OAR 410-123-1230
Buying-Up


(1)

Buying-up as defined in OAR 410-120-0000 (Acronyms and Definitions) is prohibited.

(2)

Providers are not permitted to bill and accept payment from the Division of Medical Assistance Programs (Division) or a managed care plan for a covered service when:

(a)

A non-covered service has been provided; and

(b)

Additional payment is sought or accepted from the client.

(3)

If a client wants to purchase a non-covered service or item, the client must be responsible for full payment. A payment from the Division or the managed care plan for a covered service cannot be credited toward the non-covered service and then an additional client payment sought to obtain, for example, a gold crown (not covered) instead of the stainless steel crown (covered).

Source: Rule 410-123-1230 — Buying-Up, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-123-1230 (accessed May 26, 2025).

May 26, 2025

Rule 410-123-1230's source at or​.us