OR| The Oregon Division of Insurance issues recently adopted rule amendments:

Rule Changes Listed and Linked Below:

• ID 8-2025: Amending OAR 836-150-0040 to add ORP payment parameters for plan year 2026: Rule 836-150-0040
  • Summary: The amended rule will include payment parameters for plan year 2026 (attachment point of $108,000; reinsurance cap of $1,000,000; and coinsurance rate of 50%), while deleting the provisions related to plan year 2021.
  • Filed: November 17, 2025 and Effective: January 1, 2026
• ID 10-2025: HB 3134 (2025) Prior Authorization Insurer Data Reporting Updates: Rule 836-053-1070
  • Summary: Updates the rule to align with the prior authorization data reporting requirements in HB 3134 (2025), including:
    • Amends the prior authorization aggregate data metrics to be reported to DCBS.
    • Amends the prior authorization aggregate data reporting due date from “on or before June 30” to “on or before January 31”.
    • Adds statutory definitions of standard and expedited prior authorization requests.
    • Updates statutory citations. 
    • Filed: November 18, 2025 and Effective: January 1, 2026
• ID 11-2025: 2025 Behavioral Health Parity Rule: Rule 836-053-1430
  • Summary: This rule governs annual data reporting requirements for health insurers related to behavioral health parity in Oregon. It implements changes required by SB 824 (2025), including:
    • Restoring and making permanent the quantitative data reporting requirements for behavioral health parity.
    • Adding confidentiality protections for carrier-submitted data.
    • Updating statutory citations.
    • Filed: November 20, 2025 and Effective: January 1, 2026
• ID 12-2025: Revisions to NAIC accreditation standards and related model laws and regulations implementing SB 831 (2025): Rules: 836-027-0005, 836-027-0150, 836-027-0160 
  • Summary: Adds definition for “group capital calculation” and provides explanation of the concept of the “National Association of Insurance Commissioners liquidity stress test framework.” Creates a new rule that outlines the Insurance Commissioner’s discretion to determine exemptions from filing the annual group capital calculation. In relation to insurer requirements to give notice of proposed transactions pursuant to ORS 732.574, adds additional information regarding the data of an insurer that are subject to cost sharing and management services agreements; adds provisions related to access to staff and essential services during supervision, seizure, conservatorship, or receivership; adds provisions to extend certain affiliate commitments to a guaranty association, as appropriate, if the insurer is under supervision, seizure, conservatorship or receivership.
  • Filed: November 20, 2025 and Effective: January 1, 2026
• ID 9-2025: List of Prosthetic and Orthotic Devices under Oregon SB 699 (2025): Rule: 836-052-1000 
  • Summary: Establishes list of prosthetic and orthotic devices; prohibits internal or separate limits or caps on prosthetic and orthotic devices, other than the lifetime policy maximum, when permitted by law; defines when coverage for prosthetic and orthotic devices is provided through a managed care organization.
  • Filed: November 17, 2025 and Effective: January 1, 2026