Health services for certain eligible persons
(1)Ombudsman services for individuals who receive medical assistance under ORS 411.706 (Oregon Supplemental Income Program) and for recipients who are members of coordinated care organizations. With the concurrence of the Governor and the Oregon Health Policy Board, the Director of the Oregon Health Authority shall appoint ombudsmen and may terminate an ombudsman. Ombudsmen are under the supervision and control of the director. An ombudsman shall serve as a recipient’s advocate whenever the recipient or a physician or other medical personnel serving the recipient is reasonably concerned about access to, quality of or limitations on the care being provided by a health care provider or a coordinated care organization. Recipients shall be informed of the availability of an ombudsman. Ombudsmen shall report to the Governor and the Oregon Health Policy Board in writing at least once each quarter. A report shall include a summary of the services that the ombudsman provided during the quarter and the ombudsman’s recommendations for improving ombudsman services and access to or quality of care provided to eligible persons by health care providers and coordinated care organizations.
(2)Case management services in each health care provider organization or coordinated care organization for those individuals who receive assistance under ORS 411.706 (Oregon Supplemental Income Program). Case managers shall be trained in and shall exhibit skills in communication with and sensitivity to the unique health care needs of individuals who receive assistance under ORS 411.706 (Oregon Supplemental Income Program). Case managers shall be reasonably available to assist recipients served by the organization with the coordination of the recipient’s health services at the reasonable request of the recipient or a physician or other medical personnel serving the recipient. Recipients shall be informed of the availability of case managers.
(3)A mechanism, established by rule, for soliciting consumer opinions and concerns regarding accessibility to and quality of the services of each health care provider.
(4)A choice of available medical plans and, within those plans, choice of a primary care provider.
(5)Due process procedures for any individual whose request for medical assistance coverage for any treatment or service is denied or is not acted upon with reasonable promptness. These procedures shall include an expedited process for cases in which a recipient’s medical needs require swift resolution of a dispute. An ombudsman described in subsection (1) of this section may not act as the recipient’s representative during any grievance or hearing process. [1991 c.753 §14; 1993 c.815 §18; 1997 c.581 §26; 1999 c.547 §7; 1999 c.1084 §53; 2003 c.14 §§193,193a; 2003 c.591 §§1,2; 2005 c.381 §18; 2009 c.595 §323; 2009 c.867 §46; 2011 c.602 §25; 2011 c.720 §146]
§§ 414.705 to 414.750
Law Review Citations
72 OLR 47 (1993)