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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
House Bill 2041
Sponsored by Representative NOSSE (Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure as introduced. The statement includes a measure digest written in compliance with applicable readability
standards.
Digest: Makes certain health professionals be paid the same when performing the same work
and tells insurers to treat certain claims the same as other claims. (Flesch Readability Score: 63.0).
Requires insurers to reimburse mental health professionals at the same rate as physicians and
other mental health professionals for the same services. Requires insurers to treat certain mental
health professional claims in the same way as claims from other health professionals. Exempts cer-
tain statutes from sunset provisions.
A BILL FOR AN ACT
Relating to mental health services parity; creating new provisions; and amending ORS 743A.024,
743A.036, 743A.048, 743A.052 and 746.230.
Be It Enacted by the People of the State of Oregon:
SECTION 1.
ORS 743A.024 is amended to read:
743A.024. Whenever any individual or group health insurance policy or blanket health insurance
policy described in ORS 743.536 (3) provides for payment or reimbursement for any service within
the lawful scope of service of a clinical social worker licensed under ORS 675.530:
(1) The insured under the policy shall be entitled to the services of a clinical social worker li-
censed under ORS 675.530, upon referral by a physician or psychologist.
(2) The insured under the policy shall be entitled to have payment or reimbursement made to
the insured or on behalf of the insured for the services performed. The payment or reimbursement
shall be in accordance with the benefits provided in the policy and shall be [ computed in] the same
[manner] amount whether performed by a physician, by a psychologist or by a clinical social
worker[ , according to the customary and usual fee of clinical social workers in the area served ].
(3) The provisions of ORS 743A.001 do not apply to this section.
SECTION 2.
ORS 743A.036, as amended by section 154, chapter 73, Oregon Laws 2024, is
amended to read:
743A.036. (1) Whenever any policy of health insurance provides for reimbursement for a primary
care or mental health service provided by a licensed physician, the insured under the policy is en-
titled to reimbursement for such service if provided by a licensed physician associate , [or] a licensed
nurse practitioner or a licensed mental health professional if the service is within the lawful
scope of practice of the physician associate , [ or] nurse practitioner or mental health
professional.
(2)(a) The reimbursement of a service described in subsection (1) of this section that is provided
by a licensed physician associate , [ or] a licensed nurse practitioner or a licensed mental health
professional who is in an independent practice shall be in the same amount as the reimbursement
paid under the policy to a licensed physician performing the service in the area served.
NOTE:Matter in boldfaced type in an amended section is new; matter [ italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 654
HB 2041
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(b) As used in this subsection, “independent practice” means a practice in which the licensed
physician associate , [ or] the licensed nurse practitioner or the licensed mental health profes-
sional bills insurers for services provided by the physician associate , [ or] nurse practitioner or
mental health professional using the:
(A) Diagnosis and procedure codes applicable to the services;
(B) Physician associate’s, [ or] nurse practitioner’s or mental health professional’s own name;
and
(C) National provider identifier for:
(i) The physician associate, [ or] nurse practitioner or mental health professional ; and
(ii) If required by the insurer, the facility in which the physician associate , [ or] nurse practi-
tioner or mental health professional provides the services.
(3) This section does not apply to group practice health maintenance organizations that are
federally qualified pursuant to Title XIII of the Health Maintenance Organization Act or other
insurers that employ physicians, licensed physician associates , [ or] licensed nurse practitioners or
licensed mental health professionals to provide primary care or mental health services and do
not compensate such practitioners on a fee-for-service basis.
(4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply
with this section.
(5) The provisions of ORS 743A.001 do not apply to this section.
SECTION 3.
ORS 743A.048 is amended to read:
743A.048. Whenever any provision of any individual or group health insurance policy or contract
provides for payment or reimbursement for any service which is within the lawful scope of a psy-
chologist licensed under ORS 675.010 to 675.150:
(1) The insured under such policy or contract shall be free to select, and shall have direct access
to, a psychologist licensed under ORS 675.010 to 675.150, without supervision or referral by a phy-
sician or another health practitioner, and wherever such psychologist is authorized to practice.
