2017 ORS 743B.197¹
Health Care Consumer Protection Advisory Committee

The Director of the Department of Consumer and Business Services shall appoint a Health Care Consumer Protection Advisory Committee with fair representation of health care consumers, providers and insurers. The committee shall advise the director regarding the implementation of ORS 743.008 (Reporting requirements), 743A.012 (Emergency services), 743B.001 (Definitions), 743B.195 (Enforcement of Newborns’ and Mothers’ Health Protection Act of 1996), 743B.197 (Health Care Consumer Protection Advisory Committee), 743B.200 (Requirements for insurers offering managed health insurance), 743B.202 (Requirements for insurers offering managed health or preferred provider organization insurance), 743B.204 (Required managed health insurance contract provision), 743B.220 (Requirements for insurers that require designation of participating primary care physician), 743B.250 (Required notices to applicants and enrollees), 743B.400 (Decisions regarding health care facility length of stay, level of care and follow-up care), 743B.403 (Insurer prohibited practices), 743B.405 (Medical services contract provisions), 743B.420 (Prior authorization requirements), 743B.422 (Utilization review requirements for medical services contracts to which insurer not party), 743B.423 (Utilization review requirements for insurers offering health benefit plan), 743B.424 (Applicability) and 743B.550 (Disclosure of information) and other issues related to health care consumer protection. [Formerly 743.827; 2017 c.101 §55; 2017 c.384 §11]

Note: Sections 2 and 32, chapter 515, Oregon Laws 2015, provide:

Sec. 2. (1) As used in this section:

(a) “Carrier” has the meaning given that term in ORS 743.730 [renumbered 743B.005 (Definitions)].

(b) “Grandfathered health plan” has the meaning given that term in ORS 743.730.

(c) “Health benefit plan” has the meaning given that term in ORS 743.730.

(d) “Transitional grandfathered health benefit plan” means a grandfathered health plan that is issued or renewed by an employer with 51 to 100 employees.

(e) “Transitional health benefit plan” means a health benefit plan, other than a grandfathered health plan, that is:

(A) Before January 1, 2016, issued to or renewed by an employer with 51 to 100 employees on the date the plan is issued or renewed;

(B) In effect on December 31, 2015; and

(C) According to published federal guidance, not subject to enforcement by the United States Department of Health and Human Services, the United States Department of Labor or the United States Department of the Treasury, for compliance with the requirements of:

(i) 42 U.S.C. 300gg;

(ii) 42 U.S.C. 300gg-1;

(iii) 42 U.S.C. 300gg-2;

(iv) 42 U.S.C. 300gg-5;

(v) 42 U.S.C. 300gg-6; and

(vi) 42 U.S.C. 300gg-8.

(2) A transitional health benefit plan and a transitional grandfathered health benefit plan are not subject to the requirements:

(a) In ORS 742.005 (Grounds for disapproval of policy forms) (6) unless otherwise required by rule by the Department of Consumer and Business Services;

(b) In ORS 743.736 [renumbered 743B.012 (Requirement to offer all health benefit plans to small employers)];

(c) In ORS 743.737 (1)(a), (8), (10) and (11) [renumbered 743B.013 (Requirements for small employer health benefit plans) (1)(a), (8), (10) and (11)]; and

(d) Imposing limitations on participation and contribution rates contained in ORS 743.737.

(3) On and after January 1, 2016, each transitional health benefit plan shall be renewable with respect to all eligible enrollees at the option of the policyholder, employer or contract holder unless the carrier discontinues both offering and renewing the health benefit plan in this state or in a specified service area within this state, other than a plan discontinued in a specified service area within this state:

(a) Because of the inability to reach an agreement with the health care providers or organization of health care providers to provide services under the plan within the service area;

(b) That gives notice of the decision to discontinue the plan to the Department of Consumer and Business Services and to all policyholders covered by the plan;

(c) That does not cancel coverage under the plan for 90 days after the date of the notice required under paragraph (b) of this subsection; and

(d) That offers in writing to each policyholder covered by the plan, all other group health benefit plans that the carrier offers in the specified service area. The carrier shall offer the plans at least 90 days prior to discontinuation.

(4) ORS 743.752 (2) [renumbered 743B.104 (Coverage in group health benefit plans) (2)] does not apply when a carrier discontinues a group health benefit plan due to the change in the definition of “small employer” from an employer with a maximum of 50 employees to an employer with a maximum of 100 employees.

(5) The Department of Consumer and Business Services may modify the requirements of this section or extend or delay the operative date of this section to the extent necessary to comply with published federal guidance described in subsection (1)(e)(C) of this section.

(6) No later than September 1, 2018, the department shall report to the appropriate interim committees of the Legislative Assembly on whether the repeal of this section by section 32 of this 2015 Act should be extended to a later date. [2015 c.515 §2]

Sec. 32. Section 2 of this 2015 Act is repealed on January 2, 2020. [2015 c.515 §32]

1 Legislative Counsel Committee, CHAPTER 743B—Health Benefit Plans: Individual and Group, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors743B.­html (2017) (last ac­cessed Mar. 30, 2018).
 
2 OregonLaws.org contains the con­tents of Volume 21 of the ORS, inserted along­side the per­tin­ent statutes. See the preface to the ORS An­no­ta­tions for more information.
 
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.