reglab/housing_qa huggingface dataset:
OR Rev Stat § 414.595 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.595 - External quality reviews of coordinated care organizations; limits on documentation and reporting requirements.

(1) As used in this section: (a) "Coordinated care organization" has the meaning given that term in ORS 414.025. (b) "Subcontractor" means an entity that contracts with a coordinated care organization to provide health care, dental care, behavioral health care or other services to medical assistance recipients enrolled in the coordinated care organization. (2) The Oregon Health Authority shall conduct one external quality review of each coordinated care organization annually. The authority may contract with an external quality review organization to conduct the review. (3) The authority shall compile a standard list of documents that the authority or contracted review organization collects from coordinated care organizations and subcontractors. When requesting information from a coordinated care organization about its subcontractors, the authority or contracted review organization shall inform the coordinated care organization of the documents on the standard list that have been collected from the coordinated care organization’s subcontractors in the preceding 12-month period. (4) The authority or a contracted review organization may not request information from a coordinated care organization that is duplicative of or redundant with information previously provided by the coordinated care organization or a subcontractor if the information was provided within the preceding 12-month period and the relevant content of the information has not changed. (5) The authority shall provide a contracted review organization with all information about a coordinated care organization in the authority’s possession as necessary for the contracted review organization to conduct the external quality review. A contracted review organization may not seek information from a coordinated care organization before first requesting the information from the authority. (6) This section does not apply to documents requested, submitted or collected in connection with an audit for or an investigation of fraud, waste or abuse and does not: (a) Prohibit a coordinated care organization from requesting from a subcontractor information required by law or contract; (b) Require the authority or a contracted review organization to disclose to a coordinated care organization any information described in this section collected from a coordinated care organization or a subcontractor; or (c) Permit the authority or a contracted review organization to disclose to a coordinated care organization confidential or proprietary information reported to the authority or contracted review organization by another coordinated care organization or a subcontractor. [Formerly 414.661] Note: 414.595 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 § 414.607 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.607 - Use and disclosure of member information; access by member to personal health information.

(1) The Oregon Health Authority shall ensure the appropriate use of member information by coordinated care organizations, including the use of electronic health information and administrative data that is available when and where the data is needed to improve health and health care through a secure, confidential health information exchange. (2) A member of a coordinated care organization must have access to the member’s personal health information in the manner provided in 45 C.F.R. 164.524 so the member can share the information with others involved in the member’s care and make better health care and lifestyle choices. (3) Notwithstanding ORS 179.505, a coordinated care organization, its provider network and programs administered by the Department of Human Services for seniors and persons with disabilities shall use and disclose member information for purposes of service and care delivery, coordination, service planning, transitional services and reimbursement, in order to improve the safety and quality of care, lower the cost of care and improve the health and well-being of the organization’s members. (4) A coordinated care organization and its provider network shall use and disclose sensitive diagnosis information including blood-borne infections and other health and mental health diagnoses, within the coordinated care organization for the purpose of providing whole-person care. Individually identifiable health information must be treated as confidential and privileged information subject to ORS 192.553 to 192.581 and applicable federal privacy requirements. Redisclosure of individually identifiable information outside of the coordinated care organization and the organization’s providers for purposes unrelated to this section or the requirements of ORS 413.032, 414.572, 414.598, 414.605, 414.632, 414.638 or 414.655 remains subject to any applicable federal or state privacy requirements. (5) This section does not prohibit the disclosure of information between a coordinated care organization and the organization’s provider network, and the Oregon Health Authority and the Department of Human Services for the purpose of administering the laws of Oregon. (6) The Health Information Technology Oversight Council shall develop readily available informational materials that can be used by coordinated care organizations and providers to inform all participants in the health care workforce about the appropriate uses and limitations on disclosure of electronic health records, including need-based access and privacy mandates. [Formerly 414.679]
OR Rev Stat § 414.609 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.609 - Network adequacy; member transfers.

