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