Oregon Administrative Rules › Chapter 333 - OREGON HEALTH AUTHORITY, PUBLIC HEALTH DIVISION › Division 4 - OREGON REPRODUCTIVE HEALTH PROGRAM › Section 333-004-3010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "AbortionCare
			 Clinic" means a clinic operated by an agency certified with the RH Program to
			 receive reimbursement for abortion services provided to enrollees who meet RHEA
			 eligibility criteria.
(2) "Abortion
			 services" means any services provided in an outpatient setting to end a
			 pregnancy so that it does not result in a live birth. Services include
			 medication and therapeutic abortion procedures. Contraceptive drugs, devices,
			 and supplies related to follow-up care are also included.
(3) "Acquisition cost" means the amount or
			 unit cost of the drugs, devices, or supplies the agency actually pays to the
			 pharmaceutical manufacturer, supplier or distributor after applying any
			 discounts, promotions or other reductions. Shipping and handling may be
			 included in the acquisition cost only if supported by an invoice.
(4) "Agency" means an entity certified by the
			 RH Program to operate RHCare clinics, CCare clinics, and/or AbortionCare
			 clinics.
(5) "Agency number" or
			 "Project number" means the administrative number assigned by the RH Program to
			 an agency.
(6) "Applicant agency"
			 means an entity who is applying to be certified by the RH Program to operate
			 RHCare clinics, CCare clinics, and/or AbortionCare clinics.
(7) "Authority" means the Oregon Health
			 Authority.
(8) "Authorizing
			 Official" means an individual with legal authority to act on behalf of the
			 agency.
(9) "CCare" means Oregon
			 ContraceptiveCare which is a 1115 family planning Medicaid demonstration waiver
			 that expands Medicaid coverage for contraceptive services. CCare provides
			 family planning services to Oregonians not enrolled in the Oregon Health Plan
			 (OHP), with incomes at or below 250 percent of the Federal Poverty Level (FPL).
			 CCare services are limited to those related to preventing unintended
			 pregnancy.
(10) "CCare Clinic"
			 means a clinic operated by an agency certified with the RH Program to receive
			 reimbursement for CCare services provided to enrollees who meet CCare
			 eligibility criteria.
(11) "Center"
			 means the Center for Prevention and Health Promotion, within the Public Health
			 Division of the Authority.
(12)
			 "Certification Requirements for CCare Clinics" means Oregon Reproductive Health
			 Program Certification Requirements for CCare Clinics, Version 2.
(13) "Certification Requirements for
			 AbortionCare Clinics" means Oregon Reproductive Health Program Certification
			 Requirements for AbortionCare Clinics, Version 3.
(14) "Certification Requirements for RHCare
			 Clinics" means Oregon Reproductive Health Program Certification Requirements
			 for RHCare Clinics, Version 3.
(15)
			 "Certification" means the agency has attested to meeting the certification
			 requirements, submitted all required documents, been approved by the RH
			 Program, and has an executed MSA with the RH Program.
(16) "CLIA" means the Clinical Laboratory
			 Improvement Amendments of 1988, which establishes quality standards for all
			 laboratory testing to ensure the accuracy, reliability, and timeliness of
			 patient test results, and allows for certification of clinical laboratories
			 operating in accordance with these federal amendments.
(17) "Client" means any person who has
			 reproductive capacity and is seeking reproductive health, family planning, or
			 abortion services at a RHCare, CCare, or AbortionCare clinic.
(18) "Client-centered" means care that is
			 respectful of, responsive to, and allows individual client preferences, needs,
			 and values to guide all clinical decisions.
(19) "Clinic" means a site within an agency
			 that meets certification requirements and is listed on the agency's
			 MSA.
(20) "Clinic number" or "Site
			 number" means the administrative number assigned by the RH Program to each
			 clinic within an agency.
(21)
			 "Clinic Visit Record" or "CVR" means the form or set of information that is
			 completed for each client visit and serves as the billing mechanism for the RH
			 Access Fund.
(22) "CMS" means the
			 Centers for Medicare and Medicaid Services, located within the federal
			 Department of Health and Human Services.
(23) "Drugs, devices, or supplies" means
			 FDA-approved product(s) provided to a client pursuant to reproductive health
			 services.
(24) "Enrollee" means a
			 client who has completed an RH Access Fund Enrollment Form and been enrolled in
			 the RH Access Fund.
(25) "Family
			 planning services" means clinical, counseling, or education services related to
			 achieving or preventing pregnancy.
(26) "FPL" means the federal poverty level
			 guidelines established each year by the U.S. Department of Health and Human
			 Services.
