The Oregon Administrative Rules contain OARs filed through April 15, 2013 
Oregon Health Authority
Division of Medical Assistance Programs
Division number quick links 001-050 | 120 | 121 | 122 | 123-124 | 125 | 127-129 | 130 | 131-132 | 133-136 |
138-140 | 141 | 142-143 | 145-146 | 147 | 148-150 | 160-500
410-001-0000 Model Rules of Procedure
410-001-0005 Notice of Proposed Rule
410-001-0020 Delegation of Rulemaking Authority
410-030-0010 Purpose
410-030-0020 Review Requirements
410-030-0030 Implementation
410-030-0040 Penalties for Non-Compliance
Medicaid Managed Care Tax
410-050-0100 Definitions
410-050-0110 General Administration
410-050-0120 Disclosure of Information
410-050-0130 The Medicaid Managed Care Tax: Calculation; Report; Due Date; Verification of Report
410-050-0140 Filing an Amended Report
410-050-0150 Determining the Date Filed
410-050-0160 Departmental Authority to Audit Records
410-050-0170 Assessing Tax on Failure to File
410-050-0180 Financial Penalty for Failure to File a Report or Failure to Pay Tax When Due
410-050-0190 Notice of Proposed Action
410-050-0200 Required Notice
410-050-0210 Hearing Process
410-050-0220 Final Order of Payment
410-050-0230 Remedies Available after Final Order of Payment
410-050-0240 Director Determines the Tax Rate
410-050-0250 Sunset Provisions
410-050-0700 Definitions
410-050-0710 General Administration
410-050-0720 Disclosure of Information
410-050-0730 Entities subject to the Hospital Tax
410-050-0740 The Hospital Tax: Calculation, Report, Due Date
410-050-0750 Reporting Total Net Revenue, Use of Estimated Revenue for Quarterly Reports
410-050-0760 Filing an Amended Report
410-050-0770 Determining the Date Filed
410-050-0780 Departmental Authority to Audit Records
410-050-0790 Assessing Tax on Failure to File
410-050-0800 Financial Penalty for Failure to File a Report or Failure to Pay Tax When Due
410-050-0810 Notice of Proposed Action
410-050-0820 Required Notice
410-050-0830 Hearing Process
410-050-0840 Final Order of Payment
410-050-0850 Remedies Available after Final Order of Payment
410-050-0860 Director Determines Rate of Tax
410-050-0861 Tax Rate
410-050-0870 Sunset Provisions
410-120-0000 Acronyms and Definitions
410-120-0006 Medical Eligibility Standards
410-120-0025 Administration of Division of Medical Assistance Programs' Regulation and Rule Precedence
410-120-0030 Children’s Health Insurance Program
410-120-0035 Public Entity
410-120-0045 Applications for Medical Assistance at Provider locations
410-120-0250 PHP or Coordinated Care Organizations
410-120-1140 Verification of Eligibility and Coverage
410-120-1160 Medical Assistance Benefits and Provider Rules
410-120-1180 Medical Assistance Benefits: Out-of-State Services
410-120-1190 Medically Needy Benefit Program
410-120-1195 SB 5548 Population
410-120-1200 Excluded Services and Limitations
410-120-1210 Medical Assistance Benefit Packages
410-120-1230 Client Copayment
410-120-1260 Provider Enrollment
410-120-1280 Billing
410-120-1295 Non-Participating Provider
410-120-1300 Timely Submission of Claims
410-120-1320 Authorization of Payment
410-120-1340 Payment
410-120-1350 Buying-Up
410-120-1360 Requirements for Financial, Clinical and Other Records
410-120-1380 Compliance with Federal and State Statutes
410-120-1385 Compliance with Public Meetings Law
410-120-1390 Premium Sponsorships
410-120-1395 Program Integrity
410-120-1397 Recovery of Overpayments to Providers -- Recoupments and Refunds
410-120-1400 Provider Sanctions
410-120-1460 Type and Conditions of Sanction
410-120-1510 Fraud and Abuse
410-120-1560 Provider Appeals
410-120-1570 Claim Re-Determinations
410-120-1580 Provider Appeals -- Administrative Review
410-120-1600 Provider Appeals — Contested Case Hearings
410-120-1855 Client's Rights and Responsibilities
410-120-1860 Contested Case Hearing Procedures
410-120-1865 Denial, Reduction, or Termination of Services
410-120-1870 Client Premium Payments
410-120-1875 Agency Hearing Representatives
