Or. Admin. R. 410-200-0115 - HSD Medical Programs-Effective Dates
(1) For new applicants, the effective date of
HSD Medical Program benefits is whichever comes first:
(a) The earliest date of eligibility within
the month in which the Date of Request is established; or
(b) If ineligible within the month in which
the Date of Request was established, the first day within the following month
in which the client is determined to be eligible.
(2) For EXT, the effective date is determined
according to OAR 410-200-0440.
(3)
The effective date for retroactive medical benefits (OAR 410-200-0130) for MAGI
Medicaid/CHIP and BCCTP is the earlier of:
(a)
The first day of the earliest of the three months preceding the month in which
the Date of Request was established; or
(b) If ineligible pursuant to section (a),
the earliest date of eligibility within the three months preceding the month in
which the Date of Request was established.
(4) Establishing a renewal date:
(a) For all HSD Medical Programs except EXT
(see OAR 410-200-0440), eligibility shall be renewed every 12 months. The
renewal date is the last day of the month determined as follows:
(A) For initial eligibility, the renewal date
is established by counting 12 full months, including the month in which the DOR
was established;
(B) At renewal,
the new renewal date is established by counting 12 full months following the
current renewal month.
(b) For redeterminations that are initiated
by a reported change, outside of the established renewal date, the renewal date
is not adjusted.
(5)
Effective dates of eligibility changes resulting from Reported Changes (also
see Changes That Must Be Reported OAR 410-200-0235):
(a) When the beneficiary reports a change in
circumstances, eligibility shall be redetermined for all EDG members;
(b) When a reported change results in a
reduction or loss of eligibility, the effective date for the change is:
(A) If the determination is made on or before
the 15th of the month, the first of the next month; or
(B) If the determination is made on or after
the 16th of the month, the first of the month following the next
month.
(c) For reported
changes which result in a determination of ongoing eligibility for an HSD
Medical Program at the same benefit level, the effective date of the change is
the 1st of the month following the date of processing.
(d) For beneficiaries who report a pregnancy,
the effective date of the pregnancy-related HSD Medical Program benefit is the
earlier of:
(A) The first of the month in
which the pregnancy is reported; or
(B) The date that a prenatal service related
to the pregnancy was received.
(e) For beneficiaries of CWM-level benefits
who report a change that results in eligibility for Plus level benefits, the
effective date of the Plus-level benefit is the first of the month which it's
reported.
(6) Suspending
or Closing Medical Benefits:
(a) The effective
date for closing HSD Medical Program benefits is the earliest of:
(A) The date of a beneficiary's
death;
(B) The last day of the
month in which the beneficiary becomes ineligible and a timely continuing
benefit decision notice is sent;
(C) The day prior to the start date for
Office of Child Welfare Programs or OSIPM for beneficiaries transitioning from
an HSD Medical Program;
(D) The
date the program ends; or
(E) The
last day of the month in which a timely continuing benefit decision notice is
sent if ongoing eligibility cannot be determined because the beneficiary does
not provide required information by the deadline provided.
(b) Except for benefits obtained via Hospital
Presumptive Eligibility (see OAR 410-200-0105) or a presumptive eligibility
period for BCCTP (see OAR 410-200-0400), prior to closing medical benefits, the
Agency shall:
(A) Determine eligibility for
all other HSD Medical Programs; or
(B) Refer the beneficiary to the Department,
if applicable, and confirm that the Department has made an eligibility
decision.
(c) For
beneficiaries of HSD Medical Program benefits who become incarcerated (OAR
410-200-0140), the effective date of suspension is the day following the date
on which the individual became incarcerated.
(7) Denial of Benefits. The effective date
for denying HSD Medical Program benefits is the earlier of the following:
(a) The date the decision is made that the
applicant is not eligible and notice is sent; or
(b) The end of the application processing
time frame, unless the time period has been extended to allow the applicant
more time to provide required verification.
