reglab/housing_qa huggingface dataset:
OR Rev Stat § 414.330 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.330 - Legislative findings on prescription drugs.

The Legislative Assembly finds that: (1) The cost of prescription drugs in the medical assistance program is growing and will soon be unsustainable; (2) The benefit of prescription drugs when appropriately used decreases the need for other expensive treatments and improves the health of Oregonians; and (3) Providing the most effective drugs in the most cost-effective manner will benefit both patients and taxpayers. [2001 c.897 §1; 2009 c.595 §298a] Note: 414.330 to 414.334 were enacted into law by the Legislative Assembly but were 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 § 414.332 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.332 - Policy for Practitioner-Managed Prescription Drug Plan.

It is the policy of the State of Oregon that a Practitioner-Managed Prescription Drug Plan will ensure that: (1) Oregonians have access to the most effective prescription drugs appropriate for their clinical conditions; (2) Decisions concerning the clinical effectiveness of prescription drugs are made by licensed health practitioners, are informed by the latest peer-reviewed research and consider the health condition of a patient or characteristics of a patient, including the patient’s gender, race or ethnicity; and (3) The cost of prescription drugs in the medical assistance program is managed through market competition among pharmaceutical manufacturers by considering, first, the effectiveness and safety of a given drug and, second, any substantial cost differences between drugs within the same therapeutic class. [2001 c.897 §2; 2009 c.595 §298b; 2011 c.720 §137] Note: See note under 414.330.
OR Rev Stat § 414.334 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.334 - Practitioner-Managed Prescription Drug Plan for medical assistance program.

(1) The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best possible price. (2) In adopting the plan, the authority shall consider recommendations of the Pharmacy and Therapeutics Committee. (3) The authority shall consult with representatives of the regulatory boards and associations representing practitioners who are prescribers under the medical assistance program and ensure that practitioners receive educational materials and have access to training on the Practitioner-Managed Prescription Drug Plan. (4) Notwithstanding the Practitioner-Managed Prescription Drug Plan adopted by the authority, a practitioner may prescribe any drug that the practitioner indicates is medically necessary for an enrollee as being the most effective available. (5) An enrollee may appeal to the authority a decision of a practitioner or the authority to not provide a prescription drug requested by the enrollee. (6) This section does not limit the decision of a practitioner as to the scope and duration of treatment of chronic conditions, including but not limited to arthritis, diabetes and asthma. [2001 c.897 §3; 2009 c.595 §299; 2009 c.827 §§4,10; 2011 c.720 §§138,139] Note: See note under 414.330.
OR Rev Stat § 414.337 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.337 - Limitation on rules regarding Practitioner-Managed Prescription Drug Plan.

The Oregon Health Authority may not adopt or amend any rule that requires a prescribing practitioner to contact the authority to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug list for that class of drugs adopted under ORS 414.334, unless otherwise authorized by enabling legislation setting forth the requirement for prior authorization. [2009 c.827 §11; 2009 c.827 §12] Note: 414.337 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. Note: Sections 3 and 4, chapter 544, Oregon Laws 2019, provide: Sec. 3. (1) As used in this section, "mental health drug" means a type of legend drug defined by the Oregon Health Authority by rule that includes but is not limited to: (a) Therapeutic class 7 ataractics-tranquilizers; and (b) Therapeutic class 11 psychostimulants-antidepressants. (2) Notwithstanding ORS 414.334, the authority shall reimburse the cost of a mental health drug prescribed for a medical assistance recipient if federal financial participation in the cost is available. [2019 c.544 §3] Sec. 4. Section 3, chapter 544, Oregon Laws 2019, is repealed on January 2, 2026. [2019 c.544 §4; 2021 c.628 §1]
OR Rev Stat § 414.353 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.353 - Committee established; membership.

