Chapter 546 Oregon Laws 1999
Session Law
AN ACT
SB 676
Relating to Oregon Health
Plan; amending ORS 414.065 and 414.727.
Be It Enacted by the People of the State of Oregon:
SECTION 1.
ORS 414.065 is amended to read:
414.065. (1) With respect to medical and remedial care and
services to be provided in medical assistance during any period, and within the
limits of funds available therefor, the Department of Human Resources shall
determine, subject to such revisions as it may make from time to time and with
respect to the "health services" defined in ORS 414.705, subject to
legislative funding in response to the report of the Health Services
Commission:
(a) The types and extent of medical and remedial care and
services to be provided to each eligible group of recipients of medical
assistance.
(b) Standards to be observed in the provision of medical and
remedial care and services.
(c) The number of days of medical and remedial care and
services toward the cost of which public assistance funds will be expended in
the care of any person.
(d) Reasonable fees, charges and daily rates to which public
assistance funds will be applied toward meeting the costs of providing medical
and remedial care and services to an applicant or recipient.
(e) Reasonable fees for professional medical and dental
services which may be based on usual and customary fees in the locality for
similar services.
(f) The amount and application of any copayment or other
similar cost-sharing payment that the department may require a recipient to pay
toward the cost of medical and remedial care or services.
(2) The types and extent of medical and remedial care and
services and the amounts to be paid in meeting the costs thereof, as determined
and fixed by the department and within the limits of funds available therefor,
shall be the total available for medical assistance and payments for such
medical assistance shall be the total amounts from public assistance funds
available to providers of medical and remedial care and services in meeting the
costs thereof.
(3) Except for payments under a cost-sharing plan, payments
made by the department for medical assistance shall constitute payment in full
for all medical and remedial care and services for which such payments of
medical assistance were made.
(4) Medical benefits, standards and limits established pursuant
to subsection (1)(a), (b) and (c) of this section for the eligible medically
needy, except for the aged served under ORS chapter 413 and for the blind and
disabled served under ORS chapter 412, may be less but shall not exceed medical
benefits, standards and limits established for the eligible categorically
needy, except that, in the case of a research and demonstration project entered
into under ORS 411.135, medical benefits, standards and limits for the eligible
medically needy may exceed those established for specific eligible groups of
the categorically needy.
(5) Notwithstanding the provisions of this section, the
department shall cause Type A hospitals and Type B hospitals, as defined in ORS
442.470, identified by the Office of Rural Health as rural hospitals to be
reimbursed [fully] for the cost of
covered services as follows:
(a) For services provided to
persons entitled to receive medical assistance, based on the Medicare determination
of reasonable cost as derived from the Hospital and Hospital Health Care
Complex Cost Report, referred to as the Medicare Report[, provided by the hospital to a person entitled to receive medical
assistance].
(b) In accordance with
the terms of the agreement for services provided to persons whose medical
assistance benefits are administered by the contracting health care provider
under an agreement between the hospital and a health care provider contracting
with the Department of Human Resources under ORS 414.725 (1) for reimbursement
other than that specified by ORS 414.727 (1). Hospitals reimbursed under the
terms of this paragraph are entitled to no additional reimbursement for
services provided.
(c) Hospitals that have been
reimbursed by health care providers contracting with the Department of Human
Resources under ORS 414.725 (1) in accordance with ORS 414.727 (1), are
entitled to full reimbursement from the department for the cost of covered services
provided to persons whose medical assistance benefits are administered by the
contracting health care provider according to paragraph (a) of this subsection.
SECTION 2.
ORS 414.727 is amended to read:
414.727. (1) A health care provider that contracts with the
Department of Human Resources under ORS 414.725 (1) to provide prepaid managed
care health services shall reimburse Type A and Type B hospitals, as defined in
ORS 442.470 and identified by the Office of Rural Health as rural hospitals,
fully for the cost of covered services based on the [Medicare determination of reasonable cost as derived from the most
recently finalized Hospital and Hospital Health Care Complex Cost Report,
referred to as the Medicare Report, provided by the hospital to a person
entitled to receive health services under the Oregon Health Plan.] cost-to-charge ratio used for each
hospital in setting the capitation rates paid to the contracting health care
provider for the contract period.
(2) Nothing in this section shall be construed to prohibit a
health care provider and hospital from mutually agreeing to reimbursement other
than the reimbursement specified in subsection (1) of this section.
Approved by the Governor
July 8, 1999
Filed in the office of
Secretary of State July 8, 1999
Effective date October 23,
1999
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