ORS 735.500
Requirements for certification as retainer medical practice

  • disclosures
  • rules

(1)

As used in this section and ORS 735.510 (Notice to department of specified changes to practice):

(a)

“Control” means the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting stock, by contract or otherwise. A person who is the owner of 10 percent or more ownership interest in a retainer medical practice or applicant for a certificate to operate a retainer medical practice is presumed to have control.

(b)

“Primary care” means outpatient, nonspecialty medical services or the coordination of health care for the purpose of:

(A)

Promoting or maintaining mental and physical health and wellness; and

(B)

Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.

(c)

“Provider” means a health care professional licensed or certified under ORS chapter 677, 678, 684 or 685 who provides primary care in the ordinary course of business or practice of a profession.

(d)

“Retainer medical agreement” means a written agreement between a retainer medical practice and a patient or a legal representative or guardian of a patient specifying a defined and predetermined set of primary care services to be provided in consideration for a retainer medical fee.

(e)

“Retainer medical fee” means any fee paid to a retainer medical practice pursuant to a medical retainer agreement.

(f)

“Retainer medical practice” means a provider, a group of providers or a person that employs or contracts with a provider or a group of providers to provide services under the terms of a retainer medical agreement.

(2)

A retainer medical practice must be certified by the Department of Consumer and Business Services. To qualify to become a certified retainer medical practice or to renew a certificate, the practice:

(a)

May not have or have ever had a certificate of authority to transact insurance in this state.

(b)

May not be or have ever been licensed, certified or otherwise authorized in this state or any other state to act as an insurer, managed care organization, health care service contractor or similar entity.

(c)

May not be controlled by an entity described in paragraph (a) or (b) of this subsection.

(3)

A certified retainer medical practice:

(a)

Must provide only primary care and must limit the scope of services provided or the number of patients served to an amount that is within the capacity of the practice to provide in a timely manner;

(b)

May not bill an insurer, a self-insured plan or the state medical assistance program for a service provided by the practice to a patient pursuant to a retainer medical agreement;

(c)

Must be financially responsible and have the necessary business experience or expertise to operate the practice;

(d)

Must give the written disclosures described in subsection (4) of this section;

(e)

May not use or disseminate misleading, deceptive or false statements in marketing, advertising, promotional, sales or informational materials regarding the practice or in communications with patients or prospective patients;

(f)

May not engage in dishonest, fraudulent or illegal conduct in any business or profession; and

(g)

May not discriminate based on race, religion, gender, sexual identity, sexual preference or health status.

(4)

A certified retainer medical practice must make the following written information available to prospective patients by prominently disclosing, in the manner prescribed by the department by rule, in marketing materials and retainer medical agreements:

(a)

That the practice is not insurance;

(b)

That the practice provides only the limited scope of primary care services specified in the retainer medical agreement;

(c)

That a patient must pay for all services not specified in the retainer medical agreement; and

(d)

Any other disclosures required by the department by rule.

(5)

The department may by written order deny, suspend or revoke a retainer medical practice certificate or may refuse to renew a retainer medical practice certificate if the department finds that:

(a)

The retainer medical practice does not meet the criteria in subsections (2) to (4) of this section;

(b)

The retainer medical practice has provided false, misleading, incomplete or inaccurate information in the application for a certificate or renewal of a certificate;

(c)

The retainer medical practice provides medical services through a provider whose license to provide the medical services offered on behalf of the retainer medical practice is revoked;

(d)

The authority of the retainer medical practice to operate a retainer medical practice or similar practice in another jurisdiction is denied, suspended, revoked or not renewed;

(e)

The retainer medical practice, a person who has control over the retainer medical practice or a health care provider providing services on behalf of the retainer medical practice is charged with a felony or misdemeanor involving dishonesty; or

(f)

The retainer medical practice fails to comply with subsection (7) of this section.

(6)

With respect to a certified retainer medical practice or a retainer medical practice operating without a certificate, the department is authorized to:

(a)

Investigate;

(b)

Subpoena documents and records related to the business of the practice; and

(c)

Take any actions authorized by the Insurance Code that are necessary to administer and enforce this section.

(7)

A retainer medical practice subject to an investigation under subsection (5) of this section must:

(a)

Within five business days, respond to inquiries in the form and manner specified by the department; and

(b)

Reimburse the expenses incurred by the department in conducting the investigation.

(8)

A retainer medical practice may contest any order made under subsection (5) of this section in accordance with ORS chapter 183.

(9)

A certificate issued under subsection (2) of this section is effective for one year or for a longer period as prescribed by the department by rule.

