Or. Admin. Code § 836-100-0115

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

Section 836-100-0115 - Waiver

(1) If a health insurer or health care entity demonstrates that the insurer or entity is certified by the Council for Affordable Quality Healthcare's (CAQH) Committee on Operating Rules for Information Exchange (CORE), the Director of the Department of Consumer and Business Services shall grant a waiver from the requirement to comply with the Oregon Companion Guide. A health insurer or health care entity granted a waiver under this subsection shall be deemed in compliance with the standards of the applicable Oregon Companion Guide.

(2) Until January 1, 2014, the Director of the Department of Consumer and Business Services may grant a waiver to a health insurer or health care entity subject to OAR 836-100-0110 that demonstrates that the health insurer or health care entity is unable to comply with its provisions, or for whom compliance would be an undue hardship. A health insurer or health care entity requesting a waiver must submit a letter of need to the director. If the health insurer or health care entity requires an extension of the waiver, the health insurer or health care entity may apply to the Director of the Department of Consumer and Business Services for a temporary waiver of some or all of the provisions of the applicable Oregon Companion Guide. The waiver request must:

(a) Specify the name of the Oregon Companion Guide for which the waiver is requested;

(b) Indicate whether the waiver is for the entire Oregon Companion Guide or for specific provisions in the Oregon Companion Guide for which a waiver is requested.

(c) Explain the reasons the health insurer or health care entity is unable to comply or for which compliance would cause undue hardship, including systemic or structural impediments, financial hardship, and any other factors the health insurer or health care entity believes pertinent to the request.

(d) Specify the period of time for which the waiver is requested. After January 1, 2014, an insurer or health care entity may not request a waiver for a period longer than twelve months. An insurer or entity may request a waiver for an additional twelve months as previous waivers lapse.

(e) Include the insurer's or entity's plan for coming into compliance with the provisions of OAR 836-100-0110 during the time granted by the waiver.

(3)

(a) After considering a request for a waiver submitted under section (1) of this rule, and at the director's discretion, the director may grant or deny the request.

(b) In considering whether to allow a waiver requested pursuant to section (1) of this rule, the director shall consider the efforts of the health insurer or health care entity to comply with federal requirements contained in Section 1104 of the Patient Protection and Affordable Care Act.

(4) Information and standards related to CORE certification are located at the CAQH website: http://www.caqh.org/benefits.php [File Link Not Available]

Or. Admin. Code § 836-100-0115

ID 12-2011, f. & cert. ef. 7-15-11; ID 16-2011, f. & cert. ef. 10-31-11

Stat. Auth.: ORS 731.244 & 2011 OL Ch. 130 Sec. 2 (Enrolled SB 94)

Stats. Implemented: 2011 OL Ch. 130 Sec. 2 (Enrolled SB 94)