Bill Text: OR HB2724 | 2013 | Regular Session | Introduced

---

Bill Title: Relating to health care offered through a retainer practice; declaring an emergency.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [HB2724 Detail]

Download: Oregon-2013-HB2724-Introduced.html

---

     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 2297

                         House Bill 2724

Sponsored by Representative HOYLE

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Exempts retainer dental practice from application of Insurance
Code if certified by Department of Consumer and Business
Services.
  Authorizes department to investigate and take enforcement
actions with respect to dental provider maintaining or purporting
to maintain retainer dental practice.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to health care offered through a retainer practice;
  amending ORS 731.036, 735.500 and 735.510; and declaring an
  emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 735.500 is amended to read:
  735.500. (1) As used in this section and ORS 735.510:
  (a) 'Control' means the possession, directly or indirectly, of
the power to direct or cause the direction of the management and
policies of a person, whether through the ownership of voting
stock, by contract or otherwise. A person who is the owner of 10
percent or more ownership interest in a retainer
 { - medical - } practice or applicant for a certificate to
operate a retainer
  { - medical - }  practice is presumed to have control.
  (b) 'Primary care' means outpatient, nonspecialty medical
services or the coordination of health care for the purpose of:
  (A) Promoting or maintaining mental and physical health and
wellness; and
  (B) Diagnosis, treatment or management of acute or chronic
conditions caused by disease, injury or illness.
  (c) 'Provider' means a health care professional licensed or
certified under { + :
  (A) + } ORS chapter 677, 678, 684 or 685 who provides primary
care in the ordinary course of business or practice of a
profession { + ; or
  (B) ORS chapter 679 who provides dental care in the ordinary
course of business or practice of a profession + }.
  (d) 'Retainer   { - medical - }  agreement' means a written
agreement between a retainer   { - medical - }  practice and a
patient or a legal representative or guardian of a patient
specifying a defined and predetermined set of   { - primary

