§ 414.773 — Certain conditions on reimbursement of claims for behavioral health services prohibited; assignment of CCO member to primary care provider

Oregon § 414.773

• Jurisdiction: Oregon
• Vol.: 11
• Title 34: Human Services; Juvenile Code; Corrections
• Ch. 414: Medical Assistance

Text

(1) A claim for reimbursement for a behavioral health service or a physical health service provided to a medical assistance recipient may not be denied by the Oregon Health Authority or a coordinated care organization on the basis that the behavioral health service and physical health service were provided on the same day or in the same facility, unless required by state or federal law.
(2) A coordinated care organization may not require prior authorization for specialty behavioral health services provided to a medical assistance recipient at a behavioral health home or a patient centered primary care home unless permitted to do so by the authority.
(3) A coordinated care organization must assign a member of the coordinated care organization to a primary care provider if the member has not selected a primary care provider by the 90th day after enrollment in medical assistance. The coordinated care organization shall provide notice of the assignment to the member and to the primary care provider.
(4) A member may select a different primary care provider at any time.
(5) Subsection (1) of this section does not apply to coordinated care organizations’ payments to providers using a value-based payment arrangement or other alternative payment methodology.

Legislative History

2022 c.37 §10