Or. Admin. R. 333-004-3080

Current through Register Vol. 63, No. 9, September 1, 2024

Section 333-004-3080 - RH Access Fund Excluded Services by Funding Source

(1) Title X does not cover:

(a) Sterilizations for enrollees assigned female at birth;

(b) Treatment for STIs not pursuant to a family planning visit;

(c) Stand-alone visits for repeat Pap tests not pursuant to a family planning visit;

(d) Hysterectomies or abortions;

(e) Transportation to or from a clinic appointment;

(f) Procedures performed for medical reasons, whether or not the procedure results in preventing or delaying pregnancy or restoring fertility;

(g) Human papillomavirus (HPV) vaccinations; or

(h) Any other medical service or laboratory test that is not described in OAR 333-004-3070(2) (RH Access Fund Covered Services by Funding Source) and whose primary purpose is other than preventing or achieving pregnancy.

(2) CCare does not cover:

(a) Sterilizations for enrollees assigned female at birth;

(b) Treatment for STIs;

(c) Preconception or prenatal care, including pregnancy confirmations;

(d) Stand-alone visits for repeat Pap tests;

(e) Hysterectomies or abortions;

(f) Transportation to or from a clinic appointment;

(g) Procedures performed for medical reasons, whether or not the procedure results in preventing or delaying pregnancy or restoring fertility;

(h) Human papillomavirus (HPV) vaccinations; or

(i) Any other medical service or laboratory test that is not described in OAR 333-004-3070(3) (RH Access Fund Covered Services by Funding Source), and whose primary purpose is other than preventing unintended pregnancy.

(3) RHEA does not cover:

(a) Treatment for STIs;

(b) Stand-alone visits for repeat Pap tests;

(c) Hysterectomies;

(d) Transportation to or from a clinic appointment;

(e) Human papillomavirus (HPV) vaccinations;

(f) Any other medical service or laboratory test that is not described in ORS 743A.067;

(g) Mammography services. These services are available through the ScreenWise program (OAR 333-010-0120(2)(a) (Covered Services)), and under the benefit package in OAR 410-134-0004 (Healthier Oregon Funding);

(h) Abortion services not occurring in clinics certified by the RH Program. These services are available under the benefit package for this population in OAR 410-134-0004 (Healthier Oregon Funding); or

(i) Sterilization procedures. These services are available under the benefit package for this population in OAR 410-134-0004 (Healthier Oregon Funding).

Or. Admin. R. 333-004-3080

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 50-2022, temporary amend filed 04/29/2022, effective 05/01/2022 through 10/27/2022; PH 202-2022, amend filed 10/27/2022, effective 10/27/2022; PH 32-2023, temporary amend filed 06/30/2023, effective 7/1/2023 through 12/27/2023; PH 57-2023, amend filed 12/19/2023, effective 12/19/2023

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149 & OL 2022, ch. 45, sec 10

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032 & OL 2022, ch. 45, sec 10