reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.095 - Exemptions applicable to payments.

Neither medical assistance nor amounts payable to vendors out of medical assistance funds are transferable or assignable at law or in equity and none of the money paid or payable under the provisions of this chapter is subject to execution, levy, attachment, garnishment or other legal process. [1965 c.556 §11; 1967 c.502 §14; 2001 c.900 §222; 2013 c.688 §71]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.105

[1965 c.556 §12; 1967 c.502 §15; 1969 c.507 §2; 1971 c.334 §1; 1973 c.334 §1; part renumbered 416.280; 1975 c.386 §4; 1985 c.522 §4; 1991 c.66 §16; 1993 c.249 §5; 1995 c.642 §1; 2001 c.620 §5; 2001 c.900 §223; 2007 c.70 §191; 2009 c.595 §278; renumbered 416.350 in 2009]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.109 - Oregon Health Plan Fund.

(1) The Oregon Health Plan Fund is established, separate and distinct from the General Fund. Interest earned by the Oregon Health Plan Fund shall be retained by the Oregon Health Plan Fund.
(2) Moneys in the Oregon Health Plan Fund are continuously appropriated to the Department of Human Services for the purposes of funding the maintenance and expansion of the number of persons eligible for medical assistance under the Oregon Health Plan and funding the maintenance of the benefits available under the Oregon Health Plan.
(3) On June 26, 2009, all moneys in the Oregon Health Plan Fund shall be transferred to the Oregon Health Authority Fund established in ORS 413.101. [2002 s.s.3 c.2 §9; 2009 c.595 §280]
Note:
414.109 was enacted into law but was not added to or made a part of ORS chapter 414 or any series therein by law. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.115 - Medical assistance by insurance or service contracts; rules.

(1) In lieu of providing one or more of the health care and services available under medical assistance by direct payments to providers thereof and in lieu of providing such health care and services made available pursuant to ORS 414.065, the Oregon Health Authority may use available medical assistance funds to purchase and pay premiums on policies of insurance, or enter into and pay the expenses on health care service contracts, or medical or hospital service contracts that provide one or more of the health care and services available under medical
assistance. Notwithstanding other specific provisions, the use of available medical assistance funds to purchase health care and services may provide the following insurance or contract options:
(a) Differing services or levels of service among groups of eligibles as defined by rules of the authority; and
(b) Services and reimbursement for these services may vary among contracts and need not be uniform.
(2) The policy of insurance or the contract by its terms, or the insurer or contractor by written acknowledgment to the authority must guarantee:
(a) To provide health care and services of the type, within the extent and according to standards prescribed under ORS 414.065;
(b) To pay providers of health care and services the amount due, based on the number of days of care and the fees, charges and costs established under ORS 414.065, except as to medical or hospital service contracts which employ a method of accounting or payment on other than a fee-for-service basis;
(c) To provide health care and services under policies of insurance or contracts in compliance with all laws, rules and regulations applicable thereto; and
(d) To provide such statistical data, records and reports relating to the provision, administration and costs of providing health care and services to the authority as may be required by the authority for its records, reports and audits.
(3) The authority may purchase insurance under this section through the health insurance exchange. [1967 c.502 §9; 1975 c.401 §1; 1981 c.825 §5; 1991 c.66 §17; 2009 c.595 §281; 2011 c.602 §36; 2013 c.688 §72]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.117 - Premium assistance for health insurance coverage.

Subject to funds available, the Oregon Health Authority may provide medical assistance in the form of premium assistance for the purchase of health insurance coverage provided by public programs or private insurance, including but not limited to medical assistance described in ORS 414.115. [Formerly 414.839]
Note:
414.117 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 414.125 - Rates on insurance or service contracts; requirements for insurer or contractor.

(1) Any payment of available medical assistance funds for policies of insurance or service contracts shall be according to such uniform area-wide rates as the Oregon Health Authority shall have established and which it may revise from time to time as may be necessary or practical, except that, in the case of a research and demonstration project entered into under ORS 411.135 special rates may be established.
(2) No premium or other periodic charge on any policy of insurance, health care service contract, or medical or hospital service contract shall be paid from available medical assistance funds unless the insurer or contractor issuing such policy or contract is by law authorized to transact business as an insurance company, health care service contractor or hospital association in this state. [1967 c.502 §10; 1975 c.509 §6; 1991 c.66 §18; 2009 c.595 §282]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.135 - Contracts relating to direct providers of care and services.