care - }  services to be provided in consideration for a retainer
 { - medical - }  fee.
   { +  (e) 'Retainer dental practice' means a provider, a group
of providers or a person that employs or contracts with a
provider or a group of providers to provide dental care under the
terms of a retainer agreement. + }
    { - (e) - }  { +  (f) + } 'Retainer   { - medical - }  fee'
means any fee paid to a retainer   { - medical - }  practice
pursuant to a   { - medical - }  retainer agreement.
    { - (f) - }  { +  (g) + } 'Retainer medical practice' means a
provider, a group of providers or a person that employs or
contracts with a provider or a group of providers to provide
 { + primary care + } services under the terms of a retainer
 { - medical - }  agreement.
   { +  (h) 'Retainer practice' means a:
  (A) Retainer dental practice; or
  (B) Retainer medical practice. + }
  (2) A retainer   { - medical - }  practice must be certified by
the Department of Consumer and Business Services. To qualify to
become a certified retainer   { - medical - }  practice or to
renew a certificate, the practice:
  (a) May not have or have ever had a certificate of authority to
transact insurance in this state.
  (b) May not be or have ever been licensed, certified or
otherwise authorized in this state or any other state to act as
an insurer, managed care organization, health care service
contractor or similar entity.
  (c) May not be controlled by an entity described in paragraph
(a) or (b) of this subsection.
  (3) A certified retainer   { - medical - }  practice:
    { - (a) Must provide only primary care and must limit the
scope of services provided or the number of patients served to an
amount that is within the capacity of the practice to provide in
a timely manner; - }
    { - (b) - }  { +  (a) + } May not bill an insurer, a
self-insured plan or the state medical assistance program for a
service provided by the practice to a patient pursuant to a
retainer   { - medical - }  agreement;
    { - (c) - }  { +  (b) + } Must be financially responsible and
have the necessary business experience or expertise to operate
the practice;
    { - (d) - }  { +  (c) + } Must give the written disclosures
described in subsection (4) of this section;
    { - (e) - }  { +  (d) + } May not use or disseminate
misleading, deceptive or false statements in marketing,
advertising, promotional, sales or informational materials
regarding the practice or in communications with patients or
prospective patients;
    { - (f) - }  { +  (e) + } May not engage in dishonest,
fraudulent or illegal conduct in any business or profession; and
    { - (g) - }  { +  (f) + } May not discriminate based on race,
religion, gender, sexual identity, sexual preference or health
status.
  (4) A certified retainer   { - medical - }  practice must make
the following written information available to prospective
patients by prominently disclosing, in the manner prescribed by
the department by rule, in marketing materials and retainer
 { - medical - }  agreements:
  (a) That the practice is not insurance;
  (b) That the practice provides only the limited scope of
primary care { +  or dental care + } services specified in the
retainer
  { - medical - }  agreement;
  (c) That a patient must pay for all services not specified in
the retainer   { - medical - }  agreement; and
  (d) Any other disclosures required by the department by rule.
   { +  (5)(a) A certified retainer medical practice must provide
only primary care and must limit the scope of services provided
or the number of patients served to an amount that is within the
capacity of the practice to provide in a timely manner.
  (b) A certified retainer dental practice must provide only
dental care and must limit the scope of services provided or the
number of patients served to an amount that is within the
capacity of the practice to provide in a timely manner. + }
    { - (5) - }  { +  (6) + } The department may by written order
deny, suspend or revoke a retainer   { - medical - }  practice
certificate or may refuse to renew a retainer   { - medical - }
practice certificate if the department finds that:
  (a) The retainer   { - medical - }  practice does not meet the
criteria in subsections (2) to   { - (4) - }  { +  (5) + } of
this section;
  (b) The retainer   { - medical - }  practice has provided
false, misleading, incomplete or inaccurate information in the
application for a certificate or renewal of a certificate;
  (c) The retainer   { - medical - }  practice provides
medical { +  or dental + } services through a provider whose
license to provide the
  { - medical - }  services offered on behalf of the retainer
 { - medical - } practice is revoked;
  (d) The authority of the retainer   { - medical - }  practice
to operate a retainer   { - medical - }  practice or similar
practice in another jurisdiction is denied, suspended, revoked or
not renewed;
  (e) The retainer   { - medical - }  practice, a person who has
control over the retainer   { - medical - }  practice or a health
care provider providing services on behalf of the retainer
 { - medical - }  practice is charged with a felony or
misdemeanor involving dishonesty; or
  (f) The retainer   { - medical - }  practice fails to comply
with subsection   { - (7) - }  { +  (8) + } of this section.
    { - (6) - }  { +  (7) + } With respect to a certified
retainer   { - medical - } practice or a retainer
 { - medical - }  practice operating without a certificate, the
department is authorized to:
  (a) Investigate;
  (b) Subpoena documents and records related to the business of
the practice; and
  (c) Take any actions authorized by the Insurance Code that are
necessary to administer and enforce this section.
    { - (7) - }  { +  (8) + } A retainer   { - medical - }
practice subject to an investigation under subsection
 { - (5) - }  { +  (7) + } of this section must:
  (a) Within five business days, respond to inquiries in the form
and manner specified by the department; and
  (b) Reimburse the expenses incurred by the department in
conducting the investigation.
    { - (8) - }  { +  (9) + } A retainer   { - medical - }
practice may contest any order made under subsection
 { - (5) - }  { +  (6) + } of this section in accordance with ORS
chapter 183.
    { - (9) - }  { +  (10) + } A certificate issued under
subsection (2) of this section is effective for one year or for a
longer period as prescribed by the department by rule.
    { - (10) - }  { +  (11) + } The department may adopt rules
necessary or appropriate to implement the provisions of this
section.
  SECTION 2. ORS 735.510 is amended to read:
  735.510. A certified retainer   { - medical - }  practice
shall:
  (1) Notify the Department of Consumer and Business Services
immediately whenever:

