Or. Admin. R. 461-195-0301 - Definitions

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

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

Or. Admin. R. 461-195-0301
AFS 62-1989, f. 10-5-89, cert. ef. 10-15-89; AFS 26-1993, f. 10-29-93, cert. ef. 11-1-93; Renumbered from 461-010-0100; SSP 19-2005, f. 12-30-05, cert. ef. 1-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14; SSP 15-2015, f. 3-30-15, cert. ef. 4/1/2015

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

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