Oregon

Quick Facts

Key Provisions

• No DPC-Specific Legislation: Oregon stands apart from many states by not having a dedicated statute that formally defines DPC or exempts it from insurance code. This means DPC practices must navigate the existing landscape of general business, medical practice, and insurance laws to ensure compliance.
• Avoiding Insurance Classification: To operate without being regulated as an insurance entity, a DPC agreement must be carefully structured. It should offer a defined set of primary care services for a fixed, periodic fee and must not involve the transfer or sharing of financial risk for services outside the DPC practice.
• Mandatory Patient Agreement Disclosures: All patient contracts must be in writing and clearly state that the DPC membership is not health insurance. The agreement must transparently detail the scope of included services, the fee structure, and the terms for cancellation by either the patient or the provider. While not mandated by a DPC-specific law, a 30-day notice period for termination is a common and recommended practice.
• Provider Licensure Requirements: All healthcare professionals operating a DPC practice must hold a current, valid license in Oregon. This includes physicians (MD/DO) governed by ORS 677 and nurse practitioners (NP) governed by ORS 678.375–678.390, ensuring that all care is provided by qualified and state-approved practitioners.
• Compliance with General Consumer Laws: DPC practices are subject to Oregon's standard consumer protection and anti-discrimination laws, such as those outlined in ORS 659A. Practices cannot discriminate against patients and must adhere to contractual obligations regarding services and refunds as specified in their patient agreements.

Medication Dispensing

In Oregon, DPC practices are permitted to dispense medications directly to their patients from their offices, which can enhance convenience and affordability. However, this activity is regulated. Physicians wishing to offer in-office dispensing must first register with the Oregon Medical Board. This registration ensures they comply with the standards set for handling, storing, and distributing prescription drugs. The practice is governed by ORS 689.685, which applies to all licensed providers who dispense. DPC practices receive no special exemptions or restrictions; they must follow the same state and federal pharmacy laws as any other dispensing practitioner, including rules on labeling, record-keeping, and sourcing of medications.

Medicaid Provisions

Oregon's regulations create specific pathways for DPC practices to interact with patients covered by the Oregon Health Plan (OHP), the state's Medicaid program, and state employee health plans. For OHP members, a DPC provider can privately charge for services under strict conditions outlined in OAR 410-120-1990. The provider must give the patient a written, signed agreement that discloses the estimated cost, clarifies that the patient is responsible for payment, and confirms that the provider will not also bill Medicaid for the same service. Furthermore, for state employees with commercial insurance, Oregon law requires insurers to apply payments made to a DPC provider toward the member's annual deductible and out-of-pocket maximum. This provision applies if the services are medically necessary, the claim is not submitted to the insurer for reimbursement, and the cost is less than the plan's in-network rate for equivalent services.