reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0020 - Procurement Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may enter into
			 contracts for the planning, erection, completion, and furnishing of
			 new buildings and additions to its institutions, and may establish
			 contracts for goods and services of all kinds necessary for the
			 successful management and maintenance of the institutions within the
			 Authority's jurisdiction. The Authority may procure goods, services,
			 personal services, construction materials, equipment, and supplies
			 for the Authority's institutions. The Authority may also make
			 procurements in connection with the construction, demolition,
			 exchange, maintenance, operation, and equipping of housing for
			 persons with chronic mental illness.
(2) The Director of the Authority
			 may exercise all powers necessary to effectively and expeditiously
			 carry out procurement functions.
Stat. Auth.: ORS
				  179.040,
				  279A.065,
				  279A.070,
				  413.033 &
				  413.042
Stats. Implemented: ORS
				  413.033
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0030 - Contractor Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No contract or other agreement
			 for more than $1,000 may be entered into, renewed, or extended with
			 any individual unless the individual certifies in writing, under
			 penalty of perjury, that the individual is not in violation of any
			 tax laws described in ORS
			 305.385.
(2) A contractor who is a
			 corporation, partnership, or who has an assumed business name shall
			 be registered with the Oregon Secretary of State in accordance with
			 ORS chapters 58, 60, 62, 63, 65, 67, 70, and 648. This registration
			 is the obligation of the contractor, not the Authority.
(a) Architects, engineers, and land
			 surveyors shall be registered with the appropriate licensing boards
			 under the provisions of ORS
			 671.020,
			 672.020, and
			 672.025.
(b) The statutory requirements for
			 contractors to register with the Oregon Secretary of State may be
			 subject to a limited number of exceptions under federal law. For
			 example, sole proprietors or national banks, when they contract with
			 the Authority, are not subject to the registration
			 requirement.
(c) The
			 contractor shall be registered at the time of the execution of the
			 contract and thereafter.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0040 - Independent Contractors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may, within the
			 limits of its delegation and its legislatively approved budget,
			 contract for personal services with providers who are independent
			 contractors.
(2)
			 "Independent contractor" means an individual who provides services to
			 the Authority in which the Authority neither controls nor has the
			 right to control the means or manner by which work is performed. The
			 Authority may control the results of the services, but not control
			 the means or manner of how a contractor performs the work.
(3) Within the parameters of
			 employment, workers' compensation, and other relevant state and
			 federal laws, and after determining that the contract will not
			 violate any collective bargaining agreements, the Authority may
			 contract for personal services when:
(a) The work cannot be done in a
			 reasonable time with Authority's own workforce;
(b) An independent and impartial
			 evaluation is required; or
(c) It will be less expensive to
			 contract for the work.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0050 - ORS 190 Agreements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority, when it enters
			 into an agreement under ORS
			 190.110,
			 190.420, or
			 190.485, or an
			 agreement under ORS
			 190.112 or
			 660.342, shall post a
			 summary of the agreement on an applicable electronic procurement
			 system within the 30-day period immediately following the effective
			 date of the agreement.
(2) The summary shall include:
(a) Names of the parties to the
			 agreement;
(b) Date of
			 the agreement;
(c)
			 Subject matter of the agreement; and
(d) The agency through which a
			 person may obtain a copy of the agreement.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0060 - Contract Amendments

Current through Register Vol. 63, No. 7, July 1, 2024
The Authority may amend a contract without additional
				competition in any of the following circumstances:
(1) The amendment is within the
			 scope of the procurement as described in the solicitation documents,
			 or if no solicitation documents, as described in the sole source
			 notice or the approved special procurement or the contract, if any.
			 The amendment is not within the scope of the procurement if the
			 Authority determines that requested changes were not covered in the
			 solicitation and would have likely increased competition or affected
			 award of the contract.
(2) These rules would otherwise
			 permit the Authority to award a contract without competition for the
			 goods or services to be procured under the amendment.
(3) The amendment is necessary to
			 comply with a change in law that affects performance of the
			 contract.
