reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.500 - Findings regarding medical assistance for persons with hemophilia.

The Legislative Assembly finds that there are citizens of this state who have the disease of hemophilia and that hemophilia is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended upon termination of employment. The Legislative Assembly further finds that there is a need for a statewide program for the medical care of persons with hemophilia who are unable to pay for their necessary medical services, wholly or in part. [1975 c.513 §1; 1989 c.224 §81]
Note:
414.500 to 414.530 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.510 - Definitions.

(1) "Eligible individual" means a resident of the State of Oregon over the age of 20 years.
(2) "Hemophilia services" means a program for medical care, including the cost of blood transfusions and the use of blood derivatives. [1975 c.513 §2]
Note:
See note under 414.500.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.520 - Hemophilia services.

Within the limit of funds expressly appropriated and available for medical assistance to hemophiliacs, hemophilia services under ORS 414.500 to 414.530 shall be made available to eligible persons as recommended by the Medical Advisory Committee of the Oregon Chapter of the National Hemophilia Foundation. [1975 c.513 §3]
Note:
See note under 414.500.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.530 - When payments not made for hemophilia services.

Payments under ORS 414.500 to 414.530 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.500 to 414.530 is intended to limit in any way state participation in any federal program for medical care of persons with hemophilia. [1975 c.513 §4]
Note:
See note under 414.500.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.532 - Definitions for ORS 414.534 to 414.538.

As used in ORS 414.534 to 414.538:
(1) "Medical assistance" has the meaning given that term in ORS 414.025.
(2) "Provider" has the meaning given that term in ORS 743B.001. [2001 c.902 §1]
Note:
414.532 to 414.540 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.534 - Treatment for breast or cervical cancer; eligibility criteria for medical assistance; rules.

(1) The Oregon Health Authority shall provide medical assistance, as defined in ORS 414.025, to a woman who:
(a) Is found by a provider to be in need of treatment for breast or cervical cancer;
(b) Meets the eligibility criteria for the Oregon Breast and Cervical Cancer Program prescribed by rule by the authority;
(c) Does not otherwise have creditable coverage, as defined in 42 U.S.C. 300gg(c); and
(d) Is 64 years of age or younger.
(2) The period of time a woman can receive medical assistance based on the eligibility criteria of subsection (1) of this section:
(a) Begins:
(A) On the date the Department of Human Services or the Oregon Health Authority makes a formal determination that the woman is eligible for medical assistance in accordance with subsection (1) of this section; or
(B) Up to three months prior to the month in which the woman applied for medical assistance if on the earlier date the woman met the eligibility criteria of subsection (1) of this section.
(b) Ends when:
(A) The woman is no longer in need of treatment; or
(B) The department or the authority determines the woman no longer meets the eligibility criteria of subsection (1) of this section. [2001 c.902 §2; 2009 c.595 §313; 2011 c.555 §1; 2013 c.688 §75]
Note:
See note under 414.532.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.536 - Presumptive eligibility for medical assistance for treatment of breast or cervical cancer.

(1) If the Department of Human Services or the Oregon Health Authority determines that a woman likely is eligible for medical assistance under ORS 414.534, the department or the authority shall determine her to be presumptively eligible for medical assistance until a formal determination on eligibility is made.
(2) The period of time a woman may receive medical assistance based on presumptive eligibility is limited. The period of time:
(a) Begins on the date that the department or the authority determines the woman likely meets the eligibility criteria under ORS 414.534; and
(b) Ends on the earlier of the following dates:
(A) If the woman applies for medical assistance following the determination by the department or the authority that the woman is presumptively eligible for medical assistance, the date on which a formal determination on eligibility is made by the department or the authority in accordance with ORS 414.534; or
(B) If the woman does not apply for medical assistance following the determination by the department or the authority that the woman is presumptively eligible for medical assistance, the last day of the month following the month in which presumptive eligibility begins. [2001 c.902 §3; 2009 c.595 §314; 2013 c.688 §76]
Note:
See note under 414.532.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.538 - Prohibition on coverage limitations; priority to low-income women.