Notes
Statutory/Other Authority: ORS, 411.402, 411.404, 413.042 & 414.534
Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) For new applicants, the effective date of HSD Medical Program benefits is whichever comes first:
(a) The earliest date of eligibility within the month in which the Date of Request is established; or
(b) If ineligible within the month in which the Date of Request was established, the first day within the following month in which the client is determined to be eligible.
(2) For EXT, the effective date is determined according to OAR 410-200-0440.
(3) The effective date for retroactive medical benefits (OAR 410-200-0130) for MAGI Medicaid/CHIP and BCCTP is the earlier of:
(a) The first day of the earliest of the three months preceding the month in which the Date of Request was established; or
(b) If ineligible pursuant to section (a), the earliest date of eligibility within the three months preceding the month in which the Date of Request was established.
(4) Establishing a renewal date:
(a) For all HSD Medical Programs except EXT (see OAR 410-200-0440), eligibility shall be renewed every 12 months. The renewal date is the last day of the month determined as follows:
(A) For initial eligibility, the renewal date is established by counting 12 full months, including the month in which the DOR was established;
(B) At renewal, the new renewal date is established by counting 12 full months following the current renewal month.
(b) For redeterminations that are initiated by a reported change, outside of the established renewal date, the renewal date is not adjusted.
(5) Effective dates of eligibility changes resulting from Reported Changes (also see Changes That Must Be Reported OAR 410-200-0235):
(a) When the beneficiary reports a change in circumstances, eligibility shall be redetermined for all EDG members;
(b) When a reported change results in a reduction or loss of eligibility, the effective date for the change is:
(A) If the determination is made on or before the 15th of the month, the first of the next month; or
(B) If the determination is made on or after the 16th of the month, the first of the month following the next month.
(c) For reported changes which result in a determination of ongoing eligibility for an HSD Medical Program at the same benefit level, the effective date of the change is the 1st of the month following the date of processing.
(d) For beneficiaries who report a pregnancy, the effective date of the pregnancy-related HSD Medical Program benefit is the earlier of:
(A) The first of the month in which the pregnancy is reported; or
(B) The date that a prenatal service related to the pregnancy was received.
(e) For beneficiaries of CWM-level benefits who report a change that results in eligibility for Plus level benefits, the effective date of the Plus-level benefit is the first of the month which it's reported.
(6) Suspending or Closing Medical Benefits:
(a) The effective date for closing HSD Medical Program benefits is the earliest of:
(A) The date of a beneficiary's death;
(B) The last day of the month in which the beneficiary becomes ineligible and a timely continuing benefit decision notice is sent;
(C) The day prior to the start date for Office of Child Welfare Programs or OSIPM for beneficiaries transitioning from an HSD Medical Program;
(D) The date the program ends; or
(E) The last day of the month in which a timely continuing benefit decision notice is sent if ongoing eligibility cannot be determined because the beneficiary does not provide required information by the deadline provided.
(b) Except for benefits obtained via Hospital Presumptive Eligibility (see OAR 410-200-0105) or a presumptive eligibility period for BCCTP (see OAR 410-200-0400), prior to closing medical benefits, the Agency shall:
(A) Determine eligibility for all other HSD Medical Programs; or
(B) Refer the beneficiary to the Department, if applicable, and confirm that the Department has made an eligibility decision.
(c) For beneficiaries of HSD Medical Program benefits who become incarcerated (OAR 410-200-0140), the effective date of suspension is the day following the date on which the individual became incarcerated.
(7) Denial of Benefits. The effective date for denying HSD Medical Program benefits is the earlier of the following:
(a) The date the decision is made that the applicant is not eligible and notice is sent; or
(b) The end of the application processing time frame, unless the time period has been extended to allow the applicant more time to provide required verification.
Notes
Statutory/Other Authority: ORS, 411.402, 411.404, 413.042 & 414.534
Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706