reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-036-0000  to OAR
				409-036-0150:
(1) "Authority" means
			 the Oregon Health Authority.
(2)
			 "Board" means the Oregon Health Policy Board.
(3) "Carrier" means a medical professional
			 liability insurer holding a valid certificate of authority from the Director of
			 the Department of Consumer and Business Services (DCBS) that authorizes the
			 transaction of insurance as defined in ORS 731.066 and 731.072, and does not
			 include DCBS-listed insurers pursuant to ORS 735.300 to 735.365 and 735.400 to
			 735.495.
(4) "Clinical
			 Psychologist" means an individual licensed to practice psychology pursuant to
			 ORS 675.010 to 675.090.
(5)
			 "Clinical Social Worker" means an individual licensed to practice clinical
			 social work pursuant to ORS 675.510 to 675.600.
(6) "Communities of color" means members of
			 the following racial or ethnic communities:
(a) American Indian;
(b) Alaska Native;
(c) Hispanic or Latino;
(d) Asian;
(e) Native Hawaiian;
(f) Pacific Islander;
(g) Black or African American;
(h) Middle Eastern;
(i) North African;
(j) Mixed race; or
(k) Other racial or ethnic
			 minorities.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0020 - Types of Incentives Offered Under the Program

Current through Register Vol. 63, No. 7, July 1, 2024
The types of incentives provided under this program
				include:
(1)
Loan Repayment
			 subsidies
that meet the requirements of OAR 409-036-0030; to support the
			 retention of health care providers in the area;
(2)
Loan Forgiveness payments
to
			 support the expansion of health care workforce capacity in rural areas of the
			 state;
(3)
Scholarships for
			 students in health professional training programs at the Oregon Health and
			 Science University
in a manner consistent with ORS
			 348.303 and meet the requirements in OAR 409-036-0040  to help students locate in rural
			 and non-rural underserved areas;
(4)
Scholarships for students in health
			 professional training programs at other institutions of higher learning
to help students locate in rural and non-rural underserved areas;
(5)
Community Workforce Assistance
			 Grants
to support recruitment and retention of providers who will
			 deliver care that supports the opportunity for people to be healthy;
(6)
Medical malpractice insurance
			 premium subsidies
that meet the requirements in OAR 409-036-0050  and
			 enable providers to remain practicing in rural areas of the state;
			 and
(7)
Other
			 incentives
as identified and directed by the Board.
Statutory/Other Authority: ORS
				  676.454
Statutes/Other Implemented: ORS
				  676.454
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0030 - Eligibility Criteria specific to Loan Repayment Subsidies

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An eligible provider may receive a loan
			 repayment subsidy if they are not at the same time receiving loan repayment or
			 forgiveness under a separate, competing service obligation pursuant to ORS
			 676.460.
(2) The Authority may offer loan repayment
			 subsidies based on the most recent Health Care Workforce needs assessment
			 conducted by the Board, as identified in Oregon Laws 2017, Chapter
			 718.
Statutory/Other Authority: ORS
				  676.454
Statutes/Other Implemented: ORS
				  676.454
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0040 - Eligibility Criteria specific to Scholarships for Students in Health Professional Training Programs at Other Institutions of Higher Learning

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Public and
			 private institutions of higher learning in Oregon not governed by ORS
			 348.303 may make available scholarships using rules developed by the institution
			 subject to the approval of the Authority that specify:
(a) The maximum amount of the
			 scholarship;
(b) The duration of
			 the scholarship;
(c) That
			 scholarships shall only be available to students who commit to practicing in
			 Oregon in areas identified by the Authority as needing providers;
(d) That successful awardees agree to serve
			 as ambassadors for the program during participation; and
(e) That successful awardees may be asked to
			 develop a project during their training that relate to delivery and promising
			 practices that lead to improved health.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0050 - Eligibility Criteria and Program Requirements specific to Medical Malpractice Insurance Premium Subsidies

