Services provided by certified nurse practitioner or licensed physician assistant
(1) Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician assistant or a certified nurse practitioner if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.
(2)(a) The reimbursement of a service described in subsection (1) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.
(b) As used in this subsection, “independent practice” means the licensed physician assistant or the certified nurse practitioner bills insurers for services provided by the physician assistant or nurse practitioner using the:
(A) Diagnosis and procedure codes applicable to the services;
(B) Physician assistant’s or nurse practitioner’s own name; and
(C) National provider identifier for:
(i) The physician assistant or nurse practitioner; and
(ii) If required by the insurer, the facility in which the physician assistant or nurse practitioner provides the services.
(3) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act or other insurers that employ physicians, licensed physician assistants or certified nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee-for-service basis.
(4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section. [Formerly 743.712; 2013 c.430 §§1,4; 2015 c.377 §1; 2016 c.54 §1]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.