Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 120 - MEDICAL ASSISTANCE PROGRAMS › Section 410-120-0025 - Administration of Division of Medical Assistance Programs, Regulation and Rule Precedence

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Oregon Health Authority (Authority) and its Division of Medical Assistance
			 Programs (Division) may adopt reasonable and lawful policies, procedures,
			 rules, and interpretations to promote the orderly and efficient administration
			 of medical assistance programs including the Oregon Health Plan pursuant to ORS
			 414.065 (generally,
			 fee-for-service), 414.591 (Coordinated Care Organizations), and 414.115 to
			 414.145 (services contracts), subject to the rulemaking requirements of the
			 Oregon Revised Statutes and Oregon Administrative Rule (OAR)
			 procedures.
(2) In applying its
			 policies, procedures, rules, and interpretations, the Division shall construe
			 them as much as possible to be complementary. In the event that Division
			 policies, procedures, rules and interpretations may not be complementary, the
			 Division shall apply the following order of precedence to guide its
			 interpretation:
(a) For purposes of the
			 provision of covered medical assistance to Division clients, including but not
			 limited to authorization and delivery of service or denials of authorization or
			 services, the Division, clients, enrolled providers, Coordinated Care
			 Organizations, and the Prepaid Health Plans shall apply the following order of
			 precedence:
(A) Oregon Revised Statutes
			 governing medical assistance programs;
(B) Consistent with ORS
			 413.071, those federal laws and
			 regulations governing the operation of the medical assistance program and any
			 waivers granted the Authority by the Centers for Medicare and Medicaid Services
			 to operate medical assistance programs including the Oregon Health
			 Plan;
(C) Generally for Coordinated
			 Care Organizations, the requirements applicable to the providing covered
			 medical assistance to Division clients are found in OAR 410-141-3500  through
			 410-141-5380; and where applicable, 410-120-0000  through 410-120-1990; and the
			 provider rules applicable to the category of medical service;
(D) Generally for Prepaid Health Plans, the
			 requirements applicable to providing covered medical assistance to Division
			 clients are found in OAR 410-141-3500  through 410-141-5380; and where
			 applicable, 410-120-0000  through 410-120-1990; and the provider rules
			 applicable to the category of medical service;
(E) Generally for enrolled fee-for-service
			 providers or other contractors, the requirements applicable to providing
			 covered medical assistance to Division clients are found in OAR 410-120-0000  through 410-120-1990, the Prioritized List and program coverage set forth in
			 410-141-3820  to 410-141-3830, and the provider rules applicable to the category
			 of medical service;
(F) Any other
			 applicable duly promulgated rules issued by the Division and other offices or
			 units within the Authority or Department of Human Services necessary to
			 administer the State of Oregon's medical assistance programs, such as
			 electronic data transaction rules in OAR 943-120-0100  to 943-120-0200;
			 and
(G) The basic framework for
			 provider enrollment in OAR 943-120-0300  through 943-120-0380 that generally
			 apply to providers enrolled with the Authority or Department, subject to more
			 specific requirements applicable to the administration of the Oregon Health
			 Plan and medical assistance programs administered by the Authority. For
			 purposes of this rule, "more specific" means the requirements, laws and rules
			 applicable to the provider type and covered services described in paragraphs
			 (A)-(F) of this section of this rule.