(1) The Department of Human Services and the Oregon Health Authority may not impose income or resource limitations or a prior period of uninsurance on a woman who otherwise qualifies for medical assistance under ORS 414.534 or 414.536.
(2) In establishing eligibility requirements for medical assistance under ORS 414.534, the department and the authority shall give priority to low-income women. [2001 c.902 §4; 2009 c.595 §315; 2011 c.720 §141]
Note:
See note under 414.532.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.540 - Rules.

The Oregon Health Authority shall adopt rules necessary for the implementation and administration of ORS 414.534 to 414.538. [2001 c.902 §5; 2009 c.595 §316]
Note:
See note under 414.532.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.550 - Definitions for ORS 414.550 to 414.565.

As used in ORS 414.550 to 414.565:
(1) "Cystic fibrosis services" means a program for medical care, including the cost of prescribed medications and equipment, respiratory therapy, physical therapy, counseling services that pertain directly to cystic fibrosis related health needs and outpatient services including physician, physician assistant, naturopathic physician or nurse practitioner fees, X-rays and necessary clinical tests to insure proper ongoing monitoring and maintenance of the patient’s health.
(2) "Eligible individual" means a resident of the State of Oregon over 18 years of age. [1985 c.532 §2; 2014 c.45 §38; 2017 c.356 §33]
Note:
414.550 to 414.565 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.555 - Findings regarding medical assistance for persons with cystic fibrosis.

The Legislative Assembly finds that there are citizens of this state who have the disease of cystic fibrosis and that cystic fibrosis is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended upon termination of employment. The Legislative Assembly further finds that there is a need for a statewide program for the medical care of persons with cystic fibrosis who are unable to pay for their necessary medical services, wholly or in part. [1985 c.532 §1; 1989 c.224 §82]
Note:
See note under 414.550.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.560 - Cystic fibrosis services.

(1) Within the limit of funds expressly appropriated and available for medical assistance to individuals who have cystic fibrosis, cystic fibrosis services under ORS 414.550 to 414.565 shall be made available by the Services for Children with Special Health Needs to eligible individuals as recommended by the review committee. The review committee shall consist of the Cystic Fibrosis Center Director, the Oregon Cystic Fibrosis Chapter Medical Advisory Committee and other recognized and knowledgeable community leaders in the area of health care delivery designated to serve on the review committee by the Director of the Services for Children with Special Health Needs.
(2) No member of the review committee shall be held criminally or civilly liable for actions pursuant to this section provided the member acts in good faith, on probable cause and without malice. [1985 c.532 §3; 1989 c.224 §83]
Note:
See note under 414.550.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.565 - When payments not made for cystic fibrosis services.

Payments under ORS 414.550 to 414.565 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.550 to 414.565 is intended to limit in any way state participation in any federal program for medical care of persons with cystic fibrosis. [1985 c.532 §4]
Note:
See note under 414.550.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.570 - System established.

(1) There is established the Oregon Integrated and Coordinated Health Care Delivery System. The system shall consist of state policies and actions that make coordinated care organizations accountable for care management and provision of integrated and coordinated health care for each organization’s members, primarily managed within fixed global budgets, by providing care so that efficiency and quality improvements reduce medical cost inflation while supporting the development of regional and community accountability for the health of the residents of each region and community, and while maintaining regulatory controls necessary to ensure quality and affordable health care for all Oregonians.
(2) The Oregon Health Authority shall seek input from groups and individuals who are part of underserved communities, including ethnically diverse populations, geographically isolated groups, seniors, people with disabilities and people using mental health services, and shall also seek input from providers, coordinated care organizations and communities, in the development of strategies that promote person centered care and encourage healthy behaviors, healthy lifestyles and prevention and wellness activities and promote the development of patients’ skills in self-management and illness management.
(3) The authority shall regularly report to the Oregon Health Policy Board, the Governor and the Legislative Assembly on the progress of payment reform and delivery system change including:
(a) The achievement of benchmarks;
(b) Progress toward eliminating health disparities;
(c) Results of evaluations;
(d) Rules adopted;
(e) Customer satisfaction;
(f) Use of patient centered primary care homes and behavioral health homes;
(g) The involvement of local governments in governance and service delivery; and
(h) Other developments with respect to coordinated care organizations. [Formerly 414.620; 2023 c.584 §20]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.577 - Community health assessment and adoption of community health improvement plan; rules.