410-120-1880 Contracted Services
410-120-1920 Institutional Reimbursement Changes
410-120-1940 Interest Payments on Overdue Claims
410-120-1960 Payment of Private Insurance Premiums
410-120-1980 Requests for Information and Public Records
410-121-0000 Foreward and Definition of Terms
410-121-0021 Organizations Authorized to Provide Pharmaceutical Prescription Services
410-121-0030 Practitioner-Managed Prescription Drug Plan
410-121-0032 Supplemental Rebate Agreements
410-121-0033 Polypharmacy Profiling
410-121-0040 Prior Authorization Required for Drugs and Products
410-121-0060 How to Get Prior Authorization for Drugs
410-121-0061 Durable Medical Equipment, Medical Supplies, and Medical Surgical Services (Physician Administered Drugs)
410-121-0100 Drug Use Review
410-121-0111 Drug Use Review/Pharmacy and Therapeutics Committee
410-121-0135 Pharmacy Management Program Requirements
410-121-0143 Client Confidentiality
410-121-0145 Prescription Requirements
410-121-0146 Dispensing Limitations
410-121-0147 Exclusions and Limitations
410-121-0148 Dispensing in a Nursing Facility or Community Based Care Living Facility
410-121-0149 Medicaid Temporary Prescription Drug Assistance for Fully Dual Eligible Medicare Part D Clients
410-121-0150 Billing Requirements
410-121-0155 Reimbursement
410-121-0157 Participation in the Medicaid Drug Rebate Program
410-121-0160 Dispensing Fees
410-121-0185 Pharmacy Based Immunization Delivery
410-122-0188 DMEPOS Rebate Agreements
410-121-0190 Medication Therapy Management Services and Clozapine Therapy Monitoring
410-121-0200 Billing Forms
410-121-0220 Instructions for Completion of the Prescription Drug Invoice
410-121-0280 Billing Quantities, Metric Quantities and Package Sizes
410-121-0300 CMS Federal Upper Limits for Drug Payments
410-121-0420 DESI Less-Than-Effective Drug List
410-121-0580 Oregon Medicaid and Pharmaceutical Manufacturers' Dispute Resolution Procedures
410-121-0625 Items Covered in the All-Inclusive Rate for Nursing Facilities
Oregon Prescription Drug Program
410-121-2000 Definitions
410-121-2005 General Administration
410-121-2010 Pharmacy Providers
410-121-2020 Program Price
410-121-2030 Preferred Drug List
410-121-2050 Enrollment
410-121-2065 Contracted Services
Non-Medicaid Rules CAREAssist
410-121-3000 AIDS Drug Assistance Program
Non-Medicaid Rules Prescription Drug Monitoring Program
410-121-4000 Purpose
410-121-4005 Definitions
410-121-4010 Reporting Requirements
410-121-4015 Notification to Patients
410-121-4020 Information Access
410-122-0010 Definitions
410-122-0020 Orders
410-122-0040 Prior Authorization
410-122-0055 OHP Standard Benefit Package Limitations
410-122-0080 Conditions of Coverage, Limitations, Restrictions and Exclusions
410-122-0180 Healthcare Common Procedure Coding System (HCPCS) Level II Coding
410-122-0182 Legend
410-122-0184 Repairs, Maintenance, Replacement, Delivery and Dispensing
410-122-0186 Payment Methodology
410-122-0200 Pulse Oximeter for Home Use
410-122-0202 Positive Airway Pressure (PAP) Devices for Adult Obstructive Sleep Apnea (OSA)
410-122-0203 Oxygen and Oxygen Equipment
410-122-0204 Nebulizer
410-122-0205 Respiratory Assist Devices
410-122-0206 Intermittent Positive Pressure Breathing (IPPB)
410-122-0207 Respiratory Supplies
410-122-0208 Suction Pumps
410-122-0209 Tracheostomy Care Supplies
410-122-0210 Ventilators
410-122-0211 Cough Stimulating Device
410-122-0220 Pacemaker Monitor
410-122-0240 Apnea Monitors for Infants
410-122-0250 Breast Pumps
410-122-0260 Home Uterine Monitoring
410-122-0280 Heating/Cooling Accessories
410-122-0300 Light Therapy
410-122-0320 Manual Wheelchair Base
410-122-0325 Motorized/Power Wheelchair Base
410-122-0330 Power-Operated Vehicle
410-122-0340 Wheelchair Options/Accessories
410-122-0360 Canes and Crutches
410-122-0365 Standing and Positioning Aids
410-122-0375 Walkers
410-122-0380 Hospital Beds
410-122-0400 Pressure Reducing Support Surfaces
