Definition


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Legislation Signed into Law

2018

Primary Focus Mandated Benefit: SUD
Title/Description Treatment of chemical dependency, including alcoholism, and mental or nervous conditions; rules
Citation ORS § 743A.168
Summary

A group health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide coverage for expenses arising from the diagnosis of and treatment for chemical dependency, including alcoholism, and for mental or nervous conditions at the same level as, and subject to limitations no more restrictive than, those imposed on coverage or reimbursement of expenses arising from treatment for other medical conditions.
ORS § 743A.168 also sets out definitions as well as related provisions with regard to the coverage.

Effective Date 1/1/2018
Notes

Formerly 743.556. Amended by Ore. HB 3091.

2017

Primary Focus Access to services/Eligibility
Title/Description Provider networks; rules
Citation ORS § 743B.505
Summary

An insurer offering a health benefit plan in this state that provides coverage to individuals or to small employers, as defined under the law, through a specified network of health care providers shall:
(a) Contract with or employ a network of providers that is sufficient in number, geographic distribution and types of providers to ensure that all covered services under the health benefit plan, including mental health and substance abuse treatment, are accessible to enrollees without unreasonable delay.

Effective Date 5/25/2017
Notes

Amended by Ore. HB 2341.

SB 860
Introduced 2/2017
Sponsor Health Care
Status Signed into Law 8/2017
Summary

This bill changed the section of state insurance law so that the Department of Consumer and Business Services must do the following:

  • Examine historical data to determine if insurers were paying in-network behavioral health providers reimbursement rates that were “equivalent” to those in place for in-network medical providers.
  • Examine insurers to determine if utilization management practices for outpatient behavioral health care was more restrictive than utilization management practices for other medical outpatient care, particularly regarding the approval or denial of outpatient sessions of longer duration.
  • Examine if insurers pay “equivalent” reimbursement rates for time-based procedural codes for both in-network behavioral health providers and in-network medical providers.
  • Examine whether the methodology insurers use to set reimbursement rates for in-network behavioral health providers was equivalent to the methodology used to set reimbursement rates for in-network medical providers.
  • Submit a report documenting the results of the above examinations by September 1, 2019.

The bill authorized a maximum of $600,000 to fund the examinations and report above.

2015

HB 2468
Introduced 1//2015
Sponsor Office of the Governor
Status Signed into Law 5/2015
Summary

This bill changed the section of state insurance law so that insurance plans had to meet health care provider network standards. Among other things, the bill requires that a plan’s provider network have a sufficient number, geographic distribution, and type of providers to ensure access to covered services. The bill specifically mentions that mental health and substance use treatment must be accessible.

2013

SB 365
Introduced 1/2013
Sponsor Rep. Conger, Sen. Devlin, Rep. McLane, Rep. Parrish, Sen. Hass, and Sen. Johnson
Status Signed into Law 8/2013
Summary This bill changed the section of the state insurance law about autism coverage to what it is currently, particularly the requirements about applied behavior analysis. Scroll to the bottom of the page to read the summary of this section of the law.
HB 2385
Introduced 1/2013
Sponsor Rep. Barnhart and Rep. Greenlick
Status Signed into Law 6/2013
Summary This bill changed the parity section of the state insurance law so that insurance plans are no longer exempt from covering court-ordered services that are the result of a conviction for driving while intoxicated.

2011

Primary Focus Parity: General
Title/Description Services provided by psychologist
Citation ORS § 743A.048
Summary

Whenever any provision of any individual or group health insurance policy or contract provides for payment or reimbursement for any service which is within the lawful scope of a licensed psychologist:
(1) The insured under such policy or contract shall be free to select, and shall have direct access to, a licensed psychologist, without supervision or referral by a physician or another health practitioner, and wherever such psychologist is authorized to practice.
(2) The insured under such policy or contract shall be entitled to have payment or reimbursement made to the insured or on the insured’s behalf for the services performed.

Notes Formerly 743.709.
HB 2103
Introduced 1/2011
Sponsor Requested by the Oregon Health Authority
Status Signed into Law 6/2011
Summary This bill changed state law so that court-ordered services that are the result of a conviction for driving while intoxicated can be covered by Medicaid, if the services are medically necessary.

2009

HB 2506
Introduced 2/2009
Sponsor Rep. Buckley
Status Signed into Law 6/2009
Summary This bill changed state law so that if a plan provides coverage for services offered by a clinical social worker, the plan must also cover services provided by a professional counselor or marriage and family therapist.

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