The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 

DIVISION 22
HUMAN IMMUNODEFICIENCY
VIRUS
HIV Testing and Confidentiality
333-022-0200
Definitions
For purposes of
OAR 333-022-0205 through 333-022-0210, unless otherwise specified the following
definitions shall apply:
(1) "Division"
means the Public Health Division within the Oregon Health Authority.
(2) “Health
care provider” has the meaning given that term in ORS 433.045.
(3) "HIV
test" has the meaning given that term in ORS 433.045.
(4) "HIV-positive
test" means a positive result on the most definitive HIV test procedure used to
test a particular individual. In the absence of any recommended confirming tests,
this means the positive result of the initial test done.
(5) “Insurance
producer” has the meaning given that term in ORS 746.600.
(6) “Insurance-support
organization” has the meaning given that term in ORS 746.600.
(7) “Insurer”
has the meaning given that term in ORS 731.106.
(8) "Licensed
health care facility" means a health care facility as defined in ORS 442.015 and
a mental health facility, alcohol treatment facility or drug treatment facility
licensed or operated under ORS chapters 426 or 430.
(9) "Local
public health administrator" has the meaning given that term in ORS 433.060.
(10) “Local
public health authority” has the meaning given that term in ORS 431.260.
(11) “Next
of kin” means an individual within the first applicable class of the following
listed classes:
(a) The spouse
of the decedent;
(b) A son
or daughter of the decedent 18 years of age or older;
(c) Either
parent of the decedent;
(d) A brother
or sister of the decedent 18 years of age or older;
(e) A guardian
of the decedent at the time of death;
(f) A person
in the next degree of kindred to the decedent;
(g) The personal
representative of the estate of the decedent; or
(h) The person
nominated as the personal representative of the decedent in the decedent’s
last will.
(12) "Personal
representative" means a person who has authority to act on behalf of an individual
in making decisions related to health care.
(13) "Substantial
exposure" means an exposure to blood or certain body fluids that have a potential
for transmitting the human immunodeficiency virus based upon current scientific
information and may include but is not limited to contact with blood or blood components,
semen, or vaginal/cervical secretions through percutaneous inoculation or contact
with an open wound, non-intact skin, or mucous membrane of the exposed person.
Stat. Auth.: ORS
433.045 - 433.080

Stats. Implemented:
ORS 433.006 & 433.065

Hist.: PH
6-2013, f. & cert. ef 2-4-13
333-022-0205
HIV Testing,
Notification, Right to Decline
(1) Pursuant to
ORS 433.045, a health care provider or the provider’s designee shall, before
subjecting an individual to an HIV test:
(a) Notify
the individual being tested; and
(b) Allow
the individual being tested the opportunity to decline the test.
(2) A health
care provider or the provider’s designee may provide an individual notice
and the opportunity to decline testing verbally or in writing, including providing
the notice and the opportunity to decline in a general medical consent form.
(3) Whenever
an insurer, insurance producer or insurance-support organization asks an applicant
for insurance to take an HIV test in connection with an application for insurance,
the insurer, insurance producer or insurance-support organization must reveal the
use of the test to the applicant and obtain the written consent of the applicant.
The consent form must disclose the purpose of the test and to whom the results may
be disclosed.
(4) Anyone
other than those listed in sections (1) through (3) of this rule who wishes to subject
an individual to an HIV test must reveal the use of the test to the individual and
obtain written consent of the individual for the HIV test.
(5) If an
individual is deceased, next of kin may consent to an HIV test pursuant to ORS 433.075.
(6) If an
individual is incapable of consenting to an HIV test, the individual’s personal
representative may consent on the individual’s behalf.
Stat. Auth.: ORS
433.045 – 433.080

Stats. Implemented:
ORS 433.045, 433.055(3), 433.065 & 433.075

Hist.: PH
6-2013, f. & cert. ef 2-4-13
333-022-0210
Confidentiality
(1) General. Pursuant
to ORS 433.045, a person may not disclose or be compelled to disclose the identity
of any individual upon whom an HIV test is performed or the results of such a test
in a manner that permits identification of the subject of the test, except as required
or permitted by federal law, the law of this state, or these rules, or as authorized
by the individual who is tested. The prohibitions on disclosure do not apply to
an individual acting in a private capacity and not in an employment, occupational
or professional capacity.
(2) Disclosure
to or for a tested individual. The results of an HIV test may be disclosed to:
(a) The tested
individual;
(b) The health
care provider or licensed health care facility or person ordering the test; and
(c) Any individual
to whom the tested individual has authorized disclosure.
(3) Medical
records. When a health care provider or licensed health care facility obtains HIV
test results of an individual, the test results may be entered into the routine
medical record of that individual maintained by that health care provider or licensed
health care facility. The information in the record may be disclosed in a manner
consistent with ORS 192.553 to 192.581 and the Health Information Portability and
Accountability Act (HIPAA) regulations, 45 CFR 160 to 164.
(4) Public
health purposes.
(a) Anyone
may report the identity and HIV-related test result of an individual to the local
public health authority or Division for public health purposes.
(b) The Division
or local public health authority may inform an individual who has had a substantial
exposure to HIV of that exposure if the Division or local public health authority
determines that there is clear and convincing evidence that disclosure is necessary
to avoid an immediate danger to the individual or to the public.
(c) The Division
or local public health authority may disclose the identity of an individual with
an HIV-positive test to a health care provider for the purpose of referring or facilitating
treatment for HIV infection.
(d) The Division
or local public health authority may only disclose the minimum amount of information
necessary to carry out the purposes of the disclosure.
(5) Anatomical
donations. The identity of a HIV tested individual and that individual’s HIV
test results may be released to a health care provider or licensed health care facility
to the minimum extent necessary to make medical decisions concerning organ or tissue
transplants.
(6) Nothing
in this rule is intended to limit the extent to which a licensed health care facility
or health care provider can use or disclose HIV related health information in accordance
with other state and federal laws.
Stat. Auth.: ORS
433.008, 433.045