410-122-0420 Hospital Bed Accessories
410-122-0475 Therapeutic Shoes for Diabetics
410-122-0480 Pneumatic Compression Devices (Used for Lymphedema)
410-122-0500 Transcutaneous Electrical Nerve Stimulator (TENS)
410-122-0510 Osteogenesis Stimulator
410-122-0515 Neuromuscular Electrical Stimulator (NMES)
410-122-0520 Glucose Monitors and Diabetic Supplies
410-122-0525 External Insulin Infusion Pump
410-122-0540 Ostomy Supplies
410-122-0560 Urological Supplies
410-122-0580 Bath Supplies
410-122-0590 Patient Lifts
410-122-0600 Toilet Supplies
410-122-0620 Miscellaneous Supplies
410-122-0625 Surgical Dressing
410-122-0630 Incontinent Supplies
410-122-0640 Eye Prosthetics
410-122-0655 External Breast Prostheses
410-122-0658 Gradient Compression Stockings
410-122-0660 Orthotics and Prosthetics
410-122-0662 Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses
410-122-0678 Dynamic Adjustable Extension/Flexion Device
410-122-0680 Facial Prostheses
410-122-0700 Negative Pressure Wound Therapy Pumps
410-122-0720 Pediatric Wheelchairs
410-123-1000 Eligibility, Providing Services and Billing
410-123-1060 Definition of Terms
410-123-1100 Services Reviewed by the Division of Medical Assistance Programs (DMAP)
410-123-1160 Prior Authorization (PA)
410-123-1200 Services Not To Be Billed Separately
410-123-1220 Coverage according to the Prioritized List of Health Services
410-123-1230 Buying-Up
410-123-1240 The Dental Claim Invoice
410-123-1260 OHP Plus Dental Benefits
410-123-1490 Hospital Dentistry
410-123-1540 Citizen/Alien-Waived Emergency Medical
410-123-1600 Managed Care Organizations
410-123-1620 Procedure and Diagnosis Codes
410-123-1640 Prescriptions
410-123-1670 OHP Standard Limited Emergency Dental Benefit
410-124-0000 Transplant Services
410-124-0005 Donor Services
410-124-0010 Eligibility for Transplant Services
410-124-0020 Prior Authorization for All Covered Transplants, Except Cornea and Kidney
410-124-0040 Emergency Transplants
410-124-0060 Criteria and Contraindications for Heart Transplants
410-124-0063 Criteria and Contraindications for Heart-Lung Transplants
410-124-0065 Criteria and Contraindications for Single Lung Transplants
410-124-0070 Criteria and Contraindications for Bilateral Lung Transplants
410-124-0080 Criteria and Contraindications for Autologous and Allogeneic Bone Marrow, Autologous and Allogeneic Peripheral Stem Cell and Allogeneic Cord Blood Transplant
410-124-0090 Criteria and Contraindications for Harvesting Autologous Bone Marrow and Peripheral Stem Cells
410-124-0100 Criteria and Contraindications for Liver and Liver-Kidney Transplants
410-124-0105 Criteria and Contraindications for Intestine and Intestine-Liver Transplants
410-124-0120 Criteria and Contraindications for Simultaneous Pancreas-Kidney and Pancreas After Kidney Transplants
410-124-0140 Kidney Transplants
410-124-0160 Cornea Transplants
410-125-0000 Determining When the Patient Has Medical Assistance
410-125-0020 Retroactive Eligibility
410-125-0030 Hospital Hold
410-125-0040 Title XIX/Title XXI Clients
410-125-0041 Non-Title XIX/XXI Clients
410-125-0045 Coverage and Limitations
410-125-0047 Limited Hospital Benefit for the OHP Standard Population
410-125-0050 Client Copayments
410-125-0080 Prior Authorization/Prior Notification
410-125-0085 Outpatient Services
410-125-0086 Prior Authorization for FCHP/MHO Clients
410-125-0090 Inpatient Rate Calculations -- Type A, Type B, and Critical Access Oregon Hospitals
410-125-0095 Hospitals Providing Specialized Inpatient Services
410-125-0101 Hospital-Based Nursing Facilities and Medicaid Swing Beds
410-125-0102 Medically Needy Clients
410-125-0103 Medicare Clients
410-125-0115 Non-Contiguous Area Out-of-State Hospitals
410-125-0120 Transportation To and From Medical Services
410-125-0121 Contiguous Area Out-of-State Hospitals
410-125-0124 Retroactive Authorization
410-125-0125 Free-Standing Inpatient Psychiatric Facilities (IMDS)
410-125-0140 Prior Authorization Does not Guarantee Payment