(1) A coordinated care organization that contracts with the Oregon Health Authority must maintain a network of providers sufficient in numbers and areas of practice and geographically distributed in a manner to ensure that the health services provided under the contract are reasonably accessible to members. (2) A member may transfer from one organization to another organization no more than once during each enrollment period. [Formerly 414.645]
OR Rev Stat § 414.611 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.611 - Transfer of 500 or more members of coordinated care organization.

(1) The Oregon Health Authority may approve the transfer of 500 or more members from one coordinated care organization to another coordinated care organization if: (a) The members’ provider has contracted with the receiving organization and has stopped accepting patients from or has terminated providing services to members of the transferring organization; and (b) Members are offered the choice of remaining members of the transferring organization. (2) Members may not be transferred under this section until the authority has evaluated the receiving organization and determined that the organization meets criteria established by the authority by rule, including but not limited to criteria that ensure that the organization meets the requirements of ORS 414.609 (1). (3) The authority shall provide notice of a transfer under this section to members that will be affected by the transfer at least 90 days before the scheduled date of the transfer. (4)(a) The authority may not approve the transfer of members under this section if: (A) The transfer results from the termination of a provider’s contract with a coordinated care organization for just cause; and (B) The coordinated care organization has notified the authority that the provider’s contract was terminated for just cause. (b) A provider is entitled to a contested case hearing in accordance with ORS chapter 183, on an expedited basis, to dispute the denial of a transfer of members under this subsection. (c) As used in this subsection, "just cause" means that the contract was terminated for reasons related to quality of care, competency, fraud or other similar reasons prescribed by the authority by rule. (5) The provider and the organization shall be the parties to any contested case proceeding to determine whether the provider’s contract was terminated for just cause. The authority may award attorney fees and costs to the party prevailing in the proceeding, applying the factors in ORS 20.075. [Formerly 414.647]
OR Rev Stat § 414.613 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.613 - Discrimination based on scope of practice prohibited; appeals; rules.

(1) A coordinated care organization may not discriminate with respect to participation in the organization or coverage against any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. This section does not require that an organization contract with any health care provider willing to abide by the terms and conditions for participation established by the organization. This section does not prevent an organization from establishing varying reimbursement rates based on quality or performance measures. (2) An organization may establish an internal review process for a provider aggrieved under this section, including an alternative dispute resolution or peer review process. An aggrieved provider may appeal the determination of the internal review to the Oregon Health Authority. (3) The authority shall adopt by rule a process for resolving claims of discrimination under this section and, in making a determination of whether there has been discrimination, must consider the organization’s: (a) Network adequacy; (b) Provider types and qualifications; (c) Provider disciplines; and (d) Provider reimbursement rates. (4) A prevailing party in an appeal under this section shall be awarded the costs of the appeal. [Formerly 414.646]
OR Rev Stat § 414.619 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.619 - Coordination between Oregon Health Authority and Department of Human Services.

(1) The Oregon Health Authority and the Department of Human Services shall cooperate with each other by coordinating actions and responsibilities necessary to implement the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. (2) The authority and the department may delegate to each other any duties, functions or powers that the authority or department are authorized to perform if necessary to carry out this section and ORS 414.572, 414.598, 414.605, 414.607, 414.632, 414.638, 414.654, 414.655 and 414.665. [Formerly 414.685]
OR Rev Stat § 414.620 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.620

[1983 c.590 §2; 1985 c.747 §2; 2011 c.602 §2; 2015 c.798 §10; renumbered 414.570 in 2019]
OR Rev Stat § 414.625 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.625

[2011 c.602 §4; 2012 c.8 §20; 2013 c.535 §3; 2015 c.798 §11; 2017 c.101 §25; 2017 c.273 §6; 2017 c.429 §1; 2017 c.489 §1; 2018 c.49 §3; 2019 c.358 §7; 2019 c.364 §1; 2019 c.478 §57; 2019 c.529 §6; renumbered 414.572 in 2019]
OR Rev Stat § 414.627 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.627

[2012 c.8 §13; 2013 c.535 §§4,5; 2017 c.82 §1; 2019 c.529 §8; renumbered 414.575 in 2019]
OR Rev Stat § 414.628 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.628 - Innovator agents.

