OAR 333-010-0105
Definitions

(1)

“Agency number” means the administrative number assigned to the service provider by the Center for Prevention and Health Promotion (Center) for identification as a ScreenWise Breast and Cervical Cancer services (ScreenWise BCC) provider.

(2)

“Ancillary provider” means a provider that performs services beyond the scope of an enrolling provider. Ancillary providers may include but is not limited to laboratories, imaging centers, surgeons and surgical facilities, and hospitals.

(3)

“Approved medical services agreement” means the completed ScreenWise BCC agreement, submitted to and approved by the Center for Prevention and Health Promotion.

(4)

“Authority” means the Oregon Health Authority.

(5)

“BCCTP” means the Breast and Cervical Cancer Treatment Program. ORS 414.534 (Treatment for breast or cervical cancer), 414.536 (Presumptive eligibility for medical assistance for treatment of breast or cervical cancer).

(6)

“Care coordination or case management” means that a client is provided with services, results, follow-up recommendations, and active tracking of progress towards follow-up recommendations.

(7)

“Center” means the Center for Prevention and Health Promotion, the office within the Oregon Health Authority that administers the ScreenWise BCC.

(8)

“CLIA” means the federal Clinical Laboratory Improvement Amendments of 1988, 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.

(9)

“Client” means a person of any age or gender who is enrolled in and receives screening or diagnostic services from the ScreenWise BCC.

(10)

“Enrolling provider” means a provider that enrolls a client into the ScreenWise BCC, provides care coordination for the client and timely data submission to ScreenWise BCC.

(11)

“FPL” means the federal poverty level guidelines established each year by the Department of Health and Human Services, used to determine eligibility for ScreenWise BCC and other federally funded programs.

(12)

“HIPAA” means the Health Insurance Portability and Accountability Act.

(13)

“ScreenWise BCC” means the ScreenWise program component that provides statewide breast and cervical cancer screening and diagnostic services to eligible clients, that is administered by the Center for Prevention and Health Promotion within the Oregon Health Authority.

(14)

“ScreenWise BCC Provider Network” means the combination of all contracted ScreenWise providers, including enrolling and ancillary providers.

(15)

“Service provider” or “provider” means a licensed health care provider operating within a scope of practice, who is authorized by the Center to bill for breast and cervical cancer screening and diagnostic services for eligible clients.

(16)

“Site number” means the administrative number assigned to the provider by the Center for identification of the geographic location of each ScreenWise BCC provider.

(17)

“Underinsured” means that health insurance does not fully cover breast and cervical cancer screening services or that out-of-pocket cost sharing for diagnostic services would pose a financial hardship.

Source: Rule 333-010-0105 — Definitions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-010-0105.

