1. (1) If the Authority determines that an applicant is eligible for CAREAssist benefits the applicant shall be notified in writing within 14 calendar days of the Authority’s determination and be assigned to a benefit group as follows:

   1. (a) Group 1: Clients who are enrolled in a private, group or individual insurance policy.
   2. (b) Group 2: Clients whose primary prescription benefits are provided by OHP or the Department of Veterans Affairs (VA).

2. (2) A client’s notification must describe:

   1. (a) The eligibility effective date and end date;
   2. (b) Group number and benefits associated with that group;
   3. (c) A list of CAREAssist in-network pharmacies;
   4. (d) Recertification date and process; and
   5. (e) The repercussions of not recertifying.
3. (3) CAREAssist eligibility is for six months.
4. (4) If the Authority determines that an applicant is not eligible for CAREAssist benefits an applicant shall be notified in writing in accordance with ORS 183.415.
5. (5) An applicant who has been denied may reapply at any time.

Statutory/Other Authority

ORS 413.042, 431.250 & 431.830

Statutes/Other Implemented

ORS 431.250 & 431.830

History

PH 23-2016, f. & cert. ef. 8-2-16
PH 30-2014, f. 11-10-14, cert. ef. 12-1-14