2019 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 414 - Medical Assistance

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Section 414.001 [Repealed by 1953 c.378 §2]
Section 414.002 [Repealed by 1953 c.378 §2]
Section 414.003 [Repealed by 1953 c.378 §2]
Section 414.004 [Repealed by 1953 c.378 §2]
Section 414.005 [Repealed by 1953 c.378 §2]
Section 414.006 [Repealed by 1953 c.378 §2]
Section 414.007 [Repealed by 1953 c.378 §2]
Section 414.008 [Repealed by 1953 c.378 §2]
Section 414.009 [Repealed by 1953 c.378 §2]
Section 414.010 [Repealed by 1953 c.378 §2]
Section 414.011 [Repealed by 1953 c.378 §2]
Section 414.012 [Repealed by 1953 c.378 §2]
Section 414.013 [Repealed by 1953 c.378 §2]
Section 414.014 [Repealed by 1953 c.378 §2]
Section 414.015 [Repealed by 1953 c.30 §2]
Section 414.016 [Repealed by 1953 c.30 §2]
Section 414.017 [Repealed by 1953 c.30 §2]

GENERAL PROVISIONS

Section 414.018 - Legislative intent; findings.
Section 414.019 [1993 c.815 §2; 1999 c.547 §4; 2005 c.22 §284; repealed by 2009 c.595 §1204]
Section 414.020 [Repealed by 1953 c.204 §9]
Section 414.021 [1993 c.815 §3; 1995 c.727 §19; 1997 c.683 §14; 1999 c.547 §5; 2003 c.47 §1; 2003 c.784 §6; repealed by 2009 c.595 §1204]
Section 414.022 [1993 c.815 §29; 1995 c.806 §3; 1995 c.807 §4; 1999 c.835 §1; 2001 c.900 §100; repealed by 2009 c.595 §1204]
Section 414.023 [1993 c.815 §30; 1997 c.249 §128; repealed by 2009 c.595 §1204]
Section 414.024 [1993 c.815 §31; 1997 c.683 §15; 1999 c.547 §6; repealed by 2009 c.595 §1204]
Section 414.025 - Definitions for ORS chapters 411, 413 and 414.
Section 414.026
Section 414.027
Section 414.028
Section 414.029
Section 414.030 [Repealed by 1953 c.204 §9]
Section 414.031 [2003 c.784 §9; repealed by 2009 c.595 §1204]
Section 414.032 [1967 c.502 §4; 1985 c.747 §10; repealed by 2009 c.595 §1204]
Section 414.033 - Expenditures for medical assistance authorized.
Section 414.034 - Acceptance of federal billing, reimbursement and reporting forms.
Section 414.035 [1965 c.556 §1; repealed by 1967 c.502 §21]
Section 414.036 [1983 c.415 §2; 1989 c.836 §1; 1991 c.753 §1; repealed by 2009 c.595 §1204]

414.037 [1967 c.502 §5; repealed by 1975 c.509 §2 (414.038 enacted in lieu of 414.037)]
Section 414.038 [1975 c.509 §§3,4 (enacted in lieu of 414.037); repealed by 2009 c.595 §1204]
Section 414.039 [1985 c.747 §12; 1989 c.31 §1; 1991 c.66 §7; 1997 c.581 §23; repealed by 2009 c.595 §1204]
Section 414.040
Section 414.041 - Simplified application process; outreach and enrollment.
Section 414.042
Section 414.044 - Notice to Department of Veterans’ Affairs of information regarding applications for health care coverage by uniformed service members and veterans; rules.
Section 414.045 [1965 c.556 §3; repealed by 1967 c.502 §21]
Section 414.047
Section 414.049
Section 414.050
Section 414.051
Section 414.055
Section 414.057
Section 414.060

MEDICAL ASSISTANCE

Section 414.065 - Determination of health care and services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules.
Section 414.066 - Billing patient for services covered by medical assistance prohibited.
Section 414.067 - Coordinated care organization assumption of costs; reports to Legislative Assembly.
Section 414.070
Section 414.071 - Timely payment for dental services.
Section 414.073
Section 414.075 - Payment of deductibles imposed under federal law.
Section 414.080
Section 414.085 [1965 c.556 §10; 1991 c.66 §15; repealed by 2009 c.595 §1204]
Section 414.090
Section 414.095 - Exemptions applicable to payments.
Section 414.105
Section 414.106
Section 414.107 [1991 c.753 §5a; 1993 c.815 §15; repealed by 2009 c.595 §1204]
Section 414.109 - Oregon Health Plan Fund.

