ORS 743B.500 Selling and Leasing of Provider Panels By Contracting Entity; Definitions

• Library: Oregon Statutes
• Edition: 2023
• Currency: Current through legislation effective January 1, 2024
• Year: 2023
• Citation: ORS 743B.500

As used in this section and ORS 743B.501 to 743B.503:

(1)

(a) "Contracting entity" means any person that contracts directly with a provider for the delivery of health care services or contracts with a third party for the purpose of selling or making available to the third party the provider's health care services or discounted rates or the services or rates of a provider panel under a provider network contract.

(b) "Contracting entity" includes a person under common ownership and control of a contracting entity.

(c) "Contracting entity" does not include:

(A) A managed care organization that is certified under ORS 656.260;

(B) A discount medical plan organization as defined in ORS 742.420;

(C) The state medical assistance program;

(D) An independent practice association; or

(E) A self-funded, employer-sponsored health insurance plan regulated under the Employee Retirement Income Security Act of 1974, as codified and amended at 29 U.S.C. 1001, et seq., or any person that provides only administrative services to the self-funded employer-sponsored health insurance plan.

(2) "Health care services" means the treatment of humans for bodily injury, disablement or death by accidental means or as a result of sickness or childbirth, or in prevention of sickness, but does not include treatment for bodily injury, disablement or occupational diseases incurred as a result of employment.

(3) "Independent practice association" has the meaning given that term in ORS 743B.001.

(4) "Person" has the meaning given that term in ORS <codecitation statecd="OR" sessionyear="2023" datatype="S" catchline=""Person."">731.116</codecitation>.</subsect>

(5)

(a) "Provider" includes:

(A) A physician as defined in ORS 677.010.

(B) A physician group, independent practice association, physician-controlled organization, hospital organization or other provider organization that contracts with a provider for the purpose of facilitating the provider's participation in a provider network contract.

(C) A person licensed, certified or otherwise authorized or permitted by the laws of this state to administer medical services or mental health services in the ordinary course of business or practice of a profession.