OAR 436-015-0037
MCO-Insurer Contracts

(1) An MCO must provide comprehensive medical services to all enrolled workers covered by the MCO-insurer contract according to the MCO’s certification.

(2) An MCO may not contract exclusively with a single insurer. However, an MCO has up to one year from the effective date of its first contract to obtain contracts with more than one insurer. If the MCO has not obtained additional contracts within this time period, the MCO must provide the director with a report documenting the MCO’s efforts to obtain additional contracts.

(3) An MCO may contract only with insurers. The contract must include the following terms and conditions:

(a) Who is governed by the contract;

(b) The covered place of employment must be within the authorized geographic service area;

(c) Insurers may contract with multiple MCOs to provide coverage for employers. All workers at any specific employer’s location must be governed by the same MCO(s). When insurers contract with multiple MCOs each worker must have initial choice at the time of injury to select which MCO will manage their care except when the employer provides a coordinated health care program;

(d) Workers enrolled in an MCO must receive medical services as prescribed by the terms and conditions of the contract; and

(e) A continuity of care provision specifying how workers will receive medical services on open claims, including the following:

(A) Upon enrollment, allowing workers to continue to treat with the current medical service providers for at least 14 days after the mailing date of the notice of enrollment; and

(B) Upon termination or expiration of the MCO-insurer contract, allowing workers to continue treatment under ORS 656.245 (Medical services to be provided)(4)(a).

(4) Notwithstanding the requirements of this rule, failure of the MCO to provide medical services does not relieve the insurers of their responsibility to ensure benefits are provided to workers under ORS chapter 656.

Source: Rule 436-015-0037 — MCO-Insurer Contracts, .

436‑015‑0001
Purpose and Applicability of These Rules 436‑015‑0005
Definitions 436‑015‑0007
Entities Allowed to Manage Care 436‑015‑0008
Request for Review before the Director 436‑015‑0009
Formed, Owned, or Operated 436‑015‑0010
Notice of Intent to Form an MCO 436‑015‑0030
Applying for Certification 436‑015‑0035
Coverage Responsibility of an MCO 436‑015‑0037
MCO-Insurer Contracts 436‑015‑0040
Reporting Requirements for an MCO 436‑015‑0050
Record Keeping and Place of Business 436‑015‑0060
Commencement and Termination of Panel Providers 436‑015‑0065
Monitoring and Auditing 436‑015‑0070
Come-along Providers 436‑015‑0075
Worker Exams 436‑015‑0080
Suspension 436‑015‑0090
Charges and Fees 436‑015‑0110
Dispute Resolution 436‑015‑0120
Sanctions and Civil Penalties

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

OAR 436-015-0037 MCO-Insurer Contracts

OAR 436-015-0037
MCO-Insurer Contracts