2011 Oregon Revised Statutes
ORS Volume 10, Chapters 366 - 430
ORS Chapter 414

• 414.001 [Repealed by 1953 c.378 2]
• 414.002 [Repealed by 1953 c.378 2]
• 414.003 [Repealed by 1953 c.378 2]
• 414.004 [Repealed by 1953 c.378 2]
• 414.005 [Repealed by 1953 c.378 2]
• 414.006 [Repealed by 1953 c.378 2]
• 414.007 [Repealed by 1953 c.378 2]
• 414.008 [Repealed by 1953 c.378 2]
• 414.009 [Repealed by 1953 c.378 2]
• 414.010 [Repealed by 1953 c.378 2]
• 414.011 [Repealed by 1953 c.378 2]
• 414.012 [Repealed by 1953 c.378 2]
• 414.013 [Repealed by 1953 c.378 2]
• 414.014 [Repealed by 1953 c.378 2]
• 414.015 [Repealed by 1953 c.30 2]
• 414.016 [Repealed by 1953 c.30 2]
• 414.017 [Repealed by 1953 c.30 2] GENERAL PROVISIONS
• 414.018 Legislative intent; findings.
• Note: 414.018 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.019 [1993 c.815 2; 1999 c.547 4; 2005 c.22 284; repealed by 2009 c.595 1204]
• 414.020 [Repealed by 1953 c.204 9]
• 414.021 [1993 c.815 3; 1995 c.727 19; 1997 c.683 14; 1999 c.547 5; 2003 c.47 1; 2003 c.784 6; repealed by 2009 c.595 1204]
• 414.022 [1993 c.815 29; 1995 c.806 3; 1995 c.807 4; 1999 c.835 1; 2001 c.900 100; repealed by 2009 c.595 1204]
• 414.023 [1993 c.815 30; 1997 c.249 128; repealed by 2009 c.595 1204]
• 414.024 [1993 c.815 31; 1997 c.683 15; 1999 c.547 6; repealed by 2009 c.595 1204]
• 414.025 Definitions for ORS chapters 411, 413 and 414.
• 414.026 [2001 c.980 2; renumbered 414.420 in 2005]
• 414.027 [2001 c.980 3; renumbered 414.422 in 2005]
• 414.028 [Formerly 414.305; renumbered 414.426 in 2005]
• 414.029 [2003 c.76 1; renumbered 414.428 in 2005]
• 414.030 [Repealed by 1953 c.204 9]
• 414.031 [2003 c.784 9; repealed by 2009 c.595 1204]
• 414.032 [1967 c.502 4; 1985 c.747 10; repealed by 2009 c.595 1204]
• 414.033 Expenditures for medical assistance authorized.
• 414.034 Acceptance of federal billing, reimbursement and reporting forms.
• Note: 414.034 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.035 [1965 c.556 1; repealed by 1967 c.502 21]
• 414.036 [1983 c.415 2; 1989 c.836 1; 1991 c.753 1; repealed by 2009 c.595 1204]
• 414.037 [1967 c.502 5; repealed by 1975 c.509 2 (414.038 enacted in lieu of 414.037)]
• 414.038 [1975 c.509 3,4 (enacted in lieu of 414.037); repealed by 2009 c.595 1204]
• 414.039 [1985 c.747 12; 1989 c.31 1; 1991 c.66 7; 1997 c.581 23; repealed by 2009 c.595 1204]
• 414.040 [1953 c.204 2; renumbered 414.810 and then 566.310]
• 414.041 Simplified application process; outreach and enrollment.
• Note: 414.041 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.042 [1967 c.502 6; 1971 c.503 1; 1989 c.836 20; 1991 c.66 8; 1991 c.753 2; 1993 c.815 20; 1995 c.807 2; 1997 c.581 24; 2007 c.861 21; 2009 c.595 269; 2009 c.867 42; renumbered 411.404 in 2009]
• 414.045 [1965 c.556 3; repealed by 1967 c.502 21]
• 414.047 [1967 c.502 7; 1969 c.68 8; 1971 c.779 46; 1991 c.66 9; 2003 c.14 189; renumbered 411.400 in 2009]
• 414.049 [2003 c.810 17; 2009 c.595 272; renumbered 411.402 in 2009]
• 414.050 [1953 c.204 2; renumbered 414.820 and then 566.320]
• 414.051 [1979 c.296 2; 1991 c.66 10; 2009 c.595 273; renumbered 411.459 in 2009]
• 414.055 [1965 c.556 4; 1971 c.734 45; 1971 c.779 47; 1991 c.66 11; renumbered 411.408 in 2009]
• 414.057 [1967 c.502 8; 1971 c.779 48; 1991 c.66 12; renumbered 411.406 in 2009]
• 414.060 [1953 c.204 3; renumbered 414.830 and then 566.330] MEDICAL ASSISTANCE
• 414.065 Determination of health care and services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules.
