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

ORS 414.002. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.003. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.004. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.005. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.006. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.007. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.008. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.009. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.010. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.011. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.012. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.013. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.014. [Repealed by 1953 c.378 2]
ORS Chapter 414 — Medical Assistance

ORS 414.015. [Repealed by 1953 c.30 2]
ORS Chapter 414 — Medical Assistance

ORS 414.016. [Repealed by 1953 c.30 2]
ORS Chapter 414 — Medical Assistance

ORS 414.017. [Repealed by 1953 c.30 2] GENERAL PROVISIONS
ORS Chapter 414 — Medical Assistance

ORS 414.020. [Repealed by 1953 c.204 9]
ORS Chapter 414 — Medical Assistance

ORS 414.028. [Formerly
ORS Chapter 414 — Medical Assistance

ORS 414.030. [Repealed by 1953 c.204 9]
ORS Chapter 414 — Medical Assistance

ORS 414.033. Expenditures for medical assistance authorized. The Oregon Health Authority may: (1) Subject to the allotment system provided for in ORS 291.234 to 291.260, expend such sums as are required to be expended in this state to provide medical assistance. Expenditures for medical assistance include, but are not limited to, expenditures for deductions, cost sharing, enrollment fees, premiums or similar charges imposed with respect to hospital insurance benefits or supplementary health insurance benefits, as established by federal law. (2) Enter into agreements with, join with or accept grants from the federal government for cooperative research and demonstration projects for public welfare purposes, including, but not limited to, any project for: (a) Providing medical assistance to individuals who are dually eligible for Medicare and Medicaid using global or alternative payment methodologies or integrated and coordinated health care and services; or (b) Evaluating service delivery systems.
ORS Chapter 414 — Medical Assistance

ORS 414.034. Acceptance of federal billing, reimbursement and reporting forms. The Oregon Health Authority shall accept federal Centers for Medicare and Medicaid Services billing, reimbursement and reporting forms instead of department billing, reimbursement and reporting forms if the federal forms contain substantially the same information as required by the department forms. [2003 c.135 1; 2009 c.595 266] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.038. [1975 c.509 3,4 (enacted in lieu of 414.037); repealed by 2009 c.595 1204]
ORS Chapter 414 — Medical Assistance

ORS 414.041. Simplified application process; outreach and enrollment. (1) The Oregon Health Authority, under the direction of the Oregon Health Policy Board and in collaboration with the Department of Human Services, shall implement a streamlined and simple application process for the medical assistance and premium assistance programs administered by the Oregon Health Authority. The process must meet the requirements of ORS 411.400, 411.402, 411.404, 411.406, 411.408 and 411.967. (2) In developing the simplified application process, the authority shall consult with persons not employed by the authority who have experience in serving vulnerable and hard-to-reach populations. (3) The authority and the department shall facilitate outreach and enrollment efforts to connect eligible individuals with all available publicly funded health programs. [2009 c.867 35; 2009 c.828 58; 2011 c.720 130; 2013 c.681 47; 2013 c.688 69] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.044. Notice to Department of Veterans Affairs of information regarding applications for health care coverage by uniformed service members and veterans; rules. (1) As used in this section: (a) Uniformed service means the Armed Forces of the United States, the Army National Guard or the Air National Guard when the member is engaged in active duty for training, inactive duty for training or full-time National Guard duty, the commissioned corps of the United States Public Health Service and any other category of persons designated by the President of the United States in time of war or national emergency. (b) Written information means information that is in written form and includes but is not limited to information obtained by electronic means, such as electronic mail, facsimile or other form of electronic communication. (2)(a) Subject to subsection (3) of this section, the Director of the Oregon Health Authority shall notify the Director of Veterans Affairs at least once each month regarding receipt of written information from a member or veteran of a uniformed service in connection with an application for health care coverage. (b) The notification required under this subsection is limited to notifying the Director of Veterans Affairs of the name and residence address or mailing address of the member or veteran. (c) The authorization of a member or veteran as required by subsection (3) of this section may be contained in the written information at the time it is received by the Oregon Health Authority or separately at another time, but the authorization must specifically authorize the notification to be made under this section. (3) The Director of the Oregon Health Authority shall notify the Director of Veterans Affairs as required by subsection (2) of this section only if authorized to do so in writing by the member or veteran of a uniformed service. (4) The Oregon Health Authority, in consultation with the Department of Veterans Affairs, shall adopt rules to implement the provisions of this section, including but not limited to the method of notification required under subsection (2) of this section. [2015 c.621 1] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.060. [1953 c.204 3; renumbered 414.830 and then 566.330] MEDICAL ASSISTANCE
ORS Chapter 414 — Medical Assistance

