Or. Admin. R. 333-022-1120

Current through Register Vol. 63, No. 6, June 1, 2024

Section 333-022-1120 - Restricted Status

(1) The Authority may place a client on restriction if the client fails to return a complete Client Eligibility Review (CER) by the requested deadline.

(2) The effective date and duration of the restriction shall be as follows:

(a) Restriction takes effect on the first day of the client's new eligibility period.

(b) The restricted period shall not exceed three consecutive months. If the Authority has not received a complete CER at the end of three months, the client is no longer eligible for benefits and the client will be notified in accordance with OAR 333-022-1090.

(3) Ending restriction:

(a) Six full months of unrestricted benefits shall be approved if the Authority receives a complete CER before the end of the restricted period and determines the client eligible.

(b) The effective date for full benefits shall be the date of receipt of the complete CER.

(4) The Authority shall notify a client of the restricted status. The notice must comply with ORS 183.415 and explain:

(a) How long the restriction is in effect;

(b) How the client can come into compliance and have the restriction lifted; and

(c) The consequences of not coming into compliance within the specified time period.

(5) If a client is placed on restricted status the Authority may only provide the following benefits to the client:

(a) Payment of insurance premiums; and

(b) Payment of medications that treat HIV, viral hepatitis and opportunistic infections, as those are described in the CAREAssist restricted formulary, available on the CAREAssist website.

(6) Restricted clients are ineligible for assistance with the cost of:

(a) Prescriptions not listed on the Restricted Formulary; and

(b) All medical services, even when that service continues to be paid by the client's primary insurance.

(7) Restricted clients are required to recertify, as indicated in OAR 333-022-1090.

Or. Admin. R. 333-022-1120

PH 30-2014, f. 11-10-14, cert. ef. 12-1-14; PH 23-2016, f. & cert. ef. 8/2/2016

Stat. Auth.: ORS 413.042, 431.250, 431.830

Stats. Implemented: ORS 431.250, 431.830