The Oregon Health Authority may enter into nonexclusive contracts under which funds available for medical assistance may be administered and disbursed by the contractor to direct providers of medical and remedial care and services available under medical assistance in consideration of services rendered and supplies furnished by them in accordance with the provisions of this chapter. Payment shall be made according to the rules of the authority pursuant to the number of days and the fees, charges and costs established under ORS 414.065. The contractor must guarantee the authority by written acknowledgment:
(1) To make all payments under this chapter promptly but not later than 30 days after receipt of the proper evidence establishing the validity of the provider’s claim.
(2) To provide such data, records and reports to the authority as may be required by the authority. [1967 c.502 §11; 1991 c.66 §19; 2009 c.595 §283]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.145 - Implementation of ORS 414.115, 414.125 or 414.135.

(1) The provisions of ORS 414.115, 414.125 or 414.135 shall be implemented whenever it appears to the Oregon Health Authority that such implementation will provide comparable benefits at equal or less cost than provision thereof by direct payments by the authority to the providers of medical assistance, but in no case greater than the legislatively approved budgeted cost per eligible recipient at the time of contracting.
(2) When determining comparable benefits at equal or less cost as provided in subsection (1) of this section, the authority must take into consideration the recipients’ need for reasonable access to preventive and remedial care, and the contractor’s ability to assure continuous quality delivery of both routine and emergency services. [1967 c.502 §11a; 1975 c.401 §3; 1983 c.590 §9; 1985 c.747 §12a; 1991 c.66 §20; 2009 c.595 §284]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.150 - Purpose of ORS 414.150 to 414.153.

It is the purpose of ORS 414.150 to 414.153 to take advantage of opportunities to:
(1) Enhance the state and local public health partnership;
(2) Improve the access to care and health status of women and children; and
(3) Strengthen public health programs and services at the local level. [1991 c.337 §1; 2015 c.736 §58]
Note:
414.150 to 414.153 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 414.152 - Duty of state agencies to work with local health departments.

To capitalize on the successful public health programs provided by local health departments and the sizable investment by state and local governments in the public health system, state agencies shall encourage agreements that allow local health departments and other publicly supported programs to continue to be the providers of those prevention and health promotion services now available, plus other maternal and child health services such as prenatal outreach and care, child health services and family planning services to women and children who become eligible for poverty level medical assistance program benefits pursuant to ORS 414.153. [1991 c.337 §3; 2015 c.736 §59]
Note:
See note under 414.150.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.211 - Medicaid Advisory Committee.

(1) There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor.
(2) The committee shall be composed of:
(a) A physician licensed under ORS chapter 677;
(b) Two members of health care consumer groups that include Medicaid recipients;
(c) Two Medicaid recipients, one of whom shall be a person with a disability;
(d) The Director of the Oregon Health Authority or designee;
(e) The Director of Human Services or designee;
(f) Health care providers;
(g) Persons associated with health care organizations, including but not limited to coordinated care organizations under contract to the Medicaid program; and
(h) Members of the general public.
(3) In making appointments, the Governor shall consult with appropriate professional and other interested organizations. All members appointed to the committee shall be familiar with the medical needs of low income persons.
(4) The term of office for each member shall be two years, but each member shall serve at the pleasure of the Governor.
(5) Members of the committee shall receive no compensation for their services but, subject to any applicable state law, shall be allowed actual and necessary travel expenses incurred in the performance of their duties from the Oregon Health Authority Fund. [1995 c.727 §43; 2007 c.70 §192; 2009 c.595 §287; 2011 c.602 §37; 2011 c.720 §132]
Note:
414.211 and 414.221 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 414.221 - Duties of committee.