INSURANCE AND SERVICE CONTRACTS

STATE AND LOCAL PUBLIC HEALTH PARTNERSHIP

Section 414.150 - Purpose of ORS 414.150 to 414.153.
Section 414.151
Section 414.152 - Duty of state agencies to work with local health departments.
Section 414.153 - Services provided by local health departments.
Section 414.205 [1967 c.502 §18; 1981 c.825 §1; repealed by 1995 c.727 §48]
Section 414.210 [1957 c.692 §1; repealed by 1963 c.631 §2]

ADVISORY COMMITTEES

Section 414.211 - Medicaid Advisory Committee.
Section 414.215 [1967 c.502 §19; 1991 c.66 §21; repealed by 1995 c.727 §48]
Section 414.220 [1957 c.692 §2; repealed by 1963 c.631 §2]
Section 414.221 - Duties of committee.
Section 414.225 - Oregon Health Authority to consult with committee.
Section 414.227 - Application of public meetings law to advisory committees.
Section 414.229 [Formerly 414.751; 2011 c.602 §38; repealed by 2015 c.318 §56]
Section 414.230 [1957 c.692 §5; repealed by 1963 c.631 §2]

HEALTH CARE FOR ALL OREGON CHILDREN PROGRAM

Section 414.231 - Eligibility for Health Care for All Oregon Children program; 12-month continuous enrollment; verification of eligibility.
Section 414.240 [1957 c.692 §3; repealed by 1963 c.631 §2]
Section 414.250 [1957 c.692 §4; repealed by 1963 c.631 §2]
Section 414.260 [1957 c.692 §6; repealed by 1963 c.631 §2]
Section 414.270 [1957 c.692 §7(1); repealed by 1963 c.631 §2]
Section 414.280 [1957 c.692 §7(2); repealed by 1963 c.631 §2]
Section 414.290 [1957 c.692 §7(3); repealed by 1963 c.631 §2]
Section 414.300 [1957 c.692 §8; repealed by 1963 c.631 §2]
Section 414.305
Section 414.310 [1957 c.692 §9; 1961 c.130 §2; repealed by 1963 c.631 §2]

PRESCRIPTION DRUGS

Section 414.312 - Oregon Prescription Drug Program.
Section 414.314 - Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees.
Section 414.316 [2003 c.714 §3; 2007 c.697 §19; 2009 c.595 §293; repealed by 2015 c.318 §56]
Section 414.318 - Prescription Drug Purchasing Fund.
Section 414.320 - Rules.
Section 414.325 - Prescription drugs; use of legend or generic drugs; prior authorization; rules.
Section 414.326 - Supplemental rebates from pharmaceutical manufacturers.
Section 414.327 - Electronically transmitted prescriptions; rules.
Section 414.328 - Synchronization of prescription drug refills.
Section 414.329 - Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules.
Section 414.330 - Legislative findings on prescription drugs.
Section 414.332 - Policy for Practitioner-Managed Prescription Drug Plan.
Section 414.334 - Practitioner-Managed Prescription Drug Plan for medical assistance program.
Section 414.336 [2003 c.810 §22; repealed by 2009 c.827 §14]
Section 414.337 - Limitation on rules regarding Practitioner-Managed Prescription Drug Plan.
Section 414.338 [2001 c.869 §1; 2009 c.595 §301; repealed by 2011 c.720 §228]
Section 414.340 [2001 c.869 §3; 2005 c.381 §15; repealed by 2009 c.263 §1]
Section 414.342 [2001 c.869 §4; repealed by 2009 c.263 §1]
Section 414.344 [2001 c.869 §10; repealed by 2009 c.263 §1]
Section 414.346 [2001 c.869 §8; repealed by 2009 c.263 §1]
Section 414.348 [2001 c.869 §6; 2005 c.22 §285; repealed by 2009 c.263 §1]
Section 414.350 [1993 c.578 §1; 2009 c.595 §302; repealed by 2011 c.720 §228]
Section 414.351 - Definitions for ORS 414.351 to 414.414.
Section 414.353 - Committee established; membership.
Section 414.354 - Meetings; advisory committees; public notice and testimony.
Section 414.355 [1993 c.578 §2; 2009 c.595 §303; repealed by 2011 c.720 §228]
Section 414.356 - Executive session.
Section 414.359 - Mental Health Clinical Advisory Group.
Section 414.360 [1993 c.578 §6; 2003 c.70 §1; 2009 c.595 §304; repealed by 2011 c.720 §228]
Section 414.361 - Committee to advise and make recommendations on drug utilization review standards and interventions; preferred drug list.
Section 414.364 - Intervention approaches.
Section 414.365 [1993 c.578 §7; 2009 c.595 §305; repealed by 2011 c.720 §228]
Section 414.369 - Prospective drug use review program.
Section 414.370 [1993 c.578 §8; 2003 c.70 §2; repealed by 2011 c.720 §228]
Section 414.371 - Retrospective drug use review program.
Section 414.372 - Pharmacy lock-in program; rules.
Section 414.375 [1993 c.578 §13; 2009 c.595 §306; repealed by 2011 c.720 §228]
Section 414.380 [1993 c.578 §12; 2009 c.595 §307; repealed by 2011 c.720 §228]
Section 414.381 - Annual reports; educational materials; procedures to protect confidential information.
Section 414.382 - Requirements for annual report.
Section 414.385 [1993 c.578 §11; repealed by 2011 c.720 §228]
Section 414.390 [1993 c.578 §10; 2009 c.595 §308; repealed by 2011 c.720 §228]
Section 414.395 [1993 c.578 §14; repealed by 2011 c.720 §228]
Section 414.400 [1993 c.578 §4; 2001 c.900 §103; repealed by 2011 c.720 §228]
Section 414.410 [1993 c.578 §5; 2009 c.595 §309; repealed by 2011 c.720 §228]
Section 414.414 - Use and disclosure of confidential information.
Section 414.415 [1993 c.578 §9; repealed by 2011 c.720 §228]
Section 414.420
Section 414.422
Section 414.424

MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS

MEDICAL ASSISTANCE BASED ON CONDITION

OREGON INTEGRATED AND COORDINATED CARE DELIVERY SYSTEM

Section 414.570 - System established.
Section 414.572 - Coordinated care organizations; rules.
Section 414.575 - Community advisory councils.
Section 414.577 - Community health assessment and adoption of community health improvement plan; rules.
Section 414.578 - Community health improvement plan.
Section 414.581 - Tribal Advisory Council established; membership; terms.
Section 414.584 - Meetings of coordinated care organization governing body to be open to public; recording and taking of minutes required.
Section 414.590 - Coordinated care organization contracts; terms and amendments; 60 days’ advance notice; refusal to renew.
Section 414.591 - Coordinated care organization contracts; financial reporting; rules.
Section 414.593 - Reporting and public disclosure of expenditures by coordinated care organizations.
Section 414.595 - External quality reviews of coordinated care organizations; limits on documentation and reporting requirements.
Section 414.598 - Alternative payment methodologies.
Section 414.605 - Consumer and provider protections.
Section 414.607 - Use and disclosure of member information; access by member to personal health information.
Section 414.609 - Network adequacy; member transfers.
Section 414.610 [1983 c.590 §1; 1985 c.747 §8; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.611 - Transfer of 500 or more members of coordinated care organization.
Section 414.613 - Discrimination based on scope of practice prohibited; appeals; rules.
Section 414.615 [Formerly 414.640; 2017 c.356 §34; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.618 [Formerly 414.630; 2014 c.45 §39; 2017 c.356 §35; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.619 - Coordination between Oregon Health Authority and Department of Human Services.
Section 414.620
Section 414.625
Section 414.627
Section 414.628 - Innovator agents.
Section 414.629
Section 414.630
Section 414.631 - Mandatory enrollment in coordinated care organization; exemptions.
Section 414.632 - Services to individuals who are dually eligible for Medicare and Medicaid.
Section 414.635
Section 414.637
Section 414.638 - Metrics and scoring subcommittee; identification of outcome and quality measures and benchmarks.
Section 414.640
Section 414.645
Section 414.646
Section 414.647
Section 414.650 [1983 c.590 §7; 1987 c.660 §19; 1989 c.513 §1; 1991 c.66 §26; repealed by 1995 c.727 §48]
Section 414.651
Section 414.652
Section 414.653
Section 414.654 - Persons served by prepaid managed care health services organizations; funding of health information technology.
Section 414.655 - Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations.
Section 414.660 [1983 c.590 §5; 1985 c.747 §3; 1991 c.66 §27; 2009 c.11 §57; repealed by 2009 c.595 §1204]
Section 414.661
Section 414.665 - Traditional health workers utilized by coordinated care organizations; rules.
Section 414.667 - Definition for ORS 414.667 to 414.669.
Section 414.668 - Access to doula services.
Section 414.669 - Payment for doula services.
Section 414.670 [1983 c.590 §6; 1985 c.747 §3a; 1991 c.66 §28; repealed by 2009 c.595 §1204]
Section 414.672 - Tribal-based practices for mental health and substance abuse prevention, counseling and treatment.
Section 414.679
Section 414.685
Section 414.686 - Health assessments for foster children.
Section 414.688 - Commission established; membership.
Section 414.689 - Members; meetings.
Section 414.690 - Prioritized list of health services.
Section 414.694 - Commission review of covered reproductive health services.
Section 414.695 - Medical technology assessment.
Section 414.698 - Comparative effectiveness of medical technologies.
Section 414.701 - Commission may not rely solely on comparative effectiveness research.
Section 414.704 - Advisory committee.
Section 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

