Or. Admin. Code § 410-123-1230

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-123-1230 - Buying-Up

(1) Buying-up as defined in OAR 410-120-0000 is prohibited.

(2) Providers are not permitted to bill and accept payment from the Division or an MCE for a covered service when:

(a) A non-covered service has been provided; and

(b) Additional payment is sought or accepted from the member.

(3) If a member wants to purchase a non-covered service or item, the member shall sign and date a provider-completed Agreement to Pay Form before becoming responsible for full payment. A payment from the Division or the managed care plan for a covered service cannot be credited toward the non-covered service and then an additional member payment sought to obtain, for example, a gold crown (not covered) instead of the stainless steel crown (covered).

Or. Admin. Code § 410-123-1230

OMAP 14-1999(T), f. & cert. ef. 4-1-99 thru 9-1-99; OMAP 29-1999, f. 6-9-99, cert. ef. 6-10-99; OMAP 48-2002, f. & cert. ef. 10-1-02; DMAP 38-2008, f. 12-11-08, cert. ef. 1-1-09; DMAP 50-2021, amend filed 12/24/2021, effective 1/1/2022; DMAP 62-2024, minor correction filed 02/21/2024, effective 2/21/2024

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: ORS 414.065