ORS 414.025
Definitions for ORS chapters 411, 413 and 414


As used in this chapter and ORS chapters 411 and 413, unless the context or a specially applicable statutory definition requires otherwise:

(1)

Intentionally left blank —Ed.

(a)

“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.

(b)

“Alternative payment methodology” includes, but is not limited to:

(A)

Shared savings arrangements;

(B)

Bundled payments; and

(C)

Payments based on episodes.

(2)

“Behavioral health assessment” means an evaluation by a behavioral health clinician, in person or using telemedicine, to determine a patient’s need for immediate crisis stabilization.

(3)

“Behavioral health clinician” means:

(a)

A licensed psychiatrist;

(b)

A licensed psychologist;

(c)

A licensed nurse practitioner with a specialty in psychiatric mental health;

(d)

A licensed clinical social worker;

(e)

A licensed professional counselor or licensed marriage and family therapist;

(f)

A certified clinical social work associate;

(g)

An intern or resident who is working under a board-approved supervisory contract in a clinical mental health field; or

(h)

Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.

(4)

“Behavioral health crisis” means a disruption in an individual’s mental or emotional stability or functioning resulting in an urgent need for immediate outpatient treatment in an emergency department or admission to a hospital to prevent a serious deterioration in the individual’s mental or physical health.

(5)

“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.

(6)

“Category of aid” means assistance provided by the Oregon Supplemental Income Program, aid granted under ORS 411.877 (Definitions for program) to 411.896 (Annual report on program) and 412.001 (Definitions) to 412.069 (Appeal from denial of or failure to act on application or from modification or cancellation of aid) or federal Supplemental Security Income payments.

(7)

“Community health worker” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who:

(a)

Has expertise or experience in public health;

(b)

Works in an urban or rural community, either for pay or as a volunteer in association with a local health care system;

(c)

To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community the worker serves;

(d)

Assists members of the community to improve their health and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;

(e)

Provides health education and information that is culturally appropriate to the individuals being served;

(f)

Assists community residents in receiving the care they need;

(g)

May give peer counseling and guidance on health behaviors; and

(h)

May provide direct services such as first aid or blood pressure screening.

(8)

“Coordinated care organization” means an organization meeting criteria adopted by the Oregon Health Authority under ORS 414.572 (Coordinated care organizations).

(9)

“Dually eligible for Medicare and Medicaid” means, with respect to eligibility for enrollment in a coordinated care organization, that an individual is eligible for health services funded by Title XIX of the Social Security Act and is:

(a)

Eligible for or enrolled in Part A of Title XVIII of the Social Security Act; or

(b)

Enrolled in Part B of Title XVIII of the Social Security Act.

(10)

Intentionally left blank —Ed.

(a)

“Family support specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provides supportive services to and has experience parenting a child who:

(A)

Is a current or former consumer of mental health or addiction treatment; or

(B)

Is facing or has faced difficulties in accessing education, health and wellness services due to a mental health or behavioral health barrier.

(b)

A “family support specialist” may be a peer wellness specialist or a peer support specialist.

(11)

“Global budget” means a total amount established prospectively by the Oregon Health Authority to be paid to a coordinated care organization for the delivery of, management of, access to and quality of the health care delivered to members of the coordinated care organization.

(12)

“Health insurance exchange” or “exchange” means an American Health Benefit Exchange described in 42 U.S.C. 18031, 18032, 18033 and 18041.

(13)

“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 414.690 (Prioritized list of health services):

(a)

Services required by federal law to be included in the state’s medical assistance program in order for the program to qualify for federal funds;

(b)

Services provided by a physician as defined in ORS 677.010 (Definitions for chapter), a nurse practitioner licensed under ORS 678.375 (Nurse practitioners), a behavioral health clinician or other licensed practitioner within the scope of the practitioner’s practice as defined by state law, and ambulance services;

(c)

Prescription drugs;

(d)

Laboratory and X-ray services;

(e)

Medical equipment and supplies;

(f)

Mental health services;

(g)

Chemical dependency services;

(h)

Emergency dental services;

(i)

Nonemergency dental services;

(j)

Provider services, other than services described in paragraphs (a) to (i), (k), (L) and (m) of this subsection, defined by federal law that may be included in the state’s medical assistance program;

(k)

Emergency hospital services;

(L)

Outpatient hospital services; and

(m)

Inpatient hospital services.

