2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 413 - Oregon Health Authority › Section 413.234 - Supplemental payments to emergency services providers.

(1) As used in ORS 413.234 and 413.235:
(a) "Emergency medical services" means the services provided by emergency medical services providers to an individual experiencing a medical emergency in order to:
(A) Assess, treat and stabilize the individual’s medical condition; or
(B) Prepare and transport the individual by ground to a medical facility.
(b) "Emergency medical services provider" or "provider" means an entity that employs individuals who are licensed by the Oregon Health Authority under ORS chapter 682 to provide emergency medical services and that is owned or operated by a local government, a state agency or a federally recognized Indian tribe.
(c) "Federal financial participation" means the portion of medical assistance expenditures for emergency medical services that are paid or reimbursed by the Centers for Medicare and Medicaid Services in accordance with the state plan for medical assistance.
(d) "Local government" has the meaning given that term in ORS 174.116.
(2) Upon request, an emergency medical services provider that has entered into a provider agreement with the authority or a contract with a coordinated care organization is eligible to receive Medicaid supplemental reimbursement from the authority or coordinated care organization for the cost of providing emergency medical services to a medical assistance recipient. The Medicaid supplemental reimbursement shall be added to the payment by the authority or coordinated care organization for the emergency medical services as permitted by the Centers for Medicare and Medicaid Services.
(3)(a) Except as provided in paragraph (b) of this subsection, the Medicaid supplemental reimbursement paid to an emergency medical services provider shall be equal to the amount of federal financial participation received by the authority for the provider’s cost for the emergency medical services.
(b) The Medicaid supplemental reimbursement paid to a provider under this section may not exceed the provider’s actual costs for the emergency medical services, determined in accordance with standards established by the authority, less the amount of reimbursement that the provider is eligible to receive from all public and private sources.
(4) An emergency medical services provider shall make readily available to the authority documentation, data and certifications, as prescribed by the authority, necessary to establish that the emergency medical services expenditures qualify for federal financial participation and to calculate the amount of Medicaid supplemental reimbursement that is due.
(5)(a) Except as provided in paragraph (b) of this subsection, the authority shall modify the method for calculating or paying the Medicaid supplemental reimbursement if modification is necessary to ensure that emergency medical services expenditures qualify for federal financial participation.
(b) This section does not authorize the payment of Medicaid supplemental reimbursement to an emergency medical services provider if the provider has not entered into a provider agreement with the authority, or a contract with a coordinated care organization, to serve medical assistance recipients.
(c) If the Centers for Medicare and Medicaid Services approves the implementation of this section and later revokes its approval or expresses its intent to revoke or refuse to renew its approval, the authority shall report the fact at the next convening of the interim or regular session committees of the Legislative Assembly related to health care.
(6) General Fund moneys may not be used to implement this section. As a condition of receiving Medicaid supplemental reimbursement, an emergency medical services provider must enter into and comply with an agreement with the authority to reimburse the authority for the costs of administering this section. [2016 c.34 §2; 2021 c.623 §4]