Chapter 414 — Chapter 414

ORS 414.060 [1953 c.204 §3; renumbered 414.830 and then 566.330]

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ORS 414.065 Determination of health services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules. (1)(a) Consistent with ORS 414.690, 414.710, 414.712 and 414.766 and other statutes governing the provision of and payments for health services in medical assistance, the Oregon Health Authority shall determine, subject to such revisions as it may make from time to time and to legislative funding

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ORS 414.066 Billing patient for services covered by medical assistance prohibited. (1) A health care provider may not bill or solicit payment from a medical assistance applicant or recipient for services, except for copayments or other charges authorized by the Oregon Health Authority by rule

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ORS 414.067 Coordinated care organization assumption of costs; reports to Legislative Assembly. (1) If the Oregon Health Authority or the Department of Human Services requires a coordinated care organization to provide a service, paid for out of the organization’s global budget, that was previously reimbursed by the authority or the department on a fee-for-service basis, the authority or the department must provide the organization with a statement of the costs incurred by the authority or the department in reimbursing the service during the three-year period prior to the organization’s assumption of the cost of the service

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ORS 414.070 [1953 c.204 §4; renumbered 414.840 and then 566.340]

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ORS 414.071 Timely payment for dental services. The Oregon Health Authority and the Department of Human Services shall approve or deny prior authorization requests for dental services not later than 30 days after submission thereof by the provider, and shall make payments to providers of prior authorized dental services not later than 30 days after receipt of the invoice of the provider. [Formerly 411.459]

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ORS 414.072 Prior authorization data and reports. (1) As used in this section, “coordinated care organization” has the meaning given that term in ORS 414.025

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ORS 414.073 [1971 c.188 §2; 1991 c.66 §14; 2009 c.595 §277; renumbered 411.463 in 2009]

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ORS 414.074 Timely prior authorization determinations for repair of complex rehabilitation technology. (1) As used in this section, “complex rehabilitation technology” means manual or power wheelchair systems, adaptive seating systems, alternative positioning systems, adaptive strollers, standing frames, gait trainers or specifically designated options or accessories that are

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ORS 414.075 Payment of deductibles imposed under federal law. Medical assistance provided to any individual who is covered by the hospital insurance benefits or supplementary health insurance benefits, or either of them, as established by federal law, may include

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ORS 414.080 [1953 c.204 §5; renumbered 414.850 and then 566.350]

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ORS 414.085 [1965 c.556 §10; 1991 c.66 §15; repealed by 2009 c.595 §1204]

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ORS 414.090 [1953 c.204 §6; renumbered 414.860 and then 566.360]

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ORS 414.095 Exemptions applicable to payments. Neither medical assistance nor amounts payable to vendors out of medical assistance funds are transferable or assignable at law or in equity and none of the money paid or payable under the provisions of this chapter is subject to execution, levy, attachment, garnishment or other legal process. [1965 c.556 §11; 1967 c.502 §14; 2001 c.900 §222; 2013 c.688 §71]

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ORS 414.105 [1965 c.556 §12; 1967 c.502 §15; 1969 c.507 §2; 1971 c.334 §1; 1973 c.334 §1; part renumbered 416.280; 1975 c.386 §4; 1985 c.522 §4; 1991 c.66 §16; 1993 c.249 §5; 1995 c.642 §1; 2001 c.620 §5; 2001 c.900 §223; 2007 c.70 §191; 2009 c.595 §278; renumbered 416.350 in 2009]

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ORS 414.106 [1995 c.642 §2; 2001 c.900 §224; 2009 c.595 §279; renumbered 416.351 in 2009]

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ORS 414.107 [1991 c.753 §5a; 1993 c.815 §15; repealed by 2009 c.595 §1204]

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ORS 414.109 Oregon Health Plan Fund. (1) The Oregon Health Plan Fund is established, separate and distinct from the General Fund. Interest earned by the Oregon Health Plan Fund shall be retained by the Oregon Health Plan Fund

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ORS 414.115 Medical assistance by insurance or service contracts; rules. (1) In lieu of providing one or more of the health care and services available under medical assistance by direct payments to providers thereof and in lieu of providing such health care and services made available pursuant to ORS 414.065, the Oregon Health Authority may use available medical assistance funds to purchase and pay premiums on policies of insurance, or enter into and pay the expenses on health care service contracts, or medical or hospital service contracts that provide one or more of the health care and services available under medical

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ORS 414.117 Premium assistance for health insurance coverage. Subject to funds available, the Oregon Health Authority may provide medical assistance in the form of premium assistance for the purchase of health insurance coverage provided by public programs or private insurance, including but not limited to medical assistance described in ORS 414.115. [Formerly 414.839]

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ORS 414.125 Rates on insurance or service contracts; requirements for insurer or contractor. (1) Any payment of available medical assistance funds for policies of insurance or service contracts shall be according to such uniform area-wide rates as the Oregon Health Authority shall have established and which it may revise from time to time as may be necessary or practical, except that, in the case of a research and demonstration project entered into under ORS 411.135 special rates may be established

