Oregon Administrative Code

945-001-0006 Notice of Proposed Rulemaking and Adoption of Temporary Rules (1) Except as provided in ORS 183.335(7) or (12) or 183.341, before permanently adopting, amending, or repealing an administrative rule, the Oregon Health Insurance Marketplace shall give notice of the int…

945-020-0010 Purpose; Applicability (1) The purpose of OAR chapter 945, division 20 is to establish the process for certification of: (a) Health plans as qualified health plans (QHPs); and (b) Standalone dental plans (SADPs) as providing pediatric dental benefits. (2) Except for …

945-020-0020 Certification of QHPs and Marketplace SADPs (1) Each health benefit plan or dental plan offered through the Oregon Health Insurance Marketplace must have in effect a certification issued by the Marketplace. This certification evidences that the health benefit plan is…

945-020-0025 Certification of Non-Marketplace Stand-alone Dental Plans This rule applies only to SADPs offered outside the Marketplace. The Marketplace will, upon satisfaction of the following criteria, certify as providing pediatric dental benefits a stand alone dental plan (SAD…

945-020-0030 Enrollment Authority of the Director In the event that an insurer ceases to provide qualified health plan coverage or ceases to offer one or more qualified health plans under a qualified health plan product through the health insurance exchange, the Director shall ha…

945-020-0040 QHP Addendum for Indian Health Care Providers (1) If a health insurer contracts with a Tribal Health Provider in the state of Oregon for services provided through a Marketplace QHP, the insurer shall: (a) Use the QHP Addendum for Indian Health Care Providers, Exhibit…

945-030-0010 Purpose The purpose of division 30 is to establish a process for the adoption of an administrative charge to be paid by health insurers offering a qualified health plan or stand alone dental plan through the Marketplace to pay the administrative and operational expen…

945-030-0030 Administrative Charge on Insurers and Health Care Service Contractors (1) Effective January 1, 2015, each health insurer or health care service contractor offering: (a) Qualified health plans through the Marketplace shall pay a monthly administrative charge equal to …

945-030-0040 Assessment and Collection of Administrative Charge on Insurers (1) By the last Wednesday of each month, an insurer shall report to the Marketplace the insurer’s effectuated enrollment as of 11:59 PM on the 15th of the month and the anticipated effectuated enrollment …

945-030-0045 Administrative Assessment on State Programs (1) The administrative assessment on state programs shall be established in an Intergovernmental Agreement between the Marketplace and the Oregon Health Authority. (2) The administrative assessment, expressed as a per membe…

945-040-0020 Eligibility for Enrollment in a Qualified Health Plan in the Individual Market (1) To qualify for enrollment in a qualified health plan in the individual market, an applicant must: (a) Be a United States citizen or national, or a lawfully present non-citizen; (b) Be …

945-040-0030 Eligibility for the Small Business Health Options Program (SHOP) (1) To qualify for the Marketplace’s Small Business Health Options Program (SHOP), a small employer must: (a) Meet the definition of small employer in ORS 743.730; (b) At a minimum, offer coverage in a …

945-040-0040 Eligibility for Insurance Affordability Programs (1) Advance Payments of the Premium Tax Credit. In order to qualify for advance payments of the premium tax credit, a tax filer must have household income greater than or equal to 100 percent, but not more than 400 per…

945-040-0050 Eligibility Standards for Special Populations (1) Advance Payments of the Premium Tax Credit for Lawfully Present Noncitizens Ineligible for Medicaid. The Marketplace must determine a tax filer eligible for advance payments of the premium tax credit if he or she: (a)…

945-040-0160 Appeal to the United States Department of Health and Human Services If an appellant disagrees with the appeal decision of the Exchange, he or she may make an appeal request to HHS within 30 days of the date of the notice of appeal decision through any of the methods …

950-020-0000 Purpose (1) These rules establish uniform standards for Regional Health Equity Coalitions (RHECs) and support alignment to the RHEC model. The Oregon Health Authority (OHA) is a funding partner for Regional Health Equity Coalitions. (2) The RHECs act as a link betwee…