(4) The
			 amendment results from renegotiation of the terms and conditions,
			 including the contract price, are advantageous to the Authority,
			 subject to all of the following conditions:
(a) The goods or services to be
			 provided under the amended contract are the same as the goods or
			 services to be provided under the current contract;
(b) The Authority determines that,
			 with all things considered, the amended contract is at least as
			 favorable to Authority as the unamended contract; and
(c) The amended contract does not
			 have a total term greater than allowed in the solicitation documents,
			 if any, or if no solicitation documents, as described in the sole
			 source notice or the approved special procurement, if any, after
			 combining the initial and extended terms.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0070 - Payment Authorization for Cost Overruns for Services Contracts

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Payments on contracts for trade
			 or personal services that exceed the maximum contract consideration
			 (cost overruns) require approval of the DPO in accordance with
			 section (2) of this rule. If the aggregated value of the contract,
			 including cost overruns, exceeds $150,000, the cost overrun may also
			 require approval from the Department of Justice under OAR
			 137-045-0010  to 137-045-0090.
(2) The Authority may grant
			 approval of the payment of a cost overrun if:
(a) The original contract was duly
			 executed and, if required, approved by the Attorney
			 General;
(b) Payments
			 relate to services that were provided during the term of the
			 contract;
(c) The cost
			 overrun is not associated with any change in the statement of work of
			 the original contract;
(d) The cost overrun arose from
			 extraordinary circumstances or conditions encountered in the course
			 of contract performance that were not reasonably anticipated at the
			 time of the original contract or the most recent amendment, if any.
			 Such circumstances include but are not limited to emergencies arising
			 in the course of the contract that require prompt action to protect
			 the work already completed, compliance with official or judicial
			 commands or directives issued during contract performance, or a need
			 to ensure that the purpose of the contract will be
			 realized;
(e) The cost
			 overrun was incurred in good faith, results from the good faith
			 performance by the contractor, and is not greater than the prescribed
			 hourly rate or the reasonable value of the additional work or
			 performance rendered; and
(f) The aggregated value of the
			 contract, including the cost overrun, and the contract's objective
			 are within the Authority's procurement authority and the Authority
			 has funds available for payment under the contract.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0080 - Purchases Through Federal Programs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may purchase
			 goods and services under the federal programs identified in ORS
			 279A.180 without
			 competitive sealed bidding, competitive sealed proposals, or other
			 competition required under ORS
			 279B.050 to
			 279B.085, provided
			 that the Authority has federal authorization to purchase through the
			 program.
(2) To purchase
			 through a federal program, the DPO shall document in the contract
			 file that:
(a) The acquisition
			 meets the Authority's requirements;
(b) The price and other terms of
			 the acquisition are advantageous to Authority; and
(c) Required preference programs,
			 outlined in OAR 943-060-0090(2)(a)-(d), were considered.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0090 - Buy Decision

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Buy decision" means the
			 decision to buy goods and services through socio-economic programs,
			 agreements, or the open market.
(2) The Authority shall make its
			 buy decision in the priority order set forth in sections (a) through
			 (d). If a higher priority source satisfies a procurement, the
			 Authority shall procure through that higher priority source and shall
			 not elect to procure through a lower priority source.
(a) Surplus property. Promotes the
			 efficient use of existing resources (OAR 125-050-0100  to
			 125-050-0400).
(b)
			 Qualified rehabilitation facilities (QRFs). Assists individuals with
			 disabilities through gainful employment (ORS
			 279.835 to
			 279.855 and OAR
			 125-055-0005  to 125-055-0045).
(c) Inmate labor (Oregon
			 Constitution, Article I, section 41).
(d) Statewide price agreements.
			 Promotes economy and efficiency through volume and strategic
			 purchases.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0100 - Special Procurements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may award a
			 contract as a special procurement as authorized by ORS
			 413.033.
(2) The DPO may approve or deny
			 special procurement requests submitted on the designated form. The
			 special procurement request shall identify whether it is for one or
			 more particular contracts or class of contracts. A request for a
			 special procurement concerns the procurement process only.
(3) Special procurement requests
			 shall contain the following:
(a)
			 Reasons why the Authority has elected to use a special procurement
			 and how it will benefit the Authority or the public.
(b) Findings, market research, or
			 other documentation that the special procurement:
(A) Is unlikely to encourage
			 favoritism in the awarding of public contracts or to substantially
			 diminish competition for public contracts, and
(B) Either:
(i) Is reasonably expected to
			 result in substantial cost savings to the Authority or to the public;
			 or
(ii) Otherwise
			 substantially promotes the public interest in a manner that could not
			 practicably be realized by complying with requirements that are
			 applicable under ORS
			 279B.055,
			 279B.060,
			 279B.065, or
			 279B.070 or under any
			 related rules.