• 414.070 [1953 c.204 4; renumbered 414.840 and then 566.340]
• 414.071 Timely payment for dental services.
• Note: 414.071 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.073 [1971 c.188 2; 1991 c.66 14; 2009 c.595 277; renumbered 411.463 in 2009]
• 414.075 Payment of deductibles imposed under federal law.
• 414.080 [1953 c.204 5; renumbered 414.850 and then 566.350]
• 414.085 [1965 c.556 10; 1991 c.66 15; repealed by 2009 c.595 1204]
• 414.090 [1953 c.204 6; renumbered 414.860 and then 566.360]
• 414.095 Exemptions applicable to payments.
• 414.105 [1965 c.556 12; 1967 c.502 15; 1969 c.507 2; 1971 c.334 1; 1973 c.334 1; part renumbered 416.280; 1975 c.386 4; 1985 c.522 4; 1991 c.66 16; 1993 c.249 5; 1995 c.642 1; 2001 c.620 5; 2001 c.900 223; 2007 c.70 191; 2009 c.595 278; renumbered 416.350 in 2009]
• 414.106 [1995 c.642 2; 2001 c.900 224; 2009 c.595 279; renumbered 416.351 in 2009]
• 414.107 [1991 c.753 5a; 1993 c.815 15; repealed by 2009 c.595 1204]
• 414.109 Oregon Health Plan Fund.
• Note: 414.109 was enacted into law but was not added to or made a part of ORS chapter 414 or any series therein by law. See Preface to Oregon Revised Statutes for further explanation. INSURANCE AND SERVICE CONTRACTS
• 414.115 Medical assistance by insurance or service contracts; rules.
• 414.125 Rates on insurance or service contracts; requirements for insurer or contractor.
• 414.135 Contracts relating to direct providers of care and services.
• 414.145 Implementation of ORS 414.115, 414.125 or 414.135.
• 414.150 Purpose of ORS 414.150 to 414.153.
• Note: 414.150 to 414.153 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.151 [1991 c.337 2; 1993 c.18 100; 2001 c.900 101; 2009 c.595 285; renumbered 411.435 in 2009]
• 414.152 Duties of state agencies.
• Note: See note under 414.150.
• 414.153 Services provided by local government.
• Note: See note under 414.150.
• 414.205 [1967 c.502 18; 1981 c.825 1; repealed by 1995 c.727 48]
• 414.210 [1957 c.692 1; repealed by 1963 c.631 2] ADVISORY COMMITTEES
• 414.211 Medicaid Advisory Committee.
• Note: 414.211 and 414.221 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.215 [1967 c.502 19; 1991 c.66 21; repealed by 1995 c.727 48]
• 414.220 [1957 c.692 2; repealed by 1963 c.631 2]
• 414.221 Duties of committee.
• Note: See note under 414.211.
• 414.225 Oregon Health Authority to consult with committee.
• 414.227 Application of public meetings law to advisory committees.
• 414.229 Office for Oregon Health Policy and Research Advisory Committee.
• Note: 414.229 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.230 [1957 c.692 5; repealed by 1963 c.631 2] HEALTH CARE FOR ALL OREGON CHILDREN PROGRAM
• 414.231 Eligibility for Healthy Kids program; 12-month continuous enrollment; verification of eligibility; uninsurance requirement; rules.
• 414.240 [1957 c.692 3; repealed by 1963 c.631 2]
• 414.250 [1957 c.692 4; repealed by 1963 c.631 2]
• 414.260 [1957 c.692 6; repealed by 1963 c.631 2]
• 414.270 [1957 c.692 7(1); repealed by 1963 c.631 2]
• 414.280 [1957 c.692 7(2); repealed by 1963 c.631 2]
• 414.290 [1957 c.692 7(3); repealed by 1963 c.631 2]
• 414.300 [1957 c.692 8; repealed by 1963 c.631 2]
• 414.305 [1969 c.507 3; 1971 c.33 1; 1977 c.384 5; 1991 c.66 23; 2001 c.900 102; renumbered 414.028 in 2001]
• 414.310 [1957 c.692 9; 1961 c.130 2; repealed by 1963 c.631 2] PRESCRIPTION DRUGS (Oregon Prescription Drug Program)
• 414.312 Oregon Prescription Drug Program.