ORS 414.066. Billing patient for services covered by medical assistance prohibited. (1) A health care provider may not bill or solicit payment from a medical assistance applicant or recipient for services, except for copayments or other charges authorized by the Oregon Health Authority by rule. (2)(a) A health care provider that submits a claim for payment to the authority or a coordinated care organization shall wait to receive payment for at least 90 days after submitting the claim before assigning the claim to a collection agency or similar entity to recover from the patient. (b) If the claim remains unpaid 90 days after a health care provider submits the claim to the authority or a coordinated care organization, the health care provider shall first query the medical assistance program database to confirm the patients eligibility for medical assistance. (c) The health care provider may not assign the claim for collection if the authority confirms that the patient was eligible for medical assistance at the time the services were provided.
ORS Chapter 414 — Medical Assistance

ORS 414.067. Coordinated care organization assumption of costs; reports to Legislative Assembly. (1) If the Oregon Health Authority or the Department of Human Services requires a coordinated care organization to provide a service, paid for out of the organizations global budget, that was previously reimbursed by the authority or the department on a fee-for-service basis, the authority or the department must provide the organization with a statement of the costs incurred by the authority or the department in reimbursing the service during the three-year period prior to the organizations assumption of the cost of the service. (2) If the authority or the department requires a coordinated care organization to assume the cost of a service as described in subsection (1) of this section, the authority or the department shall report to the Legislative Assembly, not later than February 1 of the following year, a statement of the increased cost to the coordinated care organization of providing the service, calculated as the average annual cost incurred by the authority or the department in reimbursing the service during the three-year period prior to the organizations assumption of the cost of the service.
ORS Chapter 414 — Medical Assistance

ORS 414.071. Timely payment for dental services. The Oregon Health Authority and the Department of Human Services shall approve or deny prior authorization requests for dental services not later than 30 days after submission thereof by the provider, and shall make payments to providers of prior authorized dental services not later than 30 days after receipt of the invoice of the provider. [Formerly 411.459] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.072. Prior authorization data and reports. (1) As used in this section, coordinated care organization has the meaning given that term in ORS 414.025. (2) The Oregon Health Authority shall compile and annually post to the authoritys website a report of the following information, in the aggregate, that was reported to the authority by coordinated care organizations regarding requests for prior authorization received by coordinated care organizations or risk-bearing entities acting for or in concert with coordinated care organizations: (a) The number of requests received; (b) The number of requests that were initially denied and the reasons for the denials, including, but not limited to, lack of medical necessity or incomplete requests; and (c) The number of denials that were reversed on an appeal. [2021 c.154 1] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.075. Payment of deductibles imposed under federal law. Medical assistance provided to any individual who is covered by the hospital insurance benefits or supplementary health insurance benefits, or either of them, as established by federal law, may include: (1) The full amount of any deductible imposed with respect to such individual under the hospital insurance benefits; and (2) All or any part of any deductible, cost sharing, or similar charge imposed with respect to such individual under the health insurance benefits.
ORS Chapter 414 — Medical Assistance

ORS 414.095. Exemptions applicable to payments. Neither medical assistance nor amounts payable to vendors out of medical assistance funds are transferable or assignable at law or in equity and none of the money paid or payable under the provisions of this chapter is subject to execution, levy, attachment, garnishment or other legal process.
ORS Chapter 414 — Medical Assistance

ORS 414.109. Oregon Health Plan Fund. (1) The Oregon Health Plan Fund is established, separate and distinct from the General Fund. Interest earned by the Oregon Health Plan Fund shall be retained by the Oregon Health Plan Fund. (2) Moneys in the Oregon Health Plan Fund are continuously appropriated to the Department of Human Services for the purposes of funding the maintenance and expansion of the number of persons eligible for medical assistance under the Oregon Health Plan and funding the maintenance of the benefits available under the Oregon Health Plan. (3) On June 26, 2009, all moneys in the Oregon Health Plan Fund shall be transferred to the Oregon Health Authority Fund established in ORS 413.101. [2002 s.s.3 c.2 9; 2009 c.595 280] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.115. Medical assistance by insurance or service contracts; rules. (1) In lieu of providing one or more of the health care and services available under medical assistance by direct payments to providers thereof and in lieu of providing such health care and services made available pursuant to ORS 414.065, the Oregon Health Authority may use available medical assistance funds to purchase and pay premiums on policies of insurance, or enter into and pay the expenses on health care service contracts, or medical or hospital service contracts that provide one or more of the health care and services available under medical assistance. Notwithstanding other specific provisions, the use of available medical assistance funds to purchase health care and services may provide the following insurance or contract options: (a) Differing services or levels of service among groups of eligibles as defined by rules of the authority; and (b) Services and reimbursement for these services may vary among contracts and need not be uniform. (2) The policy of insurance or the contract by its terms, or the insurer or contractor by written acknowledgment to the authority must guarantee: (a) To provide health care and services of the type, within the extent and according to standards prescribed under ORS 414.065; (b) To pay providers of health care and services the amount due, based on the number of days of care and the fees, charges and costs established under ORS
ORS Chapter 414 — Medical Assistance