(14)

“Income” has the meaning given that term in ORS 411.704 (Definitions for ORS 411.141, 411.706 and 411.708).

(15)

Intentionally left blank —Ed.

(a)

“Integrated health care” means care provided to individuals and their families in a patient centered primary care home or behavioral health home by licensed primary care clinicians, behavioral health clinicians and other care team members, working together to address one or more of the following:

(A)

Mental illness.

(B)

Substance use disorders.

(C)

Health behaviors that contribute to chronic illness.

(D)

Life stressors and crises.

(E)

Developmental risks and conditions.

(F)

Stress-related physical symptoms.

(G)

Preventive care.

(H)

Ineffective patterns of health care utilization.

(b)

As used in this subsection, “other care team members” includes but is not limited to:

(A)

Qualified mental health professionals or qualified mental health associates meeting requirements adopted by the Oregon Health Authority by rule;

(B)

Peer wellness specialists;

(C)

Peer support specialists;

(D)

Community health workers who have completed a state-certified training program;

(E)

Personal health navigators; or

(F)

Other qualified individuals approved by the Oregon Health Authority.

(16)

“Investments and savings” means cash, securities as defined in ORS 59.015 (Definitions for Oregon Securities Law), negotiable instruments as defined in ORS 73.0104 (Negotiable instrument) and such similar investments or savings as the department or the authority may establish by rule that are available to the applicant or recipient to contribute toward meeting the needs of the applicant or recipient.

(17)

“Medical assistance” means so much of the medical, mental health, preventive, supportive, palliative and remedial care and services as may be prescribed by the authority according to the standards established pursuant to ORS 414.065 (Determination of health care and services covered), including premium assistance under ORS 413.610 (Purpose of Compact of Free Association Premium Assistance Program) to 413.613 (COFA Premium Assistance Program Fund), 414.115 (Medical assistance by insurance or service contracts) and 414.117 (Premium assistance for health insurance coverage), payments made for services provided under an insurance or other contractual arrangement and money paid directly to the recipient for the purchase of health services and for services described in ORS 414.710 (Services not subject to prioritized list).

(18)

“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. Except as provided in ORS 411.439 (Twelve-month continuation of medical assistance of persons with serious mental illness admitted to state hospital) and 411.447 (Suspension of medical assistance provided to inmates), “medical assistance” does not include care or services for a resident of a nonmedical public institution.

(19)

“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 414.655 (Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations) and that incorporates the following core attributes:

(a)

Access to care;

(b)

Accountability to consumers and to the community;

(c)

Comprehensive whole person care;

(d)

Continuity of care;

(e)

Coordination and integration of care; and

(f)

Person and family centered care.

(20)

“Peer support specialist” means any of the following individuals who meet qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provide supportive services to a current or former consumer of mental health or addiction treatment:

(a)

An individual who is a current or former consumer of mental health treatment; or

(b)

An individual who is in recovery, as defined by the Oregon Health Authority by rule, from an addiction disorder.

(21)

“Peer wellness specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who is responsible for assessing mental health and substance use disorder service and support needs of a member of a coordinated care organization through community outreach, assisting members with access to available services and resources, addressing barriers to services and providing education and information about available resources for individuals with mental health or substance use disorders in order to reduce stigma and discrimination toward consumers of mental health and substance use disorder services and to assist the member in creating and maintaining recovery, health and wellness.

(22)

“Person centered care” means care that:

(a)

Reflects the individual patient’s strengths and preferences;

(b)

Reflects the clinical needs of the patient as identified through an individualized assessment; and

(c)

Is based upon the patient’s goals and will assist the patient in achieving the goals.

(23)

“Personal health navigator” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provides information, assistance, tools and support to enable a patient to make the best health care decisions in the patient’s particular circumstances and in light of the patient’s needs, lifestyle, combination of conditions and desired outcomes.

(24)

“Prepaid managed care health services organization” means a managed dental care, mental health or chemical dependency organization that contracts with the authority under ORS 414.654 (Persons served by prepaid managed care health services organizations) or with a coordinated care organization on a prepaid capitated basis to provide health services to medical assistance recipients.

