individuals who are dually eligible for Medicare and Medicaid. (1) Subject to the Oregon Health Authority obtaining any necessary authorization from the Centers for Medicare and Medicaid Services, coordinated care organizations that meet the criteria adopted under ORS 414.572 are responsible for providing covered Medicare and Medicaid services, other than Medicaid-funded long term care services, to members who are dually eligible for Medicare and Medicaid in addition to medical assistance recipients. (2) An individual who is dually eligible for Medicare and Medicaid shall be permitted to enroll in and remain enrolled in a: (a) Program of all-inclusive care for the elderly, as defined in 42 C.F.R. 460.6; and (b) Medicare Advantage plan, as defined in 42 C.F.R. 422.2, until the plan is fully integrated into a coordinated care organization. (3) Except for the enrollment in coordinated care organizations of individuals who are dually eligible for Medicare and Medicaid, the rights and benefits of Medicare beneficiaries under Title XVIII of the Social Security Act shall be preserved.
ORS Chapter 414 — Medical Assistance

ORS 414.640. c.792 2]
ORS Chapter 414 — Medical Assistance

ORS 414.651. [Formerly
ORS Chapter 414 — Medical Assistance

ORS 414.654. Persons served by prepaid managed care health services organizations; funding of health information technology. (1)(a) The Oregon Health Authority shall continue to contract with one or more prepaid managed care health services organizations, as defined in ORS 414.025, that are in compliance with contractual obligations owed to the state or local government on July 27, 2015, and that serve: (A) A geographic area of the state that a coordinated care organization has not been certified to serve; or (B) Individuals described in ORS 414.631 (2), (3) and (4). (b) Contracts authorized by this subsection are not subject to ORS chapters 279A and 279B, except ORS 279A.250 to 279A.290 and 279B.235. (2) Prepaid managed care health services organizations contracting with the authority under this section are subject to the applicable requirements for, and are permitted to exercise the rights of, coordinated care organizations under ORS 413.022, 414.153, 414.572, 414.591, 414.605, 414.607, 414.655,
ORS Chapter 414 — Medical Assistance

ORS 414.655. Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. (1) The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. (2) Each coordinated care organization shall implement, to the maximum extent feasible, patient centered primary care homes and behavioral health homes, including developing capacity for services in settings that are accessible to families, diverse communities and underserved populations, including the provision of integrated health care. The organization shall require its other health and services providers to communicate and coordinate care with the patient centered primary care home or behavioral health home in a timely manner using electronic health information technology. (3) Standards established by the authority for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations may require the use of federally qualified health centers, rural health clinics, school-based health clinics and other safety net providers that qualify as patient centered primary care homes or behavioral health homes to ensure the continued critical role of those providers in meeting the needs of underserved populations. (4) In order to promote the full integration of behavioral health and physical health services in primary care, behavioral health care and urgent care settings, providers in patient centered primary care homes and behavioral health homes may use billing codes applicable to the behavioral health and physical health services that are provided. (5) Each coordinated care organization shall report to the authority on uniform quality measures prescribed by the authority by rule for patient centered primary care homes and behavioral health homes. (6) Patient centered primary care homes and behavioral health homes must participate in the learning collaborative described in ORS 413.259 (3).
ORS Chapter 414 — Medical Assistance

ORS 414.665. Traditional health workers utilized by coordinated care organizations; rules. (1) As used in this section, traditional health worker includes any of the following: (a) A community health worker. (b) A personal health navigator. (c) A peer wellness specialist. (d) A peer support specialist. (e) A doula. (f) A tribal traditional health worker. (2) In consultation with the Traditional Health Workers Commission established under ORS 413.600, the Oregon Health Authority, for purposes related to the regulation of traditional health workers, shall adopt by rule: (a) The qualification criteria, including education and training requirements, for the traditional health workers utilized by coordinated care organizations; (b) Appropriate professional designations for supervisors of the traditional health workers; and (c) Processes by which other occupational classifications may be approved to supervise the traditional health workers. (3) The criteria and requirements established under subsection (2) of this section: (a) Must be broad enough to encompass the potential unique needs of any coordinated care organization; (b) Must meet requirements of the Centers for Medicare and Medicaid Services to qualify for federal financial participation; and (c) May not require certification by the Home Care Commission.
ORS Chapter 414 — Medical Assistance

ORS 414.667. Definition for ORS 414.667 to 414.669. As used in ORS 414.667, 414.668 and
ORS Chapter 414 — Medical Assistance

ORS 414.668. Access to doula services. A coordinated care organization shall make information about how to access doula services available on a website operated by or on behalf of the coordinated care organization and shall provide the information in print whenever a printed explanation of benefits is available.
ORS Chapter 414 — Medical Assistance

