reglab/housing_qa huggingface dataset:
OR Rev Stat § 735.515 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.515 - Charges for services not covered by contract.

(1) As used in this section: (a) "Dental services contract" means a contract between an insurer and a provider or a group of providers to provide dental health services for enrollees. "Dental services contract" does not include a contract of employment or a contract creating legal entities and ownership thereof that are authorized under ORS chapter 58, 60 or 70, or other similar professional organizations permitted by statute. (b) "Enrollee" means a person entitled to receive dental health benefits from an insurer. (c) "Provider" means a person licensed or otherwise authorized by the laws of this state to administer dental health services in the ordinary course of business or practice of a profession. (2) A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer. [2010 c.74 §2] Note: 735.515 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 735 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 735.520 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.520 - Oregon Essential Workforce Health Care Program; supplemental payments to eligible employers; requirements for participation; rules.

(1) As used in this section: (a) "Eligible employer" means an operator of a facility that: (A) Is a participating provider in the state medical assistance program; (B) Elects to participate in the Oregon Essential Workforce Health Care Program; and (C) Meets other requirements prescribed by the Oregon Health Authority by rule. (b) "Facility" includes: (A) A long term care facility licensed under ORS 441.020; (B) A residential facility as defined in ORS 443.400; and (C) An in-home care agency licensed under ORS 443.315. (2) The Oregon Essential Workforce Health Care Program is established in the Oregon Health Authority. The authority, in coordination with the Department of Human Services, shall provide supplemental payments, as approved by the Centers for Medicare and Medicaid Services, to eligible employers to be used by the eligible employers to provide health care benefits to the employees of their facilities. (3) To participate in the program, an eligible employer shall: (a) Enter into a memorandum of understanding with the authority that specifies how the supplemental payments will be used; (b) Agree to participate in evidence-based workforce and quality of care improvements; and (c) Annually report quality and other metrics. (4) The authority, in coordination with the department, may adopt rules to carry out the provisions of this section. [2021 c.595 §1] Note: 735.520 becomes operative upon receipt of approval from the Centers for Medicare and Medicaid Services. See section 4, chapter 595, Oregon Laws 2021. Note: 735.520 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 735 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation. Note: Section 3, chapter 595, Oregon Laws 2021, provides: Sec. 3. (1) The Oregon Health Authority shall seek approval from the Centers for Medicare and Medicaid Services to make the supplemental payments to eligible employers under section 1 of this 2021 Act [735.520]. (2) The authority shall notify the Legislative Counsel upon receipt of the approval or denial of approval by the Centers for Medicare and Medicaid Services under subsection (1) of this section. [2021 c.595 §3]
OR Rev Stat § 735.532 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.532 - Registration of pharmacy benefit managers; fees; rules.

(1) To conduct business in this state, a pharmacy benefit manager must register with the Department of Consumer and Business Services and annually renew the registration. (2) To register under this section, a pharmacy benefit manager must: (a) Submit an application to the department on a form prescribed by the department by rule. (b) Pay a registration fee in an amount adopted by the department by rule. (3) To renew a registration under this section, a pharmacy benefit manager must pay a renewal fee in an amount adopted by the department by rule. (4) The department shall deposit all moneys collected under this section into the Consumer and Business Services Fund created in ORS 705.145. (5) Any fee adopted by the department under this section must be based on the department’s reasonable costs in administering ORS 735.530 to 735.552. [2013 c.570 §3; 2017 c.73 §3] Note: See note under 735.530.
OR Rev Stat § 735.533 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.533 - Denial, suspension or revocation of registration as pharmacy benefit manager; basis; complaint; rules.