The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on:
(1) Medical care, including mental health and alcohol and drug treatment and remedial care to be provided under ORS chapter 414; and
(2) The operation and administration of programs provided under ORS chapter 414. [1995 c.727 §44; 2003 c.784 §7; 2007 c.697 §16; 2009 c.595 §288; 2011 c.720 §133]
Note:
See note under 414.211.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.225 - Oregon Health Authority to consult with committee.

The Oregon Health Authority shall consult with the Medicaid Advisory Committee concerning the determinations required under ORS 414.065. [1967 c.502 §20; 1991 c.66 §22; 1995 c.727 §46; 2003 c.784 §8; 2009 c.595 §289]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.227 - Application of public meetings law to advisory committees.

(1) ORS 192.610 to 192.705 apply to any meeting of an advisory committee with the authority to make decisions for, conduct policy research for or make recommendations to the Oregon Health Authority, the Oregon Health Policy Board or the Department of Human Services on administration or policy related to the medical assistance program operated under this chapter.
(2) Subsection (1) of this section applies only to advisory committee meetings attended by two or more advisory committee members who are not employed by a public body. [2001 c.353 §2; 2009 c.595 §290; 2011 c.720 §134]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.231 - Eligibility for Cover All People program; 12-month continuous enrollment; verification of eligibility.

(1) As used in this section:
(a) "Adult" means a person 19 years of age or older.
(b) "Child" means a person under 19 years of age.
(2) The Cover All People program is established to make affordable, accessible health care available to all residents in this state. The program provides medical assistance, funded in whole or in part by Title XIX of the Social Security Act, by the State Children’s Health Insurance Program under Title XXI of the Social Security Act or by moneys appropriated or allocated by the Legislative Assembly to supplement funds received under Title XIX or XXI of the Social Security Act.
(3) A child is eligible for medical assistance under subsection (2) of this section if the child resides in this state and the income of the child’s family is at or below 300 percent of the federal poverty guidelines.
(4) An adult is eligible for medical assistance under subsection (2) of this section if the adult resides in this state and would be eligible for medical assistance but for the adult’s immigration status.
(5) There is no asset limit to qualify for the program.
(6)(a) A child receiving medical assistance through the Cover All People program is continuously eligible for a minimum period of 12 months or until the child reaches 19 years of age, whichever comes first.
(b) The Department of Human Services or the Oregon Health Authority shall reenroll a child for successive 12-month periods of enrollment as long as the child is eligible for medical assistance on the date of reenrollment and the child has not yet reached 19 years of age.
(c) A child may not be required to submit a new application as a condition of reenrollment under paragraph (b) of this subsection.
(7) The department or the authority must determine eligibility for or reenrollment in medical assistance under this section using information and sources available to the department or the authority. If information and sources available to the department or the authority are not adequate to verify eligibility, the department or the authority may require the adult or a child’s caretaker to provide additional documentation in accordance with ORS 411.400 and 411.402. Information requested or obtained by the department or the authority under this subsection is subject to the requirements of ORS 410.150 and 413.175. [2009 c.867 §27; 2009 c.867 §28; 2011 c.9 §56; 2011 c.720 §135; 2013 c.365 §1; 2013 c.640 §§12,13; 2017 c.652 §2; 2021 c.554 §1]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.241 - Oregon Health Authority to administer bridge program.

The Oregon Health Authority shall administer a bridge program to provide affordable health care coverage, improve the continuity of coverage and care for Oregonians and reduce health inequities for individuals who regularly enroll and disenroll in the medical assistance program due to fluctuations in their incomes. [2022 c.29 §5; 2022 c.29 §9]
Note:
414.241 and 414.245 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 414.245 - Bridge Plan Fund.

The Bridge Plan Fund is established in the State Treasury, separate and distinct from the General Fund, consisting of federal funds received by the Oregon Health Authority to administer the bridge program described in ORS 414.241. Moneys in the Bridge Plan Fund are continuously appropriated to the Oregon Health Authority to carry out ORS 414.241. [2022 c.29 §8]
Note:
See note under 414.241.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.305

[1969 c.507 §3; 1971 c.33 §1; 1977 c.384 §5; 1991 c.66 §23; 2001 c.900 §102; renumbered 414.028 in 2001]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.314 - Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees.

