71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 2258
House Bill 2496
Sponsored by Representative KRUSE
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Requires health benefit plans to provide payment or
reimbursement for diabetes related supplies, equipment and
self-management education programs.
A BILL FOR AN ACT
Relating to health insurance coverage; creating new provisions;
amending ORS 750.055 and 750.333; and repealing ORS 743.704.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2001 Act is added to and made
a part of ORS chapter 743. + }
SECTION 2. { + (1)(a) All health benefits plans as defined in
ORS 743.730 must provide payment or reimbursement for supplies,
equipment and diabetes self-management education programs
associated with the treatment of insulin-dependent diabetes,
insulin-using diabetes, gestational diabetes and noninsulin-using
diabetes prescribed by a health care professional legally
authorized to prescribe such items.
(b) Equipment and supplies covered under subsection (1) of this
section include but are not limited to:
(A) Insulin;
(B) Syringes;
(C) Injection aids;
(D) Blood glucose meters;
(E) Test strips for glucose meters and visual reading and urine
test strips;
(F) Insulin pumps and accessories to the insulin pumps;
(G) Insulin infusion devices;
(H) Prescriptive medication for controlling blood sugar levels;
(I) Medical nutrition therapy; and
(J) Diabetes self-management education programs.
(2) Health care professionals with expertise in diabetes must
provide diabetes self-management education programs.
(3) A health benefit plan must cover only an enrollee's first
diabetes self-management education program if the enrollee
successfully completes the program, unless a health care
professional diagnoses a significant change in medical condition
that requires reeducation.
(4) As used in this section, 'diabetes self-management
education programs' means instruction on an outpatient basis for
a person with diabetes to learn the disease and its control. + }
SECTION 3. { + Section 2 of this 2001 Act is exempt from the
automatic repeal provided by ORS 743.700. + }
SECTION 4. { + ORS 743.704 is repealed. + }
SECTION 5. ORS 750.055 is amended to read:
750.055. (1) The following provisions of the Insurance Code
shall apply to health care service contractors to the extent so
applicable and not inconsistent with the express provisions of
ORS 750.005 to 750.095:
(a) ORS 731.004 to 731.150, 731.162, 731.216 to 731.362,
731.382, 731.385, 731.386, 731.390, 731.398 to 731.430, 731.450,
731.454, 731.488, 731.504, 731.508, 731.509, 731.510, 731.511,
731.512, 731.574 to 731.620, 731.592, 731.594, 731.640 to
731.652, 731.730, 731.731, 731.735, 731.737, 731.740, 731.750,
731.804 and 731.844 to 731.992.
(b) ORS 732.215, 732.220, 732.230, 732.245, 732.250, 732.320,
732.325 and 732.517 to 732.592, not including ORS 732.549 and
732.574 to 732.592.
(c)(A) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.620, 733.635 to 733.680 and 733.695 to
733.780 apply to not-for-profit health care service contractors.
(B) ORS chapter 733, not including ORS 733.630, applies to
for-profit health care service contractors.
(d) ORS chapter 734.
(e) ORS 742.001 to 742.009, 742.013, 742.061, 742.065, 742.150
to 742.162, 742.400, 742.520 to 742.540, 743.010, 743.013,
743.018 to 743.030, 743.050, 743.100 to 743.109, 743.402,
743.412, 743.472, 743.492, 743.495, 743.498, 743.522, 743.523,
743.524, 743.526, 743.527, 743.528, 743.529, 743.549 to 743.555,
743.556, 743.560, 743.600 to 743.610, 743.650 to 743.656,
743.693, 743.697, 743.699, 743.701, { - 743.704, - } 743.706
to 743.712, 743.721, 743.722, 743.726, 743.727, 743.728, 743.729,
743.804, 743.807, 743.808, 743.809, 743.814 to 743.839, 743.842,
743.845 and 743.847 { + and section 2 of this 2001 Act + }.