• Note: 414.312 to 414.320 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.314 Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees.
• Note: See note under 414.312.
• 414.316 Preferred drug list for Oregon Prescription Drug Program.
• Note: See note under 414.312.
• 414.318 Prescription Drug Purchasing Fund.
• Note: See note under 414.312.
• 414.320 Rules.
• Note: See note under 414.312. (Prescription Drug Coverage by Medical Assistance)
• 414.325 Prescription drugs; use of legend or generic drugs; prior authorization; rules.
• Note: 414.720 was repealed by section 228, chapter 720, Oregon Laws 2011. The text of 414.325 was not amended by enactment of the Legislative Assembly to reflect the repeal. Editorial adjustment of 414.325 for the repeal of 414.720 has not been made.
• Note: The amendments to 414.325 by section 8, chapter 827, Oregon Laws 2009, become operative January 2, 2014. See section 13, chapter 827, Oregon Laws 2009. The text that is operative on and after January 2, 2014, is set forth for the user s convenience.
• 414.325. (1) As used in this section: (a) Legend drug means any drug requiring a prescription by a practitioner, as defined in ORS 689.005. (b) Urgent medical condition means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the development of more serious medical problems. (2) A licensed practitioner may prescribe such drugs under this chapter as the practitioner in the exercise of professional judgment considers appropriate for the diagnosis or treatment of the patient in the practitioner s care and within the scope of practice. Prescriptions shall be dispensed in the generic form pursuant to ORS 689.515 and pursuant to rules of the Oregon Health Authority unless the practitioner prescribes otherwise and an exception is granted by the authority. (3) Except as provided in subsections (4) and (5) of this section, the authority shall place no limit on the type of legend drug that may be prescribed by a practitioner, but the authority shall pay only for drugs in the generic form unless an exception has been granted by the authority. (4) Notwithstanding subsection (3) of this section, an exception must be applied for and granted before the authority is required to pay for minor tranquilizers and amphetamines and amphetamine derivatives, as defined by rule of the authority. (5)(a) Notwithstanding subsections (1) to (4) of this section and except as provided in paragraph (b) of this subsection, the authority is authorized to: (A) Withhold payment for a legend drug when federal financial participation is not available; and (B) Require prior authorization of payment for drugs that the authority has determined should be limited to those conditions generally recognized as appropriate by the medical profession. (b) The authority may not require prior authorization for therapeutic classes of nonsedating antihistamines and nasal inhalers, as defined by rule by the authority, when prescribed by an allergist for treatment of any of the following conditions, as described by the Health Evidence Review Commission on the funded portion of its prioritized list of services: (A) Asthma; (B) Sinusitis; (C) Rhinitis; or (D) Allergies. (6) The authority shall pay a rural health clinic for a legend drug prescribed and dispensed under this chapter by a licensed practitioner at the rural health clinic for an urgent medical condition if: (a) There is not a pharmacy within 15 miles of the clinic; (b) The prescription is dispensed for a patient outside of the normal business hours of any pharmacy within 15 miles of the clinic; or (c) No pharmacy within 15 miles of the clinic dispenses legend drugs under this chapter. (7) Notwithstanding ORS 414.334, the authority may conduct prospective drug utilization review prior to payment for drugs for a patient whose prescription drug use exceeded 15 drugs in the preceding six-month period. (8) Notwithstanding subsection (3) of this section, the authority may pay a pharmacy for a particular brand name drug rather than the generic version of the drug after notifying the pharmacy that the cost of the particular brand name drug, after receiving discounted prices and rebates, is equal to or less than the cost of the generic version of the drug. (9)(a) Within 180 days after the United States patent expires on an immunosuppressant drug used in connection with an organ transplant, the authority shall determine whether the drug is a narrow therapeutic index drug. (b) As used in this subsection, narrow therapeutic index drug means a drug that has a narrow range in blood concentrations between efficacy and toxicity and requires therapeutic drug concentration or pharmacodynamic monitoring.
• 414.326 Supplemental rebates from pharmaceutical manufacturers.
• Note: 414.326 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.327 Electronically transmitted prescriptions; rules.
• Note: 414.327 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.329 Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules.
• Note: 414.329 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation. (Practitioner-Managed Prescription Drug Plan)
• 414.330 Legislative findings on prescription drugs.
• Note: 414.330 to 414.334 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.332 Policy for Practitioner-Managed Prescription Drug Plan.
• Note: See note under 414.330.
• 414.334 Practitioner-Managed Prescription Drug Plan for medical assistance program.
