Learn about the Primary Care Provider mandate in Oregon

Primary care physicians (PCPs) help manage a person’s health care. Having a PCP can help a patient monitor and manage chronic conditions like heart disease and diabetes. PCPs can also help prevent disease through regular screenings, as well as assist in obtaining a specialist when necessary.

Beginning July 1, 2024, the PCP provision of Oregon Senate Bill 1529 goes into effect and states that health insurance companies must assign a PCP to members who haven’t selected one by the 90^th day of their plan year. This mandate applies to all members on a Regence BlueCross BlueShield of Oregon plan who are also residents of Oregon.We will notify members without an assigned PCP of the new rules by mail.

If members choose not to select a PCP by the 90^th day of their plan year, we will assign one based on claims data showing the member has an existing relationship with a provider and/or geographic location of the provider. We will notify members by mail of their and/or their dependent’s PCP assignment(s). Members can change their PCP selection at any time.

ASO (self-funded) group health plans may opt out of the mandate upon renewal, as noted in their annual Summary of Changes document. These groups will need to work with their Account Executive to inform us of their opt-out decision. ASO non-ERISA groups follow state law and therefore must comply with this mandate.

Medicare members, Joint Administration groups and members on Clark County, Washington plans are not affected by this mandate.

Eligible providers must meet the following criteria:

1. The provider must be designated as a PCP in our Provider Search directory and taking new patients. Members can sign in to their regence.com account and select Find Care.

2. Their PCP can be a medical doctor (M.D.) or doctor of osteopathic medicine (D.O.). 

3. Qualifying PCPs can practice in any of these specialties: 

4. Additionally, members can choose an in-network nurse practitioner or advanced registered nurse practitioner; an in-network physician associate can be chosen if they work under the license of an M.D. or D.O.

This new mandate does not affect member claims or benefits, and members can continue to see any in-network provider for their care.