Or. Admin. Code § 333-022-1010

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

Section 333-022-1010 - Definitions

(1) "AIDS" means acquired immunodeficiency syndrome.

(2) "Authority" means the CAREAssist program, administered by the Oregon Health Authority.

(3) "CAREAssist" includes benefits provided to clients under Bridge, UPP, Group 1 or Group 2 as those terms are used in OAR 333-022-1000 through 333-022-1170.

(4) "CAREAssist formulary" or "formulary" means a list of medications available to enrolled clients of CAREAssist when the same drug or a therapeutically comparable medication is not available through the client's primary health insurance.

(5) "Federal Poverty Level" or "FPL" means the annual poverty income guidelines, published by the United States Department of Health and Human Services.

(6) "Family" means all individuals counted by the Authority in determining the applicant's or client's family size.

(7) "Monthly income" means the monthly average of any and all monies received on a periodic or predictable basis, which the family relies on to meet personal needs.

(8) "Gross monthly income" means income before taxes or other withholdings.

(9) "HIV" means the human immunodeficiency virus, the causative agent of AIDS.

(10) "OHP" means the Oregon Health Plan.

(11) "Oregon residency" means that an individual:

(a) Has a physical location to reside in Oregon; and

(b) Is in Oregon at least six months out of the year; and

(c) Is not absent from Oregon more than three consecutive months; or

(d) Is living out of state for more than three months due to temporary or seasonal employment outside of Oregon; or

(e) Is living out of state for more than three months while attending an education institution full time.

(12) "Refuses" means a client or applicant actively declines enrollment in the insurance identified by the Authority.

(13) "Seasonal worker" means the applicant performs work cyclically during the year and most often the work is defined by seasons and typically defined by the calendar year.

(14) "Special enrollment period" means a time period outside of open enrollment in which a client is eligible to apply for private insurance because they experienced a qualifying event as defined by the Affordable Care Act.

(15) "UPP" means the CAREAssist Uninsured Persons Program.

Or. Admin. Code § 333-022-1010

PH 30-2014, f. 11-10-14, cert. ef. 12-1-14; PH 23-2016, f. & cert. ef. 8/2/2016

Stat. Auth.: ORS 413.042, 431.250, 431.830

Stats. Implemented: ORS 431.250, 431.830