Oregon § 743A.169 Behavioral and physical health services provided on same day or in same facility; behavioral health services provided by behavioral health home specialist or patient centered primary care home specialist

Oregon Statutes

§ 743A.169 — Behavioral and physical health services provided on same day or in same facility; behavioral health services provided by behavioral health home specialist or patient centered primary care home specialist

Oregon § 743A.169

Vol.18

Title 56Insurance

Ch. 743AHealth Insurance: Reimbursement of Claims

This text of Oregon § 743A.169 (Behavioral and physical health services provided on same day or in same facility; behavioral health services provided by behavioral health home specialist or patient centered primary care home specialist) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Or. Rev. Stat. § 743A.169 (2026).

Text

(1)As used in this section:

(a)“Behavioral health home” means an entity providing behavioral health services that the Oregon Health Authority has found to meet the core attributes established under ORS 413.259 for a behavioral health home.

(b)“Patient centered primary care home” means an entity providing health care services that the authority has found to meet the core attributes established under ORS 413.259 for a patient centered primary care home.

(2)An individual or group policy or certificate of health insurance that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, may not:

(a)Exclude coverage for a behavioral health service or a physical health service on the

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(1) As used in this section:
(a) “Behavioral health home” means an entity providing behavioral health services that the Oregon Health Authority has found to meet the core attributes established under ORS 413.259 for a behavioral health home.
(b) “Patient centered primary care home” means an entity providing health care services that the authority has found to meet the core attributes established under ORS 413.259 for a patient centered primary care home.
(2) An individual or group policy or certificate of health insurance that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, may not:
(a) Exclude coverage for a behavioral health service or a physical health service on the basis that the behavioral health service and physical health service were provided on the same day or in the same facility.
(b) Impose a copayment for physical health services provided by an in-network provider in a behavioral health home on the same day or in the same facility that a copayment was charged for behavioral health services.
(c) Impose a copayment for behavioral health services provided by an in-network provider in a patient centered primary care home on the same day or in the same facility that a copayment was charged for physical health services.
(d) Require prior authorization for a covered behavioral health service provided by a specialist in a behavioral health home or a patient centered primary care home.
(3) Subsection (2)(a) of this section does not apply to a health benefit plan in which providers are reimbursed by payment of a fixed global budget, using a value-based payment arrangement or using other alternative payment methodologies.
(4) This section is exempt from ORS 743A.001.