| We take your inquiries and comments seriously. When we receive an inquiry that requires a policy decision,
we'll list the issue on this page. We'll then add status updates and post the final decision with the inquiry. If you have input about any policy issues on this page, please get in touch with
the contact person listed for each issue. |
| |
| 2004 |
| Issue:
Attorney fees at administrative review under ORS 656.385. |
| Question: |
Received: |
Contact: |
|
1. Can a party prevail in an administrative review when the merits of the dispute are not addressed, and be awarded attorney fees?
|
6/8/04 |
Cathy
Ostrand-Ponsioen
503-947-7528 |
|
Decision/Action:
|
| Although the facts of each case are unique and attorney fees are awarded on a case-by-case basis, a fee is awardable
if all statutory and rule criteria are met. This may include cases in which administrative review is requested but the matter resolves before an order addressing the merits of the underlying dispute
is issued. In any specific case, the award is appealable. |
| |
| 2003 |
| Issue:
Information for injured workers and insurers on HIPAA provisions for
disclosure of psychotherapy notes |
| Question: |
Received: |
Contact: |
|
1. Do HIPAA provisions relating to psychotherapy notes apply to disclosures for workers' compensation purposes?
2. Is the HIPAA Privacy rule retroactive to services provided before April 14, 2003?
|
6/19/03 |
Ed
Lanssens
503-947-7805 |
|
Decision/Action: The division believes that psychotherapy notes may be disclosed for workers' compensation purposes because
it is a use that is required by law. However, the disclosure must be limited to the relevant requirements. 45 CFR 164.508(a)(1)(ii) and 164.512(a)(1). The law requiring the disclosure is ORS
656.252 and OAR 436-010-0240(2). Thus, if psychotherapy notes are relevant to the determination of a workers' compensation claim, then those notes may be disclosed by the covered entity utilizing
the provisions of OAR 436-010-0240.
2. On December 29, 2000 (FederalRegister, Vol. 65, No. 251, page 82944) the Department of Health and Human Services (DHHS) issued
a technical correction to the Privacy rule that clarifies the effective date as April 14, 2003. Furthermore, DHHS says that it will not enforce the regulation prior to that date, and "the
regulation's provisions will not preempt or otherwise alter state or other law prior to those dates."
|
| |
| 2002 |
| Issue:
Worker’s entitlement to request a Worker Requested Medical Examination |
| Question: |
Received: |
Contact: |
|
1. What if the insurer does not send the IME to the attending physician as required by OAR 436-010-0265(11)?
2. OAR 436-060-0147 requires the worker to submit documentation that the attending physician did not concur with the IME. What if
the attending physician does not check either yes or no that he/she concurs with the IME, or if the attending physician never sends the letter back?
|
3/12/02 |
Kevin
Willingham
503-947-7731 |
|
Decision/Action: The facts of each case are unique and decided on a case-by-case basis. The following may provide general
guidance:
OAR 436-010-0265(11) provides that the “examining physician shall send a report to the insurer and the attending physician
within seven days.” Alternatively, the worker or his/her representative may request the report pursuant to OAR 436-010-0240(18). The worker must establish basis for the exam, which includes
attending physician non-concurrence with the report.
|
| |
| 2001 |
| Issue:
Insurer payment for NC-stat Nerve Conduction Monitoring System |
| Question: Will Oregon workers' compensation support reimbursement for the use of the NC-stat Nerve
Conduction Monitoring System? |
Received: |
Contact: |
| 7/26/01 |
Medical
Review Unit
503-947-7816 |
| Decision/Action: Based on current information,
neither Oregon Revised Statute or Oregon Administrative Rule prohibits use of this system. This should be billed under the existing "Physicians' Current Procedural Terminology (CPT®)"
code 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve: motor, with F-wave study). This CPT® code could be used in addition to the appropriate office visit evaluation
and management code. When billing for the NC-stat service, like an office visit, documentation to support the service provided should be attached to the billing. |
