69th OREGON LEGISLATIVE ASSEMBLY--1997 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 1756-1

                         House Bill 2271

Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
  Presession filed (at the request of Representative Sharon Wylie
  for People for Choice in Health Care (PEACH))


                             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 entities furnishing health care services to make
services of all categories of licensed health care providers
available when needed and within scope of practice. Prohibits
direct or indirect discrimination in reimbursement among
different provider categories. Allows patient to require that
person acting to limit service access be person licensed in
particular listed category of health care provider. Establishes
minimum requirements for appeal process when patient is refused
referral to different provider or category of provider.

                        A BILL FOR AN ACT
Relating to nondiscrimination among categories of licensed health
  care providers.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + As used in this section and section 2 of this
Act:
  (1) 'Gatekeeper' means a licensed health care provider who is
responsible for providing primary care case management decision
making services to any patient.
  (2) 'Managed care organization' means any government or private
entity providing health care services in which gatekeepers or
procedures governing access to licensed health care providers are
utilized for the purpose of controlling health care costs.
  (3) 'Patient' means any person to whom health care services are
provided. + }
  SECTION 2.  { + (1) Any government or private entity that is
obligated by law or contract to provide health care services to a
patient shall ensure that:
  (a) The services of all categories of licensed health care
providers are available if those services are needed and within
the scope of practice of the provider;
  (b) Appropriate procedures and qualified persons are in place
to identify patients for whom a particular method of treatment is
not successful; and
  (c) Appropriate procedures and qualified persons are in place
to facilitate the patient's selection of an alternative treatment
or alternative category of licensed health care provider.
  (2) No government or private entity shall directly or
indirectly, by law or contract, discriminate against a category
of licensed health care provider in the reimbursement for
rendering a covered health care service that is within the lawful
scope of practice for the licensed health care provider.
  (3) A patient has the right to choose as a gatekeeper a
licensed health care provider from among any of the following
categories:
  (a) A Doctor of Medicine or Doctor of Osteopathy licensed under
ORS chapter 677;
  (b) A chiropractor licensed under ORS chapter 684;
  (c) A naturopath licensed under ORS chapter 685; or
  (d) A nurse practitioner certified under ORS 678.375.
  (4) If a patient receiving health care services subject to
subsection (1) or (2) of this section is required to obtain a
referral from a particular licensed health care provider or
provider category before obtaining services from another provider
or provider category, the person shall be entitled to appeal the
refusal of a referral. The appeal process shall include at least:
  (a) The right to a review by an appeal panel of the refusal.
  (b) The right to a second review with different individuals.
  (c) The right to appear before the panel and be heard in at
least one of the levels of review.
  (d) An expedited appeal process for emergency cases in which
delay could adversely affect the condition of the patient.
  (5) Nothing in this section is intended to alter the scope of
practice for any licensed health care provider category as that
scope may otherwise be established by law.
  (6) This section does not apply to persons confined in jails,
juvenile facilities or correctional institutions. + }
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