OAR 333-022-1145
CareAssist: 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 (CareAssist: Eligibility); 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 (CareAssist: Application Process) and an application shall be reviewed by the Authority in accordance with OAR 333-022-1040 (CareAssist: Review of Applications), 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)

Recertification date and process; and

(e)

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 (Notice of right to hearing).

(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.

(c)

Medication therapy management; and

(d)

Tobacco cessation services.

(9)

An UPP client must notify the Authority immediately if he or she becomes eligible for insurance or obtains insurance.

Source: Rule 333-022-1145 — CareAssist: Uninsured Persons Program, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-022-1145.

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 333-022-1145’s source at or​.us