(c) The alternative process
			 designed by the Authority shall include a description of the goods
			 and services that are the subject of the special procurement and a
			 procurement process, including provisions for amendment and criteria
			 for selection.
(d) The
			 DPO may require any additional information the DPO determines
			 reasonably necessary to evaluate the Authority's request for approval
			 of a special procurement.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0110 - Special Procurements by Rule

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Client placement and client
			 health care services.
(a) The
			 Authority may use this special procurement to initiate client
			 placement and client health care services as described in this rule
			 prior to execution of a contract, per applicable policy. When the
			 Authority determines a need exists to secure or maintain client
			 placement services or to secure client health care services, the
			 Authority may contract subject to the following definitions and
			 conditions:
(A) "Client placement
			 services" means securing, enhancing, or continuing the placement of a
			 client in a structured family-like setting or residential setting
			 operated by a qualified provider.
(B) "Client health care services"
			 means health care services or provision of incidental or specialized
			 supplies related to the health of a client. Client health care
			 services include but are not limited to preventive, diagnostic,
			 therapeutic, behavioral, rehabilitative, maintenance, palliative
			 care, counseling, assessment, or procedure with respect to the
			 physical or mental condition, or functional status of a client, or
			 that affect a structure or function of the body, and the sale or
			 dispensing of a drug, device, equipment, or other item in accordance
			 with a prescription.
(C)
			 Services that may prevent a placement or placement disruption but
			 that cannot definitively be classified as client placement services
			 by the Authority constitute client placement services and are subject
			 to this special procurement.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 60 - PUBLIC CONTRACTING AND PROCUREMENT › Section 943-060-0120 - Grant Authority

Current through Register Vol. 63, No. 7, July 1, 2024
If the Authority is a grant recipient or grantor in
				an agreement, the definition of grant in ORS
				279A.010 determines if
				the agreement is subject to the public procurement code and these
				rules. If the grantor or the Authority has substantial involvement in
				the program or activity of the Authority, the agreement is not a
				grant.
Stat. Auth.: ORS
				  179.040,
				  279A.065,
				  279A.070,
				  413.033 &
				  413.042
Stats. Implemented: ORS
				  279A.025
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0000 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0010 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0020 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0030 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0040 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 70 - Renumbered › Section 943-070-0050 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS 413.042 & ORS
				  413.161
Statutes/Other Implemented: ORS
				  413.161
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 90 - Renumbered › Section 943-090-0000 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042, 2013 OL Ch. 240
				  & ORS
				  676.850
Statutes/Other Implemented: 2013 OL Ch. 240, ORS
				  676.850,
				  HB 2011 (2019) & ORS
				  413.450
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 90 - Renumbered › Section 943-090-0010 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042 & 2013 OL Ch.
				  240
Statutes/Other Implemented: 2013 OL Ch. 240, HB 2011 (2019),
				  ORS
				  413.450  & 676.850
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 90 - Renumbered › Section 943-090-0020 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042 & 2013 OL Ch.
				  240
Statutes/Other Implemented: 2013 OL Ch. 240 & HB 2011
				  (2019)
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0110 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These
			 rules establish requirements applicable to providers, CCOs, PHPs, and
			 allied agencies that want to conduct electronic data transactions
			 with the Authority. These rules govern the conduct of all web portal
			 or EDI transactions with the Authority. These rules only apply to
			 services or items that are paid for by the Authority. If the service
			 or item is paid for by a plan or an allied agency, these rules do not
			 apply.
(2) These rules
			 establish the Authority's electronic data transaction requirements
			 for purposes of the Health Insurance Portability and Accountability
			 Act of 1996,  42 USC 1320d-1320d-8, Public Law
			 104-191,
			 sec.
			 262and sec. 264, and the
			 implementing standards for electronic transactions rules. Where a
			 federal HIPAA standard has been adopted for an electronic data
			 transaction, this rule implements and does not alter the federal
			 standard.
(3) These rules
			 establish procedures that must be followed by any provider, CCO, PHP,
			 or allied agency in the event of a security or privacy incident,
			 regardless of whether the incident is related to the use of an
			 electronic data transaction.
