justicedao/ipfs_state_laws huggingface dataset:
410-200-0438 Specific Requirements: OHP Bridge – Basic Health Program In addition to the general requirements applicable to OHP Bridge – Basic Health Program set forth in this Division 200, this rule describes specific eligibility requirements for OHP Bridge – Basic Health Program. (1) OHP Bridge – Basic Health Program is effective on July 1, 2024. (2) To be eligible for OHP Bridge – Basic Health Program an individual must: (a) Be age 19 or older and under age 65; (b) Have, as required under OAR 410-200-0315, monthly MAGI-based income which exceeds 133 percent of the federal poverty level (FPL) for the applicable family size; have annual household income for the applicable family size between 133 percent and up to and including 200 percent FPL for the coverage year being requested; and (c) Meet citizenship status requirements outlined in OAR 410-200-0215(1), or non-citizen status requirements outlined in OAR 410-200-0215(5). (3) Even if an individual meets the requirements in section (2) of this rule, the individual shall not be eligible for OHP Bridge – Basic Health Program if they: (a) Are enrolled in Medicare benefits under part A or B of Title XVIII of the Act; or (b) Are receiving other healthcare coverage that qualifies as Minimum Essential Coverage as defined in OAR 410-200-0015(55), unless that coverage is an Insurance Affordability Program as defined in OAR 410-200-0015(50); or (c) Are able to access affordable coverage as described in section 36B(c)(2)(C)(i)(II) of the IRS Code and 26 CFR section 1.36B–2(c)(3)(v)(A)(1). The required contribution percentage is indexed annually under section 26 U.S.C. 36B(c)(2)(C)(iv); or (d) Are receiving Supplemental Security Income (SSI) benefits. (4) OHP Bridge – Basic Health Program eligibility is re-evaluated every twelve (12) months. (5) An individual who is approved for OHP Bridge – Basic Health Program coverage is entitled to twelve (12) months of coverage provided they continue to meet non-financial eligibility criteria. Once approved, an individual’s OHP Bridge – Basic Health Program coverage shall not be terminated during a twelve (12) month eligibility period due to an increase of countable income. Statutory/Other Authority: ORS 411.402, 411.404, 413.042, 414.241, 414.534, 42 CFR 433.138, 433.145-433.148, 435.3-435.4, 435.110, 435.115-435.119, 435.190, 435.222, 435.403, 435.406-435.407, 435.608, 435.610, 435.916-435.917, 435.940, 435.952, 435.956, 435.1008, 435.1200, 435.1205, 447.56, 457.80, 457.320, 457.340, 457.350, 457.360, 457.380, 457.805, 458.350, 435.112, 435.170 & 42 CFR 600 Statutes/Other Implemented: ORS 411.402, 411.404, 414.241, ORS 411.060, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.440, 414.534, 414.536, 414.706, 411.095 & 411.400 History: DMAP 85-2025, amend filed 12/02/2025, effective 12/02/2025 DMAP 49-2025, temporary amend filed 06/10/2025, effective 06/10/2025 through 12/06/2025 DMAP 94-2024, adopt filed 05/29/2024, effective 06/01/2024
410-200-0445 Specific Requirements – Compact Of Free Association (COFA) Dental Program (1) The Compact of Free Association (COFA) Dental Program is effective January 1, 2023. (2) To be eligible for the COFA Dental Program, an individual must: (a) Be lawfully residing in the United States in accordance with the Compacts of Free Association (I.e., the governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau); (b) Be a resident of Oregon; and (c) Have MAGI-based income (see OAR 410-200-0015 General Definitions (54)) within 138% FPL; (3) To be eligible for the COFA Dental Program, an individual must not be eligible for Medicaid under Title XIX of the Social Security Act or the Children’s Health Insurance Program under Title XXI of the Social Security Act. (4) The begin-date of COFA Dental Program benefits will align with OAR 410-200-0115 HSD Medical Programs – Effective Dates. (5) The Agency shall accept self-attestation of the eligibility requirements described in this rule, unless questionable. Statutory/Other Authority: ORS 411.095, 411.402, 411.404, 413.038, 414.025 & 414.534 Statutes/Other Implemented: ORS 411.095, 411.402, 411.404, 413.038, 414.025, 411.400, 411.406, 411.439, 413.032, 414.231, 414.536 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 89-2022, adopt filed 12/16/2022, effective 01/01/2023
