Title 34, Human Services; Juvenile Code; Corrections

(1) As used in this section, “traditional health worker” includes any of the following: (a) A community health worker. (b) A personal health navigator. (c) A peer wellness specialist. (d) A peer support specialist. (e) A doula. (f) A tribal traditional health worker. (2) In consu…

As used in ORS 414.667 to 414.671: (1) “Doula” has the meaning given that term in ORS 414.025. (2) “Lactation counselor” has the meaning given that term in ORS 676.665. (3) “Lactation educator” has the meaning given that term in ORS 676.665. [2017 c.281 §2; 2025 c.539 §6]

(1) In determining the types and extent of health care and services to be provided to medical assistance recipients under ORS 414.065, the Oregon Health Authority and a coordinated care organization shall ensure that recipients have access to services provided by doulas, lactatio…

(1) The Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall in each even-numbered year review, and revise if necessary, any rates of reimbursement in the state medical assistance program for doulas. When reviewing and revising rates of r…

(1) No later than September 15 of each even-numbered year, the Oregon Health Authority, in coordination with the Traditional Health Workers Commission, shall report on the status of doulas in this state, in the manner provided in ORS 192.245, to the interim committees of the Legi…

A medical assistance program shall consider tribal-based practices for mental health and substance abuse prevention, counseling and treatment services for members who are Native American or Alaska Native as equivalent to evidence-based practices for purposes of meeting standards …

(1) A coordinated care organization shall provide an initial health assessment on any child enrolled in the coordinated care organization who is in the custody of the Department of Human Services no later than 60 days after the date that the Oregon Health Authority notifies the c…

(1) As used in this section: (a) “Practice of pharmacy” has the meaning given that term in ORS 689.005. (b) “Retail drug outlet” has the meaning given that term in ORS 689.005. (2) The Health Evidence Review Commission is established in the Oregon Health Authority, consisting of …

(1) The Health Evidence Review Commission shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers the commission determines necessary for the performance of the functions of the offices. (2) A majority of the members of…

(1) The Health Evidence Review Commission shall regularly solicit testimony and information from stakeholders representing consumers, advocates, providers, carriers and employers in conducting the work of the commission. (2) The commission shall actively solicit public involvemen…

The Health Evidence Review Commission shall review the coverage described in ORS 743A.067 (2) and, no later than November 1 of each even-numbered year, report to the interim committees of the Legislative Assembly related to health any recommended changes to the coverage described…

(1) As used in this section and ORS 414.698: (a) “Medical technology” means medical equipment and devices, medical or surgical procedures and techniques used by health care providers in delivering medical care to individuals, and the organizational or supportive systems within wh…

(1) The Health Evidence Review Commission shall conduct comparative effectiveness research of medical technologies selected in accordance with ORS 414.695. The commission may conduct the research by comprehensive review of the comparative effectiveness research undertaken by reco…

(1) As used in this section, “peer-reviewed medical literature” has the meaning given that term in ORS 414.690. (2) The Health Evidence Review Commission, in ranking health services or developing guidelines under ORS 414.690 or in assessing medical technologies under ORS 414.698,…

The Health Evidence Review Commission shall consult with an advisory committee in determining priorities for mental health care and chemical dependency. The advisory committee shall include mental health and chemical dependency professionals who provide inpatient and outpatient m…

Within available funds and subject to the rules of the Oregon Health Authority, medical assistance shall be provided to an individual who is a resident of this state and who: (1) Is receiving a category of aid; (2) Would be eligible for a category of aid but is not receiving a ca…

If insufficient resources are available during a biennium, the population of eligible persons receiving health services may not be reduced below the population of eligible persons approved and funded in the legislatively adopted budget for the Oregon Health Authority for the bien…

The following services are not subject to ORS 414.690: (1) Nursing facilities, institutional and home- and community-based waivered services funded through the Department of Human Services; and (2) Services to children who are wards of the Department of Human Services by order of…

The Oregon Health Authority shall provide health services under ORS 414.591, 414.631 and 414.688 to 414.745 to eligible persons who are determined eligible for medical assistance as defined in ORS 414.025. The Oregon Health Authority shall also provide the following: (1) Ombudsma…

(1) As used in this section: (a) “Interdisciplinary team” means a group composed of the following individuals who are trained or certified in palliative care: (A) A case manager who is a registered nurse licensed under ORS 678.010 to 678.415; (B) A medical social worker; and (C) …

The Oregon Health Authority shall adopt by rule requirements for coordinated care organizations to provide housing navigation services and address the social determinants of health through care coordination. [2021 c.667 §11] Note: 414.719 was enacted into law by the Legislative A…

(1) As used in this section: (a) “Coordinated care organization” and “medical assistance” have the meanings given those terms in ORS 414.025. (b) “Post-hospital extended care benefit” means short-term medical assistance provided for an individual’s stay in a skilled nursing facil…

(1) As used in this section: (a)(A) “Audio only” means the use of audio telephone technology, permitting real-time communication between a health care provider and a patient for the purpose of diagnosis, consultation or treatment. (B) “Audio only” does not include: (i) The use of…

(1) As used in this section: (a) “Certified health care interpreter” has the meaning given that term in ORS 413.550. (b) “Qualified health care interpreter” has the meaning given that term in ORS 413.550. (2) The Oregon Health Authority shall adopt rules to ensure that a coordina…

For services provided on a fee-for-service basis to persons who are entitled to receive medical assistance, the Oregon Health Authority shall reimburse Type A and Type B hospitals and rural critical access hospitals, as described in ORS 442.470 and identified by the Office of Rur…

