reglab/housing_qa huggingface dataset:
OR Rev Stat § 414.770 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.770 - Participants in clinical trials.

(1) As used in this section: (a) "Approved clinical trial" has the meaning given that term in ORS 743A.192. (b) "Routine health care": (A) Means the types and extent of health care and services that the Oregon Health Authority requires to be provided in medical assistance in accordance with ORS 414.065. (B) Does not include: (i) The drug, device or service being tested in an approved clinical trial, unless a coordinated care organization would provide or pay for the drug, device or service if provided to a member who is not enrolled in an approved clinical trial; (ii) Items or services required solely for the provision of the drug, device or service being tested in an approved clinical trial; (iii) Items or services required solely for the clinically appropriate monitoring of the drug, device or service being tested in an approved clinical trial; (iv) Items or services that are provided solely to satisfy data collection and analysis needs associated with an approved clinical trial and that are not used in the direct clinical management of the member; or (v) Items or services customarily provided by a clinical trial sponsor free of charge to any participant in an approved clinical trial. (2) A coordinated care organization may not discriminate against a member on the basis of the member’s participation in an approved clinical trial by: (a) Denying the provision of or payment for routine health care; or (b) Excluding, limiting or imposing additional conditions on the provision of or payment for routine health care furnished in connection with the member’s participation in an approved clinical trial. (3) A coordinated care organization that provides routine health care to a member enrolled in an approved clinical trial is not, based on the provision of that care, liable for any adverse effects of the approved clinical trial. [2016 c.26 §5]
OR Rev Stat § 414.772 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.772 - Limits on use of step therapy.

(1) As used in this section, "step therapy" means a drug protocol in which the cost of a prescribed drug is reimbursed only if the patient has first tried a specified drug or series of drugs. (2) A coordinated care organization that requires step therapy shall make easily accessible to any provider who is reimbursed by the organization, directly or through a risk-bearing entity, to provide health services to members of the organization, clear explanations of: (a) The clinical criteria for each step therapy protocol; (b) The procedure by which a provider may submit to the organization or risk-bearing entity, the provider’s medical rationale for determining that a particular step therapy protocol is not appropriate for a particular patient based on the patient’s medical condition and history; and (c) The documentation, if any, that a provider must submit to the organization or risk-bearing entity for the organization or entity to determine the appropriateness of step therapy for a specific patient. [Formerly 414.637]
OR Rev Stat § 414.781 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.781 - Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services.

The Oregon Health Authority shall reimburse the cost of co-occurring mental health and substance use disorder treatment services paid for on a fee-for-service basis at an enhanced rate based on: (1) Existing reimbursement codes used for co-occurring disorder treatments; (2) Clinical complexity; and (3) The education level of the provider. [2021 c.667 §2] Note: 414.781 and 414.782 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 § 414.805 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.805 - Liability of individual for medical services received while in custody of law enforcement officer.

(1) An individual who receives medical services while in the custody of a law enforcement officer is liable: (a) To the provider of the medical services for the charges and expenses therefor; and (b) To the Oregon Health Authority for any charges or expenses paid by the authority out of the Law Enforcement Medical Liability Account for the medical services. (2) A person providing medical services to an individual described in subsection (1) of this section shall first make reasonable efforts to collect the charges and expenses thereof from the individual before seeking to collect them from the authority out of the Law Enforcement Medical Liability Account. (3)(a) If the provider has not been paid within 45 days of the date of the billing, the provider may bill the authority who shall pay the account out of the Law Enforcement Medical Liability Account. (b) A bill submitted to the authority under this subsection must be accompanied by evidence documenting that: (A) The provider has billed the individual or the individual’s insurer or health care service contractor for the charges or expenses owed to the provider; and (B) The provider has made a reasonable effort to collect from the individual or the individual’s insurer or health care service contractor the charges and expenses owed to the provider. (c) If the provider receives payment from the individual or the insurer or health care service contractor after receiving payment from the authority, the provider shall repay the authority the amount received from the public agency less any difference between payment received from the individual, insurer or contractor and the amount of the billing. (4) As used in this section: (a) "Law enforcement officer" means: (A) An officer who is commissioned and employed by a public agency as a peace officer to enforce the criminal laws of this state or laws or ordinances of a public agency; or (B) An authorized tribal police officer as defined in ORS 181A.940. (b) "Public agency" means the state, a city, university that has established a police department under ORS 352.121 or 353.125, port, school district, mass transit district or county. [1991 c.778 §7; 2007 c.71 §105; 2009 c.595 §342; 2011 c.506 §37; 2011 c.644 §§29,52; 2013 c.180 §§38,39; 2015 c.174 §20] Note: 414.805 to 414.815 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 § 414.807 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.807 - Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury.

