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Oregon Bulletin

January 1, 2012

 

Department of Consumer and Business Services,
Insurance Division
Chapter 836

Rule Caption: Registration of Contracting Entity that Enters into Contracts for Provider Leasing.

Adm. Order No.: ID 18-2011

Filed with Sec. of State: 11-16-2011

Certified to be Effective: 1-1-12

Notice Publication Date: 10-1-2011

Rules Adopted: 836-200-0250, 836-200-0255

Subject: This rulemaking establishes the process for a contracting entity that is not operating under a certificate of authority or license issued by the Department of Consumer and Business Services (DCBS) to register with DCBS. A contracting entity is a person that contracts directly with a provider for the delivery of health care services or contracts with a third party for the purposes of selling or making available to the third party the provider’s health care services or discounted rates or the services or rates of a provider panel under a provider network contract. If the contracting entity is not an authorized insurer or licensee operating under a certificate of authority or license issued by DCBS, the contracting entity is required to register annually with DCBS.

Rules Coordinator: Sue Munson—(503) 947-7272

836-200-0250

Purpose and Authority

OAR 836-200-0255 is adopted to implement the provisions of Section 3, chapter 561, Oregon Laws 2011. OAR 836-014-0255 applies to a contracting entity as defined in Section 1, chapter 561, Oregon Laws 2011 (Enrolled Senate Bill 634) other than an entity operating under a certificate of authority or license issued by the Department of Consumer and Business Services that enters into or renews a contract subject to Section 4, chapter 561, Oregon Laws 2011 on or after January 1, 2012.

Stat. Auth.: ORS 731.244 & sec. 3, ch. 561, OL 2011 (Enrolled SB 634)

Stat. Implemented.: Sec. 1 to 5, ch. 561, OL 2011 (Enrolled SB 634))

Hist.: ID 18-2011, f. 11-16-11, cert. ef. 1-1-12

836-200-0255

Registration of Contracting Entity

(1) A contracting entity, as defined in Section 1, chapter 561, Oregon Laws 2011 (Enrolled Senate Bill 634), that is not operating under a certificate of authority or license issued by the Department of Consumer and Business Services shall register annually with the Department of Consumer and Business Services by submitting the following information to the department in the manner requested by the Director, along with a $150 fee:

(a) The official name of the entity and any secondary, alternative or substitute designations;

(b) The mailing address and telephone number of the headquarters of the entity; and

(c) The name and phone number of a representative of the entity who shall serve as the primary contact for the department.

(2) The requirements of this rule do not apply to a contracting entity that is under common ownership and control of a contracting entity that is licensed by or has a certificate of authority from the department.

Stat. Auth.: ORS 731.244 & sec. 3, ch. 561, OL 2011 (Enrolled SB 634)

Stat. Implemented.: Sec. 1 to 5, ch. 561, OL 2011 (Enrolled SB 634))

Hist.: ID 18-2011, f. 11-16-11, cert. ef. 1-1-12

 

Rule Caption: Certified Retainer Medical Practices Application, Renewal and Disclosure Requirements.

Adm. Order No.: ID 19-2011

Filed with Sec. of State: 11-29-2011

Certified to be Effective: 1-1-12

Notice Publication Date: 10-1-2011

Rules Adopted: 836-200-0300, 836-200-0305, 836-200-0310, 836-200-0315

Subject: These rules implement Chapter 499, Oregon Laws 2011 (Enrolled Senate Bill 86). Senate Bill 86 creates an exemption from the Insurance Code for certified retainer medical practices. To be certified, a retainer medical practice must submit an application to the Department of Consumer and Business Services (DCBS) and meet certain criteria. These rules establish a certification framework that includes the process and requirements for applying for initial certification and a process to renew the certification. The rules also include provisions to clarify the statutory patient disclosure requirements and add one additional disclosure requirement.