  (a) The license of a provider who has provided services on
behalf of the practice is denied, suspended, revoked or not
renewed in this state or in any other jurisdiction; or
  (b) The authority of the practice to operate in another
jurisdiction is denied, suspended, revoked or not renewed.
  (2) Notify the department no later than 30 days after any
change to the name, address or contact information that is
provided in the application for certification under ORS 735.500.
  SECTION 3. ORS 731.036 is amended to read:
  731.036. Except as provided in ORS 743.061 or as specifically
provided by law, the Insurance Code does not apply to any of the
following to the extent of the subject matter of the exemption:
  (1) A bail bondsman, other than a corporate surety and its
agents.
  (2) A fraternal benefit society that has maintained lodges in
this state and other states for 50 years prior to January 1,
1961, and for which a certificate of authority was not required
on that date.
  (3) A religious organization providing insurance benefits only
to its employees, if the organization is in existence and exempt
from taxation under section 501(c)(3) of the federal Internal
Revenue Code on September 13, 1975.
  (4) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
tort liability in accordance with ORS 30.282.
  (5) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
property damage in accordance with ORS 30.282.
  (6) Cities, counties, school districts, community college
districts, community college service districts or districts, as
defined in ORS 198.010 and 198.180, that either individually or
jointly insure for health insurance coverage, excluding
disability insurance, their employees or retired employees, or
their dependents, or students engaged in school activities, or
combination of employees and dependents, with or without employee
or student contributions, if all of the following conditions are
met:
  (a) The individual or jointly self-insured program meets the
following minimum requirements:
  (A) In the case of a school district, community college
district or community college service district, the number of
covered employees and dependents and retired employees and
dependents aggregates at least 500 individuals;
  (B) In the case of an individual public body program other than
a school district, community college district or community
college service district, the number of covered employees and
dependents and retired employees and dependents aggregates at
least 500 individuals; and
  (C) In the case of a joint program of two or more public
bodies, the number of covered employees and dependents and
retired employees and dependents aggregates at least 1,000
individuals;
  (b) The individual or jointly self-insured health insurance
program includes all coverages and benefits required of group
health insurance policies under ORS chapters 743 and 743A;
  (c) The individual or jointly self-insured program must have
program documents that define program benefits and
administration;
  (d) Enrollees must be provided copies of summary plan
descriptions including:
  (A) Written general information about services provided, access
to services, charges and scheduling applicable to each enrollee's
coverage;
  (B) The program's grievance and appeal process; and

