Relating to mandatory health insurance coverage for certain medical conditions; creating new provisions; amending ORS 743.726, 750.055 and 750.333; repealing ORS 743.726; and declaring an emergency.

 
 
 
     72nd OREGON LEGISLATIVE ASSEMBLY--2003 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 1418
 
                           B-Engrossed
 
                         Senate Bill 74
                   Ordered by the House May 9
 Including Senate Amendments dated March 25 and House Amendments
                           dated May 9
 
Printed pursuant to Senate Interim Rule 213.28 by order of the
  President of the Senate in conformance with presession filing
  rules, indicating neither advocacy nor opposition on the part
  of the President (at the request of Joint Interim Committee on
  Judiciary for Senator Peter Courtney)
 
 
                             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.
 
    { - Exempts statute requiring - }   { + Extends + } insurance
coverage of certain metabolic disorders   { - from automatic
repeal provisions - }  { +  until July 3, 2009 + }.
  Declares emergency, effective July 3, 2003.
 
                        A BILL FOR AN ACT
Relating to mandatory health insurance coverage for certain
  medical conditions; creating new provisions; amending ORS
  743.726, 750.055 and 750.333; repealing ORS 743.726; and
  declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 743.726 is amended to read:
  743.726. (1) All individual and group health insurance policies
providing coverage for hospital, medical or surgical expenses,
other than coverage limited to expenses from accidents or
specific diseases, shall include coverage for treatment of inborn
errors of metabolism that involve amino acid, carbohydrate and
fat metabolism and for which medically standard methods of
diagnosis, treatment and monitoring exist, including
quantification of metabolites in blood, urine or spinal fluid or
enzyme or DNA confirmation in tissues. Coverage shall include
expenses of diagnosing, monitoring and controlling the disorders
by nutritional and medical assessment, including but not limited
to clinical visits, biochemical analysis and medical foods used
in the treatment of such disorders.
  (2) As used in this section, 'medical foods' means foods that
are formulated to be consumed or administered enterally under the
supervision of a physician, as defined in ORS 677.010, that are
specifically processed or formulated to be deficient in one or
more of the nutrients present in typical nutritional
counterparts, that are for the medical and nutritional management
of patients with limited capacity to metabolize ordinary
foodstuffs or certain nutrients contained therein or have other
specific nutrient requirements as established by medical
evaluation and that are essential to optimize growth, health and
metabolic homeostasis.
   { +  (3) This section is exempt from ORS 743.700. + }
 { +  + }
  SECTION 2.  { + ORS 743.726 is repealed on July 3, 2009. + }
  SECTION 3. 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 705.137, 705.139, 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, 731.428, 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,
731.750, 731.752, 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, 743.694, 743.697, 743.699, 743.701, 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, 743.847,
743.854, 743.856, 743.857, 743.858, 743.859, 743.861, 743.862,
743.863, 743.864, 743.866 and 743.868.
  (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 4. 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, 743.694, 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, 743.847,
743.854, 743.856, 743.857, 743.858, 743.859, 743.861, 743.862,
743.863 and 743.864.
  (f) ORS 743.556, 743.701, 743.703, 743.706, 743.707, 743.709,
743.710, 743.712, 743.713, 743.714, 743.717, 743.718, 743.719,
743.721, 743.722  { - , - }  { +  and + } 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 5.  { + The amendments to ORS 750.055 and 750.333 by
sections 3 and 4 of this 2003 Act become operative on July 3,
2009. + }
  SECTION 6.  { + If this 2003 Act does not become effective
until after July 3, 2003, the amendments to ORS 743.726 by
section 1 of this 2003 Act revive ORS 743.726. If this 2003 Act
does not become effective until after July 3, 2003, this 2003 Act
shall be operative retroactively to that date, and the operation
and effect of ORS 743.726 shall continue unaffected from July 3,
2003, to the effective date of this 2003 Act and thereafter. Any
otherwise lawful action taken or otherwise lawful obligation
incurred under the authority of ORS 743.726 after July 3, 2003,
and before the effective date of this 2003 Act, is ratified and
approved. + }
  SECTION 7.  { + This 2003 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2003 Act takes effect July 3,
2003. + }
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