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Health Care Provider Incentive Fund
			 may subsidize health care practitioners for the cost of liability insurance
			 premiums in force, or renewed on or after the effective date of this
			 rule.
(2) A practitioner who
			 provides health services in rural Oregon as determined by the Authority is
			 eligible for a subsidy under the program, if the practitioner:
(a) Holds an active, unrestricted license or
			 certification; and is
(b) Covered
			 by a medical professional liability insurance policy issued by an authorized
			 carrier with minimum coverage limits coverage of $1 million per occurrence and
			 $1 million annual aggregate.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0060 - Participation and Application Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Loan repayment, loan forgiveness and
			 scholarship recipients must agree to serve at a qualifying practice
			 site.
(2) Loan Repayment recipients
			 may commit to practice full-time or part-time in a qualifying practice site for
			 the duration of the contract. Subject to approval by the Authority, the initial
			 agreement may be renewed for additional years of service.
(3) To qualify for consideration for loan
			 repayment an eligible provider must submit an application that:
(a) Documents the individual having, or
			 having applied for, an unrestricted license or certification (if required) to
			 practice in Oregon within their discipline;
(b) Includes a signed and dated statement
			 certifying that the individual is not currently participating in the National
			 Health Services Corps (NHSC), NurseCorps, State Loan Repayment Program or the
			 NHSC Scholarship Program, or is working under another current service
			 obligation; and
(c) Provides all
			 other information required by the program to determine the suitability of
			 making an award from program funds.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0070 - Application and Review Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority and its contracted designee
			 have published application processes online.
(2) The Authority or its contracted designee
			 shall review those applications that meet all requirements of OAR 409-036-0020.
(a) The Authority shall return incomplete
			 applications, and upon resubmittal, they shall be processed as of the new date
			 of receipt when they are determined complete.
(b) The Authority shall notify applicants of
			 the status of their completed applications within 90 days of application
			 submission.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0080 - Maximum Award Amounts

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
Health Care Provider Incentive Program Loan Repayment subsidy
			 recipients
are eligible for a maximum loan repayment award in the
			 following manner:
(a) Full-Time Service:
(A) Those with less than $29,000 in
			 qualifying loan debt are eligible to receive up to 100% of qualifying loan debt
			 for initial 3-year service obligation, not to exceed the lesser of their total
			 qualifying loan amount or $20,000.
(B) Those with $29,000 or more in qualifying
			 loan debt are eligible to receive:
(i) Seventy
			 percent of the balance owed on qualifying loans upon program entry for an
			 initial three years of service;
(ii) Eighty percent of the balance owed on
			 remaining qualifying loans for an additional three years of service;
			 or
(iii) One hundred percent of the
			 balance owed on remaining qualifying loans for a final three years of
			 service.
(iv) A participant may
			 receive no more than $50,000 in a single year for full-time service.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0090 - Transfer of Provider Service Obligation to Another Site

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In the event of a practice failure or
			 other extenuating circumstance, a participating provider with Authority
			 approval may transfer the service obligation to another qualifying practice
			 site. This is intended to be a rare instance and may not be granted without
			 prior approval. A transfer without prior approval is considered a violation of
			 the service agreement. A participating provider must submit a written transfer
			 request to the Authority documenting the:
(a)
			 Circumstances surrounding the need to transfer;
(b) Proposed new qualifying practice site;
			 and
(c) Name of the director or
			 administrator at the proposed new practice site.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0100 - Suspension or Waiver of Minimum Service Obligation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may agree to suspend a
			 participating provider's service obligation for a specified time under
			 circumstances it deems appropriate, including, but not limited to parental
			 leave, medical leave, military service leave, or other factors beyond a
			 provider's control. During the time of suspension, awards shall be
			 suspended.
(2) A participant
			 requesting a suspension of minimum service obligation shall make a written
			 request to the Authority, citing the reasons and providing documentation of the
			 circumstances.
(3) The Authority
			 may waive all or part of the minimum service obligation under the following
			 circumstances:
(a) Upon receipt of written
			 documentation acceptable to the Authority of the death of the
			 participant;
(b) Upon receipt of
			 written documentation acceptable to the Authority of the total and permanent
			 disability of the participant; or
(c) Upon receipt of written documentation of
			 other significant changes in life circumstances that are out of the control of
			 the participant and that the Authority determines warrant a waiver of service
			 commitment.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0110 - Monitoring and Follow-up Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To maintain participation in the program,
			 a provider must:
(a) Notify the Authority
			 immediately upon beginning work at a qualifying practice site.
(b) Promptly submit semi-annual reports
			 signed by the provider and the administrator of the qualifying practice site
			 verifying the provider's employment, or licensed business (in the case of a
			 sole provider), and providing any additional information as requested by the
			 Authority, including but not limited to:
(A)
			 Site's and Provider's caseload (panel size or equivalent);
(B) Site's and Provider's Medicaid caseload
			 and Medicare caseload;
(C) Provider
			 full-time equivalent (FTE) status; and
(D) Number and percentages of practice site's
			 patients whose health care is covered by Medicaid and by Medicare, and the
			 number of patients at the practice site who are uninsured.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0120 - Failure to Comply; Penalties & Appeals

