ORS 414.613
Discrimination based on scope of practice prohibited

  • appeals
  • rules

(1)

A coordinated care organization may not discriminate with respect to participation in the organization or coverage against any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. This section does not require that an organization contract with any health care provider willing to abide by the terms and conditions for participation established by the organization. This section does not prevent an organization from establishing varying reimbursement rates based on quality or performance measures.

(2)

An organization may establish an internal review process for a provider aggrieved under this section, including an alternative dispute resolution or peer review process. An aggrieved provider may appeal the determination of the internal review to the Oregon Health Authority.

(3)

The authority shall adopt by rule a process for resolving claims of discrimination under this section and, in making a determination of whether there has been discrimination, must consider the organization’s:

(a)

Network adequacy;

(b)

Provider types and qualifications;

(c)

Provider disciplines; and

(d)

Provider reimbursement rates.

(4)

A prevailing party in an appeal under this section shall be awarded the costs of the appeal. [Formerly 414.646]

Source: Section 414.613 — Discrimination based on scope of practice prohibited; appeals; rules, 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

Current through early 2024

§ 414.613’s source at oregon​.gov