Or. Admin. Code § 410-115-0005

Current through Register Vol. 64, No. 1, January 1, 2025

Section 410-115-0005 - Acronyms and Definitions

(1) The acronyms and definitions within this rule specifically pertain to OHP Bridge. This rule does not include an exhaustive list of acronyms and definitions that apply to OHP Bridge. Other acronyms and definitions that may apply to OHP Bridge are found in OAR 410-141-3500, OAR 410-120-0000, and OAR 410-200-0015.

(2) "Basic Health Program" means a joint federal and state funded program for medical assistance established under section 1331 of the federal Patient Protection and Affordable Care Act of 2010 and Title 42, Chapter IV, Subchapter 1 of the Code of Federal Regulations, which the state has elected to adopt and implement as OHP Bridge.

(3) "Oregon Health Plan (OHP) Bridge" means the health insurance programs established by the state under Oregon House Bill 4035 (2022 Regular Session) and in accordance with ORS 414.241 which is available to individuals who meet certain age, financial, and other eligibility requirements OAR Chapter 410, Division 200. OHP Bridge provides the same health insurance benefits (covered services) to all eligible individuals but due to federal law, OHP Bridge is delivered through two different medical assistance programs which are listed below in this rule:

(a) "OHP Bridge - Basic Medicaid" means the Medicaid eligibility category created by the state to provide OHP Bridge covered services to OHP Bridge - Basic Medicaid members described in OAR 410-200-0437.

(b) "OHP Bridge - Basic Health Program" means the Basic Health Program established by the state as a medical assistance program administered by the Authority, which provides OHP Bridge covered services to OHP Bridge - Basic Health Program members described in OAR 410-200-0438.

(4) "OHP Bridge Covered Services" means the services provided to OHP Bridge members.

(a) The OHP Bridge covered services for the OHP Bridge- Basic Health Program are described in OAR 410-115-0030 and in the OHP Bridge - Basic Health Program CCO Contract; and,

(b) The OHP Bridge covered services for recipients or members of OHP Bridge - Basic Medicaid are described in OAR 410-115-0030 and in the Medicaid CCO Contract.

(5) . "OHP Bridge Members" means those individuals who are either:

(a) Enrolled in Coordinated Care Organizations after the Authority has processed their applications for medical assistance and determined they meet the financial and non-financial eligibility requirements for the OHP Bridge - Basic Health Program described in OAR 410-200-0438; or,

(b) Enrolled in OHP Bridge - Basic Medicaid after the Authority has processed their applications for medical assistance and determined they meet the financial and non-financial eligibility requirements described in OAR 410-200-0437.

(6) "OHP Bridge - BHP Trust Fund" means the Bridge Plan Fund established by ORS 414.245 to receive federal and non-federal funds that shall be used for the sole purpose of implementing and administering the OHP Bridge - Basic Health Program in compliance with Basic Health Program regulations found in 42 C.F.R. Part 600, Subpart H, and this OAR Chapter 410, Division 115.

(7) "OHP Bridge - Basic Health Program CCO Contract(s)" means an agreement between the State of Oregon acting by and through the Authority and a CCO to provide OHP Bridge - Basic Health Program covered services to OHP Bridge - Basic Health Program members.

(8) "Long-term Care" and "Long-term Services and Supports" has the same definition as in OAR 410-120-0000.

Or. Admin. Code § 410-115-0005

DMAP 94-2024, adopt filed 05/29/2024, effective 6/1/2024

Statutory/Other Authority: ORS 413.071, 414.025, 414.241, 414.245 & 42 CFR 600.5

Statutes/Other Implemented: 414.025, 414.241, 414.245, ORS 413.042, 414.65 & 414.706