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
A loan
			 repayment recipient
who fails to complete the minimum service obligation
			 in a qualifying practice site and does not receive a waiver shall be considered
			 to have breached the terms of the program. The Authority shall impose a penalty
			 on any such provider in an amount up to the sum of:
(a) The total paid from the Health Care
			 Provider Incentive Fund to the participant or on behalf of the participant for
			 any periods of obligated service not served;
(b) $7,500 for each month of the minimum
			 service period not completed according to the terms of the obligation;
			 and
(c) Interest on the above
			 amounts at the maximum prevailing rate, as determined by the Oregon Department
			 of Revenue, calculated from the date of breach until full repayment has been
			 made.
(d) The participant may
			 appeal decisions made by the Authority under the provisions of ORS Chapter
			 183.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0130 - Contributions to the Health Care Provider Incentive Fund

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority shall publish on its
			 website terms and conditions for receipt of funds from qualifying practice
			 sites or other sources to contribute toward the cost of the subsidies for
			 participants.
(2) The Authority
			 shall deposit all contributions to the Health Care Provider Incentive Fund
			 established in ORS
			 676.450.
Statutory/Other Authority: ORS
				  676.454
Statutes/Other Implemented: ORS
				  676.454
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0140 - Program Integrity

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Authority shall analyze and monitor the operation of the program and audit and
			 verify the accuracy and appropriateness of all payments made under the terms of
			 this program. To promote the integrity of the program, the Authority may
			 require participants and any other parties to develop and maintain adequate
			 financial and other documentation as determined by the Board to be necessary.
			 The Authority may communicate with and coordinate any program integrity actions
			 with the federal and state oversight authorities.
(2) Any overpayment made to an individual or
			 carrier is subject to recovery. The Authority shall take appropriate action and
			 may redress payment errors or false claims for payment under the
			 program.
Statutory/Other Authority: ORS
				  676.454
Statutes/Other Implemented: ORS
				  676.454
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 36 - HEALTH CARE PROVIDER INCENTIVE PROGRAM › Section 409-036-0150 - Data Sharing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Authority may not share data about program participants, other than for
			 purposes of planning, program evaluation or analysis.
(2) Data may only be shared with:
(a) Agencies, offices, or contractors of the
			 Authority;
(b) The Oregon
			 Employment Department; and
(c)
			 Non-governmental not noted above only with written approval from the Director
			 of the Authority.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0000

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0010

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0020

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0030

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0040

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0050

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0060

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0070

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 37 - MEDICAID PRIMARY CARE LOAN REPAYMENT PROGRAM › Section 409-037-0080

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: 2013 OL Ch. 177
Stats. Implemented: 2013 OL Ch.
				  177
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 40 - COMMUNITY-BASED HEALTH CARE IMPROVEMENT PROGRAM › Section 409-040-0100 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  735.723
Stats. Implemented: ORS
				  735.721,
				  735.723,
				  735.725 &
				  735.727
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 40 - COMMUNITY-BASED HEALTH CARE IMPROVEMENT PROGRAM › Section 409-040-0105 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  735.723
Stats. Implemented: ORS
				  735.721
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 40 - COMMUNITY-BASED HEALTH CARE IMPROVEMENT PROGRAM › Section 409-040-0110 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  735.723
Stats. Implemented: ORS
				  735.721,
				  735.723 &
				  735.725
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 40 - COMMUNITY-BASED HEALTH CARE IMPROVEMENT PROGRAM › Section 409-040-0115 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  735.723
Stats. Implemented: ORS
				  735.721,
				  735.723,
				  735.725 &
				  735.727
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0025 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-045-0025  to
				409-045-0135:
(1) "Authority" means
			 the Oregon Health Authority.
(2)
			 "Credentialing" means a standardized process of inquiry undertaken by
			 credentialing organizations to validate specific information that confirms a
			 health care practitioner's identity, background, education, competency, and
			 qualifications related to a specific set of established standards or
			 criteria.
(3) "Credentialing
			 information" means information necessary to credential or recredential a health
			 care practitioner.
(4)
			 "Credentialing organization" means a health care organization that credentials
			 health care practitioners. This includes, but is not limited to the following:
(a) Ambulatory surgical centers;
(b) Coordinated care organizations;
(c) Self-insured health plans;
(d) Third-party administrators;
(e) Worker's compensation health
			 plans;
(f) Dental plan
			 issuers;
(g) Health plan
			 issuers;
(h) Hospitals;
(i) Independent practice associations as
			 defined in ORS
			 743B.001;
(j) Health care practitioner organizations;
			 and
(k) Other health care
			 facilities or organizations that are required to credential health care
			 practitioners.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0030

