Laws and Rules

Proposed rules

Many health care providers and insurers are transitioning from using classification codes found in the "Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, Fourth Edition" (DSM-IV) to the coding in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5). Until all users have transitioned entirely to the DSM-5, it is necessary to include applicable diagnostic codes from both versions in defining mental or nervous condition for purposes of the mandatory requirements of Oregon's mental health parity statute. These rules add appropriate diagnostic codes from the DSM-5 to the rule and clarify allowable exceptions and exclusions to the mental health parity statute.

The agency requests public comment on whether other options should be considered for achieving the rule’s substantive goals while reducing the negative economic impact of the rule on business.

Filed: March 13, 2015

Public hearing: April 30, 2015, 10:30 a.m.

Last day for public comment: May 6, 2015, 5 p.m.

Documents

​​​

This new proposed permanent rule adopts requirements for payers to accept a uniform prescription drug prior authorization form. This requirement was established by the 2013 Legislative Assembly in Senate Bill 382 (SB 382). Acceptance of a uniform form by all payers in Oregon is expected to streamline and simplify requests for prior approval for prescription drugs prescribed by providers. The proposed rule applies to payers as defined in ORS 743.061 which includes health insurers, third party administrators, prepaid managed care health services organizations , any person or public body that either individually or jointly establishes a self-insurance plan, program or contract, including but not limited to persons and public bodies that are otherwise exempt from the Insurance Code under ORS 731.036, health care clearinghouses or other entities that process or facilitate the processing of health care financial and administrative transactions from a nonstandard format to a standard format and any other person identified by the department that processes health care financial and administrative transactions between a health care provider and an entity described in this subsection.

The proposed rule does not require payers to reject a request for prior authorization for a prescription drug if the provider submits a form other than the uniform form, but it does require a payer to accept the form whenever it is used by a provider to submit a request.

The rule also specifies that if the payer fails to respond to the provider’s request within five business days, the prior authorization is deemed approved.

The agency requests public comment on whether other options should be considered for achieving the rule’s substantive goals while reducing the negative economic impact of the rule on business.

Filed: December 15, 2014

Public hearing: January 20, 2015, 2:00 p.m.

Last day for public comment: January 27, 2015 Extended to February 13, 2015

Documents

​​​​​​

The rulemaking adds a new rule and modifies existing rules to incorporate desired pieces of the August, 2014 NAIC Long Term Care Insurance Model Regulation. In addition, new policy options are established for Long Term Care Partnership Policies while still complying with federal requirements.

The agency requests public comment on whether other options should be considered for achieving the rule’s substantive goals while reducing the negative economic impact of the rule on business.

Filed: December 15, 2014

Public hearing: January 21, 2015, 1:30 p.m.

Last day for public comment: January 26, 2015 Extended to February 13, 2015

Documents

​​​​​
​​
​​​​​​​​​​​​​

Where to send comments on proposed rules

Insurance Division
ins.rules@oregon.gov

Key links

Oregon Revised Statutes

​​​​