• Note: The amendments to 414.334 by section 10, chapter 827, Oregon Laws 2009, become operative January 2, 2014. See section 13, chapter 827, Oregon Laws 2009. The text that is operative on and after January 2, 2014, including amendments by section 139, chapter 720, Oregon Laws 2011, is set forth for the user s convenience.
• 414.334. (1) The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best possible price. (2) In adopting the plan, the authority shall consider recommendations of the Pharmacy and Therapeutics Committee. (3) The authority shall consult with representatives of the regulatory boards and associations representing practitioners who are prescribers under the medical assistance program and ensure that practitioners receive educational materials and have access to training on the Practitioner-Managed Prescription Drug Plan. (4) Notwithstanding the Practitioner-Managed Prescription Drug Plan adopted by the authority, a practitioner may prescribe any drug that the practitioner indicates is medically necessary for an enrollee as being the most effective available. (5) An enrollee may appeal to the authority a decision of a practitioner or the authority to not provide a prescription drug requested by the enrollee. (6) This section does not limit the decision of a practitioner as to the scope and duration of treatment of chronic conditions, including but not limited to arthritis, diabetes and asthma.
• Note: See note under 414.330.
• 414.336 [2003 c.810 22; repealed by 2009 c.827 14]
• 414.337 Limitation on rules regarding Practitioner-Managed Prescription Drug Plan.
• Note: 414.337 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.338 [2001 c.869 1; 2009 c.595 301; repealed by 2011 c.720 228]
• 414.340 [2001 c.869 3; 2005 c.381 15; repealed by 2009 c.263 1]
• 414.342 [2001 c.869 4; repealed by 2009 c.263 1]
• 414.344 [2001 c.869 10; repealed by 2009 c.263 1]
• 414.346 [2001 c.869 8; repealed by 2009 c.263 1]
• 414.348 [2001 c.869 6; 2005 c.22 285; repealed by 2009 c.263 1]
• 414.350 [1993 c.578 1; 2009 c.595 302; repealed by 2011 c.720 228] (Pharmacy and Therapeutics Committee)
• 414.351 Definitions for ORS 414.351 to 414.414.
• Note: 414.351 to 414.414 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.353 Committee established; membership.
• Note: See note under 414.351.
• Note: Section 3, chapter 720, Oregon Laws 2011, provides:
• Sec. 3.
• 414.354 Meetings; advisory committees; public notice and testimony.
• Note: See note under 414.351.
• 414.355 [1993 c.578 2; 2009 c.595 303; repealed by 2011 c.720 228]
• 414.356 Executive session.
• Note: See note under 414.351.
• 414.360 [1993 c.578 6; 2003 c.70 1; 2009 c.595 304; repealed by 2011 c.720 228]
• 414.361 Drug utilization review standards and interventions; preferred drug list; rules.
• Note: See note under 414.351.
• 414.364 Intervention approaches.
• Note: See note under 414.351.
• 414.365 [1993 c.578 7; 2009 c.595 305; repealed by 2011 c.720 228]
• 414.369 Prospective drug use review program.
• Note: See note under 414.351.
• 414.370 [1993 c.578 8; 2003 c.70 2; repealed by 2011 c.720 228]
• 414.371 Retrospective drug use review program.
• Note: See note under 414.351.
• 414.375 [1993 c.578 13; 2009 c.595 306; repealed by 2011 c.720 228]
• 414.380 [1993 c.578 12; 2009 c.595 307; repealed by 2011 c.720 228]
• 414.381 Annual reports; educational materials; procedures to protect confidential information.
• Note: See note under 414.351.
• 414.382 Requirements for annual report.
• Note: See note under 414.351.
• 414.385 [1993 c.578 11; repealed by 2011 c.720 228]
• 414.390 [1993 c.578 10; 2009 c.595 308; repealed by 2011 c.720 228]
• 414.395 [1993 c.578 14; repealed by 2011 c.720 228]
• 414.400 [1993 c.578 4; 2001 c.900 103; repealed by 2011 c.720 228]
• 414.410 [1993 c.578 5; 2009 c.595 309; repealed by 2011 c.720 228]
• 414.414 Use and disclosure of confidential information.
• Note: See note under 414.351.
• 414.415 [1993 c.578 9; repealed by 2011 c.720 228]
• 414.420 [Formerly 414.026; 2009 c.595 309a; renumbered 411.443 in 2009]
• 414.422 [Formerly 414.027; renumbered 411.445 in 2009]
• 414.424 [2005 c.494 2; 2007 c.70 193; 2009 c.414 1; renumbered 411.439 in 2009] MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS
• 414.426 Payment of cost of medical care for institutionalized persons.