(f) The provisions of ORS chapter 744 relating to the
regulation of agents.
(g) ORS 746.005 to 746.140, 746.160, 746.180, 746.220 to
746.370 and 746.600 to 746.690.
(h) ORS 743.714, except in the case of group practice health
maintenance organizations that are federally qualified pursuant
to Title XIII of the Public Health Service Act unless the patient
is referred by a physician associated with a group practice
health maintenance organization.
(i) ORS 735.600 to 735.650.
(j) ORS 743.680 to 743.689.
(k) ORS 744.700 to 744.740.
(L) ORS 743.730 to 743.773.
(m) ORS 731.485, except in the case of a group practice health
maintenance organization that is federally qualified pursuant to
Title XIII of the Public Health Service Act and that wholly owns
and operates an in-house drug outlet.
(2) For the purposes of this section only, health care service
contractors shall be deemed insurers.
(3) Any for-profit health care service contractor organized
under the laws of any other state which is not governed by the
insurance laws of such state, will be subject to all requirements
of ORS chapter 732.
(4) The Director of the Department of Consumer and Business
Services may, after notice and hearing, adopt reasonable rules
not inconsistent with this section and ORS 750.003, 750.005,
750.025 and 750.045 that are deemed necessary for the proper
administration of these provisions.
SECTION 6. ORS 750.333 is amended to read:
750.333. (1) The following provisions of the Insurance Code
apply to trusts carrying out a multiple employer welfare
arrangement:
(a) ORS 731.004 to 731.150, 731.162, 731.216 to 731.268,
731.296 to 731.316, 731.324, 731.328, 731.378, 731.386, 731.390,
731.398, 731.406, 731.410, 731.414, 731.418 to 731.434, 731.454,
731.484, 731.486, 731.488, 731.512, 731.574 to 731.620, 731.640
to 731.652, 731.804 to 731.992.
(b) ORS 733.010 to 733.050, 733.140 to 733.170, 733.210,
733.510 to 733.680 and 733.695 to 733.780.
(c) ORS chapter 734.
(d) ORS 742.001 to 742.009, 742.013, 742.061 and 742.400.
(e) ORS 743.028, 743.053, 743.524, 743.526, 743.527, 743.528,
743.529, 743.530, 743.560, 743.562, 743.600, 743.601, 743.602,
743.610, 743.693, 743.699, 743.727, 743.728, 743.730 to 743.773
(except 743.760 to 743.773), 743.801, 743.804, 743.807, 743.808,
743.809, 743.814 to 743.839, 743.842, 743.845 and 743.847
{ + and section 2 of this 2001 Act + }.
(f) ORS 743.556, 743.701, 743.703, { - 743.704, - } 743.706,
743.707, 743.709, 743.710, 743.712, 743.713, 743.714, 743.717,
743.718, 743.719, 743.721, 743.722, 743.725 and 743.726. Multiple
employer welfare arrangements to which ORS 743.730 to 743.773
apply are subject to the sections referred to in this paragraph
only as provided in ORS 743.730 to 743.773.
(g) Provisions of ORS chapter 744 relating to the regulation of
agents and insurance consultants, and ORS 744.700 to 744.740.
(h) ORS 746.005 to 746.140, 746.160, 746.180 and 746.220 to
746.370.
(i) ORS 731.592 and 731.594.
(2) For the purposes of this section:
(a) A trust carrying out a multiple employer welfare
arrangement shall be considered an insurer.
(b) References to certificates of authority shall be considered
references to certificates of multiple employer welfare
arrangement.
(c) Contributions shall be considered premiums.
(3) The provision of health benefits under ORS 750.301 to
750.341 shall be considered to be the transaction of health
insurance.
SECTION 7. { + Section 2 of this 2001 Act and the amendments
to ORS 750.055 and 750.333 by sections 5 and 6 of this 2001 Act
apply to health benefit plans issued or renewed on or after the
effective date of this 2001 Act. + }
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