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Compliance Corner

State Updates

OR State Updates - 2015 Jan 06 No.02

October 06, 2015

On Sept. 23, 2015, the Oregon Department of Consumer and Business Services adopted a new temporary rule, OAR 836-010-0014, to provide carriers with guidance for filing expanded transitional health benefit plans. Expanded transitional health benefit plans are plans that are issued to or renewed by an employer with 51 to 100 employees before Jan. 1, 2016. This temporary rule incorporates Exhibit 1 which contains guidance provided to carriers on the process and procedures related to these plans and for rate filings for these plans.

As background, on Jan. 1, 2016, under PPACA, the definition of ‘small group’ changes from 1-50 employees to 1-100 employees, meaning small group plans in the 51-100 group will become subject to many of PPACA’s requirements. However, on March 5, 2014, the CCIIO published a bulletin announcing transition relief for non-PPACA compliant plans with plan years beginning on or before Oct. 1, 2016. The CCIIO transitional policy allows small employers with between 51-100 employees to renew their existing policies and remain in the large group market without violating PPACA.

Effective Jan. 1, 2016, the definition of ‘small group’ set forth in ORS 743.730(29)(a) is modified to mean an employer that employed at least one but not more than 100 employees. The Oregon Legislature enacted Senate Bill 2466 (2015 Regular Session) that allows carriers the option to provide transitional relief to employer groups with 51 to 100 employees. HB 2466 also provides that the division shall adopt rules for determining group size.

The Division has made available on their website separate guidance that covers how small or large group size will be calculated. The calculation method mirrors federal requirements and is being provided immediately to assist carriers in determining the correct placement of employer groups. The division will adopt an administrative rule incorporating this guidance and correcting inconsistencies in existing rules.

Although the rule is directed toward carriers, Oregon employers in the 51-100 group should take notice of the rule and work with their carriers to determine if transitional renewal is an appropriate course of action.

Note that this edition of Compliance Corner includes an article on recent federal legislative developments that could alter PPACA’s definition of ‘small group’. As such, Oregon may alter this temporary rule. We will continue to monitor this issue and will notify you of any developments pertaining to this temporary rule.

As of now, this temporary rule is effective Sept. 23, 2015 through March 18, 2016.

Notice and Procedural Requirements for Expanded Transitional Health Benefit Plans »
Exhibit 1 to OAR 836-010-0014(T) »

OR State Updates - 2015 Jan 06 No.01

October 06, 2015

On Sept. 15, 2015, the Oregon Department of Consumer and Business Services adopted new temporary rules, OAR 836-053-0600, 836-053-0605, 836-053-0610 and 836-053-0615, to implement the provisions of HB 2758 (2015 Regular Session). These rules set forth the requirements imposed on carriers and third party administrators (TPAs) related to the use of the new uniform "Oregon Confidential Communication Request Form".

As background, HB 2758 prohibits carriers and TPAs from disclosing to anyone other than the enrollee receiving services personal information about an enrollee, upon the request of the dependent enrollee. It also specifies procedures for enrollees making a confidential communication request.

HB 2758 specifies that a communication request form must be developed and be available within 90 days after the effective date of the legislation, which is Sept. 16, 2015. Thus, these temporary rules are provided now for immediate direction on the newly developed form. These temporary rules are also being provided as notice to carriers and TPAs of the baseline reporting requirements of information first reportable by Dec. 1, 2015.

These temporary rules are effective Sept. 15, 2015 through March 4, 2016.

ID 08-2015 (temporary): Implementing Requirements of House Bill 2758 Related to Oregon Confidential Communications
Request Form »

Oregon Confidential Communications Request Form »
Oregon Request for Confidential Communication »

OR State Updates - 2015 Jan 25 No.01

August 25, 2015

On Aug.12, 2015, Gov. Brown signed HB 3530 into law, adding Chapter 832 to the Insurance Code. The law prohibits specified terms imposed on vision care providers by vision care insurance or a vision care discount card.

