(1) The director
has established the fee schedule in section (3) of this rule for professional
costs and direct worker purchases. The schedule sets maximum spending limits
per claim opening for each category; however, the insurer may spend more than
the maximum limit. Spending limits will be adjusted annually, effective July 1,
based on the conversion factor published with the cost-of-living matrix in
Bulletin 124.
(2) For workers
needing an extended training plan under OAR
436-120-0443, the fee schedule
spending limits for the Training category and Direct Employment/Training
Combined category listed below must be increased by 30 percent.
(3) Amounts include professional costs,
travel and wait time, and other travel expenses: [Table not included. See ED.
NOTE.]
NOTE: *Each limit is shown as a percentage of Oregon's state
average weekly wage (SAWW), determined under ORS
656.211. Dollar amounts are
published in Bulletin 124 and are adjusted annually, effective July 1, based on
changes in the SAWW.
(4) The
insurer must pay, within 60 days of receipt, the provider's bill for services
provided under the insurer-provider agreement. The insurer may not deny payment
on the grounds the worker was not eligible for the assistance if the provider
performed the services in good faith without knowledge of the
ineligibility.
Notes
Or. Admin. Code §
436-120-0720
WCD
6-1980(Admin), f. 5-22-80, ef. 6-1-80; WCD 4-1981(Admin), f. 12-4-81, ef.
1-1-82; WCD 11-1982(Admin)(Temp), f. 12-29-82, ef. 1-1-83; WCD 2-1983(Admin),
f. & ef. 6-30-83; WCD 5-1983(Admin), f. 12-14-83, ef. 1-1-84; WCD 7-1985,
f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0120; WCD 11-1987, f.
12-17-87, ef. 1-1-88; WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered
from 436-120-0070 & 436-120-0215; WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96;
WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00; WCD 4-2001, f. 4-13-01, cert. ef.
5-15-01; WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02; WCD 3-2004, f. 3-5-04 cert.
ef. 4-1-04; WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05; WCD 8-2007, f. 11-1-07,
cert. ef. 12-1-07; WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10; WCD 5-2010, f.
9-15-10, cert. ef. 11-15-10;
WCD
4-2016, f. 11-28-16, cert. ef.
1/1/2017;
WCD
15-2024, amend filed 06/07/2024, effective
7/1/2024
Tables referenced are available from the agency.
To view attachments referenced in rule text,
click here to view
rule.
Statutory/Other Authority: ORS
656.340(9)
& 656.726(4)
Statutes/Other Implemented: ORS
656.340 &
656.258