Stat. Auth.: ORS
				  413.042  &414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0112 - Scope and Sequence of Electronic Data Transmission Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority communicates with
			 and receives communications from its providers, CCOs, PHPs, and
			 allied agencies using a variety of methods appropriate to the
			 services being provided, the nature of the entity providing the
			 services, and constantly changing technology. These rules describe
			 some of the basic ways that the Authority will exchange data
			 electronically. Additional details may be provided in the Authority's
			 access control rules, provider-specific rules, or the applicable
			 contract documents.
(2)
			 Access to eligibility information about covered individuals may occur
			 using one or more of the following methods:
(a) Automated voice response, via a
			 telephone;
(b) Web portal
			 access;
(c) EDI submitter
			 access; or
(d) Point of
			 sale (POS) for pharmacy providers.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0114 - Provider Enrollment Agreement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When a provider applies to
			 enroll, the application form will include information about how to
			 participate in the web portal for use of DDE and automated voice
			 response (AVR) inquiries. The enrollment agreement shall include a
			 section describing the process that will permit the provider, once
			 enrolled, to participate in DDE over the Internet using the secure
			 Authority web portal. This does not include providers enrolled
			 through the use of the DMAP 3108 Managed Care Plan and FFS Non Paid
			 Provider Application. CCOs and PHPs shall receive the information
			 described in this rule, along with PINs and other information
			 required for access.
(2)
			 When the provider number is issued by the Authority, the provider
			 will also receive two PINs: one that may be used to access the web
			 portal and one that may be used for AVR.
(a) If the PINs are not activated
			 within 60 days of issuance, the Authority will initiate a process to
			 inactivate the PIN. If the provider wants to use PIN-based access to
			 the web portal or AVR after deactivation, the provider must submit an
			 update form to obtain another PIN.
(b) Activating the PIN will require
			 Internet access and the provider must supply security data that will
			 be associated with the use of the PIN.
(c) Providers, CCOs, and PHPs using
			 the PIN must protect the confidentiality and security of the PIN
			 pursuant to OAR 943-120-0170.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0116 - Web Portal Submitter

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any provider, CCO, or PHP
			 activating their web portal access for web portal submission may be a
			 web portal submitter. The provider will be referred to as the web
			 portal submitter when functioning in that capacity, and shall be
			 required to comply with these rules governing web portal
			 submitters.
(2) The
			 authorized signer of the provider enrollment agreement shall be the
			 individual who is responsible for the provider's, CCO's, or PHP's DDE
			 claims submission process.
(a) If a
			 provider, CCO, or PHP submits their own claims directly, the
			 provider, CCO, or PHP will be referred to as the web portal submitter
			 when functioning in that capacity and shall be required to comply
			 with these rules.
(b) If
			 a provider, CCO, or PHP uses an agent or clinic to submit DDE claims
			 using the Authority's web portal, the agent or clinic will be
			 referred to as the web portal submitter when functioning in that
			 capacity and shall be required to comply with these rules.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0118 - Conduct of Direct Data Entry Using Web Portal

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The web portal submitter is
			 responsible for the conduct of the DDE transactions submitted on
			 behalf of the provider, CCO, or PHP, as follows:
(a) The web portal submitter must
			 take reasonable care to ensure that data and DDE transmissions are
			 timely, complete, accurate, and secure, and must take reasonable
			 precautions to prevent unauthorized access to the information system
			 or the DDE transmission. The Authority may not correct or modify an
			 incorrect DDE transaction prior to processing. The transactions may
			 be rejected and the web portal submitter shall be notified of the
			 rejection.
(b) The web
			 portal submitter and the Authority must bear their own information
			 system costs. The web portal submitter must, at their own expense,
			 obtain access to Internet service that is compatible with and has the
			 capacity for secure access to the Authority's web portal. Web portal
			 submitters must pay their own costs for all charges, including but
			 not limited to charges for equipment, software and services, Internet
			 connection and use time, terminals, connections, telephones, and
			 modems. The Authority is not responsible for providing technical
			 assistance for access to or use of Internet web portal services or
			 the processing of a DDE transaction.
(c) The web portal submitter must
			 send and receive all data transactions in the Authority's approved
			 format. Any attempt to modify or alter the DDE transaction format may
			 result in denial of web portal access.
