OAR 333-022-1060
CareAssist: 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.

Source: Rule 333-022-1060 — CareAssist: Group 1 and 2 Benefits, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-022-1060.

333‑022‑0200
HIV Testing and Confidentiality: Definitions 333‑022‑0205
HIV Testing, Notification, Right to Decline 333‑022‑0210
Confidentiality 333‑022‑0300
Occupational and Health Care Setting Exposures: Procedures for Requesting a Source Person Consent to an HIV Test Following an Occupational Exposure 333‑022‑0305
Occupational and Health Care Setting Exposures: Petition for Mandatory Testing of Source Persons 333‑022‑0310
Occupational and Health Care Setting Exposures: Substantial Exposure While Being Administered Health Care 333‑022‑0315
Occupational and Health Care Setting Exposures: Employer Program for Prevention, Education and Testing 333‑022‑1000
CareAssist: Purpose and Description of Program 333‑022‑1010
CareAssist: Definitions 333‑022‑1020
CareAssist: Eligibility 333‑022‑1030
CareAssist: Application Process 333‑022‑1040
CareAssist: Review of Applications 333‑022‑1050
CareAssist: Approval or Denial of Application 333‑022‑1060
CareAssist: Group 1 and 2 Benefits 333‑022‑1070
CareAssist: Prescriptions 333‑022‑1080
CareAssist: Payments and Cost Coverage 333‑022‑1090
CareAssist: Client Eligibility Review 333‑022‑1100
CareAssist: Client Reporting Requirements 333‑022‑1120
CareAssist: Restricted Status 333‑022‑1130
CareAssist: Incarcerated Applicants or Clients 333‑022‑1140
CareAssist: Bridge Program 333‑022‑1145
CareAssist: Uninsured Persons Program 333‑022‑1147
CareAssist: Dental Benefits 333‑022‑1150
CareAssist: Client Rights 333‑022‑1160
CareAssist: Termination from CAREAssist 333‑022‑1170
CareAssist: Hearings 333‑022‑2000
HIV Case Management: Purpose 333‑022‑2010
HIV Case Management: Definitions 333‑022‑2020
HIV Case Management: Eligibility 333‑022‑2030
HIV Case Management: Enrollment Process 333‑022‑2040
HIV Case Management: Approval or Denial of Enrollment 333‑022‑2050
HIV Case Management: Determination of Service Needs 333‑022‑2060
HIV Case Management: Client Rights 333‑022‑2070
HIV Case Management: Client Responsibilities 333‑022‑2080
HIV Case Management: Supportive Services 333‑022‑2090
HIV Case Management: Client Enrollment Review 333‑022‑2100
HIV Case Management: Incarcerated Applicants or Clients 333‑022‑2110
HIV Case Management: Termination 333‑022‑2120
HIV Case Management: Hearings 333‑022‑3000
Oregon Housing Opportunity in Partnership Program
Last Updated

Jun. 8, 2021

Rule 333-022-1060’s source at or​.us