(1) If insufficient resources are available during a contract period: (a) The population of eligible persons determined by law may not be reduced. (b) The reimbursement rate for providers and plans established under the contractual agreement may not be reduced. (2) In the circums…

The Oregon Health Authority may not establish capitation rates or global budgets that include payment for mental health drugs. The authority shall reimburse pharmacy providers for mental health drugs only on a fee-for-service payment basis. [2003 c.810 §11; 2009 c.595 §336; 2011 …

(1) Except as provided in subsection (2) of this section, a coordinated care organization that does not have a contract with a hospital to provide inpatient or outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745 must, using Medicare payment methodology,…

Any health care provider or plan contracting to provide services to the eligible population under ORS 414.591, 414.631 and 414.688 to 414.745 shall not be subject to criminal prosecution, civil liability or professional disciplinary action for failing to provide a service which t…

The Oregon Health Authority shall establish fee-for-service reimbursement rates for inpatient hospital services provided by hospitals that receive Medicare reimbursement on the basis of diagnostic related groups as follows: (1) For the period from October 1, 2009, through Septemb…

The Oregon Health Authority shall ensure that the Oregon Health and Science University receives net reimbursement of at least 87 percent but no more than 100 percent of the university’s costs of providing services that are paid for, in whole or in part, with Medicaid funds. Net r…

(1) The Oregon Health Authority shall provide reimbursement in the state’s medical assistance program for services provided by patient centered primary care homes and behavioral health homes. If practicable, efforts to align financial incentives to support patient centered primar…

Notwithstanding ORS 414.065 and 414.690, a coordinated care organization and the Oregon Health Authority shall provide to medical assistance recipients who are 18 years of age or younger the devices and services described in ORS 743A.140 and 743A.141. [2023 c.424 §2]

(1) As used in this section: (a) “Child abuse assessment” has the meaning given that term in ORS 418.782. (b) “Children’s advocacy center” has the meaning given that term in ORS 418.782. (c) “Forensic interview” has the meaning given that term in ORS 418.782. (2) The Oregon Healt…

(1) As used in this section, “prescription contraceptive” means a drug or device that requires a prescription and is approved by the United States Food and Drug Administration to prevent pregnancy. (2) In determining the extent of prescription drugs to be provided in medical assi…

(1) The Oregon Health Authority may reimburse a pharmacist or pharmacy for any health service: (a) Provided to a medical assistance recipient who is not enrolled in a coordinated care organization or a prepaid managed care health services organization; (b) That is within the lawf…

Every three years, the Oregon Health Authority shall: (1) Conduct a survey of retail pharmacy providers that are enrolled as Medicaid providers in the state medical assistance program to determine the costs of the providers for dispensing prescription drugs; and (2) If the survey…

(1) Notwithstanding ORS 414.065 and 414.690, a coordinated care organization must provide behavioral health services to its members that include but are not limited to all of the following: (a) For a member who is experiencing a behavioral health crisis: (A) A behavioral health a…

The Oregon Health Authority shall contract with a third-party vendor to survey medical assistance recipients about their experiences with behavioral health care and services using a standardized survey tool. [2021 c.667 §9] Note: 414.767 was enacted into law by the Legislative As…

(1) As used in this section, “gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence between the individual’s gender identity and the individual’s sex as…

(1) As used in this section: (a) “Approved clinical trial” has the meaning given that term in ORS 743A.192. (b) “Routine health care”: (A) Means the types and extent of health care and services that the Oregon Health Authority requires to be provided in medical assistance in acco…

(1) The Oregon Health Authority may not require a primary care provider to order a covered care management service, as listed in the schedule developed under subsection (2) of this section, as a condition of reimbursing the costs of the service when: (a) The service is provided t…

(1) As used in this section, “step therapy” means a drug protocol in which the cost of a prescribed drug is reimbursed only if the patient has first tried a specified drug or series of drugs. (2) A coordinated care organization that requires step therapy shall make easily accessi…

(1) A claim for reimbursement for a behavioral health service or a physical health service provided to a medical assistance recipient may not be denied by the Oregon Health Authority or a coordinated care organization on the basis that the behavioral health service and physical h…

(1) At least once each biennium, the Oregon Health Authority shall conduct a nursing market study for the purpose of determining the appropriate Medicaid reimbursement rates for providers of private duty nursing for medically fragile children. (2) No later than July 1 each year, …

Notwithstanding ORS 414.065 and 414.690, medical assistance provided to a member of a coordinated care organization or a medical assistance recipient who is not enrolled in a coordinated care organization shall include the testing and treatment, as described in ORS 689.662, perfo…

(1) As used in this section, “licensed art therapist,” “licensed certified art therapist” and “provisional licensed art therapist” have the meanings given those terms in ORS 681.740. (2) The Oregon Health Authority and a coordinated care organization shall provide reimbursement i…

(1) As used in this section: (a) “Behavioral health coverage” means mental health treatment and services and substance use disorder treatment or services reimbursed by a coordinated care organization. (b) “Coordinated care organization” has the meaning given that term in ORS 414.…

The Oregon Health Authority shall reimburse the cost of co-occurring mental health and substance use disorder treatment services paid for on a fee-for-service basis at an enhanced rate based on: (1) Existing reimbursement codes used for co-occurring disorder treatments; (2) Clini…

The Oregon Health Authority, with the advice of stakeholders and the Alcohol and Drug Policy Commission, may establish minimum rates of reimbursement paid by the authority or coordinated care organizations to addiction treatment providers to ensure medical assistance recipients’ …