(d) Re-submissions. The web portal
			 submitter must maintain source documents and back-up files or other
			 means sufficient to re-create a data transmission in the event that
			 re-creation becomes necessary for any purpose, within timeframes
			 required by federal or state law, or by contractual agreement. Back
			 ups, archives, or related files are subject to the terms of these
			 rules to the same extent as the original data transmission.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0120 - Registration Process - EDI Transactions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The EDI transaction process is
			 preferred by providers, CCOs, PHPs, and allied agencies for
			 conducting batch or real time transactions, rather than the
			 individual data entry process used for DDE. EDI registration is an
			 administrative process governed by these rules. The EDI registration
			 process begins with the submission of a TPA by a provider, CCO, PHP,
			 clinic, or allied agency, including all requirements and
			 documentation required by these rules.
(2) Trading partners must be
			 Authority providers, CCOs, PHPs, clinics, or allied agencies with a
			 current Authority contract. The Authority will not accept a TPA from
			 individuals or entities who do not have a current contract with the
			 Authority; however, the Authority shall accept a TPA from entities
			 that have been provisionally certified to become CCOs in order to
			 facilitate testing, pending contract signing.
(a) The Authority may receive and
			 hold the TPA for individuals or entities that have submitted a
			 provider enrollment agreement or other pending contract, subject to
			 the satisfactory execution of the pending document.
(b) Termination, revocation,
			 suspension, or expiration of the contract will result in the
			 concurrent termination, revocation, suspension, or expiration of the
			 TPA without any additional notice; except that the TPA will remain in
			 effect to the extent necessary for a trading partner or the Authority
			 to complete obligations involving EDI under the contract for dates of
			 service when the contract was in effect. Contracts that are
			 periodically renewed or extended do not require renewal or extension
			 of the TPA unless there is a lapse of time between
			 contracts.
(c) Failure to
			 identify a current Authority contract during the registration process
			 shall result in a rejection of the TPA. The Authority shall verify
			 that the contract numbers identified by a provider, CCO, PHP, clinic,
			 or allied agency are current contracts.
(d) If contract number or contract
			 status changes, the trading partner must provide the Authority with
			 updated information within five business days of the change in
			 contract status. If the Authority determines that a valid contract no
			 longer exists, the Authority shall discontinue EDI transactions
			 applicable for any time period in which the contract no longer
			 exists; except that the TPA will remain in effect to the extent
			 necessary for the trading partner or the Authority to complete
			 obligations involving EDI under the contract for dates of service
			 when the contract was in effect.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0130 - Trading Partner as EDI Submitter - EDI Transactions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 trading partner may be an EDI submitter. Registered trading partners
			 that also qualify as an EDI submitter may submit their own EDI
			 transactions directly to the Authority. A trading partner will be
			 referred to as an EDI submitter when functioning in that capacity and
			 will be required to comply with applicable EDI submitter rules,
			 except as provided in section (3) of this rule.
(2) Authorization and Registration
			 Designating Trading Partner as EDI Submitter. Before acting as an EDI
			 submitter, a trading partner must designate in the application for
			 application that they are an EDI submitter who is authorized to send
			 and receive data transmissions in the performance of EDI
			 transactions. A trading partner must complete the "Trading Partner
			 Application for Authorization to Submit EDI Transactions" and the
			 "EDI Submitter Information" required in the application. A trading
			 partner must also submit the EDI registration form identifying them
			 as an EDI submitter. A trading partner must notify the Authority of
			 any material changes in the information no less than ten days prior
			 to the effective date of the change.
(3) EDI Submitter Certification
			 Conditions. Where a trading partner is acting as its own EDI
			 submitter, the trading partner is not required to submit the EDI
			 submitter certification conditions in the application for
			 authorization applicable to agents.
Stat. Auth.: ORS
				  413.042  &414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0150 - Testing - EDI Transactions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When a trading partner or
			 authorized EDI submitter registers an EDI transaction with the
			 Authority, the Authority may require testing before authorizing the
			 transaction. Testing may include third party and business-to-business
			 testing. An EDI submitter must be able to demonstrate its capacity to
			 send and receive each transaction type for which it has registered.
			 The Authority will reject any EDI transaction if an EDI submitter
			 either refuses or fails to comply with the Authority testing
			 requirements.
