ORS 743A.012
Emergency services


(1)

As used in this section:

(a)

“Behavioral health assessment” means an evaluation by a behavioral health clinician, in person or using telemedicine, to determine a patient’s need for immediate crisis stabilization.

(b)

“Behavioral health clinician” means:

(A)

A licensed psychiatrist;

(B)

A licensed psychologist;

(C)

A licensed nurse practitioner with a specialty in psychiatric mental health;

(D)

A licensed clinical social worker;

(E)

A licensed professional counselor or licensed marriage and family therapist;

(F)

A certified clinical social work associate;

(G)

An intern or resident who is working under a board-approved supervisory contract in a clinical mental health field; or

(H)

Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.

(c)

“Behavioral health crisis” means a disruption in an individual’s mental or emotional stability or functioning resulting in an urgent need for immediate outpatient treatment in an emergency department or admission to a hospital to prevent a serious deterioration in the individual’s mental or physical health.

(d)

“Emergency medical condition” means a medical condition:

(A)

That manifests itself by acute symptoms of sufficient severity, including severe pain, that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would:
(i)
Place the health of a person, or an unborn child in the case of a pregnant woman, in serious jeopardy;
(ii)
Result in serious impairment to bodily functions; or
(iii)
Result in serious dysfunction of any bodily organ or part;

(B)

With respect to a pregnant woman who is having contractions, for which there is inadequate time to effect a safe transfer to another hospital before delivery or for which a transfer may pose a threat to the health or safety of the woman or the unborn child; or

(C)

That is a behavioral health crisis.

(e)

“Emergency medical screening exam” means the medical history, examination, ancillary tests and medical determinations required to ascertain the nature and extent of an emergency medical condition.

(f)

“Emergency medical service provider” has the meaning given that term in ORS 682.025 (Definitions).

(g)

“Emergency medical services transport” means an emergency medical services provider’s evaluation and stabilization of an individual experiencing a medical emergency and the transportation of the individual to the nearest medical facility capable of meeting the needs of the individual.

(h)

“Emergency services” means, with respect to an emergency medical condition:

(A)

An emergency medical services transport;

(B)

An emergency medical screening exam or behavioral health assessment that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition; and

(C)

Such further medical examination and treatment as are required under 42 U.S.C. 1395dd to stabilize a patient, to the extent the examination and treatment are within the capability of the staff and facilities available at a hospital.
(i)
“Grandfathered health plan” has the meaning given that term in ORS 743B.005 (Definitions).

(j)

“Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).

(k)

“Prior authorization” has the meaning given that term in ORS 743B.001 (Definitions).

(L)

“Stabilize” means to provide medical treatment as necessary to:

(A)

Ensure that, within reasonable medical probability, no material deterioration of an emergency medical condition is likely to occur during or to result from the transfer of the patient to or from a facility; and

(B)

With respect to a pregnant woman who is in active labor, to perform the delivery, including the delivery of the placenta.

(2)

All insurers offering a health benefit plan shall provide coverage without prior authorization for emergency services.

(3)

A health benefit plan, other than a grandfathered health plan, must provide coverage required by subsection (2) of this section:

(a)

For the services of participating providers, without regard to any term or condition of coverage other than:

(A)

The coordination of benefits;

(B)

An affiliation period or waiting period permitted under part 7 of the Employee Retirement Income Security Act, part A of Title XXVII of the Public Health Service Act or chapter 100 of the Internal Revenue Code;

(C)

An exclusion other than an exclusion of emergency services; or

(D)

Applicable cost-sharing; and

(b)

For the services of a nonparticipating provider:

(A)

Without imposing any administrative requirement or limitation on coverage that is more restrictive than requirements or limitations that apply to participating providers;

(B)

Without imposing a copayment amount or coinsurance rate that exceeds the amount or rate for participating providers;

(C)

Without imposing a deductible, unless the deductible applies generally to nonparticipating providers; and

(D)

Subject only to an out-of-pocket maximum that applies to all services from nonparticipating providers.

(4)

All insurers offering a health benefit plan shall provide information to enrollees in plain language regarding:

(a)

What constitutes an emergency medical condition;

(b)

The coverage provided for emergency services;

(c)

How and where to obtain emergency services; and

(d)

The appropriate use of 9-1-1.

(5)

An insurer offering a health benefit plan may not discourage appropriate use of 9-1-1 and may not deny coverage for emergency services when 9-1-1 is used.

(6)

This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [Formerly 743.699; 2011 c.500 §38; 2017 c.273 §4; 2019 c.358 §41; 2021 c.312 §1]

Source: Section 743A.012 — Emergency services, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html.

743A.001
Automatic repeal of certain statutes on individual and group health insurance
743A.010
Services provided by state hospital or state approved program
743A.012
Emergency services
743A.014
Payments for ambulance care and transportation
743A.018
Services provided by osteopathic physician
743A.020
Services provided by acupuncturist
743A.024
Services provided by clinical social worker
743A.028
Services provided by denturist
743A.032
Surgical services provided by dentist
743A.034
Services provided by expanded practice dental hygienist
743A.036
Services provided by licensed nurse practitioner or licensed physician assistant
743A.040
Services provided by optometrist
743A.044
Services provided by physician assistant
743A.048
Services provided by psychologist
743A.051
Services provided by pharmacist
743A.052
Services provided by professional counselor or marriage and family therapist
743A.058
Telemedicine services
743A.060
Definition for ORS 743A.062
743A.062
Prescription drugs
743A.063
Ninety-day supply of prescription drug refills
743A.064
Prescription drugs dispensed at rural health clinics
743A.065
Early refills of prescription eye drops for treatment of glaucoma
743A.066
Contraceptives
743A.067
Reproductive health services
743A.068
Orally administered anticancer medication
743A.069
Insulin
743A.070
Nonprescription enteral formula for home use
743A.078
Newborn nurse home visiting services
743A.080
Pregnancy and childbirth expenses
743A.082
Diabetes management for pregnant women
743A.084
Unmarried women and their children
743A.088
Use by mother of diethylstilbestrol
743A.090
Natural and adopted children
743A.100
Mammograms
743A.104
Pelvic examinations and Pap smear examinations
743A.105
HPV vaccine
743A.108
Physical examination of breast
743A.110
Mastectomy-related services
743A.111
Consumer education about post-mastectomy services
743A.124
Colorectal cancer screenings and laboratory tests
743A.130
Proton beam therapy
743A.140
Bilateral cochlear implants
743A.141
Hearing aids and hearing assistive technology systems
743A.148
Maxillofacial prosthetic services
743A.150
Treatment of craniofacial anomaly
743A.160
Alcoholism treatment
743A.168
Behavioral health treatment
743A.170
Tobacco use cessation programs
743A.175
Traumatic brain injury
743A.180
Tourette Syndrome
743A.185
Telemedical health services for treatment of diabetes
743A.188
Inborn errors of metabolism
743A.190
Children with pervasive developmental disorder
743A.192
Clinical trials
743A.250
Emergency eye care services
743A.252
Child abuse assessments
743A.260
Inmates
743A.262
Preventive health services
743A.264
Disease outbreaks, epidemics and conditions of public health importance
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