Or. Admin. Code § 410-120-0250
Current through Register Vol. 63, No. 12, December 1, 2024
Section 410-120-0250 - Managed Care Entity(1) The Authority provides clients with health services through contracts with a Managed Care Entity (MCE).(2) The MCE is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law, or MCE's contract with the Authority, and the OHP administrative rules governing MCEs (OAR chapter 410, division 141).(3) All MCEs are required to provide benefit coverage pursuant to OAR 410-120-1210 and 410-141-0480 through 410-141-0520; however, authorization criteria may vary between MCEs. It is the providers' responsibility to comply with the MCE's Prior Authorization requirements or other policies necessary for reimbursement from the MCE before providing services to any OHP client enrolled in an MCE.Or. Admin. Code § 410-120-0250
OMAP 62-2003, f. 9-8-03, cert. ef.10-1-03; OMAP 39-2005, f. 9-2-05, cert. ef. 10-1-05; OMAP 67-2005, f. 12-21-05, cert. ef. 1-1-06; DMAP 28-2012, f. 6-21-12, cert. ef. 7-1-12; DMAP 62-2017, amend filed 12/28/2017, effective 1/1/2018; DMAP 76-2022, minor correction filed 09/30/2022, effective 9/30/2022Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025, 414.065, 414.631 & 414.651