ORS 414.117. Premium assistance for health insurance coverage. Subject to funds available, the Oregon Health Authority may provide medical assistance in the form of premium assistance for the purchase of health insurance coverage provided by public programs or private insurance, including but not limited to medical assistance described in ORS 414.115. [Formerly 414.839] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.125. Rates on insurance or service contracts; requirements for insurer or contractor. (1) Any payment of available medical assistance funds for policies of insurance or service contracts shall be according to such uniform area-wide rates as the Oregon Health Authority shall have established and which it may revise from time to time as may be necessary or practical, except that, in the case of a research and demonstration project entered into under ORS 411.135 special rates may be established. (2) No premium or other periodic charge on any policy of insurance, health care service contract, or medical or hospital service contract shall be paid from available medical assistance funds unless the insurer or contractor issuing such policy or contract is by law authorized to transact business as an insurance company, health care service contractor or hospital association in this state.
ORS Chapter 414 — Medical Assistance

ORS 414.135. Contracts relating to direct providers of care and services. The Oregon Health Authority may enter into nonexclusive contracts under which funds available for medical assistance may be administered and disbursed by the contractor to direct providers of medical and remedial care and services available under medical assistance in consideration of services rendered and supplies furnished by them in accordance with the provisions of this chapter. Payment shall be made according to the rules of the authority pursuant to the number of days and the fees, charges and costs established under ORS 414.065. The contractor must guarantee the authority by written acknowledgment: (1) To make all payments under this chapter promptly but not later than 30 days after receipt of the proper evidence establishing the validity of the providers claim. (2) To provide such data, records and reports to the authority as may be required by the authority.
ORS Chapter 414 — Medical Assistance

ORS 414.145. Implementation of ORS 414.115, 414.125 or 414.135. (1) The provisions of ORS 414.115, 414.125 or 414.135 shall be implemented whenever it appears to the Oregon Health Authority that such implementation will provide comparable benefits at equal or less cost than provision thereof by direct payments by the authority to the providers of medical assistance, but in no case greater than the legislatively approved budgeted cost per eligible recipient at the time of contracting. (2) When determining comparable benefits at equal or less cost as provided in subsection (1) of this section, the authority must take into consideration the recipients need for reasonable access to preventive and remedial care, and the contractors ability to assure continuous quality delivery of both routine and emergency services. [1967 c.502 11a; 1975 c.401 3; 1983 c.590 9; 1985 c.747 12a; 1991 c.66 20; 2009 c.595 284] STATE AND LOCAL PUBLIC HEALTH PARTNERSHIP
ORS Chapter 414 — Medical Assistance

ORS 414.150. Purpose of ORS 414.150 to 414.153. It is the purpose of ORS 414.150 to
ORS Chapter 414 — Medical Assistance

ORS 414.152. Duty of state agencies to work with local health departments. To capitalize on the successful public health programs provided by local health departments and the sizable investment by state and local governments in the public health system, state agencies shall encourage agreements that allow local health departments and other publicly supported programs to continue to be the providers of those prevention and health promotion services now available, plus other maternal and child health services such as prenatal outreach and care, child health services and family planning services to women and children who become eligible for poverty level medical assistance program benefits pursuant to ORS 414.153. [1991 c.337 3; 2015 c.736 59] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.210. [1957 c.692 1; repealed by 1963 c.631 2] ADVISORY COMMITTEES
ORS Chapter 414 — Medical Assistance