Stats. Implemented:
ORS 433.045 – 433.080

Hist.: PH
6-2013, f. & cert. ef 2-4-13
Occupational and
Health Care Setting Exposures
333-022-0300
Procedures
for Requesting a Source Person Consent to an HIV Test Following an Occupational
Exposure
(1) For purposes
of this rule the following definitions apply:
(a) “Exposure”
means contact with a source person’s body fluids.
(b) “Licensed
health care provider” has the meaning given that term in ORS 433.060.
(c) “Local
public health administrator (LPHA)” means the public health administrator
of the county or district health department for the jurisdiction in which the reported
substantial exposure occurred.
(d) “Next
of kin” means an individual within the first applicable class of the following
listed classes:
(A) The spouse
of the decedent;
(B) A son
or daughter of the decedent 18 years of age or older;
(C) Either
parent of the decedent;
(D) A brother
or sister of the decedent 18 years of age or older;
(E) A guardian
of the decedent at the time of death;
(F) A person
in the next degree of kindred to the decedent;
(G) The personal
representative of the estate of the decedent; or
(H) The person
nominated as the personal representative of the decedent in the decedent’s
last will.
(e) “Occupational
exposure” means a substantial exposure of a worker in the course of the worker’s
occupation.
(f) “Qualified
person” means an individual, such as a licensed health care provider, who
has the necessary training and knowledge about infectious disease to make a determination
about whether an exposure was substantial.
(g) "Source
person" means a person whose body fluids may be the source of a substantial exposure.
(h) "Substantial
exposure" means an exposure to blood or certain body fluids that have a potential
for transmitting the human immunodeficiency virus based upon current scientific
information and may include but is not limited to contact with blood or blood components,
semen, or vaginal/cervical secretions through percutaneous inoculation or contact
with an open wound, non-intact skin, or mucous membrane of the exposed person.
(i) "Worker"
means a person who is licensed or certified to provide health care under ORS chapters
677, 678, 679, 680, 684 or 685, or ORS 682.216, an employee of a health care facility,
of a licensed health care provider or of a clinical laboratory, as defined in ORS
438.010, a firefighter, a law enforcement officer, as defined in ORS 414.805, a
corrections officer or a parole and probation officer.
(2) The Division
has determined that a worker who experiences an occupational exposure may benefit
from requesting the mandatory testing of a source person because such testing may
assist a worker in obtaining necessary prophylaxis or treatment for HIV.
(3) Pursuant
to ORS 433.065, a worker who experiences an exposure may request that a determination
be made as to whether the exposure was a substantial exposure.
(a) A worker
may make a request for a determination to:
(A) If the
source person is being treated at a licensed health care facility:
(i) The facility’s
infection control officer or other designated qualified person; or
(ii) The
source person’s treating health care provider;
(B) The worker’s
health care provider; or
(C) The LPHA.
(b) A request
for a determination must include but is not limited to:
(A) The worker’s
name and contact information;
(B) Whether
the worker has been tested for HIV and if so, when;
(C) The details
of the exposure;
(D) The name,
contact information, and current location of the source, if known;
(E) Information
about the source person’s HIV status, if known; and
(F) A citation
to ORS 433.065 and these rules as authority for the request for a determination.
(4) The health
care provider, infection control practitioner, designated qualified person or local
public health administrator to whom the request is made must determine whether an
exposure was a substantial exposure and an occupational exposure and provide that
determination in writing to the worker within 24 hours of receiving the request.
The individual making the determination may rely on the most recent guidance on
this topic issued by the federal Centers for Disease Control and Prevention. The
individual to whom the request is made may contact the worker to request additional
information and may require the release of records related to the exposure from
the worker, a licensed health care facility or a licensed health care provider in
order to make his or her determination.
(5) If the
health care provider, infection control officer, designated qualified person or
LPHA to whom the request was made determines the worker experienced a substantial
exposure and an occupational exposure the worker may request that the source person
be tested for HIV.    
(a) If the
worker knows that the source person is under the care of a licensed health care
facility or a licensed health care provider the worker may request that the health
care facility or licensed health care provider ask the source person to consent
to an HIV test. A health care facility or licensed health care provider who receives
a request from a worker as described in section (5) of this rule is required to
ask the source person to consent to an HIV test within 24 hours of receiving the
request and to report to the worker immediately whether the source person has consented
to an HIV test.
(b) If the
worker does not know whether the source person is under the care of a licensed health
care facility or a licensed health care provider the worker may contact the LPHA
and ask for assistance in locating the source person. If the source person is located
with assistance from the LPHA, the LPHA must request that the source person consent
to an HIV test.
(c) In accordance
with ORS 433.075(5) if the source person consents to the HIV test, the results of
an HIV test shall be reported to the worker by the health care provider or licensed
health care facility that ordered the test but the results may not identify the
source person and the worker is prohibited from redisclosing any information about
the test if the source person is known to the worker.
(d) A worker,
or the exposed person’s employer in the case of an occupational exposure,
is responsible for the costs of the source person’s HIV test in accordance
with ORS 433.075.
(6) If the
worker disagrees with a determination that an alleged occupational exposure was
not a substantial exposure, the worker may request a second determination from the
LPHA. If the LPHA determines that the exposure was substantial, the worker may request
that the source person be tested for HIV according to the procedures detailed in
subsections (5)(a) through (d).
(7) If the
source person refuses to consent, the health care provider or licensed health care
facility that requested that the source person be tested must document, in writing,
the source person’s refusal to consent to an HIV test and provide that documentation
to the worker. The LPHA must also be notified by the health care provider, licensed
health care facility, or the worker of the documentation of the refusal along with
the determination that the exposure was substantial.
(8) If a
source person refuses to consent to an HIV test or fails to obtain a test within
24 hours of his or her consent to the HIV test the worker may petition the circuit
court in the county in which the occupational exposure occurred in accordance with
ORS 433.080 and OAR 333-022-0305 to request mandatory testing of the source person.
Before a worker may petition the court for mandatory testing the worker must agree
to an HIV test and submit a specimen to a laboratory certified to perform testing
on human specimens under the Clinical Laboratory Improvement Amendments of 1988
(P.L. 100-578,42 U.S.C. 201 and 263(a))(CLIA) and must notify the LPHA of the failure
to obtain a test along with along with the determination that the exposure was substantial.
(9) If a
source person is deceased or is unable to consent to an HIV test, consent shall
be sought from the source person’s next of kin.
(10) If a
worker has an employer, the worker’s employer shall be required to provide
the worker with information about HIV infection, methods of preventing HIV infection,
HIV tests and treatment and assistance in following the procedures outlined above.
A worker who is self-employed may obtain this information and assistance from the
LPHA.
Stat. Auth.: ORS
433.065

Stats. Implemented:
ORS 433.065

Hist.: PH
6-2013, f. & cert. ef 2-4-13
333-022-0305
Petition
for Mandatory Testing of Source Persons
(1) If a worker
has complied with the process established in OAR 333-022-0300 and a source person
has refused to consent to an HIV test or has failed to obtain a test within the
time period established in that rule, the worker may petition the circuit court
for the county in which the exposure occurred and seek a court order for mandatory
testing in accordance with ORS 433.080.
(2) The form
for the petition shall be as prescribed by the Division and shall be obtained from
the LPHA.
(3) The petition
shall name the source person as the respondent and shall include a short and plain
statement of facts alleging:
(a) The petitioner
is a worker subjected to an occupational exposure and the respondent is the source
person;
(b) The petitioner
meets the definition of worker in ORS 433.060;
(c) All procedures
for obtaining the respondent’s consent to an HIV test as described in OAR
333-022-0300 have been exhausted by the petitioner and the respondent has refused
to consent to the test, or within the time period prescribed in OAR 333-022-0300
has failed to submit to the test;
(d) The petitioner
has no knowledge that he or she has a history of a positive HIV test and has since
the occupational exposure submitted a specimen for an HIV test to a laboratory certified
to perform testing on human specimens under the Clinical Laboratory Improvement
Amendments of 1988 (P.L. 100-578,42 U.S.C. 201 and 263(a))(CLIA).; and
(e) The injury
that petitioner is suffering or will suffer if the source person is not ordered
to submit to an HIV test.
(4) The petition
shall be accompanied by the certificate of the LPHA declaring that, based upon information
in the possession of the administrator, the facts stated in the allegations under
subsections (3)(a), (b) and (c) of this rule are true.
(5) A LPHA
must provide the petitioner a certificate as described in section (4) of this rule
and must appear at any court hearing on the petition in accordance with ORS 433.080(7).
(6) The court
is required to hold a hearing on the petition in accordance with ORS 433.080.
Stat. Auth.: ORS
433.080

Stats. Implemented:
ORS 433.080

Hist.: PH
6-2013, f. & cert. ef 2-4-13
333-022-0310
Substantial
Exposure While Being Administered Health Care
(1) For purposes
of this rule the following definitions apply:
(a) “Exposure”
means contact with a worker’s body fluids.
(b) “Local
public health administrator (LPHA)” means the public health administrator
of the county or district health department for the jurisdiction in which the reported
substantial exposure occurred.
(c) “Health
care” has the meaning given that term in ORS 192.556.
(d) “Licensed
health care provider” has the meaning given that term in ORS 433.060.
(e) “Patient”
means an individual who has experienced an exposure or substantial exposure while
being administered health care.
(f) “Qualified
person” means an individual, such as a licensed health care provider, who
has the necessary training and knowledge about infectious disease to make a determination
about whether an exposure was substantial.
(g) "Substantial
exposure" means an exposure to blood or certain body fluids that have a potential
for transmitting the human immunodeficiency virus based upon current scientific
information and may include but is not limited to contact with blood or blood components,
semen, or vaginal/cervical secretions through percutaneous inoculation or contact
with an open wound, non-intact skin, or mucous membrane of the exposed person.
(h) "Worker"
means a person who is licensed or certified to provide health care under ORS chapters
677, 678, 679, 680, 684 or 685, or ORS 682.216, an employee of a health care facility,
of a licensed health care provider or of a clinical laboratory, as defined in ORS
438.010, a firefighter, a law enforcement officer, as defined in ORS 414.805, a
corrections officer or a parole and probation officer
(2) If a
patient has experienced an exposure by a worker the worker shall report that exposure
immediately to one of the following:
(a) The worker’s
supervisor or employer, if applicable;
(b) The licensed
health care facility’s infection control officer or other designated qualified
person if the exposure occurred in a licensed health care facility as that term
is defined in ORS 442.015; or
(c) The LPHA
if the worker does not have a supervisor or employer and the exposure did not occur
in a licensed health care facility.
(3) If a
witness to the incident has reason to believe the incident was not reported, the
witness shall notify one of the individuals or entities listed in section (2) of
this rule and provide details of the incident.
(4) The individual
to whom a report was made under section (2) or (3) of this rule shall immediately
make a determination whether the exposure was substantial and shall provide that
determination to the worker in writing. The individual making the determination
may rely on the most recent guidance on this topic issued by the federal Centers
for Disease Control and Prevention. If the individual to whom the report was made
is not qualified to make such a determination the individual must consult with a
designated qualified person and that qualified person must then make the determination.
The individual making a determination may require the release of records related
to the exposure from the worker, a health care facility or a licensed health care
provider in order to make his or her determination.
(5) If a
determination is made that the exposure was substantial, the worker who was the
source of the substantial exposure to a patient shall notify the patient in writing
within 24 hours of the determination. The worker may request that his or employer,
the health care facility if the exposure occurred in a health care facility, or
the LPHA provide assistance in making the notification. The notice must include
but is not limited to:
(a) Details
of the exposure;
(b) Why it
was determined to be substantial;
(c) Whether
the worker is willing to consent to an HIV test;
(d) The worker’s
HIV status if the worker consents to that information being included in the notice;
(e) Information
about how the patient may request the worker be tested for HIV and to whom the patient
should make such a request; and
(f) A statement
that the patient will be responsible for the costs of the worker’s HIV test
in accordance with ORS 433.075.
(6) If the
patient disagrees with a determination that an alleged occupational exposure was
not a substantial exposure, the patient may request a second determination from
the LPHA. If the LPHA determines that the exposure was substantial, the patient
may request that the source person be tested for HIV according to the procedures
detailed in subsections (5)(a) through (f).
(7) A patient
who has received notification in accordance with section (5) of this rule may make
a written request for the worker to be tested for HIV to the individual or entity
listed in the notice.
(8) The individual
or entity to whom a request has been made under section (6) of this rule must:
(a) Immediately
ask the worker to consent to an HIV test; and
(b) Inform
the patient immediately whether the worker consented to the testing.
(9) If the
worker consents to an HIV test the worker must submit to a test within 24 hours
of being asked to consent.
(10) In accordance
with ORS 433.075(5) if the worker consents to the HIV test the results of a HIV
test shall be reported to the patient by the individual who ordered the test but
the results may not identify the worker and the patient is prohibited from redisclosing
any information about the results of the test if the worker is known to the patient.
(11) Pursuant
to ORS 433.065, a patient who has experienced a substantial exposure by a worker
shall be offered information about HIV infection, methods of preventing HIV infection,
and HIV tests. This information must be provided by the patient's licensed health
care provider. Upon request by the patient's health care provider, the LPHA must
provide assistance in providing this information to the patient.
Stat. Auth.: ORS
433.065