410-125-0141 DRG Rate Methodology
410-125-0142 Graduate Medical Education Reimbursement for Public Teaching Hospitals
410-125-0146 Supplemental Reimbursement for Public Academic Teaching University Medical Practitioners
410-125-0150 Disproportionate Share (Effective for services rendered on or after January 1, 2001)
410-125-0155 Upper Limits on Payment (UPL) of Hospital Claims
410-125-0165 Transfers and Reimbursement
410-125-0170 Death Occurring on Day of Admission
410-125-0175 Hospitals Providing Specialized Outpatient Services
410-125-0180 Public Rates
410-125-0181 Non-Contiguous and Contiguous Area Out-of-State Hospitals
410-125-0190 Outpatient Rate Calculations -- Type A, Type B, and Critical Access Oregon Hospitals
410-125-0195 Outpatient Services In-State DRG Hospitals
410-125-0200 Time Limitation for Submission of Claims
410-125-0201 Independent ESRD Facilities
410-125-0210 Third Party Resources and Reimbursement
410-125-0220 Services Billed on the Electronic 837I or on the Paper UB-04 and Other Claim Forms
410-125-0221 Payment in Full
410-125-0360 Definitions and Billing Requirements
410-125-0400 Discharge
410-125-0401 Definitions: Emergent, Urgent, and Elective Admissions
410-125-0410 Readmission
410-125-0450 Provider Preventable Conditions
410-125-0550 X-Ray or EKG Procedures Furnished in Emergency Room
410-125-0600 Non-Contiguous Out-of-State Hospital Services
410-125-0620 Special Reports and Exams and Medical Records
410-125-0640 Third Party Payers -- Other Resources, Client Responsibility and Liability
410-125-0641 Medicare
410-125-0720 Adjustment Requests
410-125-1020 Filing of Cost Statement
410-125-1040 Accounting and Record Keeping
410-125-1060 Fiscal Audits
410-125-1070 Type A and Type B Hospitals
410-125-1080 Documentation
410-125-2000 Access to Records
410-125-2020 Post Payment Review
410-125-2030 Recovery of Payments
410-125-2040 Provider Appeals -- Administrative Review
410-125-2060 Provider Appeals -- Hearing Request
410-125-2080 Administrative Errors
410-127-0020 Definitions
410-127-0040 Coverage
410-127-0050 Client Copayments
410-127-0055 Copayment for Standard Benefit Package
410-127-0060 Reimbursement and Limitations
410-127-0065 Signature Requirements
410-127-0080 Prior Authorization
410-127-0200 Home Health Revenue Center Codes
SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID SERVICES
410-129-0020 Therapy Goals/Outcome
410-129-0040 Maintenance
410-129-0060 Prescription Required
410-129-0065 Licensing Requirements
410-129-0070 Limitations
410-129-0080 Prior Authorization
410-129-0100 Medicare/Medicaid Claims
410-129-0180 Procedure Codes
410-129-0190 Client Copayments
410-129-0195 Standard Benefit Package
410-129-0200 Speech-Language Pathology Procedure Codes
410-129-0220 Augmentative Communications System or Device
410-129-0240 Audiologist and Hearing Aid Procedure Codes
410-129-0260 Hearing Aids and Hearing Aid Technical Service and Repair
410-129-0280 Hearing Testing for Diagnostic Purposes (On Physician's Referral Only)
410-130-0000 Foreword
410-130-0005 Federally Qualified Primary Care Provider
410-130-0160 Codes
410-130-0163 Standard Benefit Package
410-130-0180 Drugs
410-130-0190 Tobacco Cessation
410-130-0200 Prior Authorization
410-130-0220 Not Covered/BundledServices
410-130-0225 Teaching Physicians
410-130-0230 Administrative Medical Examinations and Reports
410-130-0240 Medical Services
410-130-0245 Early and Periodic Screening, Diagnostic and Treatment Program
410-130-0255 Immunizations and Immune Globulins
410-130-0365 Ambulatory Surgical Center and Birthing Center Services
410-130-0368 Anesthesia Services
410-130-0380 Surgery Guidelines
410-130-0562 Abortion
410-130-0580 Hysterectomies and Sterilization
410-130-0585 Family Planning Services
410-130-0587 Family Planning Clinic Services
410-130-0595 Maternity Case Management (MCM)
410-130-0610 Telemedicine
410-130-0670 Death With Dignity
410-130-0680 Laboratory and Radiology
410-130-0700 HCPCS Supplies and DME
