reglab/housing_qa huggingface dataset:
OR Rev Stat § 414.719 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.719 - Housing navigation services and social determinants of health; rules.

The Oregon Health Authority shall adopt by rule requirements for coordinated care organizations to provide housing navigation services and address the social determinants of health through care coordination. [2021 c.667 §11] Note: 414.719 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.723 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.723 - Telemedicine services; rules.

(1) As used in this section: (a)(A) "Audio only" means the use of audio telephone technology, permitting real-time communication between a health care provider and a patient for the purpose of diagnosis, consultation or treatment. (B) "Audio only" does not include: (i) The use of facsimile, electronic mail or text messages. (ii) The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results. (b) "Telemedicine" means the mode of delivering health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a patient’s health care. (2) To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to: (a) Health services transmitted via landlines, wireless communications, the Internet and telephone networks; (b) Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and (c) Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians. (3)(a) The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology. (b) Paragraph (a) of this subsection does not prohibit the use of value-based payment methods, including global budgets or capitated, bundled, risk-based or other value-based payment methods, and does not require that any value-based payment method reimburse telemedicine health services based on an equivalent fee-for-service rate. (4) The authority shall include the costs of telemedicine services in its rate assumptions for payments made to clinics or other providers on a prepaid capitated basis. (5) This section does not require the authority or a coordinated care organization to pay a provider for a service that is not included within the Healthcare Procedure Coding System or the American Medical Association’s Current Procedural Terminology codes. (6) The authority shall adopt rules to ensure that coordinated care organizations reimburse the cost of health services delivered using telemedicine, consistent with subsections (2) and (3) of this section. [2021 c.117 §2] Note: 414.723 was added to and made a part of ORS chapter 414 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.725 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.725

[1989 c.836 §6; 1991 c.753 §8; 2003 c.14 §194; 2003 c.735 §13; 2003 c.794 §277; 2003 c.810 §4; 2005 c.806 §8; 2007 c.458 §1; 2009 c.595 §325; 2009 c.795 §3; 2011 c.602 §26; renumbered 414.651 in 2011]
OR Rev Stat § 414.726 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.726 - Requirement to use certified or qualified health care interpreters; reimbursement; rules.

(1) As used in this section: (a) "Certified health care interpreter" has the meaning given that term in ORS 413.550. (b) "Qualified health care interpreter" has the meaning given that term in ORS 413.550. (2) The Oregon Health Authority shall adopt rules to ensure that a coordinated care organization, in accordance with ORS 414.572 (2)(e), and any other health care provider that is reimbursed for the cost of health care by the state medical assistance program: (a) Works with a certified health care interpreter or a qualified health care interpreter when interacting with a recipient of medical assistance, or a caregiver of a recipient of medical assistance, who has limited English proficiency or who communicates in signed language; and (b) Is reimbursed for the cost of the certified health care interpreter or qualified health care interpreter. [2021 c.453 §6] Note: 414.726 becomes operative July 1, 2022. See section 18, chapter 453, Oregon Laws 2021. Note: 414.726 was added to and made a part of ORS chapter 414 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.728 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.728 - Reimbursement of rural hospitals on fee-for-service basis.

For services provided on a fee-for-service basis to persons who are entitled to receive medical assistance, the Oregon Health Authority shall reimburse Type A and Type B hospitals and rural critical access hospitals, as described in ORS 442.470 and identified by the Office of Rural Health as rural hospitals, fully for the cost of covered services based on the most recent audited Medicare cost report for Oregon hospitals adjusted to reflect the Medicaid mix of services. [2005 c.806 §4; 2009 c.595 §327; 2011 c.602 §43]
OR Rev Stat § 414.730 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.730

[1989 c.836 §7; 1995 c.79 §209; 2005 c.22 §286; 2011 c.720 §148; renumbered 414.704 in 2011]
OR Rev Stat § 414.735 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.735 - Reduction in scope of health services in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers.

(1) If insufficient resources are available during a contract period: (a) The population of eligible persons determined by law may not be reduced. (b) The reimbursement rate for providers and plans established under the contractual agreement may not be reduced. (2) In the circumstances described in subsection (1) of this section, reimbursement shall be adjusted by reducing the health services for the eligible population by eliminating services in the order of priority recommended by the Health Evidence Review Commission, starting with the least important and progressing toward the most important. (3) The Oregon Health Authority shall obtain the approval of the Legislative Assembly, or the Emergency Board if the Legislative Assembly is not in session, before instituting the reductions. In addition, providers contracting to provide health services under ORS 414.591, 414.631 and 414.688 to 414.745 must be notified at least two weeks prior to any legislative consideration of such reductions. Any reductions made under this section shall take effect no sooner than 60 days following final legislative action approving the reductions. (4) This section does not apply to reductions made by the Legislative Assembly in a legislatively adopted or approved budget. [1989 c.836 §8; 1991 c.753 §9; 2003 c.14 §195; 2009 c.595 §328; 2009 c.827 §18; 2011 c.720 §149]
OR Rev Stat § 414.737 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.737

[2003 c.810 §3; 2007 c.751 §8; 2009 c.595 §§330,331; 2011 c.602 §§27,28; renumbered 414.631 in 2011]
OR Rev Stat § 414.742 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.742 - Payment for mental health drugs.

