Medical assistance for certain eligible persons
The Department of Human Services shall provide medical assistance under ORS 414.705 (Definitions for ORS 414.705 to 414.750) to 414.750 (Authority of Legislative Assembly to authorize services for other persons) to eligible persons who receive assistance under ORS 411.706 (Oregon Supplemental Income Program) and to children described in ORS 414.025 (Definitions) (2)(f), (i), (j), (k) and (m), 418.001 (Definition for ORS 418.005 to 418.030) to 418.034 (Department responsible for costs of medical care of certain children in detention or lockup facilities), 418.189 (Policy on child abuse and neglect) to 418.970 (ORS 418.950 to 418.970 inapplicable to existing facilities) and 657A.020 (Duties of division) to 657A.460 (Separate sleeping quarters not required for certain persons providing child care or babysitting services) and those mental health and chemical dependency services recommended according to standards of medical assistance and according to the schedule of implementation established by the Legislative Assembly. In providing medical assistance services described in ORS 414.018 (Goals) to 414.024 (Guidelines for selecting areas for initial operation of programs), 414.042 (Determination of need for and amount of medical assistance), 414.107 (Entitlement to mental health care and chemical dependency services), 414.710 (Services available to certain eligible persons), 414.720 (Public hearings) and 735.712 (Office to encourage health insurance coverage among small employers), the Department of Human Services shall also provide the following:
(1) Ombudsman services for eligible persons who receive assistance under ORS 411.706 (Oregon Supplemental Income Program). With the concurrence of the Governor, the Director of Human Services shall appoint ombudsmen and may terminate an ombudsman. Ombudsmen are under the supervision and control of the director. An ombudsman shall serve as a patient’s advocate whenever the patient or a physician or other medical personnel serving the patient is reasonably concerned about access to, quality of or limitations on the care being provided by a health care provider. Patients shall be informed of the availability of an ombudsman. Ombudsmen shall report to the Governor in writing at least once each quarter. A report shall include a summary of the services that the ombudsman provided during the quarter and the ombudsman’s recommendations for improving ombudsman services and access to or quality of care provided to eligible persons by health care providers.
(2) Case management services in each health care provider organization for those eligible persons who receive assistance under ORS 411.706 (Oregon Supplemental Income Program). Case managers shall be trained in and shall exhibit skills in communication with and sensitivity to the unique health care needs of people who receive assistance under ORS 411.706 (Oregon Supplemental Income Program). Case managers shall be reasonably available to assist patients served by the organization with the coordination of the patient’s health care services at the reasonable request of the patient or a physician or other medical personnel serving the patient. Patients shall be informed of the availability of case managers.
(3) A mechanism, established by rule, for soliciting consumer opinions and concerns regarding accessibility to and quality of the services of each health care provider.
(4) A choice of available medical plans and, within those plans, choice of a primary care provider.
(5) Due process procedures for any individual whose request for medical assistance coverage for any treatment or service is denied or is not acted upon with reasonable promptness. These procedures shall include an expedited process for cases in which a patient’s medical needs require swift resolution of a dispute. [1991 c.753 §14; 1993 c.815 §18; 1997 c.581 §26; 1999 c.547 §7; 1999 c.1084 §53; 2003 c.14 §§193,193a; 2003 c.591 §§1,2; 2005 c.381 §18]
Note: See note under 414.705 (Definitions for ORS 414.705 to 414.750).
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