410-131-0040 Foreword for Physical and Occupation Therapy
410-131-0080 Therapy Plan of Care and Record Requirements
410-131-0100 Maintenance
410-131-0120 Limitations of Coverage and Payment
410-131-0160 Prior Authorization for Payment
410-132-0020 Private Duty Nursing Services
410-132-0030 Definitions
410-132-0050 Client Copayments
410-132-0055 Copayment for Standard Benefit Package
410-132-0060 Private Duty Nursing Transition Into Maintenance
410-132-0070 Documentation Requirements
410-132-0080 Limitations
410-132-0100 Prior Authorization
410-132-0120 Billing Information
410-132-0180 Procedure Codes
410-132-0200 Provider Enrollment
410-133-0000 Purpose
410-133-0040 Definitions
410-133-0060 Health Services
410-133-0080 Coverage
410-133-0090 Public Education Agency School Medical Provider Payment Requirements
410-133-0100 School Medical Provider Requirements
410-133-0120 Medically Qualified Staff
410-133-0140 School Medical Provider Enrollment Provisions
410-133-0160 Licensed Practitioner Recommendation
410-133-0180 Duplication of Service
410-133-0200 Not Covered Services
410-133-0220 Billing and Payment
410-133-0245 Cost Determination and Payment
410-133-0280 Rebilling
410-133-0300 Procedure Codes
410-133-0320 Documentation and Record keeping Requirements
410-133-0340 Client Rights and Record Confidentiality
410-136-0030 Contracted Medical Transportation Services
410-136-0040 Reimbursement
410-136-0045 Non-Emergent Medical Transportation for Standard Benefit Package
410-136-0050 Out-of State Transportation
410-136-0060 Taxi Services
410-136-0070 Wheelchair Car/Van Service
410-136-0080 Additional Client Transport
410-136-0100 Deceased Client
410-136-0120 Transportation of Inpatient Client from Hospital to Other Hospital (or Facility) and Return
410-136-0140 Conditions for Payment
410-136-0160 Non-Emergency Medical Transportation
410-136-0180 Base Rate
410-136-0200 Emergency Medical Transportation (With Need for an Emergency Medical Technician)
410-136-0220 Air Ambulance Transport
410-136-0240 Secured Transports
410-136-0245 Child Transports
410-136-0260 Neonatal Intensive Care Transport
410-136-0280 Required Documentation
410-136-0300 Authorization
410-136-0320 Billing
410-136-0340 Billing for Clients Who Have Both Medicare and Medicaid Coverage
410-136-0350 Billing for Each Additional Client
410-136-0360 Billing -- Ambulance
410-136-0420 Emergency Medical Transportation Procedure Codes
410-136-0440 Non-Emergency Medical Transportation Procedure Codes
410-136-0800 Prior Authorization of Client Reimbursed Mileage, Meals and Lodging
410-136-0820 Qualifying Criteria for Meals/Lodging/Attendant
410-136-0840 Common Carrier and Public Transportation
410-136-0860 Overpayments - Clients Mileage/Per Diem
410-138-0000 Targeted Case Management Definitions
410-138-0005 Payment for Targeted Case Management Services Eligible for Federal Financial Participation
410-138-0007 Targeted Case Management — Covered Services
410-138-0009 Targeted Case Management — Services Not Covered
410-138-0020 Targeted Case Management Programs
410-138-0040 Targeted Case Management Babies First/CaCoon Program Risk Criteria
410-138-0060 Targeted Case Management Program — Provider Requirements
410-138-0080 Targeted Case Management Program Billing Policy
410-138-0390 Targeted Case Management Retroactive Payments
410-138-0420 Targeted Case Management Asthma/Healthy Home — Risk Criteria
410-140-0000 Foreword
410-140-0020 Managed Health Care Organizations
410-140-0040 Prior Authorization
410-140-0050 Eligibility
410-140-0060 Health Insurance Claim Form (HCFA-1500)
410-140-0080 Medicare/Medicaid Assistance Program Claims
410-140-0110 Client Copayments
410-140-0120 Procedure Codes
410-140-0140 Ophthalmological Diagnostic and Treatment Services Coverage
410-140-0160 Contact Lens Services
410-140-0180 Ocular Prosthetics, Artificial Eye
410-140-0200 Fitting and Repair
410-140-0210 Buy-Ups
410-140-0220 Other Procedures