Stats. Implemented:
ORS 433.065

Hist.: PH
6-2013, f. & cert. ef 2-4-13
333-022-0315
Employer
Program for Prevention, Education and Testing
(1) Pursuant to
ORS 433.075(4), where an employer provides a program of prevention, education and
testing for HIV exposures for its employees, the program will be considered to be
approved by the Division if employees receive counseling regarding HIV infection
control, uniform body fluids precautions, sexual/needle-sharing abstinence and safer
sex practices including advice about precautionary measures to be taken with partners
at risk of exposure to HIV while test results are pending.
(2) The Division
may make the educational materials needed for such a program available to an employer
who requests such materials in writing.
(3) An employer
that provides HIV testing to employees must use a laboratory certified to perform
testing on human specimens under the Clinical Laboratory Improvement Amendments
of 1988 (P.L. 100-578,42 U.S.C. 201 and 263(a))(CLIA).
(4) If an
employer does not have a testing program in place, the employer shall notify the
exposed worker of a health care provider who will perform testing, or an exposed
worker may seek medical treatment from a health care provider of his or her choice.
Stat. Auth.: ORS
433.075

Stats. Implemented:
ORS 433.075

Hist.: PH
6-2013, f. & cert. ef 2-4-13
Infected Health Care
Providers
333-022-0400
Definitions
For the purpose
of OAR 333-022-0400 through 333-022-0460, the following definitions apply. Other
definitions pertaining to these rules are listed in OAR 333-022-0200:
(1) "Health
Care Provider" as defined in OAR 333-017-0000(25) means a person who has direct
or supervisory responsibility for the delivery of health care or medical services.
This shall include, but not be limited to: Licensed physicians, nurse practitioners,
physician assistants, nurses, dentists, medical examiners, and administrators, superintendents
and managers of clinics, health care facilities as defined in ORS 442.015(13) and
licensed laboratories.
(2) "Reviewable
Health Care Provider" means a health care provider who routinely performs or participates
in the performance of surgical, obstetric, or dental procedures that:
(a) Pose
a significant risk of a bleeding injury to the arm or hand of the health care provider;
and
(b) Are of
a nature that reasonably could result in the patient having an exposure to the health
care provider's blood in a manner capable of effectively transmitting HIV or hepatitis
B virus (HBV), for example, due to the inability of the health care provider to
withdraw the injured limb. Examples of procedures that do not carry this significant
risk include, but are not limited to: oral, rectal, or vaginal examinations; phlebotomy;
administering intramuscular, intradermal, or subcutaneous injections; needle biopsies,
needle aspirations, and lumbar punctures; cutdown and angiographic procedures; excision
of epidermal or dermal lesions; suturing of superficial lacerations; endoscopy;
placing and maintaining peripheral and central intravascular lines, nasogastric
tubes, rectal tubes, and urinary catheters; or acupuncture.
(3) "HBsAg"
means the surface antigen of the hepatitis B virus.
(4) "HBeAg"
means the "e" antigen of the hepatitis B virus.
(5) "OR-OSHA"
means the Oregon Occupational Safety and Health Division of the Oregon Department
of Consumer and Business Services.
Stat. Auth.: ORS
431.110(1), 433.001 & 433.004

Stats. Implemented:
ORS 431.110(1), 433.001 & 433.004

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; HD 29-1994, f. & cert. ef. 12-2-94;
Renumbered from 333-012-0280, PH 6-2013, f. & cert. ef. 2-14-13
333-022-0405
Preamble
(1) The purpose
of OAR 333-022-0400 through 333-022-0460 is to prevent the transmission of hepatitis
B virus and human immunodeficiency virus to patients from infected health care providers.
The Division declares that strict adherence to proper infection control procedures
by all health care providers is the primary way to prevent such transmission. The
Division recognizes that when proper infection control procedures are used, the
risk of transmission of HIV or hepatitis B virus from reviewable health care providers
to their patients is negligible.
(2) In the
event that an HIV-infected health care provider demonstrates symptoms of cognitive,
emotional, behavioral or neurologic impairment, he or she should be treated like
any other distressed and/or impaired health care provider, following the standards
of the appropriate professional licensing board.
Stat. Auth.: ORS
431.110(1) & 433.004

Stats. Implemented:
ORS 431.110(1) & 433.004

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0290, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0410
Infection
Control
(1) All health care
providers and health care facilities shall strictly adhere to the infection control
requirements of OAR 333- 017-0005(1) and applicable sections of the OSHA rules,
"Occupational Exposure to Bloodborne Pathogens" (OAR 437-002 - 1910.1030). This
includes the proper use of hand washing, protective barriers, and care in the use
and sterilization or disposal of needles and other sharp instruments as described
in the U.S. Public Health Service's Centers for Disease Control and Prevention recommendations
found in "Recommendations for Prevention of HIV Transmission in Health Care Settings",
Morbidity and Mortality Weekly Report 1987; 36 (supplement number 2S); 1-18S and
"Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency
Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health Care Settings",
Morbidity and Mortality Weekly Report 1988; 37:377-82, 387-88.
(2) Any health
care provider who observes that another health care provider or health care facility
is not practicing current infection control standards shall seek correction of that
problem through procedures appropriate to the setting. Such procedures may include,
for example, discussing the needed corrective actions directly with the health care
provider, reporting the breaches of infection control practice to the health care
facility's infection control committee, or other actions/reporting as recommended
by the infection control committee or required by other regulations.
[Publications: Publications
referenced are available from the agency.]
Stat. Auth.:
ORS 431.110(1) & 433.004(1)(d)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)(d)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0300, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0415
Infection
Control Training
(1) All health care
providers and health care facilities shall adhere to the infection control training
requirements of the OSHA rules, "Occupational Exposure to Bloodborne Pathogens"
(OAR 437-002 – 1910.1030). These include employers ensuring that all employees
with potential occupational exposures to bloodborne pathogens participate in a training
program at the time of initial assignment to the tasks where occupational exposure
may take place and at least annually thereafter.
(2) Any institution
in Oregon providing professional training leading to a degree or certificate as
a health care provider shall provide formal training in infection control procedures
as a prerequisite for graduation.
Stat. Auth.: ORS
431.110(1) & 433.004(1)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0310, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0420
HIV and Hepatitis
B Testing of Health Care Providers
(1) HIV testing
and hepatitis B testing of health care providers is not required by the Division.
(2) All reviewable
health care providers are encouraged to voluntarily undergo testing for HIV infection.
Any reviewable health care provider is encouraged to either:
(a) Demonstrate
serologic evidence of immunity to the hepatitis B virus from vaccination; or
(b) To know
his or her HBsAg status and, if that status is positive, is encouraged to know his
or her HBeAg status.
(3) The provisions
of section (2) of this rule shall not be deemed to authorize any health care provider,
health care facility, clinical laboratory, blood or sperm bank, insurer, insurance
agent, insurance-support organization as defined in ORS 746.600, government agency,
employer, research organization or agent of any of them to require HIV testing of
any health care provider as a condition of practice. Nor shall such provisions be
deemed to create a legal standard of care for reviewable health care providers.
Stat. Auth.: ORS
431.110(1) & 433.004(1)(d)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)(d)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0320, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0425
Hepatitis
B Immunization
Every reviewable
health care provider, whether or not directly subject to regulation by OR-OSHA,
is encouraged to determine whether he or she has serologic evidence of immunity
to hepatitis B or to obtain complete hepatitis B immunization.
Stat. Auth.: ORS
431.110(1) & 433.004(1)(d)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0330, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0430
Process for
Initiating Review of the Professional Practice of a Reviewable Health Care Provider
with a HIV-Positive Test or a Positive Test for HBsAg and HBeAg
(1) Any reviewable
health care provider who learns that he or she has a HIV-positive test or a positive
test for both HBsAg and HBeAg is encouraged to refrain from participating in the
performance of procedures outlined in OAR 333-022-0400(2) until he or she ensures
that his or her HIV and/or HBsAg/HBeAg infection status is reported to either:
(a) The Division
for the purpose of undergoing a review of his or her professional practice as described
in OAR 333-022-0435; or
(b) His or
her own institution of employment for the purpose of undergoing a review of his
or her professional practice, if such a process exists.
(2) Reports
to the Division should be made directly to the State Epidemiologist, the Deputy
State Epidemiologist, or the State Health Officer.
(3) Health
care providers who are uncertain as to whether or not they are reviewable may seek
anonymous guidance from the Division.
Stat. Auth.: ORS
431.110 & 433.004

