OAR 410-120-0006
Medical Eligibility Standards

As the state Medicaid and CHIP agency, the Oregon Health Authority (Authority) is responsible for establishing and implementing eligibility policies and procedures consistent with applicable law. As outlined in OAR 943-001-0020 (Oregon Health Authority Shared Service and Cooperative Relationships with Department of Human Services), the Authority and the Department of Human Services (Department) work together to adopt rules to assure that medical assistance eligibility procedures and determinations are consistent across both agencies.
(1) The Authority adopts and incorporates by reference the rules established in OAR Chapter 461 for all overpayment, personal injury liens, and estates administration for Authority programs covered under OAR chapter 410, division 200.
(2) Any reference to OAR chapter 461 in contracts of the Authority are deemed to be references to the requirements of this rule and shall be construed to apply to all eligibility policies, procedures, and determinations by or through the Authority.
(3) For purposes of this rule, references in OAR chapter 461 to the Department or to the Authority shall be construed to be references to both agencies.

Source: Rule 410-120-0006 — Medical Eligibility Standards, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-120-0006.

410–120–0000
Acronyms and Definitions 410–120–0003
OHP Standard Benefit Package 410–120–0006
Medical Eligibility Standards 410–120–0011
Effect of COVID-19 Emergency Authorities on Administrative Rules 410–120–0025
Administration of Division of Medical Assistance Programs, Regulation and Rule Precedence 410–120–0030
Children’s Health Insurance Program 410–120–0035
Public Entity 410–120–0045
Applications for Medical Assistance at Provider locations 410–120–0250
Managed Care Entity 410–120–1140
Verification of Eligibility and Coverage 410–120–1160
Medical Assistance Benefits and Provider Rules 410–120–1180
Medical Assistance Benefits: Out-of-State Services 410–120–1190
Medically Needy Benefit Program 410–120–1195
SB 5548 Population 410–120–1200
Excluded Services and Limitations 410–120–1210
Medical Assistance Benefit Packages and Delivery System 410–120–1260
Provider Enrollment 410–120–1280
Billing 410–120–1285
Recoupment and Data Sharing with Third-Party Insurers 410–120–1295
Non-Participating Provider 410–120–1300
Timely Submission of Claims 410–120–1320
Authorization of Payment 410–120–1340
Payment 410–120–1350
Buying-Up 410–120–1360
Requirements for Financial, Clinical and Other Records 410–120–1380
Compliance with Federal and State Statutes 410–120–1385
Compliance with Public Meetings Law 410–120–1390
Premium Sponsorships 410–120–1395
Program Integrity 410–120–1396
Provider and Contractor Audits 410–120–1397
Recovery of Overpayments to Providers — Recoupments and Refunds 410–120–1400
Provider Sanctions 410–120–1460
Type and Conditions of Sanction 410–120–1510
Fraud and Abuse 410–120–1560
Provider Appeals 410–120–1570
Claim Re-Determinations 410–120–1580
Provider Appeals — Administrative Review 410–120–1600
Provider Appeals — Contested Case Hearings 410–120–1855
Client’s Rights and Responsibilities 410–120–1860
Contested Case Hearing Procedures 410–120–1865
Denial, Reduction, or Termination of Services 410–120–1870
Client Premium Payments 410–120–1875
Agency Hearing Representatives 410–120–1880
Contracted Services 410–120–1920
Institutional Reimbursement Changes 410–120–1940
Interest Payments on Overdue Claims 410–120–1960
Payment of Private Insurance Premiums 410–120–1980
Requests for Information and Public Records 410–120–1990
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Last Updated

Jun. 8, 2021

Rule 410-120-0006’s source at or​.us