(1) An individual or entity described in ORS 414.312 (4) may apply to participate in the Oregon Prescription Drug Program. Participants shall apply on an application provided by the Oregon Health Authority. The authority may charge participants a nominal fee to participate in the program. The authority shall issue a prescription drug identification card to participants of the program.
(2) The authority shall provide a mechanism to calculate and transmit the program prices for prescription drugs to a pharmacy. The pharmacy shall charge the participant the program price for a prescription drug.
(3) A pharmacy may charge the participant the professional dispensing fee set by the authority.
(4) Prescription drug identification cards issued under this section must contain the information necessary for proper claims adjudication or transmission of price data. [2003 c.714 §2; 2007 c.67 §2; 2007 c.697 §18; 2009 c.595 §292]
Note:
See note under 414.312.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.318 - Prescription Drug Purchasing Fund.

The Prescription Drug Purchasing Fund is established separate and distinct from the General Fund. The Prescription Drug Purchasing Fund shall consist of moneys appropriated to the fund by the Legislative Assembly and moneys received by the Oregon Health Authority for the purposes established in this section in the form of gifts, grants, bequests, endowments or donations. The moneys in the Prescription Drug Purchasing Fund are continuously appropriated to the authority and shall be used to purchase prescription drugs, reimburse pharmacies for prescription drugs and reimburse the authority for the costs of administering the Oregon Prescription Drug Program, including contracted services costs, computer costs, professional dispensing fees paid to retail pharmacies and other reasonable program costs. Interest earned on the fund shall be credited to the fund. [2003 c.714 §4; 2007 c.697 §20; 2009 c.595 §294]
Note:
See note under 414.312.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.320 - Rules.

The Oregon Health Authority shall adopt rules to implement and administer ORS 414.312 to 414.318. The rules shall include but are not limited to establishing procedures for:
(1) Issuing prescription drug identification cards to individuals and entities that participate in the Oregon Prescription Drug Program; and
(2) Enrolling pharmacies in the program. [2003 c.714 §5; 2007 c.697 §21; 2009 c.595 §295]
Note:
See note under 414.312.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.326 - Supplemental rebates from pharmaceutical manufacturers.

(1) The Oregon Health Authority shall negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates that are in addition to the discount required under federal law to participate in the medical assistance program.
(2) The authority may participate in a multistate prescription drug purchasing pool for the purpose of negotiating supplemental rebates.
(3) ORS 414.325 and 414.334 apply to prescription drugs purchased for the medical assistance program under this section. [Formerly 414.747; 2013 c.14 §7]
Note:
414.326 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 414.327 - Electronically transmitted prescriptions; rules.

The Oregon Health Authority shall adopt rules permitting a practitioner to communicate prescription drug orders by electronic means directly to the dispensing pharmacist. [2001 c.623 §8; 2003 c.14 §192; 2009 c.595 §297]
Note:
414.327 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 414.328 - Synchronization of prescription drug refills.

(1) As used in this section, "synchronization policy" means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.
(2) Each coordinated care organization shall implement a synchronization policy for the dispensing of prescription drugs to members of the organization.
(3) The Oregon Health Authority shall implement a synchronization policy for the dispensing of prescription drugs to recipients of medical assistance who are not enrolled in a coordinated care organization. [2014 c.25 §4; 2015 c.800 §2]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.329 - Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules.

(1) Notwithstanding ORS 414.591, 414.631 and 414.688 to 414.745, the Oregon Health Authority shall adopt rules modifying the prescription drug benefits for persons who are eligible for Medicare Part D prescription drug coverage and who receive prescription drug benefits under the state medical assistance program or Title XIX of the Social Security Act. The rules shall include but need not be limited to:
(a) Identification of the Part D classes of drugs for which federal financial participation is not available and that are not covered classes of drugs;
(b) Identification of the Part D classes of drugs for which federal financial participation is not available and that are covered classes of drugs;
(c) Identification of the classes of drugs not covered under Medicare Part D prescription drug coverage for which federal financial participation is available and that are covered classes of drugs; and
(d) Cost-sharing obligations related to the provision of Part D classes of drugs for which federal financial participation is not available.
(2) As used in this section, "covered classes of drugs" means classes of prescription drugs provided to persons eligible for prescription drug coverage under the state medical assistance program or Title XIX of the Social Security Act. [2005 c.754 §1; 2009 c.595 §298]
Note:
414.329 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 414.330 - Legislative findings on prescription drugs.