(25)

“Quality measure” means the health outcome and quality measures and benchmarks identified by the Health Plan Quality Metrics Committee and the metrics and scoring subcommittee in accordance with ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (4) and 414.638 (Metrics and scoring subcommittee) and the quality metrics developed by the Behavioral Health Committee in accordance with ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (5).

(26)

“Resources” has the meaning given that term in ORS 411.704 (Definitions for ORS 411.141, 411.706 and 411.708). For eligibility purposes, “resources” does not include charitable contributions raised by a community to assist with medical expenses.

(27)

“Tribal traditional health worker” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who:

(a)

Has expertise or experience in public health;

(b)

Works in a tribal community or an urban Indian community, either for pay or as a volunteer in association with a local health care system;

(c)

To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community the worker serves;

(d)

Assists members of the community to improve their health, including physical, behavioral and oral health, and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;

(e)

Provides health education and information that is culturally appropriate to the individuals being served;

(f)

Assists community residents in receiving the care they need;

(g)

May give peer counseling and guidance on health behaviors; and

(h)

May provide direct services, such as tribal-based practices.

(28)

Intentionally left blank —Ed.

(a)

“Youth support specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who, based on a similar life experience, provides supportive services to an individual who:

(A)

Is not older than 30 years of age; and

(B)

Intentionally left blank —Ed.
(i)
Is a current or former consumer of mental health or addiction treatment; or
(ii)
Is facing or has faced difficulties in accessing education, health and wellness services due to a mental health or behavioral health barrier.

(b)

A “youth support specialist” may be a peer wellness specialist or a peer support specialist. [1965 c.556 §2; 1967 c.502 §3; 1969 c.507 §1; 1971 c.488 §1; 1973 c.651 §10; 1974 c.16 §1; 1977 c.114 §1; 1981 c.825 §3; 1983 c.415 §3; 1985 c.747 §9; 1987 c.872 §1; 1989 c.697 §2; 1989 c.836 §19; 1991 c.66 §6; 1995 c.343 §42; 1995 c.807 §1; 1997 c.581 §22; 1999 c.59 §107; 1999 c.350 §1; 1999 c.515 §1; 2003 c.14 §188; 2005 c.381 §13; 2007 c.70 §190; 2007 c.486 §11; 2007 c.861 §18,18a; 2009 c.595 §264; 2009 c.867 §36; 2010 c.73 §1; 2011 c.69 §7; 2011 c.602 §§20,69; 2011 c.700 §5; 2013 c.688 §68; 2015 c.3 §45; 2015 c.389 §9; 2015 c.765 §25; 2015 c.792 §5; 2015 c.798 §3; 2015 c.836 §3; 2017 c.273 §3; 2017 c.618 §§2,3; 2019 c.358 §6; 2021 c.514 §2; 2021 c.569 §12; 2021 c.667 §20]
Note: The amendments to 414.025 (Definitions for ORS chapters 411, 413 and 414) by section 2, chapter 628, Oregon Laws 2021, become operative January 2, 2026. See section 5, chapter 628, Oregon Laws 2021. The text that is operative on and after January 2, 2026, is set forth for the user’s convenience.
414.025 (Definitions for ORS chapters 411, 413 and 414). As used in this chapter and ORS chapters 411 and 413, unless the context or a specially applicable statutory definition requires otherwise:

(1)

Intentionally left blank —Ed.

(a)

“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.

(b)

“Alternative payment methodology” includes, but is not limited to:

(A)

Shared savings arrangements;

(B)

Bundled payments; and

(C)

Payments based on episodes.

(2)

“Behavioral health assessment” means an evaluation by a behavioral health clinician, in person or using telemedicine, to determine a patient’s need for immediate crisis stabilization.

(3)

“Behavioral health clinician” means:

(a)

A licensed psychiatrist;

(b)

A licensed psychologist;

(c)

A licensed nurse practitioner with a specialty in psychiatric mental health;

(d)

A licensed clinical social worker;

(e)

A licensed professional counselor or licensed marriage and family therapist;

(f)

A certified clinical social work associate;

(g)

An intern or resident who is working under a board-approved supervisory contract in a clinical mental health field; or

(h)

Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.