410-140-0240 Prescription Required
410-140-0260 Purchase of Ophthalmic Materials
410-140-0280 Vision Therapy Services
410-140-0300 Postsurgical Care
410-140-0320 Radiological Services
410-140-0380 Administrative Exam Services Authorized by the Branch Office -- Effective for Services Provided on or After December 15, 1992
410-140-0400 Contractor Services/Provider Ordering
410-141-0000 Definitions
410-141-0010 Prepaid Health Plan Contract Procurement Screening and Selection Procedures
410-141-0020 Administration of Oregon Health Plan Regu lation and Rule Precedence
410-141-0050 MHO Enrollment for Children Receiving Child Welfare Services
410-141-0060 Oregon Health Plan Managed Care Enrollment Requirements
410-141-0070 Managed Care Fully Capitated Health Plan and Physician Care Organization Pharmaceutical Drug List Requirements
410-141-0080 Managed Care Disenrollment from Prepaid Health Plans
410-141-0085 Oregon Health Plan Disenrollment from Primary Care Managers
410-141-0120 Managed Care Prepaid Health Plan Provision of Health Care Services
410-141-0140 Oregon Health Plan Prepaid Health Plan Emergency and Urgent Care Services
410-141-0160 Oregon Health Plan Prepaid Health Plan (PHP) Coordination and Continuity of Care
410-141-0180 Oregon Health Plan Prepaid Health Plan Record Keeping
410-141-0200 Oregon Health Plan Prepaid Health Plan Quality Improvement (QI) System
410-141-0220 Managed Care Prepaid Health Plan Accessibility
410-141-0260 Managed Care Prepaid Health Plan Complaint or Grievance and Appeal Procedures
410-141-0261 PHP Complaint Procedures
410-141-0262 The Prepaid Health Plan Appeal Procedures
410-141-0263 Notice of Action by a Prepaid Health Plan
410-141-0264 Administrative Hearings
410-141-0265 Request for Expedited Appeal or Expedited Administrative Hearing
410-141-0266 PHP’s Responsibility for Documentation and Quality Improvement Review of the Grievance System
410-141-0270 Oregon Health Plan Marketing Requirements
410-141-0280 Managed Care Prepaid Health Plan Potential Member Informational Requirements
410-141-0300 Managed Care Prepaid Health Plan Member Education Requirements
410-141-0320 Oregon Health Plan Prepaid Health Plan Member Rights and Respon sibilities
410-141-0340 Oregon Health Plan Prepaid Health Plan Financial Solvency
410-141-0400 Oregon Health Plan Prepaid Health Plan Case Management Services
410-141-0405 Oregon Health Plan Fully Capitated Health Plan and Physician Care Organization Exceptional Needs Care Coordination (ENCC)
410-141-0407 Oregon Health Plan Ombudsman Services
410-141-0410 Oregon Health Plan Primary Care Managers
410-141-0420 Managed Care Prepaid Health Plan Billing and Payment under the Oregon Health Plan
410-141-0440 Prepaid Health Plan Hospital Contract Dispute Resolution
410-141-0480 Oregon Health Plan Benefit Package of Covered Services
410-141-0500 Excluded Services and Limitations for Oregon Health Plan Clients and/or Division Members
410-141-0520 Prioritized List of Health Services
410-141-0660 Oregon Health Plan Primary Care Manager Provision of Health Care Services
410-141-0680 Oregon Health Plan Primary Care Manager Emergency and Urgent Care Medical Services
410-141-0700 OHP PCM Continuity of Care
410-141-0720 Oregon Health Plan Primary Care Manager Medical Record Keeping
410-141-0740 Oregon Health Plan Primary Care Case Manager Quality Assurance System
410-141-0760 Oregon Health Plan Primary Care Managers Accessibility
410-141-0780 Oregon Health Plan Primary Care Manager Complaint Procedures
410-141-0800 Oregon Health Plan Primary Care Manager Informational Requirements
410-141-0820 Oregon Health Plan Primary Care Manager Member Education
410-141-0840 Oregon Health Plan Primary Care Manager Member Rights And Responsibilities
410-141-0860 Oregon Health Plan Primary Care Manager and Patient Centered Primary Care Home Provider Qualification and Enrollment
410-141-3000 Definitions
410-141-3010 CCO Application, Certification, and Contracting Procedures