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042 &
				  441.226
Statutes/Other Implemented: ORS
				  441.226
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0035 - Oregon Practitioner Credentialing Application

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Credentialing organizations shall use the
			 latest versions of the Oregon Practitioner Credentialing Application and the
			 Oregon Practitioner Recredentialing Application approved and published by the
			 Authority based on recommendations from the Advisory Committee on Physician
			 Credentialing Information.
(2) The
			 Authority approved applications are available on the Committee's website at
https://www.oregon.gov/oha/HPA/OHIT-ACPCI/Pages/index.aspx
.
(3) Each credentialing organization shall use
			 the application forms listed in section (1) of this rule for the purpose of
			 credentialing and recredentialing health care practitioners.
(4) Credentialing organizations shall have
			 ten months to comply with sections (1) and (3) of this rule after new
			 version(s) of the application forms are approved and published by the
			 Authority.
Statutory/Other Authority: ORS
				  413.042,
				  441.056  & 441.223
Statutes/Other Implemented: ORS
				  441.056  & 441.221
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0040

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 441.056, ORS
				  413.042,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056  & 441.221 - 441.233
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0045

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056  & 441.221 - 441.233
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0050

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056  & 441.221 - 441.233
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0055

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056  & 441.221 - 441.233
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0060

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056  & 441.221 - 441.233
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0065

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223,
				  441.226  & 441.233
Statutes/Other Implemented: ORS
				  441.056,
				  441.221  - 441.223 & 441.232
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0070

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056,
				  441.221  - 441.223 & 441.226
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0075

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056,
				  441.221  - 441.223 & 441.226
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0115 - Telemedicine Providers General Applicability Credentialing Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules
			 apply to all:
(a) Telemedicine health care
			 practitioners who provide telemedicine services from any distant-site hospital
			 or health care facility in Oregon to patients in originating-site hospitals or
			 health care facilities in Oregon.
(b) Originating-site hospitals or health care
			 facilities located in Oregon that credential telemedicine health care
			 practitioners located at distant-site hospitals or health care facilities in
			 Oregon.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0120 - Telemedicine Providers Standard List of Credentialing Documents

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To become
			 credentialed by an originating-site hospital or health care facility a
			 telemedicine health care practitioner or the distant-site hospital or health
			 care facility must provide the following information and documentation to the
			 originating-site hospital or health care facility:
(a) A completed current (within the past 6
			 months) Oregon Practitioner Credentialing Application (OPCA) and the following
			 documents:
(A) A copy of the state license
			 authorizing practice;
(B) Drug
			 Enforcement Agency certificate;
(C)
			 State approved foreign education equivalency certificate or report, if
			 applicable; and
(D) Certification
			 of professional liability insurance.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0125 - Telemedicine Providers Distant-Site Hospital Agreements

Current through Register Vol. 63, No. 7, July 1, 2024
Health care facilities or hospitals may use delegated
				credentialing agreements instead of the requirements in OAR-409-045-0120  to
				stipulate that the medical staff of the originating-site hospital or health
				care facility shall rely upon the credentialing and privileging decisions of
				the distant-site hospital or health care facility in making recommendations to
				the governing body of the originating-site hospital or health care facility as
				to whether to credential a telemedicine provider, practicing at the
				distant-site hospital or health care facility either as an employee or under
				contract, to provide telemedicine services to patients in the originating-site
				hospital or health care facility. If a delegated credentialing agreement is in
				place, the originating-site hospital or health care facility is not limited to
				the information and documents set forth in OAR 409-045-0120.
Statutory/Other Authority: ORS
				  413.042,
				  441.056  & 441.223
Statutes/Other Implemented: ORS
				  441.056,
				  441.223  & 442.015
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0130