(1) Upon the request of a coordinated care organization, the Oregon Health Authority shall assign to the coordinated care organization one employee of the authority, called an innovator agent, to act as the single point of contact between the coordinated care organization and the authority. The innovator agent must be available to the organization on a day-to-day basis to facilitate the exchange of information between the coordinated care organization and the authority. The organization may provide a work space to enable the agent to be colocated at a site of the coordinated care organization if practical. (2) Innovator agents must observe the meetings of the community advisory councils and report on the meetings to the authority. (3) Not less than once every calendar quarter, all of the innovator agents must meet in person to discuss the ideas, projects and creative innovations planned or undertaken by their assigned coordinated care organizations. (4) The innovator agent shall be made available by the authority for a period of four years beginning on the date that the coordinated care organization first contracts with the authority to be a coordinated care organization. Upon the request of the coordinated care organization, the authority may extend the period. [2012 c.8 §14] Note: 414.628 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 § 414.629 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.629

[2013 c.598 §1; 2015 c.402 §3; 2019 c.529 §10; renumbered 414.578 in 2019]
OR Rev Stat § 414.630 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.630

[1983 c.590 §3; 1991 c.66 §24; 2003 c.794 §275; 2009 c.595 §317; 2011 c.602 §40; renumbered 414.618 in 2011]
OR Rev Stat § 414.632 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.632 - Services to individuals who are dually eligible for Medicare and Medicaid.

(1) Subject to the Oregon Health Authority obtaining any necessary authorization from the Centers for Medicare and Medicaid Services, coordinated care organizations that meet the criteria adopted under ORS 414.572 are responsible for providing covered Medicare and Medicaid services, other than Medicaid-funded long term care services, to members who are dually eligible for Medicare and Medicaid in addition to medical assistance recipients. (2) An individual who is dually eligible for Medicare and Medicaid shall be permitted to enroll in and remain enrolled in a: (a) Program of all-inclusive care for the elderly, as defined in 42 C.F.R. 460.6; and (b) Medicare Advantage plan, as defined in 42 C.F.R. 422.2, until the plan is fully integrated into a coordinated care organization. (3) Except for the enrollment in coordinated care organizations of individuals who are dually eligible for Medicare and Medicaid, the rights and benefits of Medicare beneficiaries under Title XVIII of the Social Security Act shall be preserved. [2011 c.602 §7; 2012 c.8 §25]
OR Rev Stat § 414.635 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.635

[2011 c.602 §§8,9; 2012 c.8 §5; 2013 c.27 §1; 2017 c.618 §4; 2019 c.364 §3; renumbered 414.605 in 2019]
OR Rev Stat § 414.637 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.637

[2014 c.55 §6; renumbered 414.772 in 2019]
OR Rev Stat § 414.638 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.638 - Metrics and scoring subcommittee; identification of outcome and quality measures and benchmarks.

(1) There is created in the Health Plan Quality Metrics Committee a nine-member metrics and scoring subcommittee appointed by the Director of the Oregon Health Authority. The members of the subcommittee serve two-year terms and must include: (a) Three members at large; (b) Three individuals with expertise in health outcomes measures; and (c) Three representatives of coordinated care organizations. (2) The subcommittee shall select, from the health outcome and quality measures identified by the Health Plan Quality Metrics Committee, the health outcome and quality measures applicable to services provided by coordinated care organizations. The Oregon Health Authority shall incorporate these measures into coordinated care organization contracts to hold the organizations accountable for performance and customer satisfaction requirements. The authority shall notify each coordinated care organization of any changes in the measures at least three months before the beginning of the contract period during which the new measures will be in place. (3) The subcommittee shall evaluate the health outcome and quality measures annually, reporting recommendations based on its findings to the Health Plan Quality Metrics Committee, and adjust the measures to reflect: (a) The amount of the global budget for a coordinated care organization; (b) Changes in membership of the organization; (c) The organization’s costs for implementing outcome and quality measures; and (d) The community health assessment and the costs of the community health assessment conducted by the organization under ORS 414.575. (4) The authority shall evaluate on a regular and ongoing basis the outcome and quality measures selected by the subcommittee under this section for members in each coordinated care organization and for members statewide. [2011 c.602 §10; 2012 c.8 §21; 2015 c.389 §10]
OR Rev Stat § 414.640 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.640

