Or. Admin. Code § 410-200-0130

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-200-0130 - Retroactive Medical

(1) The Authority may evaluate for retroactive medical eligibility for all HSD Medical Programs, except retroactive eligibility for OHP Bridge - Basic Health Program is not permitted.

(2) The Authority shall evaluate for retroactive medical eligibility for the three calendar months preceding the month in which the Date of Request was established for the following individuals:

(a) Applicants requesting HSD Medical Programs who have unpaid medical bills or received donated medical services that may have been covered by Oregon Medicaid/CHIP; and

(b) Deceased individuals who have unpaid medical bills or received donated medical services that may have been covered by Oregon Medicaid/CHIP, who may have been eligible for Medicaid covered services had they, or someone acting on their behalf, applied.

(3) If eligible for retroactive medical, the individual's eligibility shall not start earlier than the date indicated by OAR 410-200-0115 Effective Dates.

(4) The Authority reviews each month individually for retroactive medical eligibility.

(5) If an individual is determined to be eligible for retroactive medical eligibility, the period of retroactive eligibility shall be approved for months in which an individual received coverage during a Hospital Presumptive Eligibility period (OAR 410-200-0105), unless the retroactive benefits may be a reduction in benefit-level compared to the Hospital Presumptive Eligibility benefits.

Or. Admin. Code § 410-200-0130

DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14; DMAP 20-2014, f. & cert. ef. 3-28-14; DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15; DMAP 3-2015, f. & cert. ef. 1/30/2015; DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16; DMAP 24-2016, f. & cert. ef. 6/2/2016; DMAP 23-2020, amend filed 05/07/2020, effective 5/8/2020; DMAP 94-2024, amend filed 05/29/2024, effective 6/1/2024

Statutory/Other Authority: ORS 411.402, 411.404 & 414.534

Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 414.025, 414.231, 414.534, 414.536 & 414.706