Or. Admin. Code § 836-052-1000
Current through Register Vol. 63, No. 12, December 1, 2024
Section 836-052-1000 - [Effective 1/1/2025] Prosthetic and Orthotic Devices(1) For purposes of this rule, the terms "orthotic device" and "prosthetic device" have the meanings given to those terms under ORS 743A.145.(2) The list of devices that must be covered under ORS 743A.145, includes any prosthetic or orthotic device for which the Centers for Medicare and Medicaid Services (CMS) has established an L Code in the Healthcare Common Procedure Coding System (HCPCS) Level II.(3) Coverage for the prosthetic and orthotic devices and supplies described in subsection (2) of this section may not be subject to internal or separate limits or caps other than the policy lifetime maximum benefits. This subsection does not authorize a health benefit plan or other policy of health insurance to impose a lifetime or annual dollar limit that is otherwise prohibited under state or federal law.(4) For purposes of ORS 743A.145, coverage provided through a managed care organization includes a health insurance policy that requires an enrollee to use a closed network of providers managed, owned, under contract with or employed by the insurer in order to receive benefits under the plan.Or. Admin. Code § 836-052-1000
ID 12-2007, f. 12-18-07, cert. ef. 1-1-08; ID 12-2009, f. & cert. ef. 12-18-09; ID 8-2011, f. & cert. ef. 2-23-11; ID 8-2012, f. & cert. ef. 4-5-12; ID 4-2016, f. & cert. ef. 4/8/2016; ID 51-2023, amend filed 12/18/2023, effective 1/1/2024; ID 36-2024, amend filed 11/08/2024, effective 1/1/2025Statutory/Other Authority: ORS 731.244 & 743A.145
Statutes/Other Implemented: 743A.145