Oregon Administrative Rules Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS
Here’s a refined overview of Oregon Administrative Rules – Chapter 410: Oregon Health Authority, Health Systems Division: Medical Assistance Programs (current as of May 26, 2025)
🗂️ Chapter 410 Structure
Chapter 410 encompasses a comprehensive framework for Oregon’s medical assistance (Medicaid/OHP), organized into approximately 42 divisions:
Division 1 – Procedural Rules (§ 410‑001‑0000 to ‑0020): rulemaking and administrative procedures
Division 14 – Privacy (§ 410‑014‑0000 to ‑0070): handling protected health information
Division 30 – Client Civil Rights (§ 410‑030‑0010 to ‑0040): nondiscrimination and due process
Division 50 – Tax Rules (§ 410‑050‑0100 to ‑0870): taxation-related provisions
Division 110 to 136: distinct service categories (e.g., safety net grants, hospital, dental, durable equipment, home health, long-term services, medical-surgical services)
Division 141 – Oregon Health Plan (OHP): benefit design, CCO coordination, care coordination rules
Division 200 – Eligibility (§ 410‑200‑0010 to ‑0521): criteria to qualify for coverage
Division 500 – Rural Practitioner Subsidy: supports rural medical providers
🔍 Key Divisions Highlighted
✅ Division 120 – Medical Assistance Programs
Detailing covered and excluded services; providers must comply with statewide rules
Covered Services: include acupuncture, SUD treatment, dental, therapy, surgical, audiology, chiropractic, EPSDT for children
Excluded/limited services (§ 410‑120‑1200): routine adult check-ups, cosmetic procedures, experimental treatments, convenience services, etc
📑 Division 141 – Oregon Health Plan (OHP)
Defines OHP Plus and other benefit packages (e.g., limited drugs, Medicare dual-eligible bundles, COFA dental)
Requires Coordinated Care Organizations (CCOs) to conduct health risk assessments within 90 days, maintain care profiles, and actively coordinate services across health, behavioral, and social support domains
👤 Division 200 – Eligibility
Specifies criteria to determine eligibility for various medical assistance programs (e.g., OHP, Medicaid expansions)
🏛️ Purpose & Core Themes
Administration & Compliance
Standardizes rulemaking, provider enrollment, billing, audits, and reporting protocols.
Service Definitions & Coverage Limits
Clearly outlines what’s covered, what’s excluded, and under what conditions.
Care Coordination & OHP Structure
Supports comprehensive care through CCO-managed coordination and benefit packages.
Rights & Protections
Ensures privacy, civil rights, and due process for clients.
Eligibility Guidelines
Defines who qualifies for programs, including special categories (e.g., dual-eligible, COFA, rural practitioners).
📌 Summary
OAR Chapter 410 is the regulatory backbone for Oregon’s Medicaid/OHP system, guiding everything from administrative processes and eligibility to service coverage, provider responsibilities, care coordination, and client protections.
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