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The Oregon Administrative Rules contain OARs filed through November 15, 2014
 
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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

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