The Insurance Division proposes to adopt two new rules,
OAR 836-053-0100 and 836-053-0105. These rules are necessary to implement ORS
656.247, as amended by House Bill 4104 (2014 Legislative Session). The rules
compliment rules of the Workers’ Compensation Division intended to facilitate
better management and payment for interim medical benefits resulting from a
work-related injury or disease.
The proposed rules prohibit a carrier from imposing a waiver or exclusion in
a health benefit plan for coverage of a service otherwise provided solely on
the basis that the service is provided for a work-related injury or disease.
The proposed rules also establish an expedited preauthorization process for
approving the provision of interim medical services. The rules also specify how payment is accomplished if a workers’ compensation
claim is approved or denied.
Finally the rules clarify when a claim is deemed a “clean claim”
for purposes of prompt payment of claims.
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: July 15, 2014
Public hearing: August
25, 2014, 9 a.m.
Last day for public comment: August