Stats. Implemented:
ORS 431.110 & 433.004

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; HD 29-1994, f. & cert. 12-2-94; Renumbered
from 333-012-0340, PH 6-2013, f. & cert. ef. 2-14-13
333-022-0435
Division
Response to the Report of a Reviewable Health Care Provider with a HIV-Positive
Test or Positive Tests for HBsAg and HBeAg
The following procedures
shall be undertaken by the Division at the request of a reviewable health care provider
with a positive test for HIV or positive tests for HBsAg and HBeAg:
(1) The Division
shall interview the reviewable health care provider and his or her personal licensed
physician or primary health care provider within two weeks of receipt of the report
to determine:
(a) The date
of the initial positive test result;
(b) An estimated
date of initial infection, if available from clinical and exposure history information;
(c) The reviewable
health care provider's current medical status with special emphasis on presence
or absence of exudative lesions or weeping dermatitis, pulmonary tuberculosis, and
cognitive, emotional, behavioral or neurologic impairment; and
(d) Whether
the reviewable health care provider complies with standard infection control procedures
and whether he or she has a history of incidents in which there was a substantial
likelihood that a patient received a substantial exposure to the reviewable health
care provider's blood;
(e) Pursuant
to ORS 433.008 and 433.045, confidentiality of the reviewable health care provider's
HIV or HBsAg/HBeAg status shall be maintained during this investigation.
(2) The Division
shall convene an expert panel within two weeks of completion of the investigation
to make recommendations regarding the reviewable health care provider's continued
practice.
(3) The identity
of the reviewable health care provider will not be revealed to the expert panel,
unless the reviewable health care provider consents to this disclosure.
Stat. Auth.: ORS
431.110(1) & 433.004(1)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; HD 29-1994, f. & cert. 12-2-94; Renumbered
from 333-012-0350, PH 6-2013, f. & cert. ef. 2-14-13
333-022-0440
Composition
of the Expert Panel and Its Responsibilities
(1) The expert panel
shall include: An infectious disease specialist, with expertise in the epidemiology
of HIV and hepatitis B infections, who is not involved in the care of the reviewable
health care provider; a health professional with expertise in the procedures performed
by the reviewable health care provider; a representative of the Division; and others
at the discretion of the Division. With the consent of the reviewable health care
provider, the reviewable health care provider's personal licensed physician or primary
health care provider shall also be offered a position on the panel. The reviewable
health care provider shall have the right to review the composition of the panel.
(2) The expert
panel shall consider all information obtained by the Division's investigation and
may request further information of the Division or the reviewable health care provider
as needed.
(3) The expert
panel shall make recommendations to the Division regarding the reviewable health
care provider's further practice. The panel will focus on the reviewable health
care provider's ability to comply with infection control procedures and his or her
ability to provide competent care. Restrictions in future practice will be recommended
only if there are medical impairments, infection control breaches, or scientific
evidence to indicate that, in the Division's judgment, the reviewable health care
provider's current practice activities pose a significant risk of transmission to
the patient. Job modifications, limitations, or other restrictions are warranted
only if there is clear evidence that the reviewable health care provider's current
practice activities pose a significant risk of transmitting infection to patients.
If restrictions are recommended, the panel will recommend the least restrictive
alternative. If warranted, the panel may recommend one or more of the following:
(a) Additional
infection control procedures;
(b) Restrictions
on specific procedures;
(c) Monitoring
of the reviewable health care provider's practice for compliance with the recommendations
of the expert panel;
(d) Medical
monitoring (both content and frequency) of the reviewable health care provider;
and
(e) Frequency
with which the panel should reconvene to reconsider its recommendations in light
of the changing medical condition of the reviewable health care provider.
(4) The expert
panel shall furnish the reviewable health care provider with a draft of its recommendations
and an opportunity for comment. Before finalizing its recommendations to the Division,
the expert panel shall take into account any comments received from the reviewable
health care provider or the provider's representative.
Stat. Auth.: ORS
431.110(1) & 433.004(1)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; HD 29-1994, f. & cert. 12-2-94; Renumbered
from 333-012-0360, PH 6-2013, f. & cert. ef. 2-14-13
333-022-0445
Division
Recommendations to Reviewable Health Care Provider
The Division shall
consider the specific recommendations of the expert panel and comments, if any,
of the reviewable health care provider or the provider's representative, and shall
prepare written recommendations to the reviewable health care provider. These written
recommendations shall be presented to the reviewable health care provider within
one week after completion of the panel's recommendations.
Stat. Auth.: ORS
431.110 & 433.004

Stats. Implemented:
ORS 431.110 & 433.004

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0370, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0450
Notification
of the Appropriate Licensing Board
If the Division
has reason to believe that the reviewable health care provider poses a significant
risk of transmission of HIV or hepatitis B virus to the patient, whether or not
an HIV-infected or HBsAg/HBeAg-positive reviewable health care provider has been
reported to the Division and has consented to voluntary review as outlined above,
the Division may notify the appropriate licensing board, and shall inform the reviewable
health care provider, in writing, of this notification.
Stat. Auth.: ORS
431.110 & 433.004

Stats. Implemented:
ORS 431.110 & 433.004

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0380, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0455
Notification
and Counseling of Some or All Past or Present Patients of the Reviewable Health
Care Provider
Notification of
patients as to their possible exposure to HIV or hepatitis B shall not occur except
in any of the following circumstances:
(1) HIV or
hepatitis B transmission from reviewable health care provider to at least one of
his or her patients has occurred;
(2) The patient
to be notified has had a substantial exposure to the reviewable health care provider's
blood or body fluids; or
(3) The reviewable
health care provider has had significant violations of infection control practices
that were standard at the time of the patient contact and which resulted in a significant
risk of a substantial exposure to the patient being notified;
(4) The identity
of the HIV-infected health care provider shall not be explicitly disclosed during
the notification process.
Stat. Auth.: ORS
431.110(1) & 433.004(1)(d)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)(d)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0390, PH 6-2013,
f. & cert. ef. 2-14-13
333-022-0460
Confidentiality
The report of a
reviewable health care provider, the Division's investigation, the deliberations
and recommendations of the expert panel, and the Division's recommendations pursuant
to these rules shall be held in the strictest confidence under ORS 433.008 and 433.045,
except as outlined in OAR 333-022-0450 and 333-022-0455.
Stat. Auth.: ORS
431.110(1) & 433.004(1)

Stats. Implemented:
ORS 431.110(1) & 433.004(1)

