Or. Admin. Code § 836-053-1355

Current through Register Vol. 63, No. 11, November 1, 2024

Section 836-053-1355 - Synopses

(1) The synopses of decisions required to be filed by independent review organizations under ORS 743B.256(5) with the Director of the Department of Consumer and Business Services must meet the requirements of this rule.

(2) Synopses of decisions shall include the following for each decision:

(a) A description of the dispute sought to be reviewed by the independent review organization, including whether the dispute is alleged to concern the determination of medical necessity or experimental or investigational treatment, whether an active course of treatment is occurring for the purpose of determining whether a person is eligible for continuity of care, or whether the dispute concerns some other issue.

(b) A determination by the independent review organization whether the dispute falls within any of the categories of issues that are eligible for independent review.

(c) A determination of the dispute by the independent review organization in favor of the insurer or enrollee.

(3) A synopsis may include a statement describing the illness, condition or other object of medical treatment, subject to section (4) of this rule.

(4) Synopses must exclude all facts and other matters that identify or may identify an enrollee. The facts and other matters include but are not limited to the name or address of an enrollee, the location of the provider office or other place of treatment, and the disease, condition or other treated matter, the disclosure of which may reveal the identity of the enrollee.

Or. Admin. Code § 836-053-1355

ID 10-2002(Temp), f. & cert. ef. 4-5-02 thru 9-27-02; ID 19-2002, f. 9-27-02, cert. ef. 9-28-02; ID 27-2018, minor correction filed 08/22/2018, effective 8/22/2018

Statutory/Other Authority: ORS 731.244 & ORS 743B.256

Statutes/Other Implemented: ORS 743B.256