Oregon Administrative Rules › Chapter 461 - DEPARTMENT OF HUMAN SERVICES, SELF-SUFFICIENCY PROGRAMS › Division 195 - LIENS, OVERPAYMENTS AND IPVS › Section 461-195-0301 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For purposes of OAR
				461-195-0301 to
				461-195-0350, the following
				definitions apply:
(1) "Action" means
			 an action, suit, or proceeding.
(2)
			 "Applicant" means an applicant for
assistance
(see section (3)
			 of this rule).
(3) "Assistance"
			 means moneys for the needs of a
recipient
(see section (12) of
			 this rule) and for the needs of other individuals living with the
recipient
whom the
recipient
has an
			 obligation to support which are paid by the Department (see section (7) of this
			 rule), CCO (see section (4) of this rule), or
prepaid managed care
			 health services organization
(see section (11) of this rule) either
			 directly to the
recipient
or to others for the benefit of the
recipient
. "Assistance" includes both cash and medical
			 assistance programs. "Assistance" does not include SNAP benefits. The
			 "assistance" must be directly related to the
personal injury
(see section (10) of this rule). "Assistance" is received by the
recipient
on the date of issuance of a check for cash
			 assistance and the date of service for medical assistance, regardless of the
			 actual payment date by the Department, CCO, or
prepaid managed care
			 health services organization
.
(4) "CCO" means a Coordinated Care
			 Organization as defined in OAR
			 410-141-0000.
(5) "Claim" means a legal action or a demand
			 by, or on behalf of, a recipient for damages for or arising out of a
personal injury
which is against any person or public body,
			 agency or commission other than the State Accident Insurance Fund Corporation
			 or Workers' Compensation Board.
(6)
			 "Compromise" means a compromise between a
recipient
and any
			 person or public body, agency or commission against whom the
recipient
has a
claim
(see section (5) of
			 this rule).
(7) "Department" means
			 any combination of the Oregon Department of Human Services, the Department of
			 Early Learning and Care, and the Oregon Health Authority.
(8) "Judgment" means a judgment in any
action
(see section (1) of this rule) or proceeding brought by
			 a
recipient
to enforce the
claim
of the
recipient
.
(9)
			 "Loan receipts" means an arrangement in which a CCO or
prepaid managed
			 care health services organization
pays medical costs for or to the
recipient
, and the
recipient
agrees to repay
			 the CCO or
prepaid managed care health services organization
from a recovery the
recipient
receives from a third party that
			 injured the
recipient
, or any similar arrangement.
(10) "Personal injury" means a physical or
			 emotional injury to an individual, for which the individual has a
claim
including, but not limited to, injuries arising from
			 assault, battery, or medical malpractice.
(11) "Prepaid managed care health services
			 organization" means a managed health, dental, or mental health care
			 organization that contracts with the Department on a prepaid basis under the
			 Oregon Health Plan (OHP) (see OAR
			 410-200-0015). A "prepaid
			 managed care health services organization" may be a dental care organization,
			 fully capitated health plan, mental health organization, physician care
			 organization, chemical dependency organization, or CCO.
(12) "Recipient" means an individual who
			 receives or received
assistance
or whose needs are or were
			 included in a public assistance grant.
(13) "Settlement" means a settlement between
			 a
recipient
and any person or public body, agency or
			 commission against whom the
recipient
has a
claim
, and includes any agreement to pay, or payment of or
			 compensation received by a
recipient
under Oregon Laws 2013,
			 chapter 5.
(14) "Trust agreements"
			 means an arrangement in which a CCO or
prepaid managed care health
			 services organization
pays medical expenses for or to the
recipient
, and the
recipient
agrees to hold
			 in trust for the
prepaid managed care health services
			 organization
money from a recovery the
recipient
receives from a third party that injured the
recipient
, or any
			 similar arrangement.
Statutory/Other Authority: ORS
				  409.050,
				  410.070,
				  411.060,
				  411.070,
				  412.049,
				  413.033,
				  413.042 & OLs 2013 Ch 14
				  sec. 10
Statutes/Other Implemented: 411.060, 411.070, 412.049,
				  413.033, 413.042, ORS
				  409.010 &
				  416.510 -
				  416.610