This rule establishes eligibility criteria for medical
assistance based on an individual's need of treatment for breast or cervical
cancer, including pre-cancerous conditions (treatment). The Authority
administers the Oregon Breast and Cervical Cancer Treatment Program (BCCTP) by
entering into agreements with qualified entities as approved by the Authority
to provide screening services for BCCTP funded by the Centers for Disease
Control in support of the National Breast and Cervical Cancer Early Detection
Program.
(1) To be eligible for BCCTP,
an individual must:
(a) Be found to need
treatment following screening services provided by a qualified
entity;
(b) Be under the age of
65;
(c) Not be covered for
treatment by minimum essential coverage; and
(d) Not be receiving Medicaid through a
Medicaid program listed in
42 U.S.C. §
1396a(a)(10)(A)(i)
(mandatory Medicaid eligibility groups).
(2) An individual is presumptively eligible
for BCCTP beginning the day a qualified entity determines on the basis of
preliminary information that she is likely to meet the requirements of section
(1). A qualified entity that determines an individual presumptively eligible
for BCCTP shall:
(a) Notify the Authority of
the determination within five working days; and
(b) Explain to the individual at the time the
determination is made the circumstances under which an application for medical
assistance shall be submitted to the Authority and the deadline for the
application (see section (3)).
(3) To remain eligible for benefits, an
individual determined by a qualified entity to be presumptively eligible for
BCCTP shall apply for medical assistance no later than the last day of the
month following the month in which the determination of presumptive eligibility
is made. Presumptive eligibility for BCCTP ends on:
(a) The last day of the month following the
month in which presumptive eligibility begins, if the individual does not file
an application by that date;
(b)
The day on which a determination is made for other Medicaid/CHIP program
benefits.
(4) An
individual found eligible for the BCCTP by the Authority becomes ineligible at
the point at which any of the following occur:
(a) The treating health professional
determines the course of treatment is complete;
(b) Upon reaching age 65;
(c) When the individual becomes covered for
treatment by minimum essential coverage;
(d) Upon becoming a resident of another
state;
(e) When the Authority
determines they do not meet the requirements for eligibility.
Notes
Or. Admin. Code
§
410-200-0400
DMAP 54-2013(Temp), f.
& cert. ef. 10-1-13 thru 3-30-14; DMAP 4-2014(Temp), f. & cert. ef.
1-15-14 thru 3-30-14; DMAP 20-2014, f. & cert. ef. 3-28-14; DMAP
67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15;
DMAP
3-2015, f. & cert. ef.
1/30/2015;
DMAP
23-2020, amend filed 05/07/2020, effective
5/8/2020
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,
414.540 &
414.706
