OAR 291-124-0085: Charges for Elective Care or Treatment

(1) An AIC may request approval to purchase elective care or treatment, including a request to purchase a healthcare service 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 the elective care before the requested service is scheduled or before the requested item is ordered, unless other financial arrangements have been made. The cost of elective care includes expenses associated with providing the treatment, including follow-up care, as well as all costs associated with transport and security. To obtain an elective service or item under this rule, an AIC must sign a withdrawal request form for their trust account before the Department will provide the service or item. The AIC's trust account will be charged for the estimated or actual cost of the service or item. If an AIC must pre-pay before obtaining the service or item, the AIC must sign a withdrawal request form with sufficient funds available and debited before the service or item is provided. Upon delivery of the device, any variance from the actual cost will be indebted or credited to the AIC's trust account accordingly. (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. (c) Health Services may consider the following when determining whether to authorize an AIC to purchase a service or item, or whether an AIC must pre-pay or may incur indebtedness to obtain the service or 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. (d ) Except as provided in OAR 291-124- 0041, OAR 291-124-0043 (eyeglasses), OAR 291-124-0044 (hearing aids) and OAR 291-124-0045 (durable medical equipment), an AIC is generally required to pay for elective devices that become the personal property of the AIC. An AIC is not generally required to pay for medical items that are provided for limited -term 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 .) (e) Footwear: Health Services may approve footwear that is not subject to OAR 291-124-0045, on a case-by-case basis. (f ) Health Services may decline to authorize elective devices 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. (g ) 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. (2) 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.