Current through Register Vol. 63, No. 9, September 1, 2024
(1)
The Health Care Provider Incentive Fund may subsidize health care practitioners
for the cost of liability insurance premiums in force, or renewed on or after
the effective date of this rule.
(2) A practitioner who provides health
services in rural Oregon as determined by the Authority is eligible for a
subsidy under the program, if the practitioner:
(a) Holds an active, unrestricted license or
certification; and is
(b) Covered
by a medical professional liability insurance policy issued by an authorized
carrier with minimum coverage limits coverage of $1 million per occurrence and
$1 million annual aggregate.
(3) A nurse practitioner employed by a
licensed physician is eligible for a subsidy if covered by a medical
professional liability insurance policy that names and separately calculates
the premium for the nurse practitioner.
(4) A practitioner whose medical professional
liability insurance coverage is provided through a health care facility, as
defined in ORS 442.400, and also meets the
requirements of OAR 409-036-0020(6)
of this rule is eligible for a premium subsidy if the Authority determines that
practitioner:
(a) Is not an employee of the
health care facility;
(b) Is
covered by a medical professional liability insurance policy that names the
practitioner and separately calculates the premium for the practitioner;
and
(c) Fully reimburses the health
care facility for the premium calculated for the practitioner.
(5) A practitioner must provide an
annual attestation to the Authority to be eligible to participate in the
program. The Authority shall establish criteria and procedures for making the
eligibility determinations and annual attestation.
(6) The Authority shall forward to each
participating authorized carrier a list of eligible practitioners with respect
to that provider that includes the:
(a)
Practitioner's name;
(b) Practice
site mailing address; and
(c)
Specialty and applicable professional license or certification number issued by
either the Oregon Medical Board or the Oregon Board of Nursing.
(7) To participate in the program,
a carrier must provide written notice and certification to the Authority not
less than 30 days prior to the beginning date of a calendar quarter, signed by
an individual authorized to represent the carrier. The notice and certification
must be delivered to the Authority at the following address: Oregon Health
Authority, 500 Summer St NE, Salem, OR 97301, Attention: Health Care Provider
Incentive Program-Medical Malpractice Insurance Subsidy.
(a) The written notification must certify
that the carrier:
(A) Is a medical
professional liability insurer holding a valid certificate of authority from
the Director of the Department of Consumer and Business Services (DCBS) that
authorizes the transaction of insurance as defined in ORS
731.066(1) and
731.072(1), and
does not include DCBS listed insurers pursuant to ORS
735.300 to
735.365 and ORS
735.400 to
735.495;
(B) Understands the Authority may confirm the
representations in paragraph (B) with DCBS, and that DCBS' determination about
whether the carrier holds a valid certificate of authority to engage in
professional liability insurance in the state of Oregon and the other criteria
in paragraph (A) shall be relied upon by the Authority in determining whether
an insurer is an authorized carrier; and
(C) Agrees to comply with the terms and
conditions of the rules applicable to this program in effect at the time of
initial certification and those rules in effect when any request for subsidy
payment is submitted to the Authority for payment.
(b) The Authority shall confirm in writing
that the carrier meets the criteria as an authorized carrier. If the Authority
determines that an entity is not eligible to participate as a carrier, the
Authority shall provide notice to the entity of its determination and shall
deny participation in the program. Entities may appeal a determination
following the process set forth in OAR
409-036-0120.
(c) If an insurer fails to provide the notice
and certification to the Authority within the time established, the insurer may
not submit a request for premium subsidy payment for the next calendar quarter
and practitioners may not receive a premium subsidy for that quarter.
(d) A carrier must notify the Authority in
writing of a material change in any status or condition that relates to their
eligibility to participate in the program.
(8) A carrier shall notify the Authority at
least 90 days prior to the beginning date of the next calendar quarter if the
carrier wants to discontinue participation in the program. The carrier shall
notify its insured participating practitioners of its intent to discontinue to
participate at least 60 days prior to the date of the next calendar
quarter.
(9) The Authority may
determine that funds available for the program are insufficient to provide
maximum premium subsidy for all qualified practitioners, and the Authority may
reduce or eliminate subsidies. There is no guarantee of any amount of premium
subsidy provided to any carrier.
(10) Each carrier must electronically (using
Microsoft Excel or similar spreadsheet application) submit a report to the
Authority within 30 days after the end of each billing period (monthly or
quarterly), showing the following information for each eligible practitioner
who has been determined eligible for a premium subsidy as of the end of the
billing quarter. The information must include the following:
(a) Carrier's name;
(b) Practitioner's name; and
(c) For each practitioner:
(A) Oregon Board of Medical Examiners license
number or Oregon State Board of Nursing certification number;
(B) Practitioner's specialty and specialty
class;
(C) Insurance Services
Office (ISO) code;
(D) Policy
number and effective date;
(E)
Billing period coverage start and end dates;
(F) Billing frequency (annually, quarterly,
monthly);
(G) Current in-force
annual premium for coverage limits of $1 million per occurrence and up to $3
million annual aggregate;
(H)
Premium subsidy percentage, calculated in accordance with
409-036-0080
(3);
(I) Dollar amount of premium subsidy,
calculated in accordance with these rules;
(J) Explanation of any adjustments under this
program from previous reports;
(K)
Policy coverage limits;
(L)
Claims-made step of practitioner, if applicable; and
(M) Identify practitioners who were not on
the eligible list at the beginning of the quarter.
(d) Each January all carriers must provide
the Authority with a copy of their base rates and increased limits factors
table. The carrier must also inform the Authority of the base rates and
increased limits factors table from their current rate filing for Oregon within
30 days of any change to those rates and table.
(e) Failure to make a timely submission may
result in delay in processing the payment request. The Authority shall
calculate the payment of premium subsidies from the Rural Medical Liability
Subsidy Fund based on the funds available for the applicable billing period. In
the event of insufficient funds, the risk of carrier delay in submission of a
request for subsidy payment is on the carrier, because payments shall be based
on the subsidy requests received timely for each applicable billing
period.
(11) Each
carrier must provide its participating practitioners with the following
information each quarter:
(a) The quarterly
premium due before the premium subsidy is applied;
(b) The amount of the premium
subsidy;
(c) The premium after the
premium subsidy is applied; and
(d)
The carrier shall display these three figures on each participating
practitioner's billing statement.
(12) If there are insufficient funds to
provide the maximum premium subsidy to all qualifying practitioners who have
applied for such subsidy, the Authority may reduce or eliminate subsidies for
practitioners in an equitable manner, and shall notify affected carriers and
participants. A carrier shall reduce the premium charged to a practitioner by
the amount of any premium subsidy paid or to be paid under this
Program.
Statutory/Other Authority: ORS
676.454
Statutes/Other Implemented: ORS
676.454
