Title 34, Human Services; Juvenile Code; Corrections

(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’ …

(1) An individual who receives medical services while in the custody of a law enforcement officer is liable: (a) To the provider of the medical services for the charges and expenses therefor; and (b) To the Oregon Health Authority for any charges or expenses paid by the authority…

(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…

(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 Orego…

As used in ORS 414.853 to 414.869 and 414.900: (1) “Charity care” means costs for providing inpatient or outpatient care services free of charge or at a reduced charge because of the indigence or lack of health insurance of the patient receiving the care services. (2) “Contractua…

(1) An assessment is imposed on the net inpatient revenue and net outpatient revenue of each hospital in this state. The assessment shall be imposed at a rate determined by the Director of the Oregon Health Authority by rule that is the director’s best estimate of the rate needed…

Notwithstanding ORS 414.855, the Director of the Oregon Health Authority shall reduce the rate of assessment imposed under ORS 414.855 (1) to the maximum rate allowed under federal law if the reduction is required to comply with federal law. [2003 c.736 §3; 2013 c.608 §3; 2017 c.…

(1) Any hospital that has paid an amount that is not required under ORS 414.853 to 414.869 and 414.900 may file a claim for refund with the Oregon Health Authority. (2) Any hospital that is aggrieved by an action of the authority or by an action of the Director of the Oregon Heal…

The Oregon Health Authority may audit the records of any hospital in this state to determine compliance with ORS 414.853 to 414.869 and 414.900. The authority may audit records at any time for a period of five years following the date an assessment is due to be reported and paid …

Amounts collected by the Oregon Health Authority from the assessments imposed under ORS 414.855 shall be deposited in the Hospital Quality Assurance Fund established under ORS 414.869. [2003 c.736 §8; 2005 c.757 §1; 2013 c.608 §6] Note: 414.867 is repealed January 2, 2038, and ap…

(1) The Hospital Quality Assurance Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Hospital Quality Assurance Fund shall be credited to the Hospital Quality Assurance Fund. (2) Amounts in the Hospital Quality Assuranc…

ORS 414.853 to 414.869 and 414.900 apply to net inpatient revenues and net outpatient revenues earned by hospitals during a period beginning July 1, 2019, and ending the earlier of December 31, 2032, or the date on which the assessment no longer qualifies for federal financial pa…

(1) As used in this section and ORS 414.882 and 414.902: (a) “Managed care organization” means: (A) A coordinated care organization as defined in ORS 414.025; and (B) A prepaid managed care health services organization as defined in ORS 414.025. (b) “Premium equivalent” means the…

(1) A managed care organization that has paid an amount that is not required under ORS 414.880 may file a claim for refund with the Oregon Health Authority. (2) Any managed care organization that is aggrieved by an action of the authority taken pursuant to subsection (1) of this …

ORS 414.880, 414.882 and 414.902 apply to any payments made to a managed care organization by the Oregon Health Authority for the period beginning January 1, 2020, and ending December 31, 2032. [2017 c.538 §12; 2019 c.2 §10; 2025 c.4 §9] Note: 414.884 is repealed January 2, 2038.…

(1) A hospital that fails to file a report or pay an assessment under ORS 414.855 by the date the report or payment is due shall be subject to a penalty of up to $500 per day of delinquency. The total amount of penalties imposed under this section for each reporting period may no…

(1) If a managed care organization fails to timely pay an assessment under ORS 414.880, the Oregon Health Authority shall impose a penalty on the managed care organization of up to $500 per day of delinquency. The total amount of penalties imposed under this section for a calenda…

(1) As used in this section: (a) “Attachment point” means the threshold dollar amount, adopted by the Oregon Health Authority by rule, for costs incurred by a coordinated care organization in a calendar year for a member, after which threshold the costs are eligible for state rei…

(1) The Oregon Health Authority may adopt rules to carry out the provisions of ORS 415.012 to 415.430. (2) The authority shall adopt rules for regulating the financial solvency of coordinated care organizations that align with the following provisions of the Insurance Code regula…

As used in ORS 415.012 to 415.430: (1) “Coordinated care organization” has the meaning given that term in ORS 414.025. (2) “Medical assistance program” means the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. [2019 c.478 §1]

(1) The Oregon Health Authority shall enforce the provisions of ORS 415.012 to 415.430 and 415.501 and rules adopted pursuant to ORS 415.011, 415.012 to 415.430 and 415.501 for the public good. (2) The authority has the powers and authority expressly conferred by or reasonably im…

(1) An officer or employee of the Oregon Health Authority who is delegated responsibilities in the enforcement of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011 may not: (a) Be a director, officer or employee of or be financially interested in any coordinated car…