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ORS 414.135 Contracts relating to direct providers of care and services. The Oregon Health Authority may enter into nonexclusive contracts under which funds available for medical assistance may be administered and disbursed by the contractor to direct providers of medical and remedial care and services available under medical assistance in consideration of services rendered and supplies furnished by them in accordance with the provisions of this chapter. Payment shall be made according to the rules of the authority pursuant to the number of days and the fees, charges and costs established under ORS 414.065. The contractor must guarantee the authority by written acknowledgment

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ORS 414.145 Implementation of ORS 414.115, 414.125 or 414.135. (1) The provisions of ORS 414.115, 414.125 or 414.135 shall be implemented whenever it appears to the Oregon Health Authority that such implementation will provide comparable benefits at equal or less cost than provision thereof by direct payments by the authority to the providers of medical assistance, but in no case greater than the legislatively approved budgeted cost per eligible recipient at the time of contracting

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ORS 414.150 Purpose of ORS 414.150 to 414.153. It is the purpose of ORS 414.150 to 414.153 to take advantage of opportunities to

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ORS 414.151 [1991 c.337 §2; 1993 c.18 §100; 2001 c.900 §101; 2009 c.595 §285; renumbered 411.435 in 2009]

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ORS 414.152 Duty of state agencies to work with local health departments. To capitalize on the successful public health programs provided by local health departments and the sizable investment by state and local governments in the public health system, state agencies shall encourage agreements that allow local health departments and other publicly supported programs to continue to be the providers of those prevention and health promotion services now available, plus other maternal and child health services such as prenatal outreach and care, child health services and family planning services to women and children who become eligible for poverty level medical assistance program benefits pursuant to ORS 414.153. [1991 c.337 §3; 2015 c.736 §59]

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ORS 414.153 Services provided by local health departments. In order to make advantageous use of the system of public health care and services available through local health departments and other publicly supported programs and to ensure access to public health care and services through contract under ORS chapter 414, the state shall

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ORS 414.205 [1967 c.502 §18; 1981 c.825 §1; repealed by 1995 c.727 §48]

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ORS 414.210 [1957 c.692 §1; repealed by 1963 c.631 §2]

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ORS 414.211 Medicaid Advisory Committee. (1) There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor

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ORS 414.215 [1967 c.502 §19; 1991 c.66 §21; repealed by 1995 c.727 §48]

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ORS 414.220 [1957 c.692 §2; repealed by 1963 c.631 §2]

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ORS 414.221 Duties of committee. The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on

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ORS 414.225 Oregon Health Authority to consult with committee. The Oregon Health Authority shall consult with the Medicaid Advisory Committee concerning the determinations required under ORS 414.065. [1967 c.502 §20; 1991 c.66 §22; 1995 c.727 §46; 2003 c.784 §8; 2009 c.595 §289]

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ORS 414.227 Application of public meetings law to advisory committees. (1) ORS 192.610 to 192.705 apply to any meeting of an advisory committee with the authority to make decisions for, conduct policy research for or make recommendations to the Oregon Health Authority, the Oregon Health Policy Board or the Department of Human Services on administration or policy related to the medical assistance program operated under this chapter

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ORS 414.229 [Formerly 414.751; 2011 c.602 §38; repealed by 2015 c.318 §56]

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ORS 414.230 [1957 c.692 §5; repealed by 1963 c.631 §2]

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ORS 414.231 Eligibility for Cover All People program; 12-month continuous enrollment; verification of eligibility. (1) As used in this section

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ORS 414.240 [1957 c.692 §3; repealed by 1963 c.631 §2]

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ORS 414.241 Oregon Health Authority to administer bridge program. The Oregon Health Authority shall administer a bridge program to provide affordable health care coverage, improve the continuity of coverage and care for Oregonians and reduce health inequities for individuals who regularly enroll and disenroll in the medical assistance program due to fluctuations in their incomes. [2022 c.29 §5; 2022 c.29 §9]

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ORS 414.245 Bridge Program Fund. The Bridge Program Fund is established in the State Treasury, separate and distinct from the General Fund, consisting of federal funds received by the Oregon Health Authority to administer the bridge program described in ORS 414.241. Moneys in the Bridge Program Fund are continuously appropriated to the Oregon Health Authority to carry out ORS 414.241. [2022 c.29 §8; 2025 c.2 §17]

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ORS 414.250 [1957 c.692 §4; repealed by 1963 c.631 §2]

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ORS 414.260 [1957 c.692 §6; repealed by 1963 c.631 §2]

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ORS 414.270 [1957 c.692 §7(1); repealed by 1963 c.631 §2]

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ORS 414.280 [1957 c.692 §7(2); repealed by 1963 c.631 §2]

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ORS 414.290 [1957 c.692 §7(3); repealed by 1963 c.631 §2]

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ORS 414.300 [1957 c.692 §8; repealed by 1963 c.631 §2]

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ORS 414.305 [1969 c.507 §3; 1971 c.33 §1; 1977 c.384 §5; 1991 c.66 §23; 2001 c.900 §102; renumbered 414.028 in 2001]

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ORS 414.310 [1957 c.692 §9; 1961 c.130 §2; repealed by 1963 c.631 §2]

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ORS 414.312 Oregon Prescription Drug Program. (1) As used in ORS 414.312 to 414.318

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