Title 34, Human Services; Juvenile Code; Corrections

(1) It is the intention of the Legislative Assembly to achieve the goals of universal access to an adequate level of high quality health care at an affordable cost. (2) The Legislative Assembly finds: (a) A significant level of public and private funds is expended each year for t…

As used in this chapter and ORS chapters 411 and 413, unless the context or a specially applicable statutory definition requires otherwise: (1)(a) “Alternative payment methodology” means a payment other than a fee-for-services payment, used by coordinated care organizations as co…

The Oregon Health Authority may: (1) Subject to the allotment system provided for in ORS 291.234 to 291.260, expend such sums as are required to be expended in this state to provide medical assistance. Expenditures for medical assistance include, but are not limited to, expenditu…

The Oregon Health Authority shall accept federal Centers for Medicare and Medicaid Services billing, reimbursement and reporting forms instead of department billing, reimbursement and reporting forms if the federal forms contain substantially the same information as required by t…

(1) The Oregon Health Authority, under the direction of the Oregon Health Policy Board and in collaboration with the Department of Human Services, shall implement a streamlined and simple application process for the medical assistance and premium assistance programs administered …

(1) As used in this section: (a) “Uniformed service” means the Armed Forces of the United States, the Army National Guard or the Air National Guard when the member is engaged in active duty for training, inactive duty for training or full-time National Guard duty, the commissione…

(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 le…

(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. (2)(a) A health care provider that submits a claim for payment to th…

(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, th…

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 la…

(1) As used in this section, “coordinated care organization” has the meaning given that term in ORS 414.025. (2) The Oregon Health Authority shall compile and annually post to the authority’s website a report of the following information, in the aggregate, that was reported to th…

(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: (a)…

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: (1) The full amount of any deductible imposed with respect to such individual…

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 …

(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. (2) Moneys in the Oregon Health Plan Fund are continuously appropriated to the Department …

(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 avail…

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 OR…

(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…

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 considerati…

(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 provider…

It is the purpose of ORS 414.150 to 414.153 to take advantage of opportunities to: (1) Enhance the state and local public health partnership; (2) Improve the access to care and health status of women and children; and (3) Strengthen public health programs and services at the loca…

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 supp…

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: (1)…

(1) There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor. (2) The committee shall be composed of: (a) A physician licensed under ORS chapter 677; (b) Two members of health care consumer groups that include Medicaid re…

The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on: (1) Medical care, including mental health and alcohol and drug treatment and remedial care to be provided under ORS chapter 414; and (2) The operation a…

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]

(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 administrat…

(1) As used in this section: (a) “Adult” means a person 19 years of age or older. (b) “Child” means a person under 19 years of age. (2) The Cover All People program is established to make affordable, accessible health care available to all residents in this state. The program pro…

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 d…

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 continuo…

(1) As used in ORS 414.312 to 414.318: (a) “Pharmacy benefit manager” means an entity that negotiates and executes contracts with pharmacies, manages preferred drug lists, negotiates rebates with prescription drug manufacturers and serves as an intermediary between the Oregon Pre…

(1) An individual or entity described in ORS 414.312 (4) may apply to participate in the Oregon Prescription Drug Program. Participants shall apply on an application provided by the Oregon Health Authority. The authority may charge participants a nominal fee to participate in the…

The Prescription Drug Purchasing Fund is established separate and distinct from the General Fund. The Prescription Drug Purchasing Fund shall consist of moneys appropriated to the fund by the Legislative Assembly and moneys received by the Oregon Health Authority for the purposes…

The Oregon Health Authority shall adopt rules to implement and administer ORS 414.312 to 414.318. The rules shall include but are not limited to establishing procedures for: (1) Issuing prescription drug identification cards to individuals and entities that participate in the Ore…

(1) As used in this section: (a) “Prior authorization” has the meaning given that term in ORS 743B.001. (b) “Step therapy” has the meaning given that term in ORS 743B.001. (2) Notwithstanding ORS 414.325, the Oregon Health Authority and a coordinated care organization may not req…

(1) As used in this section: (a) “Legend drug” means any drug requiring a prescription by a practitioner, as defined in ORS 689.005. (b) “Urgent medical condition” means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the d…

(1) The Oregon Health Authority shall negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates that are in addition to the discount required under federal law to participate in the medical assistance program. (2) The authority may participate…

The Oregon Health Authority shall adopt rules permitting a practitioner to communicate prescription drug orders by electronic means directly to the dispensing pharmacist. [2001 c.623 §8; 2003 c.14 §192; 2009 c.595 §297] Note: 414.327 was enacted into law by the Legislative Assemb…

(1) As used in this section, “synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently. (2) Each coordinated care organization shall implement a syn…

(1) Notwithstanding ORS 414.591, 414.631 and 414.688 to 414.745, the Oregon Health Authority shall adopt rules modifying the prescription drug benefits for persons who are eligible for Medicare Part D prescription drug coverage and who receive prescription drug benefits under the…

The Legislative Assembly finds that: (1) The cost of prescription drugs in the medical assistance program is growing and will soon be unsustainable; (2) The benefit of prescription drugs when appropriately used decreases the need for other expensive treatments and improves the he…

It is the policy of the State of Oregon that a Practitioner-Managed Prescription Drug Plan will ensure that: (1) Oregonians have access to the most effective prescription drugs appropriate for their clinical conditions; (2) Decisions concerning the clinical effectiveness of presc…

(1) The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best p…

The Oregon Health Authority may not adopt or amend any rule that requires a prescribing practitioner to contact the authority to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug…

As used in ORS 414.351 to 414.414: (1) “Compendia” means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources: (a) The American Hospital Formulary Service drug information. (b) The United States Pharmacopeia dr…

(1) There is created an 11-member Pharmacy and Therapeutics Committee responsible for advising the Oregon Health Authority on the implementation of the retrospective and prospective programs and on the Practitioner-Managed Prescription Drug Plan. (2) The Director of the Oregon He…

(1) Except as provided in ORS 414.356, the Pharmacy and Therapeutics Committee shall operate in accordance with ORS chapter 192. The committee shall annually elect a chairperson from the members of the committee. (2) A committee member is not entitled to compensation but is entit…

(1) Notwithstanding ORS 192.610 to 192.705, the Pharmacy and Therapeutics Committee shall meet in an executive session for purposes of: (a) Reviewing the prescribing or dispensing practices of individual physicians or pharmacists; (b) Discussing drug use review data pertaining to…

(1) The Mental Health Clinical Advisory Group is established in the Oregon Health Authority. The Mental Health Clinical Advisory Group shall develop evidence-based algorithms for mental health treatments, including treatments with mental health drugs based on: (a) The efficacy of…

(1) The Pharmacy and Therapeutics Committee shall advise the Oregon Health Authority on: (a) Adoption of rules to implement ORS 414.351 to 414.414 in accordance with ORS chapter 183. (b) Implementation of the medical assistance program retrospective and prospective programs as de…