Or. Admin. R. ch. 410, div. 120 – Medical Assistance Programs | Midpage

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Oregon Administrative Rules

Division 120

Or. Admin. R. ch. 410, div. 120

Medical Assistance Programs

Oregon Health Authority

0000Acronyms and Definitions 0001Interpreter Services 0003OHP Standard Benefit Package 0006Medical Eligibility Standards 0025Administration of Division of Medical Assistance Programs, Regulation and Rule Precedence 0030Children’s Health Insurance Program 0035Public Entity 0045Applications for Medical Assistance at Provider Locations 0250Managed Care Entity 1140Verification of Eligibility and Coverage 1160Medical Assistance Benefits and Provider Rules 1180Medical Assistance Benefits: Out-of-State Services 1190Medically Needy Benefit Program 1200Excluded Services and Limitations 1210Medical Assistance Benefit Packages and Delivery System 1260Provider Enrollment 1280Billing 1285Recoupment and Data Sharing with Third-Party Insurers 1295Non-Participating Provider 1300Timely Submission of Claims 1320Authorization of Payment 1340Payment 1350Buying-Up 1360Requirements for Financial, Clinical and Other Records 1380Compliance with Federal and State Statutes 1385Compliance with Public Meetings Law 1390Premium Sponsorships 1395Program Integrity 1396Provider and Contractor Audits 1397Recovery of Overpayments to Providers — Recoupments and Refunds 1400Provider Sanctions 1460Type and Conditions of Sanction 1510Fraud and Abuse 1560Provider Appeals 1570Claim Re-Determinations 1580Provider Appeals — Administrative Review 1600Provider Appeals — Contested Case Hearings 1855Client’s Rights and Responsibilities 1860Contested Case Hearing Procedures 1865Denial, Reduction, or Termination of Services 1875Agency Hearing Representatives 1880Contracted Services 1920Institutional Reimbursement Changes 1940Interest Payments on Overdue Claims 1960Payment of Private Insurance Premiums 1980Requests for Information and Public Records 1990Telehealth 2000HRSN Services Delivery 2005HRSN Service Eligibility; Identifying HRSN Eligible Members; HRSN Outreach and Engagement Services.2010HRSN Service Requests 2015HRSN Eligibility Screening.2020Authorization of HRSN Services; Referral to HRSN Service Provider.2025HRSN Person-Centered Service Plan (PCSP)2030HRSN Service Provider Qualifications