Oregon Administrative Rules
Chapter 291 - DEPARTMENT OF CORRECTIONS
Division 124 - HEALTH SERVICES (AIC)
Section 291-124-0085 - Charges for Elective Care or Treatment
Universal Citation: OR Admin Rules 291-124-0085
Current through Register Vol. 63, No. 3, March 1, 2024
(1) An AIC may request approval to purchase healthcare from a healthcare provider in the community. The department will only approve those requests that in the department's judgment are medically appropriate and are otherwise consistent with the department's concerns for institution security and order, public safety, and sound correctional practice.
(a)
The AIC's trust account must have sufficient funds to pay for the purchase of
care before the treatment is scheduled unless other financial arrangements have
been made. Cost of care includes expenses associated with providing the
treatment, including follow-up care, as well as all costs associated with
transport and security.
(b) For
medical requests, the chief medical officer of the facility must review and
approve follow-up care and treatment recommended by community providers. Any
requests to purchase elective dental care from community providers must be
reviewed and approved by the department's dental director.
(2) Orthoses, Prosthetics Devices, Mechanical Aids, and Self Care Items. Orthoses, prosthetic devices, and mechanical aids are specialized mechanical devices used chronically to support or supplement joints or limbs or are artificial devices to replace missing body parts.
(a) Except as provided in OAR 291-124-0086,
an AIC is generally required to pay for elective orthoses, prostheses devices,
or other mechanical aids that become the personal property of the AIC. An AIC
is not generally required to pay for medical aids provided for acute treatment
of a limited medical condition (casts, splints, ace wraps,) for short-term use
(canes, crutches, or braces), or for a medically necessary procedure (heart
valves, cardiac stent, inter-ocular lens implants).
(b) Health Services allows appropriate but
elective orthoses, prostheses, or other mechanical aids that are not essential
to prevent significant deterioration in the health of the AIC but are
nevertheless reasonably expected to significantly improve the quality of life
of the AIC as it relates to a proven chronic or ongoing medical condition.
Examples of such items include dentures; dental prosthetics; glasses; contact
lenses; artificial eyes; artificial limbs; knee or ankle or foot braces;
hearing aids; support hose; transcutaneous electrical nerve stimulation (TENS)
units; non-institution issued shoes; suspenders; batteries for hearing aids or
other devices; maintenance or repair of any such item.
(c) Health Services may decline to authorize
elective orthoses, prostheses, or other mechanical aids that are of minimal
proven medical value, and authorization decisions must be weighed against
safety and security concerns. Examples of items that are not generally
authorized include but are not limited to high-top tennis shoes, soft pillows,
heating pads, and knee sleeves for sports.
(d) Health Services may consider the
following when determining whether to allow elective orthoses, prosthetic
devices, and mechanical aids and whether the AIC must pre-pay for the item
prior to ordering or delivery, or whether the AIC may incur indebtedness to
obtain the item:
(A) Urgency of
need;
(B) Time left on
sentence;
(C) Overall
necessity;
(D) Morbidity;
(E) Mortality;
(F) Functional disability;
(G) Expected improvement;
(H) Alternatives;
(I) Risks and benefits;
(J) Costs and benefits; and
(K) Security concerns.
(e) Refractive Eye Examinations and
Eyeglasses: Health Services may approve a refractive eye examination once every
two years.
(A) An AIC may purchase eyeglasses,
eyewear, and eyewear accessories from the department.
(B) The Health Services Eyeglasses Review
Committee may approve an AIC to incur debt to obtain an eye examination or
purchase eyeglasses on a case-by-case basis. The Eyeglasses Review Committee
will make that approval based on a review of the AIC's release date, past
optical information, current visual acuity, and a six-month review of the AIC's
trust fund activities, and the AIC's effort and compliance with a correctional
case management plan.
(C) Health
Services does not provide contact lens examinations. AICs may purchase contact
lenses and lens solution.
(f) Audiogram examination and hearing aids:
Health Services, after conducting a medical evaluation to identify possible
medically or surgically correctable causes of the reported hearing loss, may
refer an AIC who reports subjective hearing loss for an audiogram evaluation.
Health Services may authorize an audiogram examination and hearing aid or
hearing aids for an AIC who reports subjective hearing loss that meets the
requirements of Level 3 Care or Treatment under OAR 291-124-0041. Health
Services may authorize a monoaural hearing aid or binaural hearing aids, when
clinically indicated, once every five years, subject to OAR
291-124-0086.
(g) Footwear: Health
Services may approve special footwear if that footwear is a recognized and
appropriate part of a medical treatment plan or may be medically necessary (for
example, peripheral vascular disorders, diabetic complications, amputation,
clubfoot) if there would be serious deterioration or significant risk to the
AIC's basic health without the special footwear, and if no reasonable treatment
alternative exists. An AIC may incur indebtedness to obtain special footwear
approved by the department.
(h) The
AIC must sign a withdrawal request form before the service or item is provided.
The AIC's trust account will be charged for the estimated or actual cost of the
device. If an AIC must pre-pay before obtaining a service or item, the AIC must
sign a withdrawal request form with sufficient funds available and debited
before the service or item is provided.
(i) Upon delivery of the device, any variance
from the actual cost will be indebted or credited to the AIC's trust account
accordingly.
(j) An AIC shall not
be denied prostheses or other devices that are medically necessary because of
lack of funds. However, the AIC may incur debt if the AIC's trust account does
not have sufficient funds to cover the cost of the device.
(k) Items for self-care are available on the
commissary list. An AIC may be advised to purchase a particular self-care item
by Health Services employees. Such advice is intended as education in self-care
and is not a directive that the item is considered medically
necessary.
(3) Expenses for Medical Care for AICs on Escape, Short-Term Transitional Leave, Non-Prison Leave, Parole, Post-Prison Supervision, or Emergency Leave:
(a) Expenses incurred for healthcare of
offenders on parole or post-prison supervision are the responsibility of the
offender.
(b) Expenses incurred for
healthcare of AICs on escape status are not the responsibility of the
department.
(c) Expenses incurred
for healthcare of AICs on short-term transition leave and non-prison leave are
the responsibility of the AIC.
(4) Refusal of Medical Appointments:
(a) Any AIC who willfully refuses to keep a
prearranged medical appointment in the community may have their trust account
charged or indebted.
(b) A decision
under this section to charge or indebt an AIC's trust account is subject to the
administrative review process in the rules on Trust Accounts (AIC) (OAR
291-158).
(5) Destruction of Property: Any AIC who willfully destroys or misuses Health Services equipment or supplies is subject to disciplinary action in accordance with the rules on Prohibited AIC Conduct and Processing Disciplinary Actions (OAR 291-105).
Statutory/Other Authority: ORS 179.040, 423.020, 423.030 & 423.075
Statutes/Other Implemented: ORS 179.040, 423.020, 423.030 & 423.075
Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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