(10)

The department may adopt rules necessary or appropriate to implement the provisions of this section. [2011 c.499 §2]
Note: 735.500 (Requirements for certification as retainer medical practice) and 735.510 (Notice to department of specified changes to practice) were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 735 or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 735.500 — Requirements for certification as retainer medical practice; disclosures; rules, https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html.

735.005
Definitions for ORS 735.005 to 735.145
735.015
Purpose
735.025
Construction
735.035
Application
735.045
Oregon FAIR Plan Association
735.055
Association board of directors
735.065
Required association functions
735.075
Discretionary association functions
735.085
Plan of operation
735.095
Contents of plan of operation
735.105
Regulation of association as insurer
735.115
Exemption of association from fees and taxes
735.145
Immunity from legal action in carrying out duties
735.150
Definitions for ORS 735.150 to 735.190
735.152
Application of laws
735.154
Rules
735.156
Confidentiality of documents and materials
735.158
Certificate of authority
735.160
Business name
735.162
Capital and surplus requirements
735.164
Incorporation of pure captive insurer and association captive insurer
735.166
Investment requirements for association captive insurer
735.168
Allowable risks for captive insurer
735.170
Rating organization
735.172
Reporting
735.174
Examination
735.176
Compliance with sound actuarial principles
735.178
Suspension or revocation of certificate of authority
735.180
Branch captive insurer as pure captive insurer
735.182
Examination of branch captive insurer and alien captive insurer
735.184
Requirements for foreign captive insurer to provide insurance in this state
735.186
Management of assets of captive reinsurer
735.188
Application of captive reinsurer for certificate of authority
735.190
Incorporation of captive reinsurer
735.200
Legislative findings
735.205
Definitions for ORS 735.200 to 735.260
735.210
Formation of market assistance plans
735.215
Findings prior to formation of joint underwriting association
735.220
Formation of joint underwriting association
735.225
Membership in joint underwriting association
735.230
Rates
735.235
Board of directors
735.240
Annual statement
735.245
Conditions for policyholder surcharge
735.250
Exemption from liability
735.255
State not liable to pay debts of association
735.260
Rules
735.265
Liquor liability insurance risk and rate classifications
735.300
Purpose of ORS 735.300 to 735.365
735.305
Definitions for ORS 735.300 to 735.365
735.310
Qualifications for risk retention group
735.315
Foreign risk retention groups
735.320
Relationship to insurance guaranty fund and joint underwriting association
735.325
Exemption of purchasing groups from certain laws
735.330
Purchasing groups
735.335
Purchase of insurance by purchasing group
735.340
Insurance Code enforcement authority subject to federal law
735.345
Violation of 735.300 to 735.365
735.350
Agent or broker
735.355
Court orders enforceable in Oregon
735.360
Rules
735.365
Short title
735.400
Purposes of ORS 735.400 to 735.495
735.405
Definitions for ORS 735.400 to 735.495
735.406
Cost of living adjustment to net worth, revenues and expenses of exempt commercial purchasers
735.410
Conditions for procuring insurance through nonadmitted insurer
735.415
Qualifications for placement of coverage with nonadmitted insurer
735.417
Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks
735.418
Director authorized to enter into interstate compact for premium tax allocation
735.420
Declaration of ineligibility of surplus lines insurer
735.425
Filing by licensee after placement of surplus lines insurance
735.430
Surplus Line Association of Oregon
735.435
Evidence of insurance
735.440
Validity of contracts
735.445
Effect of payment of premium to surplus lines licensee
735.450
Requirements for license as surplus lines insurance licensee
735.455
Authority of licensee
735.460
Records of licensee
735.465
Monthly reports
735.470
Premium tax
735.475
Suit to recover unpaid tax
735.480
Suspension or revocation of license
735.485
Actions against surplus lines insurer
735.490
Jurisdiction in action against insurer
735.492
Application of certain Insurance Code provisions to surplus lines insurers
735.495
Short title
735.500
Requirements for certification as retainer medical practice
735.510
Notice to department of specified changes to practice
735.515
Charges for services not covered by contract
735.520
Oregon Essential Workforce Health Care Program
735.530
Definitions for ORS 735.530 to 735.552
735.532
Registration of pharmacy benefit managers
735.533
Denial, suspension or revocation of registration as pharmacy benefit manager
735.534
Claim reimbursement
735.536
Requirements for pharmacy benefit manager’s reimbursement for cost of drugs
735.540
Definitions for ORS 735.540 to 735.552
735.542
Pharmacy claims audits
735.544
Pharmacy claims audits
735.546
Pharmacy claims audits
735.548
Pharmacy claims audits
735.550
Pharmacy claims audits
735.552
Pharmacy claims audits
Green check means up to date. Up to date