Specifically, contracts between vision care providers and an entity that offers vision care insurance or a vision care discount card may not:

Limit or specify the fee that a vision care provider may charge for vision care services or materials that are not reimbursed, in whole or in part, by the vision care insurance or discount card;

Require a vision care provider to participate in a particular vision care insurance plan or discount card program as a condition for participating in another insurance plan;

Change the terms, the contractual discount or the reimbursement rates under vision care insurance or a vision care discount card without a signed acknowledgment that the vision care provider agrees to the changes; or

Directly or indirectly restrict or limit a vision care provider’s choice of suppliers of materials

This new law also allows the use of a discount card by a patient of a vision care provider if:

The enrollment of the vision care provider is 1) completely voluntary, and 2) not conditioned upon the vision care provider’s participation in any other discount card program with different provider terms and conditions or in another insurance plan.

The discount card program does not reimburse the vision care provider for the cost of the vision care services that were discounted.

The law is effective Jan. 1, 2016.

HB 3530 »

OR State Updates - 2015 Jan 11 No.01

August 11, 2015

On July 27, 2015, Gov. Brown signed SB 841 into law, amending sections 2 and 4 of Chapter 25 of the Oregon insurance code and creating new sections.

The new law requires health benefit plans (as defined in ORS 743.730(18)) that include prescription drug coverage to reimburse the cost of prescription drugs in accordance with the plan’s synchronization policy. ‘Synchronization policy’ means a procedure for aligning the refill dates of a patient’s prescription drugs so prescriptions that are refilled at the same frequency may be refilled concurrently.

Plans must also:

Prorate the copayment or adjust the copayment using a method approved by the Department of Consumer and Business Services for drugs dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills; and

Reimburse fully the dispensing fee for partially filled or refilled prescription drugs.The law specifies that these requirements do not apply to a prepaid group practice health plan with at least 200,000 enrollees in Oregon.

In addition, the law requires the Oregon Health Authority to implement a synchronization policy for dispensing prescription drugs to medical assistance recipients who are not enrolled in coordinated care organizations.

This law is effective Jan. 1, 2016.

SB 841 »

OR State Updates - 2015 Jan 14 No.02

July 14, 2015

On June 10, 2015, Gov. Brown signed SB 144 into law, expanding telemedicine in the state by requiring health plans to cover telemedicine services regardless of where the patient is located. As background, ORS 743A.058 requires a health benefit plan to provide coverage of telemedicine services when services are medically necessary, evidence-based and do not duplicate or supplant what is available in person. The new law amends that section of the Oregon Insurance Code to eliminate the requirement that the plan provide coverage if the health service does not duplicate or supplant a health service available to the patient in person and deletes the originating sites requirement. Additionally, the law does not mandate that insurers compensate providers the same amount for remote visits as it does for an actual visit, but defers to compensation based on the contractual agreement between the parties. The law applies to fully insured group health benefit plans issued or renewed on or after Jan. 1, 2016.

Senate Bill 144 – Chapter 340 »

OR State Updates - 2015 Jan 14 No.01

July 14, 2015

On July 6, 2015, Gov. Brown signed SB 93 into law, requiring fully insured plans to provide reimbursement for up to a 90-day supply of previously dispensed eligible prescription drugs if certain conditions are met. Two such conditions are that the prescription drug is covered by the plan and the quantity of the prescription drug dispensed does not exceed the total remaining quantity of the prescription drug the prescribing practitioner authorized to be dispensed through refills. The law also clarifies that a prescription benefit plan or a prescription drug benefit offered under a health benefit plan determines the reimbursement rates. The provisions of this law apply to contracts entered into or renewed on or after Jan. 1, 2016.

