Or. Admin. R. 945-060-0020 - Review and, Approval of COFA Premium Assistance Program Application by the Department; Waiting List

The department shall:

(1) Review and process applications in the order they are received;
(2) Provide language assistance services for purposes of completing and submitting the application to the department to COFA applicants with limited English proficiency as defined in ORS 413.550.
(3) Within three business days of receipt of an incomplete application:
(a) Notify the COFA applicant that the application is incomplete;
(b) Provide instructions to the COFA applicant on how to complete the application; and
(c) Notify the COFA applicant of the date, consistent with the timeline established in OAR 945-060-0015(2), by which the application must be completed and postmarked, or if not mailed, received by the department.
(4) Waitlist a COFA applicant who submits an application if enrollment in the program reaches a level at which the department reasonably determines that the COFA Premium Assistance Program Fund will be insufficient to pay the premium costs or out-of-pocket costs for the COFA applicant or one or more existing program participants during the entirety of the applicable plan year;
(5) Within five business days of receipt of a complete application:
(a) Approve or hold the application;
(b) Notify the COFA applicant of the approval or holding of the application; and
(c) If the application is held, notify the COFA applicant of the:
(A) Reason for holding the application; and
(B) COFA applicant's appeal rights under OAR 945-060-0040;
(d) Waitlist a COFA applicant if required by paragraph (4) of this rule; or
(e) If a COFA applicant is waitlisted, notify the COFA applicant of the:
(A) Reason the COFA applicant was waitlisted;
(B) COFA applicant's position on the waiting list and
(C) COFA applicant's appeal rights under OAR 945-060-0040.
(6) Enroll an applicant in the COFA Program effective:
(a) On the first of the month following submission of a complete application if the application is received on or before the fifteenth of the month in which the application was submitted; and
(b) On the first of the second month following the submission of a complete application if the application is received after the fifteenth of the month in which the application was submitted.
(7) Notwithstanding Paragraph (6) of this rule, enroll an applicant in the COFA Program effective:
(a) On the first of the month following the month of the submission of the application if:
(A) The application is complete and is received during the individual's birth month; and
(B) The applicant turns 19 years of age after the fifteenth of the month of the submission of the application or the applicant is covered by the Oregon Health Plan after the 15th of the month of the submission of the application; or
(C) The applicant is eligible for a special enrollment, but verification of the special enrollment is delayed beyond the fifteenth of the month due to action or inaction by the Centers for Medicare and Medicaid Services.
(b) On the first of the second month following the month of the submission of the application if:
(A) The application is complete and is received by the Marketplace after the fifteenth of the month in which the application was submitted; and
(B) The applicant is eligible for a special enrollment, but verification of the special enrollment is delayed beyond the last day of the month of the submission of the application due to action or inaction by the Centers for Medicare and Medicaid Services.

Notes

Or. Admin. R. 945-060-0020
HMP 3-2016, f. & cert. ef. 9/8/2016; HMP 5-2017, temporary amend filed 10/31/2017, effective 10/31/2017; HMP 4-2017, minor correction filed 10/23/2017, effective 10/23/2017; HMP 1-2018, amend filed 04/30/2018, effective 4/30/2018

Statutory/Other Authority: OL 2016 & Ch. 94

Statutes/Other Implemented: OL 2016 & Ch. 94

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