Chapter 414  Medical Assistance

General Provisions

§ 414.018 Legislative intent
§ 414.025 Definitions for ORS chapters 411, 413 and 414
§ 414.033 Expenditures for medical assistance authorized
§ 414.034 Acceptance of federal billing, reimbursement and reporting forms
§ 414.041 Simplified application process

Medical Assistance

§ 414.065 Determination of health care and services covered
§ 414.067 Coordinated care organization assumption of costs
§ 414.071 Timely payment for dental services
§ 414.075 Payment of deductibles imposed under federal law
§ 414.095 Exemptions applicable to payments
§ 414.109 Oregon Health Plan Fund

Insurance And Service Contracts

§ 414.115 Medical assistance by insurance or service contracts
§ 414.125 Rates on insurance or service contracts
§ 414.135 Contracts relating to direct providers of care and services
§ 414.145 Implementation of ORS 414.115, 414.125 or 414.135

State And Local Public Health Partnership

§ 414.150 Purpose of ORS 414.150 to 414.153
§ 414.152 Duties of state agencies
§ 414.153 Services provided by local government

Advisory Committees

§ 414.211 Medicaid Advisory Committee
§ 414.221 Duties of committee
§ 414.225 Oregon Health Authority to consult with committee
§ 414.227 Application of public meetings law to advisory committees
§ 414.229 Office for Oregon Health Policy and Research Advisory Committee

Health Care For All Oregon Children Program

§ 414.231 Eligibility for Healthy Kids program

Prescription Drugs

(Oregon Prescription Drug Program)

§ 414.312 Oregon Prescription Drug Program
§ 414.314 Application and participation in Oregon Prescription Drug Program
§ 414.316 Preferred drug list for Oregon Prescription Drug Program
§ 414.318 Prescription Drug Purchasing Fund
§ 414.320 Rules

(Prescription Drug Coverage By Medical Assistance)

§ 414.325 Prescription drugs
§ 414.326 Supplemental rebates from pharmaceutical manufacturers
§ 414.327 Electronically transmitted prescriptions
§ 414.329 Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage

(Practitioner Managed Prescription Drug Plan)

§ 414.330 Legislative findings on prescription drugs
§ 414.332 Policy for Practitioner-Managed Prescription Drug Plan
§ 414.334 Practitioner-Managed Prescription Drug Plan for medical assistance program
§ 414.337 Limitation on rules regarding Practitioner-Managed Prescription Drug Plan

(Pharmacy And Therapeutics Committee)

§ 414.351 Definitions for ORS 414.351 to 414.414
§ 414.353 Committee established
§ 414.354 Meetings
§ 414.356 Executive session
§ 414.361 Drug utilization review standards and interventions
§ 414.364 Intervention approaches
§ 414.369 Prospective drug use review program
§ 414.371 Retrospective drug use review program
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Medical Assistance For Certain Individuals

§ 414.426 Payment of cost of medical care for institutionalized persons
§ 414.428 Coverage for American Indian and Alaskan Native beneficiaries

Medical Assistance Based On Condition

(Hemophilia)

§ 414.500 Findings regarding medical assistance for persons with hemophilia
§ 414.510 Definitions
§ 414.520 Hemophilia services
§ 414.530 When payments not made for hemophilia services

(Breast And Cervical Cancer)

§ 414.532 Definitions for ORS 414.534 to 414.538
§ 414.534 Treatment for breast or cervical cancer
§ 414.536 Presumptive eligibility for medical assistance for treatment of breast or cervical cancer
§ 414.538 Prohibition on coverage limitations
§ 414.540 Rules

(Cystic Fibrosis)

§ 414.550 Definitions for ORS 414.550 to 414.565
§ 414.555 Findings regarding medical assistance for persons with cystic fibrosis
§ 414.560 Cystic fibrosis services
§ 414.565 When payments not made for cystic fibrosis services

Oregon Integrated And Coordinated Care Delivery System

(Prepaid Managed Care Health Services Organizations)

§ 414.610 Legislative intent
§ 414.615 Selection of providers
§ 414.618 Authorization for alternatives to reimbursement of coordinated care organizations

(Coordinated Care Organizations)

§ 414.620 System established
§ 414.625 Coordinated care organizations
§ 414.627 Community advisory councils
§ 414.628 Innovator agents

(Temporary Provisions Relating To Transition Are Compiled As Notes Following Ors 414.628)

§ 414.631 Mandatory enrollment in coordinated care organization
§ 414.632 Services to individuals who are dually eligible for Medicare and Medicaid
§ 414.635 Consumer and provider protections
§ 414.638 Metrics and scoring committee
§ 414.645 Network adequacy
§ 414.646 Discrimination based on scope of practice prohibited
§ 414.647 Transfer of 500 or more enrollees
§ 414.651 Coordinated care organization contracts
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(Health Evidence Review Commission)

§ 414.688 Commission established
§ 414.689 Members
§ 414.690 Prioritized list of health services
§ 414.695 Medical technology assessment
§ 414.698 Comparative effectiveness of medical technologies
§ 414.701 Commission may not rely solely on comparative effectiveness research
§ 414.704 Advisory committee

Scope Of Covered Health Services

§ 414.706 Persons eligible for medical assistance
§ 414.709 Adjustment of population of eligible persons in event of insufficient resources prohibited
§ 414.710 Services not subject to prioritized list
§ 414.712 Health services for certain eligible persons
§ 414.721 Federal approval for funding services with assessments
§ 414.727 Reimbursement of rural hospitals by prepaid managed care health services organization
§ 414.728 Reimbursement of rural hospitals on fee-for-service basis
§ 414.735 Reduction in scope of health services in event of insufficient resources
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Payment Of Medical Expenses Of Person In Custody Of Law Enforcement Officer

§ 414.805 Liability of individual for medical services received while in custody of law enforcement officer
§ 414.807 Oregon Health Authority to pay for medical services related to law enforcement activity
§ 414.815 Law Enforcement Medical Liability Account

Premium Assistance

§ 414.825 Policy
§ 414.826 Private health option
§ 414.828 Assistance subject to legislative appropriation
§ 414.839 Premium assistance for health insurance coverage

Hospital Assessment

(Temporary Provisions Relating To Hospital Assessment Are Compiled As Notes Following Ors 414.839)