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223,
				  441.226  & 441.228
Statutes/Other Implemented: ORS
				  441.056,
				  441.223,
				  441.226,
				  441.228  & 442.015
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 45 - HEALTH CARE PRACTITIONER CREDENTIALING › Section 409-045-0135 - Telemedicine Providers Information Sharing or Use of Data

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Telemedicine health care practitioners
			 must provide written, signed permission that explicitly allows the sharing of
			 required documents and necessary evidence by a distant-site hospital with
			 originating-site hospitals, including but not limited to any release required
			 under HIPAA or other applicable laws.
(2) Dissemination of information received
			 under these rules shall only be made to individuals with a demonstrated and
			 legitimate need to know the information.
Statutory/Other Authority: ORS
				  413.042,
				  441.056,
				  441.223  & 441.226
Statutes/Other Implemented: ORS
				  441.056,
				  441.223  & 442.015
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 50 - PAIN MANAGEMENT › Section 409-050-0100 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The Pain Management Commission is established within the Oregon
				Health Authority for the purpose of developing pain management educational
				programs, recommendations and curriculum; representing patient concerns to the
				Governor and Legislative Assembly; and creating ways to improve pain management
				in Oregon through research, policy analysis, and model projects. In addition,
				the Pain Management Commission is charged with developing a specific pain
				management educational program for required completion by health care
				professionals under specified Licensing Boards.
Stat. Authority: ORS
				  409.570
Stats. Implemented: ORS
				  409.500 -
				  409.570
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 50 - PAIN MANAGEMENT › Section 409-050-0110 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purposes of this Division 409-050, the following
				definitions apply:
(1) "Commission"
			 means the Oregon Pain Management Commission.
(2) "Licensed health care professionals"
			 means those specifically identified licensees that report to the following
			 Licensing Boards:
(a) Oregon Board of Medical
			 Examiners, which includes: physicians, physician assistants and acupuncturists
			 (with the exception of those listed under OAR 847-008-0075, identified as
			 waived);
(b) Oregon State Board of
			 Nursing, which includes: all registered nurses, licensed practical nurses and
			 nurse practitioners;
(c) Oregon
			 Board of Psychologist Examiners, which includes: all licensed
			 psychologists;
(d) Oregon Board of
			 Chiropractic Examiners, which includes: all licensed chiropractors;
(e) Oregon Board of Naturopathic Examiners,
			 which includes: all licensed naturopathic physicians; and
(f) Oregon Board of Pharmacy, which includes:
			 all licensed pharmacists.
(g)
			 Oregon Board of Dentistry, which includes all licensed dentists.
(h) Oregon Board of Occupational Therapy,
			 which includes all licensed occupational therapists.
(i) Oregon Board of Physical Therapy, which
			 includes all licensed physical therapists.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 50 - PAIN MANAGEMENT › Section 409-050-0120 - Commission Positions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Commission consists of:
(a) Nineteen members -
			 seventeen voting members and two non-voting ex-officio members from the Oregon
			 legislature; and
(b) Members that
			 have experience or a demonstrated interest in pain management issues.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 50 - PAIN MANAGEMENT › Section 409-050-0130 - Pain Management Education Program Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Licensed health care professionals must
			 complete a pain management education program in order to improve the care and
			 treatment of individuals with painful conditions. The program includes:
(a) Six accredited hours of continuing
			 education in pain management, end of life care or a combination of both;
			 and
(b) The web-based training
			 offered by the Commission.
(c)
			 Dentists licensed under Oregon Board of Dentistry are only required to complete
			 the web-based training offered by the Commission.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0000 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
These rules (OAR 409-055-0000  to 409-055-0090) establish the
				Patient-Centered Primary Care Home (PCPCH) Program and define criteria and
				process that the Authority shall use to recognize and verify status as PCPCHs.
				The PCPCH is a model of primary care that has received attention in Oregon and
				across the country for its potential to advance the "triple aim" goals of
				health reform: a healthy population, extraordinary patient care for everyone,
				and reasonable costs, shared by all. PCPCHs achieve these goals through a focus
				on wellness and prevention, coordination of care, active management and support
				of individuals with special health care needs, and a patient and
				family-centered approach to all aspects of care. PCPCHs emphasize whole-person
