1. (1) Each of the funding sources that make up the Reproductive Health Access Fund (RH Access Fund) may only be used to cover the services defined in this rule and only for enrollees who meet the funding source’s eligibility requirements as defined in OAR 333-004-3090 (Client Eligibility for the RH Access Fund).

2. (2) Title X covers preventive reproductive health and related services.

   1. (a) Covered services include:

      1. (A) Annual visits that include education, counseling, or clinical services related to preventing or achieving pregnancy;
      2. (B) Contraceptive drugs, devices, and supplies;
      3. (C) Clinically indicated follow-up visits to evaluate effectiveness of a contraceptive method, including but not limited to, management of side effects related to a contraceptive method; and, changing a contraceptive method if medically necessary or requested by the enrollee, including the removal of contraceptive devices;
      4. (D) Counseling and education related to pregnancy intention, including effective contraceptive use or preconception care;
      5. (E) Health screenings, laboratory tests, medical procedures, and pharmaceutical supplies and devices directly related to preventing or achieving pregnancy;
      6. (F) Treatment and rescreening for gonorrhea and Chlamydia (GC/CT) pursuant to a family planning visit;
      7. (G) Repeat Pap tests pursuant to a family planning visit;
      8. (H) Non-emergent medical transportation to and from clinic appointments provided through a brokerage, as that term is defined in OAR 410-136-3000; and
      9. (I) Vasectomy services.
   2. (b) Each enrollee may receive up to a one-year supply of contraceptives per date of service.

3. (3) CCare covers a specific set of family planning services to prevent unintended pregnancies.

   1. (a) Covered services include:

      1. (A) Annual visits that support contraceptive use;
      2. (B) Contraceptive drugs, devices, and supplies;
      3. (C) Clinically indicated follow-up visits to evaluate effectiveness of a contraceptive method, including but not limited to, management of side effects related to a contraceptive method; and, changing a contraceptive method if medically necessary or requested by the enrollee, including the removal of contraceptive devices;
      4. (D) Counseling and education to support contraceptive use;
      5. (E) Health screenings, laboratory tests, medical procedures, and drugs, devices, and supplies directly related to contraceptive use;
      6. (F) Non-emergent medical transportation to and from clinic appointments provided through a brokerage, as that term is defined in OAR 410-136-3000; and
      7. (G) Vasectomy services.
   2. (b) Each enrollee may receive up to a one-year supply of contraceptives per date of service.

4. (4) Reproductive Health Equity Act (RHEA) covers services, drugs, devices, products, and procedures related to reproductive health.

   1. (a) Covered services include:

      1. (A) Annual visits that include education, counseling, or clinical services;
      2. (B) Contraceptive drugs, devices, and supplies;
      3. (C) Clinically indicated follow-up visits to evaluate effectiveness of a contraceptive method, including but not limited to, management of side effects related to a contraceptive method; and, changing a contraceptive method if medically necessary or requested by the enrollee, including the removal of contraceptive devices;
      4. (D) Counseling and education related to pregnancy intention, including effective contraceptive use or preconception care;
      5. (E) Health screenings, laboratory tests, medical procedures, and pharmaceutical supplies and devices directly related to preventing or achieving pregnancy;
      6. (F) Sexually transmitted infections (STI) screening;
      7. (G) Non-emergent medical transportation to and from clinic appointments provided through a brokerage, as that term is defined in OAR 410-136-3000; and
      8. (H) Repeat Pap tests.

   2. (b) Abortion services include:

      1. (A) Pre-abortion visits;
      2. (B) Abortion procedures, including medication abortion (MAB) and therapeutic abortion (TAB) procedures performed in an outpatient setting;
      3. (C) Abortion-related medical services, including but not limited to laboratory tests, ultrasounds, and pain management;
      4. (D) Contraceptive drugs, devices, and supplies provided immediately following abortion procedures; and
      5. (E) Post-abortion follow-up visits.

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

History

PH 117-2024, amend filed 12/13/2024, effective 01/01/2025
PH 202-2022, amend filed 10/27/2022, effective 10/27/2022
PH 50-2022, temporary amend filed 04/29/2022, effective 05/01/2022 through 10/27/2022
PH 84-2020, adopt filed 12/18/2020, effective 01/01/2021