410-141-3015 Certification Criteria for Coordinated Care Organizations
410-141-3020 Administration of Oregon Integrated and Coordinated Health Care Delivery System Regulation and Rule Precedence
410-141-3030 Implementation and Transition
410-141-3050 CCO Enrollment for Certain Children Receiving Health Services
410-141-3060 Enrollment Requirements in a CCO
410-141-3070 Pharmaceutical Drug List Requirements
410-141-3080 Disenrollment from Coordinated Care Organizations
410-141-3120 Operations and Provision of Health Services
410-141-3140 Emergency and Urgent Care Services
410-141-3145 Community Health Assessment and Community Health Improvement Plans
410-141-3160 Enrollment Requirements in a CCO
410-141-3170 Intensive Care Coordination Services (Exceptional Needs Care Coordination (ENCC))
410-141-3180 Record Keeping and Use of Health Information Technology
410-141-3200 Outcome and Quality Measures
410-141-3220 Coordinated Care Organization Member Rights and Responsibilities
410-141-3260 Grievance and Appeal System
410-141-3261 Requirements for CCO Grievance Process
410-141-3262 Requirements for CCO Appeal
410-141-3263 Notice of Action
410-141-3264 Contested Case Hearings
410-141-3268 Process for Resolving Disputes on Formation of CCO
410-141-3270 Marketing Requirements
410-141-3280 Potential Member Information Requirements
410-141-3300 Member Education Requirements
410-141-3320 Coordinated Care Organization Member Rights and Responsibilities
410-141-3340 Procedure for General Financial Reporting and for Determining Financial Solvency Matters
410-141-3345 General Financial Reporting and Financial Solvency Matters; CCO Reporting Method
410-141-3350 Assets, Liabilities, Reserves – DCBS REPORTING CCOs ONLY
410-141-3355 Restricted Reserves, Capital and Surplus– DCBS Reporting CCOs Only
410-141-3360 Risk-based capital – DCBS Reporting CCOs Only
410-141-3365 Financial Reporting– DCBS Reporting CCOs Only
410-141-3370 Solvency Monitoring and Corrective Actions
410-141-3375 Hazardous Operations
410-141-3380 Disallowance of Transactions – DCBS Reporting CCOs Only
410-141-3385 Holding Company
410-141-3390 Transparency
410-141-3395 Member Protection Provisions
410-141-3420 Billing and Payment
410-141-3430 Coordinated Care Organization Encounter Claims Data Reporting
410-142-0020 Definitions
410-142-0040 Eligibility for Hospice Services
410-142-0060 Certification of Terminal Illness
410-142-0080 Informed Consent
410-142-0100 Election of Hospice Care
410-142-0110 Concurrent Care for Children
410-142-0120 Duration of Hospice Care
410-142-0140 Changing the Designated Hospice
410-142-0160 Revoking the Election of Hospice Care
410-142-0180 Plan of Care
410-142-0200 Interdisciplinary Group
410-142-0220 Requirements for Coverage
410-142-0225 Signature Requirements
410-142-0240 Hospice Core Services
410-142-0260 Hospice Level of Care
410-142-0280 Recipient Benefits
410-142-0290 Hospice Services in a Nursing Facility
410-142-0300 Hospice Reimbursement and Limitations
410-142-0380 Death With Dignity
410-143-0020 Definitions -- Effective for Services Provided on or After February 1, 1994
410-143-0040 Provider Qualification -- Effective for Services Provided on or After February 1, 1994
410-143-0060 Procedure Codes -- Effective for Services Provided on or After February 1, 1994
410-145-0000 Definitions
410-145-0010 Application Procedures
410-145-0020 Board of Governors
410-145-0030 Annual Report
410-145-0040 Review and Evaluation of Annual Report
410-145-0050 Complaint Procedure
410-145-0060 Action on Complaints
410-145-0070 Confidentiality of Information
410-145-0080 Reconsideration and Judicial Review
410-146-0000 Foreword
410-146-0020 Memorandum of Agreement Reimbursement Methodology
410-146-0021 American Indian/Alaska Native (AI/AN) Provider Enrollment
410-146-0022 OHP Standard Benefit for AI/AN Clients
410-146-0040 ICD-9-CM Diagnosis Codes and CPT/HCPCs Procedure Codes
410-146-0060 Prior Authorization
410-146-0075 Client Copayments