(2) The
			 Authority may require EDI submitters to complete compliance testing
			 at an EDI submitter's expense for each transaction type if either the
			 Authority or an EDI submitter has experienced a change to hardware or
			 software applications by entering into business-to-business
			 testing.
(3) When third
			 party and/or business-to-business testing is completed to the
			 Authority's satisfaction, the Authority will notify an EDI submitter
			 that it will register and accept the transactions in the production
			 environment. This notification authorizes an EDI submitter to submit
			 the registered EDI transactions to the Authority for processing and
			 response, as applicable. If there are any changes in the trading
			 partner or EDI submitter authorization, profile data or EDI
			 registration information on file with the Authority, updated
			 information must be submitted to the Authority as required in OAR
			 943-120-0190.
(4) Testing
			 will be conducted using secure electronic media communications
			 methods.
(5) An EDI
			 submitter may be required to re-test with the Authority if the
			 Authority format changes or if the EDI submitter format
			 changes.
Stat. Auth.: ORS
				  413.042  &414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0160 - Conduct of Transactions - EDI Transactions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) EDI
			 Submitter Obligations. An EDI submitter is responsible for the
			 conduct of the EDI transactions registered on behalf of a trading
			 partner, including the following:
(a) EDI Transmission Accuracy. An
			 EDI submitter shall take reasonable care to ensure that data and data
			 transmissions are timely, complete, accurate, and secure; and shall
			 take reasonable precautions to prevent unauthorized access to the
			 information system, the data transmission, or the contents of an
			 envelope which is transmitted either to or from the Authority. The
			 Authority will not correct or modify an incorrect transaction prior
			 to processing. The transaction may be rejected and an EDI submitter
			 notified of the rejection.
(b) Re-transmission of
			 Indecipherable Transmissions. Where there is evidence that a data
			 transmission is lost or indecipherable, the sending party must make
			 best efforts to trace and re-transmit the original data transmission
			 in a manner which allows it to be processed by the receiving party as
			 soon as practicable.
(c)
			 Cost of Equipment. An EDI submitter and the Authority will pay for
			 their own information system costs. An EDI submitter shall, at its
			 own expense, obtain and maintain its own information system. An EDI
			 submitter shall pay its own costs for all charges related to data
			 transmission including, without limitation, charges for information
			 system equipment, software and services, electronic mailbox
			 maintenance, connect time, terminals, connections, telephones,
			 modems, any applicable minimum use charges, and for translating,
			 formatting, sending, and receiving communications over the electronic
			 network to the electronic mailbox, if any, of the Authority. The
			 Authority is not responsible for providing technical assistance in
			 the processing of an EDI transaction.
(d) Back-up Files. EDI submitters
			 must maintain adequate data archives and back-up files or other means
			 sufficient to re-create a data transmission in the event that
			 re-creation becomes necessary for any purpose, within timeframes
			 required by state and federal law, or by contractual agreement. Data
			 archives or back-up files shall be subject to these rules to the same
			 extent as the original data transmission.
(e) Transmissions Format. Except as
			 otherwise provided herein, EDI submitters must send and receive all
			 data transmissions in the federally mandated format, or (if no
			 federal standard has been promulgated) other formats as the Authority
			 designates.
(f) Testing.
			 EDI submitters must, prior to the initial data transmission and
			 throughout the term of a TPA, test and cooperate with the Authority
			 in the testing of information systems as the Authority considers
			 reasonably necessary to ensure the accuracy, timeliness,
			 completeness, and confidentiality of each data
			 transmission.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0165 - Pharmacy Point of Sale Access

Current through Register Vol. 63, No. 7, July 1, 2024
Pharmacy providers who electronically bill
				pharmaceutical claims must participate in and submit claims using the
				POS system, except as provided in OAR 410-121-0150.
Stat. Auth.: ORS
				  413.042  &414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0180 - Record Retention and Audit

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Records Retention. A provider,
			 CCO, PHP, web portal submitter, trading partner, and EDI submitter
			 shall maintain, for a period of no less than seven years from the
			 date of service, complete, accurate, and unaltered copies of all
			 source documents associated with all data transmissions.
