ORS 442.325
Certificate of need for health care facility of health maintenance organization; exempt activities; policy relating to health maintenance organizations


(1)

A certificate of need shall be required for the development or establishment of a health care facility of any new health maintenance organization.

(2)

Any activity of a health maintenance organization which does not involve the direct delivery of health services, as distinguished from arrangements for indirect delivery of health services through contracts with providers, shall be exempt from certificate of need review.

(3)

Nothing in ORS 244.050 (Persons required to file statement of economic interest), 431.250 (Federal grants to be handled by Oregon Health Authority), 441.015 (Licensing of facilities and health maintenance organizations) to 441.087 (General inspection of long term care facility), 442.015 (Definitions) to 442.420 (Application for financial assistance) and 442.450 (Exemption from cost review regulations) applies to any decision of a health maintenance organization involving its organizational structure, its arrangements for financing health services, the terms of its contracts with enrolled beneficiaries or its scope of benefits.

(4)

With the exception of certificate of need requirements, when applicable, the licensing and regulation of health maintenance organizations shall be controlled by ORS 750.005 (Definitions) to 750.095 (Requirements of contract between provider and subscriber) and statutes incorporated by reference therein.

(5)

It is the policy of ORS 244.050 (Persons required to file statement of economic interest), 431.250 (Federal grants to be handled by Oregon Health Authority), 441.015 (Licensing of facilities and health maintenance organizations) to 441.087 (General inspection of long term care facility), 442.015 (Definitions) to 442.420 (Application for financial assistance) and 442.450 (Exemption from cost review regulations) to encourage the growth of health maintenance organizations as an alternative delivery system and to provide the facilities for the provision of quality health care to the present and future members who may enroll within their defined service area.

(6)

(a) It is also the policy of ORS 244.050 (Persons required to file statement of economic interest), 431.250 (Federal grants to be handled by Oregon Health Authority), 441.015 (Licensing of facilities and health maintenance organizations) to 441.087 (General inspection of long term care facility), 442.015 (Definitions) to 442.420 (Application for financial assistance) and 442.450 (Exemption from cost review regulations) to consider the special needs and circumstances of health maintenance organizations. Such needs and circumstances include the needs of and costs to members and projected members of the health maintenance organization in obtaining health services and the potential for a reduction in the use of inpatient care in the community through an extension of preventive health services and the provision of more systematic and comprehensive health services. The consideration of a new health service proposed by a health maintenance organization shall also address the availability and cost of obtaining the proposed new health service from the existing providers in the area that are not health maintenance organizations.

(b)

The Oregon Health Authority shall issue a certificate of need for beds, services or equipment to meet the needs or reasonably anticipated needs of members of health maintenance organizations when beds, services or equipment are not available from nonplan providers. [1977 c.751 §56; 1981 c.693 §11; 1995 c.727 §40; 1999 c.581 §9; 2009 c.595 §752]

Source
Last accessed
May. 15, 2020