LEGAL SERVICES BULLETIN
Gwen Dayton, Vice President and General Counsel September 2001, Volume 1, No. 3
REGULATORY UPDATE

The Office of Medical Assistance Programs has revised many of its administrative rules. The changes will take effect October 1, 2001. The following is a brief description of the revised rules. If you need more information, please call Gwen Dayton at (503) 636-2204 or e-mail her at gdayton@oahhs.org. The Oregon Administrative Rules are available on-line at www.state.or.us. Most of these rules were reviewed by participants in the OAHHS OMAP reimbursement rule review committee, aka the "cyber committee" because we conduct business entirely by e-mail. If you would like to participate in this committee, please let Gwen know.

• OAR 410-125-0090 and OAR 410-125-190 are rewritten to reflect the statutory requirement (ORS 414.727) that OMAP engage in cost-based reimbursement for Type A, Type B and Critical Access hospitals. The rules describe how reimbursement will be determined. OAR 410-125-0090 provides that Type A, Type B and Critical Access hospitals are eligible for disproportionate share reimbursement but not for cost outlier, capital or medical education payments.
  
  
• Table I following OAR 410-125-0080, the OMAP Prior Authorization List for Medical Services and Surgical Procedures, is revised.
  
  
• OAR 410-125-0141 is revised to include Critical Access Hospitals with Type A and Type B hospitals for purposes of determining Operating Costs and Unit Value, and to remove Day Outliers.
  
  
• OAR 410-125-0142 is revised to reflect current calculations for reimbursement of Graduate Medical Education for public teaching hospitals.
  
  
• OAR 410-141-0420 is revised to add language clarifying managed care plan reimbursement requirements for Graduate Medical Education in non-public teaching hospitals.
  
  
• OAR 410-125-0150 clarifies disproportionate share determination. Includes managed care.
  
  
• OAR 410-125-0155 is revised to clarify that upper limits on payment of claims does not apply to Pro-Share eligible academic hospitals.
  
  
• OAR 410-125-0700 is amended to clarify which revenue codes require HCR coding, version 19.
  
  
• Two new rules are written explaining the new BIPA rule allowing OMAP to maximize inpatient and outpatient payments to eligible academic hospitals.
  
  
• OAR 410-120-1280 is rewritten to clarify provider billing of OMAP and clients. The intention is not to change the law but to make it more clear.
  
  
• OAR 410-141-0000 defines "hospital hold."
  
  
• OAR 410-141-0500, listing services that are excluded from the OHP, removes language stating "(j) ICD-9 and CPT codes appearing on Appendix A are not subject to consideration under this rule."
  
  
• OAR 410-141-0060, dealing with Oregon Health Plan managed care enrollment requirements, is amended to add "(h) When an area changes from mandatory to voluntary, the client will remain with their PHP for the remainder of their eligibility period, unless the client meets the criteria stated in OAR 410-141-0060(4), or as provided by OAR 410-141-0080."
  
  
• OAR 410-141-0280, relating to OHP Prepaid Health Plan informational requirements, is amended to remove language relating to marketing by subcontracts and remove language requiring written information provided to OMAP members to be approved by OMAP.