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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
A-Engrossed
Senate Bill 716
Ordered by the Senate April 15
Including Senate Amendments dated April 15
Sponsored by Senator GORSEK (Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure. The statement includes a measure digest written in compliance with applicable readability standards.
Digest: Makes health insurers and OHA pay more for services at some urgent care cen-
ters than other urgent care centers until 2033. Tells DCBS to make some rules and submit
a report about this Act. (Flesch Readability Score: 60.1).
[Digest: Tells OHA to make rules about registering urgent care centers and creates some stan-
dards. Tells some insurers to cover cost of care at registered urgent care centers at a set rate. (Flesch
Readability Score: 65.5).]
[Requires the Oregon Health Authority to adopt rules for registering urgent care centers and
specifiesrequirements.]
[Requires coverage of services provided by registered urgent care centers by health insurance that
reimburses medical costs, plans offered by the Public Employees’ Benefit Board and Oregon Educators
Benefit Board, health maintenance organizations and multiple employer welfare arrangements and es-
tablishes requirements for rates of reimbursement.]
[Takes effect on the 91st day following adjournment sine die.]
Requires a policy or certificate of health insurance to reimburse medical care provided
at an eligible urgent care center in an amount that is 20 percent higher for the same services
when the services are provided at an urgent care center that is not eligible. Includes this
coverage requirement for the state medical assistance program, Oregon Educators Benefit
Board, Public Employees’ Benefit Board, health care services contractors and trusts carry-
ing out multiple employer welfare arrangements.
Requires the Department of Consumer and Business Services to makes rules and submit
a report on the implementation of this Act.
Sunsets the coverage requirements for eligible urgent care centers on January 2, 2033.
A BILL FOR AN ACT
Relating to urgent care centers; creating new provisions; and amending ORS 743A.036.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Section 2 of this 2025 Act is added to and made a part of the Insurance Code.
SECTION 2.(1) As used in this section:
(a) “Eligible urgent care center” means an urgent care center located in a rural area that
provides services regardless of the form of reimbursement and has onsite radiology and lab-
oratory services.
(b) “Urgent care center” means a facility or portion of a facility that is open to the public
and provides medical care to individuals on a walk-in and episodic basis for illnesses or in-
juries that are acute but not life-threatening or do not require emergency medical services.
(2) A policy or certificate of health insurance issued in this state that reimburses the
cost of medical care provided by an urgent care center must reimburse the cost of medical
services provided by an eligible urgent care center in an amount that is 20 percent higher
than the reimbursement paid for the same services when provided by an urgent care center
that is not an eligible urgent care center.
NOTE:Matter in boldfaced type in an amended section is new; matter [italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 1357 A-Eng. SB 716
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(3) This section is exempt from ORS 743A.001.
(4) The Department of Consumer and Business Services shall adopt rules establishing the
requirements for qualification as an eligible urgent care center.
SECTION 3. ORS 743A.036, as amended by section 154, chapter 73, Oregon Laws 2024, is
amended to read:
743A.036. (1) 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 en-
titled 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.
(2)(a) Except as provided in section 2 of this 2025 Act, the reimbursement of a service de-
scribed in subsection (1) of this section that is provided by a licensed physician associate or a li-
censed 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.
(b) 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:
(A) Diagnosis and procedure codes applicable to the services;
(B) Physician associate’s or nurse practitioner’s own name; and
(C) National provider identifier for:
(i) The physician associate or nurse practitioner; and
(ii) If required by the insurer, the facility in which the physician associate or nurse practitioner
provides the services.
(3) 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.
(4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply
with this section.
SECTION 4. ORS 743A.036, as amended by section 154, chapter 73, Oregon Laws 2024, and
section 3 of this 2025 Act, is amended to read:
743A.036. (1) 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 en-
titled 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.
(2)(a) [Except as provided in section 2 of this 2025 Act,] 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.
(b) 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:
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(A) Diagnosis and procedure codes applicable to the services;
(B) Physician associate’s or nurse practitioner’s own name; and
(C) National provider identifier for:
(i) The physician associate or nurse practitioner; and
(ii) If required by the insurer, the facility in which the physician associate or nurse practitioner
provides the services.
(3) 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.
(4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply
with this section.
SECTION 5. Section 6 of this 2025 Act is added to and made a part of ORS chapter 414.
SECTION 6.(1) As used in this section:
(a) “Eligible urgent care center” has the meaning given that term in section 2 of this 2025
Act, as further defined by rule by the Department of Consumer and Business Services.
(b) “Urgent care center” has the meaning given that term in section 2 of this 2025 Act.
(2) The Oregon Health Authority and a coordinated care organization shall reimburse the
cost of services provided by an eligible urgent care center in an amount that is 20 percent
higher than the reimbursement paid for the same services when provided by an urgent care
center that is not an eligible urgent care center.
SECTION 7. (1) In addition the requirements in ORS 243.144, benefit plans offered by the
Public Employees’ Benefit Board that reimburse the cost of medical and other health ser-
vices and supplies must comply with the requirements for health benefit plan coverage de-
scribed in section 2 of this 2025 Act.
(2) In addition to the requirements in ORS 243.877, benefit plans offered by the Oregon
Educators Benefit Board that reimburse the cost of medical and other health services and
supplies must comply with the requirements for health benefit plan coverage described in
section 2 of this 2025 Act.
(3) In addition to the requirements in ORS 750.055, a health care service contractor shall
comply with the requirements of section 2 of this 2025 Act to the extent it is not inconsistent
with the express provisions of ORS 750.005 to 750.095.
(4) In addition to the requirements in ORS 750.333, the requirements of section 2 of this
2025 Act apply to trusts carrying out a multiple employer welfare arrangement.
SECTION 8. The Oregon Health Authority and the Department of Consumer and Busi-
ness Services shall submit a report on the implementation of sections 2 and 6 of this 2025
Act in the manner provided by ORS 192.245 no later than January 1, 2031. The report shall
include but is not limited to:
(1) An analysis of the cost and benefit.
(2) A summary of patient demographics that includes a reason for the patient visit to the
eligible urgent care center.
(3) An analysis of reimbursement type.
SECTION 9. (1) Sections 2, 6 and 7 of this 2025 Act and the amendments to ORS 743A.036
by section 3 of this 2025 Act become operative on January 1, 2027.
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(2) The amendments to ORS 743A.036 by section 4 of this 2025 Act become operative on
January 1, 2033.
SECTION 10. (1) Section 2 of this 2025 Act applies to health benefit plans issued, renewed
or extended on or after January 1, 2027.
(2) Section 6 of this 2025 Act applies to medical assistance provided on or after January
1, 2027, and to contracts with coordinated care organizations for periods beginning on or af-
ter January 1, 2027.
(3) Section 7 of this 2025 Act applies to benefit plans, health care services contracts and
multiple employer welfare arrangements, issued, renewed or extended on or after January
1,2027.
SECTION 11.(1) Sections 2, 6 and 7 of this 2025 Act are repealed on January 2, 2033.
(2) Section 8 of this 2025 Act is repealed on January 2, 2031.
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