Regulatory Alerts1996-01-01 | Bulletin 96-2Bulletin 96-2: Application of the Insurance Code to Health Benefit Arrangements that Include Provider Risk Sharing
Oregon Insurance Commissioner Kerry Barnett issued Bulletin 96-2 to clarify when health care provider risk sharing arrangements constitute the transaction of insurance under state law. The bulletin mandates that providers must obtain a certificate of authority if they engage in capitation or global payment models with non-exempt purchasers, as these arrangements transfer risk from the purchaser to the provider. The guidance further distinguishes these regulated risk-sharing contracts from exempt self-funded ERISA plans and permissible limited fee-for-service discounts.
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