Oregon Senate Bill 1529, now in effect, intends to expand access to care and improve health outcomes. The following is an overview of the law’s key requirements and what you can expect from PacificSource.
The law applies only to Oregon members covered by fully insured commercial medical plans, not Medicare or Medicaid.
Waiving cost-share for the first three PCP visits
This section requires health insurance companies to reimburse the cost of at least three primary care visits for behavioral or physical health treatment without cost sharing on all Oregon off-exchange individual, small, and large group plans.
Is PacificSource implementing this mandate yet?
Yes. We are still working through operational details and will add more information to this page as soon as possible.
Primary care provider (PCP) assignment
This section of the bill requires health insurers to assign a PCP to applicable members if they have not done so by the 90th day of their plan year. These members are not required to see you, and they can switch to a different provider at any time.
How are PCP assignments made?
Assignments are based on claims history, provider availability, and/or proximity to the member’s home address. We will do our best to find a good match.
How is PacificSource communicating about this law?
- We are reaching out to members who don’t have a PCP to encourage them to choose one and to let them know they will be assigned one if they don’t do so within 90 days of the plan year. This message will also tell members how to set their PCP in our Provider Directory or by calling us.
- When we must assign a PCP, we will notify the member or their parent by mail.
- Providers will receive a summary of assigned members via mail no more than weekly, which will include member names and ID numbers.
What if our practice is at capacity?
In order for us to comply with this mandate, it is important that you keep us notified of your current practice capacity. Please complete the Provider Capacity Form (PDF) to report changes in PCP status or auto-assignment preferences.
We rely on you to keep us notified of any changes to your practice. Please contact your PacificSource Provider Service Representative or complete the Provider Capacity Form (PDF) to report new providers, leaves, panel status, and other demographic changes.
What if I am an urgent care or specialist provider?
If members were assigned to you in error (for example, your practice is an urgent care facility or you are a specialist) you can contact your PacificSource Provider Service Representative.
Can I see a report of PacificSource members who have selected me, or have been assigned to me, as their PCP?
You can see a current list of your PacificSource patients through our secure provider portal, InTouch. If you don’t yet have an account, you can learn more about InTouch and how to register.
What else do providers need to know or do?
We encourage you to reach out to these members to schedule a new patient visit as soon as you are able.
Thank you for your cooperation and patience with these changes. If you have questions, our Customer Service team is happy to help. Call 888-977-9299, TTY: 711. (We accept all relay calls.) Or email CS@PacificSource.com.