950-020-0010 Definitions (1) Regional health equity coalitions are: (a) Autonomous, community-led, cross-sector groups focused on addressing health inequities experienced by priority populations, at the policy, system, and environmental levels, with the leading priority being com…

950-020-0020 Grants (1) The Authority establishes and enters into partnership with Regional Health Equity Coalitions through a competitive solicitation process that includes participation of existing RHEC’s. (2) The Authority shall award grants to RHECs consistent with legislativ…

950-030-0000 Purpose These rules establish uniform standards and practices for the collection of data on race, ethnicity, preferred spoken or signed and preferred written language, disability, sexual orientation and gender identity by the Oregon Health Authority (OHA) and others …

950-030-0010 Definitions The following definitions apply to OAR 950, divisions 30 and 38: (1) “Caregiver” means a person, paid or unpaid, related or unrelated, who acts on behalf of or cares for the individual. (2) “Contractor” means a person or governmental entity who has a lega…

950-030-0020 Demographic Data Collection Standards (1) To the greatest extent practicable, all programs and activities of the Oregon Health Authority (OHA), including activities to promote workforce diversity, and any data collection or reporting OHA does on behalf of other state…

950-030-0030 Race and Ethnicity Demographic Data Collection Standard (1) A requestor must ask an open-ended question: "How do you identify your race, ethnicity, tribal affiliation, country of origin, or ancestry?" (2) A requestor must ask an “Which of the following describes your…

950-030-0040 Language and Communication Needs Demographic Data Collection Standards (1) A requestor is only required to ask a child under the age of five or an adult answering on behalf of a child under the age of five to answer the questions in section (2) of this rule when the …

950-030-0050 Disability Demographic Data Collection Standards (1) A requestor must ask the following questions regarding functional limitations of individuals of any age, except as specified in section (9) of this rule: (a) "Are you deaf or do you have serious difficulty hearing?…

950-030-0060 Sexual Orientation and Gender Identity (SOGI) Demographic Data Collection Standards (1) A requestor must ask the questions in this rule using the following age-based guidelines: (a) For individuals under age 5, a requestor must ask the question in section (4) of this…

950-030-0200 Reporting Progress on Implementation (1) All programs of the Oregon Health Authority (OHA) that collect demographic data must report to the OHA Equity and Inclusion Division in February of each even numbered year. Reports shall include information about each program’…

950-033-0000 REALD & SOGI Grant Program (1) Establishes the REALD & SOGI Grant Program Rules. The Program offers grants supporting safe data collection by community health organizations and community-based groups with demonstrated experience serving tribal communities, communitie…

950-033-0010 Definitions The following definitions apply to OAR 950-033-0000 to 950-033-0045, unless otherwise noted: (1) “Awardee” means an applicant that is selected for a grant award through the REALD & SOGI grant program. (2) “Grant agreement” means a legal document agreed to…

950-033-0020 Grant Announcement The Oregon Health Authority must announce availability of funding from the REALD & SOGI Grant Program and the announcement must include: (1) Available funding; (2) Eligible entities and services; (3) Term of the grant; (4) Template grant agreement;…

950-033-0025 Eligible Entities and Eligible Services Community health organizations and community-based groups in Oregon are eligible to apply for the REALD & SOGI grant. In accordance with ORS 413.166. The Oregon Health Authority, Equity and Inclusion Division encourages grant a…

950-033-0030 Application Criteria An application for REALD & SOGI grant funding must contain all information required by OHA in the grant solicitation, including but not limited to: (1) A detailed scope of work that provides a description of the services to be offered or training…

950-033-0035 Evaluation and Review Process (1) The Oregon Health Authority, Equity and Inclusion Division, REALD & SOGI section shall appoint a grant review panel. (2) The grant review panel will review and evaluate each grant application based on the following criteria: (a) If t…

950-033-0040 Grant Approval Process (1) Awards may be funded in-whole or in-part. (2) Any applicants not funded will be notified in writing by the Oregon Health Authority, Equity and Inclusion Division . Statutory/Other Authority: ORS 413.446 Statutes/Other Implemented: ORS 413.4…