(1)(a) When charges and expenses are incurred for medical services provided to an individual for injuries related to law enforcement activity and subject to the availability of funds in the account, the cost of such services shall be paid by the Oregon Health Authority out of the Law Enforcement Medical Liability Account established in ORS 414.815 if the provider of the medical services has made all reasonable efforts to collect the amount, or any part thereof, from the individual who received the services. (b) When a law enforcement agency involved with an injury certifies that the injury is related to law enforcement activity, the Oregon Health Authority shall pay the provider: (A) If the provider is a hospital, in accordance with current fee schedules established by the Director of the Department of Consumer and Business Services for purposes of workers’ compensation under ORS 656.248; or (B) If the provider is other than a hospital, 75 percent of the customary and usual rates for the services. (2) After the injured person is incarcerated and throughout the period of incarceration, the Oregon Health Authority shall continue to pay, out of the Law Enforcement Medical Liability Account, charges and expenses for injuries related to law enforcement activities as provided in subsection (1) of this section. Upon release of the injured person from actual physical custody, the Law Enforcement Medical Liability Account is no longer liable for the payment of medical expenses of the injured person. (3) If the provider of medical services has filed a medical services lien as provided in ORS 87.555, the Oregon Health Authority shall be subrogated to the rights of the provider to the extent of payments made by the authority to the provider for the medical services. The authority may foreclose the lien as provided in ORS 87.585. (4) The authority shall deposit in the Law Enforcement Medical Liability Account all moneys received by the authority from: (a) Providers of medical services as repayment; (b) Individuals whose medical expenses were paid by the authority under this section; and (c) Foreclosure of a lien as provided in subsection (3) of this section. (5) As used in this section: (a) "Injuries related to law enforcement activity" means injuries sustained prior to booking, citation in lieu of arrest or release instead of booking that occur during and as a result of efforts by a law enforcement officer to restrain or detain, or to take or retain custody of, the individual. (b) "Law enforcement officer" has the meaning given that term in ORS 414.805. [1991 c.778 §2; 1993 c.196 §9; 2009 c.595 §343] Note: See note under 414.805.
OR Rev Stat § 414.810 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.810

[Formerly 414.040; renumbered 566.310]
OR Rev Stat § 414.815 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.815 - Law Enforcement Medical Liability Account; limited liability; rules; report.

(1) The Law Enforcement Medical Liability Account is established separate and distinct from the General Fund. Interest earned, if any, shall inure to the benefit of the account. The moneys in the Law Enforcement Medical Liability Account are appropriated continuously to the Oregon Health Authority to pay expenses in administering the account and paying claims out of the account as provided in ORS 414.807. (2) The liability of the Law Enforcement Medical Liability Account is limited to funds allocated to the account from the Criminal Fine Account, or collected from individuals under ORS 414.805. (3) The authority may contract with persons experienced in medical claims processing to provide claims processing for the account. (4) The authority shall adopt rules to implement administration of the Law Enforcement Medical Liability Account including, but not limited to, rules that establish reasonable deadlines for submission of claims. (5) Each biennium, the Oregon Health Authority shall submit a report to the Legislative Assembly regarding the status of the Law Enforcement Medical Liability Account. Within 30 days of the convening of each odd-numbered year regular session of the Legislative Assembly, the authority shall submit the report to the chair of the Senate Judiciary Committee and the chair of the House Judiciary Committee. The report shall include, but is not limited to, the number of claims submitted and paid during the biennium and the amount of money in the fund at the time of the report. [1991 c.778 §1; 1993 c.196 §10; 1999 c.1051 §256; 2005 c.804 §8; 2009 c.595 §344; 2011 c.545 §49; 2011 c.597 §62] Note: See note under 414.805.
OR Rev Stat § 414.820 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.820

