- (1) The Authority provides clients with health services through contracts with a Managed Care Entity (MCE).
- (2) The MCE is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law, or MCE's contract with the Authority, and the OHP administrative rules governing MCEs (OAR chapter 410, division 141).
- (3) All MCEs are required to provide benefit coverage pursuant to OAR 410-120-1210 and 410-141-0480 through 410-141-0520; however, authorization criteria may vary between MCEs. It is the providers' responsibility to comply with the MCE's Prior Authorization requirements or other policies necessary for reimbursement from the MCE before providing services to any OHP client enrolled in an MCE.
Statutory/Other Authority
ORS 413.042
Statutes/Other Implemented
ORS 414.025, 414.065, 414.631 & 414.651
History
DMAP 76-2022, minor correction filed 09/30/2022, effective 09/30/2022
DMAP 62-2017, amend filed 12/28/2017, effective 01/01/2018
DMAP 28-2012, f. 6-21-12, cert. ef. 7-1-12
OMAP 67-2005, f. 12-21-05, cert. ef. 1-1-06
OMAP 39-2005, f. 9-2-05, cert. ef. 10-1-05
OMAP 62-2003, f. 9-8-03, cert. ef.10-1-03