1. (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. (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. (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. (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.

   [ED. NOTE: Tables referenced are available from the agency.]

   [ED. NOTE: To view attachments referenced in rule text, click here for PDF copy.]

Statutory/Other Authority

ORS 656.340(9) & 656.726(4)

Statutes/Other Implemented

ORS 656.340 & 656.258

History

WCD 15-2024, amend filed 06/07/2024, effective 07/01/2024
WCD 4-2016, f. 11-28-16, cert. ef. 1-1-17
WCD 5-2010, f. 9-15-10, cert. ef. 11-15-10
WCD 3-2009, f. 12-1-09, cert. ef. 1-1-10
WCD 8-2007, f. 11-1-07, cert. ef. 12-1-07
WCD 6-2005, f. 6-9-05, cert. ef. 7-1-05
WCD 3-2004, f. 3-5-04, cert. ef. 4-1-04
WCD 7-2002, f. 5-30-02, cert. ef. 7-1-02
WCD 4-2001, f. 4-13-01, cert. ef. 5-15-01
WCD 6-2000, f. 4-27-00, cert. ef. 6-1-00
WCD 6-1996, f. 2-6-96, cert. ef. 3-1-96
WCD 10-1994, f. 11-1-94, cert. ef. 1-1-95, Renumbered from 436-120-0070 & 436-120-0215
WCD 11-1987, f. 12-17-87, cert. ef. 1-1-88
WCD 7-1985, f. 12-12-85, cert. ef. 1-1-86, Renumbered from 436-061-0120
WCD 5-1983, f. 12-14-83, cert. ef. 1-1-84
WCD 2-1983, f. & cert. ef. 6-30-83
WCD 11-1982(Temp), f. 12-29-82, cert. ef. 1-1-83
WCD 4-1981, f. 12-4-81, cert. ef. 1-1-82
WCD 6-1980, f. 5-22-80, cert. ef. 6-1-80