Or. Admin. Code § 410-140-0010

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

Section 410-140-0010 - Definitions and Acronyms

(1) Aphakia is a condition in which the eye lens of one or both eyes are missing.

(2) Comorbidity has the meaning provided in OAR 410-141-3820 (10 & 11).

(3) Congenital aphakia is a congenital eye defect presenting at birth with no lens formation.

(4) Contractor is SWEEP Optical Laboratories, providing vision materials and supplies for OHP members with FFS coverage (refer to OAR 410-140-0400);

(5) "Coordinated Care Organization (CCO)" has the meaning as provided in OAR 410-141-3500. A CCO is a Managed Care Entity for its managed care contract(s) with the Authority, without regard to whether the contract(s) involves federal funds or state funds or both.

(6) "Covered Services" has the meaning as provided in OAR 410-120-0000.

(7) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services" means the federally mandated comprehensive and preventative child health program for individuals under the age of 21, under the Omnibus Budget Reconciliation Act of 1989 and Section 1905(r)(5) of the Social Security Act. Consistent with state and federal law and regulations, the OHP Dental Program ensures that all dentally necessary services and screenings are provided, either directly or through an Authority contracted MCE for EPSDT covered services (Chapter 410, Division 151).

(8) "Fraud" has the meaning as provided in OAR 410-120-0000.

(9) "Health Care Interpreter (HCI)" means an individual who has been approved and certified by the Authority under ORS 413.558 to accurately interpret oral statements and documents to a person with limited English proficiency or in sign language. Qualified Health Care Interpreter has the same meaning.

(10) Health Evidence Review Commission (HERC) has the meaning provided in OAR 410-120-0000.

(11) "Interpreter Services" means services available to those with Limited English Proficiency (LEP) as described in Title VI of the Civil Rights Act of 1964; Section 1557 of the Affordable Care Act; and ORS 413.550 for Meaningful Language Access Interpreter services may also be accessed for deaf or hard of hearing members to ensure effective communication, as required by the Americans with Disabilities Act. The interpreter shall be a certified or qualified health care interpreter (HCI).

(12) Keratoconus is an eye condition in which your cornea gets thinner and gradually bulges outward into a cone shape.

(13) Managed Care Entity (MCE) has the meaning provided in OAR 410-120-0000.

(14) "Medicaid Division" (Division) has the meaning as provided in OAR 410-120-0000 and is within the Authority. The Division is responsible for managing the Oregon Health Plan (OHP), which is Oregon's Medicaid program.

(15) Ocular prosthesis has the meaning as provided in OAR 410-122-0010.

(16) Ophthalmologist is a specialist in the study and treatment of disorders and diseases of the eye;

(17) Optometrist has the meaning provided in OAR 410-120-0000;

(18) Optometric services has the meaning provided in OAR 410-120-0000;

(19) Oregon Health Authority (Authority) has the meaning provided in OAR 410-120-0000.

(20) Oregon Health Plan (OHP) has the meaning provided in OAR 410-120-0000 and OAR 410-141-3500.

(21) "Prescription" means the definition provided in OAR 410-121-0144.

(22) "Prioritized List of Health Services" (Prioritized list) means the comprehensive list of health services, ranked by priority. The Oregon Health Plan benefits are made from The List and determined by the Oregon Legislature.

(23) Pseudophakia is a term used for placing an artificial lens into the eye. Also referred to as intraocular, "fake lenses" or lens implants.

(24) Refraction determination is testing performed by an optometrist or ophthalmologist to determine refractive error in vision causing nearsightedness, farsightedness, or astigmatism.

(25) The Division of Medical Assistance Programs (Division) has the meaning provided in OAR 410-120-0000.

(26) Third-Party Liability (TPL) has the meaning provided in OAR 410-120-0000.

(27) "Vision Services" refer to services provided by an optometrist or ophthalmologist.

Or. Admin. Code § 410-140-0010

DMAP 127-2024, adopt filed 10/08/2024, effective 10/8/2024

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: 414.065, 414.025 & 414.075