OAR 836-053-0350: Provider Directory Requirements for Network Adequacy

(1)(a) A carrier shall post electronically a current, accurate and complete provider directory for each of its network plans with the information and search functions, as described in section (2) of this rule. (b) In making the directory available electronically, the carrier shall ensure that the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract number. (c)(A) A carrier shall update each network plan provider directory at least monthly. The provider directory shall disclose the frequency with which it is updated. (B) The carrier shall include a disclosure in the directory that the information included in the directory is accurate as of the date posted to the web or printed and that enrollees or prospective enrollees should consult the carrier to obtain current provider directory information. (d) A carrier shall provide a print copy, or a print copy of the requested directory information, of a current provider directory with the information described in section (2) of this rule upon request of an enrollee or a prospective enrollee. (e) For each network plan, a carrier shall include in plain language in both the electronic and print directory, the following general information: (A) A description of the criteria the carrier has used to build its provider network; (B) If applicable, a description of the criteria the carrier has used to tier providers; (C) If applicable, information about how the carrier designates the different provider tiers or levels in the network and identifies for each specific provider, hospital, or other type of facility in the network which tier each is placed, for example by name, symbols or grouping, in order for an enrollee or a prospective enrollee to be able to identify the provider tier; and (D) If applicable, note that authorization or referral may be required to access some providers. (f)(A) A carrier shall make it clear in both its electronic and print directories which provider directory applies to which network plan, such as including the specific name of the network plan as marketed and issued in this state. (B) The carrier shall include in both its electronic and print directories a customer service email address and telephone number or electronic link that enrollees or the general public may use to notify the carrier of inaccurate provider directory information. (g) For the pieces of information required under this section in a provider directory pertaining to a health care professional, a hospital or a facility other than a hospital, the carrier shall make available through the directory a general explanation of the source of the information and any limitations, if applicable. (h) A provider directory, whether in electronic or print format, shall accommodate the communication needs of individuals with disabilities, and include a link to or information regarding available assistance for persons with limited English proficiency. (2) The carrier shall make available through an electronic provider directory that includes search functions, for each network plan, all of the following information: (a) For health care professionals: (A) Name; (B) Gender; (C) Participating office locations; (D) Specialty, if applicable; (E) Participating facility affiliations, if applicable; (F) Languages spoken by provider other than English, if applicable; (G) Whether interpreter services (spoken or signed) are available at the provider's practice location, and the types of access supported (e.g., in-person, telephonic, video remote); (H) Whether the provider self-identifies as having clinical focus in serving one or more of the following populations: (i) Individuals from diverse cultural or ethnic backgrounds; (ii) Individuals with disabilities; (iii) Individuals with specified physical or behavioral health conditions; (iv) Individuals who identify as LGBTQIA+ or with diverse gender identities or sexual orientations. (I) Whether accepting new patients; (J) Network affiliations; (K) Tier level, if applicable; (L) Contact information; and (M) Board certifications. (b) For hospitals: (A) Hospital name; (B) Participating hospital location; (C) Hospital accreditation status; (D) Network affiliations; (E) Tier level, if applicable; and (F) Telephone number. (c) For facilities, other than hospitals, by type: (A) Facility name; (B) Facility type; (C) Participating facility locations; (D) Network affiliations; (E) Tier level, if applicable; and (F) Telephone number.