Or. Admin. Code § 836-010-0155 - Gender Specific Contract Language
(1) As used in this rule, "provider" includes
but is not limited to:
(a) A physician as
defined in ORS 677.010.
(b) A physician group, independent practice
association, physician-controlled organization, hospital organization or other
provider organization that contracts with a provider for the purpose of
facilitating the provider's participation in a provider network contract.
(c) A person licensed or certified
by the laws of this state to administer medical services or mental health
services in the ordinary course of business or practice of a profession. A
person grandfathered under the provisions of Section 3, chapter 674, Oregon
Laws 2015 (Enrolled Senate Bill 696) shall be considered licensed or certified
under this section.
(2)
An individual's attending provider determines whether a sex-specific
recommended preventive service that is required to be covered without cost
sharing under section 2713 of the Public Health Service Act and its
implementing regulations is medically appropriate for a particular individual.
When an attending provider determines that a recommended service is medically
appropriate for an individual and the individual satisfies the criteria for the
service or treatment, the insurer must provide coverage for the recommended
service regardless of sex assigned at birth, gender identity, or gender of the
individual otherwise recorded by the insurer.
Notes
Stat. Auth.: ORS 731.244
Stats Implemented: ORS 743A.066, 743A.080, 743A.100, 743A.104, 743A.105, 743A.108, 743A.110 and 743A.120
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