Title 34, Human Services; Juvenile Code; Corrections

In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following: (1) Information disseminated to prescribers and pharmacists to ensure that they are aware of the duties and powers of the Pharmacy and Therapeutics Committee. (2) Written, oral o…

The prospective drug use review program must use guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee. The program must ensure that prior to the prescription being filled or delivered a review will …

The retrospective drug use review program must use: (1) Guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee; and (2) The mechanized drug claims processing and information retrieval system to analyz…

(1)(a) If necessary to avoid overutilization by a recipient of medical assistance, the Oregon Health Authority may restrict, for 18 months or less, the recipient’s pharmacy choices for filling and refilling prescriptions to a mail order pharmacy that contracts with the authority,…

In addition to the duties described in ORS 414.361, the Pharmacy and Therapeutics Committee shall do the following subject to the approval of the Director of the Oregon Health Authority: (1) Publish an annual report, as described in ORS 414.382. (2) Publish and disseminate educat…

(1) The annual report required under ORS 414.381 (1) is subject to public comment prior to its submission to the Director of the Oregon Health Authority and must include the following: (a) An overview of the activities of the Pharmacy and Therapeutics Committee and the prospectiv…

(1) Information collected under ORS 414.351 to 414.414 that identifies an individual is confidential and may not be disclosed by the Pharmacy and Therapeutics Committee, the retrospective program or the Oregon Health Authority to any person other than a health care provider appea…

The Oregon Health Authority is hereby authorized to pay the cost of care for patients in institutions operated under ORS 179.321 under the medical assistance program established by ORS chapter 414. [Formerly 414.028; 2009 c.595 §310] Note: 414.426 was enacted into law by the Legi…

(1) An individual who is eligible for or receiving medical assistance, as defined in ORS 414.025, pursuant to a demonstration project under section 1115 of the Social Security Act and who is an American Indian and Alaska Native beneficiary shall receive the same package of health…

(1) The Oregon Health Authority shall prescribe by rule appropriate time frames within which a pregnant medical assistance recipient whose medical assistance is reimbursed on a fee-for-service basis and who needs general or specialty dental care must have the opportunity to be se…

(1) The Oregon Health Authority shall administer a program to reimburse the cost of medically appropriate services, drugs, devices, products and procedures described in ORS 743A.067, for individuals who can become pregnant and who would be eligible for medical assistance if not f…

Medical assistance shall be provided to an individual who: (1) Is at least 18 years of age and not older than 25 years of age; (2) Resides in this state; (3) Was in foster care in the custody of any state on the date the individual attained 18 years of age; and (4) Was enrolled i…

(1) The Oregon Health Authority shall review, and amend as needed, current administrative rules and contracts to ensure that individuals receiving medical assistance who are under 21 years of age have timely access to the services described in subsection (2) of this section. (2) …

The Legislative Assembly finds that there are citizens of this state who have the disease of hemophilia and that hemophilia is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended upon termina…

(1) “Eligible individual” means a resident of the State of Oregon over the age of 20 years. (2) “Hemophilia services” means a program for medical care, including the cost of blood transfusions and the use of blood derivatives. [1975 c.513 §2] Note: See note under 414.500.

Within the limit of funds expressly appropriated and available for medical assistance to hemophiliacs, hemophilia services under ORS 414.500 to 414.530 shall be made available to eligible persons as recommended by the Medical Advisory Committee of the Oregon Chapter of the Nation…

Payments under ORS 414.500 to 414.530 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.500 to 414.530 is intended to limit …

As used in ORS 414.534 to 414.538: (1) “Medical assistance” has the meaning given that term in ORS 414.025. (2) “Provider” has the meaning given that term in ORS 743B.001. [2001 c.902 §1] Note: 414.532 to 414.540 were enacted into law by the Legislative Assembly but were not adde…

(1) The Oregon Health Authority shall provide medical assistance, as defined in ORS 414.025, to a woman who: (a) Is found by a provider to be in need of treatment for breast or cervical cancer; (b) Meets the eligibility criteria for the Oregon Breast and Cervical Cancer Program p…

(1) If the Department of Human Services or the Oregon Health Authority determines that a woman likely is eligible for medical assistance under ORS 414.534, the department or the authority shall determine her to be presumptively eligible for medical assistance until a formal deter…

(1) The Department of Human Services and the Oregon Health Authority may not impose income or resource limitations or a prior period of uninsurance on a woman who otherwise qualifies for medical assistance under ORS 414.534 or 414.536. (2) In establishing eligibility requirements…

The Oregon Health Authority shall adopt rules necessary for the implementation and administration of ORS 414.534 to 414.538. [2001 c.902 §5; 2009 c.595 §316] Note: See note under 414.532. (Cystic Fibrosis)

As used in ORS 414.550 to 414.565: (1) “Cystic fibrosis services” means a program for medical care, including the cost of prescribed medications and equipment, respiratory therapy, physical therapy, counseling services that pertain directly to cystic fibrosis related health needs…

The Legislative Assembly finds that there are citizens of this state who have the disease of cystic fibrosis and that cystic fibrosis is generally excluded from any private medical insurance coverage except in an employment situation under group coverage which is usually ended up…

