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Medicaid/CHIP Data Requirements in Oregon

        Oregon has a robust medical assistance program that provides a number of health care delivery and payment options to qualifying individuals.  As part of this program, the state has enacted a number of laws governing the collection, use and disclosure of protected information from individuals participating in Medicaid, CHIP and related waiver programs.  As a baseline condition of participation in the program, all Medicaid providers must maintain confidential clinical records for all patients receiving services, including information on the patient’s diagnosis and medical need for services, and must maintain such records for seven years.1  Clients in the medical assistance program have the right to access their own records, unless otherwise restricted by law.2

        The Department of Human Services must obtain a completed and signed authorization for release of information from the client before obtaining, using or disclosing protected health information about the individual from or to a third party.  The Department or other authorized persons may use or disclose protected health information about  a client without his permission for certain purposes, including for treatment, payment and health care operations and to the extent necessary to provide emergency treatment.3

 

Certain programs and providers have different requirements that govern the collection, use and disclosure of protected information about clients.  The primary care manager providing care management services to an Oregon Health Plan client must maintain clinical records on each client for four years after the date of medical services and may only release the records to the extent permitted by the provider agreement.4

 

The law mandates reporting specific to the medical assistance program.  Pharmacies must report when dispensing a controlled substance to a fee-for-service client, including the patient’s name, address, and date of birth, the drug information and the prescriber’s information.5  All insurers providing coverage to Medicaid beneficiaries must report health care data for use in evaluating the demands for and allocation of healthcare resources.6

 

 

Footnotes

  • 1. Or. Admin. R.  410-120-1360
  • 2. Or. Admin. R. 410-120-1855
  • 3. Or. Admin. R. 407-014-0020
  • 4. Or. Admin. R. 410-141-0720
  • 5. Or. Admin. R. 410-121-4010
  • 6. Or. Rev. Stat. §442.466

 

Medicaid/CHIP Data Requirements in Oregon

Subtopic Statute/Regulation Description
Mandatory reporting by Medicaid providers (cost/utilization information) Or. Admin. R. 410-120-1360 - Requirements for Financial, Clinical and Other Records Medicaid participating providers must maintain financial and clinical records.  The records must be well documented and be complete before...
Access to Medicaid data (by patients, providers, and government agencies) Or. Admin. R. 309-015-0010 - Conditions of Service Provider Participation As a condition of participation in the Medicaid program, a provider of inpatient services at a psychiatric hospital must maintain clinical records...
Or. Admin. R. 333-004-0060 - Standards of Care for Contraceptive Management Services Providers participating in the Family Planning Expansion Program must agree to provide contraceptive management services according to the following...
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) Or. Admin. R. 309-015-0010 - Conditions of Service Provider Participation As a condition of participation in the Medicaid program, a provider of inpatient services at a psychiatric hospital must maintain clinical records...
Medicaid/CHIP Data Requirements Or. Admin. R. 333-004-0120 - Requirements for Financial, Clinical and Other Records The Office of Family Health is responsible for analyzing and monitoring the operation of the Family Planning Expansion Program and for auditing and...
Or. Admin. R. 407-014-0020 - Uses and Disclosures of Client or Participant Protected Information The Department of Human Services, Administrative Services Division must obtain a completed and signed authorization for release of information from...
Or. Admin. R. 407-014-0030 - Client Privacy Rights Client, defined as individuals requesting services from the Department of Human Services, including recipients of public assistance, may access,...
Or. Admin. R. 410-121-4010 - Reporting Requirements Within one week of dispensing a controlled substance to a Division of Medical Assistance Program fee-for-service client, pharmacies must...
Or. Admin. R. 410-141-0180 - Oregon Health Plan Prepaid Health Plan Record Keeping Prepaid Health Plans (PHPs) and participating providers must have written policies and procedures to ensure that individually identifiable health...
Or. Admin. R. 410-141-0720 - Oregon Health Plan Primary Care Manager Medical Record Keeping A Primary Care Manager (PCM) is a health care provider that agrees to provide primary care management services to an Oregon Health Plan client...
Or. Admin. R. 411-045-0100 - Confidentiality and Reporting Each Program of All-Inclusive Care for the Elderly (PACE) must have written policies and procedures to assure that participants’ clinical...
Or. Rev. Stat. § 413.201 - Targeted outreach for Health Care for All Oregon Children program To maximize the enrollment and retention of eligible children in the Health Care for All Oregon Children program, the Oregon Health Authority will...
Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) Or. Admin. R. 410-120-1855 - Client’s Rights and Responsibilities Client’s Rights and Responsibilities Division of Medical Assistance Program clients have several rights, including: Be actively involved in...