The Legislative Assembly finds that:
(1) The cost of prescription drugs in the medical assistance program is growing and will soon be unsustainable;
(2) The benefit of prescription drugs when appropriately used decreases the need for other expensive treatments and improves the health of Oregonians; and
(3) Providing the most effective drugs in the most cost-effective manner will benefit both patients and taxpayers. [2001 c.897 §1; 2009 c.595 §298a]
Note:
414.330 to 414.334 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.332 - Policy for Practitioner-Managed Prescription Drug Plan.

It is the policy of the State of Oregon that a Practitioner-Managed Prescription Drug Plan will ensure that:
(1) Oregonians have access to the most effective prescription drugs appropriate for their clinical conditions;
(2) Decisions concerning the clinical effectiveness of prescription drugs are made by licensed health practitioners, are informed by the latest peer-reviewed research and consider the health condition of a patient or characteristics of a patient, including the patient’s gender, race or ethnicity; and
(3) The cost of prescription drugs in the medical assistance program is managed through market competition among pharmaceutical manufacturers by considering, first, the effectiveness and safety of a given drug and, second, any substantial cost differences between drugs within the same therapeutic class. [2001 c.897 §2; 2009 c.595 §298b; 2011 c.720 §137]
Note:
See note under 414.330.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.334 - Practitioner-Managed Prescription Drug Plan for medical assistance program.

(1) The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best possible price.
(2) In adopting the plan, the authority shall consider recommendations of the Pharmacy and Therapeutics Committee.
(3) The authority shall consult with representatives of the regulatory boards and associations representing practitioners who are prescribers under the medical assistance program and ensure that practitioners receive educational materials and have access to training on the Practitioner-Managed Prescription Drug Plan.
(4) Notwithstanding the Practitioner-Managed Prescription Drug Plan adopted by the authority, a practitioner may prescribe any drug that the practitioner indicates is medically necessary for an enrollee as being the most effective available.
(5) An enrollee may appeal to the authority a decision of a practitioner or the authority to not provide a prescription drug requested by the enrollee.
(6) This section does not limit the decision of a practitioner as to the scope and duration of treatment of chronic conditions, including but not limited to arthritis, diabetes and asthma. [2001 c.897 §3; 2009 c.595 §299; 2009 c.827 §§4,10; 2011 c.720 §§138,139]
Note:
See note under 414.330.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.337 - Limitation on rules regarding Practitioner-Managed Prescription Drug Plan.

The Oregon Health Authority may not adopt or amend any rule that requires a prescribing practitioner to contact the authority to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug list for that class of drugs adopted under ORS 414.334, unless otherwise authorized by enabling legislation setting forth the requirement for prior authorization. [2009 c.827 §11; 2009 c.827 §12]
Note:
414.337 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Note:
Sections 3 and 4, chapter 544, Oregon Laws 2019, provide:
Sec. 3.
(1) As used in this section, "mental health drug" means a type of legend drug defined by the Oregon Health Authority by rule that includes but is not limited to:
(a) Therapeutic class 7 ataractics-tranquilizers; and
(b) Therapeutic class 11 psychostimulants-antidepressants.
(2) Notwithstanding ORS 414.334, the authority shall reimburse the cost of a mental health drug prescribed for a medical assistance recipient if federal financial participation in the cost is available. [2019 c.544 §3]
Sec. 4.
Section 3, chapter 544, Oregon Laws 2019, is repealed on January 2, 2026. [2019 c.544 §4; 2021 c.628 §1]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.353 - Committee established; membership.