(1) Within the limit of funds expressly appropriated and available for medical assistance to individuals who have cystic fibrosis, cystic fibrosis services under ORS 414.550 to 414.565 shall be made available by the Services for Children with Special Health Needs to eligible indi…

Payments under ORS 414.550 to 414.565 shall not be made for any services which are available to the recipient under any other private, state or federal programs or under other contractual or legal entitlements. However, no provision of ORS 414.550 to 414.565 is intended to limit …

(1) There is established the Oregon Integrated and Coordinated Health Care Delivery System. The system shall consist of state policies and actions that make coordinated care organizations accountable for care management and provision of integrated and coordinated health care for …

(1) The Oregon Health Authority shall adopt by rule the qualification criteria and requirements for a coordinated care organization and shall integrate the criteria and requirements into each contract with a coordinated care organization. Coordinated care organizations may be loc…

(1) A coordinated care organization must have a community advisory council to ensure that the health care needs of the consumers and the community are being addressed. The council must: (a) Include representatives of the community and of each county government served by the coord…

(1) As used in this section: (a) “Local mental health authority” has the meaning given that term in ORS 430.630. (b) “Local planning committee” has the meaning given that term in ORS 430.306. (2) A coordinated care organization shall collaborate with local public health authoriti…

(1) A community health improvement plan adopted by a coordinated care organization and its community advisory council in accordance with ORS 414.577 shall include a component for addressing the health of children and youth in the areas served by the coordinated care organization …

(1) The Tribal Advisory Council is established. The duties of the council are to: (a) Serve as a channel of communication between the coordinated care organizations and Indian tribes in this state regarding the health of tribal communities; and (b) Oversee the tribal liaisons in …

(1) Meetings of a governing body of a coordinated care organization in which substantive decisions are made final must: (a) Be open to the public; (b) Provide an opportunity for members of the public to provide written or oral testimony; and (c) Include the minutes or other recor…

(1) As used in this section: (a) “Benefit period” means a period of time, shorter than the contract term, for which specific terms and conditions in a contract between a coordinated care organization and the Oregon Health Authority are in effect. (b) “Renew” means an agreement by…

(1) The Oregon Health Authority shall use, to the greatest extent possible, coordinated care organizations to provide fully integrated physical health services, chemical dependency and mental health services and oral health services. This section, and any contract entered into pu…

Notwithstanding ORS 414.590: (1) Contracts between the Oregon Health Authority and coordinated care organizations or individual providers for the provision of behavioral health services must align with the quality metrics and incentives developed by the Behavioral Health Committe…

(1) As used in this section: (a) “Coordinated care organization” has the meaning given that term in ORS 414.025. (b) “Medical assistance” has the meaning given that term in ORS 414.025. (c) “Related party” means an entity that: (A) Provides administrative services or financing to…

(1) As used in this section: (a) “Coordinated care organization” has the meaning given that term in ORS 414.025. (b) “Subcontractor” means an entity that contracts with a coordinated care organization to provide health care, dental care, behavioral health care or other services t…

(1) The Oregon Health Authority shall encourage coordinated care organizations to use alternative payment methodologies that: (a) Reimburse providers on the basis of health outcomes and quality measures instead of the volume of care; (b) Hold organizations and providers responsib…

(1) The Oregon Health Authority shall adopt by rule safeguards for members enrolled in coordinated care organizations that protect against underutilization of services and inappropriate denials of services. In addition to any other consumer rights and responsibilities established…

(1) The Oregon Health Authority shall ensure the appropriate use of member information by coordinated care organizations, including the use of electronic health information and administrative data that is available when and where the data is needed to improve health and health ca…

(1) A coordinated care organization that contracts with the Oregon Health Authority must maintain a network of providers, including but not limited to addiction treatment providers, sufficient in numbers and areas of practice and geographically distributed in a manner to ensure t…

(1) The Oregon Health Authority may approve the transfer of 500 or more members from one coordinated care organization to another coordinated care organization if: (a) The members’ provider has contracted with the receiving organization and has stopped accepting patients from or …

(1) A coordinated care organization may not discriminate with respect to participation in the organization or coverage against any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. This section does not requ…

(1) The Oregon Health Authority and the Department of Human Services shall cooperate with each other by coordinating actions and responsibilities necessary to implement the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. (2) The authority…

(1) Upon the request of a coordinated care organization, the Oregon Health Authority shall assign to the coordinated care organization one employee of the authority, called an innovator agent, to act as the single point of contact between the coordinated care organization and the…

(1) Except as provided in subsections (2), (3), (4) and (5) of this section and ORS 414.632 (2), a person who is eligible for or receiving health services must be enrolled in a coordinated care organization to receive the health services for which the person is eligible. For purp…

(1) Subject to the Oregon Health Authority obtaining any necessary authorization from the Centers for Medicare and Medicaid Services, coordinated care organizations that meet the criteria adopted under ORS 414.572 are responsible for providing covered Medicare and Medicaid servic…

(1)(a) The Oregon Health Authority shall continue to contract with one or more prepaid managed care health services organizations, as defined in ORS 414.025, that are in compliance with contractual obligations owed to the state or local government on July 27, 2015, and that serve…

(1) The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations. (2) Each coordinated care organization shall implement, to the maximum extent feasible, patient cent…