Or. Admin. Code § 333-004-3080

Current through Register Vol. 64, No. 1, January 1, 2025

Section 333-004-3080 - Reproductive Health Access Fund Excluded Services by Funding Source

(1) Title X does not cover:

(a) Sterilizations for enrollees assigned female at birth;

(b) Treatment for sexually transmitted infections (STIs) not pursuant to a family planning visit;

(c) Stand-alone visits for repeat Pap tests not pursuant to a family planning visit;

(d) Hysterectomies or abortions;

(e) Procedures performed for medical reasons, whether or not the procedure results in preventing or delaying pregnancy or restoring fertility;

(f) Human papillomavirus (HPV) vaccinations; or

(g) Any other medical service or laboratory test that is not described in OAR 333-004-3070(2) (Reproductive Health Access Fund Covered Services by Funding Source) and whose primary purpose is other than preventing or achieving pregnancy.

(2) CCare does not cover:

(a) Sterilizations for enrollees assigned female at birth;

(b) Treatment for STIs;

(c) Preconception or prenatal care, including pregnancy confirmations;

(d) Stand-alone visits for repeat Pap tests;

(e) Hysterectomies or abortions;

(f) Procedures performed for medical reasons, whether or not the procedure results in preventing or delaying pregnancy or restoring fertility;

(g) Human papillomavirus (HPV) vaccinations; or

(h) Any other medical service or laboratory test that is not described in OAR 333-004-3070(3) (RH Access Fund Covered Services by Funding Source), and whose primary purpose is other than preventing unintended pregnancy.

(3) Reproductive Health Equity Act (RHEA) does not cover:

(a) Treatment for STIs;

(b) Stand-alone visits for repeat Pap tests;

(c) Hysterectomies;

(d) Human papillomavirus (HPV) vaccinations;

(e) Any other medical service or laboratory test that is not described in ORS 743A.067;

(f) Mammography services. These services are available through the ScreenWise program (OAR 333-010-0120(2)(a) (Covered Services));

(g) Abortion services not occurring in clinics certified by the Reproductive Health Program (RH Program). These services, for individuals with a household income and size at or below 185 percent of the federal poverty level (FPL), are available under the benefit package for this population in OAR 410-134-0003(2)(c) (Healthier Oregon and Healthier Oregon Cover All Kids Coverage); or

(h) Sterilization procedures. These services, for individuals with a household income and size at or below 138 percent of the FPL, are available under the benefit package for this population in OAR 410-134-0003(2)(c) (Healthier Oregon and Healthier Oregon Cover All Kids Coverage).

Or. Admin. Code § 333-004-3080

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 50-2022, temporary amend filed 04/29/2022, effective 05/01/2022 through 10/27/2022; PH 202-2022, amend filed 10/27/2022, effective 10/27/2022; PH 32-2023, temporary amend filed 06/30/2023, effective 7/1/2023 through 12/27/2023; PH 57-2023, amend filed 12/19/2023, effective 12/19/2023; PH 117-2024, amend filed 12/13/2024, effective 1/1/2025

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149, ORS 435.205 & ORS 435.230

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032, ORS 435.205 & ORS 435.230