(1) There is created an 11-member Pharmacy and Therapeutics Committee responsible for advising the Oregon Health Authority on the implementation of the retrospective and prospective programs and on the Practitioner-Managed Prescription Drug Plan.
(2) The Director of the Oregon Health Authority shall appoint the members of the committee, who shall serve at the pleasure of the director for a term of three years. An individual appointed to the committee may be reappointed upon completion of the individual’s term. The membership of the committee shall be composed of the following:
(a) Five persons licensed as physicians under ORS 677.100 to 677.228 and actively engaged in the practice of medicine in Oregon, who may be from among persons recommended by organizations representing physicians;
(b) Four persons licensed in and actively practicing pharmacy in Oregon who may be from among persons recommended by organizations representing pharmacists whether affiliated or unaffiliated with any association; and
(c) Two persons who are not physicians or pharmacists.
(3) If the committee determines that it lacks current clinical or treatment expertise with respect to a particular therapeutic class, or at the request of an interested outside party, the director shall appoint one or more medical experts otherwise qualified as described in subsection (2)(a) of this section who have such expertise. The medical experts shall have full voting rights with respect to recommendations made under ORS 414.361 (3) and (4). The medical experts may participate but may not vote in any other activities of the committee.
(4) The director shall fill a vacancy on the committee by appointing a new member to serve the remainder of the unexpired term. [2011 c.720 §2; 2017 c.409 §9]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.354 - Meetings; advisory committees; public notice and testimony.

(1) Except as provided in ORS 414.356, the Pharmacy and Therapeutics Committee shall operate in accordance with ORS chapter 192. The committee shall annually elect a chairperson from the members of the committee.
(2) A committee member is not entitled to compensation but is entitled to reimbursement for actual and necessary travel expenses incurred in connection with the member’s duties, pursuant to ORS 292.495.
(3) A quorum consists of six members of the committee.
(4) The committee may establish advisory committees to assist in carrying out the committee’s duties under ORS 414.351 to 414.414, with the approval of the Director of the Oregon Health Authority.
(5) The Oregon Health Authority shall provide staff and support services to the committee.
(6) The committee shall meet no less than four times each year at a place, day and hour determined by the director. The committee also shall meet at other times and places specified by the call of the director or a majority of the members of the committee. No less than 30 days prior to a meeting the committee shall post to the authority website:
(a) The agenda for the meeting;
(b) A list of the drug classes to be considered at the meeting; and
(c) Background materials and supporting documentation provided to committee members with respect to drugs and drug classes that are before the committee for review.
(7) The committee shall provide appropriate opportunity for public testimony at each regularly scheduled committee meeting. Immediately prior to deliberating on any recommendations regarding a drug or a class of drugs, the committee shall accept testimony, in writing or in person, that is offered by a manufacturer of those drugs or another interested party.
(8) The committee may consider more than 20 classes of drugs at a meeting only if:
(a) There is no new clinical evidence for the additional class of drugs; and
(b) The committee is considering only substantial cost differences between drugs within the same therapeutic class. [2011 c.720 §11]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.356 - Executive session.

(1) Notwithstanding ORS 192.610 to 192.705, the Pharmacy and Therapeutics Committee shall meet in an executive session for purposes of:
(a) Reviewing the prescribing or dispensing practices of individual physicians or pharmacists;
(b) Discussing drug use review data pertaining to individual physicians or pharmacists;
(c) Reviewing profiles of individual patients; or
(d) Reviewing confidential drug pricing information, including substantial cost differences between drugs within the same therapeutic class, that is necessary for the committee to make final recommendations under ORS 414.361 or to comply with ORS 414.414.
(2) A meeting held in executive session is subject to the requirements of ORS 192.650 (2). [2011 c.720 §10]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.364 - Intervention approaches.

In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following:
(1) Information disseminated to prescribers and pharmacists to ensure that they are aware of the duties and powers of the Pharmacy and Therapeutics Committee.
(2) Written, oral or electronic reminders of recipient-specific or drug-specific information that are designed to ensure recipient, prescriber and pharmacist confidentiality, and suggested changes in the prescribing or dispensing practices designed to improve the quality of care.
(3) Face-to-face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention.
(4) Intensified reviews or monitoring of selected prescribers or pharmacists.
(5) Educational outreach through the retrospective program focusing on improvement of prescribing and dispensing practices.
(6) The timely evaluation of interventions to determine if the interventions have improved the quality of care.
(7) The review of case profiles before the conducting of an intervention.
(8) The actions specified in ORS 414.372. [2011 c.720 §6; 2015 c.467 §6]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.369 - Prospective drug use review program.