410-146-0085 Encounter and Recognized Practitioners
410-146-0086 Multiple Encounters
410-146-0100 Vaccines for Children (VFC)
410-146-0120 Maternity Case Management Services
410-146-0130 Modifiers
410-146-0160 Administrative Medical Examinations and Reports
410-146-0200 Pharmacy
410-146-0220 Death With Dignity
410-146-0240 Transportation
410-146-0380 OHP Standard Emergency Dental Benefit
410-146-0440 Prepaid Health Plan Supplemental Payments
410-146-0460 Compensation for Outstationed Eligibility Workers
410-147-0000 Foreword
410-147-0020 Professional Ambulatory Services
410-147-0040 ICD-9-CM Diagnosis and CPT/HCPCs Procedure Codes
410-147-0060 Prior Authorization
410-147-0080 Prepaid Health Plans (PHPs)
410-147-0085 Client Copayments
410-147-0120 Division Encounter and Recognized Practitioners
410-147-0125 OHP Standard Emergency Dental Benefit
410-147-0140 Multiple Encounters
410-147-0160 Modifiers
410-147-0180 Vaccines for Children (VFC) Program
410-147-0200 Maternity Case Management Services
410-147-0240 Administrative Medical Examinations and Reports
410-147-0260 Death With Dignity
410-147-0280 Drugs
410-147-0320 Federally Qualified Health Center Rural Health Clinics Enrollment
410-147-0340 Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) /Provider Numbers
410-147-0360 Encounter Rate Determination
410-147-0362 Change in Scope of Services
410-147-0365 Rural Health Clinic Obstetrics Care Delivery Procedures Reimbursement
410-147-0380 Accounting and Record Keeping
410-147-0400 Compensation for Outstationed Outreach Activities
410-147-0420 Rebasing
410-147-0440 Medicare Economic Index (MEI)
410-147-0460 Prepaid Health Plan Supplemental Payments
410-147-0480 Cost Statement Instructions
410-147-0500 Total Encounters for Cost Reports
410-147-0520 Depreciation
410-147-0540 Related Party Transactions
410-147-0560 Sanctions
410-148-0000 Foreword
410-148-0020 Home Enteral/Parenteral Nutrition and IV Services
410-148-0040 Requirements for Home Enteral/Parenteral Nutrition and IV Services
410-148-0060 Authorization
410-148-0080 Equipment Rental/Purchase/Repair
410-148-0090 Standard Benefit Package
410-148-0095 Client Copayments
410-148-0100 Reimbursement
410-148-0120 Reimbursement Limitations for Clients in a Nursing Facility
410-148-0140 Billing Information
410-148-0160 Billing for Clients Who Have Both Medicare and Basic Health Care Coverage
410-148-0260 Home Enteral Nutrition
410-148-0280 Home Parenteral Nutrition
410-148-0300 Other Home IV and Enteral/Parenteral Administration Services
410-148-0320 Billing Quantities, Metric Quantities and Package Sizes
410-150-0040 Request Requirements
LAW ENFORCEMENT LIABILITY ACCOUNT (LEMLA)
410-160-0000 Definitions
410-160-0100 Process and Procedure
OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM
410-165-0000 Basis and Purpose
410-165-0020 Definitions
410-165-0040 Application
410-165-0060 Eligibility
410-165-0080 Meaningful Use
410-165-0100 Participation and Incentive Payments
410-165-0120 Appeals
410-165-0140 Oversight and Audits
RURAL MEDICAL PRACTITIONERS INSURANCE SUBSIDY PROGRAM
410-500-0000 Purpose
410-500-0010 Definitions
410-500-0020 Eligibility Criteria for Rural Practitioners
410-500-0030 Determination of Subsidy Amount
410-500-0040 Authorized Carriers
410-500-0050 Program Integrity
410-500-0060 Appeals: Administrative Review
Notes
1.) The OAR Compilation is updated on the first of each month to include all rule actions filed with the Secretary of State’s Office by the 15th of the previous month, or by the previous workday if the 15th is on a weekend or holiday.
2.) The official copy of an Oregon Administrative Rule is contained in the Administrative Order filed at the Archives Division, 800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the published version are satisfied in favor of the Administrative Order. The Oregon Administrative Rules and the Oregon Bulletin are copyrighted by the Oregon Secretary of State. Terms and Conditions of Use