Or. Admin. R. 333-022-1140

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

Section 333-022-1140 - CareAssist: Bridge Program

(1) The Bridge Program provides limited benefits to an individual whose medical provider has applied for the program on the patient's behalf. The program provides payment for basic services and medications for an individual who is in the process of applying for CAREAssist and insurance.

(2) Bridge Program eligibility. In order to be eligible for the Bridge Program an individual must:

(a) Be HIV positive or have AIDS;

(b) Reside in Oregon;

(c) Have income at or below 550 percent of the FPL;

(d) Be in the process of applying for long-term medication assistance programs such as Medicaid, Medicare, or applying to CAREAssist; and

(e) Have not previously received Bridge Program benefits or have not been terminated from the CAREAssist program within the past 365 days.

(3) To apply for Bridge Program benefits a patient's medical provider must, on behalf of the patient, submit a form prescribed by the Authority and sign the form attesting that the individual is HIV positive or has AIDS. If the health care provider is licensed outside of Oregon, the Authority may request a copy of the applicant's most current laboratory results.

(4) The Authority must notify an applicant whether the patient's application has been approved or denied, in accordance with ORS 183.415.

(5) An individual enrolled in the Bridge Program is not guaranteed to be determined eligible for CAREAssist benefits.

(6) The Bridge Program benefits include:

(a) Assistance with the cost of a 30-day supply of prescription drugs listed on the CAREAssist formulary and designated as available to Bridge Program participants, only if dispensed by a CAREAssist contract in-network pharmacy.

(b) Payment of the costs of medical services and laboratory tests as defined by the list of approved Current Procedural Terminology (CPT) codes noted on the Bridge Program instructions and application forms.

(7) The Authority may only pay for an individual's medical visits or laboratory tests for dates of service that are on or after the individual's enrollment in the Bridge Program.

(8) Individuals enrolled in the Bridge Program must actively participate with an assigned CAREAssist caseworker to assure progress toward a sustainable means of medication access. Failure to do so may result in cancellation of enrollment. At a minimum, the client is expected to submit a full application for ongoing assistance with CAREAssist within the 30 days of Bridge Program enrollment.

(9) The Bridge Program is not available to an individual who has primary health insurance coverage.

Or. Admin. R. 333-022-1140

PH 30-2014, f. 11-10-14, cert. ef. 12-1-14; PH 23-2016, f. & cert. ef. 8/2/2016; PH 51-2022, amend filed 05/02/2022, effective 5/24/2022

Statutory/Other Authority: ORS 413.042, 431.250 & 431.830

Statutes/Other Implemented: ORS 431.250 & 431.830