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 3607
House Bill 3846
Sponsored by Representative SIMMONS
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.
Provides patient freedom of choice of health care physician and
primary care physician among all health care physicians.
A BILL FOR AN ACT
Relating to health care.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + As used in sections 1 to 5 of this 2001 Act:
(1) 'Casualty insurance' has the meaning given that term in ORS
731.158.
(2) 'Dental care' means services within the professional scope
of practice of a Doctor of Medical Dentistry or a Doctor of
Dental Science licensed under ORS chapter 679.
(3) 'Enrollee' means an individual who is enrolled in a managed
care plan.
(4) 'Foot care' means services within the professional scope of
practice of a Doctor of Podiatric Medicine licensed under ORS
chapter 677.
(5) 'Health care physician' means a person selected in
accordance with section 3 (2) of this 2001 Act to provide
medical, dental, foot or vision care to an insured person or an
enrollee.
(6) 'Health insurance' has the meaning given that term in ORS
731.162.
(7) 'Insurer' has the meaning given that term in ORS 731.106.
(8) 'Managed care entity' means any person, including, but not
limited to, a health insurer providing health insurance as
defined in ORS 731.162, a health care facility as defined in ORS
442.015, a health care service contractor as defined in ORS
750.005, a preferred provider organization or a third party
administrator who establishes or maintains a network of
participating health care professionals or provides a health
benefit plan as defined in ORS 743.730.
(9) 'Managed care plan' means a plan or policy operated by a
managed care entity that provides payment for or delivery of
health care services to enrollees of a plan with financial
incentives for enrollees to use participating health care
professionals and procedures covered by the plan.
(10) 'Policy' has the meaning given that term in ORS 731.122.
(11) 'Primary care physician' means a health care physician
qualified under section 3 (2) of this 2001 Act and selected by an
enrollee or insured person, when required by the managed care
plan or insurance policy, to coordinate, supervise or provide
ongoing medical care to the patient.
(12) 'Public employee' means an employee of a public employer,
including the State of Oregon and cities, counties, community
colleges, school districts, special districts, mass transit
districts, metropolitan service districts, public service
corporations or municipal corporations and public and
quasi-public corporations in this state.
(13) 'Vision care' means services provided within the
professional scope of practice of a Doctor of Optometry licensed
under ORS chapter 683. + }
SECTION 2. { + (1) All managed care plans offered by a managed
care entity, all health insurance policies and all casualty
insurance policies provided to residents of Oregon shall:
(a) Provide for patient freedom of choice of health care
physician and primary care physician among all physicians
providing medical services within the physician's professional
scope of practice; and
(b) Provide a determination of policy benefits that is unbiased
and independent of a patient's choice of health care physician or
primary care physician, including but not limited to a
determination of the extent and reimbursement, payment and
delivery of medical, dental, foot or vision care.
(2) Notwithstanding subsection (1)(a) of this section,
selection of a primary care physician limits a patient's freedom
of choice to the selected primary care physician and referrals by
the primary care physician to other health care physicians.
Subsection (1)(a) of this section does not limit a patient's
freedom to choose any service or procedure that is considered to
be dental, foot or vision care. + }
SECTION 3. { + (1) All managed care plans offered by a managed
care entity, all health insurance policies and all casualty
insurance policies subject to sections 1 to 5 of this 2001 Act
may require the enrollee or insured person to select a health
care physician from the medical care category described in
subsection (2) of this section as a primary care physician for
medical care. Enrollees and insured persons are permitted to
change primary care physicians at will, except that a managed
care plan, health insurance policy or casualty insurance policy
may restrict the enrollee or insured person to changing primary
care physician not more than twice in a 12-month period.
(2) An enrollee or insured person has the right to select a
health care physician or primary care physician to provide care
for covered services in accordance with the following categories:
(a) For medical services, a Doctor of Medicine or a Doctor of
Osteopathy licensed under ORS chapter 677, or a Doctor of
Chiropractic licensed under ORS chapter 684;
(b) For dental care service, a Doctor of Medical Dentistry or a
Doctor of Dental Science licensed under ORS chapter 679; and
(c) For vision care services, a Doctor of Medicine licensed in
accordance with ORS chapter 677 or a Doctor of Optometry licensed
under ORS chapter 683. + }
SECTION 4. { + Nothing in this 2001 Act is intended to alter
the scope of practice of any licensed health care physician as
that scope may otherwise be established by law. + }
SECTION 5. { + Sections 1 to 5 of this 2001 Act do not apply
to medical services, dental care services or vision care services
provided by the Oregon Medical Assistance Program, the Oregon
Health Plan and student health insurance programs, services
provided under ORS chapter 656, services provided to persons
confined in jails, juvenile facilities or correctional
institutions, managed care plans offered by a managed care entity
and health insurance and casualty insurance policies provided as
employee benefits to public employees in Oregon. + }
SECTION 6. { + The Department of Consumer and Business
Services shall adopt rules necessary to implement and administer
sections 1 to 5 of this 2001 Act. The department shall establish
an advisory committee to assist the department in the development
of the rules. + }
SECTION 7. Sections 1 to 5 of this 2001 Act apply to plans and
policies issued or renewed after the effective date of this 2001
Act.
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