(4)

“Behavioral health crisis” means a disruption in an individual’s mental or emotional stability or functioning resulting in an urgent need for immediate outpatient treatment in an emergency department or admission to a hospital to prevent a serious deterioration in the individual’s mental or physical health.

(5)

“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.

(6)

“Category of aid” means assistance provided by the Oregon Supplemental Income Program, aid granted under ORS 411.877 (Definitions for program) to 411.896 (Annual report on program) and 412.001 (Definitions) to 412.069 (Appeal from denial of or failure to act on application or from modification or cancellation of aid) or federal Supplemental Security Income payments.

(7)

“Community health worker” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who:

(a)

Has expertise or experience in public health;

(b)

Works in an urban or rural community, either for pay or as a volunteer in association with a local health care system;

(c)

To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community the worker serves;

(d)

Assists members of the community to improve their health and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;

(e)

Provides health education and information that is culturally appropriate to the individuals being served;

(f)

Assists community residents in receiving the care they need;

(g)

May give peer counseling and guidance on health behaviors; and

(h)

May provide direct services such as first aid or blood pressure screening.

(8)

“Coordinated care organization” means an organization meeting criteria adopted by the Oregon Health Authority under ORS 414.572 (Coordinated care organizations).

(9)

“Dually eligible for Medicare and Medicaid” means, with respect to eligibility for enrollment in a coordinated care organization, that an individual is eligible for health services funded by Title XIX of the Social Security Act and is:

(a)

Eligible for or enrolled in Part A of Title XVIII of the Social Security Act; or

(b)

Enrolled in Part B of Title XVIII of the Social Security Act.

(10)

Intentionally left blank —Ed.

(a)

“Family support specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provides supportive services to and has experience parenting a child who:

(A)

Is a current or former consumer of mental health or addiction treatment; or

(B)

Is facing or has faced difficulties in accessing education, health and wellness services due to a mental health or behavioral health barrier.

(b)

A “family support specialist” may be a peer wellness specialist or a peer support specialist.

(11)

“Global budget” means a total amount established prospectively by the Oregon Health Authority to be paid to a coordinated care organization for the delivery of, management of, access to and quality of the health care delivered to members of the coordinated care organization.

(12)

“Health insurance exchange” or “exchange” means an American Health Benefit Exchange described in 42 U.S.C. 18031, 18032, 18033 and 18041.

(13)

“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 414.690 (Prioritized list of health services):

(a)

Services required by federal law to be included in the state’s medical assistance program in order for the program to qualify for federal funds;

(b)

Services provided by a physician as defined in ORS 677.010 (Definitions for chapter), a nurse practitioner licensed under ORS 678.375 (Nurse practitioners), a behavioral health clinician or other licensed practitioner within the scope of the practitioner’s practice as defined by state law, and ambulance services;

(c)

Prescription drugs;

(d)

Laboratory and X-ray services;

(e)

Medical equipment and supplies;

(f)

Mental health services;

(g)

Chemical dependency services;

(h)

Emergency dental services;

(i)

Nonemergency dental services;

(j)

Provider services, other than services described in paragraphs (a) to (i), (k), (L) and (m) of this subsection, defined by federal law that may be included in the state’s medical assistance program;

(k)

Emergency hospital services;

(L)

Outpatient hospital services; and

(m)

Inpatient hospital services.

(14)

“Income” has the meaning given that term in ORS 411.704 (Definitions for ORS 411.141, 411.706 and 411.708).

(15)

Intentionally left blank —Ed.

(a)

“Integrated health care” means care provided to individuals and their families in a patient centered primary care home or behavioral health home by licensed primary care clinicians, behavioral health clinicians and other care team members, working together to address one or more of the following:

(A)

Mental illness.

(B)

Substance use disorders.

(C)

Health behaviors that contribute to chronic illness.

(D)

Life stressors and crises.

(E)

Developmental risks and conditions.

(F)

Stress-related physical symptoms.

(G)

Preventive care.

(H)

Ineffective patterns of health care utilization.

