Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 120 - MEDICAL ASSISTANCE PROGRAMS › Section 410-120-0000 - Acronyms and Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Identification of acronyms and definitions within this rule
				specifically pertain to their use within the Oregon Health Authority
				(Authority), Health Systems Division (Division) administrative rules,
				applicable to the medical assistance program. This rule does not include an
				exhaustive list of Division acronyms and definitions. For more information, see
				Oregon Health Plan (OHP) program, (i) OAR 410-141-3500  Acronyms and
				Definitions, (ii) OAR 410-200-0015  General Definitions, and (iii) any
				appropriate governing acronyms and definitions in the Oregon Department of
				Human Services (Department) administrative rules set found in chapters 411,
				413, or 461 or contact the Division.
(1) "Abuse" means provider practices that are
			 inconsistent with sound fiscal, business, or medical practices and result in an
			 unnecessary cost to the Authority or in reimbursement for services that are not
			 medically necessary or medically appropriate. It also includes recipient
			 practices that result in unnecessary cost to the Authority.
(2) "Action" means a termination, suspension
			 of, or reduction in covered benefits, services, eligibility or an increase in
			 beneficiary liability. This includes a determination by a skilled nursing
			 facility or nursing facility to transfer or discharge a resident, or an adverse
			 determination with regard to the preadmission screening and resident review
			 requirements. For the definition as it is related to a Coordinated Care
			 Organization (CCO) member, refer to OAR 410-141-3500.
(3) "Acupuncturist" means an individual
			 licensed to practice acupuncture by the relevant state licensing
			 board.
(4) "Acupuncture Services"
			 means services provided by a licensed acupuncturist within the scope of
			 practice as defined under state law.
(5) "Acute" means a condition, diagnosis, or
			 illness with a sudden onset and that is of short duration.
(6) "Acquisition Cost" means, unless
			 specified otherwise in individual program administrative rules, the net invoice
			 price of the item, supply, or equipment plus any shipping or postage for the
			 item.
(7) "Addictions and Mental
			 Health Division" means the Division within the Authority's Health Systems
			 Division that administers mental health and addiction programs and
			 services.
(8) "Adequate Record
			 Keeping" means documentation that supports the level of service billed. See OAR
			 410-120-1360, Requirements for Financial, Clinical, and Other Records, and the
			 individual provider rules.
(9)
			 "Administrative Medical Examinations and Reports" means examinations,
			 evaluations, and reports, including copies of medical records requested on the
			 Oregon Health Plan (OHP) 729 form through the local Department branch office or
			 requested or approved by the Authority to establish client eligibility for a
			 medical assistance program or for casework planning.
(10) "Adults and Youths Discharged from an
			 Institution for Mental Disease (IMD)" means Members who have been discharged
			 from an IMD (as such term is defined in
			 42 CFR
			 435.1010) within the last 365 calendar days.
			 Eligibility for HRSN Services shall expire on the 366th calendar day after
			 discharge from an IMD.
(11) "Adults
			 and Youths Released from Incarceration" means Members released from
			 incarceration within the past 365 calendar days, including those released from
			 state and federal prisons, local correctional facilities, juvenile detention
			 facilities, Oregon Youth Authority closed custody corrections, or tribal
			 correctional facilities. Eligibility for HRSN Services shall expire on the
			 366th calendar day after release from a carceral facility.
(12) "Advance Directive" means an
			 individual's instructions to an appointed person specifying actions to take in
			 the event that the individual is no longer able to make decisions due to
			 illness or incapacity.
(13)
			 "Adverse determination" means a determination made that the individual does not
			 require the level of services provided by a nursing facility or that the
			 individual does or does not require specialized services.
(14) "Adverse Event" means an undesirable and
			 unintentional, though not necessarily unexpected, result of medical
			 treatment.
(15) "Affiliation" means
			 for provider requesting enrollment or revalidation as an Oregon Medicaid
			 provider any of the following:
(a) Five (5)
			 percent or greater direct or indirect ownership interest that an individual or
			 entity has in another organization;
(b) A general or limited partnership interest
			 (regardless of the percentage) that an individual or entity has in another
			 organization;
(c) An interest in
			 which an individual or entity exercises operational or managerial control over,
			 or directly or indirectly conducts, the day-to-day operations of another
			 organization, either under contract or through some other arrangement,
			 regardless of whether or not the managing individual or entity is a W-2
			 employee of the organization; includes sole proprietorships;
(d) An interest in which an individual is
			 acting as an officer or director of a corporation; or
(e) Any payment assignment relationship under
			 42 CFR
			 447.10(g).