Submitted August 4, 2017.
Adamson fled the briefs pro se.
F. Rosenblum, Attorney General, Benjamin Gutman, Solicitor
General, and Judy C. Lucas, Assistant Attorney General, fled
the brief for respondent.
Lagesen, Presiding Judge, and DeVore, Judge, and James,
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.
410-141-3060(2) and (3) held valid.
Or.App. 502] LAGESEN, P. J.
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.
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
"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."
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 ...