Or. Admin. R. 461-135-0880

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

Section 461-135-0880 - OSIPM and QMB Programs; COVID-19

The provisions in this rule apply to the OSIPM and QMB programs.

(1) Subject to subsection (5)(b) of this rule, the Department amends the following rules or rule sections regarding the OSIPM and QMB programs.

(a) OAR 461-115-0700,

(b) OAR 461-175-0704,

(c) OAR 461-180-0030, and

(d) OAR 461-180-0120(1), (2), and (3)(b).

(2) Subject to subsection (5)(b) of this rule, and notwithstanding OAR 461-180-0030 and OAR 461-180-0120(1), (2), and (3)(b), the Department shall suspend the effective date for all actions that reduce or close OSIPM or QMB program benefits, except for:

(a) Program closures when an individual:

(A) Passes away,

(B) Is confirmed to have moved out of state,

(C) Requests a voluntary closure,

(D) In the QMB programs, is no longer eligible for Medicare,

(E) Is approved for a one-time cash payment, such as a special needs payment for home repairs,

(F) Is no longer eligible for an ongoing special needs payment,

(G) Is approved for benefits due to an administrative error (see OAR 461-195-0501), or

(H) When a court determines the individual made a false or misleading statement, or misrepresented, concealed, or withheld a fact for the purpose of establishing or maintaining eligibility.

(b) Benefit reductions when an individual

(A) Requests a voluntary reduction.

(B) Is no longer eligible for the same level or amount of a special needs payment.

(c) Increases to patient liability when restoring previous liability.

(d) Benefit suspension when an individual becomes a resident of a correctional facility under OAR 461-135-0950.

(3) Subject to subsection (5)(b) of this rule, and notwithstanding OAR 461-115-0700, the Department will accept self-attestation (see OAR 461-115-0700(2)(b)) to verify all eligibility criteria, except US citizenship, US national, and non-US citizen status.

(4) Subject to subsection (5)(b) of this rule, and notwithstanding OAR 461-115-0704(10), if the Department cannot promptly verify US citizenship, US national, or qualified non-US citizen status; the Department extends the reasonable opportunity period to 180 days from the date the notice is received.

(5) In accordance with the Consolidated Appropriations Act, 2023, the provisions of this rule shall end effective April 1, 2023, as outlined in subsections below.

(a) Individuals continuously receiving benefits prior to March 31, 2023 will maintain the protections afforded under this rule until the Department initiates a renewal of benefit eligibility (see OAR 461-001-0000). The Department will begin renewals in April 2023.

(A) When a completed and signed renewal form is required, the individual will have 90 days to provide the required documents.

(B) When additional information is required to complete the renewal, the individual will have 90 days to provide the requested information.

(C) When, during the renewal process, an individual is found ineligible for benefits, eligible for a lesser benefit, or the individual fails to complete the renewal process, the Department will send a decision notice (see OAR 461-001-0000) at least 60 days before the effective date of the closure or reduction.

(b) Once the renewal process of an individual is complete under subsection (a) of this section, the provisions of this rule no longer apply to that individual.

Or. Admin. R. 461-135-0880

SSP 14-2020, temporary adopt filed 06/16/2020, effective 6/16/2020 through 12/12/2020; SSP 30-2020, temporary adopt filed 09/02/2020, effective 09/02/2020 through 12/12/2020; SSP 33-2020, adopt filed 09/21/2020, effective 10/1/2020; SSP 28-2021, temporary amend filed 03/25/2021, effective 3/25/2021 through 9/20/2021; SSP 34-2021, amend filed 06/23/2021, effective 7/1/2021; SSP 60-2021, minor correction filed 12/13/2021, effective 12/13/2021; SSP 11-2023, amend filed 03/22/2023, effective 4/1/2023

Statutory/Other Authority: ORS 409.050, ORS 411.060, 411.070, 411.083, 412.006, ORS 84.001 to 84.061, 412.009, 412.024, 412.049, 412.064 & 412.089

Statutes/Other Implemented: ORS 411.060, 411.070, 411.083, 412.006, ORS 84.001 to 84.061, 412.009, 412.024, 412.049, 412.064, 412.089, 409.010, 411.081, 411.087, 45 CFR 206.10, 45 CFR 263.2, 45 CFR 400.155, Pub. L. 116-127, 42 CFR 435.907, 42 CFR 435.914, 42 CFR 433.400 & H.R. 2617 (117th)