410-200-0450 Specific Requirements – Veteran Dental Program (1) The Veteran Dental Program is effective January 1, 2023. (2) To be eligible for the Veteran Dental Program, an individual must: (a) Be a resident of Oregon; (b) Be a veteran as described in ORS 408.225, except the individual may be discharged or released under honorable conditions or other conditions; and (c) Have MAGI-based income (see OAR 410-200-0015 General Definitions (54)) within 400% FPL. (3) Individuals found eligible for the Veteran Dental Program must provide verification of discharge as a condition of ongoing eligibility. (4) To be eligible for the Veteran Dental program an individual must not be eligible for Medicaid under Title XIX of the Social Security Act or the Children’s Health Insurance Program under Title XXI of the Social Security Act, except an individual may be eligible for and receive Medicare Savings Programs. (5) The begin-date of Veteran Dental Program benefits will align with OAR 410-200-0115 HSD Medical Programs – Effective Dates. (6) Eligibility for Veteran Dental Program is subject to the availability of funds. The agency may close enrollment and implement the Veteran Dental Program reservation list when enrollment has reached capacity. The reservation list will retain the information of individuals who would have been found eligible for the Veteran Dental Program if not for closed enrollment. (a) Individuals who apply and are denied the Veteran Dental Program due solely to closed enrollment will be added to the reservation list in date-order, based on the Date of Request (DOR) of the application that was denied. (b) When enrollment is reopened, individuals will be selected from the reservation list in oldest to newest DOR date order. Once selected, the agency shall: (A) Initiate a DOR on the individual’s behalf; (B) Send notification to inform the individual that they’ve been selected from the reservation list; (C) Provide 45 days to reapply. (c) Failure to reapply within the timeframe provided will result in inactivation of their reservation. Individuals may reapply at any time. Statutory/Other Authority: ORS 411.095, 411.402, 411.404, 413.038 & 414.025 Statutes/Other Implemented: ORS 411.095, 411.402, 411.404, 413.038, 414.025, 414.534, 411.400, 411.406, 411.439, 413.032, 414.231, 414.536 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 89-2022, adopt filed 12/16/2022, effective 01/01/2023
410-200-0521 Unwinding Period - HSD Medical Programs (1) The provisions in this rule apply to all Health Systems Division (HSD) Medical Program determinations effective April 1, 2023, through February 28, 2025. Notwithstanding any other rule to the contrary in these chapter 410 division 200 rules, during the unwinding period, HSD Medical Program eligibility shall be determined as set forth in this rule. (2) For the purposes of this rule, the term “unwinding period” refers to the period of April 1, 2023 through February 28, 2025 in which the agency will initiate a full eligibility renewal for all HSD Medical Program beneficiaries. (3) In accordance with the Consolidated Appropriations Act, 2023, the continuous enrollment conditions established via the Families First Coronavirus Response Act end effective March 31, 2023. (4) Except for individuals receiving coverage during a period of presumptive eligibility (see OAR 410-200-0105), individuals who were receiving HSD Medical Program benefits prior to April 1, 2023, shall maintain coverage as described in OAR 410-200-0520 until their unwinding period renewal activity is initiated. (5) Individuals receiving coverage during a period of presumptive eligibility shall maintain presumptive eligibility coverage until: (a) A full eligibility determination is completed; or (b) The individual’s benefits are terminated due to failure to complete the full application process. (6) The Agency shall determine eligibility based on self-attestation of financial eligibility information and will request necessary verification (see OAR 410-200-0230 – Verification) via post-eligibility Request for Information (RFI). (7) Information about RFIs during the unwinding period: (a) The Agency will provide 90-days to respond to RFIs; (b) Failure to respond to a post-eligibility RFI will result in termination of benefits in accordance with section (8) of this rule, with the following exceptions: (A) For individuals age 18 years and younger, failure to respond to a post-eligibility RFI for income verification will not result in termination of benefits; eligibility will be maintained through the 12-month Continuous Eligibility period (see OAR 