Oregon Administrative Code

943-060-0050 ORS 190 Agreements (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 …

943-060-0060 Contract Amendments 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 descr…

943-060-0070 Payment Authorization for Cost Overruns for Services Contracts (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 aggr…

943-060-0080 Purchases Through Federal Programs (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, …

943-060-0090 Buy Decision (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 priori…

943-060-0100 Special Procurements (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…

943-060-0110 Special Procurements by Rule (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 applicab…

943-060-0120 Grant Authority 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 involvemen…

943-120-0100 Definitions The following definitions apply to OAR 943-120-0100 through 943-120-0200: (1) "Access" means the ability or means necessary to read, write, modify, or communicate data or information or otherwise use any information system resource. (2) "Agent" means a th…

943-120-0110 Purpose (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. Thes…

943-120-0112 Scope and Sequence of Electronic Data Transmission Rules (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 entit…

943-120-0114 Provider Enrollment Agreement (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…

943-120-0116 Web Portal Submitter (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 com…

943-120-0118 Conduct of Direct Data Entry Using Web Portal (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 …

943-120-0120 Registration Process — EDI Transactions (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 admin…

943-120-0130 Trading Partner as EDI Submitter — EDI Transactions (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…

943-120-0140 Trading Partner Agents as EDI Submitters — EDI Transactions (1) Responsibility for Agents. If a trading partner uses the services of an agent, including but not limited to an EDI submitter in any capacity in order to receive, transmit, store, or otherwise process dat…

943-120-0150 Testing — EDI Transactions (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. …

943-120-0160 Conduct of Transactions — EDI Transactions (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…

943-120-0165 Pharmacy Point of Sale Access 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. Statutory/Other Authority: ORS 413.042 & 414.065 Statutes/Other Implemen…

943-120-0170 Security (1) Individually Identifiable Health Information. All providers, CCOs, PHPs, and allied agencies are responsible for ensuring the security of individually identifiable health information, consistent with the requirements of the privacy statutes and regulatio…

943-120-0180 Record Retention and Audit (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 …

943-120-0190 Material Changes (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 c…

943-120-0200 Authority System Administration (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…

943-120-0300 Definitions In addition to the definitions in OAR chapter 410 division 120, the following definitions apply to OAR 943-120-0300 to 943-120-0350: (1) "Claim" means a bill for services, a line item of a service, or all services for one client within a bill. Claim inclu…

943-120-0310 Provider Requirements (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 9…

943-120-0320 Provider Enrollment (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 wit…

943-120-0330 Billing Procedures (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 f…

943-120-0350 Payments and Overpayments (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 establi…

943-120-1505 Audits and Overpayment Recovery Providers or contractors receiving payments from or through the Oregon Health Authority are subject to audit or other post payment review procedures for all payments applicable to items or services furnished or supplied by the provider…

944-001-0000 Purpose (1) These rules prescribe general minimum operational standards including services and supports provided by the Behavioral Health Resource Networks (BHRN). (2) These rules prescribe the formation, implementation, and operation of Behavioral Health Resource Ne…

944-001-0010 Definitions (1) "Access to Care Grants" means funds distributed by the Oversight and Accountability Council and Oregon Health Authority through direct award or request for grant proposal for purposes of increasing access to one or more of the services described in SB…

944-001-0020 Operational, Policy, and Service and Support Requirements of Behavioral Health Resource Networks (1) Each Behavioral Health Resource Network (BHRN) or applicant to receive funding as a BHRN must fulfill all requirements of SB 755, Section 2(2)(d) and basic operationa…

944-001-0030 Formation of Behavioral Health Resource Networks and Funding for Behavioral Health Resource Networks (1) Organizations, local governments, the Nine Federally Recognized Tribes of Oregon, and the Urban Indian Health Program may seek to establish a Behavioral Health Re…

944-001-0040 Data collecting and reporting requirements for Behavioral Health Resource Networks and recipients of grants or funds (1) Financial recordkeeping and reporting is required as follows: (a) BHRNs and Access to Care grants and funding recipients must keep accurate books,…

944-010-0000 Behavioral Health Resource Networks (1) These rules prescribe general criteria and requirements for each Behavioral Health Resource Network (BHRN), individually and jointly, including the requirements to collect and report information necessary for the Secretary of S…

944-010-0010 Definitions (1) "ASAM Criteria" means the Fourth Edition of the American Society of Addiction Medicine (ASAM) for the Treatment of Addictive, Substance-related, and Co-Occurring Conditions, which is a clinical guide to develop patient-centered service plans and make …

944-010-0020 Operational, Policy, and Service and Support Requirements of Behavioral Health Resource Networks (1) An entity that receives funding under ORS 430.389(2) must: (a) Provide services in compliance with ORS 430.389 and these rules; (b) Maintain, implement, and formalize…

944-010-0030 Screenings (1) Screening services provided by an entity funded under ORS 430.389(2) must be provided by a Peer Support Specialist, Certified Recovery Mentor, Peer Wellness Specialist, or other addiction professional acting within their scope of practice to determine …

944-010-0040 Comprehensive Behavioral Health Needs Assessments (1) Comprehensive behavioral health needs assessment services provided by an entity funded under ORS 430.389(2) must include a substance use disorder screening to determine if an individual has been appropriately diag…

944-010-0050 Ongoing Peer Counseling and Support (1) Each Behavioral Health Resource Network must provide the following ongoing peer counseling and support services, but no single funded entity is required to provide all of the services: (a) Implementation of individual intervent…

944-010-0060 Harm Reduction Services, Information and Education (1) Harm reduction services provided by an entity funded under ORS 430.389(2) must be low-barrier and must reduce the negative individual and public health outcomes of substance use and substance related harm. (2) Ha…

944-010-0070 Low-Barrier Substance Use Treatment (1) An entity funded under ORS 430.389(2) to provide low-barrier substance use treatment: (a) Can not: (A) Have programmatic barriers such as lengthy intake, appointment requirements, assessments or treatment planning sessions. (B)…

944-010-0080 Transitional and Supportive Housing for Individuals with Substance Use (1) An entity funded under ORS 430.389(2) to provide transitional and supportive housing for individuals with substance use disorders must prior to providing housing conduct an assessment of an in…

944-010-0090 Data collecting and reporting requirements for recipients of grants or funds (1) An entity that receives funding under ORS 430.389(2) must: (a) Keep accurate books records and accounts in accordance with Generally Acceptable Accounting Procedures (GAAP) that are subj…

944-020-0000 Grant Application Process for Drug Treatment and Recovery Services Funds (1) The Oregon Health Authority (the Authority) must implement a grant application and award for funding entities to provide services described in OAR 944-010-0030 to 944-010-0080 that includes …

944-020-0010 Grant Application Review Criteria (1) The Authority’s grant review panel will review and evaluate each grant application based on the following criteria: (a) If the grantee has previously received DTRSF funding, the effectiveness of services provided. (b) The demonst…

944-020-0020 Grant Approval Process (1) OHA shall determine funding awards under ORS 430.389. The Authority may consult the OAC on funding priorities and distributions but retains final decision-making authority. (2) Any applicants selected for funding by the Authority will be no…

944-020-0030 Appeal of Denial of Grant (1) For applications submitted to the Authority before January 1, 2026, applicant that was notified that they did not meet minimum grant application criteria or did not receive a minimum evaluation score, can submit a written request to the …

945-001-0002 Definitions The following definitions govern the meaning of terms used in administrative rules in this chapter, except where the context otherwise requires: (1) “Advance payments of the premium tax credit” means payment of the federal health insurance premium tax cre…