Chapter 743A — Chapter 743A
75 sections in this chapter.
ORS 743A.145 Orthotic and prosthetic devices; rules. (1) As used in this section
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(a) “Device” means: (A) An orthotic device. (B) A prosthetic device. (b) “Orthotic device” means a rigid or semirigid device supporting a weak or deformed leg, foot, arm, hand, back or neck, or restricting or eliminating motion in a diseased or injured leg, foot, arm, hand, back …
ORS 743A.148 Maxillofacial prosthetic services. (1) The Legislative Assembly declares that all group health insurance policies providing hospital, medical or surgical expense benefits, other than limited benefit coverage, include coverage for maxillofacial prosthetic services considered necessary for adjunctive treatment
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(2) As used in this section, “maxillofacial prosthetic services considered necessary for adjunctive treatment” means restoration and management of head and facial structures that cannot be replaced with living tissue and that are defective because of disease, trauma or birth and …
ORS 743A.150 Treatment of craniofacial anomaly. (1) As used in this section, “craniofacial anomaly” means a physical disorder identifiable at birth that affects the bony structures of the face or head, including but not limited to cleft palate, cleft lip, craniosynostosis, craniofacial microsomia and Treacher Collins syndrome
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(2) All health benefit plans, as defined in ORS 743B.005, providing coverage of hospital, surgical or dental services, shall provide coverage for dental and orthodontic services for the treatment of craniofacial anomalies if the services are medically necessary to restore functio…
ORS 743A.160 Alcoholism treatment. A health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide, at the request of the applicant, coverage for expenses arising from treatment for alcoholism. The following conditions apply to the requirement for such coverage
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(1) The applicant shall be informed of the applicant’s option to request this coverage. (2) The inclusion of the coverage may be made subject to the insurer’s usual underwriting requirements. (3) The coverage may be made subject to provisions of the policy that apply to other ben…
ORS 743A.164 [Formerly 743.480; 2017 c.21 §73; repealed by 2017 c.206 §16]
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[Repealed or reserved.]
ORS 743A.168 Behavioral health treatment; qualified providers; rules. (1) As used in this section
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(a) “Behavioral health assessment” means an evaluation by a provider, in person or using telemedicine, to determine a patient’s need for behavioral health treatment. (b) “Behavioral health condition” has the meaning prescribed by rule by the Department of Consumer and Business Se…
ORS 743A.169 Behavioral and physical health services provided on same day or in same facility; behavioral health services provided by behavioral health home specialist or patient centered primary care home specialist. (1) As used in this section
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(a) “Behavioral health home” means an entity providing behavioral health services that the Oregon Health Authority has found to meet the core attributes established under ORS 413.259 for a behavioral health home. (b) “Patient centered primary care home” means an entity providing …
ORS 743A.170 Tobacco use cessation programs. (1) A health benefit plan as defined in ORS 743B.005 must provide payment, coverage or reimbursement of at least $500 for a tobacco use cessation program for a person enrolled in the plan who is 15 years of age or older
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(2) As used in this section, “tobacco use cessation program” means a program recommended by a physician that follows the United States Public Health Service guidelines for tobacco use cessation. “Tobacco use cessation program” includes education and medical treatment components d…
ORS 743A.171 Payment for substance use disorder treatment. (1) As used in this section
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(a) “Group health insurance” has the meaning given that term in ORS 731.098. (b) “Health benefit plan” has the meaning given that term in ORS 743B.005. (c) “Substance use disorder” has the meaning given that term in the fifth edition of the Diagnostic and Statistical Manual of Me…
ORS 743A.175 Traumatic brain injury. (1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage of medically necessary therapy and services for the treatment of traumatic brain injury
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(2) This section is exempt from ORS 743A.001. [2009 c.423 §2]
ORS 743A.180 Tourette Syndrome. For purpose of coverage by group health insurers, health care service contractors and health maintenance organizations, reimbursement for treatment of Tourette Syndrome shall be made on the basis of the diagnosis and treatment modality employed. [Formerly 743.717]
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Note: See 743A.001.
ORS 743A.184 [Formerly 743.694; repealed by 2017 c.206 §16]
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[Repealed or reserved.]