(1) In accordance with ORS chapter 183, the Department of Consumer and Business Services may deny an application for registration as a pharmacy benefit manager or an application for renewal of a registration as a pharmacy benefit manager, and may suspend or revoke a registration as a pharmacy benefit manager, if the department finds that an applicant or registrant: (a) Falsified an application for registration or for the renewal of a registration or engaged in any dishonest act in relation to the application; (b) Engaged in dishonesty, fraud or gross negligence in the conduct of business as a pharmacy benefit manager; (c) Engaged in conduct that resulted in a conviction of a felony under the laws of any state or of the United States, to the extent that such conduct may be considered under ORS 670.280; (d) Was convicted under the laws of any state or of the United States of any crime of which an essential element is dishonesty or fraud; (e) Had a certificate of authority or authority to conduct business as a pharmacy benefit manager denied, revoked or suspended in another state; (f) Failed to pay a civil penalty imposed by final order of the department or to comply with the terms of suspension set by the department; (g) Failed to meet the terms of a consent decree approved by a court of competent jurisdiction in this state, or a consent order made between the department and the pharmacy benefit manager; (h) Refused to be examined or to produce accounts, records or files for examination, including the refusal by any officer of the applicant or registrant to give information with respect to the affairs of the pharmacy benefit manager, or refused to perform any other legal obligation with respect to an examination by the department; or (i) Violated any rule or order of the department or any provision of the Insurance Code. (2) The department may prescribe by rule a procedure by which a pharmacy or an entity acting on behalf of a pharmacy may file a complaint with the department alleging that a pharmacy benefit manager has engaged in conduct described in this section. The department may restrict the right of a pharmacy or entity to file a complaint only to the extent necessary to prevent abuse of the complaint process. [2017 c.73 §2] Note: See note under 735.530.
OR Rev Stat § 735.536 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.536 - Requirements for pharmacy benefit manager’s reimbursement for cost of drugs; rules.

(1) As used in this section, "out-of-pocket cost" means the amount paid by an enrollee under the enrollee’s coverage, including deductibles, copayments, coinsurance or other expenses as prescribed by the Department of Consumer and Business Services by rule. (2) A pharmacy benefit manager registered under ORS 735.532: (a) May not require a prescription to be filled or refilled by a mail order pharmacy as a condition for reimbursing the cost of the drug. (b) Except as provided in paragraph (c) of this subsection, may require a prescription for a specialty drug to be filled or refilled at a specialty pharmacy as a condition for the reimbursement of the cost of a drug. (c) Shall reimburse the cost of a specialty drug that is filled or refilled at a network pharmacy that is a long term care pharmacy. (d)(A) Shall allow a network pharmacy to mail, ship or deliver prescription drugs to its patients as an ancillary service. (B) Is not required to reimburse a delivery fee charged by a pharmacy for a delivery described in subparagraph (A) of this paragraph unless the fee is specified in the contract between the pharmacy benefit manager and the pharmacy. (e) May not require a patient signature as proof of delivery of a mailed or shipped prescription drug if the network pharmacy: (A)(i) Maintains a mailing or shipping log signed by a representative of the pharmacy; or (ii) Maintains each notification of delivery provided by the United States Postal Service or a package delivery service; and (B) Is responsible for the cost of mailing, shipping or delivering a replacement for a drug that was mailed or shipped but not received by the enrollee. (f) May not penalize a network pharmacy for or otherwise directly or indirectly prevent a network pharmacy from informing an enrollee of the difference between the out-of-pocket cost to the enrollee to purchase a prescription drug using the enrollee’s pharmacy benefit and the pharmacy’s usual and customary charge for the prescription drug. (3) The Department of Consumer and Business Services may adopt rules to carry out the provisions of this section. [2019 c.526 §2] Note: 735.536 applies to pharmacy benefits and to contracts entered into, renewed or extended on or after January 1, 2021. See section 5, chapter 526, Oregon Laws 2019. Note: See note under 735.530.
OR Rev Stat § 735.540 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.540 - Definitions for ORS 735.540 to 735.552.

As used in ORS 735.540 to 735.552: (1) "Audit" means an on-site or remote review of the records of a pharmacy by or on behalf of an entity. (2) "Clerical error" means a minor error: (a) In the keeping, recording or transcribing of records or documents or in the handling of electronic or hard copies of correspondence; (b) That does not result in financial harm to an entity; and (c) That does not involve dispensing an incorrect dose, amount or type of medication or dispensing a prescription drug to the wrong person. (3) "Entity" includes: (a) A pharmacy benefit manager; (b) An insurer; (c) A third party administrator; (d) A state agency; or (e) A person that represents or is employed by one of the entities described in this subsection. (4) "Fraud" means knowingly and willfully executing or attempting to execute a scheme, in connection with the delivery of or payment for health care benefits, items or services, that uses false or misleading pretenses, representations or promises to obtain any money or property owned by or under the custody or control of any person. [2013 c.570 §4] Note: See note under 735.530.
OR Rev Stat § 735.542 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.542 - Pharmacy claims audits; requirements.