950-033-0045 Appeal of Denial of Grant (1) An applicant that was not awarded a grant may submit a written appeal request to Oregon Health Authority, Equity and Inclusion Division, REALD & SOGI section within five (5) business days after receiving the notice. A written appeal requ…

950-038-0010 REALD and SOGI Advisory Committee (1) The Authority and Department may create and implement shared or parallel definitions, policies, procedures and practices that expand on the minimum criteria of these rules. (2) The Authority, in collaboration with the Department,…

950-040-0000 Cultural Competency Continuing Educaton Purpose OAR chapter 950, division 40 defines requirements for the Oregon Health Authority to provide education resources and support to identified healthcare provider Boards for improving the cultural competence of regulated he…

950-040-0010 Definitions The following definitions apply to OAR 950-040-0000 through 950-040-0020: (1) “Authority” means the Oregon Health Authority. (2) “Continuing Education” means a unit or units of education as defined by the Authority or the specified Boards listed in ORS 67…

950-040-0020 Cultural Competency Continuing Education Resources and Support (1) The Authority, through its Office of Equity and Inclusion, shall create, maintain and make available a registry of approved continuing education opportunities for developing cultural competence for re…

950-050-0000 Purpose (1) These rules establish the Health Care Interpreter (HCI) program, a central registry, and a process for certification and qualification of health care interpreters for persons with limited English proficiency, those who prefer to communicate in a language …

950-050-0010 Definitions As used in chapter 950, division 50 the following definitions apply: (1) "Applicant" means any individual who applies for qualification or certification as a health care interpreter under these rules. (2) “Authority” means the Oregon Health Authority. (3)…

950-050-0020 Health Care Interpreter Services Any individual providing health care interpreting services as defined in this division may voluntarily meet the eligibility standards established in OAR 950-050-0040 and be: (1) Added to the central registry; and (2) Issued a valid le…

950-050-0030 Central Registry (1) The Authority shall maintain a central registry of individuals who are certified or qualified to provide health care interpreting services as provided in OAR 950-050-0020. (2) The Oregon Health Authority shall maintain a list of languages for whi…

950-050-0040 Eligibility Standards for Central Registry Enrollment, Qualification and Certification (1) To be enrolled in the Health Care Interpreter (HCI) central registry, an individual must: (a) Be at least 18 years of age. (b) Reside in the United States. (c) Have at least a …

950-050-0050 Application Procedure (1) Upon request, the Authority shall provide a link to the Health Workforce Registry Applicant Portal or a link to the Health Care Interpreter (HCI) application packet to any individual seeking certification or qualification as an HCI. Applicat…

950-050-0060 Formal Training Documentation and Approval of Training Programs (1) Applicants seeking Health Care Interpreter (HCI) certification or qualification shall provide written verification of the successful completion of at least 60 hours of Authority-approved formal train…

950-050-0070 Approval of Testing Centers, Skill Evaluation and Assessment (1) The Authority shall enter into a memorandum of agreement with interpreter certification testing centers and language proficiency testing centers establishing the manner and means for testing Oregon appl…

950-050-0080 Skill Evaluation or Assessment Appeal (1) Applicants who fail to pass a test at an Authority-approved testing center may appeal the results with the testing center directly and pay any fees associated with the appeal. (2) The testing center’s determination is final. …

950-050-0090 Continuing Education (1) To qualify for central registry renewal, certified and qualified health care interpreters shall sign and submit to the Authority the designated forms and verification showing the individual has completed the required continuing education. (2)…

950-050-0100 Letter of Qualification (1) If the Authority determines that the qualification requirements in OAR 950-050-0040, 950-050-0050, and 950-050-0060 and any applicable renewal requirements have been met, a letter of qualification shall be issued. (2) Letters of qualificat…

950-050-0110 Letter of Certification (1) If the Authority determines that the certification requirements in OAR 950-050-0040, 950-050-0050 and 950-050-0060 and any applicable renewal requirements have been met, a letter of certification shall be issued. (2) Letters of certificati…