Section 414.706 - Persons eligible for medical assistance; rules.
Section 414.707 [2003 c.735 §4; 2009 c.595 §319; 2009 c.867 §44; 2011 c.602 §42; 2011 c.720 §143; repealed by 2013 c.688 §98]
Section 414.708 [2003 c.735 §11; 2005 c.381 §16; 2007 c.70 §194; 2009 c.595 §320; 2011 c.720 §144; repealed by 2013 c.688 §98]
Section 414.709 - Adjustment of population of eligible persons in event of insufficient resources prohibited.
Section 414.710 - Services not subject to prioritized list.
Section 414.712 - Health services for certain eligible persons.
Section 414.715 [1989 c.836 §4; 1991 c.753 §12; 2009 c.469 §1; repealed by 2011 c.720 §228]
Section 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]
Section 414.721 [2009 c.867 §16; 2009 c.828 §50; repealed by 2015 c.70 §18]
Section 414.725
Section 414.727 [1997 c.642 §2; 1999 c.546 §2; 2005 c.806 §2; 2009 c.595 §326; 2013 c.688 §79; repealed by 2015 c.792 §14]
Section 414.728 - Reimbursement of rural hospitals on fee-for-service basis.
Section 414.730
Section 414.735 - Reduction in scope of health services in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers.
Section 414.736 [2003 c.810 §2; 2009 c.595 §329; 2009 c.867 §47; 2009 c.886 §6; 2011 c.417 §4; 2011 c.602 §45; 2011 c.720 §150; 2013 c.688 §80; 2015 c.3 §46; 2015 c.27 §45; 2015 c.792 §7; 2015 c.798 §13; 2017 c.273 §7; 2017 c.618 §7; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.737
Section 414.738 [2003 c.810 §5; 2009 c.595 §332; 2015 c.318 §23; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.739 [2003 c.810 §5a; 2009 c.595 §333; 2015 c.318 §24; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]
Section 414.740 [2003 c.810 §6; 2009 c.595 §334; 2012 c.8 §26; 2013 c.688 §81; 2015 c.3 §47; 2015 c.798 §14; 2017 c.273 §8; 2017 c.618 §8; repealed by 2011 c.602 §§64,70; 2012 c.8 §23 and 2015 c.792 §2]
Section 414.741 [2003 c.810 §9; 2009 c.595 §335; repealed by 2011 c.720 §228]
Section 414.742 - Payment for mental health drugs.
Section 414.743 - Payment to noncontracting hospital by coordinated care organization; rules.
Section 414.744 [2003 c.810 §13; repealed by 2009 c.595 §1204]
Section 414.745 - Liability of health care providers and plans.
Section 414.746 [2009 c.867 §15; 2009 c.828 §49; 2011 c.602 §48; 2013 c.608 §11; repealed by 2013 c.608 §12]
Section 414.747
Section 414.750 [1989 c.836 §18; 1991 c.753 §11; 2009 c.595 §340; repealed by 2013 c.688 §98]
Section 414.751
Section 414.755 - Payment for hospital services.
Section 414.756 - Payments to Oregon Health and Science University.
Section 414.760 - Payment for patient centered primary care home and behavioral health home services.
Section 414.762 - Payment for child abuse assessment.
Section 414.764 - Payment for services provided by pharmacy or pharmacist.
Section 414.766 - Behavioral health treatment; rules.
Section 414.768
Section 414.770 - Participants in clinical trials.
Section 414.772 - Limits on use of step therapy.