The Oregon Health Authority may not establish capitation rates or global budgets that include payment for mental health drugs. The authority shall reimburse pharmacy providers for mental health drugs only on a fee-for-service payment basis. [2003 c.810 §11; 2009 c.595 §336; 2011 c.602 §46]
OR Rev Stat § 414.743 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.743 - Payment to noncontracting hospital by coordinated care organization; rules.

(1) Except as provided in subsection (2) of this section, a coordinated care organization that does not have a contract with a hospital to provide inpatient or outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745 must, using Medicare payment methodology, reimburse the noncontracting hospital for services provided to a member of the organization at a rate no less than a percentage of the Medicare reimbursement rate for those services. The percentage of the Medicare reimbursement rate that is used to determine the reimbursement rate under this subsection is equal to four percentage points less than the percentage of Medicare cost used by the Oregon Health Authority in calculating the base hospital capitation payment to the organization, excluding any supplemental payments. (2)(a) If a coordinated care organization does not have a contract with a hospital, and the hospital provides less than 10 percent of the hospital admissions and outpatient hospital services to members of the organization, the percentage of the Medicare reimbursement rate that is used to determine the reimbursement rate under subsection (1) of this section is equal to two percentage points less than the percentage of Medicare cost used by the Oregon Health Authority in calculating the base hospital capitation payment to the organization, excluding any supplemental payments. (b) This subsection is not intended to discourage a coordinated care organization and a hospital from entering into a contract and is intended to apply to hospitals that provide primarily, but not exclusively, specialty and emergency care to members of the organization. (3) A hospital that does not have a contract with a coordinated care organization to provide inpatient or outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745 must accept as payment in full for hospital services the rates described in subsections (1) and (2) of this section. (4) This section does not apply to type A and type B hospitals, as described in ORS 442.470, and rural critical access hospitals, as defined in ORS 442.470. (5) The Oregon Health Authority shall adopt rules to implement and administer this section. [Subsection (1) of 2003 Edition enacted as 2003 c.735 §16(1); subsections (2) to (5) of 2003 Edition enacted as 2003 c.735 §16(2) to (5) and 2003 c.810 §12(1) to (4); 2007 c.886 §§1,2; 2009 c.595 §§337,338; 2009 c.886 §§4,5; 2011 c.602 §§47,71; 2015 c.27 §46; 2017 c.718 §8]
OR Rev Stat § 414.745 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.745 - Liability of health care providers and plans.

Any health care provider or plan contracting to provide services to the eligible population under ORS 414.591, 414.631 and 414.688 to 414.745 shall not be subject to criminal prosecution, civil liability or professional disciplinary action for failing to provide a service which the Legislative Assembly has not funded or has eliminated from its funding pursuant to ORS 414.735. [1989 c.836 §10; 1991 c.753 §10]
OR Rev Stat § 414.747 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.747

[2003 c.810 §15; renumbered 414.326 in 2011]
OR Rev Stat § 414.751 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.751

[1997 c.683 §35; 2001 c.69 §2; 2009 c.595 §341; renumbered 414.229 in 2009]
OR Rev Stat § 414.755 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.755 - Payment for hospital services.

The Oregon Health Authority shall establish fee-for-service reimbursement rates for inpatient hospital services provided by hospitals that receive Medicare reimbursement on the basis of diagnostic related groups as follows: (1) For the period from October 1, 2009, through September 30, 2013, at the same rate paid by Medicare on the date of the service. (2) For the period beginning October 1, 2013, at a rate that is 70 percent of the rate paid by Medicare on the date of the service. [2009 c.867 §29; 2009 c.828 §54]
OR Rev Stat § 414.756 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.756 - Payments to Oregon Health and Science University.

The Oregon Health Authority shall ensure that the Oregon Health and Science University receives net reimbursement of at least 87 percent but no more than 100 percent of the university’s costs of providing services that are paid for, in whole or in part, with Medicaid funds. Net reimbursement means all Medicaid payments less any amount that is transferred by the university to the authority. [2017 c.538 §41; 2019 c.2 §17] Note: The amendments to 414.756 by section 18, chapter 2, Oregon Laws 2019, apply to reimbursement paid to the Oregon Health and Science University by the Oregon Health Authority on or after July 1, 2025. See section 19, chapter 2, Oregon Laws 2019. The text that applies to reimbursement paid to the university by the authority on or after July 1, 2025, is set forth for the user’s convenience. The Oregon Health Authority shall ensure that the Oregon Health and Science University receives net reimbursement of at least 84 percent but no more than 100 percent of the university’s costs of providing services that are paid for, in whole or in part, with Medicaid funds. Net reimbursement means all Medicaid payments less any amount that is transferred by the university to the authority. Note: 414.756 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.760 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.760 - Payment for patient centered primary care home and behavioral health home services.

