health maintenance organization

  • 1.

    "Health maintenance organization" or "HMO" means a public organization or a private organization organized under the laws of any state that:

    (a) Is a qualified HMO under section 1310 (d) of the U.S. Public Health Services Act; or

    (b)(A) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services:

    (i) Usual physician services;

    (ii) Hospitalization;

    (iii) Laboratory;

    (iv) X-ray;

    (v) Emergency and preventive services; and

    (vi) Out-of-area coverage;

    (B) Is compensated, except for copayments, for the provision of the basic health care services listed in subparagraph (A) of this paragraph to enrolled participants on a predetermined periodic rate basis; and

    (C) Provides physicians' services primarily directly through physicians who are either employees or partners of such organization, or through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis.

    Oregon Legislature 1
  • 2.

    "Health maintenance organization" means any health care service contractor operated on a for-profit or not for-profit basis which:

    (a) Qualifies under Title XIII of the Public Health Service Act; or

    (b)(A) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services:

    (i) Usual physician services;

    (ii) Hospitalization;

    (iii) Laboratory;

    (iv) X-ray;

    (v) Emergency and preventive services; and

    (vi) Out-of-area coverage;

    (B) Is compensated, except for copayments, for the provision of basic health care services listed in subparagraph (A) of this paragraph to enrolled participants on a predetermined periodic rate basis;

    (C) Provides physicians' services primarily directly through physicians who are either employees or partners of such organization, or through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis; and

    (D) Employs the terms "health maintenance organization" or "HMO" in its name, contracts, literature or advertising media on or before July 13, 1985. [Formerly 742.010; 1973 c.515 §5; 1979 c.799 §1; 1985 c.747 §65; 1989 c.783 §4; 1991 c.958 §3; 2003 c.33 §1]

    Oregon Legislature 2