(b)

As used in this subsection, “other care team members” includes but is not limited to:

(A)

Qualified mental health professionals or qualified mental health associates meeting requirements adopted by the Oregon Health Authority by rule;

(B)

Peer wellness specialists;

(C)

Peer support specialists;

(D)

Community health workers who have completed a state-certified training program;

(E)

Personal health navigators; or

(F)

Other qualified individuals approved by the Oregon Health Authority.

(16)

“Investments and savings” means cash, securities as defined in ORS 59.015 (Definitions for Oregon Securities Law), negotiable instruments as defined in ORS 73.0104 (Negotiable instrument) and such similar investments or savings as the department or the authority may establish by rule that are available to the applicant or recipient to contribute toward meeting the needs of the applicant or recipient.

(17)

“Medical assistance” means so much of the medical, mental health, preventive, supportive, palliative and remedial care and services as may be prescribed by the authority according to the standards established pursuant to ORS 414.065 (Determination of health care and services covered), including premium assistance under ORS 413.610 (Purpose of Compact of Free Association Premium Assistance Program) to 413.613 (COFA Premium Assistance Program Fund), 414.115 (Medical assistance by insurance or service contracts) and 414.117 (Premium assistance for health insurance coverage), payments made for services provided under an insurance or other contractual arrangement and money paid directly to the recipient for the purchase of health services and for services described in ORS 414.710 (Services not subject to prioritized list).

(18)

“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. Except as provided in ORS 411.439 (Twelve-month continuation of medical assistance of persons with serious mental illness admitted to state hospital) and 411.447 (Suspension of medical assistance provided to inmates), “medical assistance” does not include care or services for a resident of a nonmedical public institution.

(19)

“Mental health drug” means a type of legend drug, as defined in ORS 414.325 (Prescription drugs), specified by the Oregon Health Authority by rule, including but not limited to:

(a)

Therapeutic class 7 ataractics-tranquilizers; and

(b)

Therapeutic class 11 psychostimulants-antidepressants.

(20)

“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 414.655 (Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations) and that incorporates the following core attributes:

(a)

Access to care;

(b)

Accountability to consumers and to the community;

(c)

Comprehensive whole person care;

(d)

Continuity of care;

(e)

Coordination and integration of care; and

(f)

Person and family centered care.

(21)

“Peer support specialist” means any of the following individuals who meet qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provide supportive services to a current or former consumer of mental health or addiction treatment:

(a)

An individual who is a current or former consumer of mental health treatment; or

(b)

An individual who is in recovery, as defined by the Oregon Health Authority by rule, from an addiction disorder.

(22)

“Peer wellness specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who is responsible for assessing mental health and substance use disorder service and support needs of a member of a coordinated care organization through community outreach, assisting members with access to available services and resources, addressing barriers to services and providing education and information about available resources for individuals with mental health or substance use disorders in order to reduce stigma and discrimination toward consumers of mental health and substance use disorder services and to assist the member in creating and maintaining recovery, health and wellness.

(23)

“Person centered care” means care that:

(a)

Reflects the individual patient’s strengths and preferences;

(b)

Reflects the clinical needs of the patient as identified through an individualized assessment; and

(c)

Is based upon the patient’s goals and will assist the patient in achieving the goals.

(24)

“Personal health navigator” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who provides information, assistance, tools and support to enable a patient to make the best health care decisions in the patient’s particular circumstances and in light of the patient’s needs, lifestyle, combination of conditions and desired outcomes.

(25)

“Prepaid managed care health services organization” means a managed dental care, mental health or chemical dependency organization that contracts with the authority under ORS 414.654 (Persons served by prepaid managed care health services organizations) or with a coordinated care organization on a prepaid capitated basis to provide health services to medical assistance recipients.

(26)

“Quality measure” means the health outcome and quality measures and benchmarks identified by the Health Plan Quality Metrics Committee and the metrics and scoring subcommittee in accordance with ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (4) and 414.638 (Metrics and scoring subcommittee) and the quality metrics developed by the Behavioral Health Committee in accordance with ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (5).

(27)

“Resources” has the meaning given that term in ORS 411.704 (Definitions for ORS 411.141, 411.706 and 411.708). For eligibility purposes, “resources” does not include charitable contributions raised by a community to assist with medical expenses.

