Or. Admin. R. 461-135-0880 - OSIPM and QMB Programs; COVID-19

Current through Register Vol. 61, No. 4, April 1, 2022

The provisions in this rule apply to the OSIPM and QMB programs.

(1) The Department amends the following rules or rule sections regarding the OSIPM and QMB programs.
(a) OAR 461-115-0700,
(b) OAR 461-175-0704,
(c) OAR 461-180-0030, and
(d) OAR 461-180-0120(1), (2), and (3)(b).
(2) Notwithstanding OAR 461-180-0030 and OAR 461-180-0120(1), (2), and (3)(b), the Department shall suspend the effective date for all actions that reduce or close OSIPM or QMB program benefits, except for:
(a) Program closures when an individual:
(A) Passes away,
(B) Is confirmed to have moved out of state,
(C) Requests a voluntary closure,
(D) In the QMB programs, is no longer eligible for Medicare,
(E) Is approved for a one-time cash payment, such as a special needs payment for home repairs,
(F) Is no longer eligible for an ongoing special needs payment,
(G) Is approved for benefits due to an administrative error (see OAR 461-195-0501), or
(H) When a court determines the individual made a false or misleading statement, or misrepresented, concealed, or withheld a fact for the purpose of establishing or maintaining eligibility.
(b) Benefit reductions when an individual
(A) Requests a voluntary reduction.
(B) Is no longer eligible for the same level or amount of a special needs payment.
(c) Increases to patient liability when restoring previous liability.
(d) Benefit suspension when an individual becomes a resident of a correctional facility under OAR 461-135-0950.
(3) Notwithstanding OAR 461-115-0700, the Department will accept self-attestation (see OAR 461-115-0700(2)(b)) to verify all eligibility criteria, except US citizenship, US national, and non-US citizen status.
(4) Notwithstanding OAR 461-115-0704(10), if the Department cannot promptly verify US citizenship, US national, or qualified non-US citizen status; the Department extends the reasonable opportunity period to 180 days from the date the notice is received.
(5) The provisions of this rule shall end on the last day of the month in which the public health emergency declaration by the Secretary of Health and Human Services under section 319 of the Public Health Service Act based on an outbreak of coronavirus disease 2019 (COVID-19) is lifted.


Or. Admin. R. 461-135-0880
SSP 14-2020, temporary adopt filed 06/16/2020, effective 6/16/2020 through 12/12/2020; SSP 30-2020, temporary adopt filed 09/02/2020, effective 09/02/2020 through 12/12/2020; SSP 33-2020, adopt filed 09/21/2020, effective 10/1/2020; SSP 28-2021, temporary amend filed 03/25/2021, effective 3/25/2021 through 9/20/2021; SSP 34-2021, amend filed 06/23/2021, effective 7/1/2021; SSP 60-2021, minor correction filed 12/13/2021, effective 12/13/2021

Statutory/Other Authority: ORS 409.050, ORS 411.060, 411.070, 411.083, 412.006, ORS 84.001 to 84.061, 412.009, 412.024, 412.049, 412.064 & 412.089

Statutes/Other Implemented: ORS 411.060, 411.070, 411.083, 412.006, ORS 84.001 to 84.061, 412.009, 412.024, 412.049, 412.064, 412.089, 409.010, 411.081, 411.087, 45 CFR 206.10, 45 CFR 263.2, 45 CFR 400.155, Pub. L. 116-127, 42 CFR 435.907, 42 CFR 435.914 & 42 CFR 433.400

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