• Note: 414.426 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.428 Coverage for American Indian and Alaskan Native beneficiaries.
• Note: Section 2, chapter 76, Oregon Laws 2003, provides:
• Sec. 2.
• Note: 414.428 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.440 Suspension of medical assistance provided to inmates.
• Note: 414.440 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• Note: Section 3, chapter 207, Oregon Laws 2011, provides:
• Sec. 3.
• 414.500 Findings regarding medical assistance for persons with hemophilia.
• Note: 414.500 to 414.530 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.510 Definitions.
• Note: See note under 414.500.
• 414.520 Hemophilia services.
• Note: See note under 414.500.
• 414.530 When payments not made for hemophilia services.
• Note: See note under 414.500. (Breast and Cervical Cancer)
• 414.532 Definitions for ORS 414.534 to 414.538.
• Note: 414.532 to 414.540 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.534 Treatment for breast or cervical cancer; eligibility criteria for medical assistance; rules.
• Note: See note under 414.532.
• 414.536 Presumptive eligibility for medical assistance for treatment of breast or cervical cancer.
• Note: See note under 414.532.
• 414.538 Prohibition on coverage limitations; priority to low-income women.
• Note: See note under 414.532.
• 414.540 Rules.
• Note: See note under 414.532. (Cystic Fibrosis)
• 414.550 Definitions for ORS 414.550 to 414.565.
• Note: 414.550 to 414.565 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.555 Findings regarding medical assistance for persons with cystic fibrosis.
• Note: See note under 414.550.
• 414.560 Cystic fibrosis services.
• Note: See note under 414.550.
• 414.565 When payments not made for cystic fibrosis services.
• Note: See note under 414.550. OREGON INTEGRATED AND COORDINATED CARE DELIVERY SYSTEM (Prepaid Managed Care Health Services Organizations)
• 414.610 Legislative intent.
• Note: 414.610 is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• 414.615 Selection of providers; reimbursement for services not covered; actions as trade practice; actions not insurance; rules.
• Note: 414.615 (formerly 414.640) is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• 414.618 Authorization for alternatives to reimbursement of coordinated care organizations.
• Note: 414.618 (formerly 414.630) is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011. (Coordinated Care Organizations)
• 414.620 System established.
• 414.625 Coordinated care organizations; rules.
• Note: Sections 13, 14, 16, 17, 62, 64 (2) and 65, chapter 602, Oregon Laws 2011, provide:
• Sec. 13. Proposal for transition; report.
• Sec. 14. Transitional provisions.
• Sec. 16. Health care cost containment.
• Sec. 17. Federal approvals.
• Sec. 62. Approval required.
• Sec. 65. Actions prior to approval.
• Sec. 64.
• 414.630 [1983 c.590 3; 1991 c.66 24; 2003 c.794 275; 2009 c.595 317; 2011 c.602 40; renumbered 414.618 in 2011]
• 414.631 Mandatory enrollment in coordinated care organization; exemptions.
• Note: See note under 414.688.
• 414.632 Services to individuals who are dually eligible for Medicare and Medicaid.
• 414.635 Consumer and provider protections; rules.
• Note: The amendments to 414.635 by section 9, chapter 602, Oregon Laws 2011, become operative January 1, 2014. See section 63, chapter 602, Oregon Laws 2011. The text that is operative on and after January 1, 2014, is set forth for the user s convenience.