(28)

“Tribal traditional health worker” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who:

(a)

Has expertise or experience in public health;

(b)

Works in a tribal community or an urban Indian community, either for pay or as a volunteer in association with a local health care system;

(c)

To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community the worker serves;

(d)

Assists members of the community to improve their health, including physical, behavioral and oral health, and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;

(e)

Provides health education and information that is culturally appropriate to the individuals being served;

(f)

Assists community residents in receiving the care they need;

(g)

May give peer counseling and guidance on health behaviors; and

(h)

May provide direct services, such as tribal-based practices.

(29)

Intentionally left blank —Ed.

(a)

“Youth support specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 (Traditional health workers utilized by coordinated care organizations) and who, based on a similar life experience, provides supportive services to an individual who:

(A)

Is not older than 30 years of age; and

(B)

Intentionally left blank —Ed.
(i)
Is a current or former consumer of mental health or addiction treatment; or
(ii)
Is facing or has faced difficulties in accessing education, health and wellness services due to a mental health or behavioral health barrier.

(b)

A “youth support specialist” may be a peer wellness specialist or a peer support specialist.

Source: Section 414.025 — Definitions for ORS chapters 411, 413 and 414, https://www.­oregonlegislature.­gov/bills_laws/ors/ors414.­html.

414.018
Legislative intent
414.025
Definitions for ORS chapters 411, 413 and 414
414.033
Expenditures for medical assistance authorized
414.034
Acceptance of federal billing, reimbursement and reporting forms
414.041
Simplified application process
414.044
Notice to Department of Veterans’ Affairs of information regarding applications for health care coverage by uniformed service members and veterans
414.065
Determination of health care and services covered
414.066
Billing patient for services covered by medical assistance prohibited
414.067
Coordinated care organization assumption of costs
414.071
Timely payment for dental services
414.072
Prior authorization data and reports
414.075
Payment of deductibles imposed under federal law
414.095
Exemptions applicable to payments
414.109
Oregon Health Plan Fund
414.115
Medical assistance by insurance or service contracts
414.117
Premium assistance for health insurance coverage
414.125
Rates on insurance or service contracts
414.135
Contracts relating to direct providers of care and services
414.145
Implementation of ORS 414.115, 414.125 or 414.135
414.150
Purpose of ORS 414.150 to 414.153
414.152
Duty of state agencies to work with local health departments
414.153
Services provided by local health departments
414.211
Medicaid Advisory Committee
414.221
Duties of committee
414.225
Oregon Health Authority to consult with committee
414.227
Application of public meetings law to advisory committees
414.231
Eligibility for Cover All People program
414.312
Oregon Prescription Drug Program
414.314
Application and participation in Oregon Prescription Drug Program
414.318
Prescription Drug Purchasing Fund
414.320
Rules
414.325
Prescription drugs
414.326
Supplemental rebates from pharmaceutical manufacturers
414.327
Electronically transmitted prescriptions
414.328
Synchronization of prescription drug refills
414.329
Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage
414.330
Legislative findings on prescription drugs
414.332
Policy for Practitioner-Managed Prescription Drug Plan
414.334
Practitioner-Managed Prescription Drug Plan for medical assistance program
414.337
Limitation on rules regarding Practitioner-Managed Prescription Drug Plan
414.351
Definitions for ORS 414.351 to 414.414
414.353
Committee established
414.354
Meetings
414.356
Executive session
414.359
Mental Health Clinical Advisory Group
414.361
Committee to advise and make recommendations on drug utilization review standards and interventions
414.364
Intervention approaches
414.369
Prospective drug use review program
414.371
Retrospective drug use review program
414.372
Pharmacy lock-in program
414.381
Annual reports
414.382
Requirements for annual report
414.414
Use and disclosure of confidential information
414.426
Payment of cost of medical care for institutionalized persons
414.428
Coverage for American Indian and Alaska Native beneficiaries
414.430
Access to dental care for pregnant women
414.432
Reproductive health services for noncitizens
414.500
Findings regarding medical assistance for persons with hemophilia
414.510
Definitions
414.520
Hemophilia services
414.530
When payments not made for hemophilia services
414.532
Definitions for ORS 414.534 to 414.538
414.534
