74th OREGON LEGISLATIVE ASSEMBLY--2007 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 2118
Senate Bill 407
Sponsored by Senator MORRISETTE
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 from among all health care physicians.
Requires insurance to cover chiropractic physician services.
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 6 of this 2007 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 dentist 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 podiatric physician and surgeon licensed under ORS
chapter 677.
(5) 'Health care physician' means a person selected in
accordance with section 3 (2) of this 2007 Act to provide
medical, dental, foot or vision care to an enrollee or insured
person.
(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, 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 that 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 services 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 2007 Act and selected by an
enrollee or insured person, when required by the managed care
plan or health insurance policy, to coordinate, supervise or
provide ongoing medical care to the enrollee or insured person.
(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 an optometrist 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 from among all health care
physicians providing medical services within the physicians'
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, that includes, but is 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 medical, 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 6 of this 2007 Act
may require an 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. 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 physicians 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 medical
care categories:
(a) For medical services, a physician or osteopathic physician
licensed under ORS chapter 677, or a chiropractic physician
licensed under ORS chapter 684;
(b) For dental care service, a dentist licensed under ORS
chapter 679; and
(c) For vision care services, a physician licensed under ORS
chapter 677 or an optometrist licensed under ORS chapter 683. + }
SECTION 4. { + Nothing in sections 1 to 6 of this 2007 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. { + (1) All individual and group health insurance,
and policies providing coverage for hospital, medical or surgical
expenses other than coverage limited to specific diseases or
other limited benefit coverage, shall include coverage for any
clinically necessary health care service that is within the
lawful scope of practice of a chiropractic physician licensed
under ORS chapter 684, except that health insurers may:
(a) Limit coverage of adjunctive therapies to physiotherapy
modalities and rehabilitative exercises;
(b) Deny coverage for the treatment of any visceral condition
arising from problems or dysfunctions of the abdominal or
thoracic organs; or
(c) Impose reasonable deductibles, copayments, coinsurance, fee
limits, practice parameters and utilization review to the extent
that they are applied to the same services when provided by other
health care physicians.
(2) Nothing in this section is intended to limit the provision
or coverage of health care services that are within the lawful
scope of practice of licensed chiropractic physicians who are
employees or staff in hospital facilities. + }
SECTION 6. { + Sections 1 to 6 of this 2007 Act do not apply
to:
(1) Medical services, dental care services or vision care
services provided by state medical assistance programs, student
health insurance programs, services provided under ORS chapter
656 or services provided to persons confined in jails, juvenile
facilities or correctional institutions; or
(2) Managed care plans offered by managed care entities and
health insurance and casualty insurance policies provided as
employee benefits to public employees in Oregon. + }
SECTION 7. { + The Director of the Department of Consumer and
Business Services shall adopt rules necessary to implement and
administer sections 1 to 6 of this 2007 Act. The director shall
establish an advisory committee to assist the director in the
development of the rules. + }
SECTION 8. Sections 1 to 6 of this 2007 Act apply to managed
care plans and health or casualty insurance policies issued or
renewed on or after the effective date of this 2007 Act.
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