2015 Oregon Revised Statutes
Volume : 16 - Financial Institutions, Insurance
Chapter 743A - Health Insurance: Reimbursement of Claims
Section 743A.036 - Services provided by certified nurse practitioner or licensed physician assistant.

(1) Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician assistant or a certified nurse practitioner if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.

(2)(a) The reimbursement of a service described in subsection (1) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

(b) As used in this subsection, "independent practice" means the licensed physician assistant or the certified nurse practitioner bills insurers for services provided by the physician assistant or nurse practitioner using the:

(A) Diagnosis and procedure codes applicable to the services;

(B) Physician assistant’s or nurse practitioner’s own name; and

(C) National provider identifier for:

(i) The physician assistant or nurse practitioner; and

(ii) If required by the insurer, the facility in which the physician assistant or nurse practitioner provides the services.

(3) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act or other insurers that employ physicians, licensed physician assistants or certified nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee-for-service basis.

(4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section. [Formerly 743.712; 2013 c.430 §1; 2015 c.377 §1]

Note: Section 2, chapter 430, Oregon Laws 2013, provides:

Sec. 2. The amendments to ORS 743A.036 by section 1 of this 2013 Act apply:

(1) To services provided under contracts entered into or renewed on or after January 1, 2014, and before January 1, 2018, by in-network, as defined in ORS 743.871 [renumbered 743B.280], physician assistants or nurse practitioners.

(2) To services provided on or after January 1, 2014, and before January 1, 2018, by out-of-network, as defined in ORS 743.871, physician assistants or nurse practitioners.

[2013 c.430 §2]

Note: The amendments to 743A.036 by section 4, chapter 430, Oregon Laws 2013, become operative January 2, 2018. See section 5, chapter 430, Oregon Laws 2013. The text that is operative on and after January 2, 2018, is set forth for the user’s convenience.
(1) Whenever any policy of health insurance provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed and certified nurse practitioner, including prescribing or dispensing drugs, the insured under the policy is entitled to reimbursement for such service whether it is performed by a physician licensed by the Oregon Medical Board or by a duly licensed nurse practitioner.

(2) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act.