409-036-0050 Eligibility Criteria and Program Requirements specific to Medical Malpractice Insurance Premium Subsidies (1) The Health Care Provider Incentive Fund may subsidize health care practitioners for the cost of liability insurance premiums in force, or renewed on or after the effective date of this rule. (2) A practitioner who provides health services in rural Oregon as determined by the Authority is eligible for a subsidy under the program, if the practitioner: (a) Holds an active, unrestricted license or certification; and is (b) Covered by a medical professional liability insurance policy issued by an authorized carrier with minimum coverage limits coverage of $1 million per occurrence and $1 million annual aggregate. (3) A nurse practitioner employed by a licensed physician is eligible for a subsidy if covered by a medical professional liability insurance policy that names and separately calculates the premium for the nurse practitioner. (4) A practitioner whose medical professional liability insurance coverage is provided through a health care facility, as defined in ORS 442.400, and also meets the requirements of OAR 409-036-0020(6) of this rule is eligible for a premium subsidy if the Authority determines that practitioner: (a) Is not an employee of the health care facility; (b) Is covered by a medical professional liability insurance policy that names the practitioner and separately calculates the premium for the practitioner; and (c) Fully reimburses the health care facility for the premium calculated for the practitioner. (5) A practitioner must provide an annual attestation to the Authority to be eligible to participate in the program. The Authority shall establish criteria and procedures for making the eligibility determinations and annual attestation. (6) The Authority shall forward to each participating authorized carrier a list of eligible practitioners with respect to that provider that includes the: (a) Practitioner’s name; (b) Practice site mailing address; and (c) Specialty and applicable professional license or certification number issued by either the Oregon Medical Board or the Oregon Board of Nursing. (7) To participate in the program, a carrier must provide written notice and certification to the Authority not less than 30 days prior to the beginning date of a calendar quarter, signed by an individual authorized to represent the carrier. The notice and certification must be delivered to the Authority at the following address: Oregon Health Authority, 500 Summer St NE, Salem, OR 97301, Attention: Health Care Provider Incentive Program–Medical Malpractice Insurance Subsidy. (a) The written notification must certify that the carrier: (A) Is a medical professional liability insurer holding a valid certificate of authority from the Director of the Department of Consumer and Business Services (DCBS) that authorizes the transaction of insurance as defined in ORS 731.066(1) and 731.072(1), and does not include DCBS listed insurers pursuant to ORS 735.300 to 735.365 and ORS 735.400 to 735.495; (B) Understands the Authority may confirm the representations in paragraph (B) with DCBS, and that DCBS’ determination about whether the carrier holds a valid certificate of authority to engage in professional liability insurance in the state of Oregon and the other criteria in paragraph (A) shall be relied upon by the Authority in determining whether an insurer is an authorized carrier; and (C) Agrees to comply with the terms and conditions of the rules applicable to this program in effect at the time of initial certification and those rules in effect when any request for subsidy payment is submitted to the Authority for payment. (b) The Authority shall confirm in writing that the carrier meets the criteria as an authorized carrier. If the Authority determines that an entity is not eligible to participate as a carrier, the Authority shall provide notice to the entity of its determination and shall deny participation in the program. Entities may appeal a determination following the process set forth in OAR 409-036-0120. (c) If an insurer fails to provide the notice and certification to the Authority within the time established, the insurer may not submit a request for premium subsidy payment for the next calendar quarter and practitioners may not receive a premium subsidy for that quarter. (d) A carrier must notify the Authority in writing of a material change in any status or condition that relates to their eligibility to participate in the program. (8) A carrier shall notify the Authority at least 90 days prior to the beginning date of the next calendar quarter if the carrier wants to discontinue participation in the program. The carrier shall notify its insured participating practitioners of its intent to discontinue to participate at least 60 days prior to the date of the next calendar quarter. (9) The Authority may determine that funds available for the program are insufficient to provide maximum premium subsidy for all qualified practitioners, and the Authority may reduce or eliminate subsidies. There is no guarantee of any amount of premium subsidy provided to any carrier. (10) Each carrier must electronically (using Microsoft Excel or similar spreadsheet application) submit a report to the Authority within 30 days after the end of each billing period (monthly or quarterly), showing the following information for each eligible practitioner who has been determined eligible for a premium subsidy as of the end of the billing quarter. The information must include the following: (a) Carrier’s name; (b) Practitioner’s name; and (c) For each practitioner: (A) Oregon Board of Medical Examiners license number or Oregon State Board of Nursing certification number; (B) Practitioner’s specialty and specialty class; (C) Insurance Services Office (ISO) code; (D) Policy number and effective date; (E) Billing period coverage start and end dates; (F) Billing frequency (annually, quarterly, monthly); (G) Current in-force annual premium for coverage limits of $1 million per occurrence and up to $3 million annual aggregate; (H) Premium subsidy percentage, calculated in accordance with 409-036-0080 (3); (I) Dollar amount of premium subsidy, calculated in accordance with these rules; (J) Explanation of any adjustments under this program from previous reports; (K) Policy coverage limits; (L) Claims-made step of practitioner, if applicable; and (M) Identify practitioners who were not on the eligible list at the beginning of the quarter. (d) Each January all carriers must provide the Authority with a copy of their base rates and increased limits factors table. The carrier must also inform the Authority of the base rates and increased limits factors table from their current rate filing for Oregon within 30 days of any change to those rates and table. (e) Failure to make a timely submission may result in delay in processing the payment request. The Authority shall calculate the payment of premium subsidies from the Rural Medical Liability Subsidy Fund based on the funds available for the applicable billing period. In the event of insufficient funds, the risk of carrier delay in submission of a request for subsidy payment is on the carrier, because payments shall be based on the subsidy requests received timely for each applicable billing period. (11) Each carrier must provide its participating practitioners with the following information each quarter: (a) The quarterly premium due before the premium subsidy is applied; (b) The amount of the premium subsidy; (c) The premium after the premium subsidy is applied; and (d) The carrier shall display these three figures on each participating practitioner’s billing statement. (12) If there are insufficient funds to provide the maximum premium subsidy to all qualifying practitioners who have applied for such subsidy, the Authority may reduce or eliminate subsidies for practitioners in an equitable manner, and shall notify affected carriers and participants. A carrier shall reduce the premium charged to a practitioner by the amount of any premium subsidy paid or to be paid under this Program. Statutory/Other Authority: ORS 676.454 Statutes/Other Implemented: ORS 676.454 History: OHP 7-2022, amend filed 08/31/2022, effective 08/31/2022 OHP 1-2021, amend filed 03/29/2021, effective 03/29/2021 OHP 9-2019, minor correction filed 07/25/2019, effective 07/25/2019 OHP 4-2017, adopt filed 12/23/2017, effective 01/02/2018