(2) A health benefit plan offered in this state must reimburse the cost of universal newborn nurse home visiting services as prescribed by the Oregon Health Authority by rule under ORS 433.301 (7).

(3) The coverage must be provided without any cost-sharing, coinsurance or deductible applicable to the services.

(4) Carriers must offer the services in their health benefit plans but enrollees are not required to receive the services as a condition of coverage and may not be penalized or in any way discouraged from declining the services.

(5) A carrier must notify an enrollee about the services whenever an enrollee adds a newborn to coverage.

(6) A carrier may use in-network providers or may contract with local public health authorities to provide the services.

(7) This section does not require a carrier to reimburse the cost of the services in any specific manner. The services may be reimbursed using:

(a) A value-based payment methodology;

(b) A claim invoicing process;

(c) Capitated payments;

(d) A payment methodology that takes into account the need for a community-based entity providing the services to expand its capacity to provide the services and address health disparities; or

(e) Any other methodology agreed to by the carrier and the provider of the services.

(8) Carriers shall report to the authority, in the form and manner prescribed by the authority, data regarding claims submitted for services covered under this section to monitor the provision of the services. [2019 c.552 §3]

Note: See 743A.001.

Note: 743A.078 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.