ORS Chapter 414

Chapter 414 — MedicalAssistance

 

2009 EDITION

 

 

MEDICALASSISTANCE

 

HUMANSERVICES; JUVENILE CODE; CORRECTIONS

 

GENERALPROVISIONS

 

414.018     Goals;findings

 

414.025     Definitions

 

414.033     Expendituresfor medical assistance authorized

 

414.034     Acceptanceof federal billing, reimbursement and reporting forms

 

414.041     Applicationprocess; outreach and enrollment

 

MEDICALASSISTANCE

 

414.065     Determinationof health services covered; standards; cost sharing; payments by Oregon HealthAuthority as payment in full; rules

 

414.075     Paymentof deductibles imposed under federal law

 

414.095     Exemptionsapplicable to payments

 

414.109     OregonHealth Plan Fund

 

INSURANCEAND SERVICE CONTRACTS

 

414.115     Medicalassistance by insurance or service contracts; rules

 

414.125     Rateson insurance or service contracts; requirements for insurer or contractor

 

414.135     Contractsrelating to direct providers of care and services

 

414.145     Implementationof ORS 414.115, 414.125 or 414.135

 

STATEAND LOCAL PUBLIC HEALTH PARTNERSHIP

 

414.150     Purposeof ORS 414.150 to 414.153

 

414.152     Dutiesof state agencies

 

414.153     Authorizationfor payment for certain services

 

ADVISORYCOMMITTEES

 

414.211     MedicaidAdvisory Committee

 

414.221     Dutiesof committee

 

414.225     OregonHealth Authority to consult with committee

 

414.227     Applicationof public meetings law to advisory committees

 

414.229     Officefor Oregon Health Policy and Research Advisory Committee

 

HEALTHCARE FOR ALL OREGON CHILDREN PROGRAM

 

414.231     Eligibilityfor Healthy Kids program; 12-month continuous enrollment; verification ofeligibility; uninsurance requirement; rules

 

PRESCRIPTIONDRUGS

 

(OregonPrescription Drug Program)

 

414.312     OregonPrescription Drug Program

 

414.314     Applicationand participation in Oregon Prescription Drug Program; prescription drugcharges; fees

 

414.316     Preferreddrug list for Oregon Prescription Drug Program

 

414.318     PrescriptionDrug Purchasing Fund

 

414.320     Rules

 

(PrescriptionDrug Coverage by Medical Assistance)

 

414.325     Prescriptiondrugs; use of legend or generic drugs; prior authorization; rules

 

414.327     Electronicallytransmitted prescriptions; rules

 

414.329     Prescriptiondrug benefits for certain persons who are eligible for Medicare Part Dprescription drug coverage; rules

 

(Practitioner-ManagedPrescription Drug Plan)

 

414.330     Legislativefindings on prescription drugs

 

414.332     Policyfor Practitioner-Managed Prescription Drug Plan

 

414.334     Practitioner-ManagedPrescription Drug Plan for medical assistance program

 

414.337     Limitationon rules regarding Practitioner-Managed Prescription Drug Plan

 

(PatientPrescription Drug Assistance Program)

 

414.338     PatientPrescription Drug Assistance Program; College of Pharmacy at Oregon StateUniversity to operate program

 

DRUGUSE REVIEW BOARD

 

414.350     Definitionsfor ORS 414.350 to 414.415

 

414.355     DrugUse Review Board created; duties; members; term; qualifications

 

414.360     Dutiesof Drug Use Review Board regarding retrospective and prospective drug usereview programs; rules

 

414.365     Educationaland informational duties of Drug Use Review Board; procedures to insureconfidentiality

 

414.370     Authorizedintervention procedures

 

414.375     Standardsfor prospective drug use review program

 

414.380     Standardsfor retrospective drug use review program

 

414.385     Compliancewith Omnibus Budget Reconciliation Act of 1990

 

414.390     Unauthorizeddisclosure of information prohibited; staff access to information

 

414.395     Whenexecutive session authorized; public testimony

 

414.400     DrugUse Review Board subject to public record laws; chairperson; expenses; quorum;advisory committees

 

414.410     Staff

 

414.415     Contentsof annual report; public comment

 

MEDICALASSISTANCE FOR CERTAIN INDIVIDUALS

 

414.426     Paymentof cost of medical care for institutionalized persons

 

414.428     Coveragefor American Indian and Alaskan Native beneficiaries

 

414.500     Findingsregarding medical assistance for persons with hemophilia

 

414.510     Definitions

 

414.520     Hemophiliaservices

 

414.530     Whenpayments not made for hemophilia services

 

414.532     Definitionsfor ORS 414.534 to 414.538

 

414.534     Treatmentfor breast or cervical cancer; eligibility criteria for medical assistance

 

414.536     Presumptiveeligibility for medical assistance for treatment of breast or cervical cancer

 

414.538     Prohibitionon coverage limitations; priority to low-income women

 

414.540     Rules

 

414.550     Definitionsfor ORS 414.550 to 414.565

 

414.555     Findingsregarding medical assistance for persons with cystic fibrosis

 

414.560     Cysticfibrosis services

 

414.565     Whenpayments not made for cystic fibrosis services

 

OREGONHEALTH CARE COST CONTAINMENT SYSTEM

 

414.610     Legislativeintent

 

414.620     Systemestablished

 

414.630     Prepaidcapitated health care service contracts; when fee for services to be paid

 

414.640     Selectionof providers; reimbursement for services not covered; actions as tradepractice; actions not insurance; rules

 

SCOPEOF COVERED HEALTH SERVICES

 

414.705     Definitionsfor ORS 414.705 to 414.750

 

414.706     Legislativeapproval and funding of health services to certain persons

 

414.707     Levelof health services provided to certain persons

 

414.708     Conditionsfor coverage for certain elderly persons, blind persons or persons who havedisabilities

 

414.709     Adjustmentof population of eligible persons in event of insufficient resources

 

414.710     Servicesnot subject to prioritized list

 

414.712     Medicalassistance for certain eligible persons

 

414.715     HealthServices Commission; confirmation; qualifications; terms; expenses;subcommittees

 

414.720     Publichearings; public involvement; biennial reports on health services priorities;funding

 

414.721     Federalapproval for funding services with assessments

 

414.725     Prepaidmanaged care health services contracts; financial reporting; rules

 

414.727     Reimbursementof rural hospitals by prepaid managed care health services organization

 

414.728     Reimbursementof rural hospitals by Oregon Health Authority

 

414.730     Subcommitteeon Mental Health Care and Chemical Dependency

 

414.735     Adjustmentof reimbursement in event of insufficient resources; approval of LegislativeAssembly or Emergency Board; notice to providers

 

414.736     Definitions

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