333‑010‑0000
Cancer Reporting Regulations: Definitions 333‑010‑0020
Cancer Reporting Regulations: Reporting Requirements for Health Care Facilities 333‑010‑0030
Cancer Reporting Regulations: Reporting Requirements for Practitioners 333‑010‑0032
Cancer Reporting Regulations: Reporting Requirements for Clinical Laboratories 333‑010‑0035
Cancer Reporting Regulations: Patient Notification Requirement 333‑010‑0040
Cancer Reporting Regulations: Quality Standards 333‑010‑0050
Cancer Reporting Regulations: Confidentiality and Access to Data 333‑010‑0055
Cancer Reporting Regulations: Research Studies 333‑010‑0060
Cancer Reporting Regulations: Special Studies 333‑010‑0070
Cancer Reporting Regulations: Advisory Committee 333‑010‑0080
Cancer Reporting Regulations: Training and Consultation 333‑010‑0090
Cancer Reporting Regulations: Fees 333‑010‑0100
ScreenWise Breast and Cervical Cancer Program: Description of the ScreenWise Breast and Cervical Cancer Program 333‑010‑0105
Definitions 333‑010‑0110
Client Eligibility 333‑010‑0115
Client Enrollment 333‑010‑0120
Covered Services 333‑010‑0125
Excluded Services 333‑010‑0130
Standards of Care for Breast and Cervical Cancer Screening and Diagnostic Services 333‑010‑0135
Provider Enrollment 333‑010‑0140
Billing 333‑010‑0145
Claims and Data Submission 333‑010‑0150
Timely Submission of Claims and Data 333‑010‑0155
Payment 333‑010‑0160
Requirements for Financial, Clinical and Other Records 333‑010‑0165
Compliance with Federal and State Statutes 333‑010‑0170
Denial or Recovery of Reimbursement Resulting from Review or Audit 333‑010‑0175
Recovery of Overpayments to Providers Resulting from Review or Audit 333‑010‑0180
Provider Sanctions 333‑010‑0185
Provider Appeals 333‑010‑0190
Provider Appeals (Level 1) — Claims Reconsideration 333‑010‑0195
Provider Appeals (Level 2) — Contested Case Hearing 333‑010‑0197
Presumptive Eligibility for BCCTP 333‑010‑0200
ScreenWise WISEWOMAN Program: Description of the WISEWOMAN Program 333‑010‑0205
Definitions 333‑010‑0210
Client Eligibility 333‑010‑0215
Client Enrollment 333‑010‑0220
Provider Enrollment 333‑010‑0225
Standards of Care for WISEWOMAN Program Screening and Services 333‑010‑0230
Submission of Information by Ancillary Providers 333‑010‑0235
Covered Services 333‑010‑0240
Excluded Services 333‑010‑0245
Claims and Billing 333‑010‑0250
Payment 333‑010‑0255
Denial or Recovery of Reimbursement Resulting from Review or Audit 333‑010‑0260
Recovery of Overpayments to Providers Resulting from Review or Audit 333‑010‑0265
Client Data Submission 333‑010‑0270
Requirements for Financial, Clinical and Other Records 333‑010‑0275
Compliance with Federal and State Statutes 333‑010‑0280
Provider Sanctions 333‑010‑0285
Provider Appeals (Level 1) — Claims Reconsideration 333‑010‑0290
Provider Appeals (Level 2) — Contested Case Hearing 333‑010‑0300
Tobacco Prevention and Education Program: Definitions 333‑010‑0310
Tobacco Prevention and Education Program: Purpose and Intent 333‑010‑0320
Tobacco Prevention and Education Program: Framework for Grant Awards 333‑010‑0330
Tobacco Prevention and Education Program: Local Coalitions and Community-Based Programs 333‑010‑0350
Tobacco Prevention and Education Program: Statewide Public Awareness and Education Programs 333‑010‑0360
Tobacco Prevention and Education Program: Statewide and Regional Projects Programs 333‑010‑0370
Tobacco Prevention and Education Program: Reporting 333‑010‑0600
Childhood Diabetes Database: Definitions 333‑010‑0610
Childhood Diabetes Database: General Authority and Purpose 333‑010‑0620
Childhood Diabetes Database: Reporting Requirements for Schools 333‑010‑0630
Childhood Diabetes Database: Reporting Requirements for Practitioners 333‑010‑0640
Childhood Diabetes Database: Confidentiality and Access to Data 333‑010‑0650
Childhood Diabetes Database: Research Studies 333‑010‑0660
Childhood Diabetes Database: Advisory Committee 333‑010‑0700
Dental Pilot Projects: Purpose 333‑010‑0710
Dental Pilot Projects: Definitions 333‑010‑0720
Dental Pilot Projects: Application Procedure 333‑010‑0730
Dental Pilot Projects: Application Review Process 333‑010‑0740
Dental Pilot Projects: Project Application Provisional Approval or Denial 333‑010‑0750
Dental Pilot Projects: Provisional Approval 333‑010‑0760
Dental Pilot Projects: Minimum Standards 333‑010‑0770
Dental Pilot Projects: Informed Consent 333‑010‑0780
Dental Pilot Projects: Pilot Project Evaluation and Monitoring by Sponsor 333‑010‑0790
Dental Pilot Projects: Authority Responsibilities 333‑010‑0800
Dental Pilot Projects: Project Modifications 333‑010‑0810
Dental Pilot Projects: Discontinuation or Completion of Project 333‑010‑0820
Dental Pilot Projects: Suspension, Denial or Termination of Project
Last Updated

Jun. 8, 2021

Rule 333-010-0105’s source at or​.us