Rules Coordinator: Sue Munson—(503) 947-7272

836-200-0300

Statement of Purpose; Authority

OAR 836-200-0300 to 836-200-0315 are adopted by the Director of the Department of Consumer and Business Services pursuant to sections 2 and 3, chapter 499, Oregon Laws 2011 (Enrolled Senate Bill 86). The purpose of OAR 836-200-0300 to 836-200-0315 is to establish the requirements for initial certification, disclosure requirements and certification renewal, for a retainer medical practice.

Stat. Auth.: ORS 731.244 & sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Stats. Implemented: sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Hist.: ID 19-2011, f. 11-29-11, cert. ef. 1-1-12

836-200-0305

Retainer Medical Practice Application for Certification

(1) The Director of the Department of Consumer and Business Services may certify a retainer medical practice for a period of one year or more, if the applicant:

(a) Acts in accordance with the attestations required by paragraph (c) of this section;

(b) Complies with and meets the requirements of OAR 836-200-0300 to 836-200-0315 and sections 2 and 3, chapter 499, Oregon Laws 2011 (Enrolled Senate Bill 86); and

(c) Completes and submits to the satisfaction of the director a retainer medical practice application as set forth on the website for the Insurance Division of the Department of Consumer and Business Services at www.insurance.oregon.gov. As required on the form, the applicant shall:

(A) Attest to the following:

(i) Under the retainer medical agreement providers providing services are licensed or certified under ORS chapters 677, 678, 684, or 685 and the services provided will be limited to primary care services allowed within the scope of such licenses or certifications.

(ii) The applicant is not and has never been authorized in this or any other state to transact insurance or act as an insurer, managed care organization, health care services contractor, or similar entity;

(iii) The applicant is not controlled by any person described in subparagraph (ii) of this paragraph;

(iv) The applicant will structure the retainer medical practice to ensure that all services promised under the retainer medical agreement are within the capacity of the practice to provide in a timely manner;

(v) The applicant is financially responsible and has the necessary business experience or expertise to operate the practice;

(vi) The applicant will not discriminate based on race, religion, gender, sexual identity, sexual preference, or health status;

(vii) The applicant is authorized to conduct business in the State of Oregon and has complied with all registration requirements of this State; and

(viii) The information provided in the application and all supplemental and additional information is true and complete, and the applicant will submit to the jurisdiction of the courts of the State of Oregon.

(B) Establish to the satisfaction of the director that the applicant is financially responsible. To establish that an applicant is financially responsible, the applicant must provide all of the following:

(i) A statement of whether the applicant has filed for bankruptcy during the 25- year period prior to the application or renewal.

(ii) The applicant’s business plan, including a discussion of how the applicant intends to monitor the practice to ensure the services promised under the retainer medical agreement are provided in a timely manner. The plan must include a clear description of how the retainer medical practice will ensure repayment of retainer medical fees paid in advance if the retainer medical practice is unable to provide the services promised under the retainer medical agreement.

(iii) A copy of any marketing materials and the retainer medical agreement that will be used for the 12-month certification period and each subsequent renewal. The agreement must include provisions that obligate the retainer medical practice to reimburse retainer medical patients for retainer medical fees paid in advance in the event the retainer medical practice is unable to provide services promised under the retainer medical agreement.

(C) Establish that the applicant has the necessary experience and expertise to operate a retainer medical practice by providing all of the following:

(i) The name of any other jurisdiction in which the applicant currently holds a license, registration or certification to transact business as a retainer medical practice or similar entity, or has held such a license or certification within ten years prior to the date of the application.

(ii) A statement of whether any license or registration of the applicant or any person with control of the applicant has ever been denied, suspended, revoked or not renewed in this or any other state and whether the applicant or any person with control of the applicant has otherwise ever been the subject of an enforcement action taken by a licensing or registration agency. For any action taken, the applicant shall provide the name and address of the licensing or registration agency, the date of the action taken against the license or registration and a description of the reason for the action taken against the license or registration.