Hist.: HD
18-1993, f. 10-26-93, cert. ef. 10-28-93; Renumbered from 333-012-0400, PH 6-2013,
f. & cert. ef. 2-14-13
CAREAssist
333-022-1000
Purpose and Description of Program
(1) The CAREAssist program is Oregon’s
AIDS Drug Assistance Program (ADAP). The core purpose of CAREAssist is to ensure
access to HIV-related prescription drugs to underinsured and uninsured individuals
living with HIV/AIDS. CAREAssist also helps people living with HIV or AIDS pay for
medical care expenses, including but not limited to medication, insurance premiums
and medical services. The program is funded through Part B of the Ryan White HIV/AIDS
Treatment Extension Act of 2009 (Public Law 111-87), which provides grants to states
and territories.
(2) The Oregon Health Authority
(Authority) shall make funds available for the CAREAssist program as long as it
continues to receive grant funds from the federal government.
(3) If insufficient funds
are available for the CAREAssist program the Authority may:
(a) Modify group benefits
for approved clients; and
(b) Institute a waiting list
in lieu of accepting applications.
(4) Ryan White funds may
not be used for any item or service if payment has been made, or can reasonably
be expected to be made by another payment source. ADAP is a last-resort payment
source. As such, the Authority may require the applicant or client to enroll in
the most cost-effective insurance available, as determined by the Authority. If
the client or applicant refuses to enroll in health insurance that the Authority
has identified as the most cost-effective plan for which he or she is eligible,
the Authority shall only provide assistance with the cost of HIV antiretroviral
and opportunistic infection-related medications as identified in the formulary.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: HD 14-1987(Temp),
f. & ef. 9-30-87; HD 9-1988, f. 5-11-88, cert. ef. 5-12-88; HD 1-1990(Temp),
f. & cert. ef. 1-8-90; PH 9-2005, f. 6-15-05, cert. ef. 6-21-05; PH 25-2010(Temp),
f. & cert. ef. 10-1-10 thru 3-29-11; Renumbered from 333-012-0250 by DMAP 5-2011,
f. & cert. ef. 3-29-1; Renumbered from 410-121-3000, PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
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 therapeutic all 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
but is a full-time student attending an educational institution and maintaining
a residential address in Oregon; or
(e) Has employment outside
of the state which requires temporary relocation of more than three consecutive
months to accomplish the work.
(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.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1020
Eligibility
To qualify for the CAREAssist program
an individual must:
(1) Be HIV positive or have
AIDS; and
(2) Reside in Oregon; and
(3) Have a monthly income
based on family size which is at or below 400 percent of the FPL.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1030
Application Process
(1) An individual may apply for CAREAssist
benefits by completing a form prescribed by the Authority and providing the documentation
as instructed in the application so that the Authority can verify that the applicant:
(a) Has tested positive for
HIV or has AIDS; and
(b) Has a monthly income
based on family size at or below 400 percent of the FPL; and
(c) Is a resident of Oregon.
(2) An applicant must sign
an authorization that permits the Authority to contact and exchange information
with the applicant’s health care providers, insurers, and any other individual
or entity necessary to determine the applicant’s eligibility for CAREAssist,
process payments and facilitate care coordination for the client.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1040
Review of Applications
(1) The Authority must review an application
to determine if it is complete.
(a) An applicant or the applicant’s
case manager shall be notified by the Authority if the application is incomplete.
Notifications shall identify what information is missing and the deadline for submitting
the missing information.
(b) If the applicant does
not provide the requested information before the deadline the Authority must notify
the applicant in writing that the application is incomplete, shall no longer be
reviewed, and that the applicant may reapply at any time.
(2) Once an application is
deemed complete the Authority must verify the information submitted and make a determination
within 10 business days as to whether the applicant is eligible for CAREAssist benefits.
(3) Verification of Oregon
residency.
(a) An applicant must provide
documentation verifying Oregon residency, as outlined in the application.
(b) An applicant may be asked
to appear at an Authority office or a local case management provider’s office
in person if the applicant’s residency status is in question.
(c) If an applicant is a
seasonal worker who must be out of state for more than three consecutive months
for employment, the applicant may be considered to reside in Oregon but must receive
prior authorization, in writing, from the program before leaving the state for work.
(4) Verification of HIV/AIDS
status. The applicant must ensure that a form prescribed by the Authority that
verifies an applicant’s HIV/AIDS status is signed and submitted to the Authority
by:
(a) The applicant’s
health care provider; or
(b) The applicant’s
HIV case manager, if the case manager has received documentation of HIV/AIDS status
directly from a health care provider.
(5) Determination of family
size. The Authority shall determine an applicant’s family size by counting
the individuals related by birth, marriage, adoption, or legally defined dependent
relationships who either live in the same household as the applicant and for whom
the applicant is financially responsible, or whom do not live in the same household
as the applicant but fall within the categories listed in subsections (b), (c) or
(d) of this section, including but not limited to:
(a) A legal spouse; or
(b) A child 18 years of age
or younger who qualifies as a dependent for tax filing purposes; or
(c) A child age 19 to 26
who takes 12 or more credit hours in a school term, or its equivalent; or
(d) An adult for whom the
applicant has legal guardianship.
(6) Determination of monthly
income.
(a) An applicant must submit
to the Authority income documentation for all family members and from all sources.
The Authority shall use the documentation to calculate the total monthly income
for a family. Income after taxes or other withholdings may only be used when:
(A) A self-employed applicant
or the applicant’s family member provides a copy of the most recent year’s
IRS Form 1040 (Schedule C) in which case the Authority may allow a 50 percent deduction
from gross receipts or sales; or
(B) An applicant or applicant’s
family member has income from rental real estate and provides a copy of the most
recent year’s IRS Form 1040 (Schedule E). In this case the Authority may use
the total rental real estate income, as reported on the Schedule E. If the Schedule
E shows a loss, the applicant or applicant’s family member shall be considered
to have no income from this source.
(b) The Authority must determine
an applicant’s income by adding together all sources of family income, and
dividing that number by the applicable FPL. The resultant sum is the applicant’s
percentage of the FPL. For example, if total annual income for a family of two is
$31,460 and 100 percent FPL for a family of two is $15,730 for the current year:
$31,460 divided by $15,730 equals two or 200 percent FPL.
Stat. Auth.: ORS 413.042, 431.250, 431.830