				care to address a patient and family's physical and behavioral health care
				needs.
Statutory/Other Authority: ORS
				  413.042,
				  413.259  & 414.655
Statutes/Other Implemented: ORS
				  413.259,
				  413.260  & 414.655
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-055-0000  to
				409-055-0090:
(1) "Authority" means
			 the Oregon Health Authority.
(2)
			 "NCQA" means National Committee for Quality Assurance.
(3) "Patient Centered Medical Home (PCMH)"
			 means a practice or provider who has been recognized as such by the National
			 Committee for Quality Assurance.
(4) "Patient-Centered Primary Care Home
			 (PCPCH)" means a health care team or clinic as defined in ORS
			 414.655, meets the standards
			 pursuant to OAR 409-055-0040, and has been recognized through the process
			 pursuant to OAR 409-055-0040.
(5)
			 "Personal Health Information" means demographic information, medical history,
			 test and laboratory results, insurance information and other data that is
			 collected by a health care professional to identify an individual and determine
			 appropriate care.
(6) "Practice"
			 means an individual, facility, institution, corporate entity, or other
			 organization which provides direct health care services or items, also termed a
			 performing provider, or bills, obligates and receives reimbursement on behalf
			 of a performing provider of services, also termed a billing provider (BP). The
			 term provider refers to both performing providers and BP(s) unless otherwise
			 specified.
(7) "Program" means
			 Patient-Centered Primary Care Home Program.
(8) "Program website" means
www.primarycarehome.oregon.gov
.
(9) "Provider" means an individual, facility,
			 institution, corporate entity, or other organization which provides direct
			 health care services or items, also termed a performing provider, or bills,
			 obligates and receives reimbursement on behalf of a performing provider of
			 services, also termed a billing provider (BP). The term provider refers to both
			 performing providers and BP(s) unless otherwise specified.
(10) "Recognition" means the process through
			 which the Authority determines if a practice has met the Oregon
			 Patient-Centered Primary Care Home Standards.
(11) "Recognized" means that the Authority
			 has affirmed that a practice meets the Oregon Patient-Centered Primary Care
			 Home Standards.
(12) "Tier" means
			 the level of Patient-Centered Primary Care Home at which the Authority has
			 scored a practice.
(13)
			 "Verification" means the process that the Authority shall conduct to ensure
			 that a practice has submitted accurate information to the Authority for
			 purposes of Patient-Centered Primary Care Home recognition.
(14) "Health Equity Designation" means a
			 designation assigned to Patient-Centered Primary Care Homes meeting specific
			 PCPCH measures.
Statutory/Other Authority: ORS
				  413.042,
				  413.259,
				  414.655
Statutes/Other Implemented: ORS
				  413.259,
				  413.260,
				  414.655
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0020 - Program Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The Program is intended to ensure that there is a uniform process for
			 recognizing PCPCHs throughout the State of Oregon in order to support primary
			 care transformation.
(2) The
			 Authority shall recognize practices as PCPCHs upon meeting defined criteria
			 through the Program.
(3) The
			 Authority shall administer the Program, including data collection and analysis,
			 recognition, and verification that a practice meets the defined PCPCH criteria.
			 The Authority may also provide technical assistance as is feasible.
(4) The Authority may contract for any of the
			 work it deems necessary for efficient and effective administration of the
			 Program.
Stat. Auth: ORS
				  413.042, 413.259 &
				  414.655
Stats. Implemented: ORS 413.259,
				  413.260 &
				  414.655
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0030 - Practice Application and Recognition Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Practices, or other entities on behalf of
			 the practice, that wish to be recognized as a PCPCH shall submit a PCPCH
			 Recognition Application electronically to the Authority via the Program's
			 online application system found on the Program website or by mail to the
			 address posted on the Program website. The application shall include the
			 quantitative data described in OAR 409-055-0040.
(2) The Authority shall review the
			 application within 60 days of its submission to determine whether it is
			 accurate, complete, and meets the recognition requirements. If the application
			 is incomplete the Authority shall notify the applicant in writing of the
			 information that is missing and when it must be submitted.
(3) The Authority shall review a complete
			 application within 60 days of submission. If the Authority determines that the
			 applicant has met the requirements of these rules the Authority shall:
(a) Inform the applicant in writing that the
			 application has been approved as a recognized PCPCH;
(b) Assign a Tier level; and
(c) Include the effective recognition
			 date.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0040 - Recognition Criteria