• 414.635. (1) The Oregon Health Authority shall adopt by rule safeguards for members enrolled in coordinated care organizations that protect against underutilization of services and inappropriate denials of services. In addition to any other consumer rights and responsibilities established by law, each member: (a) Must be encouraged to be an active partner in directing the member s health care and services and not a passive recipient of care. (b) Must be educated about the coordinated care approach being used in the community and how to navigate the coordinated health care system. (c) Must have access to advocates, including qualified peer wellness specialists where appropriate, personal health navigators, and qualified community health workers who are part of the member s care team to provide assistance that is culturally and linguistically appropriate to the member s need to access appropriate services and participate in processes affecting the member s care and services. (d) Shall be encouraged within all aspects of the integrated and coordinated health care delivery system to use wellness and prevention resources and to make healthy lifestyle choices. (e) Shall be encouraged to work with the member s care team, including providers and community resources appropriate to the member s needs as a whole person. (2) The authority shall establish and maintain an enrollment process for individuals who are dually eligible for Medicare and Medicaid that promotes continuity of care and that allows the member to disenroll from a coordinated care organization that fails to promptly provide adequate services and: (a) To enroll in another coordinated care organization of the member s choice; or (b) If another organization is not available, to receive Medicare-covered services on a fee-for-service basis. (3) Members and their providers and coordinated care organizations have the right to appeal decisions about care and services through the authority in an expedited manner and in accordance with the contested case procedures in ORS chapter 183. (4) A health care entity may not unreasonably refuse to contract with an organization seeking to form a coordinated care organization if the participation of the entity is necessary for the organization to qualify as a coordinated care organization. (5) A health care entity may refuse to contract with a coordinated care organization if the reimbursement established for a service provided by the entity under the contract is below the reasonable cost to the entity for providing the service. (6) A health care entity that unreasonably refuses to contract with a coordinated care organization may not receive fee-for-service reimbursement from the authority for services that are available through a coordinated care organization either directly or by contract. (7) The authority shall maintain the process, approved by the Legislative Assembly, for resolving disputes involving an entity s refusal to contract with a coordinated care organization under subsections (4) and (5) of this section. The process must include the use of an independent third party arbitrator. (8) A coordinated care organization may not unreasonably refuse to contract with a licensed health care provider. (9) The authority shall: (a) Monitor and enforce consumer rights and protections within the Oregon Integrated and Coordinated Health Care Delivery System and ensure a consistent response to complaints of violations of consumer rights or protections. (b) Monitor and report on the statewide health care expenditures and recommend actions appropriate and necessary to contain the growth in health care costs incurred by all sectors of the system.
• 414.638 Outcome and quality measures and benchmarks.
• 414.640 [1983 c.590 4; 1991 c.66 25; 2003 c.794 276; 2009 c.595 318; renumbered 414.615 in 2011]
• 414.645 Network adequacy; enrollee transfers.
• 414.647 Transfer of 500 or more enrollees.
• 414.650 [1983 c.590 7; 1987 c.660 19; 1989 c.513 1; 1991 c.66 26; repealed by 1995 c.727 48]
• 414.651 Coordinated care organization contracts; financial reporting; rules.
• Note: See note under 414.688.
• 414.653 Alternative payment methodologies.
• 414.655 Patient centered primary care homes in coordinated care organizations.
• 414.660 [1983 c.590 5; 1985 c.747 3; 1991 c.66 27; 2009 c.11 57; repealed by 2009 c.595 1204]
• 414.665 Community health workers, personal health navigators and peer wellness specialists utilized by coordinated care organizations.
• 414.670 [1983 c.590 6; 1985 c.747 3a; 1991 c.66 28; repealed by 2009 c.595 1204]
• 414.679 Use and disclosure of member information; access by member to personal health information.
• 414.685 Coordination between Oregon Health Authority and Department of Human Services.
• 414.688 Commission established; membership.
• Note: 414.688 to 414.750 and 414.631 and 414.651 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.689 Members; meetings.
• Note: See note under 414.688.
• 414.690 Prioritized list of health services.
• Note: See note under 414.688.
• 414.695 Medical technology assessment.
• Note: 414.695 to 414.701 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.698 Comparative effectiveness of medical technologies.
• Note: See note under 414.695.
• 414.701 Commission may not rely solely on comparative effectiveness research.
• Note: See note under 414.695.
• 414.704 Advisory committee.
• Note: See note under 414.688.
• 414.705 [1989 c.836 2; 1991 c.753 4; 2003 c.735 1; 2003 c.810 7; repealed by 2011 c.602 64,70] SCOPE OF COVERED HEALTH SERVICES
• 414.706 Legislative approval and funding of health services to certain persons.
• Note: See note under 414.688.
• 414.707 Level of health services provided to certain persons.
• Note: See note under 414.688.
• 414.708 Conditions for coverage for certain elderly persons, blind persons or persons who have disabilities.
• Note: See note under 414.688.
• 414.709 Adjustment of population of eligible persons in event of insufficient resources.
• Note: See note under 414.688.
• 414.710 Services not subject to prioritized list.
• Note: See note under 414.688.
• 414.712 Health services for certain eligible persons.
• Note: See note under 414.688.
• 414.715 [1989 c.836 4; 1991 c.753 12; 2009 c.469 1; repealed by 2011 c.720 228]
• 414.720 [1989 c.836 4a; 1991 c.753 6; 1991 c.916 2a; 1993 c.754 1; 1993 c.815 19; 1997 c.245 2; 2003 c.735 10; 2003 c.810 8; 2009 c.595 324; 2011 c.545 48; repealed by 2011 c.720 228]
• 414.721 Federal approval for funding services with assessments.
• Note: See note under 414.688.