[Formerly 414.050; renumbered 566.320]
OR Rev Stat § 414.830 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.830

[Formerly 414.060; renumbered 566.330]
OR Rev Stat § 414.839 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.839

[2001 c.898 §11; 2003 c.14 §206; 2003 c.684 §7; 2003 c.735 §9; 2009 c.595 §344a; 2009 c.867 §38; 2013 c.365 §2; 2013 c.681 §51; renumbered 414.117 in 2019]
OR Rev Stat § 414.840 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.840

[Formerly 414.070; renumbered 566.340]
OR Rev Stat § 414.850 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.850

[Formerly 414.080; renumbered 566.350]
OR Rev Stat § 414.853 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.853 - Definitions.

As used in ORS 414.853 to 414.869 and 414.900: (1) "Charity care" means costs for providing inpatient or outpatient care services free of charge or at a reduced charge because of the indigence or lack of health insurance of the patient receiving the care services. (2) "Contractual adjustments" means the difference between the amounts charged based on the hospital’s full established charges and the amount received or due from the payor. (3)(a) "Hospital" means a hospital licensed under ORS chapter 441. (b) "Hospital" does not include: (A) Special inpatient care facilities; (B) Hospitals that provide only psychiatric care; (C) Pediatric specialty hospitals providing care to children at no charge; and (D) Public hospitals other than hospitals created by health districts under ORS 440.315 to 440.410. (4) "Net revenue": (a) Means the total amount of charges for inpatient or outpatient care provided by the hospital to patients, less charity care, bad debts and contractual adjustments; (b) Does not include revenue derived from sources other than inpatient or outpatient operations, including but not limited to interest and guest meals; and (c) Does not include any revenue that is taken into account in computing a long term care facility assessment under ORS 409.800 to 409.816 and 409.900. (5) "Type A hospital" has the meaning given that term in ORS 442.470. (6) "Type B hospital" has the meaning given that term in ORS 442.470. [2003 c.736 §1; 2009 c.792 §34; 2017 c.538 §26] Note: 414.853 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: 414.853 to 414.871 and 414.900 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 § 414.857 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.857 - Reduction in rate required by federal law.

Notwithstanding ORS 414.855, the Director of the Oregon Health Authority shall reduce the rate of assessment imposed under ORS 414.855 (1) to the maximum rate allowed under federal law if the reduction is required to comply with federal law. [2003 c.736 §3; 2013 c.608 §3; 2017 c.538 §30] Note: 414.857 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.860 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.860

[Formerly 414.090; renumbered 566.360]
OR Rev Stat § 414.863 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.863 - Refund of hospital assessment; right to contested case hearing.

(1) Any hospital that has paid an amount that is not required under ORS 414.853 to 414.869 and 414.900 may file a claim for refund with the Oregon Health Authority. (2) Any hospital that is aggrieved by an action of the authority or by an action of the Director of the Oregon Health Authority taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing under ORS chapter 183. [2003 c.736 §6; 2013 c.608 §4] Note: 414.863 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.865 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.865 - Audits.

The Oregon Health Authority may audit the records of any hospital in this state to determine compliance with ORS 414.853 to 414.869 and 414.900. The authority may audit records at any time for a period of five years following the date an assessment is due to be reported and paid under ORS 414.855. [2003 c.736 §7; 2013 c.608 §5; 2017 c.538 §32] Note: 414.865 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.867 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.867 - Deposit of assessments collected to Hospital Quality Assurance Fund.

Amounts collected by the Oregon Health Authority from the assessments imposed under ORS 414.855 shall be deposited in the Hospital Quality Assurance Fund established under ORS 414.869. [2003 c.736 §8; 2005 c.757 §1; 2013 c.608 §6] Note: 414.867 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.869 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.869 - Establishment of Hospital Quality Assurance Fund.

