Or. Admin. R. 461-195-0301 - Definitions
For purposes of OAR 461-195-0301 to 461-195-0350, the following definitions apply:
(1) "Action " means
an action , suit, or proceeding.
(2)
"Applicant" means an applicant for
assistance (see section (3)
of this rule).
(3) "Assistance "
means moneys for the needs of a
recipient (see section (12) of
this rule) and for the needs of other individuals living with the
recipient whom the
recipient has an
obligation to support which are paid by the Department (see section (7) of this
rule), CCO (see section (4) of this rule), or prepaid managed care
health services organization (see section (11) of this rule) either
directly to the
recipient or to others for the benefit of the
recipient . "Assistance " includes both cash and medical
assistance programs. "Assistance " does not include SNAP benefits. The
"assistance " must be directly related to the
personal injury
(see section (10) of this rule). "Assistance " is received by the
recipient on the date of issuance of a check for cash
assistance and the date of service for medical assistance , regardless of the
actual payment date by the Department, CCO, or prepaid managed care
health services organization.
(5) "Claim " means a legal action or a demand
by, or on behalf of, a recipient for damages for or arising out of a
personal injury which is against any person or public body,
agency or commission other than the State Accident Insurance Fund Corporation
or Workers' Compensation Board.
(6)
"Compromise" means a compromise between a
recipient and any
person or public body, agency or commission against whom the
recipient has a
claim (see section (5) of
this rule).
(7) "Department " means
any combination of the Oregon Department of Human Services, the Department of
Early Learning and Care, and the Oregon Health Authority.
(8) "Judgment" means a judgment in any
action (see section (1) of this rule) or proceeding brought by
a
recipient to enforce the
claim of the
recipient .
(9)
"Loan receipts" means an arrangement in which a CCO or prepaid managed
care health services organization pays medical costs for or to the
recipient , and the
recipient agrees to repay
the CCO or
prepaid managed care health services organization
from a recovery the
recipient receives from a third party that
injured the
recipient , or any similar arrangement.
(10) "Personal injury " means a physical or
emotional injury to an individual, for which the individual has a
claim including, but not limited to, injuries arising from
assault, battery, or medical malpractice.
(11) "Prepaid managed care health services
organization" means a managed health, dental, or mental health care
organization that contracts with the Department on a prepaid basis under the
Oregon Health Plan (OHP) (see OAR 410-200-0015). A "prepaid managed care health
services organization" may be a dental care organization, fully capitated
health plan, mental health organization, physician care organization, chemical
dependency organization, or CCO .
(12) "Recipient " means an individual who
receives or received
assistance or whose needs are or were
included in a public assistance grant.
(13) "Settlement" means a settlement between
a
recipient and any person or public body, agency or
commission against whom the
recipient has a
claim , and includes any agreement to pay, or payment of or
compensation received by a
recipient under Oregon Laws 2013,
chapter 5.
(14) "Trust agreements"
means an arrangement in which a CCO or prepaid managed care health
services organization pays medical expenses for or to the
recipient , and the
recipient agrees to hold
in trust for the prepaid managed care health services
organization money from a recovery the
recipient
receives from a third party that injured the
recipient , or any
similar arrangement.
Notes
Statutory/Other Authority: ORS 409.050, 410.070, 411.060, 411.070, 412.049, 413.033, 413.042 & OLs 2013 Ch 14 sec. 10
Statutes/Other Implemented: 411.060, 411.070, 412.049, 413.033, 413.042, ORS 409.010 & 416.510 - 416.610
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For purposes of OAR 461-195-0301 to 461-195-0350, the following definitions apply:
(1) "Action" means an action, suit, or proceeding.
(2) "Applicant" means an applicant for assistance (see section (3) of this rule).
(3) "Assistance" means moneys for the needs of a recipient (see section (12) of this rule) and for the needs of other individuals living with the recipient whom the recipient has an obligation to support which are paid by the Department (see section (7) of this rule), CCO (see section (4) of this rule), or prepaid managed care health services organization (see section (11) of this rule) either directly to the recipient or to others for the benefit of the recipient. "Assistance" includes both cash and medical assistance programs. "Assistance" does not include SNAP benefits. The "assistance" must be directly related to the personal injury (see section (10) of this rule). "Assistance" is received by the recipient on the date of issuance of a check for cash assistance and the date of service for medical assistance, regardless of the actual payment date by the Department, CCO, or prepaid managed care health services organization.
(4) "CCO" means a Coordinated Care Organization as defined in OAR 410-141-0000.
(5) "Claim" means a legal action or a demand by, or on behalf of, a recipient for damages for or arising out of a personal injury which is against any person or public body, agency or commission other than the State Accident Insurance Fund Corporation or Workers' Compensation Board.
(6) "Compromise" means a compromise between a recipient and any person or public body, agency or commission against whom the recipient has a claim (see section (5) of this rule).
(7) "Department" means the Department of Human Services, the Oregon Health Authority, or both.
(8) "Judgment" means a judgment in any action (see section (1) of this rule) or proceeding brought by a recipient to enforce the claim of the recipient.
(9) "Loan receipts" means an arrangement in which a CCO or prepaid managed care health services organization pays medical costs for or to the recipient, and the recipient agrees to repay the CCO or prepaid managed care health services organization from a recovery the recipient receives from a third party that injured the recipient, or any similar arrangement.
(10) "Personal injury" means a physical or emotional injury to an individual, for which the individual has a claim including, but not limited to, injuries arising from assault, battery, or medical malpractice.
(11) "Prepaid managed care health services organization" means a managed health, dental, or mental health care organization that contracts with the Department on a prepaid basis under the Oregon Health Plan (OHP) (see OAR 410-200-0015). A "prepaid managed care health services organization" may be a dental care organization, fully capitated health plan, mental health organization, physician care organization, chemical dependency organization, or CCO.
(12) "Recipient" means an individual who receives or received assistance or whose needs are or were included in a public assistance grant.
(13) "Settlement" means a settlement between a recipient and any person or public body, agency or commission against whom the recipient has a claim, and includes any agreement to pay, or payment of or compensation received by a recipient under Oregon Laws 2013, chapter 5.
(14) "Trust agreements" means an arrangement in which a CCO or prepaid managed care health services organization pays medical expenses for or to the recipient, and the recipient agrees to hold in trust for the prepaid managed care health services organization money from a recovery the recipient receives from a third party that injured the recipient, or any similar arrangement.
Notes
Stat. Auth.: ORS 409.050, 410.070, 411.060, 411.070, 412.049, 413.033, 413.042, OLs 2013 Ch 14 sec. 10
Stats. Implemented: ORS 409.010, 411.060, 411.070, 412.049, 413.033, 413.042, 416.510 - 416.610