Or. Admin. Code § 410-160-0000

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

Section 410-160-0000 - Definitions

For the purposes of OAR 410-160-0000 through 410-160-0100, the following definitions shall apply:

(1) LEMLA means the Law Enforcement Medical Liability Account.

(2) LEMLA Patient means a person who has suffered injuries related to law enforcement activity.

(3) Injuries Related to Law Enforcement Activity means injuries sustained prior to booking, citation in lieu of arrest or release instead of booking that occur during and as a result of efforts by a law enforcement officer to restrain or detain, or to take or retain custody of, the individual. Whether injuries related to law enforcement activity have occurred shall be determined by the law enforcement agency.

(4) Release Date means the date the LEMLA patient was released from actual physical custody, as determined by the law enforcement agency.

(5) Cost of Such Services means "usual charge" as defined in OAR 410-120-0000.

(6) Hospital means a hospital as defined in OAR 410-120-0000.

(7) Overpayment means payment made by LEMLA to a claimant in excess of the amount due for the covered services and items billed.

(8) Claimant means a Medicaid provider.

(9) Medicaid Provider means a provider who has been issued a provider number by the Division and is not currently subject to sanction by the Division.

(10) Prior Payment Amount means the total of all payments received by the claimant from all other sources, including the LEMLA patient, prior to submitting a LEMLA claim.

(11) LEMLA Claim Amount means the total cost of such services provided to a LEMLA patient that are directly connected to injuries related to law enforcement activity. It shall not include any charges for services provided to a LEMLA patient for a preexisting disease or condition, or services that are unrelated to the "injuries related to law enforcement activities."

Or. Admin. Code § 410-160-0000

AFS 1-1992, f. 1-14-92, cert. ef. 2-1-92; AFS 6-1992, f. & cert. ef. 3-9-92; AFS 24-1993, f. 10-27-93, cert. ef. 11-1-93; AFS 10-2002, f. & cert. ef. 7-1-02; Renumbered from 461-012-0100, DMAP 9-2011, f. 6-6-11, cert. ef. 7-1-11

Stat. Auth.: ORS 413-042, ORS 414.065

Stats. Implemented: ORS 414.805 -- ORS 414.815