Or. Admin. R. 410-123-1600 - Managed Care Organizations

Current through Register Vol. 60, No. 12, December 1, 2021

(1) The Division of Medical Assistance Programs (Division) contracts with Managed Care Organizations (MCO) and Primary Care Managers (PCM) to provide medical services for clients under the Division (Title XIX and Title XXI services):
(a) MCOs for dental services are called Dental Care Organizations (DCO). See General Rules OAR 410-120-0250 -- Managed Care Organizations for definitions and responsibilities of MCOs;
(b) See General Rules OAR 410-120-1210(4) -- Medical Assistance Programs and Delivery Systems for a description of how clients receive services through MCOs and PCMs.
(2) The Division prepays DCOs to cover dental services, including the professional component of any services provided in an Ambulatory Surgical Center (ASC) or an outpatient or inpatient hospital setting for hospital dentistry. See OAR 410-123-1490 for more information about hospital dentistry.
(3) The Division will not pay for services covered by a MCO; reimbursement is a matter between the MCO and the provider.
(4) For clients enrolled in a DCO, it is the responsibility of the dental provider to coordinate all dental services with the client's DCO prior to providing services.

Notes

Or. Admin. R. 410-123-1600
OMAP 23-1999, f. & cert. ef. 4-30-99; OMAP 17-2000, f. 9-28-00, cert. ef. 10-1-00; OMAP 48-2002, f. & cert. ef. 10-1-02; DMAP 16-2009 f. 6-12-09, cert. ef. 7-1-09

Stat. Auth.: ORS 413.042, 414.065, 414.725

Stats. Implemented: ORS 414.725

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