• 414.725 [1989 c.836 6; 1991 c.753 8; 2003 c.14 194; 2003 c.735 13; 2003 c.794 277; 2003 c.810 4; 2005 c.806 8; 2007 c.458 1; 2009 c.595 325; 2009 c.795 3; 2011 c.602 26; renumbered 414.651 in 2011]
• 414.727 Reimbursement of rural hospitals by prepaid managed care health services organization.
• Note: See note under 414.688.
• 414.728 Reimbursement of rural hospitals on fee-for-service basis.
• Note: See note under 414.688.
• 414.730 [1989 c.836 7; 1995 c.79 209; 2005 c.22 286; 2011 c.720 148; renumbered 414.704 in 2011]
• 414.735 Adjustment of reimbursement in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers.
• Note: See note under 414.688.
• 414.736 Definitions for ORS chapters 414 and 416, ORS 192.493 and section 9, chapter 867, Oregon Laws 2009.
• Note: 414.736 is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• Note: See note under 414.688.
• 414.737 [2003 c.810 3; 2007 c.751 8; 2009 c.595 330,331; 2011 c.602 27,28; renumbered 414.631 in 2011]
• 414.738 Use of physician care organizations.
• Note: 414.738 is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• Note: See note under 414.688.
• 414.739 Circumstances under which fully capitated health plan may contract as physician care organization.
• Note: 414.739 is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• Note: See note under 414.688.
• 414.740 Contracts with certain prepaid group practice health plans.
• Note: 414.740 is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011.
• Note: 414.705 was repealed by section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011. The text of 414.740 was not amended by enactment of the Legislative Assembly to reflect the repeal. Editorial adjustment of 414.740 for the repeal of 414.705 has not been made.
• Note: See note under 414.688.
• 414.741 [2003 c.810 9; 2009 c.595 335; repealed by 2011 c.720 228]
• 414.742 Payment for mental health drugs.
• Note: See note under 414.688.
• 414.743 Payment to noncontracting hospital by coordinated care organization; rules.
• Note: 414.743 is repealed January 2, 2014. See section 7, chapter 886, Oregon Laws 2009.
• Note: See note under 414.688.
• 414.744 [2003 c.810 13; repealed by 2009 c.595 1204]
• 414.745 Liability of health care providers and plans.
• Note: See note under 414.688.
• 414.746 Hospital add-on to coordinated care organization payment rate.
• Note: See note under 414.688.
• 414.747 [2003 c.810 15; renumbered 414.326 in 2011]
• 414.750 Authority of Legislative Assembly to authorize services for other persons.
• Note: See note under 414.688.
• 414.751 [1997 c.683 35; 2001 c.69 2; 2009 c.595 341; renumbered 414.229 in 2009]
• 414.755 Hospital reimbursement rates.
• 414.760 Payment for patient centered primary care home services.
• Note: 414.760 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation. PAYMENT OF MEDICAL EXPENSES OF PERSON IN CUSTODY OF LAW ENFORCEMENT OFFICER
• 414.805 Liability of individual for medical services received while in custody of law enforcement officer.
• Note: The amendments to 414.805 by section 52, chapter 644, Oregon Laws 2011, become operative July 1, 2015. See section 58, chapter 644, Oregon Laws 2011, as amended by section 77, chapter 644, Oregon Laws 2011. The text that is operative on and after July 1, 2015, is set forth for the user s convenience.
• 414.805. (1) An individual who receives medical services while in the custody of a law enforcement officer is liable: (a) To the provider of the medical services for the charges and expenses therefor; and (b) To the Oregon Health Authority for any charges or expenses paid by the authority out of the Law Enforcement Medical Liability Account for the medical services. (2) A person providing medical services to an individual described in subsection (1) of this section shall first make reasonable efforts to collect the charges and expenses thereof from the individual before seeking to collect them from the authority out of the Law Enforcement Medical Liability Account. (3)(a) If the provider has not been paid within 45 days of the date of the billing, the provider may bill the authority who shall pay the account out of the Law Enforcement Medical Liability Account. (b) A bill submitted to the authority under this subsection must be accompanied by evidence documenting that: (A) The provider has billed the individual or the individual s insurer or health care service contractor for the charges or expenses owed to the provider; and (B) The provider has made a reasonable effort to collect from the individual or the individual s insurer or health care service contractor the charges and expenses owed to the provider. (c) If the provider receives payment from the individual or the insurer or health care service contractor after receiving payment from the authority, the provider shall repay the authority the amount received from the public agency less any difference between payment received from the individual, insurer or contractor and the amount of the billing. (4) As used in this section: (a) Law enforcement officer means an officer who is commissioned and employed by a public agency as a peace officer to enforce the criminal laws of this state or laws or ordinances of a public agency. (b) Public agency means the state, a city, university that has established a police department under ORS 352.383, port, school district, mass transit district or county.
