Oregon Bulletin
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.
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