Oregon Health Authority
Health Policy and Analytics - Chapter 409
Division 36
HEALTH CARE PROVIDER INCENTIVE PROGRAM
409-036-0010
Definitions
The following definitions apply to OAR 409-036-0000 to OAR 409-036-0150:
(1) “Authority” means the Oregon Health Authority.
(2) “Board” means the Oregon Health Policy Board.
(3) “Carrier” means a medical professional liability insurer holding a valid certificate of authority from the Director of the Department of Consumer and Business Services (DCBS) that authorizes the transaction of insurance as defined in ORS 731.066 and 731.072, and does not include DCBS-listed insurers pursuant to ORS 735.300 to 735.365 and 735.400 to 735.495.
(4) “Clinical Psychologist” means an individual licensed to practice psychology pursuant to ORS 675.010 to 675.090.
(5) “Clinical Social Worker” means an individual licensed to practice clinical social work pursuant to ORS 675.510 to 675.600.
(6) “Communities of color” means members of the following racial or ethnic communities:
(a) American Indian;
(b) Alaska Native;
(c) Hispanic or Latino;
(d) Asian;
(e) Native Hawaiian;
(f) Pacific Islander;
(g) Black or African American;
(h) Middle Eastern;
(i) North African;
(j) Mixed race; or
(k) Other racial or ethnic minorities.
(7) "DCBS” means the Department of Consumer and Business Services.
(8) “Dentist” means any individual licensed to practice dentistry pursuant to ORS 679.010.
(9) “Eligible provider” means a practitioner in Oregon delivering health care services to patients in Oregon. The Authority may determine eligible professions based upon the most recent assessment of health care professional need. Eligible provider types will be published on the Office’s program’s webpage.
(10) “Essential health care services” means medical, dental or behavioral health services that have been determined to be necessary to support the health of the population of the community.
(11) “Expanded Practice Dental Hygienist” means an individual licensed to practice dental hygiene with an expanded practice dental hygienist permit issued under ORS 680.200.
(12) “Licensed Professional Counselor” has the meaning given that term in ORS 675.705.
(13) “Long Term Care” means in home, community based care and nursing facilities.
(14) “Marriage and Family Therapist or Professional Counselor” has the meaning given that term in ORS 675.705.
(15) “Medical assistance” has the meaning given that term in ORS 414.025.
(16) “Medicare” means medical coverage provided under Title XVIII of the Social Security Act.
(17) “Naturopathic Physician” means an individual licensed pursuant to ORS 685.010 to 685.135.
(18) "Nurse Practitioner" means any individual licensed pursuant to ORS 678.375.
(19) “Office” means the Office of Rural Health or the Authority.
(20) “Pharmacist” has the meaning given that term in ORS 689.005.
(21) "Physician" means any individual licensed pursuant to ORS 677.100 to 677.228.
(22) "Physician Assistant" means any individual licensed pursuant to ORS 677.495 to 677.545.
(23) "Practice full-time" means working at a minimum of 32 hours per week spent providing direct patient care, averaged over the month for a minimum of 45 weeks per service year. The Authority shall consider patient charting a component of offering direct patient care. The Authority may consider telehealth as direct patient care when the receiving site (location of the patient) is located in Oregon.
(24) “Practice part-time” means working a minimum of 16 hours per week spent providing direct patient care, averaged over the month for a minimum of 45 weeks per service year. The Authority shall consider patient charting a component of offering direct patient care. The Authority may consider telehealth as direct patient care when the receiving site (location of the patient) is located in Oregon.
(25) “Priority Populations” means groups that disproportionately experience avoidable illness, death or other poor health or social outcomes attributable directly or indirectly to racism, including:
(a) Communities of color;
(b) Oregon’s nine federally recognized tribes and the descendants of the members of the tribes, or other tribal members;
(c) Immigrants;
(d) Refugees;
(e) Migrant and seasonal farmworkers;
(f) Low-income individuals and families;
(g) Medicaid or uninsured Persons with disabilities; and
(h) Individuals who identify as lesbian, gay, bisexual, transgender or queer or who question their sexual or gender identity.
