This rulemaking suspends rules adopted by the Department of Consumer and Business Services related to physician credential and recredentialing by health care service contractors.   During the 2009 Legislative Session, the statutory authority for adopting these rules was transferred from DCBS to the Oregon Health Authority.  The Oregon Health Authority is proposing to adopt temporary rules that replace this DCBS rule and that make further changes to these rules, rather than relying on the rules in force previously adopted by DCBS.  To avoid confusion, the DCBS rule will be suspended until permanent rules are adopted by the Oregon Health Authority, at which time the DCBS rule will be repealed.

Certificate & Order, Statement of Need and Justification, Oregon Health Authority Rules

These rules implement provisions of Chapter 500, Oregon Laws 2011 (Enrolled Senate Bill 89). The rules ensure that the Oregon Insurance Code is consistent with the federal Affordable Care Act, the federal health care reform law signed by President Obama on March 23, 2010. The rules also make changes to Oregon administrative rules to ensure consistency with other state and federal legislation. The changes are generally in these areas:

• Revisions to Oregon's rescission provisions including requirements for the contents of the notice required to be provided to enrollees whose coverage is rescinded, and requirements and timelines for notice of rescissions that insurers must provide to the director of the Department of Consumer and Business Services Division.  
• Clarifying when notice requirements are triggered when an insurer takes administrative action to cancel coverage under an individual health benefit plan.
• Implementing the changes made to the state continuation laws including clarifying the requirements of the notice that insurers must send to covered persons and qualified beneficiaries eligible for state continuation coverage; defining or clarifying statutory terms and explaining circumstances under which a person is not considered to be a qualified beneficiary.
• Defining requirements for cultural and linguistic appropriateness in accordance with federal law.
• Implementing changes to Oregon's internal and external review processes for adverse benefit determinations in a manner that is consistent with and approved by federal regulators.
• A number of changes to clarify and make the rules consistent with the statutory changes enacted by Senate Bill 89.

Certificate & Order, Summary of Testimony and Hearing Officer's Recommendation