ORS 743A.190
Children with pervasive developmental disorder


(1)

A health benefit plan, as defined in ORS 743B.005 (Definitions), must cover for a child enrolled in the plan who is under 18 years of age and who has been diagnosed with a pervasive developmental disorder all medical services, including rehabilitation services, that are medically necessary and are otherwise covered under the plan.

(2)

The coverage required under subsection (1) of this section, including rehabilitation services, may be made subject to other provisions of the health benefit plan that apply to covered services, including but not limited to:

(a)

Deductibles, copayments or coinsurance;

(b)

Prior authorization or utilization review requirements; or

(c)

Treatment limitations regarding the number of visits or the duration of treatment.

(3)

As used in this section:

(a)

“Medically necessary” means in accordance with the definition of medical necessity that is specified in the policy, certificate or contract for the health benefit plan and that applies uniformly to all covered services under the health benefit plan.

(b)

“Pervasive developmental disorder” means a neurological condition that includes autism spectrum disorder, developmental delay, developmental disability or mental retardation.

(c)

“Rehabilitation services” means physical therapy, occupational therapy or speech therapy services to restore or improve function.

(4)

The provisions of ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) do not apply to this section.

(5)

The definition of “pervasive developmental disorder” is not intended to apply to coverage required under ORS 743A.168 (Behavioral health treatment) or section 2, chapter 771, Oregon Laws 2013. [2007 c.872 §2; 2013 c.771 §7]
Note: The amendments to 743A.190 (Children with pervasive developmental disorder) by section 20, chapter 771, Oregon Laws 2013, become operative January 2, 2030. See section 24, chapter 771, Oregon Laws 2013, as amended by section 6, chapter 674, Oregon Laws 2015, and section 2, chapter 650, Oregon Laws 2021. The text that is operative on and after January 2, 2030, is set forth for the user’s convenience.
743A.190 (Children with pervasive developmental disorder). (1) A health benefit plan, as defined in ORS 743B.005 (Definitions), must cover for a child enrolled in the plan who is under 18 years of age and who has been diagnosed with a pervasive developmental disorder all medical services, including rehabilitation services, that are medically necessary and are otherwise covered under the plan.

(2)

The coverage required under subsection (1) of this section, including rehabilitation services, may be made subject to other provisions of the health benefit plan that apply to covered services, including but not limited to:

(a)

Deductibles, copayments or coinsurance;

(b)

Prior authorization or utilization review requirements; or

(c)

Treatment limitations regarding the number of visits or the duration of treatment.

(3)

As used in this section:

(a)

“Medically necessary” means in accordance with the definition of medical necessity that is specified in the policy, certificate or contract for the health benefit plan and that applies uniformly to all covered services under the health benefit plan.

(b)

“Pervasive developmental disorder” means a neurological condition that includes autism spectrum disorder, developmental delay, developmental disability or mental retardation.

(c)

“Rehabilitation services” means physical therapy, occupational therapy or speech therapy services to restore or improve function.

(4)

The provisions of ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) do not apply to this section.

(5)

The definition of “pervasive developmental disorder” is not intended to apply to coverage required under ORS 743A.168 (Behavioral health treatment).
Note: 743A.190 (Children with pervasive developmental disorder) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743A.190 — Children with pervasive developmental disorder, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html.

743A.001
Automatic repeal of certain statutes on individual and group health insurance
743A.010
Services provided by state hospital or state approved program
743A.012
Emergency services
743A.014
Payments for ambulance care and transportation
743A.018
Services provided by osteopathic physician
743A.020
Services provided by acupuncturist
743A.024
Services provided by clinical social worker
743A.028
Services provided by denturist
743A.032
Surgical services provided by dentist
743A.034
Services provided by expanded practice dental hygienist
743A.036
Services provided by licensed nurse practitioner or licensed physician assistant
743A.040
Services provided by optometrist
743A.044
Services provided by physician assistant
743A.048
Services provided by psychologist
743A.051
Services provided by pharmacist
743A.052
Services provided by professional counselor or marriage and family therapist
743A.058
Telemedicine services
743A.060
Definition for ORS 743A.062
743A.062
Prescription drugs
743A.063
Ninety-day supply of prescription drug refills
743A.064
Prescription drugs dispensed at rural health clinics
743A.065
Early refills of prescription eye drops for treatment of glaucoma
743A.066
Contraceptives
743A.067
Reproductive health services
743A.068
Orally administered anticancer medication
743A.069
Insulin
743A.070
Nonprescription enteral formula for home use
743A.078
Newborn nurse home visiting services
743A.080
Pregnancy and childbirth expenses
743A.082
Diabetes management for pregnant women
743A.084
Unmarried women and their children
743A.088
Use by mother of diethylstilbestrol
743A.090
Natural and adopted children
743A.100
Mammograms
743A.104
Pelvic examinations and Pap smear examinations
743A.105
HPV vaccine
743A.108
Physical examination of breast
743A.110
Mastectomy-related services
743A.111
Consumer education about post-mastectomy services
743A.124
Colorectal cancer screenings and laboratory tests
743A.130
Proton beam therapy
743A.140
Bilateral cochlear implants
743A.141
Hearing aids and hearing assistive technology systems
743A.148
Maxillofacial prosthetic services
743A.150
Treatment of craniofacial anomaly
743A.160
Alcoholism treatment
743A.168
Behavioral health treatment
743A.170
Tobacco use cessation programs
743A.175
Traumatic brain injury
743A.180
Tourette Syndrome
743A.185
Telemedical health services for treatment of diabetes
743A.188
Inborn errors of metabolism
743A.190
Children with pervasive developmental disorder
743A.192
Clinical trials
743A.250
Emergency eye care services
743A.252
Child abuse assessments
743A.260
Inmates
743A.262
Preventive health services
743A.264
Disease outbreaks, epidemics and conditions of public health importance
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