The prospective drug use review program must use guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee. The program must ensure that prior to the prescription being filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from the following:
(1) Therapeutic duplication.
(2) Drug-drug interactions, including serious interactions with nonprescription or over-the-counter drugs.
(3) Incorrect dosage and duration of treatment.
(4) Drug-allergy interactions.
(5) Clinical abuse and misuse.
(6) Drug-disease contraindications. [2011 c.720 §7]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.371 - Retrospective drug use review program.

The retrospective drug use review program must use:
(1) Guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee; and
(2) The mechanized drug claims processing and information retrieval system to analyze claims data on drug use against explicit predetermined standards that are based on compendia and other sources to monitor the following:
(a) Therapeutic appropriateness.
(b) Overutilization or underutilization.
(c) Fraud and abuse.
(d) Therapeutic duplication.
(e) Drug-disease contraindications.
(f) Drug-drug interactions.
(g) Incorrect drug dosage or duration of drug treatment.
(h) Clinical abuse and misuse. [2011 c.720 §8]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.372 - Pharmacy lock-in program; rules.

(1)(a) If necessary to avoid overutilization by a recipient of medical assistance, the Oregon Health Authority may restrict, for 18 months or less, the recipient’s pharmacy choices for filling and refilling prescriptions to a mail order pharmacy that contracts with the authority, a retail pharmacy selected by the recipient and a specialty pharmacy selected by the recipient, if the recipient:
(A) Uses three or more pharmacies in a six-month period;
(B) Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period;
(C) Alters a prescription; or
(D) Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse.
(b) This subsection does not apply to a recipient who:
(A) Is a member of a coordinated care organization;
(B) Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage;
(C) Is a child in the custody of the Department of Human Services; or
(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.
(c) The authority shall prescribe by rule:
(A) Exceptions to the limitation imposed under paragraph (a) of this subsection; and
(B) The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy.
(2) The authority may conduct prospective drug utilization review, in accordance with rules adopted under ORS 414.361, prior to payment for drugs for a patient who has filled prescriptions for more than 15 drugs in the preceding six-month period. [2015 c.467 §2]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.381 - Annual reports; educational materials; procedures to protect confidential information.

In addition to the duties described in ORS 414.361, the Pharmacy and Therapeutics Committee shall do the following subject to the approval of the Director of the Oregon Health Authority:
(1) Publish an annual report, as described in ORS 414.382.
(2) Publish and disseminate educational information to prescribers and pharmacists regarding the committee and the drug use review programs, including information on the following:
(a) Identifying and reducing the frequency of patterns of fraud, abuse or inappropriate or medically unnecessary care among prescribers, pharmacists and recipients.
(b) Potential or actual severe or adverse reactions to drugs.
(c) Therapeutic appropriateness.
(d) Overutilization or underutilization.
(e) Appropriate use of generic products.
(f) Therapeutic duplication.
(g) Drug-disease contraindications.
(h) Drug-drug interactions.
(i) Drug allergy interactions.
(j) Clinical abuse and misuse.
(3) Adopt and implement procedures designed to ensure the confidentiality of any information that identifies individual prescribers, pharmacists or recipients and that is collected, stored, retrieved, assessed or analyzed by the committee, staff of the committee, the Oregon Health Authority or contractors to the committee or the authority. [2011 c.720 §5]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.382 - Requirements for annual report.

(1) The annual report required under ORS 414.381 (1) is subject to public comment prior to its submission to the Director of the Oregon Health Authority and must include the following:
(a) An overview of the activities of the Pharmacy and Therapeutics Committee and the prospective and retrospective programs;
(b) A summary of interventions made, including the number of cases brought before the committee and the number of interventions made;
(c) An assessment of the impact of the interventions, criteria and standards used, including an overall assessment of the impact of the educational programs and interventions on prescribing and dispensing patterns;
(d) An assessment of the impact of the criteria, standards and educational interventions on quality of care; and
(e) An estimate of the cost savings generated as a result of the prospective and retrospective programs, including an overview of the fiscal impact of the programs to other areas of the medical assistance program such as hospitalization or long term care costs. This analysis should include a cost-benefit analysis of both the prospective and retrospective programs and should take into account the administrative costs of the drug utilization review program.
(2) Copies of the annual report shall be submitted to the President of the Senate, the Speaker of the House of Representatives and other persons who request copies of the report. [2011 c.720 §12]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.414 - Use and disclosure of confidential information.