PAYMENT OF MEDICAL EXPENSES OF PERSON IN CUSTODY OF LAW ENFORCEMENT OFFICER

Section 414.805 - Liability of individual for medical services received while in custody of law enforcement officer.
Section 414.807 - Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury.
Section 414.810
Section 414.815 - Law Enforcement Medical Liability Account; limited liability; rules; report.
Section 414.820
Section 414.821 [2001 c.898 §1; 2003 c.14 §196; repealed by 2003 c.735 §5]
Section 414.823 [2001 c.898 §2; 2003 c.14 §197; repealed by 2003 c.735 §5]
Section 414.825 [2001 c.898 §3; 2003 c.14 §198; repealed by 2013 c.365 §9 and 2013 c.640 §16]
Section 414.826 [2009 c.867 §30; 2011 c.700 §1; 2013 c.681 §49; 2015 c.3 §48; repealed by 2013 c.365 §9 and 2013 c.640 §16]
Section 414.827 [2001 c.898 §4; 2003 c.14 §199; repealed by 2003 c.735 §5]
Section 414.828 [2009 c.867 §31; 2013 c.681 §50; repealed by 2013 c.365 §9 and 2013 c.640 §16]
Section 414.829 [2001 c.898 §5; 2003 c.14 §200; repealed by 2003 c.684 §13 and 2003 c.735 §5]
Section 414.830
Section 414.831 [2001 c.898 §5a; 2003 c.14 §201; 2003 c.684 §6; 2005 c.744 §37; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.833 [2001 c.898 §6; 2003 c.14 §202; repealed by 2003 c.735 §5]
Section 414.834 [2001 c.898 §7; 2003 c.14 §203; repealed by 2003 c.735 §5]
Section 414.835 [2001 c.898 §8; 2003 c.14 §204; repealed by 2003 c.735 §5]
Section 414.837 [2001 c.898 §10; 2003 c.14 §205; repealed by 2003 c.735 §5]
Section 414.839
Section 414.840
Section 414.841 [Formerly 735.720; 2011 c.70 §1; 2011 c.700 §2; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.842 [Formerly 735.722; 2011 c.70 §2; 2011 c.700 §6; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.844 [Formerly 735.724; 2011 c.70 §3; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.846 [Formerly 735.726; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.848 [Formerly 735.728; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.850
Section 414.851 [Formerly 735.730; 2011 c.700 §4; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.852 [Formerly 735.731; repealed by 2013 c.681 §65 and 2013 c.640 §21]

HOSPITAL ASSESSMENT

Section 414.853 - Definitions.
Section 414.854 [Formerly 735.732; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.855 - Hospital assessment; rates; rules.
Section 414.856 [Formerly 735.733; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.857 - Reduction in rate required by federal law.
Section 414.858 [Formerly 735.734; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.860
Section 414.861 [Formerly 735.736; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.862 [Formerly 735.738; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.863 - Refund of hospital assessment; right to contested case hearing.
Section 414.864 [Formerly 735.740; 2011 c.70 §4; repealed by 2013 c.681 §65 and 2013 c.640 §21]
Section 414.865 - Audits.
Section 414.866 [Formerly 735.750; 2011 c.70 §5; repealed by 2013 c.681 §65, 2013 c.640 §21 and 2013 c.688 §98]
Section 414.867 - Deposit of assessments collected to Hospital Quality Assurance Fund.
Section 414.868 [Formerly 735.752; 2011 c.70 §6; repealed by 2013 c.681 §65, 2013 c.640 §§20,21, 2013 c.688 §98 and 2013 c.698 §42]
Section 414.869 - Establishment of Hospital Quality Assurance Fund.
Section 414.870 [Formerly 735.754; repealed by 2013 c.681 §65, 2013 c.640 §21 and 2013 c.688 §98]
Section 414.871 - Applicability of hospital assessment.
Section 414.872 [Formerly 735.756; repealed by 2013 c.681 §65, 2013 c.640 §§20,21, 2013 c.688 §98 and 2013 c.698 §42]

MANAGED CARE ORGANIZATION ASSESSMENT

PENALTIES

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2019 Oregon Revised StatutesVolume : 11 - Juvenile Code, Human ServicesChapter 414 - Medical Assistance

2019 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 414 - Medical Assistance