OREGON
Employee Selects
The worker may choose an attending doctor, physician or nurse practitioner within the State of Oregon. The worker may choose the initial attending physician or nurse practitioner and may subsequently change attending physician or nurse practitioner two times without approval from the director. If the worker thereafter selects another attending physician or nurse practitioner, the insurer or self-insured employer may require the director's approval of the selection. The decision of the director is subject to review under ORS 656.704. The worker also may choose an attending doctor or physician in another country or in any state or territory or possession of the United States with the prior approval of the insurer or self-insured employer. (ORS § 656.245 (2)(a))

Change of Provider
The worker may choose an attending doctor, physician or nurse practitioner within the State of Oregon. The worker may choose the initial attending physician or nurse practitioner and may subsequently change attending physician or nurse practitioner two times without approval from the director. If the worker thereafter selects another attending physician or nurse practitioner, the insurer or self-insured employer may require the director's approval of the selection. The decision of the director is subject to review under ORS 656.704. The worker also may choose an attending doctor or physician in another country or in any state or territory or possession of the United States with the prior approval of the insurer or self-insured employer. (ORS § 656.245 (2)(a))

The worker may choose to change his or her attending physician or authorized nurse practitioner only twice after the initial choice. When the worker requests a referral by the attending physician or authorized nurse practitioner to another attending physician or authorized nurse practitioner, the change will count as one of the worker's choices. The limitation of the worker's right to choose attending physicians or authorized nurse practitioners begins with the date of injury and extends through the life of the claim. (Or. Admin. R. 436-010-0220 (2))

If a worker not enrolled in an MCO has changed attending physicians or authorized nurse practitioners by choice twice (or for MCO enrolled workers, the maximum allowed by the MCO) and wants to change again, the worker must request approval from the insurer. The worker must make the request in writing or by signing Form 827. The insurer must respond to the worker within 14 days of receiving the request whether the change is approved. If the insurer objects to the change, the insurer must: (A) Send the worker a written explanation of the reasons; (B) Send the worker Form 2332 (Worker's Request to Change Attending Physician or Authorized Nurse Practitioner); and (C) Inform the worker that he or she may request director approval by sending Form 2332 to the director. (Or. Admin. R. 436-010-0220 (4)(a))

Panels
Not allowed

Panel Provisions
Only an MCO may provide managed care services as described in ORS 656.260(4)(d) and under these rules, except as allowed under 436-015-0009. An insurer or someone acting on behalf of an insurer may not manage the care of non-MCO enrolled workers by limiting choice of medical providers, except as allowed under ORS chapter 656, or by requiring medical providers to abide by specific treatment standards, treatment guidelines, and treatment protocols. (Or. Admin. R. 436-015-0007)
Except as otherwise provided in this Chapter, only a MCO certified by the Director may: (a) Restrict the choice of a health care provider or medical service provider by a worker;
(b) Restrict the access of a worker to any category of medical service providers;
(c) Restrict the ability of a medical service provider to refer a worker to another provider;
(d) Require preauthorization or precertification to determine the necessity of medical services or treatment; or
(e) Restrict treatment provided to a worker by a medical service provider to specific treatment guidelines, protocols or standards. (ORS 656.260 (21) (A))

OREGON MCO
Employee Selects from Network
An MCO enrolled worker must choose:
(a) A panel provider unless the MCO approves a non-panel provider, or
(b) A "come-along provider" who provides medical services subject to the terms and conditions of the governing MCO. A come-along provider is a primary care physician, chiropractic physician, or an ANP who is not a Managed Care Organization (MCO) panel provider and who continues to treat the worker when the worker becomes enrolled in an MCO. (Or. Admin. R. 436-010-0220 (5))

The Managed Care Organization plan must provide a description of the times, places, and manner of providing services adequate to ensure that workers governed by the MCO will be able to:
(a) Access an MCO panel with a minimum of one attending physician within the MCO for every 1,000 workers covered by the plan;
(b) Receive initial treatment by the worker's choice of an attending physician or authorized nurse practitioner within 24 hours of the MCO's knowledge of the need or a request for treatment;
(c) Receive initial treatment by the worker's choice of an attending physician or authorized nurse practitioner in the MCO within 5 working days, after treatment by a physician outside the MCO.;
(e)Receive necessary treatment from any category of medical service provider as defined in subsection (7)(a) of this rule and have a choice of at least 3 medical service providers within each category. The worker also must be able to choose from at least 3 physical therapists and three psychologists. For categories in which the MCO has fewer than three providers, the MCO must allow workers to seek treatment outside the MCO from providers in those categories, consistent with the MCO's treatment and utilization standards.;
(f) Access medical providers, including attending physicians, within a reasonable distance from the worker's place of employment, considering the normal patterns of travel. For purposes of this rule, 30 miles (one way) in urban areas and 60 miles (one way) in rural areas will be considered a reasonable distance; (Or. Admin. R. 436-015-0030 (4))

The plan must provide: (a) An adequate number of medical service providers from each provider category. For purposes of these rules, the categories include acupuncturist, chiropractic physician, dentist, naturopathic physician, optometric physician, osteopathic physician, medical physician, and podiatric physician, as listed in ORS 676.110. The plan must meet this section's requirements unless the MCO established that there is not an adequate number of providers in a given category able or willing to become members of the MCO. (Or. Admin. R. 436-015-0030(7))

Change of Provider
If a worker not enrolled in an MCO has changed attending physicians or authorized nurse practitioners by choice twice (or for MCO workers, the maximum allowed by the MCO) and wants to change again, the worker must request approval from the insurer. The worker must make the request in writing or by signing Form 827. The insurer must respond to the worker within 14 days of receiving the request, whether the change is approved. If the insurer objects to the change, the insurer must:
(A) Send the worker a written explanation of the reasons;
(B) Send the worker Form 2332 (Worker's Request to Change Attending Physician or Authorized Nurse Practitioner); and
(C) Inform the worker that he or she may request director approval by sending Form 2332 to the director. (Or. Admin. R. 436-010-0220 (4)(a))

Note: Request to Change Attending Physician
http://wcd.oregon.gov//forms/pages/bulletins.aspx?b=251

Change of Provider
Not Addressed

Panel Provisions
See Direction of Care law.

The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.