Chapter 414 — Chapter 414

ORS 414.728 Reimbursement of rural hospitals on fee-for-service basis. 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 Rural Health as rural hospitals, fully for the cost of covered services based on the most recent audited Medicare cost report for Oregon hospitals adjusted to reflect the Medicaid mix of services. [2005 c.806 §4; 2009 c.595 §327; 2011 c.602 §43]

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ORS 414.730 [1989 c.836 §7; 1995 c.79 §209; 2005 c.22 §286; 2011 c.720 §148; renumbered 414.704 in 2011]

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ORS 414.735 Reduction in scope of health services in event of insufficient resources; approval of Legislative Assembly or Emergency Board; notice to providers. (1) If insufficient resources are available during a contract period

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ORS 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c.720 §150; 2013 c.688 §80; 2015 c.3 §46; 2015 c.27 §45; 2015 c.792 §7; 2015 c.798 §13; 2017 c.273 §7; 2017 c.618 §7; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]

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ORS 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]

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ORS 414.738 [2003 c.810 §5; 2009 c.595 §332; 2015 c.318 §23; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]

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ORS 414.739 [2003 c.810 §5a; 2009 c.595 §333; 2015 c.318 §24; repealed by 2011 c.602 §§64,70, 2012 c.8 §23 and 2015 c.792 §2]

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ORS 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c.810 §6; 2009 c.595 §334; 2012 c.8 §26; 2013 c.688 §81; 2015 c.3 §47; 2015 c.798 §14; 2017 c.273 §8; 2017 c.618 §8; repealed by 2011 c.602 §§64,70; 2012 c.8 §23 and 2015 c.792 §2]

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ORS 414.741 [2003 c.810 §9; 2009 c.595 §335; repealed by 2011 c.720 §228]

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ORS 414.742 Payment for mental health drugs. 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 c.602 §46]

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ORS 414.743 Payment to noncontracting hospital by coordinated care organization; rules. (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, reimburse the noncontracting hospital for services provided to a member of the organization at a rate no less than a percentage of the Medicare reimbursement rate for those services. The percentage of the Medicare reimbursement rate that is used to determine the reimbursement rate under this subsection is equal to four percentage points less than the percentage of Medicare cost used by the Oregon Health Authority in calculating the base hospital capitation payment to the organization, excluding any supplemental payments

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ORS 414.744 [2003 c.810 §13; repealed by 2009 c.595 §1204]

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ORS 414.745 Liability of health care providers and plans. 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 the Legislative Assembly has not funded or has eliminated from its funding pursuant to ORS 414.735. [1989 c.836 §10; 1991 c.753 §10]

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ORS 414.746 [2009 c.867 §15; 2009 c.828 §49; 2011 c.602 §48; 2013 c.608 §11; repealed by 2013 c.608 §12]

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ORS 414.747 [2003 c.810 §15; renumbered 414.326 in 2011]

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ORS 414.750 [1989 c.836 §18; 1991 c.753 §11; 2009 c.595 §340; repealed by 2013 c.688 §98]

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ORS 414.751 [1997 c.683 §35; 2001 c.69 §2; 2009 c.595 §341; renumbered 414.229 in 2009]

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ORS 414.755 Payment for hospital services. 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

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ORS 414.756 The Oregon Health Authority shall ensure that the Oregon Health and Science University receives net reimbursement of at least 84 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 reimbursement means all Medicaid payments less any amount that is transferred by the university to the authority

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ORS 414.760 Payment for patient centered primary care home and behavioral health home services. (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 primary care homes and behavioral health homes for enrollees in medical assistance programs should be aligned with efforts of the learning collaborative described in ORS 413.259 (3)

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ORS 414.761 Payment for bilateral cochlear implants, hearing aids and hearing assistive technology systems for minors. 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]

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ORS 414.762 Payment for child abuse assessment. (1) As used in this section

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ORS 414.763 Payment for dispensing of 12-month supply of prescription contraceptives. (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

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ORS 414.764 Payment for services provided by pharmacy or pharmacist. (1) The Oregon Health Authority may reimburse a pharmacist or pharmacy for any health service

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ORS 414.765 Periodic surveys of pharmacists regarding costs of dispensing prescription drugs. Every three years, the Oregon Health Authority shall

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ORS 414.766 Behavioral health treatment; rules. (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

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ORS 414.767 Survey of medical assistance recipients regarding experience with behavioral health care and services. 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]

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ORS 414.768 [2017 c.281 §3; renumbered 414.669 in 2019]

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ORS 414.769 Payment for gender-affirming treatment; rules. (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 assignment at birth

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ORS 414.770 Participants in clinical trials. (1) As used in this section

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ORS 414.771 Payment for certain registered nurse services without order from primary care provider. (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

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ORS 414.772 Limits on use of step therapy. (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

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ORS 414.773 Certain conditions on reimbursement of claims for behavioral health services prohibited; assignment of CCO member to primary care provider. (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 health service were provided on the same day or in the same facility, unless required by state or federal law

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ORS 414.774 Payment for private duty nursing services for medically fragile children; rules. (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

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ORS 414.775 Payment for COVID-19 testing and treatment. 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, performed or provided by a pharmacist. [2024 c.17 §2]

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ORS 414.776 Payment for behavioral health services provided by licensed art therapists, licensed certified art therapists and provisional licensed art therapists. (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

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ORS 414.780 Coordinated care organization reporting of data to assess compliance with mental health parity requirements; annual assessment. (1) As used in this section

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ORS 414.781 Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services. 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

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ORS 414.782 Reimbursement to ensure access to addiction treatment statewide. 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’ access, without delay, to all modalities of addiction treatment within each geographic region of this state. [2021 c.667 §8]

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ORS 414.805 Liability of individual for medical services received while in custody of law enforcement officer. (1) An individual who receives medical services while in the custody of a law enforcement officer is liable

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ORS 414.807 Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury. (1)(a) When charges and expenses are incurred for medical services provided to an individual for injuries related to law enforcement activity and subject to the availability of funds in the account, the cost of such services shall be paid by the Oregon Health Authority out of the Law Enforcement Medical Liability Account established in ORS 414.815 if the provider of the medical services has made all reasonable efforts to collect the amount, or any part thereof, from the individual who received the services

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ORS 414.810 [Formerly 414.040; renumbered 566.310]

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ORS 414.815 Law Enforcement Medical Liability Account; limited liability; rules; report. (1) The Law Enforcement Medical Liability Account is established separate and distinct from the General Fund. Interest earned, if any, shall inure to the benefit of the account. The moneys in the Law Enforcement Medical Liability Account are appropriated continuously to the Oregon Health Authority to pay expenses in administering the account and paying claims out of the account as provided in ORS 414.807

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ORS 414.820 [Formerly 414.050; renumbered 566.320]

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ORS 414.821 [2001 c.898 §1; 2003 c.14 §196; repealed by 2003 c.735 §5]

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ORS 414.823 [2001 c.898 §2; 2003 c.14 §197; repealed by 2003 c.735 §5]

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ORS 414.825 [2001 c.898 §3; 2003 c.14 §198; repealed by 2013 c.365 §9 and 2013 c.640 §16]

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ORS 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]

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ORS 414.827 [2001 c.898 §4; 2003 c.14 §199; repealed by 2003 c.735 §5]

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ORS 414.828 [2009 c.867 §31; 2013 c.681 §50; repealed by 2013 c.365 §9 and 2013 c.640 §16]

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