Treatment for breast or cervical cancer
414.536
Presumptive eligibility for medical assistance for treatment of breast or cervical cancer
414.538
Prohibition on coverage limitations
414.540
Rules
414.550
Definitions for ORS 414.550 to 414.565
414.555
Findings regarding medical assistance for persons with cystic fibrosis
414.560
Cystic fibrosis services
414.565
When payments not made for cystic fibrosis services
414.570
System established
414.572
Coordinated care organizations
414.575
Community advisory councils
414.577
Community health assessment and adoption of community health improvement plan
414.578
Community health improvement plan
414.581
Tribal Advisory Council established
414.584
Meetings of coordinated care organization governing body to be open to public
414.590
Coordinated care organization contracts
414.591
Coordinated care organization contracts
414.592
Requirements for contracts between authority and providers
414.593
Reporting and public disclosure of expenditures by coordinated care organizations
414.595
External quality reviews of coordinated care organizations
414.598
Alternative payment methodologies
414.605
Consumer and provider protections
414.607
Use and disclosure of member information
414.609
Network adequacy
414.611
Transfer of 500 or more members of coordinated care organization
414.613
Discrimination based on scope of practice prohibited
414.619
Coordination between Oregon Health Authority and Department of Human Services
414.628
Innovator agents
414.631
Mandatory enrollment in coordinated care organization
414.632
Services to individuals who are dually eligible for Medicare and Medicaid
414.638
Metrics and scoring subcommittee
414.654
Persons served by prepaid managed care health services organizations
414.655
Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations
414.665
Traditional health workers utilized by coordinated care organizations
414.667
Definition for ORS 414.667 to 414.669
414.668
Access to doula services
414.669
Payment for doula services
414.672
Tribal-based practices for mental health and substance abuse prevention, counseling and treatment
414.686
Health assessments for foster children
414.688
Commission established
414.689
Members
414.690
Prioritized list of health services
414.694
Commission review of covered reproductive health services
414.695
Medical technology assessment
414.698
Comparative effectiveness of medical technologies
414.701
Commission may not rely solely on comparative effectiveness research
414.704
Advisory committee
414.706
Persons eligible for medical assistance
414.709
Adjustment of population of eligible persons in event of insufficient resources prohibited
414.710
Services not subject to prioritized list
414.712
Health services for certain eligible persons
414.717
Palliative care program
414.719
Housing navigation services and social determinants of health
414.723
Telemedicine services
414.726
Requirement to use certified or qualified health care interpreters
414.728
Reimbursement of rural hospitals on fee-for-service basis
414.735
Reduction in scope of health services in event of insufficient resources
414.742
Payment for mental health drugs
414.743
Payment to noncontracting hospital by coordinated care organization
414.745
Liability of health care providers and plans
414.755
Payment for hospital services
414.756
Payments to Oregon Health and Science University
414.760
Payment for patient centered primary care home and behavioral health home services
414.762
Payment for child abuse assessment
414.764
Payment for services provided by pharmacy or pharmacist
414.766
Behavioral health treatment
414.767
Survey of medical assistance recipients regarding experience with behavioral health care and services
414.770
Participants in clinical trials
414.772
Limits on use of step therapy
414.780
Coordinated care organization reporting of data to assess compliance with mental health parity requirements
414.781
Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services
414.782
Reimbursement to ensure access to addiction treatment statewide
414.805
Liability of individual for medical services received while in custody of law enforcement officer
414.807
Oregon Health Authority to pay for medical services related to law enforcement activity
414.815
Law Enforcement Medical Liability Account
414.853
Definitions
414.855
Hospital assessment
414.857
Reduction in rate required by federal law
414.863
Refund of hospital assessment
414.865
Audits
414.867
Deposit of assessments collected to Hospital Quality Assurance Fund
414.869
Establishment of Hospital Quality Assurance Fund
414.871
Applicability of hospital assessment
414.880
Managed care organization assessment
414.882
Refund of managed care organization assessment
414.884
Applicability of managed care organization assessment
414.900
Hospital assessment
414.902
Managed care organization assessment
Green check means up to date. Up to date