410-200-0135) or the end of the month in which they turn 19 years of age, whichever is earlier; (B) For pregnant individuals, failure to respond to a post-eligibility RFI for income verification will not result in termination of benefits; eligibility will be maintained through the duration of pregnancy and the postpartum eligibility period (see OAR 410-200-0135). (8) Recipients who are determined ineligible for ongoing HSD Medical Benefits will be provided 60-day advance notice of termination or reduction of coverage and referred to the Federally Facilitated Marketplace as described in OAR 410-200-0100, if applicable. Statutory/Other Authority: ORS 411.402 Statutes/Other Implemented: ORS 411.402 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 11-2023, adopt filed 03/30/2023, effective 04/01/2023
411-001-0100 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Purpose (1) The purpose of the rules in OAR chapter 411, division 001 is to establish procedures for the operation of the Medicaid Long Term Care Quality and Reimbursement Advisory Council (Council). (2) The Council was established by the 1995 Legislative Assembly and consists of 12 stakeholders including the Long Term Care Ombudsman, consumers, advocates, and providers. Council appointments are made by the Governor, the President of the Senate, the Speaker of the House, the Governor's Commission on Senior Services, and the Oregon Disabilities Commission as described in ORS 410.550. (3) The Council is directed to advise the Department of Human Services or the Oregon Health Authority on changes or modifications to the Medicaid reimbursement system and the adverse and positive effects of the changes or modifications on the quality of long term care and community-based services and reimbursement for long term care and community-based services. Statutory/Other Authority: ORS 410.070 & 410.555 Statutes/Other Implemented: ORS 410.550 - 410.555 History: SPD 49-2013, f. 12-17-13, cert. ef. 1-1-14 SPD 18-2009, f. 12-23-09, cert. ef. 1-1-10 SPD 18-2006, f. 5-12-06, cert. ef. 6-1-06 SSD 7-1996, f. 8-30-96, cert. ef. 9-1-96
411-001-0110 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Definitions (1) "Authority" means the Oregon Health Authority. (2) "Council" means the Medicaid Long Term Care Quality and Reimbursement Advisory Council. (3) "Department" means the Department of Human Services. (4) "Medicaid Reimbursement System" means the method or methodology associated with reimbursing providers of long term care and community-based services under the Department. The Medicaid reimbursement system does not include rates established by collective bargaining, rates established by actuarial calculations, or rate increases that have been approved and funded by the Legislature. (5) "Quality" means the degree to which long term care systems, services, and supplies for individuals and populations increase the likelihood of positive outcomes. (6) "These Rules" mean the rules in OAR chapter 411, division 001. Statutory/Other Authority: ORS 410.070 & 410.555 Statutes/Other Implemented: ORS 410.550–410.555 History: SPD 49-2013, f. 12-17-13, cert. ef. 1-1-14 SPD 18-2009, f. 12-23-09, cert. ef. 1-1-10 SPD 18-2006, f. 5-12-06, cert. ef. 6-1-06 SSD 7-1996, f. 8-30-96, cert. ef. 9-1-96
411-001-0115 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Council Administration Council By-Laws supplement ORS 410.550 to 410.555 and these rules. Statutory/Other Authority: ORS 410.070 & 410.555 Statutes/Other Implemented: ORS 410.550 - 410.555 History: SPD 18-2009, f. 12-23-09, cert. ef. 1-1-10
411-001-0118 Medicaid Long-Term Care Quality and Reimbursement Advisory Council - Council Scope (1) At the beginning of each legislative session, the Council shall review the Governor's Recommended Budget for the Department. The Council may submit a recommendation in support or opposition of the Governor's Recommended Budget. (2) The Department or Authority shall submit any proposed change or modification to the Medicaid reimbursement system to the Council for the Council's review and recommendation. (3) Upon review of any proposed change or modification under section (2) of this rule, the Council shall issue a written advisory recommendation to the Department or Authority as described in OAR 411-001-0120. (4) Prior to implementing any change or modification to the Medicaid reimbursement system, the Department or Authority shall submit the Council's written recommendation to the Legislative Assembly