Or. Admin. R. 333-004-3130

Current through Register Vol. 63, No. 8, August 1, 2024

Section 333-004-3130 - Payment for RH Access Fund Claims

(1) The RH Program shall make payments to an agency that actually performs the services for enrollees. The exception to this is if an agency contracts with a provider for RH Program-approved services, then the RH Program will make payment to the agency and the agency will disburse payment to the contracted provider.

(2) Reimbursement rates for reproductive health and abortion services are set by the RH Program. Claims are reimbursed at the rates in effect on the date of service. Current reimbursement rates are available on the RH Program's website (www.healthoregon.org/rh).

(3) The RH Program will not make payment on claims that have been assigned, sold, or otherwise transferred. This includes, but is not limited to, transfer to a collection agency or party who advances money to an agency for accounts receivable.

(4) The RH Program shall only pay for services that are adequately documented and for drug, device, and supply costs that are supported by invoice.

(5) Consistent with OAR 333-004-3150 (RH Access Fund Requirements for Financial, Clinical and Other Records), payment on a claim shall be made only for services that are adequately documented and billed in accordance with OAR 333-004-3110 (RH Access Billing and Claims) and all applicable administrative rules related to the covered services for which the client is eligible.

Or. Admin. R. 333-004-3130

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 190-2022, minor correction filed 09/07/2022, effective 9/7/2022

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149 & OL 2022, ch. 45, sec. 10

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032 & OL 2022, ch. 45, sec. 10