(1) There is created an 11-member Pharmacy and Therapeutics Committee responsible for advising the Oregon Health Authority on the implementation of the retrospective and prospective programs and on the Practitioner-Managed Prescription Drug Plan. (2) The Director of the Oregon Health Authority shall appoint the members of the committee, who shall serve at the pleasure of the director for a term of three years. An individual appointed to the committee may be reappointed upon completion of the individual’s term. The membership of the committee shall be composed of the following: (a) Five persons licensed as physicians under ORS 677.100 to 677.228 and actively engaged in the practice of medicine in Oregon, who may be from among persons recommended by organizations representing physicians; (b) Four persons licensed in and actively practicing pharmacy in Oregon who may be from among persons recommended by organizations representing pharmacists whether affiliated or unaffiliated with any association; and (c) Two persons who are not physicians or pharmacists. (3) If the committee determines that it lacks current clinical or treatment expertise with respect to a particular therapeutic class, or at the request of an interested outside party, the director shall appoint one or more medical experts otherwise qualified as described in subsection (2)(a) of this section who have such expertise. The medical experts shall have full voting rights with respect to recommendations made under ORS 414.361 (3) and (4). The medical experts may participate but may not vote in any other activities of the committee. (4) The director shall fill a vacancy on the committee by appointing a new member to serve the remainder of the unexpired term. [2011 c.720 §2; 2017 c.409 §9] Note: See note under 414.351.
OR Rev Stat § 414.354 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.354 - Meetings; advisory committees; public notice and testimony.

(1) Except as provided in ORS 414.356, the Pharmacy and Therapeutics Committee shall operate in accordance with ORS chapter 192. The committee shall annually elect a chairperson from the members of the committee. (2) A committee member is not entitled to compensation but is entitled to reimbursement for actual and necessary travel expenses incurred in connection with the member’s duties, pursuant to ORS 292.495. (3) A quorum consists of six members of the committee. (4) The committee may establish advisory committees to assist in carrying out the committee’s duties under ORS 414.351 to 414.414, with the approval of the Director of the Oregon Health Authority. (5) The Oregon Health Authority shall provide staff and support services to the committee. (6) The committee shall meet no less than four times each year at a place, day and hour determined by the director. The committee also shall meet at other times and places specified by the call of the director or a majority of the members of the committee. No less than 30 days prior to a meeting the committee shall post to the authority website: (a) The agenda for the meeting; (b) A list of the drug classes to be considered at the meeting; and (c) Background materials and supporting documentation provided to committee members with respect to drugs and drug classes that are before the committee for review. (7) The committee shall provide appropriate opportunity for public testimony at each regularly scheduled committee meeting. Immediately prior to deliberating on any recommendations regarding a drug or a class of drugs, the committee shall accept testimony, in writing or in person, that is offered by a manufacturer of those drugs or another interested party. (8) The committee may consider more than 20 classes of drugs at a meeting only if: (a) There is no new clinical evidence for the additional class of drugs; and (b) The committee is considering only substantial cost differences between drugs within the same therapeutic class. [2011 c.720 §11] Note: See note under 414.351.
OR Rev Stat § 414.356 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.356 - Executive session.

(1) Notwithstanding ORS 192.610 to 192.690, the Pharmacy and Therapeutics Committee shall meet in an executive session for purposes of: (a) Reviewing the prescribing or dispensing practices of individual physicians or pharmacists; (b) Discussing drug use review data pertaining to individual physicians or pharmacists; (c) Reviewing profiles of individual patients; or (d) Reviewing confidential drug pricing information, including substantial cost differences between drugs within the same therapeutic class, that is necessary for the committee to make final recommendations under ORS 414.361 or to comply with ORS 414.414. (2) A meeting held in executive session is subject to the requirements of ORS 192.650 (2). [2011 c.720 §10] Note: See note under 414.351.
OR Rev Stat § 414.364 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.364 - Intervention approaches.

In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following: (1) Information disseminated to prescribers and pharmacists to ensure that they are aware of the duties and powers of the Pharmacy and Therapeutics Committee. (2) Written, oral or electronic reminders of recipient-specific or drug-specific information that are designed to ensure recipient, prescriber and pharmacist confidentiality, and suggested changes in the prescribing or dispensing practices designed to improve the quality of care. (3) Face-to-face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention. (4) Intensified reviews or monitoring of selected prescribers or pharmacists. (5) Educational outreach through the retrospective program focusing on improvement of prescribing and dispensing practices. (6) The timely evaluation of interventions to determine if the interventions have improved the quality of care. (7) The review of case profiles before the conducting of an intervention. (8) The actions specified in ORS 414.372. [2011 c.720 §6; 2015 c.467 §6] Note: See note under 414.351.
OR Rev Stat § 414.369 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.369 - Prospective drug use review program.