Stats. Implemented: ORS 431.250,
431.830

Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1050
Approval or Denial of Application
(1) If the Authority determines that
an applicant is eligible for CAREAssist benefits the applicant shall be notified
in writing within 10 business days of the Authority’s determination and be
assigned to a benefit group as follows:
(a) Group 1: Clients who
are enrolled in a private, group or individual insurance policy and who may be required
to participate in cost sharing in accordance with OAR 333-022-1110; or
(b) Group 2: Clients whose
primary prescription benefits are provided by OHP or the Department of Veterans
Affairs (VA).
(2) A client’s notification
must describe:
(a) The eligibility effective
date and end date;
(b) Group number and benefits
associated with that group;
(c) A list of CAREAssist
in-network pharmacies;
(d) Cost-sharing responsibilities,
if applicable;
(e) Recertification date
and process; and
(f) The repercussions of
not recertifying.
(3) CAREAssist eligibility
is for six months.
(4) If the Authority determines
that an applicant is not eligible for CAREAssist benefits an applicant shall be
notified in writing in accordance with ORS 183.415.
(5) An applicant who has
been denied may reapply at any time.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1060
Group 1 and 2 Benefits
(1) Group 1 and 2 clients are eligible
for assistance with:
(a) The cost of health insurance
premiums if applicable, provided the coverage, at a minimum includes pharmaceutical
benefits equivalent to the HIV antiretroviral and opportunistic infection-related
medications on the CAREAssist formulary as well as coverage for other essential
medical benefits as defined by the Affordable Care Act.
(b) Copays, coinsurance and
deductibles on prescription drugs covered by the client’s primary health insurance,
with the exception of medications prescribed to treat erectile dysfunction.
(c) Copays, coinsurance and
deductibles on medical services covered by the client’s primary health insurance,
up to a maximum amount set by the program each calendar year. Eligible medical services
include but are not limited to laboratory tests, office visits, emergency room visits,
X-rays, and hospital stays.
(d) The full cost of CAREAssist
formulary prescriptions, filled at an in-network pharmacy when:
(A) The client has successfully
enrolled in insurance but coverage is not yet active; or
(B) The client’s insurance
policy does not cover the cost of the prescription; and
(C) The prescribing provider
submitted a Prior Authorization Request to the client’s primary insurance,
the request was denied and there is no acceptable therapeutic substitution.
(e) Prescription drugs if
the required copay exceeds the cost of the prescription medication and the insurance
policy therefore does not pay.
(f) Medication therapy management.
(2) CAREAssist clients who
smoke or chew tobacco may be eligible to receive additional and enhanced services
from the Oregon Tobacco Quit Line (1-800-QUIT-NOW), if funding is available.
(3) A client on restricted
status may not be entitled to some of the benefits described in section (1) and
(2) of this rule.
(4) The Authority shall only
make payments directly to a service provider or benefits administrator. No reimbursements
or direct payments may be made to a client or an individual who pays on behalf of
a client.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1070
Prescriptions
(1) Unless an exception applies under
subsections (3)(a) or (b) of this rule, CAREAssist clients must use an Authority-approved
CAREAssist in-network pharmacy for all:
(a) Medications not designated
as acute on the CAREAssist formulary;
(b) Chronic care medications;
and
(c) Medications paid for
in full by the Authority
(2) The Authority must provide
to each client a list of approved pharmacies and post the information on the CAREAssist
website.
(3) A CAREAssist client may
use a non-CAREAssist in-network pharmacy if:
(a) His or her insurance
carrier requires use of a pharmacy that is not a CAREAssist in-network pharmacy;
and
(b) He or she has provided
the Authority with a copy of the insurance summary of benefits for that insurance
plan and the requirement to use a non-CAREAssist in-network pharmacy is explicitly
stated in that insurance summary.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1080
Payments and Cost Coverage
(1) The Authority may only make insurance
premium payments directly to the insurance carrier or benefits administrator. No
direct payments may be made to a client.
(2) When no other payer for
health coverage (public assistance or private) is available, CAREAssist may pay
insurance premiums for a limited time for a client’s insurance plan that covers
his or her family members if the monthly premium cannot by divided, until the Authority
determines that the client’s family members can obtain their own policies.
(3) The Authority may not
use CAREAssist funds to pay for any administrative costs, which are in addition
to the premium payment.
(4) Authority payments for
prescriptions follow the health insurance pharmacy benefits defined within the policy
and may not pay for the cost to dispense a brand-name drug when a generic equivalent
is the preferred option of the health insurance.
(5) The Authority shall only
cover the costs of medications that are covered by the client’s health insurance
or those specifically listed on the CAREAssist formulary as additional benefits
to the client, and prior to any payments being made by the Authority must receive
a determination by the prescriber that no acceptable therapeutic equivalent is available
through the primary insurance.
(6) The Authority may only
pay for HIV medications or a combination of HIV drugs as approved in the federal
Department of Health and Human Services (DHHS) Treatment Guidelines, which can be
found at http://aidsinfo.nih.gov/guidelines.
(a) The CAREAssist Pharmacy
Benefits Manager (PBM) clinical pharmacist team (team) assesses each client’s
medication regimen to ensure that it conforms to current DHHS guidelines. In the
event that a treatment recommendation or guideline is not followed, the clinical
pharmacist at the PBM shall notify the Authority that payment may not be made until
the prescriber submits a prior authorization form to the PBM’s clinical pharmacist.
(b) The Authority may deny
payment for medications that are determined to be clinically inappropriate pursuant
to the DHHS Treatment Guidelines.
(7) Third party benefits.
(a) The Authority shall identify
and inform clients of an amount to be provided within the calendar year for medical
service copays and deductible. The annual financial amount shall be posted on the
CAREAssist website at the beginning of each calendar year. All costs exceeding the
published amount are the client’s responsibility.
(b) The Authority may pay
for a client’s out-of-pocket medical service expense for an insurance-covered
medical service or durable medical equipment, up to an annual maximum amount. The
client’s primary insurance must cover the service or device before CAREAssist
assumes any financial cost
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1090
Client Eligibility Review
(1) The Authority must verify a client’s
eligibility every six months, but may conduct an eligibility review at any time
and as many times as necessary within an eligibility period.
(2) The Authority must provide
CAREAssist clients with a Client Eligibility Review (CER) form and instructions
within 60 days of the expiration of their current eligibility period.
(3) A client must submit
the CER and any other required documentation within the timeframe established by
the Authority in the instructions. A deadline for submitting the CER or requested
documentation may be extended at the discretion of the Authority.
(4) The Authority shall review
a client’s application and supporting documentation and verify the information
in accordance with OAR 333-022-1040.
(5) The Authority must notify
a client in writing whether his or her benefits continue and whether there are any
changes. If a client is not found eligible for continued benefits the client shall
have a right to a hearing in accordance with ORS 183.415.
(6) A CAREAssist client who
fails to submit the required renewal documents by the requested deadline shall no
longer be eligible to receive benefits, but may reapply at any time. The Authority
must provide notice to the client that he or she is no longer eligible for benefits
because eligibility could not be verified and inform the client that benefits shall
end effective the first day of the following month.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1100
Client Reporting Requirements
(1) A CAREAssist client is required
to notify the Authority within 15 calendar days of any of the following:
(a) Receiving notification
of changes to premium payments or benefits from his or her insurance company or
a benefits administrator;
(b) Changes in contact information
including address and phone number; or
(c) Changes in eligibility
for group or individual insurance coverage, whether private or publicly funded.
(2) A client’s failure
to notify the Authority in accordance with section (1) of this rule may result in
a client being terminated from the program in accordance with OAR 333-022-1160.
A client who is terminated under this section because the client failed to notify
the Authority that his or her insurance plan was cancelled may not be eligible to
reapply until the client is enrolled in an insurance plan.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1110
Cost Sharing Program
(1) All Group 1 and UPP clients with
monthly income greater than 150 percent of the FPL must participate in the cost
sharing program.
(a) A group 1 or UPP client
is required to pay to the Authority monthly a sum equaling two percent of the client’s
monthly income, adjusted for family size;
(b) Payment must be received
by the 21st of each month.
(2) The Authority may permit
each client to have a payment grace period through the last day of the billing month
(3) The Authority may grant
a client an extension of time beyond the grace period for good cause to make a cost
sharing payment at its discretion. An extension may be requested by the client
or the client’s HIV case manager. For the purposes of this rule, "good cause"
means an action, delay, or failure to act that arises from an excusable mistake
or from factors beyond a client’s reasonable control.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1120
Restricted Status
(1) The Authority may place a client
on restricted status if the client falls more than one month behind on cost share
payments.
(2) The Authority shall notify
a client of the restricted status. The notice must comply with ORS 183.415 and explain:
(a) How long the restriction
is in effect;
(b) How the client can come
into compliance and have the restriction lifted; and
(c) The consequences of not
coming into compliance within the specified time period.
(3) If a client is placed
on restricted status the Authority may only provide the following benefits to the
client:
(a) Payment of insurance
premiums; and
(b) Payment of medications
that treat HIV, viral hepatitis and opportunistic infections, as those are described
in the CAREAssist formulary.
(4) Clients on restricted
status are ineligible for copay assistance for any medical service, even when that
service continues to be paid by the client’s primary insurance.
(5) A client who is placed
on restricted status the first time in a 12 month period shall be re-instated to
full benefits after the end of the three month restricted period, unless reinstated
at an earlier date. The balance remaining at the end of this restricted period
shall be removed. The client is no longer obligated to pay this amount.
(6) A client who is placed
on restricted status a second time within a 12 month period shall remain on restricted
status until the unpaid balance has been paid to the Authority.
(7) A client shall be eligible