ORS 414.211. Medicaid Advisory Committee. (1) There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor. (2) The committee shall be composed of: (a) A physician licensed under ORS chapter 677; (b) Two members of health care consumer groups that include Medicaid recipients; (c) Two Medicaid recipients, one of whom shall be a person with a disability; (d) The Director of the Oregon Health Authority or designee; (e) The Director of Human Services or designee; (f) Health care providers; (g) Persons associated with health care organizations, including but not limited to coordinated care organizations under contract to the Medicaid program; and (h) Members of the general public. (3) In making appointments, the Governor shall consult with appropriate professional and other interested organizations. All members appointed to the committee shall be familiar with the medical needs of low income persons. (4) The term of office for each member shall be two years, but each member shall serve at the pleasure of the Governor. (5) Members of the committee shall receive no compensation for their services but, subject to any applicable state law, shall be allowed actual and necessary travel expenses incurred in the performance of their duties from the Oregon Health Authority Fund. [1995 c.727 43; 2007 c.70 192; 2009 c.595 287; 2011 c.602 37; 2011 c.720 132] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.221. Duties of committee. The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on: (1) Medical care, including mental health and alcohol and drug treatment and remedial care to be provided under ORS chapter 414; and (2) The operation and administration of programs provided under ORS chapter 414. [1995 c.727 44; 2003 c.784 7; 2007 c.697 16; 2009 c.595 288; 2011 c.720 133] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.225. Oregon Health Authority to consult with committee. The Oregon Health Authority shall consult with the Medicaid Advisory Committee concerning the determinations required under ORS 414.065.
ORS Chapter 414 — Medical Assistance

ORS 414.227. Application of public meetings law to advisory committees. (1) ORS 192.610 to 192.705 apply to any meeting of an advisory committee with the authority to make decisions for, conduct policy research for or make recommendations to the Oregon Health Authority, the Oregon Health Policy Board or the Department of Human Services on administration or policy related to the medical assistance program operated under this chapter. (2) Subsection (1) of this section applies only to advisory committee meetings attended by two or more advisory committee members who are not employed by a public body.
ORS Chapter 414 — Medical Assistance

ORS 414.229. [Formerly
ORS Chapter 414 — Medical Assistance

ORS 414.230. [1957 c.692 5; repealed by 1963 c.631 2] COVER ALL PEOPLE PROGRAM
ORS Chapter 414 — Medical Assistance

ORS 414.231. Eligibility for Cover All People program; 12-month continuous enrollment; verification of eligibility. (1) As used in this section: (a) Adult means a person 19 years of age or older. (b) Child means a person under 19 years of age. (2) The Cover All People program is established to make affordable, accessible health care available to all residents in this state. The program provides medical assistance, funded in whole or in part by Title XIX of the Social Security Act, by the State Childrens Health Insurance Program under Title XXI of the Social Security Act or by moneys appropriated or allocated by the Legislative Assembly to supplement funds received under Title XIX or XXI of the Social Security Act. (3) A child is eligible for medical assistance under subsection (2) of this section if the child resides in this state and the income of the childs family is at or below 300 percent of the federal poverty guidelines. (4) An adult is eligible for medical assistance under subsection (2) of this section if the adult resides in this state and would be eligible for medical assistance but for the adults immigration status. (5) There is no asset limit to qualify for the program. (6)(a) A child receiving medical assistance through the Cover All People program is continuously eligible for a minimum period of 12 months or until the child reaches 19 years of age, whichever comes first. (b) The Department of Human Services or the Oregon Health Authority shall reenroll a child for successive 12-month periods of enrollment as long as the child is eligible for medical assistance on the date of reenrollment and the child has not yet reached 19 years of age. (c) A child may not be required to submit a new application as a condition of reenrollment under paragraph (b) of this subsection. (7) The department or the authority must determine eligibility for or reenrollment in medical assistance under this section using information and sources available to the department or the authority. If information and sources available to the department or the authority are not adequate to verify eligibility, the department or the authority may require the adult or a childs caretaker to provide additional documentation in accordance with ORS 411.400 and 411.402. Information requested or obtained by the department or the authority under this subsection is subject to the requirements of ORS 410.150 and 413.175.
ORS Chapter 414 — Medical Assistance

ORS 414.240. [1957 c.692 3; repealed by 1963 c.631 2] BRIDGE PROGRAM
ORS Chapter 414 — Medical Assistance

ORS 414.241. Oregon Health Authority to administer bridge program. The Oregon Health Authority shall administer a bridge program to provide affordable health care coverage, improve the continuity of coverage and care for Oregonians and reduce health inequities for individuals who regularly enroll and disenroll in the medical assistance program due to fluctuations in their incomes. [2022 c.29 5; 2022 c.29 9] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.245. Bridge Plan Fund. The Bridge Plan Fund is established in the State Treasury, separate and distinct from the General Fund, consisting of federal funds received by the Oregon Health Authority to administer the bridge program described in ORS 414.241. Moneys in the Bridge Plan Fund are continuously appropriated to the Oregon Health Authority to carry out ORS 414.241. [2022 c.29 8] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.270. [1957 c.692 7(1); repealed by 1963 c.631 2]
ORS Chapter 414 — Medical Assistance

ORS 414.280. [1957 c.692 7(2); repealed by 1963 c.631 2]