ORS 743A.036 Services provided by licensed nurse practitioner or licensed physician associate

Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician associate or a licensed nurse practitioner if the service is within the lawful scope of practice of the physician associate or nurse practitioner.

The reimbursement of a service described in subsection (1) of this section that is provided by a licensed physician associate or a licensed nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

As used in this subsection, “independent practice” means the licensed physician associate or the licensed nurse practitioner bills insurers for services provided by the physician associate or nurse practitioner using the:

Diagnosis and procedure codes applicable to the services;

Physician associate’s or nurse practitioner’s own name; and

National provider identifier for:

The physician associate or nurse practitioner; and

If required by the insurer, the facility in which the physician associate or nurse practitioner provides the services.

This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act or other insurers that employ physicians, licensed physician associates or licensed nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee-for-service basis.

An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section.