[1983 c.590 §4; 1991 c.66 §25; 2003 c.794 §276; 2009 c.595 §318; renumbered 414.615 in 2011]
OR Rev Stat § 414.645 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.645

[2011 c.417 §2; 2015 c.27 §43; renumbered 414.609 in 2019]
OR Rev Stat § 414.646 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.646

[2012 c.80 §4; 2012 c.80 §5; renumbered 414.613 in 2019]
OR Rev Stat § 414.647 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.647

[2011 c.417 §3; 2013 c.234 §1; 2015 c.27 §44; renumbered 414.611 in 2019]
OR Rev Stat § 414.651 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.651

[Formerly 414.725; 2015 c.792 §6; 2019 c.478 §59; renumbered 414.591 in 2019]
OR Rev Stat § 414.652 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.652

[2013 c.535 §2; 2015 c.799 §1; 2016 c.79 §1; 2018 c.49 §5; 2019 c.478 §60; 2019 c.529 §9; renumbered 414.590 in 2019]
OR Rev Stat § 414.653 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.653

[2011 c.602 §5; 2015 c.798 §12; 2017 c.489 §4; renumbered 414.598 in 2019]
OR Rev Stat § 414.654 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.654 - Persons served by prepaid managed care health services organizations; funding of health information technology.

(1)(a) The Oregon Health Authority shall continue to contract with one or more prepaid managed care health services organizations, as defined in ORS 414.025, that are in compliance with contractual obligations owed to the state or local government on July 27, 2015, and that serve: (A) A geographic area of the state that a coordinated care organization has not been certified to serve; or (B) Individuals described in ORS 414.631 (2), (3) and (4). (b) Contracts authorized by this subsection are not subject to ORS chapters 279A and 279B, except ORS 279A.250 to 279A.290 and 279B.235. (2) Prepaid managed care health services organizations contracting with the authority under this section are subject to the applicable requirements for, and are permitted to exercise the rights of, coordinated care organizations under ORS 414.153, 414.572, 414.591, 414.605, 414.607, 414.638, 414.655, 414.712, 414.728, 414.743, 414.746, 414.760, 416.510 to 416.610, 441.094, 442.372, 655.515, 659.830 and 743B.470. (3) To facilitate the full adoption of health information technology by coordinated care organizations, patient centered primary care homes and behavioral health homes, the authority shall explore options for assisting providers and coordinated care organizations in funding their use of health information technology. [2011 c.602 §14; 2012 c.8 §2; 2015 c.792 §1; 2015 c.798 §16]
OR Rev Stat § 414.655 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.655 - Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations.

(1) As used in this section, "traditional health worker" includes any of the following: (a) A community health worker. (b) A personal health navigator. (c) A peer wellness specialist. (d) A peer support specialist. (e) A doula. (f) A tribal traditional health worker. (2) In consultation with the Traditional Health Workers Commission established under ORS 413.600, the Oregon Health Authority, for purposes related to the regulation of traditional health workers, shall adopt by rule: (a) The qualification criteria, including education and training requirements, for the traditional health workers utilized by coordinated care organizations; (b) Appropriate professional designations for supervisors of the traditional health workers; and (c) Processes by which other occupational classifications may be approved to supervise the traditional health workers. (3) The criteria and requirements established under subsection (2) of this section: (a) Must be broad enough to encompass the potential unique needs of any coordinated care organization; (b) Must meet requirements of the Centers for Medicare and Medicaid Services to qualify for federal financial participation; and (c) May not require certification by the Home Care Commission. [2011 c.602 §6; 2015 c.798 §5; 2021 c.514 §3]
OR Rev Stat § 414.661 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.661

[2015 c.552 §1; renumbered 414.595 in 2019]