(2) EDI Trade Data Log. An EDI
			 submitter must establish and maintain a trade data log that must
			 record all data transmissions taking place between an EDI submitter
			 and the Authority during the term of a TPA. A trading partner and EDI
			 submitter must take necessary and reasonable steps to ensure that the
			 trade data log constitutes a current, truthful, accurate, complete,
			 and unaltered record of all data transmissions between the parties
			 and must be retained by each party for no less than 24 months
			 following the date of the data transmission. The trade data log may
			 be maintained on electronic media or other suitable means provided
			 that, if necessary, the information may be timely retrieved and
			 presented in readable form.
(3) Right to Audit. A provider, CCO
			 or PHP must allow and require any web portal submitter to allow, and
			 a trading partner must allow and require an EDI submitter or other
			 agent to allow access to the Authority, the Oregon Secretary of
			 State, the Oregon Department of Justice Medicaid Fraud Unit, or its
			 designees, and DHHS or its designees to audit relevant business
			 records, source documents, data, data transmissions, trade data logs,
			 or information systems of a provider and its web portal submitter,
			 and a trading partner, and its agents, as necessary, to ensure
			 compliance with these rules. A provider must allow and require its
			 web portal submitter to allow, and a trading partner must allow and
			 require an EDI submitter or other agent to allow the Authority, or
			 its designee, access to ensure that adequate security precautions
			 have been made and are implemented to prevent unauthorized disclosure
			 of any data, data transmissions, or other information.
Stat. Auth.: ORS
				  413.042 &
				  414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0190 - Material Changes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Changes in Any Material
			 Information - EDT Process. A trading partner must submit an updated
			 TPA, application for authorization, or EDI registration form to the
			 Authority within ten business days of any material change in
			 information. A material change includes but is not limited to mailing
			 or email address change, contract number or contract status
			 (termination, expiration, extension), identification of authorized
			 individuals of a trading partner or EDI submitter, the addition or
			 deletion of authorized transactions, or any other change that may
			 affect the accuracy of or authority for an EDI transaction. The
			 Authority may act on data transmissions submitted by a trading
			 partner and its EDI submitter based on information on file in the
			 application for authorization and EDI registration forms until an
			 updated form has been received and approved by the Authority. A
			 trading partner's signature or the signature of an authorized EDI
			 submitter is required to ensure that an updated TPA, authorization,
			 or EDI registration form is valid and authorized.
(2) Changes in Any Material
			 Information - Web Portal Access. Providers must submit an updated web
			 portal registration form to the Authority within ten business days of
			 any material changes in information. A material change includes but
			 is not limited to mailing or email address change, contract number or
			 contract status (termination, suspension, expiration), identification
			 of web portal submitter contact information, or any other change that
			 may affect the accuracy of or authority for a DDE transaction. The
			 Authority is authorized to act on data transmissions submitted by a
			 provider and its web portal submitter based on information on file in
			 the web portal registration form until an updated form has been
			 received and approved by the Authority. A provider's signature or the
			 signature of an authorized business representative is required to
			 ensure that an updated web portal registration form is valid and
			 authorized.
(3) Failure
			 to submit a timely updated form may impact the ability of a data
			 transaction to be processed without errors. Failure to submit a
			 signed, updated form may result in the rejection of a data
			 transmission.
Stat. Auth.: ORS
				  413.042 &
				  414.065
Stats. Implemented: ORS
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0200 - Authority System Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No individual or entity shall
			 be registered to conduct a web portal or an EDI transaction with the
			 Authority except as authorized under these the rules. Eligibility and
			 continued participation as a provider, CCO, PHP, allied agency or web
			 portal submitter in the conduct of DDE transactions, or as a trading
			 partner or EDI submitter in the conduct of registered transactions,
			 is conditioned on the execution and delivery of the documents
			 required in these rules, the continued accuracy of that information
			 consistent with OAR 943-120-0190, and compliance with a requirements
			 of these rules. Data, including confidential information, governed by
			 these rules may be used for purposes related to treatment, payment,
			 and health care operations and for the administration of programs or
			 services by the Authority.