(1) Information collected under ORS 414.351 to 414.414 that identifies an individual is confidential and may not be disclosed by the Pharmacy and Therapeutics Committee, the retrospective program or the Oregon Health Authority to any person other than a health care provider appearing on a recipient’s medication profile.
(2) The staff of the committee may have access to identifying information for purposes of carrying out intervention activities. The identifying information may not be released to anyone other than a staff member of the committee, the retrospective program, the authority or a health care provider appearing on a recipient’s medication profile or, for purposes of investigating potential fraud in programs administered by the authority, the Department of Justice.
(3) The committee may release cumulative, nonidentifying information for the purposes of legitimate research and for educational purposes. [2011 c.720 §9]
Note:
See note under 414.351.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.426 - Payment of cost of medical care for institutionalized persons.

The Oregon Health Authority is hereby authorized to pay the cost of care for patients in institutions operated under ORS 179.321 under the medical assistance program established by ORS chapter 414. [Formerly 414.028; 2009 c.595 §310]
Note:
414.426 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.428 - Coverage for American Indian and Alaska Native beneficiaries.

(1) An individual who is eligible for or receiving medical assistance, as defined in ORS 414.025, pursuant to a demonstration project under section 1115 of the Social Security Act and who is an American Indian and Alaska Native beneficiary shall receive the same package of health services as individuals described in ORS 414.706 (1), (2) and (3) if:
(a) The Oregon Health Authority receives 100 percent federal medical assistance percentage for payments made by the authority for the package of health services provided; or
(b) The authority receives funding from the Indian tribes for which federal financial participation is available.
(2) As used in this section, "American Indian and Alaska Native beneficiary" has the meaning given that term in ORS 414.631. [Formerly 414.029; 2007 c.861 §22; 2009 c.595 §311; 2011 c.602 §39; 2013 c.688 §74; 2021 c.97 §40]
Note:
414.428 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.430 - Access to dental care for pregnant women; rules.

(1) The Oregon Health Authority shall prescribe by rule appropriate time frames within which a pregnant medical assistance recipient whose medical assistance is reimbursed on a fee-for-service basis and who needs general or specialty dental care must have the opportunity to be seen, or referred for, and provided:
(a) Emergency dental services;
(b) Urgent dental services;
(c) Routine dental services; and
(d) An initial dental screening or examination.
(2) The time frames prescribed by the authority for recipients whose medical assistance is reimbursed on a fee-for-service basis shall be the same as or shorter than the time frames for pregnant recipients enrolled in coordinated care organizations and dental care organizations. [2015 c.750 §2]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.432 - Reproductive health services for noncitizens.

(1) The Oregon Health Authority shall administer a program to reimburse the cost of medically appropriate services, drugs, devices, products and procedures described in ORS 743A.067, for individuals who can become pregnant and who would be eligible for medical assistance if not for 8 U.S.C. 1611 or 1612.
(2) The authority shall provide the medical assistance for pregnant women that is authorized by Title XXI, section 2112, of the Social Security Act (42 U.S.C. 1397ll) for 60 days immediately postpartum.
(3) The authority shall collect data and analyze the cost-effectiveness of the services, drugs, devices, products and procedures paid for under this section.
(4) The authority, in collaboration with the Department of Consumer and Business Services if necessary, shall explore any and all opportunities to obtain federal financial participation in the costs of implementing this section, including but not limited to waivers or demonstration projects under Title X of the Public Health Service Act or Title XIX or XXI of the Social Security Act. However, the implementation of this section is not contingent upon the authority’s receipt of a waiver or authorization to operate a demonstration project. [2017 c.721 §5]