for full benefits once any unpaid cost-sharing balance has been paid. A client
shall be eligible for full CAREAssist benefits effective the day that payment has
been accepted by the Authority’s banking institution.
(8) Clients are responsible
for the cost of non-covered services incurred during the restriction period.
(9) Clients on a restricted
status are required to comply with OAR 333-022-1090.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1130
Incarcerated Applicants or Clients
(1) A CAREAssist client who is incarcerated
in a state or federal correctional institution is ineligible for CAREAssist and
shall be terminated from the program in accordance with OAR 333-022-1160.
(2) A CAREAssist client who
is incarcerated in a city or county correctional facility may remain enrolled in
the program for up to 60 days from the first day of incarceration as long as:
(a) The client’s primary
insurance coverage is maintained and active; and
(b) The client completes
recertification in accordance with OAR 333-022-1090 as scheduled.
(3) At the Authority’s
discretion, incarcerated clients, as described in section (2) may continue to receive
CAREAssist benefits for an additional 30 days if the client is expected to be released
within those additional 30 days.
(4) Pre-release application
to CAREAssist. The Authority may accept an application and determine eligibility
for an individual who is incarcerated but is expected to be released within 30 days
of submitting the application.
Stat. Author.: ORS 413.042, 431.250,
431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1140
Bridge Program
(1) The Bridge Program provides limited
benefits to an individual whose medical provider has applied for the program on
the patient’s behalf. The program provides payment for basic services and
medications for an individual who is in the process of applying for CAREAssist and
insurance.
(2) Bridge Program eligibility.
In order to be eligible for the Bridge Program an individual must:
(a) Be HIV positive or have
AIDS;
(b) Reside in Oregon;
(c) Have income at or below
400 percent of the FPL;
(d) Be in the process of
applying for long-term medication assistance programs such as Medicaid, Medicare,
or applying to CAREAssist; and
(e) Have not previously received
Bridge Program benefits or have not been terminated from the CAREAssist program
within the past 365 days.
(3) To apply for Bridge Program
benefits a patient’s medical provider must, on behalf of the patient, submit
a form prescribed by the Authority and sign the form attesting that the individual
is HIV positive or has AIDS. If the health care provider is licensed outside of
Oregon, the Authority may request a copy of the applicant's most current laboratory
results.
(4) The Authority must notify
an applicant whether the patient’s application has been approved or denied,
in accordance with ORS 183.415.
(5) An individual enrolled
in the Bridge Program is not guaranteed to be determined eligible for CAREAssist
benefits.
(6) The Bridge Program benefits
include:
(a) Assistance with the cost
of a 30-day supply of prescription drugs listed on the CAREAssist formulary and
designated as available to Bridge Program participants, only if dispensed by a CAREAssist
contract in-network pharmacy.
(b) Payment of the costs
of medical services and laboratory tests as defined by the list of approved Current
Procedural Terminology (CPT) codes noted on the Bridge Program instructions and
application forms. Reimbursement to providers is up to 125 percent of the current
Oregon Division of Medical Assistance Programs (DMAP) (Medicaid) Fee For Service
rate for that service or laboratory test.
(7) The Authority may only
pay for an individual’s medical visits or laboratory tests for dates of service
that are on or after the individual’s enrollment in the Bridge Program.
(8) Individuals enrolled
in the Bridge Program must actively participate with an assigned CAREAssist caseworker
to assure progress toward a sustainable means of medication access. Failure to do
so may result in cancellation of enrollment. At a minimum, the client is expected
to submit a full application for ongoing assistance with CAREAssist within the 30
days of Bridge Program enrollment.
(9) The Bridge Program is
not available to an individual who has primary health insurance coverage.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1145
Uninsured Persons Program
(1) The Uninsured Persons Program (UPP)
provides full-cost coverage for a limited number of medications and medical services
for clients who are ineligible for insurance.
(2) In order to be eligible
for UPP an individual must:
(a) Meet all eligibility
requirements outlined in OAR 333-022-1020; and
(b) Be ineligible for public
and private insurance that meets minimum essential coverage under the federal Affordable
Care Act, Public Law 111 - 148; and
(c) Be enrolled in Ryan White
community-based HIV Case Management Services.
(3) To apply for UPP an individual
must comply with OAR 333-022-1030 and an application shall be reviewed by the Authority
in accordance with OAR 333-022-1040, as applicable.
(4) If the Authority determines
that an applicant is eligible for CAREAssist benefits the applicant shall be notified
in writing within 10 business days of the Authority’s determination. A client’s
notification must describe:
(a) The eligibility effective
date and end date;
(b) Group number and benefits
associated with that group;
(c) A list of CAREAssist
in-network pharmacies;
(d) Cost-sharing responsibilities,
if applicable;
(e) Recertification date
and process; and
(f) The repercussions of
not recertifying.
(5) UPP eligibility is for
six months.
(6) If the Authority determines
that an applicant is not eligible for UPP benefits an applicant will be notified
in writing in accordance with ORS 183.415.
(7) An applicant who is denied
may reapply at any time.
(8) UPP benefits include:
(a) Assistance with the cost
of prescription drugs listed on the CAREAssist formulary, when dispensed by a CAREAssist
contract in-network pharmacy;
(b) Full-cost laboratory
and medical visits performed in an out-patient setting. Coverage is limited to allowable
CPT codes, as designated by the program. The program may cover the cost of each
allowable CPT code up to four times a year. Any additional coverage requires prior
authorization initiated by the client’s prescribing physician. Reimbursement
to providers is up to 125 percent of the current Oregon DMAP (Medicaid) Fee For
Service rate for that service or laboratory test;
(c) Medication therapy management;
and
(d) Smoking cessation services.
(9) An UPP client must notify
the Authority immediately if he or she becomes eligible for insurance or obtains
insurance.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1150
Client Rights
Applicants and clients have the following
rights:
(1) To receive CAREAssist
services free of discrimination based on race, color, sex, gender, ethnicity, national
origin, religion, age, class, sexual orientation, physical or mental ability.
(2) To be informed about
services and options available in the CAREAssist programs for which they may be
eligible.
(3) To have their CAREAssist
records be treated confidentially in accordance with OAR chapter 943, division 14.
(4) To have access to a written
grievance process posted on the CAREAssist website.
(5) To receive language assistance
services, including access to translation and interpreter services at no cost if
the individual has limited English proficiency.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1160
Termination from CAREAssist
(1) The Authority may terminate a client
or restrict benefits for any of the following:
(a) Failure to continue to
meet eligibility requirements;
(b) Submitting false, fraudulent
or misleading information to the Authority in order to obtain or retain benefits;
(c) Placement in a custodial
institution, such as a state or federal prison, that is legally obligated to provide
medical services; or
(d) Failure to notify the
Authority of changes in accordance with OAR 333-022-1100.
(2) The Authority must provide
a notice of termination to a client in writing in accordance with ORS 183.415.
(3) An individual who is
found to have provided false, fraudulent or misleading information to the Authority
may not reapply for CAREAssist benefits for six months following the issuance of
a final order of termination and may be required to repay the Authority for benefits
provided.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-1170
Hearings
A client who has benefits denied, restricted,
or terminated has a right to a contested case hearing in accordance with ORS chapter
183.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 30-2014, f. 11-10-14,
cert. ef. 12-1-14
HIV Case Management
333-022-2000
Purpose
(1) The Oregon HIV Case Management Program
provides case management and supportive services, through Ryan White Part B case
management agencies, that include but are not limited to client-centered services
that ensure timely and coordinated access to primary medical care, medications,
treatment adherence counseling and other support services for HIV-positive individuals.
(2) Case management and supportive
services will be available as long as the Oregon Health Authority (Authority) continues
to receive Ryan White Program, Part B funds for this purpose.
(3) If insufficient funds
are available for case management and supportive services, the Authority may reduce
case management services or reduce funding for supportive services.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2010
Definitions
(1) "Agency" refers to a contracted
provider delivering Ryan White funded services.
(2) "AIDS" means acquired
immunodeficiency syndrome.
(3) "Authority" means the
Oregon Health Authority.
(4) "Family" means all individuals
counted by an agency in determining the individual or client’s family size.
(5) "Federal Poverty Level"
or "FPL" means the annual poverty income guidelines, published by the United States
Department of Health and Human Services.
(6) "Gross monthly income"
means income before taxes or other withholdings.
(7) "HIV" means the human
immunodeficiency virus, the causative agent of AIDS.
(8) "HIV case management
service area" means all Oregon counties except Multnomah, Washington, Clackamas,
Columbia and Yamhill.
(9) "Ryan White Program,
Part B" means The Ryan White HIV/AIDS Program authorized and funded under Title
XXVI of the Public Health Services Act, as amended by the Ryan White HIV/AIDS Treatment
Extension Act of 2009 (Public Law 111-87, October 30, 2009).
(10) "Ryan White Part B case
management services agency" or "agency" means a contractor of the Authority that
is responsible for providing case management services and administering supportive
services to individuals living with HIV/AIDS in a specific jurisdiction.
(11) "Supportive services"
means financial assistance that can be authorized on behalf of an individual enrolled
in Ryan White Part B case management services.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2020
Eligibility
To be eligible for the HIV Case Management
Program an individual must:
(1) Be HIV positive or have
AIDS; and
(2) Reside in an agency’s
jurisdiction within the HIV case management service area, unless another agency
agrees to provide services and the Authority authorizes the provision of services
by that other agency
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2030
Enrollment Process
(1) To enroll in the HIV Case Management
Program an individual must go through an intake process with a local Ryan White
Part B case management services agency. A list of the agencies may be obtained on
the Authority's website at www.healthoregon.org/hiv.
(2) During the intake process
an individual must provide information to an agency that enables the agency to verify
at least the following:
(a) Identity;
(b) HIV status;
(c) Residency in the HIV
case management service area;
(d) Income;
(e) Household member information;
and
(f) Health insurance information,
if applicable.
(3) Identity may be verified
