Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1000 - Statutory Authority and Implementation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-053-1000  to 836-053-1200  are
			 adopted under the authority of ORS
			 731.244,
			 743.814, and
			 743.819, for the purpose of
			 implementing ORS 743.804,
			 743.807,
			 743.814,
			 743.817,
			 743.819,
			 743.821,
			 743.829,
			 743.837 and
			 743A.012. The filing and
			 reporting requirements in this rule and in OAR 836-053-1070, 836-053-1130,
			 836-053-1170, and 836-053-1190  apply to all domestic insurers transacting
			 health benefit plans, including health care service contractors, to all foreign
			 carriers transacting health benefit plans who transacted $2 million or more in
			 annual health benefit plan premium in Oregon, and to other carriers transacting
			 health benefit plans as determined by the Director of the Department of
			 Consumer and Business Services.
(2)
			 When an insurer maintains more than one type of health benefit plan, the
			 insurer shall comply with OAR 836-053-1000  to 836-053-1200  on a plan-by-plan
			 basis.
(3) Not later than June 30
			 of each year, each insurer shall file with the director for the immediately
			 preceding calendar year the following information as required of the insurer:
(a) An annual summary of the insurer's
			 aggregate data relating to grievances, appeals and applications for external
			 review, required by ORS 743.804of all insurers;
(b) An annual summary relating to the
			 insurer's utilization review policies, required by ORS
			 743.807(1) of
			 each insurer that provides utilization review or has utilization review
			 provided on its behalf;
(c) An
			 annual summary relating to the insurer's quality assessment activities required
			 by ORS 743.814(2) of
			 each insurer that offers managed health insurance;
(d) The results of all publicly available
			 federal Health Care Financing Administration reports and accreditation surveys
			 by national accreditation organizations required by ORS
			 743.814(3)(a)
			 of each insurer that offers managed health insurance;
(e) The insurer's health promotion and
			 disease prevention activities, if any, including a summary of screening and
			 preventive health care activities covered by the insurer, required by ORS
			 743.814(3)(b)
			 of each insurer that offers managed health insurance. The insurer may submit
			 the summary required in this subsection in the format of the insurer's
			 choosing, including a summary prepared for another purpose. The summary
			 required in this subsection shall include the following activities, to the
			 extent the insurer engages in them, and may include any additional information
			 that the insurer deems significant in describing its health promotion and
			 disease prevention activities:
(A) Tobacco
			 use and cessation;
(B) Cancer
			 screening, including mammography;
(C) Diabetes education and home
			 monitoring;
(D)
			 Immunizations;
(E) Childbirth
			 education and parenting support;
(F) Nutrition;
(G) Cardiovascular health; and
(H) Injury prevention; and
(f) An annual summary relating to
			 the scope of the insurer's network and to the accessibility of services,
			 required by ORS 743.817(1) of
			 each insurer that offers managed health insurance.