(2) In addition to the requirements
			 of section (1) of this rule, in order to qualify as a trading
			 partner:
(a) An individual or entity
			 must be a Authority provider, CCO, PHP, clinic, or allied agency
			 pursuant to a current valid contract; and
(b) A provider, CCO, PHP, clinic,
			 or allied agency must have submitted an executed TPA and all related
			 documentation, including the application for authorization that
			 identifies and authorizes an EDI submitter.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0310 - Provider Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All providers seeking
			 reimbursement from the Authority, a PHP, CCO, or a county pursuant to
			 a county agreement with the Authority for the provision of covered
			 services or items to eligible recipients, must comply with:
(a) These rules, OAR 943-120-0300  to 943-120-0350: and
(b)
			 The applicable rules or contracts of the specific programs described
			 below:
(A) Programs administered by
			 the Division of Medical Assistance Programs (Division) including the
			 OHP medical assistance program and the CHIP program that reimburse
			 providers for services or items provided to eligible recipients,
			 subject to OAR chapter 410 divisions 120 and 141 and provider rules
			 in chapter 410 applicable to the provider's service
			 category;
(B) Programs
			 administered by the Addictions and Mental Health Division (AMH) that
			 reimburse providers for services or items provided to eligible AMH
			 recipients (OAR chapters 309 and 415); or
(C) Programs administered by Aging
			 and People with Disabilities (APD) that reimburse providers for
			 services or items provided to eligible APD recipients (OAR chapter
			 411).
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0320 - Provider Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In some Authority program
			 areas, being an enrolled Authority provider is a condition of
			 eligibility for an Authority contract for certain services or
			 activities. Billing providers must be enrolled with the Authority as
			 providers consistent with the provider enrollment processes set forth
			 in OAR 410-120-0310 through 0350 and 410-120-1260. If reimbursement
			 for covered services is made under a contract with the Authority, the
			 provider must also meet the Authority's contract requirements.
			 Contract requirements are separate from the requirements of these
			 rules. Enrollment as a provider with the Authority is not a promise
			 that the enrolled provider shall receive any amount of work from the
			 Authority, a CCO, PHP, or a county.
(2) Provider enrollment establishes
			 essential Authority provider participation requirements for becoming
			 an enrolled Authority provider. The details of provider qualification
			 requirements, client eligibility, covered services, how to obtain
			 prior authorization or review, if required, documentation
			 requirements, claims submission, and available electronic access
			 instructions, and other instructions and requirements are contained
			 in Authority program-specific rules in chapter 410 or
			 contract.
(3) Prior to
			 enrollment, providers must:
(a)
			 Meet all program-specific or contract requirements identified in
			 program-specific rules or contracts and the requirements set forth in
			 these rules and OAR 410-120-1260;
(b) Meet Authority contracting
			 requirements, as specified by the Authority's Office of Contracts and
			 Procurement (OC&P);
(c) Meet Authority and federal
			 licensing and certification requirements for the type of service for
			 which the provider is enrolling; and
(d) Obtain a provider number from
			 the Authority subject to OAR 410-120-1260.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0330 - Billing Procedures

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules only apply to
			 covered services and items provided to clients that are paid for by
			 the Authority based on an Authority fee schedule or other
			 reimbursement method (often referred to as fee-for-service), or for
			 services that are paid for by the Authority at the request of a
			 county for county-authorized services.
(a) If a client's service or item
			 is paid for by a PHP or CCO, the provider must comply with the
			 billing and procedures related to claim submission established under
			 contract with that PHP, CCO, or the rules applicable to
			 non-participating providers if the provider is not under contract
			 with that PHP or CCO.
(b)
			 If the client is enrolled in a PHP or CCO, but the client is
			 permitted by a contract or program-specific rules to obtain covered
			 services reimbursed by the Authority (such as family planning
			 services that may be obtained from any provider). In addition to this
			 rule, the provider must comply with the billing and claim procedures
			 established in OAR chapter 410 division 120.
Oregon Administrative Rules › Chapter 943 - OREGON HEALTH AUTHORITY › Division 120 - PROVIDER RULES › Section 943-120-0350 - Payments and Overpayments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an individual's health
			 care services or item is reimbursed by the Medical Assistance
			 Program, either through a CCO, MCO or the Authority, the provider
			 shall comply with the payment requirements pursuant to OAR chapter
			 410 or established under contract with that CCO or MCO.
(2) All other covered services and
			 items provided to eligible individuals not part of the Medical
			 Assistance Program shall be:
(a)
			 Within the program-specific contract in effect on the date of
			 service;
(b) Based on
			 program-specific or contract fee schedules or other reimbursement
			 methods; or
(c) For
			 services that are paid for by the Authority, on behalf of a county,
			 authorized by and at the request of a county, provider reimbursement
			 shall include county service authorization information.