or to the Emergency Board if the Legislative Assembly is not in session. (5) If the Council has a disagreement with any change or modification to the Medicaid reimbursement system, the Department or Authority shall obtain the approval of the Legislative Assembly or the Emergency Board if the Legislative Assembly is not in session, before instituting the proposed change or modification. A proposed change or modification with an estimated fiscal impact of $100,000 or less is exempt from this provision. (6) The Department shall inform the Council of all rate changes within the Department's Aging and People with Disabilities Programs, including rates established by collective bargaining, rates established by actuarial calculations, and rate increases that have been approved and funded by the Legislature. (7) The Council may review the Department's strategic initiatives in order to assess the likelihood of increased quality for individuals served by the Department. Statutory/Other Authority: ORS 410.070 & 410.555 Statutes/Other Implemented: ORS 410.550–410.555 History: SPD 49-2013, f. 12-17-13, cert. ef. 1-1-14 SPD 18-2009, f. 12-23-09, cert. ef. 1-1-10
411-001-0500 Contested Case Hearings (1) OAR 411-001-0500, 411-001-0510, and 411-001-0520 apply to all contested case hearing requests authorized under OAR chapter 411, except to the extent that: (a) There is another conflicting rule in OAR chapter 411 that applies to the hearing request; or (b) There is a rule in OAR chapter 411 that applies a conflicting rule in OAR chapter 461, division 025 to the hearing request. (2) The Department of Human Services (Department) conducts contested case hearings in accordance with the Attorney General's model rules in OAR chapter 137, division 003, except to the extent that Department rules are permitted to and provide for different procedures. (3) The Department may not provide the telephone number and addresses of a witness if the Department has a reasonable concern that the release of information may affect the safety of the witness. (4) The Department’s contested case hearings based on hearing requests authorized in OAR chapter 411 are not open to the public and are closed to nonparticipants, except nonparticipants may attend subject to the consent of the parties and the Department, as well as applicable confidentiality laws. (5) The Department has adopted the exceptions to the Attorney General's model rules set out in section (3) of this rule and OAR 411-001-0510(6) due to caseload volume and because these model rule discovery procedures would unduly complicate or interfere with the hearing process. Statutory/Other Authority: ORS 409.050 Statutes/Other Implemented: ORS 409.010 History: SPD 6-2013, f. & cert. ef. 4-2-13 SPD 14-2012(Temp), f. & cert. ef. 10-5-12 thru 4-3-13
411-001-0520 Late Contested Case Hearing Requests (1) When the Department of Human Services (Department) receives a completed hearing request that is not filed within the timeframe required by the applicable rule in OAR chapter 411 but is filed no later than the deadlines set out in section (2) of this rule: (a) The Department shall refer the hearing request to the Office of Administrative Hearings for a contested case hearing on the merits of the Department's action described in the notice when: (A) The Department finds that the claimant and claimant's representative did not receive the notice and did not have actual knowledge of the notice; or (B) The Department finds good cause that the claimant did not meet the timeframe required due to excusable mistake, surprise, excusable neglect (which may include neglect due to significant cognitive or health issues), circumstances beyond the claimant’s control, reasonable reliance on the statement of a Department employee or an adverse provider relating to procedural requirements, or due to fraud, misrepresentation, or other misconduct of the Department or a party adverse to the claimant. (b) The Department refers the request for a hearing to the Office of Administrative Hearings for a contested case proceeding to determine whether the claimant is entitled to a hearing on the merits if there is a dispute between the claimant and the Department about either of the following paragraphs. (A) The claimant or claimant's representative received the notice or had actual knowledge of the notice. At the hearing, the Department must show that the claimant or claimant's representative had actual knowledge of the notice or that the