(iii) A biographical affidavit in the form and manner prescribed by the director, completed by each member of the board of directors, executive committee, or other governing board or committee of the applicant; and

(iv) A statement describing the background or training of the applicant that provides the necessary business experience or expertise to operate a retainer medical practice. The statement shall include the number of years the applicant has been in practice. The statement may also include a description of any similar business the applicant has operated, how many years the applicant operated the similar business and any pertinent training or experience the applicant has completed that has allowed the applicant to develop the necessary experience or expertise to operate a practice. The experience need not be specific to a retainer medical practice.

(D) Provide the names and Oregon license numbers of all providers providing services through the medical retainer practice.

(E) Provide the physical and mailing address, telephone number, facsimile number, email address and website address for each location providing retainer medical services.

(F) Provide the name and address for service of process for the retainer medical practice.

(G) Provide the name, mailing address, telephone number, signature and email address of the person completing the application on behalf of the applicant.

(H) Provide all names, including assumed business names, under which the retainer medical practice will operate, market or otherwise do business.

(2)(a) A retainer medical practice certification issued on or before February 1 of any given year is valid through January 31 of the following year.

(b) A retainer medical practice certification issued after February 1 of any given year is valid through January 31 of the second year following the year of certification.

Stat. Auth.: ORS 731.244 & sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Stats. Implemented: ORS 731.244, sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Hist.: ID 19-2011, f. 11-29-11, cert. ef. 1-1-12

836-200-0310

Retainer Medical Practice Application for Renewal

(1) The director may renew a retainer medical practice certification if the practice complies with all of the following:

(a) The retainer medical practice completes and submits to the satisfaction of the director a retainer medical practice renewal application as set forth on the website for the Insurance Division of the Department of Consumer and Business Services at www.insurance.oregon.gov. The renewal application must be submitted annually before February 1 of each year in accordance with OAR 836-200-0305(2).

(b) The retainer medical practice acts in accordance with the attestations required by OAR 836-200-0305(1).

(c) The retainer medical practice shall provide with the renewal application, the following information for the prior calendar year through December 31:

(A) The total number of retainer medical patients under agreement with the retainer medical practice;

(B) The total number of retainer medical patients that voluntarily terminated the retainer medical agreement;

(C) The total number of patients with whom the retainer medical practice terminated an agreement and the reasons for the terminations;

(D) The total number of applicants declined by the retainer medical practice and the reasons for the declinations; and

(E) Any changes to the information submitted on the applicant’s original application for certification.

(2) The director shall use the information required by section (1) of this rule to determine whether the retainer medical practice meets the requirements of, and complies with, section 2, chapter 499, Oregon Laws 2011 (Enrolled Senate Bill 86) for purposes of renewing a certification.

(3) A renewal certification shall be for a period of one year.

Stat. Auth.: ORS 731.244 & sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Stats. Implemented: ORS 731.244, sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Hist.: ID 19-2011, f. 11-29-11, cert. ef. 1-1-12

836-200-0315

Disclosures; Form and Contents

(1) The disclosures required by Section 2(4), chapter 499, Oregon Laws 2011 shall be in 12-point font or larger, on the first content page of marketing materials, including websites, and in the first content page of contracts with retainer medical patients, including the retainer medical agreement.

(2) In addition to the disclosures required by Section 2(4), chapter 499, Oregon Laws 2011, a retainer medical practice shall make the following written information available to retainer medical patients and prospective retainer medical patients by prominently disclosing, in 12-point font or larger, in all marketing materials, including websites and in the medical retainer agreement:

(a) “The Department of Consumer and Business Services issued a certification to this practice. You can contact consumer advocates at the Department of Consumer and Business Services at (888) 977-4894, dcbs.insmail@state.or.us, or www.insurance.oregon.gov.”;

(b) A statement explaining the retainer medical practice’s cancellation and refund policy;

(c) A statement explaining how fees are charged by the retainer medical practice; and

(d) A list of services included for the fees charged.

Stat. Auth.: ORS 731.244 & sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Stats. Implemented: ORS 731.244, sec. 2, 3, ch. 499, OL 2011 (Enrolled SB 86)

Hist.: ID 19-2011, f. 11-29-11, cert. ef. 1-1-12

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2011.

2.) Copyright 2012 Oregon Secretary of State: Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

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