  (C) Other group health plan enrollee rights, disclosure or
written procedure requirements established under ORS chapters 743
and 743A;
  (e) The financial administration of an individual or jointly
self-insured program must include the following requirements:
  (A) Program contributions and reserves must be held in separate
accounts and used for the exclusive benefit of the program;
  (B) The program must maintain adequate reserves. Reserves may
be invested in accordance with the provisions of ORS chapter 293.
Reserve adequacy must be calculated annually with proper
actuarial calculations including the following:
  (i) Known claims, paid and outstanding;
  (ii) A history of incurred but not reported claims;
  (iii) Claims handling expenses;
  (iv) Unearned contributions; and
  (v) A claims trend factor; and
  (C) The program must maintain adequate reinsurance against the
risk of economic loss in accordance with the provisions of ORS
742.065 unless the program has received written approval for an
alternative arrangement for protection against economic loss from
the Director of the Department of Consumer and Business Services;
  (f) The individual or jointly self-insured program must have
sufficient personnel to service the employee benefit program or
must contract with a third party administrator licensed under ORS
chapter 744 as a third party administrator to provide such
services;
  (g) The individual or jointly self-insured program shall be
subject to assessment in accordance with ORS 735.614 and former
enrollees shall be eligible for portability coverage in
accordance with ORS 735.616;
  (h) The public body, or the program administrator in the case
of a joint insurance program of two or more public bodies, files
with the Director of the Department of Consumer and Business
Services copies of all documents creating and governing the
program, all forms used to communicate the coverage to
beneficiaries, the schedule of payments established to support
the program and, annually, a financial report showing the total
incurred cost of the program for the preceding year. A copy of
the annual audit required by ORS 297.425 may be used to satisfy
the financial report filing requirement; and
  (i) Each public body in a joint insurance program is liable
only to its own employees and no others for benefits under the
program in the event, and to the extent, that no further funds,
including funds from insurance policies obtained by the pool, are
available in the joint insurance pool.
  (7) All ambulance services.
  (8) A person providing any of the services described in this
subsection. The exemption under this subsection does not apply to
an authorized insurer providing such services under an insurance
policy. This subsection applies to the following services:
  (a) Towing service.
  (b) Emergency road service, which means adjustment, repair or
replacement of the equipment, tires or mechanical parts of a
motor vehicle in order to permit the motor vehicle to be operated
under its own power.
  (c) Transportation and arrangements for the transportation of
human remains, including all necessary and appropriate
preparations for and actual transportation provided to return a
decedent's remains from the decedent's place of death to a
location designated by a person with valid legal authority under
ORS 97.130.
  (9)(a) A person described in this subsection who, in an
agreement to lease or to finance the purchase of a motor vehicle,
agrees to waive for no additional charge the amount specified in
paragraph (b) of this subsection upon total loss of the motor
vehicle because of physical damage, theft or other occurrence, as
specified in the agreement. The exemption established in this
subsection applies to the following persons:
  (A) The seller of the motor vehicle, if the sale is made
pursuant to a motor vehicle retail installment contract.
  (B) The lessor of the motor vehicle.
  (C) The lender who finances the purchase of the motor vehicle.
  (D) The assignee of a person described in this paragraph.
  (b) The amount waived pursuant to the agreement shall be the
difference, or portion thereof, between the amount received by
the seller, lessor, lender or assignee, as applicable, that
represents the actual cash value of the motor vehicle at the date
of loss, and the amount owed under the agreement.
  (10) A self-insurance program for tort liability or property
damage that is established by two or more affordable housing
entities and that complies with the same requirements that public
bodies must meet under ORS 30.282 (6). As used in this
subsection:
  (a) 'Affordable housing' means housing projects in which some
of the dwelling units may be purchased or rented, with or without
government assistance, on a basis that is affordable to
individuals of low income.
  (b) 'Affordable housing entity' means any of the following:
  (A) A housing authority created under the laws of this state or
another jurisdiction and any agency or instrumentality of a
housing authority, including but not limited to a legal entity
created to conduct a self-insurance program for housing
authorities that complies with ORS 30.282 (6).
  (B) A nonprofit corporation that is engaged in providing
affordable housing.
  (C) A partnership or limited liability company that is engaged
in providing affordable housing and that is affiliated with a
housing authority described in subparagraph (A) of this paragraph
or a nonprofit corporation described in subparagraph (B) of this
paragraph if the housing authority or nonprofit corporation:
  (i) Has, or has the right to acquire, a financial or ownership
interest in the partnership or limited liability company;
  (ii) Has the power to direct the management or policies of the
partnership or limited liability company;
  (iii) Has entered into a contract to lease, manage or operate
the affordable housing owned by the partnership or limited
liability company; or
  (iv) Has any other material relationship with the partnership
or limited liability company.
  (11) A community-based health care initiative approved by the
Administrator of the Office for Oregon Health Policy and Research
under ORS 735.723 operating a community-based health care
improvement program approved by the administrator.
  (12) Except as provided in ORS 735.500 and 735.510, a person
certified by the Department of Consumer and Business Services to
operate a retainer   { - medical - }  practice { +  as defined in
ORS 735.500 + }.
  SECTION 4.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
                         ----------