(27) "GC/CT" means
			 gonorrhea and Chlamydia.
(28)
			 "Health Systems Division" means the Division within the Oregon Health Authority
			 that administers the Oregon Health Plan.
(29) "Medical Services Agreement" or "MSA"
			 means an agreement that sets forth the relationship between the Center and the
			 enrolling agency regarding payment by the Center for reproductive health
			 services, drugs, devices or, supplies.
(30) "Minor" means anyone under the age of
			 18, per ORS 419B.550.
(31) "Nationally-recognized standard of care"
			 means a diagnostic, screening, or treatment process recognized by a national
			 organization, including but not limited to the American Cancer Society (ACS),
			 American College of Obstetrics and Gynecologists (ACOG), U.S. Preventative
			 Services Task Force (USPSTF), or the U.S. Medical Eligibility Criteria
			 (USMEC).
(32) "NVRA" means the
			 National Voter Registration Act.
(33) "Provider" means a licensed health care
			 professional operating within the appropriate scope of practice according to
			 their license, who works for an agency.
(34) "Reasonable opportunity period" or "ROP"
			 means a 90-day period during which individuals who declare U.S. citizenship or
			 Eligible Immigration Status may receive services under CCare while
			 documentation of such status is gathered and verified, under section 1903(x) of
			 the Social Security Act.
(35)
			 "RHCare clinic" means a clinic operated by an agency certified with the RH
			 Program to provide reproductive health services to all clients and to receive
			 reimbursement for covered reproductive health services provided to all
			 enrollees.
(36) "Reproductive
			 capacity" means able to become pregnant or cause a pregnancy.
(37) "Reproductive Health Access Fund" or "RH
			 Access Fund" means a source of coverage for reproductive health services as
			 defined in OAR 333-004-3070  (RH Access Fund Covered Services by Funding Source)
			 provided to enrollees who complete the RH Access Fund Enrollment Form and are
			 deemed eligible.
(38) "Reproductive
			 Health Program" or "RH Program" means the program within the Center for
			 Prevention and Health Promotion of the Oregon Health Authority that certifies
			 RHCare, CCare, and Abortion clinics and administers the RH Access Fund which
			 includes CCare, Title X, and RHEA funds.
(39) "Reproductive health services" or "RH
			 services" means preventive services, including family planning, and related
			 drugs, devices, and supplies, to support the healthy reproductive processes,
			 functions and system.
(40) "RHEA"
			 means Reproductive Health Equity Act (ORS
			 414.432) funding, which provides
			 access to reproductive health and abortion services to Oregonians who are able
			 to get pregnant and who would be eligible for federally funded medical
			 assistance if not for 8
			 U.S.C. 1611 or
			 1612.
(41) "RH GF" means Oregon Reproductive Health
			 Program General Funds which provide preventive reproductive health and related
			 services for individuals with reproductive capacity.
(42) "RH Program Coordinator" or "RHC" means
			 an agency staff person assigned to ensure compliance at all clinic sites within
			 each agency and to be the primary liaison between state RH Program staff and
			 the agency.
(43) "RH Access Fund
			 Eligibility Database" means the centralized, web-based data system operated by
			 the RH Program to house information about enrollees.
(44) "RH Access Fund Enrollment Form" means
			 the form whereby individuals apply for RH Access Fund coverage.
(45) "Sanction" means an action against
			 agencies taken by the Authority in cases of fraud, misuse, abuse, or
			 non-compliance of RH Program requirements.
(46) "School-Based Health Center" means a
			 health center certified by the School-Based Health Center State Program, as
			 defined in OAR 333-028-0210  (School-Based Health Center Program:
			 Definitions).
(47) "Special
			 confidentiality" means that an agency is permitted to bill the RH Program in
			 lieu of billing a private insurer because a client fears that they will suffer
			 harm if the policy holder of the private insurance finds out about the services
			 they are receiving.
(48)
			 "Telehealth" means the provision of healthcare remotely by means of
			 telecommunications technology.
(49)
			 "Title X" means Title X of the Public Health Service Act, Section 1001
			 (42 U.S.C. §
									300), which is a federal grant administered
			 by the Department of Health and Human Services, Office of Population Affairs
			 intended to ensure access to equitable, affordable, client-centered, quality
			 family planning services for clients, especially low-income clients.
Statutory/Other Authority: ORS
				  413.042, ORS
				  414.432, ORS
				  431.147, ORS
				  431.149 & OL 2022, ch. 45,
				  sec 10
Statutes/Other Implemented: ORS
				  414.432, ORS
				  431.147, ORS
				  413.032 & OL 2022, ch. 45,
				  sec 10