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 PCPCH recognition criteria are divided into "Must-Pass" measures and other
			 measures that place the practice on a scale of maturity or 'tier' that reflect
			 basic to more advanced PCPCH functions.
(2) Must-Pass and 5-point measures focus on
			 foundational PCPCH elements.
(3)
			 10- and 15-point measures reflect intermediate and advanced
			 functions.
(4) Except for the 13
			 Must-Pass measures, each measure is assigned a point value. A practice must
			 meet the following point allocation criteria to be recognized as a PCPCH:
(a) Tier 3: 100-245 points and all 13
			 Must-Pass Measures;
(b) Tier 4:
			 250-390 points and all 13 Must-Pass Measures;
(c) Tier 5: 395-530 points and all 13
			 Must-Pass Measures.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0045 - Health Equity Designation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority shall award Health Equity
			 designations to practices implementing multiple PCPCH Health Equity
			 measures.
(2) A practice seeking
			 the Health Equity Designation, must meet the following criteria:
(a) Be recognized as a PCPCH under the
			 Measures in 409-055-0040  Table 1, adopted and incorporated by
			 reference;
(b) Attest to 15 or more
			 of the 20 PCPCH Health Equity Measures in Table 2 adopted and incorporated by
			 reference;
(c) Submit all required
			 documentation for the Health Equity Measures in Table 2 attested to at the time
			 of application.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0050 - Data Reporting Requirements for Recognized PCPCHs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be recognized as a PCPCH, a practice
			 must attest to meeting the criteria and submit quantitative data elements to
			 support its attestation in accordance with 409-055-0040  Table 1 incorporated by
			 reference.
(2) Quantitative data
			 shall be aggregated at the practice level, not the individual patient level,
			 and a practice may not transfer any personal health information to the
			 Authority during the PCPCH application process.
(3) PCPCHs must submit new quantitative and
			 attestation data as a part of the recognition renewal process and must use the
			 specifications found on the Program website for calculating application
			 data.
(4) If approved by the
			 practice, other entities may submit information on behalf of a practice, as
			 long as appropriate practice staff has reviewed all application information and
			 data prior to submission.
(5)
			 Practices are required to submit 12 months of quantitative data to meet PCPCH
			 standards. A practice may request an exception to the 12-month data reporting
			 period by submitting a form prescribed by the program. The Authority may grant
			 exceptions for good cause shown.
(6) The Authority shall notify the practice
			 within 60 days of complete application and exception submission whether the
			 requested exception has been granted.
Tables referenced are not included in rule text.
Click here for PDF copy
				  of table(s)
.
Statutory/Other Authority: ORS
				  413.042,
				  413.259 & 414.655
Statutes/Other Implemented: ORS
				  413.259,
				  413.260 &
				  414.655
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM › Section 409-055-0060 - Verification

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority
			 shall conduct at least one on-site verification review of each recognized PCPCH
			 to determine compliance with PCPCH criteria every five years and at such other
			 times as the Authority deems necessary or at the request of the Health Systems
			 Division (Division), or any other applicable program within the Authority. The
			 purpose of the review is to verify reported attestation and quantitative data
			 elements for the purposes of confirming recognition and Tier level.
(2) PCPCHs selected for a verification review
			 shall be notified no less than 30 days prior to the scheduled review.
(3) PCPCHs shall permit Authority staff
			 access to the practice's place of business during the review.
(4) A verification review may include but is
			 not limited to:
(a) Review of documents and
			 records.
(b) Review of patient
			 medical records.
(c) Review of
			 electronic medical record systems, electronic health record systems, and
			 practice management systems.
(d)
			 Review of data reports from electronic systems or other patient registry and
			 tracking systems.
(e) Interviews
			 with practice management, clinical and administrative staff.
(f) On-site observation of practice
			 staff.
(g) On-site observation of
			 patient environment and physical environment.