Senate Bill 93 – Chapter 661 »

OR State Updates - 2015 Jan 30 No.05

June 30, 2015

On June 11, 2015, Gov. Brown signed HB 3343 into law, creating Chapter 412 of the 2015 Laws. The law requires plans that provide coverage for prescription drugs to also provide coverage for prescription contraceptives. Plans also must provide coverage for examinations, medical services, outpatient consultations and procedures that are necessary to administer, deliver, dispense, distribute, prescribe or remove prescription contraceptives if plans offer similar coverage for other prescription drugs. ‘Prescription contraceptives’ means drugs and devices that require a prescription and are approved by the federal Food and Drug Administration to prevent pregnancy. Plans must reimburse health-care providers or entities that dispense contraceptives intended to last for a:

Three-month period for the first dispensing of contraceptives to plan participants; and

12-month period for subsequent dispensing of the same contraceptives to plan participants regardless of whether plan participants are plan enrollees at the time of the first dispensing.

There is an exemption for religious employers, including employers that are nonprofit entities organized to promote religious beliefs (such as churches) and primarily employ employees who share employers' beliefs. These types of employers are not required to offer plans or policies that provide contraceptive coverage if contraceptive use conflicts with the employers' religious beliefs. The law is effective Jan. 1, 2016.

Chapter 412 »

OR State Updates - 2015 Jan 30 No.04

June 30, 2015

On June 11, 2015, Gov. Brown signed SB 153 into law, creating Chapter 377 of the Laws of 2015. The legislation requires that plans and policies that provide coverage for services provided by a licensed physician must also provide coverage for those services if provided by a licensed physician assistant or certified nurse practitioner, including prescribing or dispensing drugs, if the services are within the lawful scope of practice of the physician assistant or nurse practitioner.

Plans and policies that provide coverage for services that are within the scope of practice of certified nurse practitioners and licensed physician assistants must provide the same coverage for services performed by certified nurse practitioners and licensed physician assistants in independent practices if plans or policies provide coverage for the same services performed by licensed physicians. Independent practices mean that certified nurse practitioners and licensed physician assistants bill insurers for services performed using:

Diagnosis and procedure codes applicable to services;

Nurse practitioners' or licensed physician assistants’ own names; and

National provider identifier for nurse practitioners and licensed physician assistants and, if required by insurers, facilities in which nurse practitioners and licensed physician assistants provide services.

The law is effective for policies issued on or after Jan. 1, 2016.

Chapter 377 »

OR State Updates - 2015 Jan 30 No.06

June 30, 2015

On June 16, 2015, Gov. Brown signed SB 601 into law, creating Chapter 357 of the 2015 Laws. The law relates to data security breach notification amendments. While Oregon already has the Oregon Consumer Identity Theft Protection Act in place, this legislation updates this Act to expand the definition of “personal information” to include physical characteristics and health insurance policy numbers, as well as any information about a consumer’s mental or physical health, medical history, diagnosis or treatment. Importantly, it requires entities who suffer a data breach of the personal information to notify the Attorney General when the breach affects more than 250 consumers. There is an exception for hospitals or health care plans already covered by HIPAA (such as employers sponsoring self-insured plans). However, such plans must provide a copy of the breach notification to the Oregon Attorney General when the notice is provided to federal regulators. The legislation is effective Jan. 1, 2016.

Chapter 357 »

OR State Updates - 2015 Jan 30 No.02

June 30, 2015

On June 10, 2015, Gov. Brown signed HB 2600 into law, creating Chapter 232 of the 2015 Laws. The law relates to the continuation of group health insurance for employees on family leave. As background, the federal FMLA entitles employees who work for certain employers to take unpaid, job-protected leave for certain family and medical reasons and requires employers to continue providing group health insurance coverage during FMLA leave on the same terms as if they had continued to work. However, the Oregon Family Leave Act (OFLA) does not include the same requirement that the employee’s group health insurance coverage continue during the protected leave. The OFLA requirement applies to employers with 25 or more employees (versus the federal FMLA of 50 or more employees). This legislation aligns OFLA with FMLA’s continuation of group health insurance coverage provisions. Employers subject to OFLA, but too small to be subject to FMLA, should be aware of the requirement to continue an employee’s group health insurance during protected leave. The legislation is effective Jan. 1, 2016.

Chapter 232 »

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