for an individual by providing one of the following:
(a) Oregon Driver License;
(b) Tribal identification
(ID);
(c) State of Oregon ID card;
(d) Military ID;
(e) Passport;
(f) Student ID;
(g) Social Security Card;
(h) Citizenship/Naturalization
documents;
(i) Student visa;
(j) Oregon Learner's Permit
or Temporary License;
(k) Birth certificate; or
(l) Other form of verification
determined appropriate by an agency.
(4) HIV/AIDS status must
be verified within 30 days of intake by a physician or lab result.
(5) Documents that verify
that an individual resides in the HIV case management service area include but are
not limited to documents with the client's full legal name and an address, within
the service area, that matches the residential address provided during the intake.
(6) Determination and verification
of income:
(a) Family size will be determined
by counting the individuals related by birth, marriage, adoption, or legally defined
dependent relationships who either live in the same household as the individual
seeking to enroll in the HIV Case Management Program and for whom that individual
is financially responsible, or whom do not live in the same household as the individual
but fall within the categories listed in subsections (b), (c) or (d) of this section,
including but not limited to:
(A) A legal spouse; or
(B) A child 18 years of age
or younger who qualifies as a dependent for tax filing purposes; or
(C) A child age 19 to 26
years of age who takes 12 or more credit hours in a school term, or its equivalent;
or
(D) An adult for whom the
individual has legal guardianship.
(b) Gross monthly income:
(A) An individual must submit
documentation for all family members and from all sources to determine total monthly
gross income for a family. Income after taxes or other withholdings may only be
used when:
(i) A self-employed individual
or the individual’s family member files an Internal Revenue Service, Form
1040, Schedule C in which case the agency will allow a 50 percent deduction from
gross receipts or sales; or
(ii) An individual or individual’s
family member has income from rental real estate and provides a copy of the most
recent year’s IRS Form 1040 (Schedule E). In this case the agency may use
the total rental real estate income, as reported on the Schedule E. If the Schedule
E shows a loss, the applicant or applicant’s family member shall be considered
to have no income from this source.
(B) The agency must determine
an applicant’s income by adding together all sources of family income, and
dividing that number by the applicable FPL. The resultant sum is the applicant’s
percentage of the FPL.
(7) An individual must sign
any authorization necessary to permit the agency to exchange information with the
individual’s health care providers, and any other individual or entity necessary
to coordinate care and services.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2040
Approval or Denial of Enrollment
(1) The agency will make a determination
as to whether the individual is eligible for case management services within 30
days of receiving all documentation in accordance with OAR 333-022-2030.
(2) If the agency determines
that an individual cannot be enrolled in the HIV Case Management Program an individual
will be notified in accordance with ORS 183.415.
(3) An individual who has
been denied may reapply at any time.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2050
Determination of Service Needs
Once enrolled in the HIV Case Management
Program, a client must participate in a screening and assessment process with an
agency to review his or her needs and resources, for the purpose of developing a
plan to address the needs identified. The purpose of this assessment is to identify
actions to remove barriers to HIV care and treatment.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2060
Client Rights
Individuals applying for or clients
enrolled in the HIV Case Management Program have the following rights:
(1) To receive HIV case management
services free of discrimination based on race, color, sex, gender, ethnicity, national
origin, religion, age, class, sexual orientation, physical or mental ability.
(2) To be informed about
services and options available in the HIV Case Management Program.
(3) To have HIV case management
services and other program records maintained confidentially in accordance with
OAR chapter 943, division 14.
(4) To have access to a written
grievance process provided by the agency.
(5) To receive language assistance
services including access to translation and interpretation services, at no cost
if the individual or client has limited English proficiency, in order to access
HIV case management services.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2070
Client Responsibilities
A client enrolled in the HIV Case Management
Program is expected to:
(1) Participate in screening,
assessment, care plan development and implementation activities;
(2) Provide accurate eligibility
information at all times;
(3) Inform the case manager
of changes in address, phone number, income, family size, legal name change, or
health insurance coverage within 15 days;
(4) Make and keep appointments,
or cancel or change an appointment within 24 hours of the scheduled time; and
(5) Other responsibilities
as designated by the agency.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2080
Supportive Services
(1) A client enrolled in the HIV Case
Management Program may be eligible for supportive services if income is at or below
250 percent of the FPL.
(2) Authorization by an agency
of supportive services is discretionary and a decision to provide such services
will be based on the following factors:
(a) The agency is funded
to provide the services;
(b) The funds are available
in the agency budget;
(c) The services are allowable
per the contract with the Authority;
(d) No other payer exists
to provide the needed services, with the exception of those that qualify for Veteran’s
Administration or Indian Health Services who may still qualify to receive Ryan White
services;
(e) The client is eligible
and currently active in the HIV Case Management Program; and
(f) The client's need for
the service has been determined by the agency and documented in the client’s
file.
(3) An agency may authorize
supportive services for any of the following:
(a) Emergency financial assistance,
per agency budget, including but not limited to assistance with short-term medical
costs, food, utilities or housing;
(b) Housing assistance, including
but not limited to short-term assistance to support emergency, temporary or transitional
housing;
(c) Linguistics services,
meaning interpretation and translation services;
(d) Medical nutritional therapy
provided by a licensed registered dietitian outside of a primary care visit, including
the provision of nutritional supplements;
(e) Oral health care, including
but not limited to diagnostic, preventive, and therapeutic services provided by
general dental practitioners, dental specialists, dental hygienists and auxiliaries,
and other trained primary care providers;
(f) Outpatient substance
abuse services, meaning the provision of medical or other treatment or counseling
to address substance abuse problems in an outpatient setting, provided by a physician
or under the supervision of a physician or other qualified/licensed personnel;
(g) Residential substance
abuse services, meaning treatment to address substance abuse problems in a residential
health service setting, provided by a physician or under the supervision of a physician
or other qualified/licensed personnel;
(h) Home health care services
provided in the home by licensed health care workers such as nurses, and the administration
of intravenous and aerosolized treatment, parenteral feeding, diagnostic testing,
and other medical therapies;
(i) Mental health services
meaning psychological and psychiatric treatment and counseling services offered
to individuals with a mental illness, conducted in a group or individual setting,
and provided by a mental health professional licensed or authorized within the state
to render such services;
(j) Medical transportation
services necessary to access health care services; or
(k) Other services funded
by the Authority.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2090
Client Enrollment Review
(1) A client must participate with the
agency at least every six months in reviewing the client’s eligibility and
enrollment information for HIV case management services, and at any time the agency
deems it necessary within an eligibility period.
(2) An individual who does
not provide an agency with the information necessary to verify continued eligibility
may not receive supportive services until continued eligibility is documented.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2100
Incarcerated Applicants or Clients
(1) An individual who is incarcerated
may not be enrolled in the HIV Case Management Program and may not continue to be
enrolled in the program except as described in section (2) of this rule.
(2) An agency may enroll
or continue to provide services to an individual who is incarcerated in order to
facilitate an HIV positive inmate’s transition from a correctional facility
to the community under the following circumstances:
(a) The incarcerated person
will be released within 180 days; and
(b) There are no other transitional
case management or discharge planning services provided by the correctional facility.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2110
Termination
(1) A client enrolled in the HIV Case
Management Program may be terminated from the program for any of the following:
(a) Failure to continue to
meet eligibility requirements;
(b) Placement in a custodial
institution for more than 180 days, such as a state or federal prison that is legally
obligated to provide medical services;
(c) Cannot be located or
is unresponsive to program requests for more than 60 days;
(d) Submitting false, fraudulent
or misleading information in order to obtain or retain benefits;
(e) Fraudulent use of supportive
services; or
(f) Consistent documented
violations of the responsibilities outlined in OAR 333-022-2070.
(2) If an agency proposes
to terminate an individual from the program it must notify the individual in writing,
and the individual must be informed of their hearing rights per ORS 183.415. An
appeal must be submitted to the local or state authority to arrange the hearing.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-2120
Hearings
A client who has been terminated has
a right to a contested case hearing in accordance with ORS chapter 183.
Stat. Auth.: ORS 413.042, 431.250, 431.830
Stats. Implemented: ORS 431.250,
431.830
Hist.: PH 29-2014, f. 11-10-14,
cert. ef. 12-1-14
333-022-3000
Oregon Housing Opportunity in Partnership
Program
(1) The Oregon Housing Opportunities
in Partnership (OHOP) program provides housing services to eligible applicants who
have received a medical diagnosis of HIV or AIDS. OHOP assists clients in achieving
and maintaining housing stability so as to avoid or reduce homelessness and improve
their access to, and engagement in, HIV care and treatment. OHOP is designed to
promote client housing stability and act as a bridge to long-term assistance programs,
such as Section 8, or to self-sufficiency. Participation in OHOP is voluntary and
conditional.
(2) The OHOP program is funded
through grants from the U.S. Department of Housing and Urban Development and other
funds. OHOP is a needs-based program and not an entitlement program.
(3) The OHOP program is administered
and operated in accordance with the OHOP Program Policy and Procedures manual, dated
July 1, 2015, adopted and incorporated by reference. The manual may be obtained
by visiting www.healthoregon.org/hiv.
[ED. NOTE: Tables referenced are not included in rule text. Click here for PDF copy of table(s).]
Stat. Auth.: ORS 413.014, 431.250
Stats Implemented: ORS 431.250
Hist.: PH 14-2015, f. 8-28-15,
cert. ef. 9-3-15



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