Department mailed or electronically mailed the notice to the correct address of the claimant or claimant's representative, as provided to the Department. (B) The claimant has established good cause for a contested case hearing on the merits under paragraph (a)(B) of this section. (c) The Department may only dismiss such a request for hearing as untimely without a referral to the Office of Administrative Hearings if the following requirements are met: (A) The undisputed facts show that the claimant does not qualify for a hearing under this section; and (B) The notice was served personally or by registered or certified mail. (2) The Department shall consider whether a late hearing request meets the late request criteria set out in section (1) of this rule: (a) When the hearing request is received up to 120 days after a notice became a final order by default if no provider is a party to the contested case. (b) When the hearing request is received up to 60 days after a notice became a final order by default if at least one provider is a party to the contested case. (3) Unless required otherwise by the Servicemembers Civil Relief Act, the Department may dismiss a request for hearing as untimely if the Department receives a completed hearing request after the applicable deadline in section (2) of this rule. Statutory/Other Authority: ORS 409.050 & 411.103 Statutes/Other Implemented: ORS 409.010 & 411.103 History: SPD 12-2013, f. 5-31-13, cert. ef. 6-1-13 SPD 6-2013, f. & cert. ef. 4-2-13
411-002-0100 Definitions Relating to the Designation of Planning and Service Areas (1) “Area Agency on Aging” means the designated entity with which the Division contracts to meet the requirements of the Older Americans Act and ORS Chapter 410 in planning and providing services to the elderly or elderly and disabled population for a designated Planning and Service Area. (2) “Division” means the Seniors and People with Disabilities Division of the Department of Human Services. (3) “Planning and Service Area” means the geographical area, consisting of one or more counties, for which one Area Agency on Aging is designated by the Division to plan for and provide services under the Older Americans Act and ORS Chapter 410. (4)(a) “Type A Area Agency on Aging” means a designated entity that administers the Older Americans Act and Oregon Project Independence programs for a Planning and Service Area. A Type A Area Agency on Aging may be: (A) An office or agency of a unit of general purpose local government which is selected by the chief elected official of the unit to serve as an Area Agency on Aging; or (B) Any office or agency designated by the appropriate chief elected officials of any combination of units of general or general and special purpose local government formed in accordance with ORS Chapter 190; or (C) A private non-profit organization. (b) In Planning and Service Areas served by a Type A Area Agency on Aging, Medicaid, financial and adult protective services, and regulatory programs for the elderly and disabled are administered by a Multi-Service Office of the Division. (5) “Type B Area Agency on Aging” means a designated entity that meets the definition of an area agency on aging, and is administered by a unit or combination of units of general purpose local government, and administers the Medicaid, financial and adult protective services, and regulatory programs for the elderly or the elderly and disabled. (a) A Type B Area Agency on Aging may contract with the Division for services of state employees; or (b) A Type B Area Agency on Aging may have such employees transferred to employment by the Area Agency by transfer agreement. (6) “Type B1 Area Agency on Aging” means a designated entity that meets the definition of a Type B area agency on aging, and administers the Medicaid, financial and adult protective services, and regulatory programs for the elderly. In a Planning and Service Area served by a Type B1 Area Agency on Aging, the Medicaid and financial assistance program for the Disabled is administered by a Disability Service Office of the Division. (7) “Type B2 Area Agency on Aging” means a designated entity that meets the definition of a Type B1 area agency on aging and administers the Medicaid, financial, adult protective services and regulatory programs for the elderly and disabled. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.210 - 410.300 History: SDSD 9-1999, f. & cert. ef. 11-1-99 SSD 3-1986, f. & ef. 2-5-86