(2) The insured under such policy or contract shall be entitled to have payment or reimburse-
ment made to the insured or on the insured’s behalf for the services performed. Such payment or
reimbursement shall be in accordance with the benefits provided in the policy and shall be the same
amount whether performed by a physician or a psychologist licensed under ORS 675.010 to 675.150.
(3) The provisions of ORS 743A.001 do not apply to this section.
SECTION 4.
ORS 743A.052 is amended to read:
743A.052. (1) If a group health benefit plan, as described in ORS 743B.005, provides for coverage
for services performed by a clinical social worker or nurse practitioner, the plan also must cover
services provided by a professional counselor or marriage and family therapist licensed under ORS
675.715 to 675.835 when the counselor or therapist is acting within the counselor’s or therapist’s
lawful scope of practice.
(2) Health maintenance organizations may limit the receipt of covered services performed by
professional counselors and marriage and family therapists to services provided by or upon referral
by providers contracting with the health maintenance organization. Health maintenance organiza-
tions and health care service contractors may create substantive plan benefit and reimbursement
differentials at the same level as, and subject to limitations not more restrictive than, those imposed
on coverage or reimbursement of expenses arising out of other medical conditions and apply them
to contracting and noncontracting providers.
(3) An insured under such policy or contract shall be entitled to have payment or re-
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imbursement made to the insured or on the insured’s behalf for the services performed. Such
payment or reimbursement shall be in accordance with the benefits provided in the policy
or contract and shall be the same amount whether performed by a physician, clinical social
worker, nurse practitioner, physician associate, professional counselor or marriage and
family therapist.
[(3)] (4) The provisions of ORS 743A.001 do not apply to this section.
SECTION 5.
ORS 746.230, as amended by section 160, chapter 73, Oregon Laws 2024, is
amended to read:
746.230. (1) An insurer or other person may not commit or perform any of the following unfair
claim settlement practices:
(a) Misrepresenting facts or policy provisions in settling claims;
(b) Failing to acknowledge and act promptly upon communications relating to claims;
(c) Failing to adopt and implement reasonable standards for the prompt investigation of claims;
(d) Refusing to pay claims without conducting a reasonable investigation based on all available
information;
(e) Failing to affirm or deny coverage of claims within a reasonable time after completed proof
of loss statements have been submitted;
(f) Not attempting, in good faith, to promptly and equitably settle claims in which liability has
become reasonably clear;
(g) Compelling claimants to initiate litigation to recover amounts due by offering substantially
less than amounts ultimately recovered in actions brought by such claimants;
(h) Attempting to settle claims for less than the amount to which a reasonable person would
believe a reasonable person was entitled after referring to written or printed advertising material
accompanying or made part of an application;
(i) Attempting to settle claims on the basis of an application altered without notice to or consent
of the applicant;
(j) Failing, after payment of a claim, to inform insureds or beneficiaries, upon request by them,
of the coverage under which payment has been made;
(k) Delaying investigation or payment of claims by requiring a claimant or the claimant’s phy-
sician, naturopathic physician, physician associate , [ or] nurse practitioner or mental health pro-
fessional to submit a preliminary claim report and then requiring subsequent submission of loss
forms when both require essentially the same information;
(L) Failing to promptly settle claims under one coverage of a policy where liability has become
reasonably clear in order to influence settlements under other coverages of the policy;
(m) Failing to promptly provide the proper explanation of the basis relied on in the insurance
policy in relation to the facts or applicable law for the denial of a claim; or
(n) Any of the practices described in ORS 746.233.
(2) No insurer shall refuse, without just cause, to pay or settle claims arising under coverages
provided by its policies with such frequency as to indicate a general business practice in this state,
which general business practice is evidenced by:
(a) A substantial increase in the number of complaints against the insurer received by the De-
partment of Consumer and Business Services;
(b) A substantial increase in the number of lawsuits filed against the insurer or its insureds by
claimants; or
(c) Other relevant evidence.
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SECTION 6.
The amendments to ORS 743A.024, 743A.036, 743A.048 and 743A.052 by
sections 1 to 4 of this 2025 Act apply to policies or certificates issued, renewed or extended
on or after January 1, 2026.
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