Or. Admin. Code § 436-010-0210 - Attending Physician, Authorized Nurse Practitioner, and Temporary Disability Authorization
(1) An attending
physician or authorized nurse practitioner is primarily responsible for the
patient's care, authorizes temporary disability, and prescribes and monitors
ancillary care and specialized care.
(a) No
later than five days after becoming a patient's attending physician or
authorized nurse practitioner, the provider must notify the insurer using Form
827. Regardless of whether Form 827 is filed, the facts of the case and the
actions of the provider determine if the provider is the attending physician or
authorized nurse practitioner.
(b)
Type A, type B, and type C attending physicians and authorized nurse
practitioners may authorize temporary disability and manage medical services
subject to the limitations of ORS chapter 656 or a managed care organization
contract. (See Appendix A "Matrix for Health Care Provider Types"
[Attached])
(c) Except for
emergency services, or otherwise provided for by statute or these rules, all
treatments and medical services must be approved by the worker's attending
physician or authorized nurse practitioner.
(2)
Chiropractic Physicians and
Naturopathic Physicians (Type B providers).
(a) Prior to providing any compensable
medical service or authorizing temporary disability benefits under ORS
656.245, a type B provider must
certify to the director that the provider has reviewed a packet of materials
provided by the director.
(b) Type
B providers may assume the role of attending physician for a cumulative total
of 60 days or 18 visits, whichever occurs first, from the first visit on the
initial claim with any type B provider.
(c) Type B providers may authorize payment of
temporary disability compensation for a period not to exceed 30 days from the
date of the first visit on the initial claim to any type B provider.
(d) Except for chiropractic physicians
serving as the attending physician at the time of claim closure, type B
providers may not make findings regarding the worker's impairment for the
purpose of evaluating the worker's disability.
(3)
Physician Associates (Type C
providers).
(a) Prior to providing any
compensable medical service or authorizing temporary disability benefits under
ORS 656.245, a physician associate
must certify to the director that the provider has reviewed a packet of
materials provided by the director.
(b) Physician associates may assume the role
of attending physician for a cumulative total of 180 days from the date of the
first visit on the initial claim with any physician associate.
(c) Physician associates may authorize
payment of temporary disability compensation for a period not to exceed 180
days from the date of the first visit on the initial claim to any physician
associate.
(d) Physician associates
may not make findings regarding the worker's impairment for the purpose of
evaluating the worker's disability.
(4)
Authorized Nurse
Practitioners.
(a) In order to provide
any compensable medical service, a nurse practitioner licensed in Oregon under
ORS 678.375 to
678.390 must review a packet of
materials provided by the division and complete the statement of authorization.
(See www.oregonwcdoc.info)
Once the nurse practitioner has completed the statement of authorization, the
division will assign an authorized nurse practitioner number.
(b) An authorized nurse practitioner may:
(A) Provide compensable medical services to
an injured worker for a period of 180 days from the date of the first visit
with a nurse practitioner on the initial claim. Thereafter, medical services
provided by an authorized nurse practitioner are not compensable without the
attending physician's authorization; and
(B) Authorize temporary disability benefits
for a period of up to 180 days from the date of the first nurse practitioner
visit on the initial claim.
(5)
Emergency Room Physicians.
Emergency room physicians may authorize temporary disability for no more than
14 days when they refer the patient to a primary care physician. If an
emergency room physician sees a patient in the physician's private practice
apart from their duties as an emergency room physician, the physician may be
the attending physician.
(6)
Unlicensed to Provide Medical Services. Attending physicians may
prescribe services to be carried out by persons not licensed to provide a
medical service or treat independently. These services must be rendered under
the physician's direct control and supervision. Home health care provided by a
patient's family member is not required to be provided under the direct control
and supervision of the attending physician if the family member demonstrates
competency to the satisfaction of the attending physician.
(7)
Out-of-State Attending
Physicians. The worker may choose an attending physician outside the
state of Oregon with the approval of the insurer. When the insurer receives the
worker's request or becomes aware of the worker's request to treat with an
out-of-state attending physician, the insurer must give the worker written
notice of approval or disapproval of the worker's choice of attending physician
within 14 days. If an approved out-of-state attending physician does not comply
with OAR 436-009 or 436-010, the insurer may withdraw approval of the attending
physician.
(a) If the insurer approves the
worker's choice of out-of-state attending physician, the insurer must
immediately notify the worker and the physician in writing of the following:
(A) The Oregon medical fee and payment rules,
OAR 436-009;
(B) The manner in
which the out-of-state physician may provide compensable medical treatment or
services to Oregon workers; and
(C)
That the insurer cannot pay bills for compensable services above the Oregon fee
schedule.
(b) If the
insurer disapproves the worker's out-of-state attending physician or withdraws
a prior approval, the insurer must send the worker written notice that:
(A) Clearly states the reasons for the
disapproval or withdrawal of the prior approval, for example, the out-of-state
physician's refusal to comply with OAR 436-009 and 436-010;
(B) Identifies at least two other physicians
of the same healing art and specialty in the same area that the insurer would
approve;
(C) Informs the worker
that if the worker disagrees with the disapproval or withdrawal, the worker may
request approval from the director under OAR
436-010-0220; and
(D) Informs the worker that the worker may be
liable for payment of services provided after the date of notification if the
worker receives further medical services from the disapproved or no longer
approved out-of-state physician.
(c) If the insurer withdraws approval of the
out-of-state attending physician, the insurer must notify the physician of the
following in writing:
(A) The reasons for
withdrawing the approval;
(B) That
any future services provided by that physician will not be paid by the insurer;
and
(C) That the worker may be
liable for payment of services provided after the date of
notification.
(d) The
worker or worker's representative may request approval from the director under
OAR 436-010-0220 if the worker
disagrees with the insurer's decision to:
(A)
Disapprove an out-of-state attending physician; or
(B) Withdraw the approval of the out-of-state
attending physician.
Notes
To view attachments referenced in rule text, click here to view rule.
Statutory/Other Authority: ORS 656.726(4)
Statutes/Other Implemented: ORS 656.005(12), ORS 656.245, ORS 656.260 & ORS 656.799
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.