ORS 743A.185 Telemedical health services for treatment of diabetes. (1) As used in this section
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(a) “Health benefit plan” has the meaning given that term in ORS 743B.005. (b) “Originating site” means a location where health services are provided or where the patient is receiving a telemedical health service. (c) “Telemedical” means delivered through a two-way electronic com…
ORS 743A.188 Inborn errors of metabolism. (1) All individual and group health insurance policies providing coverage for hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall include coverage for treatment of inborn errors of metabolism that involve amino acid, carbohydrate and fat metabolism and for which medically standard methods of diagnosis, treatment and monitoring exist, including quantification of metabolites in blood, urine or spinal fluid or enzyme or DNA confirmation in tissues. Coverage shall include expenses of diagnosing, monitoring and controlling the disorders by nutritional and medical assessment, including but not limited to clinical visits, biochemical analysis and medical foods used in the treatment of such disorders
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(2) As used in this section, “medical foods” means foods that are formulated to be consumed or administered enterally under the supervision of a physician, as defined in ORS 677.010, that are specifically processed or formulated to be deficient in one or more of the nutrients pre…
ORS 743A.190 (1) A health benefit plan, as defined in ORS 743B.005, 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
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(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) Prio…
ORS 743A.192 Clinical trials. (1) A health benefit plan, as defined in ORS 743B.005
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(a) Shall provide coverage for the routine costs of the care of patients enrolled in and participating in approved clinical trials; (b) May not exclude, limit or impose additional conditions on the coverage of the routine costs for items and services furnished in connection with …
ORS 743A.250 Emergency eye care services. (1) As used in this section
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(a) “Eye care practitioner” means an optometrist or ophthalmologist licensed by the State of Oregon. (b) “Eye care services” means health care services related to the care of the eye and related structures as specified by a health benefit plan. (c) “Health benefit plan” has the m…
ORS 743A.252 Child abuse assessments. (1) As used in this section
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(a) “Child abuse assessment” has the meaning given that term in ORS 418.782. (b) “Children’s advocacy center” has the meaning given that term in ORS 418.782. (c) “Forensic interview” has the meaning given that term in ORS 418.782. (d) “Health benefit plan” has the meaning given t…
ORS 743A.260 Inmates. (1) As used in this section
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(a) “Detainee” means an insured who is: (A) In the custody of a local supervisory authority pending the disposition of charges; or (B) In a detention facility pending final adjudication by a juvenile court. (b) “Detention facility” has the meaning given that term in ORS 419A.004.…
ORS 743A.262 Preventive health services; cost sharing. Notwithstanding any other provision of law, a health benefit plan that is not a grandfathered health plan
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(1) Must provide coverage of preventive health services as prescribed by the United States Department of Health and Human Services pursuant to 42 U.S.C. 300gg-13 in rules adopted and in effect on January 1, 2023; and (2) May not impose cost-sharing requirements on an enrollee for…
ORS 743A.264 Disease outbreaks, epidemics and conditions of public health importance. (1) As used in this section
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(a) “Condition of public health importance” has the meaning given that term in ORS 431A.005. (b) “Disease outbreak” has the meaning given that term in ORS 431A.005. (c) “Enrollee” means an individual residing in this state who: (A) Is enrolled in a health benefit plan; and (B) Th…
ORS 743A.310 Primary care visits; rules. (1) As used in this section, “primary care” means outpatient behavioral health services, nonspecialty medical services or the coordination of health care for the purpose of
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(a) Promoting or maintaining behavioral and physical health and wellness; and (b) Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness. (2) An individual or group policy or certificate of health insurance that is not offered on th…
ORS 743A.315 Treatment for pediatric autoimmune neuropsychiatric disorders. (1) A health benefit plan, as defined in ORS 743B.005, must cover the cost of up to three monthly immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, when the following conditions have been met
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(a) Clinically appropriate trials, which may be done concurrently, of two or more less-intensive treatments were: (A) Not effective; (B) Not tolerated; or (C) Did not result in sustained improvement in symptoms, as measured by a lack of clinically meaningful improvement on a vali…
ORS 743A.325 Gender-affirming treatment; rules. (1) As used in this section
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(a) “Carrier” has the meaning given that term in ORS 743B.005. (b) “Gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence between the individual’s gende…
ORS 743A.335 Human immunodeficiency virus. (1) An insurer that offers a health benefit plan, as defined in ORS 743B.005, that reimburses the cost of counseling, prevention services or screening for sexually transmitted infections, shall provide coverage for
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(a) Drugs that have been approved by the United States Food and Drug Administration for the prevention of human immunodeficiency virus; (b) Services necessary for the commencement or continuation of human immunodeficiency virus prevention drugs described in this section, includin…