(1) Notwithstanding ORS 414.065 and 414.690, a coordinated care organization must provide behavioral health services to its members that include but are not limited to all of the following: (a) For a member who is experiencing a behavioral health crisis: (A) A behavioral health assessment; and (B) Services that are medically necessary to transition the member to a lower level of care; (b) At least the minimum level of services that are medically necessary to treat a members underlying behavioral health condition rather than a mere amelioration of current symptoms, such as suicidal ideation or psychosis, as determined in a behavioral health assessment of the member or specified in the members care plan; (c) Treatment of co-occurring behavioral health disorders or medical conditions in a coordinated manner; (d) Treatment at the least intensive and least restrictive level of care that is safe and effective and meets the needs of the individuals condition; (e) For all level of care placement decisions, placement at the level of care consistent with a members score or assessment using the relevant level of care placement criteria and guidelines; (f) If the level of placement described in paragraph (e) of this subsection is not available, placement at the next higher level of care; (g) Treatment to maintain functioning or prevent deterioration; (h) Treatment for an appropriate duration based on the individuals particular needs; (i) Treatment appropriate to the unique needs of children and adolescents; (j) Treatment appropriate to the unique needs of older adults; (k) Treatment that is culturally and linguistically appropriate; (L) Treatment that is appropriate to the unique needs of gay, lesbian, bisexual and transgender individuals and individuals of any other minority gender identity or sexual orientation; (m) Coordinated care and case management as defined by the Department of Consumer and Business Services by rule; (n) Mental health wellness appointments as prescribed by the Oregon Health Authority by rule; and (o) Medications and refills of medications prescribed for the treatment of opioid use disorder and any co-occurring substance use disorder or mental health condition, including medications and refills of medications prescribed pursuant to ORS 689.698. (2) If there is a disagreement about the level of care required by subsection (1)(e) or (f) of this section, a coordinated care organization shall provide to the behavioral health treatment provider full details of the coordinated care organizations scoring or assessment, to the extent permitted by the federal Health Insurance Portability and Accountability Act privacy regulations, 45 C.F.R. parts 160 and 164, ORS 192.553 to 192.581 or other state or federal laws limiting the disclosure of health information. (3) The Oregon Health Authority shall adopt by rule a list of behavioral health services that may not be subject to prior authorization.
‹ Prev All Oregon sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.