ORS 414.669. Payment for doula services. The Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall in each even-numbered year review, and revise if necessary, any rates of reimbursement for doulas. When reviewing and revising rates of reimbursement, the authority shall consider factors including retention of doulas, access to culturally specific doulas and evidence-based factors and empirical studies related to the cost-effectiveness of services provided by doulas. [Formerly 414.768]
ORS Chapter 414 — Medical Assistance

ORS 414.672. Tribal-based practices for mental health and substance abuse prevention, counseling and treatment. A medical assistance program shall consider tribal-based practices for mental health and substance abuse prevention, counseling and treatment services for members who are Native American or Alaska Native as equivalent to evidence-based practices for purposes of meeting standards of care and shall reimburse for those tribal-based practices.
ORS Chapter 414 — Medical Assistance

ORS 414.686. Health assessments for foster children. (1) A coordinated care organization shall provide an initial health assessment on any child enrolled in the coordinated care organization who is in the custody of the Department of Human Services no later than 60 days after the date that the Oregon Health Authority notifies the coordinated care organization that the child has been taken into the departments custody. (2) If a child has not received an initial health assessment by the date specified in subsection (1) of this section, the coordinated care organization shall act affirmatively to locate the child and make arrangements for an initial health assessment. [2017 c.277 2; 2023 c.584 17] (Health Evidence Review Commission)
ORS Chapter 414 — Medical Assistance

ORS 414.688. Commission established; membership. (1) As used in this section: (a) Practice of pharmacy has the meaning given that term in ORS 689.005. (b) Retail drug outlet has the meaning given that term in ORS 689.005. (2) The Health Evidence Review Commission is established in the Oregon Health Authority, consisting of 13 members appointed by the Governor in consultation with professional and other interested organizations, and confirmed by the Senate, as follows: (a) Five members must be physicians licensed to practice medicine in this state who have clinical expertise in the areas of family medicine, internal medicine, obstetrics, perinatal health, pediatrics, disabilities, geriatrics or general surgery. One of the physicians must be a doctor of osteopathic medicine, and one must be a hospital representative or a physician whose practice is significantly hospital-based. (b) One member must be a dentist licensed under ORS chapter 679 who has clinical expertise in general, pediatric or public health dentistry. (c) One member must be a public health nurse. (d) One member must be a behavioral health representative who may be a social services worker, alcohol and drug treatment provider, psychologist or psychiatrist. (e) Two members must be consumers of health care who are patient advocates or represent the areas of indigent services, labor, business, education or corrections. (f) One member must be a complementary or alternative medicine provider who is a chiropractic physician licensed under ORS chapter 684, a naturopathic physician licensed under ORS chapter 685 or an acupuncturist licensed under ORS chapter 677. (g) One member must be an insurance industry representative who may be a medical director or other administrator. (h) One member must be a pharmacy representative who engages in the practice of pharmacy at a retail drug outlet. (3) No more than six members of the commission may be physicians either in active practice or retired from practice. (4) Members of the commission serve for a term of four years at the pleasure of the Governor. A member is eligible for reappointment. (5) Members are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for in ORS 292.495. Claims for expenses shall be paid out of funds available to the Oregon Health Authority for purposes of the commission.
ORS Chapter 414 — Medical Assistance

ORS 414.689. Members; meetings. (1) The Health Evidence Review Commission shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers the commission determines necessary for the performance of the functions of the offices. (2) A majority of the members of the commission constitutes a quorum for the transaction of business. (3) The commission shall meet at least four times per year at a place, day and hour determined by the chairperson. The commission also shall meet at other times and places specified by the call of the chairperson or of a majority of the members of the commission. (4) The commission may use advisory committees or subcommittees whose members are appointed by the chairperson of the commission subject to approval by a majority of the members of the commission. The advisory committees or subcommittees may contain experts appointed by the chairperson and a majority of the members of the commission. The conditions of service of the experts will be determined by the chairperson and a majority of the members of the commission. (5) The Oregon Health Authority shall provide staff and support services to the commission.
ORS Chapter 414 — Medical Assistance