The prospective drug use review program must use guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee. The program must ensure that prior to the prescription being filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from the following: (1) Therapeutic duplication. (2) Drug-drug interactions, including serious interactions with nonprescription or over-the-counter drugs. (3) Incorrect dosage and duration of treatment. (4) Drug-allergy interactions. (5) Clinical abuse and misuse. (6) Drug-disease contraindications. [2011 c.720 §7] Note: See note under 414.351.
OR Rev Stat § 414.371 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.371 - Retrospective drug use review program.

The retrospective drug use review program must use: (1) Guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee; and (2) The mechanized drug claims processing and information retrieval system to analyze claims data on drug use against explicit predetermined standards that are based on compendia and other sources to monitor the following: (a) Therapeutic appropriateness. (b) Overutilization or underutilization. (c) Fraud and abuse. (d) Therapeutic duplication. (e) Drug-disease contraindications. (f) Drug-drug interactions. (g) Incorrect drug dosage or duration of drug treatment. (h) Clinical abuse and misuse. [2011 c.720 §8] Note: See note under 414.351.
OR Rev Stat § 414.372 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.372 - Pharmacy lock-in program; rules.

(1)(a) If necessary to avoid overutilization by a recipient of medical assistance, the Oregon Health Authority may restrict, for 18 months or less, the recipient’s pharmacy choices for filling and refilling prescriptions to a mail order pharmacy that contracts with the authority, a retail pharmacy selected by the recipient and a specialty pharmacy selected by the recipient, if the recipient: (A) Uses three or more pharmacies in a six-month period; (B) Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period; (C) Alters a prescription; or (D) Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse. (b) This subsection does not apply to a recipient who: (A) Is a member of a coordinated care organization; (B) Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage; (C) Is a child in the custody of the Department of Human Services; or (D) Is a patient in a hospital or other medical institution or a resident in a long term care facility. (c) The authority shall prescribe by rule: (A) Exceptions to the limitation imposed under paragraph (a) of this subsection; and (B) The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy. (2) The authority may conduct prospective drug utilization review, in accordance with rules adopted under ORS 414.361, prior to payment for drugs for a patient who has filled prescriptions for more than 15 drugs in the preceding six-month period. [2015 c.467 §2] Note: See note under 414.351.
OR Rev Stat § 414.381 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.381 - Annual reports; educational materials; procedures to protect confidential information.

In addition to the duties described in ORS 414.361, the Pharmacy and Therapeutics Committee shall do the following subject to the approval of the Director of the Oregon Health Authority: (1) Publish an annual report, as described in ORS 414.382. (2) Publish and disseminate educational information to prescribers and pharmacists regarding the committee and the drug use review programs, including information on the following: (a) Identifying and reducing the frequency of patterns of fraud, abuse or inappropriate or medically unnecessary care among prescribers, pharmacists and recipients. (b) Potential or actual severe or adverse reactions to drugs. (c) Therapeutic appropriateness. (d) Overutilization or underutilization. (e) Appropriate use of generic products. (f) Therapeutic duplication. (g) Drug-disease contraindications. (h) Drug-drug interactions. (i) Drug allergy interactions. (j) Clinical abuse and misuse. (3) Adopt and implement procedures designed to ensure the confidentiality of any information that identifies individual prescribers, pharmacists or recipients and that is collected, stored, retrieved, assessed or analyzed by the committee, staff of the committee, the Oregon Health Authority or contractors to the committee or the authority. [2011 c.720 §5] Note: See note under 414.351.
OR Rev Stat § 414.382 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.382 - Requirements for annual report.

