Oregon Statutes 414.613 – Discrimination based on scope of practice prohibited; appeals; rules
(1) A coordinated care organization may not discriminate with respect to participation in the organization or coverage against any health care provider who is acting within the scope of the provider’s license or certification under applicable state law. This section does not require that an organization contract with any health care provider willing to abide by the terms and conditions for participation established by the organization. This section does not prevent an organization from establishing varying reimbursement rates based on quality or performance measures.
Terms Used In Oregon Statutes 414.613
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Contract: A legal written agreement that becomes binding when signed.
- Coordinated care organization: means an organization meeting criteria adopted by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
(2) An organization may establish an internal review process for a provider aggrieved under this section, including an alternative dispute resolution or peer review process. An aggrieved provider may appeal the determination of the internal review to the Oregon Health Authority.
(3) The authority shall adopt by rule a process for resolving claims of discrimination under this section and, in making a determination of whether there has been discrimination, must consider the organization’s:
(a) Network adequacy;
(b) Provider types and qualifications;
(c) Provider disciplines; and
(d) Provider reimbursement rates.
(4) A prevailing party in an appeal under this section shall be awarded the costs of the appeal. [Formerly 414.646]
[Formerly 414.640; 2017 c.356 § 34; repealed by 2011 c.602 64,70, 2012 c.8 § 23 and 2015 c.792 § 2]
[Formerly 414.630; 2014 c.45 § 39; 2017 c.356 § 35; repealed by 2011 c.602 64,70, 2012 c.8 § 23 and 2015 c.792 § 2]