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Adamson v. Oregon Health Authority

Court of Appeals of Oregon

December 28, 2017

Barry ADAMSON, Petitioner,
v.
OREGON HEALTH AUTHORITY, Respondent.

          Submitted August 4, 2017.

         Oregon Health Authority

          Barry Adamson fled the briefs pro se.

          Ellen F. Rosenblum, Attorney General, Benjamin Gutman, Solicitor General, and Judy C. Lucas, Assistant Attorney General, fled the brief for respondent.

          Before Lagesen, Presiding Judge, and DeVore, Judge, and James, Judge.

         Case Summary: Petitioner seeks judicial review of sections (2) and (3) of OAR 410-141-3060, the administrative rule of the Oregon Health Authority (OHA) that identifies specific populations that are prohibited from enrolling in coordinated care organizations. Petitioner contends that OHA lacked statutory authority to promulgate those provisions. Held: The challenged provisions were within OHA's general authority to administer medical assistance under ORS chapter 414 and promulgate rules necessary to administer the statutes that it is charged with administering. ORS 413.032(1)(i); ORS 413.042.

         OAR 410-141-3060(2) and (3) held valid.

         [289 Or.App. 502] LAGESEN, P. J.

         At issue in this administrative rule review proceeding under ORS 183.400 are sections (2) and (3) of OAR 410-141-3060, the administrative rule of the Oregon Health Authority (OHA) governing enrollment in coordinated care organizations (CCOs). Those sections identify specific populations that are prohibited from enrolling in CCOs. Petitioner contends that OHA lacked statutory authority to promulgate them. We hold OAR 410-141-3060(2) and (3) valid.

         We start with the relevant statutory background. The legislature has established that OHA administers Oregon's medical assistance program: "[OHA] shall * * * [b]e the state Medicaid agency for the administration of funds from Titles XIX and XXI of the Social Security Act and administer medical assistance under ORS chapter 414[.]" ORS 413.032(1)(i). Under ORS 414.065(1)(a)(A), OHA, in administering medical assistance under ORS chapter 414, must "determine, subject to such revisions as it may make from time to time ***[t]he types and extent of health care and services to be provided to each eligible group of recipients of medical assistance." Further, OHA must do so in a manner that comports with federal requirements for receipt of federal funds: "The Department of Human Services or the Oregon Health Authority shall determine eligibility for medical assistance according to criteria prescribed by rule and in accordance with the requirements for securing federal financial participation in the costs of administering Titles XIX and XXI of the Social Security Act." ORS 411.404(1). Finally, the legislature has given OHA broad rulemaking authority to carry out the statutes it is charged with administering:

"In accordance with applicable provisions of ORS chapter 183, the Director of the Oregon Health Authority may adopt rules necessary for the administration of the laws that the Oregon Health Authority is charged with administering."

ORS 413.042.

         CCOs play a central role in the administration of medical assistance. ORS 414.651(1)(a) (requiring that OHA [289 Or.App. 503] "use, to the greatest extent possible, coordinated care organizations to provide fully integrated physical health services"). As a general rule, "a person who is eligible for or receiving health services must be enrolled in a [CCO] to receive the health services for which the person is eligible." ORS 414.631(1). However, ORS 414.631(2) exempts certain populations ...


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