(1) The Oregon Health Authority shall provide reimbursement in the state’s medical assistance program for services provided by patient centered primary care homes and behavioral health homes. If practicable, efforts to align financial incentives to support patient centered primary care homes and behavioral health homes for enrollees in medical assistance programs should be aligned with efforts of the learning collaborative described in ORS 413.259 (3). (2) The authority shall require each coordinated care organization, to the extent practicable, to offer patient centered primary care homes and behavioral health homes that meet the standards established in ORS 414.655. (3) The authority may reimburse patient centered primary care homes and behavioral health homes for interpretive services provided to people in the state’s medical assistance programs if interpretive services qualify for federal financial participation. (4) The authority shall require patient centered primary care homes and behavioral health homes receiving these reimbursements to report on quality measures described in ORS 413.259 (1)(c). [2009 c.595 §1164; 2011 c.602 §29; 2015 c.798 §15] Note: 414.760 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.762 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.762 - Payment for child abuse assessment.

(1) As used in this section: (a) "Child abuse assessment" has the meaning given that term in ORS 418.782. (b) "Children’s advocacy center" has the meaning given that term in ORS 418.782. (c) "Forensic interview" has the meaning given that term in ORS 418.782. (2) The Oregon Health Authority shall reimburse a children’s advocacy center for the services the center provides: (a) In conducting a child abuse assessment of a child who is eligible for medical assistance; and (b) That are related to the child abuse assessment including, but not limited to: (A) A forensic interview; and (B) Mental health treatment. (3) The authority shall adopt billing and payment mechanisms to ensure that the reimbursement is proportionate to the scope and intensity of the services provided by the children’s advocacy center. [2015 c.100 §2; 2019 c.141 §14]
OR Rev Stat § 414.764 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.764 - Payment for services provided by pharmacy or pharmacist.

(1) The Oregon Health Authority may reimburse a pharmacist or pharmacy for any health service: (a) Provided to a medical assistance recipient who is not enrolled in a coordinated care organization or a prepaid managed care health services organization; (b) That is within the lawful scope of practice of a pharmacist; and (c) If the authority determines the service is within the types and extent of health care and services to be provided to medical assistance recipients under ORS 414.065. (2) A coordinated care organization may reimburse a pharmacist or pharmacy for any health service: (a) Provided to a medical assistance recipient who is enrolled in the coordinated care organization or a prepaid managed care health services organization that enters into a clinical pharmacy agreement with the pharmacist or pharmacy; and (b) That is within the lawful scope of practice of a pharmacist. [2015 c.362 §6]
OR Rev Stat § 414.766 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.766 - Behavioral health treatment; rules.

(1) Notwithstanding ORS 414.065 and 414.690, a coordinated care organization must provide behavioral health services to its members that include but are not limited to all of the following: (a) For a member who is experiencing a behavioral health crisis: (A) A behavioral health assessment; and (B) Services that are medically necessary to transition the member to a lower level of care; (b) At least the minimum level of services that are medically necessary to treat a member’s underlying behavioral health condition rather than a mere amelioration of current symptoms, such as suicidal ideation or psychosis, as determined in a behavioral health assessment of the member or specified in the member’s care plan; (c) Treatment of co-occurring behavioral health disorders or medical conditions in a coordinated manner; (d) Treatment at the least intensive and least restrictive level of care that is safe and effective and meets the needs of the individual’s condition; (e) For all level of care placement decisions, placement at the level of care consistent with a member’s score or assessment using the relevant level of care placement criteria and guidelines; (f) If the level of placement described in paragraph (e) of this subsection is not available, placement at the next higher level of care; (g) Treatment to maintain functioning or prevent deterioration; (h) Treatment for an appropriate duration based on the individual’s particular needs; (i) Treatment appropriate to the unique needs of children and adolescents; (j) Treatment appropriate to the unique needs of older adults; (k) Treatment that is culturally and linguistically appropriate; (L) Treatment that is appropriate to the unique needs of gay, lesbian, bisexual and transgender individuals and individuals of any other minority gender identity or sexual orientation; (m) Coordinated care and case management as defined by the Department of Consumer and Business Services by rule; and (n) Mental health wellness appointments as prescribed by the Oregon Health Authority by rule. (2) If there is a disagreement about the level of care required by subsection (1)(e) or (f) of this section, a coordinated care organization shall provide to the behavioral health treatment provider full details of the coordinated care organization’s scoring or assessment, to the extent permitted by the federal Health Insurance Portability and Accountability Act privacy regulations, 45 C.F.R. parts 160 and 164, ORS 192.553 to 192.581 or other state or federal laws limiting the disclosure of health information. (3) The Oregon Health Authority shall adopt by rule a list of behavioral health services that may not be subject to prior authorization. [2017 c.273 §2; 2021 c.116 §1; 2021 c.629 §4]
OR Rev Stat § 414.767 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.767 - Survey of medical assistance recipients regarding experience with behavioral health care and services.

The Oregon Health Authority shall contract with a third-party vendor to survey medical assistance recipients about their experiences with behavioral health care and services using a standardized survey tool. [2021 c.667 §9] Note: 414.767 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 414.768 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.768

[2017 c.281 §3; renumbered 414.669 in 2019]