(1) The annual report required under ORS 414.381 (1) is subject to public comment prior to its submission to the Director of the Oregon Health Authority and must include the following: (a) An overview of the activities of the Pharmacy and Therapeutics Committee and the prospective and retrospective programs; (b) A summary of interventions made, including the number of cases brought before the committee and the number of interventions made; (c) An assessment of the impact of the interventions, criteria and standards used, including an overall assessment of the impact of the educational programs and interventions on prescribing and dispensing patterns; (d) An assessment of the impact of the criteria, standards and educational interventions on quality of care; and (e) An estimate of the cost savings generated as a result of the prospective and retrospective programs, including an overview of the fiscal impact of the programs to other areas of the medical assistance program such as hospitalization or long term care costs. This analysis should include a cost-benefit analysis of both the prospective and retrospective programs and should take into account the administrative costs of the drug utilization review program. (2) Copies of the annual report shall be submitted to the President of the Senate, the Speaker of the House of Representatives and other persons who request copies of the report. [2011 c.720 §12] Note: See note under 414.351.
OR Rev Stat § 414.414 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.414 - Use and disclosure of confidential information.

(1) Information collected under ORS 414.351 to 414.414 that identifies an individual is confidential and may not be disclosed by the Pharmacy and Therapeutics Committee, the retrospective program or the Oregon Health Authority to any person other than a health care provider appearing on a recipient’s medication profile. (2) The staff of the committee may have access to identifying information for purposes of carrying out intervention activities. The identifying information may not be released to anyone other than a staff member of the committee, the retrospective program, the authority or a health care provider appearing on a recipient’s medication profile or, for purposes of investigating potential fraud in programs administered by the authority, the Department of Justice. (3) The committee may release cumulative, nonidentifying information for the purposes of legitimate research and for educational purposes. [2011 c.720 §9] Note: See note under 414.351.
OR Rev Stat § 414.420 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.420

[Formerly 414.026; 2009 c.595 §309a; renumbered 411.443 in 2009]
OR Rev Stat § 414.422 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.422

[Formerly 414.027; renumbered 411.445 in 2009]
OR Rev Stat § 414.424 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.424

[2005 c.494 §2; 2007 c.70 §193; 2009 c.414 §1; renumbered 411.439 in 2009]
OR Rev Stat § 414.426 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.426 - Payment of cost of medical care for institutionalized persons.

The Oregon Health Authority is hereby authorized to pay the cost of care for patients in institutions operated under ORS 179.321 under the medical assistance program established by ORS chapter 414. [Formerly 414.028; 2009 c.595 §310] Note: 414.426 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 § 414.428 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.428 - Coverage for American Indian and Alaska Native beneficiaries.

(1) An individual who is eligible for or receiving medical assistance, as defined in ORS 414.025, pursuant to a demonstration project under section 1115 of the Social Security Act and who is an American Indian and Alaska Native beneficiary shall receive the same package of health services as individuals described in ORS 414.706 (1), (2) and (3) if: (a) The Oregon Health Authority receives 100 percent federal medical assistance percentage for payments made by the authority for the package of health services provided; or (b) The authority receives funding from the Indian tribes for which federal financial participation is available. (2) As used in this section, "American Indian and Alaska Native beneficiary" has the meaning given that term in ORS 414.631. [Formerly 414.029; 2007 c.861 §22; 2009 c.595 §311; 2011 c.602 §39; 2013 c.688 §74; 2021 c.97 §40] Note: 414.428 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 § 414.430 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.430 - Access to dental care for pregnant women; rules.

(1) The Oregon Health Authority shall prescribe by rule appropriate time frames within which a pregnant medical assistance recipient whose medical assistance is reimbursed on a fee-for-service basis and who needs general or specialty dental care must have the opportunity to be seen, or referred for, and provided: (a) Emergency dental services; (b) Urgent dental services; (c) Routine dental services; and (d) An initial dental screening or examination. (2) The time frames prescribed by the authority for recipients whose medical assistance is reimbursed on a fee-for-service basis shall be the same as or shorter than the time frames for pregnant recipients enrolled in coordinated care organizations and dental care organizations. [2015 c.750 §2]