An entity that audits claims or an independent third party that contracts with an entity to audit claims: (1) Must establish, in writing, a procedure for a pharmacy to appeal the entity’s findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy’s claims; (2) May not conduct an audit of a claim more than 24 months after the date the claim was adjudicated by the entity; (3) Must give at least 15 days’ advance written notice of an on-site audit to the pharmacy or corporate headquarters of the pharmacy; (4) May not conduct an on-site audit during the first five days of any month without the pharmacy’s consent; (5) Must conduct the audit in consultation with a pharmacist who is licensed by this or another state if the audit involves clinical or professional judgment; (6) May not conduct an on-site audit of more than 250 unique prescriptions of a pharmacy in any 12-month period except in cases of alleged fraud; (7) May not conduct more than one on-site audit of a pharmacy in any 12-month period; (8) Must audit each pharmacy under the same standards and parameters that the entity uses to audit other similarly situated pharmacies; (9) Must pay any outstanding claims of a pharmacy no more than 45 days after the earlier of the date all appeals are concluded or the date a final report is issued under ORS 735.550 (3); (10) May not include dispensing fees or interest in the amount of any overpayment assessed on a claim unless the overpaid claim was for a prescription that was not filled correctly; (11) May not recoup costs associated with: (a) Clerical errors; or (b) Other errors that do not result in financial harm to the entity or a consumer; and (12) May not charge a pharmacy for a denied or disputed claim until the audit and the appeals procedure established under subsection (1) of this section are final. [2013 c.570 §5] Note: See note under 735.530.
OR Rev Stat § 735.544 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.544 - Pharmacy claims audits; standards for review of claims.

An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs. [2013 c.570 §6] Note: See note under 735.530.
OR Rev Stat § 735.546 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.546 - Pharmacy claims audits; auditors.

An entity that contracts with an independent third party to conduct audits may not: (1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or (2) Disclose information obtained during an audit except to the contracting entity, the pharmacy subject to the audit or the holder of the policy or certificate of insurance that paid the claim. [2013 c.570 §7] Note: See note under 735.530.
OR Rev Stat § 735.548 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.548 - Pharmacy claims audits; validation of claims.

For purposes of ORS 735.540 to 735.552, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim: (1) An electronic or physical copy of a prescription that complies with ORS chapter 689 if the prescribed drug was, within 14 days of the dispensing date: (a) Picked up by the patient or the patient’s designee; (b) Delivered by the pharmacy to the patient; or (c) Sent by the pharmacy to the patient using the United States Postal Service or other common carrier; (2) Point of sale electronic register data showing purchase of the prescribed drug, medical supply or service by the patient or the patient’s designee; or (3) Electronic records, including electronic beneficiary signature logs, electronically scanned and stored patient records maintained at or accessible to the audited pharmacy’s central operations and any other reasonably clear and accurate electronic documentation that corresponds to a claim. [2013 c.570 §8] Note: See note under 735.530.
OR Rev Stat § 735.550 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.550 - Pharmacy claims audits; reports of findings; opportunity to resubmit claim and to contest finding.

(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than 45 days after the date on which the audit was completed and must be sent: (A) By mail or common carrier with a return receipt requested; or (B) Electronically with electronic receipt confirmation. (b) An entity shall provide a pharmacy receiving a preliminary report under this subsection no fewer than 45 days after receiving the report to contest the report or any findings in the report in accordance with the appeals procedure established under ORS 735.542 (1) and to provide additional documentation in support of the claim. The entity shall consider a reasonable request for an extension of time to submit documentation to contest the report or any findings in the report. (2) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to resubmit the claim using any commercially reasonable method, including facsimile, mail or electronic mail. (3) An entity must provide a pharmacy that is the subject of an audit with a final report of the audit no later than 60 days after the later of the date the preliminary report was received or the date the pharmacy contested the report using the appeals procedure established under ORS 735.542 (1). The final report must include a final accounting of all moneys to be recovered by the entity. (4) Recoupment of disputed funds from a pharmacy by an entity or repayment of funds to an entity by a pharmacy, unless otherwise agreed to by the entity and the pharmacy, shall occur after the audit and the appeals procedure established under ORS 735.542 (1) are final. If the identified discrepancy for an individual audit exceeds $40,000, any future payments to the pharmacy may be withheld by the entity until the audit and the appeals procedure established under ORS 735.542 (1) are final. [2013 c.570 §9] Note: See note under 735.530.
OR Rev Stat § 735.552 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.552 - Pharmacy claims audits; exception for fraud.

