Stat. Auth.:ORS441.098 Stats. Implemented:ORS441.098 Hist.: Ph 15-2014, F. & Cert. Ef. 6-2-14


Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 

DIVISION 72
HEALTH CARE PRACTITIONER REFERRALS
333-072-0200
Purpose
The purpose of these rules is to establish
notice requirements for patient choice and financial interest as required in ORS
441.098 when health practitioners refer patients for diagnostic testing or health
care treatment or services.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14
333-072-0205
Applicability
These rules do not apply to a referral
for a diagnostic test or health care treatment or service:
(1) When a patient is receiving
inpatient hospital services or emergency department services if the referral is
for a diagnostic test or health care treatment or service to be provided while the
patient is in the hospital or emergency department.
(2) When a referral is made
to a particular facility after the initial referral of the patient to that facility,
when notice was provided at the initial referral in accordance with these rules.
(3) When a patient has been
directed or transferred to a facility for emergency department services.
(4) When a patient is being
directed back to the referring practitioner by the practitioner or facility who
received the referral.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14
333-072-0210
Definitions
As used in OAR 333-072-0200 through
333-072-0225 the following definitions apply:
(1) "Emergency department
services" means services provided in the part of a licensed hospital facility open
24 hours a day to provide acute care treatment and services for a wide range of
illnesses and injuries.
(2) "Facility" means a hospital,
outpatient clinic owned by a hospital, ambulatory surgical center, freestanding
birthing center as defined in ORS 442.015, or a facility that receives Medicare
reimbursement as an independent diagnostic testing facility.
(3) "Financial interest"
means the direct or indirect ownership interest of five percent or more held by
a health practitioner or the practitioner’s immediate family member.
(4)(a) "Health practitioner"
means a physician, podiatric physician and surgeon, dentist, direct entry midwife,
certified nurse practitioner, licensed registered nurse who is certified by the
Oregon State Board of Nursing as a nurse midwife nurse practitioner, licensed physician
assistant or medical imaging licensee under ORS 688.405 to 688.605.
(b) "Health practitioner"
does not include a provider in health maintenance organizations as that term is
defined in ORS 750.005.
(5) "Immediate family member"
means a health practitioner’s spouse, domestic partner, child, stepchild,
mother, father or sibling.
(6) "Inpatient hospital services"
means all medical and nursing services provided to persons who require 24-hour supervision
because of acute or chronic medical or psychiatric illness.
(7) "Outpatient clinic owned
by a hospital" means a satellite or mobile satellite indorsed under a hospital’s
license under OAR 333-500-0025.
(8) "Physician" has the meaning
given that term in ORS 677.010.
(9) "Referral" means the
direction of a patient to a facility for a diagnostic test or health care treatment
or service.
(10) "These rules" means
OAR 333-072-0200 through 333-072-0225.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14
333-072-0215
Requirements for Notification of
Patient Choice
(1) A referral for a diagnostic test
or health care treatment or service shall be based on the patient’s clinical
needs and personal health choices.
(2) A health practitioner
may not deny, limit or withdraw a referral solely because the patient chooses to
have the diagnostic test or health care treatment or service at a facility other
than the one recommended by the health practitioner.
(3) A health practitioner
or the practitioner’s designee shall provide written or oral notice of patient
choice at the time the patient establishes care with the practitioner. The notice
shall include the following:
(a) The patient has a choice
and when referred to a facility for a diagnostic test or health care treatment or
service the patient may receive the diagnostic test or health care treatment or
service at a facility other than the one recommended by the health practitioner.
(b) If the patient chooses
to have the diagnostic test, health care treatment or service at a facility different
from the one recommended by a practitioner, the patient is responsible for determining
the extent or limitation of coverage for the diagnostic test, health care treatment
or service at the facility chosen by the patient.
(c) A health practitioner
may not deny, limit or withdraw a referral solely because the patient chooses to
have the diagnostic test or health care treatment or service at a facility other
than the one recommended by the health practitioner.
(4) Health practitioners
shall also post notice of patient choice in a conspicuous place. The posted notice
shall include the information set forth in subsections (3)(a) and (b) of this rule.
(5) At the time of referral
health practitioners may provide written or oral notice of patient choice. The notice
shall include the information set forth in subsection (3)(a) of this rule.
(6) Practitioners must document
all oral notifications.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14; PH 21-2014(Temp), f. & cert. ef. 7-28-14 thru 1-24-15; PH
22-2014(Temp), f. & cert. ef. 8-7-14 thru 1-24-15; PH 2-2015, f. & cert.
ef. 1-16-15
333-072-0220
Requirement for Notice of Financial
Interest
If a health practitioner refers a patient
for a diagnostic test or health care treatment or service to a facility in which
the health practitioner or an immediate family member has a financial interest of
five percent or more, the practitioner or the practitioner’s designee shall
provide notice of that financial interest orally and in writing at the time of the
referral.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14
333-072-0225
Violations and Enforcement
(1) A health practitioner who fails
to comply with these rules shall be subject to investigation and disciplinary action
in accordance with ORS 441.098.
(2) When investigating an
allegation that notice was not provided in accordance with ORS 441.098 and these
rules, the Oregon Health Licensing Agency and a health professional regulatory board
may:
(a) Review documentation
of a health practitioner’s policies and procedures for provision of notice
and accept the policies and procedures as proof that notice was given in accordance
with the policies.
(b) Rely on the practitioner’s
documentation of notice as proof that notice was given, if no policies or procedures
exist.
Stat. Auth.: ORS 441.098
Stats. Implemented: ORS 441.098
Hist.: PH 15-2014, f. &
cert. ef. 6-2-14

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