The provisions in this rule apply to the OSIPM and QMB
programs.
(1) Subject to subsection
(5)(b) of this rule, the Department amends the following rules or rule sections
regarding the OSIPM and QMB programs.
(2) Subject to subsection (5)(b) of this
rule, and 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) Subject to subsection (5)(b)
of this rule, and 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) Subject
to subsection (5)(b) of this rule, and 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) In accordance with the Consolidated
Appropriations Act, 2023, the provisions of this rule shall end effective April
1, 2023, as outlined in subsections below.
(a)
Individuals continuously receiving benefits prior to March 31, 2023 will
maintain the protections afforded under this rule until the Department
initiates a renewal of benefit
eligibility (see OAR
461-001-0000). The Department
will begin renewals in April 2023.
(A) When a
completed and signed renewal form is required, the individual will have 90 days
to provide the required documents.
(B) When additional information is required
to complete the renewal, the individual will have 90 days to provide the
requested information.
(C) When,
during the renewal process, an individual is found ineligible for benefits,
eligible for a lesser benefit, or the individual fails to complete the renewal
process, the Department will send a
decision notice (see OAR
461-001-0000) at least 60 days
before the effective date of the closure or reduction.
(b) Once the renewal process of an individual
is complete under subsection (a) of this section, the provisions of this rule
no longer apply to that individual.
Notes
Or. Admin. Code
§
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;
SSP
11-2023, amend filed 03/22/2023, effective
4/1/2023
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 & H.R. 2617
(117th)