ORS 735.540 to 735.552 do not: (1) Preclude an entity from instituting an action for fraud against a pharmacy; (2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by physical review, review of claims data or statements or other investigative methods; or (3) Apply to a state agency that is conducting audits or a person that has contracted with a state agency to conduct audits of pharmacy records for prescription drugs paid for by the state medical assistance program. [2013 c.570 §10] Note: See note under 735.530.
OR Rev Stat § 735.601 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.601

[2016 c.94 §1; 2021 c.569 §9; renumbered 413.610 in 2021]
OR Rev Stat § 735.604 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.604

[2016 c.94 §2; renumbered 413.611 in 2021]
OR Rev Stat § 735.608 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.608

[2016 c.94 §3; 2021 c.569 §10; renumbered 413.612 in 2021]
OR Rev Stat § 735.617 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.617

[2016 c.94 §5; 2021 c.569 §11; renumbered 413.613 in 2021]
OR Rev Stat § 735.720 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.720

[Formerly 653.800; 2003 c.684 §8; 2005 c.727 §§5,5a; 2005 c.744 §§23d,23e,23g; 2007 c.70 §317; renumbered 414.841 in 2009]
OR Rev Stat § 735.722 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.722

[Formerly 653.805; 2003 c.128 §1; 2003 c.683 §4; 2003 c.784 §12; 2005 c.238 §6; 2005 c.262 §6; 2005 c.727 §6; 2005 c.744 §24a; 2009 c.595 §1125; renumbered 414.842 in 2009]
OR Rev Stat § 735.724 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.724

[Formerly 653.810; 2003 c.128 §2; 2003 c.683 §1; 2005 c.238 §7; 2005 c.262 §7; 2005 c.727 §7; 2005 c.744 §25; renumbered 414.844 in 2009]
OR Rev Stat § 735.726 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.726

[Formerly 653.815; 2005 c.744 §26; renumbered 414.846 in 2009]
OR Rev Stat § 735.728 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.728

[Formerly 653.820; 2005 c.744 §27; renumbered 414.848 in 2009]
OR Rev Stat § 735.730 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.730

[Formerly 653.825; 2005 c.744 §28; renumbered 414.851 in 2009]
OR Rev Stat § 735.731 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.731

[2003 c.683 §3; 2003 c.735 §12; 2005 c.744 §29; renumbered 414.852 in 2009]
OR Rev Stat § 735.732 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.732

[Formerly 653.830; 2005 c.744 §30; renumbered 414.854 in 2009]
OR Rev Stat § 735.733 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.733

[2003 c.684 §11; 2005 c.744 §31; renumbered 414.856 in 2009]
OR Rev Stat § 735.734 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.734

[Formerly 653.835; 2005 c.744 §32; 2009 c.595 §1126; renumbered 414.858 in 2009]
OR Rev Stat § 735.736 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.736

[Formerly 653.840; 2005 c.744 §33; renumbered 414.861 in 2009]
OR Rev Stat § 735.738 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.738

[Formerly 653.845; 2005 c.238 §8; 2005 c.727 §8; renumbered 414.862 in 2009]
OR Rev Stat § 735.740 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.740

[Formerly 653.850; 2003 c.684 §9; 2005 c.744 §34; 2007 c.71 §238; renumbered 414.864 in 2009]
OR Rev Stat § 735.750 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.750

[2003 c.684 §1; 2005 c.744 §35; renumbered 414.866 in 2009]
OR Rev Stat § 735.752 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.752

[2003 c.684 §2; renumbered 414.868 in 2009]
OR Rev Stat § 735.754 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.754

[2003 c.684 §3; 2005 c.744 §36; 2009 c.595 §1127; renumbered 414.870 in 2009]
OR Rev Stat § 735.756 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 735 - Alternative Insurance|Section 735.756

[2003 c.684 §4; 2009 c.595 §1128; renumbered 414.872 in 2009]
OR Rev Stat § 736.003 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 736 - (Former Provisions)|Section 736.003

[1965 c.324 §2; 1967 c.359 §2; renumbered 731.008]