• Note: 414.805 to 414.815 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.807 Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury.
• Note: See second note under 414.805.
• 414.810 [Formerly 414.040; renumbered 566.310]
• 414.815 Law Enforcement Medical Liability Account; limited liability; rules; report.
• Note: See second note under 414.805.
• 414.820 [Formerly 414.050; renumbered 566.320]
• 414.821 [2001 c.898 1; 2003 c.14 196; repealed by 2003 c.735 5]
• 414.823 [2001 c.898 2; 2003 c.14 197; repealed by 2003 c.735 5] PREMIUM ASSISTANCE
• 414.825 Policy.
• Note: 414.825, 414.831 and 431.839 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.826 Private health option; rules.
• Note: 414.826 and 414.828 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.827 [2001 c.898 4; 2003 c.14 199; repealed by 2003 c.735 5]
• 414.828 Assistance subject to legislative appropriation.
• Note: See note under 414.826.
• 414.829 [2001 c.898 5; 2003 c.14 200; repealed by 2003 c.684 13 and 2003 c.735 5]
• 414.830 [Formerly 414.060; renumbered 566.330]
• 414.831 Expanding group coverage in Family Health Insurance Assistance Program.
• Note: See note under 414.825.
• 414.833 [2001 c.898 6; 2003 c.14 202; repealed by 2003 c.735 5]
• 414.834 [2001 c.898 7; 2003 c.14 203; repealed by 2003 c.735 5]
• 414.835 [2001 c.898 8; 2003 c.14 204; repealed by 2003 c.735 5]
• 414.837 [2001 c.898 10; 2003 c.14 205; repealed by 2003 c.735 5]
• 414.839 Premium assistance for health insurance coverage.
• Note: See note under 414.825.
• 414.840 [Formerly 414.070; renumbered 566.340]
• 414.841 Definitions for ORS 414.841 to 414.864.
• Note: 414.841 to 414.864 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.842 Purpose; administration.
• Note: See note under 414.841.
• 414.844 Application to participate in program; issuance of subsidies; restrictions; enrollment in employer-sponsored coverage.
• Note: See note under 414.841.
• 414.846 Determination of level of assistance.
• Note: See note under 414.841.
• 414.848 Subsidies limited to funds appropriated; enrollment restrictions.
• Note: See note under 414.841.
• 414.850 [Formerly 414.080; renumbered 566.350]
• 414.851 Establishment of minimum benefit requirements for plan subsidy.
• Note: See note under 414.841.
• 414.852 Coverage of immunizations; rules.
• Note: See note under 414.841.
• 414.854 Confidentiality of information in enrollment applications; exchange of information with governmental agencies; use of Social Security numbers.
• Note: See note under 414.841.
• 414.856 Basic benchmark health benefit plan eligible for subsidy.
• Note: See note under 414.841.
• 414.858 Rules.
• Note: See note under 414.841.
• 414.860 [Formerly 414.090; renumbered 566.360]
• 414.861 Family Health Insurance Assistance Program Account.
• Note: See note under 414.841.
• 414.862 Reports of program operation.
• Note: See note under 414.841.
• 414.864 Sanctions for violation of program requirements; civil penalties; rules.
• Note: See note under 414.841.
• 414.866 Definitions for ORS 414.866 to 414.872.
• Note: 414.866 to 414.872 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 414.868 Eligibility for coverage for certain members.
• Note: See note under 414.866.
• 414.870 Federal reimbursement of expenditures in Oregon Medical Insurance Pool for FHIAP enrollees.
• Note: See note under 414.866.
• 414.872 Determination of subsidies and costs.
• Note: See note under 414.866. HOSPITAL ASSESSMENT
• Note: Sections 1 to 10 and 12 to 14, chapter 736, Oregon Laws 2003, provide:
• Sec. 1.
• Sec. 3.
• Sec. 4.
• Sec. 5.
• Sec. 6.
• Sec. 7.
• Sec. 8.
• Sec. 9.
• Sec. 10.
• Sec. 12.
• Sec. 13.
• Sec. 14.
• Note: Sections 1, 9 and 11, chapter 867, Oregon Laws 2009, provide:
• Sec. 1.
• Sec. 9.
• Sec. 11.
• Note: Sections 10 and 12, chapter 867, Oregon Laws 2009, provide:
• Sec. 10.
• Sec. 12.