ORS 414.690. Prioritized list of health services. (1) The Health Evidence Review Commission shall regularly solicit testimony and information from stakeholders representing consumers, advocates, providers, carriers and employers in conducting the work of the commission. (2) The commission shall actively solicit public involvement through a public meeting process to guide health resource allocation decisions. (3) The commission shall develop and maintain a list of health services ranked by priority, from the most important to the least important, representing the comparative benefits of each service to the population to be served. The list must be submitted by the commission pursuant to subsection (5) of this section and is not subject to alteration by any other state agency. (4) In order to encourage effective and efficient medical evaluation and treatment, the commission: (a) May include clinical practice guidelines in its prioritized list of services. The commission shall actively solicit testimony and information from the medical community and the public to build a consensus on clinical practice guidelines developed by the commission. (b) May include statements of intent in its prioritized list of services. Statements of intent should give direction on coverage decisions where medical codes and clinical practice guidelines cannot convey the intent of the commission. (c) Shall consider both the clinical effectiveness and cost-effectiveness of health services, including drug therapies, in determining their relative importance using peer-reviewed medical literature as defined in ORS 743A.060. (5) The commission shall report the prioritized list of services to the Oregon Health Authority for budget determinations by July 1 of each even-numbered year. (6) The commission shall make its report during each regular session of the Legislative Assembly and shall submit a copy of its report to the Governor, the Speaker of the House of Representatives and the President of the Senate. (7) The commission may alter the list during the interim only as follows: (a) To make technical changes to correct errors and omissions; (b) To accommodate changes due to advancements in medical technology or new data regarding health outcomes; (c) To accommodate changes to clinical practice guidelines; and (d) To add statements of intent that clarify the prioritized list. (8) If a service is deleted or added during an interim and no new funding is required, the commission shall report to the Speaker of the House of Representatives and the President of the Senate. However, if a service to be added requires increased funding to avoid discontinuing another service, the commission shall report to the Emergency Board to request the funding. (9) The prioritized list of services remains in effect for a two-year period beginning no earlier than October 1 of each odd-numbered year.
ORS Chapter 414 — Medical Assistance

ORS 414.694. Commission review of covered reproductive health services. The Health Evidence Review Commission shall review the coverage described in ORS 743A.067 (2) and, no later than November 1 of each even-numbered year, report to the interim committees of the Legislative Assembly related to health any recommended changes to the coverage described in ORS 743A.067 (2) based upon the latest clinical research. [2017 c.721 9] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.695. Medical technology assessment. (1) As used in this section and ORS
ORS Chapter 414 — Medical Assistance

ORS 414.698. (a) Medical technology means medical equipment and devices, medical or surgical procedures and techniques used by health care providers in delivering medical care to individuals, and the organizational or supportive systems within which medical care is delivered. (b) Medical technology assessment means evaluation of the use, clinical effectiveness and cost of a technology in comparison with its alternatives. (2) The Health Evidence Review Commission shall develop a medical technology assessment process. The Oregon Health Authority shall direct the commission with regard to medical technologies to be assessed and the timing of the assessments. (3) The commission shall appoint and work with an advisory committee whose members have the appropriate expertise to conduct a medical technology assessment. (4) The commission shall present its preliminary findings at a public hearing and shall solicit testimony and information from health care consumers. The commission shall give strong consideration to the recommendations of the advisory committee and public testimony in developing its assessment. (5) To ensure that confidentiality is maintained, identification of a patient or a person licensed to provide health services may not be included with the data submitted under this section, and the commission shall release such data only in aggregate statistical form. All findings and conclusions, interviews, reports, studies, communications and statements procured by or furnished to the commission in connection with obtaining the data necessary to perform its functions is confidential pursuant to ORS 192.338, 192.345 and 192.355. [2011 c.720 25] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.701. Commission may not rely solely on comparative effectiveness research. The Health Evidence Review Commission, in ranking health services or developing guidelines under ORS 414.690 or in assessing medical technologies under ORS 414.698, and the Pharmacy and Therapeutics Committee, in considering a recommendation for a drug to be included on any preferred drug list or on the Practitioner-Managed Prescription Drug Plan, may not rely solely on the results of comparative effectiveness research. [2011 c.720 26a] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.704. Advisory committee. The Health Evidence Review Commission shall consult with an advisory committee in determining priorities for mental health care and chemical dependency. The advisory committee shall include mental health and chemical dependency professionals who provide inpatient and outpatient mental health and chemical dependency care. [Formerly 414.730]
ORS Chapter 414 — Medical Assistance

ORS 414.705. [1989 c.836 2; 1991 c.753 4; 2003 c.735 1; 2003 c.810 7; repealed by 2011 c.602 64,70] SCOPE OF COVERED HEALTH SERVICES
ORS Chapter 414 — Medical Assistance

ORS 414.706. Persons eligible for medical assistance; rules. Within available funds and subject to the rules of the Oregon Health Authority, medical assistance shall be provided to an individual who is a resident of this state and who: (1) Is receiving a category of aid; (2) Would be eligible for a category of aid but is not receiving a category of aid; (3) Is required by federal law to be included in the states medical assistance program in order for that program to qualify for federal funds; and (4) Is not described in subsection (3) of this section but for whom federal funding is available under Title XIX or XXI of the Social Security Act.
ORS Chapter 414 — Medical Assistance

ORS 414.709. Adjustment of population of eligible persons in event of insufficient resources prohibited. If insufficient resources are available during a biennium, the population of eligible persons receiving health services may not be reduced below the population of eligible persons approved and funded in the legislatively adopted budget for the Oregon Health Authority for the biennium.