ORS 743A.260
Inmates


(1)

As used in this section:

(a)

“Detainee” means an insured who is:

(A)

In the custody of a local supervisory authority pending the disposition of charges; or

(B)

In a detention facility pending final adjudication by a juvenile court.

(b)

“Detention facility” has the meaning given that term in ORS 419A.004 (Definitions).

(c)

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

(d)

“Supervisory authority” has the meaning given that term in ORS 144.087 (“Supervisory authority” defined).

(2)

Except as provided in subsection (4) of this section, an insurer offering a health benefit plan may not deny reimbursement for any service or supply covered by the plan or cancel the coverage of an insured under the plan on the basis that:

(a)

The insured is a detainee;

(b)

The insured receives publicly funded medical care while in the custody of a local supervisory authority or in a detention facility; or

(c)

The care was provided to the insured by an employee or contractor of a county, a local supervisory authority or a detention facility, if the employee or contractor meets the credentialing criteria of the health benefit plan.

(3)

An insurer shall reimburse a county for the costs of covered services or supplies provided to a detainee, in an amount that is no less than 115 percent of the Medicare rate for the service or supply.

(4)

An insurer offering a health benefit plan may:

(a)

Deny coverage for the treatment of injuries resulting from a violation of law;

(b)

Exclude from any requirements for reporting quality outcomes or performance, any covered services provided to a detainee;

(c)

Impose utilization controls under the health benefit plan that apply to services provided by in-network providers to insureds who are not in custody or in a detention facility, including a requirement for prior authorization;

(d)

Impose the requirements for billing and medical coding for covered services provided to a detainee that the insurer imposes on other providers;

(e)

Deny coverage of diagnostic tests or health evaluations required, as a matter of course, for all detainees;

(f)

Limit coverage of hospital and ambulatory surgical center services provided to a detainee to services provided by in-network hospitals and ambulatory surgical centers; and

(g)

Reimburse an out-of-network renal dialysis facility at either the in-network or the out-of-network rate paid by the insurer for dialysis provided to a detainee.

(5)

Intentionally left blank —Ed.

(a)

An insurer may not refuse to credential a health care provider who is an employee or contractor of a county, a local supervisory authority or a detention facility on the basis that the employee or contractor provides the services in a facility operated by the local supervisory authority or in a detention facility.

(b)

If an insurer refuses to credential a health care provider who is an employee or contractor of a county, a local supervisory authority or a detention facility, the insurer must give written notice to the provider explaining the reasons for the refusal.

(6)

This section does not:

(a)

Impair any right of an employer to remove an employee from coverage under a health benefit plan;

(b)

Release carriers from the requirement to coordinate benefits for persons who are insured by more than one carrier; or

(c)

Limit an insurer’s right to rescind coverage in accordance with ORS 743B.310 (Rescinding coverage).

(7)

A public body, as defined in ORS 174.109 (“Public body” defined), may not pay health benefit plan premiums on behalf of a detainee. [2014 c.97 §2; 2017 c.329 §1]
Note: See 743A.001 (Automatic repeal of certain statutes on individual and group health insurance).
Note: 743A.260 (Inmates) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
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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