(1) A coordinated care organization shall collaborate with local public health authorities and hospitals located in areas served by the coordinated care organization to conduct a community health assessment and adopt a community health improvement plan, shared with and endorsed by the coordinated care organization, local public health authorities and hospitals, to serve as a strategic population health and health care services plan for the residents of the areas served by the coordinated care organization, local public health authorities and hospitals. The health improvement plan must include strategies for achieving shared priorities.
(2) The coordinated care organization shall post the health improvement plan to the coordinated care organization’s website.
(3) The Oregon Health Authority may prescribe by rule requirements for health improvement plans and provide guidance for aligning the timelines for the development of the community health assessments and health improvement plans by coordinated care organizations, local public health authorities and hospitals. [2019 c.529 §1]
Note:
414.577 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.581 - Tribal Advisory Council established; membership; terms.

(1) The Tribal Advisory Council is established. The duties of the council are to:
(a) Serve as a channel of communication between the coordinated care organizations and Indian tribes in this state regarding the health of tribal communities; and
(b) Oversee the tribal liaisons in each coordinated care organization, described in ORS 414.572 (2)(r), and work with coordinated care organizations.
(2) The council consists of members who are appointed by each Indian tribe in this state and one member appointed by the members of the council to represent the urban Indian health programs in this state that are operated by urban Indian organizations pursuant to 25 U.S.C. 1651.
(3) The term of office of each member of the council is four years, but a member serves at the pleasure of the Indian tribe that appointed the member. Before the expiration of the term of a member, the tribe that appointed the member shall appoint a successor whose term begins on January 1 next following. A member is eligible for reappointment. If there is a vacancy for any cause, the vacancy shall be filled by the appointing tribe to become immediately effective for the unexpired term.
(4) Members of the council are not entitled to compensation or reimbursement of expenses and serve as volunteers on the council.
(5) The council shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers necessary for the performance of the functions of the offices as the council determines. The chairperson shall be responsible for the adoption of bylaws for the council.
(6) A majority of the members of the council constitutes a quorum for the transaction of business.
(7) The council shall meet at least once every three months at a time and place determined by the council. The council also may meet at other times and places specified by the call of the chairperson or of a majority of the members of the council.
(8) The Oregon Health Authority shall provide staff support to the council. [2019 c.529 §3]
Note:
414.581 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.584 - Meetings of coordinated care organization governing body to be open to public; recording and taking of minutes required.

(1) Meetings of a governing body of a coordinated care organization in which substantive decisions are made final must:
(a) Be open to the public;
(b) Provide an opportunity for members of the public to provide written or oral testimony; and
(c) Include the minutes or other record of the previous meeting of the governing body.
(2) A coordinated care organization shall give public notice, reasonably calculated to give actual notice to interested persons, of the time and place for meetings described in subsection (1) of this section.
(3) Meetings of a governing body of a coordinated care organization are not subject to ORS 192.610 to 192.705.
(4) The governing body of a coordinated care organization shall provide for the sound, video or digital recording or the taking of written minutes of all its meetings. Neither a full transcript nor a full recording of a meeting is required but the written minutes or recording must give a true reflection of the matters discussed at the meeting and the views of the participants. All minutes or recordings must be available to the public within a reasonable time after the meeting and must include at least the following information:
(a) All members of the governing body present;
(b) All motions, proposals, resolutions, orders, ordinances and measures proposed and their disposition;
(c) Unanimous votes on decisions or, if a vote is not unanimous, the results of the vote and the vote of each member by name; and
(d) The substance of any discussion on any matter.
(5) A coordinated care organization shall make available on its website, at a minimum, the following information:
(a) The minutes or other record of previous meetings of the governing body of the coordinated care organization; and
(b) Contact information for:
(A) The chairperson of the governing body; and
(B) A member of the governing body or a staff member of the coordinated care organization responsible for providing information to the public about the activities of the coordinated care organization. [2018 c.49 §2]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.592 - Requirements for contracts between authority and providers; alignment with behavioral quality health metrics and incentives.