(26) “Program” means the Health Care Incentive Program.
(27) "Qualified Mental Health Associate" means a mental health professional that meets the following minimum qualifications:
(a) Bachelor’s degree in a behavioral sciences field; or
(b) A combination of at least three years relevant work, education, training or experience; and
(c) Demonstrates the competency necessary to communicate effectively; understand mental health assessment, treatment and service terminology and apply these concepts; provide psychosocial skills development; implement interventions as assigned on an individual plan of care; and provide behavior management and case management duties.
(28) "Qualified mental health professional" (QMHP) means a licensed behavioral health practitioner or any other person who holds any of the following educational degrees and meets the following minimum qualifications:
(a) Graduate degree in psychology;
(b) Bachelor’s degree in nursing and licensed by the State of Oregon;
(c) Graduate degree in social work;
(d) Graduate degree in a behavioral science field;
(e) Graduate degree in recreational, music, or art therapy;
(f) Bachelor’s degree in occupational therapy and licensed by the State of Oregon; and
(g) Whose education and experience demonstrate the competency to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social and work relationships; conduct a mental status examination; document a multiaxial DSM diagnosis; write and supervise an individual plan of care; conduct a mental health assessment and provide individual, family or group therapy within the scope of their training.
(29) “Qualifying loan” means one or more government or commercial loans received solely to cover the cost of health professional training, or undergraduate or other educational training. This does not include credit card loans, lines of credit, and personal loans.
(30) “Qualifying practice site” means:
(a) A rural hospital as defined in ORS 442.470 serving Medicaid and Medicare patients in no less than the same proportion of such patients in the county or other service area as determined by the Authority, up to a maximum requirement of 50 percent of patient mix for Medicare and Medicaid combined;
(b) A federally certified Rural Health Clinic serving Medicaid and Medicare patients in no less than the same proportion of such patients in the county or other service area as determined by the Authority, up to a maximum requirement of 50 percent of patient mix for Medicare and Medicaid combined;
(c) A federally qualified Community Health Center serving Medicaid and Medicare patients in no less than the same proportion of such patients in the county or other service area as determined by the Authority, up to a maximum requirement of 50 percent of patient mix for Medicare and Medicaid combined; or
(d) A site other than those listed above that:
(A) Provides essential health care services to patients in an area approved as a medical, dental or mental Health Professional Shortage Area (HPSA) as defined by the federal Health Resources and Services Administration or ranking below the Areas of Unmet Health Care Need median as determined by the Office;
(B) Serves Medicaid and Medicare patients in no less than the same proportion of such patients in the county or other service area as determined by the Authority, up to a maximum requirement of 50 percent of patient mix for Medicare and Medicaid combined, when a majority of providers are eligible for reimbursement from these programs for health services provided;
(C) Has a majority of providers at the site eligible for reimbursement from both Medicare and Medicaid. If a majority of providers at the site are not eligible for reimbursement from both programs, the site is qualified as long as the site serves either Medicaid or Medicare patients in no less the same proportion of such patients in the county or other service area as determined by the Authority;
(D) Provides essential health care services to an underserved population, as determined by the Authority; or
(E) Serves Medicaid and/or uninsured patients in a Community Based, Residential, or Long Term Caresettings, as determined by the Authority.
(31) “Telehealth” means the provision of health services from a distance using electronic communications.
(32) “Training Program” means a course of study that results in certification, licensure or other credential related to the healthcare workforce; or other program as determined by the authority.
Statutory/Other Authority: ORS 676.454
Statutes/Other Implemented: ORS 676.454
History:
OHP 7-2022, amend filed 08/31/2022, effective 08/31/2022
OHP 4-2022, temporary amend filed 06/16/2022, effective 06/16/2022 through 09/01/2022
OHP 2-2022, temporary amend filed 03/04/2022, effective 03/06/2022 through 09/01/2022
OHP 1-2021, amend filed 03/29/2021, effective 03/29/2021
OHP 5-2019, minor correction filed 07/25/2019, effective 07/25/2019
OHP 4-2017, adopt filed 12/23/2017, effective 01/02/2018