Bill Text: OR SB416 | 2013 | Regular Session | Engrossed

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Bill Title: Relating to external review by independent review organization of adverse benefit determination by health insurer; declaring an emergency.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB416 Detail]

Download: Oregon-2013-SB416-Engrossed.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 912

                           A-Engrossed

                         Senate Bill 416
                 Ordered by the Senate April 18
           Including Senate Amendments dated April 18

Sponsored by Senator SHIELDS (at the request of Loreta Boskovic)
  (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure.

    { - Requires Department of Consumer and Business Services to
provide complaint process for challenging actions or credentials
of independent review organization and to enforce requirements
for external reviews. Allows department to reassign adverse
benefit determination dispute to another independent review
organization if department finds that independent review
organization has failed to follow legal requirements. - }
Requires Director of Department of Consumer and Business Services
to impose minimum civil penalty on insurer that does not comply
with independent review organization's reversal of adverse
benefit determination.   { - Applies to contracts entered into on
or after effective date of Act. - }
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to external review by independent review organization of
  adverse benefit determination by health insurer; amending ORS
  743.863; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 743.863 is amended to read:
  743.863. (1) An insurer shall comply in a timely manner with a
decision of an independent review organization under ORS 743.862
that reverses, in whole or in part, an adverse benefit
determination. If an insurer fails to comply with the decision,
the Director of the Department of Consumer and Business Services
  { - may - }  { +  shall + } impose on the insurer a civil
penalty of  { + not less than $100,000 and + } not more than $1
million.
  (2) A decision of an independent review organization is
admissible in any legal proceeding involving the insurer or the
enrollee and involving the disputed issues subject to external
review.
  (3) The sanctions under subsection (1) of this section and the
remedies under subsection (2) of this section are in addition to
and not in lieu of other sanctions, rights and remedies provided
by law or contract.

  SECTION 2.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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