Notwithstanding ORS 414.590:
(1) Contracts between the Oregon Health Authority and coordinated care organizations or individual providers for the provision of behavioral health services must align with the quality metrics and incentives developed by the Behavioral Health Committee under ORS 413.017 and contain provisions that ensure that:
(a) Individuals have easy access to needed care;
(b) Services are responsive to individual and community needs; and
(c) Services will lead to meaningful improvement in individuals’ lives.
(2) The authority must provide at least 90 days’ notice of changes needed to contracts that are necessary to comply with subsection (1) of this section. [2021 c.667 §18]
2023 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.
2023 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 413.022, 413.032, 414.572, 414.598, 414.605, 414.632 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]
2023 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]
2023 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]
2023 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]
2023 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 413.022, 414.572, 414.598, 414.605, 414.607, 414.632, 414.654, 414.655 and 414.665. [Formerly 414.685]
2023 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 §§1,14; 2018 c.49 §§3,4; 2019 c.358 §§7,8; 2019 c.364 §§1,2; 2019 c.478 §§57,58; 2019 c.529 §§6,7; renumbered 414.572 in 2019]
2023 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.
2023 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]
2023 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]
2023 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]
2023 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]
2023 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 413.022, 414.153, 414.572, 414.591, 414.605, 414.607, 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]
2023 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) The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations.
(2) Each coordinated care organization shall implement, to the maximum extent feasible, patient centered primary care homes and behavioral health homes, including developing capacity for services in settings that are accessible to families, diverse communities and underserved populations, including the provision of integrated health care. The organization shall require its other health and services providers to communicate and coordinate care with the patient centered primary care home or behavioral health home in a timely manner using electronic health information technology.
(3) Standards established by the authority for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations may require the use of federally qualified health centers, rural health clinics, school-based health clinics and other safety net providers that qualify as patient centered primary care homes or behavioral health homes to ensure the continued critical role of those providers in meeting the needs of underserved populations.
(4) In order to promote the full integration of behavioral health and physical health services in primary care, behavioral health care and urgent care settings, providers in patient centered primary care homes and behavioral health homes may use billing codes applicable to the behavioral health and physical health services that are provided.
(5) Each coordinated care organization shall report to the authority on uniform quality measures prescribed by the authority by rule for patient centered primary care homes and behavioral health homes.
(6) Patient centered primary care homes and behavioral health homes must participate in the learning collaborative described in ORS 413.259 (3). [2011 c.602 §6; 2015 c.798 §5]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.665 - Traditional health workers utilized by coordinated care organizations; rules.

(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 §11; 2013 c.752 §4; 2017 c.618 §5; 2021 c.514 §3]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.667 - Definition for ORS 414.667 to 414.669.

As used in ORS 414.667, 414.668 and 414.669, "doula" means an individual who meets criteria for a doula adopted by the Oregon Health Authority in accordance with ORS 414.665. [2017 c.281 §2]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.668 - Access to doula services.

A coordinated care organization shall make information about how to access doula services available on a website operated by or on behalf of the coordinated care organization and shall provide the information in print whenever a printed explanation of benefits is available. [2017 c.281 §4]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.669 - Payment for doula services.

The Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall in each even-numbered year review, and revise if necessary, any rates of reimbursement for doulas. When reviewing and revising rates of reimbursement, the authority shall consider factors including retention of doulas, access to culturally specific doulas and evidence-based factors and empirical studies related to the cost-effectiveness of services provided by doulas. [Formerly 414.768]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.672 - Tribal-based practices for mental health and substance abuse prevention, counseling and treatment.

A medical assistance program shall consider tribal-based practices for mental health and substance abuse prevention, counseling and treatment services for members who are Native American or Alaska Native as equivalent to evidence-based practices for purposes of meeting standards of care and shall reimburse for those tribal-based practices. [2019 c.364 §6]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.686 - Health assessments for foster children.

(1) A coordinated care organization shall provide an initial health assessment on any child enrolled in the coordinated care organization who is in the custody of the Department of Human Services no later than 60 days after the date that the Oregon Health Authority notifies the coordinated care organization that the child has been taken into the department’s custody.
(2) If a child has not received an initial health assessment by the date specified in subsection (1) of this section, the coordinated care organization shall act affirmatively to locate the child and make arrangements for an initial health assessment. [2017 c.277 §2; 2023 c.584 §17]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.688 - Commission established; membership.

(1) As used in this section:
(a) "Practice of pharmacy" has the meaning given that term in ORS 689.005.
(b) "Retail drug outlet" has the meaning given that term in ORS 689.005.
(2) The Health Evidence Review Commission is established in the Oregon Health Authority, consisting of 13 members appointed by the Governor in consultation with professional and other interested organizations, and confirmed by the Senate, as follows:
(a) Five members must be physicians licensed to practice medicine in this state who have clinical expertise in the areas of family medicine, internal medicine, obstetrics, perinatal health, pediatrics, disabilities, geriatrics or general surgery. One of the physicians must be a doctor of osteopathic medicine, and one must be a hospital representative or a physician whose practice is significantly hospital-based.
(b) One member must be a dentist licensed under ORS chapter 679 who has clinical expertise in general, pediatric or public health dentistry.
(c) One member must be a public health nurse.
(d) One member must be a behavioral health representative who may be a social services worker, alcohol and drug treatment provider, psychologist or psychiatrist.
(e) Two members must be consumers of health care who are patient advocates or represent the areas of indigent services, labor, business, education or corrections.
(f) One member must be a complementary or alternative medicine provider who is a chiropractic physician licensed under ORS chapter 684, a naturopathic physician licensed under ORS chapter 685 or an acupuncturist licensed under ORS chapter 677.
(g) One member must be an insurance industry representative who may be a medical director or other administrator.
(h) One member must be a pharmacy representative who engages in the practice of pharmacy at a retail drug outlet.
(3) No more than six members of the commission may be physicians either in active practice or retired from practice.
(4) Members of the commission serve for a term of four years at the pleasure of the Governor. A member is eligible for reappointment.
(5) Members are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for in ORS 292.495. Claims for expenses shall be paid out of funds available to the Oregon Health Authority for purposes of the commission. [2011 c.720 §22; 2017 c.409 §10]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.689 - Members; meetings.

(1) The Health Evidence Review Commission shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers the commission determines necessary for the performance of the functions of the offices.
(2) A majority of the members of the commission constitutes a quorum for the transaction of business.
(3) The commission shall meet at least four times per year at a place, day and hour determined by the chairperson. The commission also shall meet at other times and places specified by the call of the chairperson or of a majority of the members of the commission.
(4) The commission may use advisory committees or subcommittees whose members are appointed by the chairperson of the commission subject to approval by a majority of the members of the commission. The advisory committees or subcommittees may contain experts appointed by the chairperson and a majority of the members of the commission. The conditions of service of the experts will be determined by the chairperson and a majority of the members of the commission.
(5) The Oregon Health Authority shall provide staff and support services to the commission. [2011 c.720 §23; 2015 c.318 §22]