(1) The Hospital Quality Assurance Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Hospital Quality Assurance Fund shall be credited to the Hospital Quality Assurance Fund. (2) Amounts in the Hospital Quality Assurance Fund are continuously appropriated to the Oregon Health Authority for the purpose of: (a) Paying refunds due under ORS 414.863; (b) Funding services under ORS 414.591, 414.631 and 414.688 to 414.745, including but not limited to increasing reimbursement rates for inpatient and outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745; (c) Making payments described in ORS 414.855 (3)(a)(C); (d) Making payments to coordinated care organizations to be used to provide additional reimbursement to type A hospitals and type B hospitals to improve and expand access to services for medical assistance recipients, to the extent permitted by federal requirements; and (e) Paying administrative costs incurred by the authority to administer the assessments imposed under ORS 414.855. (3) Except for assessments imposed pursuant to ORS 414.855 (3)(b), the authority may not use moneys from the Hospital Quality Assurance Fund to supplant, directly or indirectly, other moneys made available to fund services described in subsection (2) of this section. [2003 c.736 §9; 2005 c.757 §2; 2007 c.780 §2; 2009 c.828 §53; 2009 c.867 §19; 2011 c.602 §59; 2013 c.608 §7; 2017 c.538 §§33,34,35,36] Note: 414.869 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.871 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.871 - Applicability of hospital assessment.

ORS 414.853 to 414.869 and 414.900 apply to net revenues earned by hospitals during a period beginning July 1, 2019, and ending the earlier of September 30, 2025, or the date on which the assessment no longer qualifies for federal financial participation under Title XIX or XXI of the Social Security Act. [2003 c.736 §10; 2007 c.780 §3; 2009 c.867 §20; 2013 c.608 §8; 2015 c.16 §2; 2017 c.538 §37a; 2019 c.2 §13] Note: See second note under 414.853. Note: Sections 12 (1) to 14, chapter 736, Oregon Laws 2003, provide: Sec. 12. (1) Sections 1 to 9, chapter 736, Oregon Laws 2003 [414.853 to 414.869 and 414.900], are repealed on January 2, 2031. [2003 c.736 §12; 2007 c.780 §4; 2009 c.867 §21; 2013 c.608 §9; 2015 c.16 §3; 2017 c.538 §38; 2019 c.2 §14(1)] Sec. 13. Nothing in the repeal of sections 1 to 9, chapter 736, Oregon Laws 2003 [414.853 to 414.869 and 414.900], and section 1, chapter 608, Oregon Laws 2013, by section 12, chapter 736, Oregon Laws 2003, affects the imposition and collection of a hospital assessment under sections 1 to 9, chapter 736, Oregon Laws 2003, for a calendar quarter beginning before September 30, 2025. [2003 c.736 §13; 2007 c.780 §5; 2009 c.867 §22; 2013 c.608 §10; 2015 c.16 §4; 2017 c.538 §39; 2019 c.2 §15] Sec. 14. Any moneys remaining in the Hospital Quality Assurance Fund on December 31, 2031, are transferred to the General Fund. [2003 c.736 §14; 2007 c.780 §6; 2009 c.867 §23; 2015 c.16 §5; 2017 c.538 §40; 2019 c.2 §16]
OR Rev Stat § 414.880 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.880 - Managed care organization assessment; rate.

(1) As used in this section and ORS 414.882 and 414.902: (a) "Managed care organization" means: (A) A coordinated care organization as defined in ORS 414.025; and (B) A prepaid managed care health services organization as defined in ORS 414.025. (b) "Premium equivalent" means the payments made to the managed care organization by the Oregon Health Authority for providing health services under ORS chapter 414. (2) No later than 45 days following the end of a calendar quarter, a managed care organization shall pay an assessment at a rate of two percent of the gross amount of premium equivalents received during that calendar quarter. (3) The assessment shall be paid to the authority in a manner and form prescribed by the authority. (4) Assessments received by the authority under this section shall be paid into the State Treasury and credited to the Health System Fund established under section 2, chapter 538, Oregon Laws 2017. (5) The assessment imposed under this section is in addition to and not in lieu of any tax, surcharge or other assessment imposed on a managed care organization. [2017 c.538 §9; 2019 c.2 §9] Note: 414.880 to 414.884 and 414.902 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 § 414.882 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.882 - Refund of managed care organization assessment; right to contested case hearing.

(1) A managed care organization that has paid an amount that is not required under ORS 414.880 may file a claim for refund with the Oregon Health Authority. (2) Any managed care organization that is aggrieved by an action of the authority taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing under ORS chapter 183. [2017 c.538 §11] Note: See note under 414.880.