Or. Admin. Code § 836-053-0330

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-053-0330 - Nationally Recognized Standards for Use in Demonstrating Compliance with Network Adequacy Requirements

(1) Beginning with plan year 2020, an insurer electing to demonstrate compliance with network adequacy requirements established in ORS 743B.505 by submitting for each network evidence of compliance with a nationally recognized standard may use the federal network adequacy standards applicable to Medicare Advantage plans, adjusted to reflect the age demographics of the enrollees in the plan. An insurer must adjust the Medicare Advantage network adequacy standards to ensure these specialties are included for the age demographics of the population covered by the network plan:

(a) Primary Care, including pediatrics - aggregate Medicare Advantage HSD Reference Codes 001 through 006;

(b) Endocrinology - Medicare Advantage HSD Reference Code 012;

(c) Gynecology (OB/GYN) - Medicare Advantage HSD Reference Code 016;

(d) Infectious Diseases - Medicare Advantage HSD Reference Code 017;

(e) Oncology - Medical/Surgical -Medicare Advantage HSD Reference Code 021;

(f) Oncology - Radiation/Radiology -Medicare Advantage HSD Reference Code 022;

(g) Psychiatric - Medicare Advantage HSD Reference Code 029;

(h) Cardiology - Medicare Advantage HSD Reference Code 008;

(i) Rheumatology - Medicare Advantage HSD Reference Code 031;

(j) Hospitals - Medicare Advantage HSD Reference Code 040;

(k) Outpatient Dialysis - Medicare Advantage HSD Reference Code 044; and

(l) Inpatient Psychiatric Facility Services - Medicare Advantage HSD Reference Code 052.

(2) The evidence of compliance with a nationally recognized standard must be submitted to the Director no later than March 31 each year for the immediately preceding calendar year as of December 31.

Or. Admin. Code § 836-053-0330

ID 10-2016, f. & cert. ef. 9/14/2016; ID 6-2019, amend filed 06/17/2019, effective 7/1/2019

Statutory/Other Authority: ORS 731.244 & ORS 743B.505

Statutes/Other Implemented: ORS 743B.505