Oregon Statutes 414.773 – Certain conditions on reimbursement of claims for behavioral health services prohibited; assignment of CCO member to primary care provider
(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.
Terms Used In Oregon Statutes 414.773
- Alternative payment methodology: means a payment other than a fee-for-services payment, used by coordinated care organizations as compensation for the provision of integrated and coordinated health care and services. See Oregon Statutes 414.025
- Behavioral health home: means a mental health disorder or substance use disorder treatment organization, as defined by the Oregon Health Authority by rule, that provides integrated health care to individuals whose primary diagnoses are mental health disorders or substance use disorders. See Oregon Statutes 414.025
- Coordinated care organization: means an organization meeting criteria adopted by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
- Health services: means at least so much of each of the following as are funded by the Legislative Assembly based upon the prioritized list of health services compiled by the Health Evidence Review Commission under ORS § 414. See Oregon Statutes 414.025
- Medical assistance: includes any care or services for any individual who is a patient in a medical institution or any care or services for any individual who has attained 65 years of age or is under 22 years of age, and who is a patient in a private or public institution for mental diseases. See Oregon Statutes 414.025
- Patient centered primary care home: means a health care team or clinic that is organized in accordance with the standards established by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
(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. [2022 c.37 § 10]