1. (1) Providers are not permitted to bill and accept payment from the Division or a managed care plan for a covered service:

   1. (a) When a non-covered service has been provided; and
   2. (b) Additional payment is sought or accepted from the Division client.
2. (2) Examples include, but are not limited to, charging the client an additional payment to obtain a gold crown (non covered) instead of the stainless steel crown (covered) or charging an additional client payment to obtain eyeglass frames not on the Division or managed care plan contract.
3. (3) If a client wants to purchase a non-covered service or item, the client must be responsible for full payment. The Division or managed care plan payment for a covered service cannot be credited toward the non-covered service.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.025 & 414.065

History

DMAP 27-2023, minor correction filed 04/27/2023, effective 04/27/2023
OMAP 39-2005, f. 9-2-05, cert. ef. 10-1-05
OMAP 10-1999, f. & cert. ef. 4-1-99