(1) The Oregon Health Authority shall hold a contested case hearing upon written request for a hearing by a person aggrieved by any act, threatened act or failure of the authority to act under ORS 415.012 to 415.430 or 415.501 or rules adopted pursuant to ORS 415.011, 415.012 to …

(1) A complaint made to the Oregon Health Authority against a coordinated care organization for a violation of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011, and the record of the complaint, is confidential and may not be disclosed except as provided in ORS 413.…

(1) The Oregon Health Authority may disclose or use a report as considered necessary by the authority in the administration of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law. (2) A report filed with the authority according to requirements established b…

(1) The Oregon Health Authority may use reports and financial plans of action that are made confidential under ORS 415.056 only for the purpose of monitoring the solvency of coordinated care organizations and the need for possible corrective action with respect to coordinated car…

As used in ORS 415.061 to 415.067: (1) “Compliance audit” means a voluntary internal evaluation, review, assessment, audit or investigation that is undertaken to identify or prevent noncompliance with, or promote compliance with, laws, regulations, orders or professional standard…

Except as provided in ORS 415.061 to 415.067: (1) A compliance self-evaluative audit document is privileged information and is not discoverable or admissible as evidence in any civil, criminal or administrative proceeding. (2) Any person who performs or directs the performance of…

(1) ORS 415.062 does not prohibit the Oregon Health Authority from acquiring any compliance self-evaluative audit document or examining any person in connection with the document. If the authority determines that the actions of a coordinated care organization are egregious, the a…

(1) The privilege set forth in ORS 415.062 does not apply to the extent that the privilege is expressly waived by the coordinated care organization that prepared or caused to be prepared the compliance self-evaluative audit document. (2) The privilege set forth in ORS 415.062 doe…

(1) Within 30 days after a district attorney or the Attorney General serves on a coordinated care organization a written request by certified mail for disclosure of a compliance self-evaluative audit document, the coordinated care organization that prepared or caused the document…

The privilege established under ORS 415.062 does not apply to any of the following: (1) Documents, communications, data, reports or other information expressly required to be collected, developed, maintained or reported to the Oregon Health Authority or other regulatory agency un…

Nothing in ORS 415.061 to 415.067, or in the release of any compliance self-evaluative audit document under ORS 415.061 to 415.067, shall limit, waive or abrogate the scope or nature of any statutory or common law privilege or other limitation on admissibility of evidence includi…

The Oregon Health Authority may request information from any coordinated care organization or its officers in relation to the activities or condition of the coordinated care organization or any other matter connected with a coordinated care organization’s transactions, and the pe…

A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or other information required or permitted to be filed under ORS 415.012 to 415.430 or 415.501 or rules adopted pursuant to ORS 415.011, 415.012 to…

The Oregon Health Authority, whenever the authority deems it advisable in the interest of members of a coordinated care organization or for the public good, shall investigate into the affairs of: (1) A coordinated care organization; (2) A person proposing to form a coordinated ca…

The Oregon Health Authority shall examine every coordinated care organization, including an audit of the financial affairs of the coordinated care organization, as often as the authority determines an examination to be necessary but at least once every five years. An examination …

(1) When the Oregon Health Authority determines that an examination should be conducted, the authority shall appoint one or more examiners to perform the examination and instruct them as to the scope of the examination. The authority may prescribe the examiner handbook and employ…

(1) Not later than the 60th day after an examination is completed, the examiner in charge of the examination shall submit to the Oregon Health Authority a full and true report of the examination, verified by the oath of the examiner. The report shall comprise only facts appearing…

(1) A coordinated care organization shall have an annual audit conducted by an independent certified public accountant and shall file an audited financial report annually with the Oregon Health Authority by June 30 following the end of the period to which the report applies. The …

(1) Except in the case of malfeasance in office or willful or wanton neglect of duty, a cause of action does not arise and liability may not be imposed against the Oregon Health Authority, an authorized representative of the authority or any examiner appointed by the authority fo…

(1) Whenever the Oregon Health Authority determines from any showing or statement made to the authority from any examination made by the authority that the assets of a coordinated care organization are less than its liabilities plus required capitalization, the authority may: (a)…

(1) For any reason stated in subsection (2) of this section, the Oregon Health Authority may order a coordinated care organization to be placed under supervision. (2) The authority may place a coordinated care organization under supervision if upon examination or at any other tim…

(1) A coordinated care organization placed under supervision must correct, eliminate or remedy the acts, transactions or practices that are the basis for the order of supervision and otherwise comply with the requirements of the Oregon Health Authority within the period of time a…