71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
SA to A-Eng. HB 2516
LC 1925/HB 2516-A4
SENATE AMENDMENTS TO
A-ENGROSSED HOUSE BILL 2516
By COMMITTEE ON RULES AND REDISTRICTING
June 25
On page 1 of the printed A-engrossed bill, line 2, after '
care;' insert 'amending ORS 414.065, 442.315 and 442.470;'.
Delete lines 4 through 27 and delete pages 2 and 3 and insert:
' { + SECTION 1. + } ORS 414.065 is amended to read:
' 414.065. (1) With respect to medical and remedial care and
services to be provided in medical assistance during any period,
and within the limits of funds available therefor, the Department
of Human Services shall determine, subject to such revisions as
it may make from time to time and with respect to the 'health
services' defined in ORS 414.705, subject to legislative funding
in response to the report of the Health Services Commission:
' (a) The types and extent of medical and remedial care and
services to be provided to each eligible group of recipients of
medical assistance.
' (b) Standards to be observed in the provision of medical and
remedial care and services.
' (c) The number of days of medical and remedial care and
services toward the cost of which public assistance funds will be
expended in the care of any person.
' (d) Reasonable fees, charges and daily rates to which public
assistance funds will be applied toward meeting the costs of
providing medical and remedial care and services to an applicant
or recipient.
' (e) Reasonable fees for professional medical and dental
services which may be based on usual and customary fees in the
locality for similar services.
' (f) The amount and application of any copayment or other
similar cost-sharing payment that the department may require a
recipient to pay toward the cost of medical and remedial care or
services.
' (2) The types and extent of medical and remedial care and
services and the amounts to be paid in meeting the costs thereof,
as determined and fixed by the department and within the limits
of funds available therefor, shall be the total available for
medical assistance and payments for such medical assistance shall
be the total amounts from public assistance funds available to
providers of medical and remedial care and services in meeting
the costs thereof.
' (3) Except for payments under a cost-sharing plan, payments
made by the department for medical assistance shall constitute
payment in full for all medical and remedial care and services
for which such payments of medical assistance were made.
' (4) Medical benefits, standards and limits established
pursuant to subsection (1)(a), (b) and (c) of this section for
the eligible medically needy, except for the aged served under
ORS chapter 413 and for the blind and disabled served under ORS
chapter 412, may be less but shall not exceed medical benefits,
standards and limits established for the eligible categorically
needy, except that, in the case of a research and demonstration
project entered into under ORS 411.135, medical benefits,
standards and limits for the eligible medically needy may exceed
those established for specific eligible groups of the
categorically needy.
' (5) Notwithstanding the provisions of this section, the
department shall cause Type A hospitals { + , + } { - and - }
Type B hospitals { + and rural critical access hospitals + },
as { - defined - } { + described + } in ORS 442.470,
identified by the Office of Rural Health as rural hospitals to be
reimbursed for the cost of covered services as follows:
' (a) For services provided to persons entitled to receive
medical assistance, based on the Medicare determination of
reasonable cost as derived from the Hospital and Hospital Health
Care Complex Cost Report, referred to as the Medicare Report.
' (b) In accordance with the terms of the agreement for
services provided to persons whose medical assistance benefits
are administered by the contracting health care provider under an
agreement between the hospital and a health care provider
contracting with the Department of Human Services under ORS
414.725 (1) for reimbursement other than that specified by ORS
414.727 (1). Hospitals reimbursed under the terms of this
paragraph are entitled to no additional reimbursement for
services provided.
' (c) Hospitals that have been reimbursed by health care
providers contracting with the Department of Human Services under
ORS 414.725 (1) in accordance with ORS 414.727 (1), are entitled
to full reimbursement from the department for the cost of covered
services provided to persons whose medical assistance benefits
are administered by the contracting health care provider
according to paragraph (a) of this subsection.
' { + SECTION 2. + } ORS 442.470 is amended to read:
' 442.470. As used in ORS 442.470 to 442.507:
' (1) 'Acute inpatient care facility' means a licensed hospital
with an organized medical staff, with permanent facilities that
include inpatient beds, and with comprehensive medical services,
including physician services and continuous nursing services
under the supervision of registered nurses, to provide diagnosis
and medical or surgical treatment primarily for but not limited
to acutely ill patients and accident victims.
' (2) 'Council' means the Rural Health Coordinating Council.
' (3) 'Office' means the Office of Rural Health.
' (4) 'Primary care physician' means a doctor licensed under
ORS chapter 677 whose specialty is family practice, general
practice, internal medicine, pediatrics or obstetrics and
gynecology.
' (5) { + (a) + } 'Rural hospital' means a hospital
characterized { - by - } { + as + } one of the following:
' { - (a) - } { + (A) A + } type A { - hospitals are - }
{ + hospital, which is a + } small and remote { - , have - }
{ + hospital that has + } 50 or fewer beds and
{ - are greater - } { + is more + } than 30 miles from
another acute inpatient care facility;
' { - (b) - } { + (B) A + } type B { - hospitals are - }
{ + hospital, which is a + } small and rural { - and have - }
{ + hospital that has + } 50 or fewer beds { - , - } and
{ - are - } { + is + } 30 miles or less from another acute
inpatient care facility;
' { - (c) - } { + (C) A + } type C { - hospitals are - }
{ + hospital, which is + } considered { + to be a + } rural
{ + hospital + } and { - have - } { + has + } more than 50
beds, but { - are - } { + is + } not a referral center; or
' { + (D) A rural critical access hospital as defined in ORS
316.143. + }
' { - (d) - } { + (b) + } 'Rural hospital' { - of any
class - } does not include a hospital { + of any class that
was + } designated by the federal government as a rural referral
hospital before January 1, 1989.
' { + SECTION 3. + } ORS 442.315 is amended to read:
' 442.315. (1) Any new hospital or new skilled nursing or
intermediate care service or facility not excluded pursuant to
ORS 441.065 shall obtain a certificate of need from the Health
Division prior to an offering or development.
' (2) The division shall adopt rules specifying criteria and
procedures for making decisions as to the need for such new
services or facilities.
' (3)(a) An applicant for a certificate of need shall apply to
the division on forms provided for this purpose which forms shall
be established by division rule.
' (b) An applicant shall pay a fee prescribed as provided in
this section. Subject to the approval of the Oregon Department of
Administrative Services, the division shall prescribe application
fees, based on the complexity and scope of the proposed project.
' (4) The division shall be the decision-making authority for
the purpose of certificates of need.
' (5)(a) An applicant or any affected person who is
dissatisfied with the proposed decision of the division is
entitled to an informal hearing in the course of review and
before a final decision is rendered.
' (b) Following a final decision being rendered by the
division, an applicant or any affected person may request a
reconsideration hearing pursuant to ORS 183.310 to 183.550.
' (c) In any proceeding brought by an affected person or an
applicant challenging a division decision under this subsection,
the division shall follow procedures consistent with the
provisions of ORS 183.310 to 183.550 relating to a contested
case.
' (6) Once a certificate of need has been issued, it may not be
revoked or rescinded unless it was acquired by fraud or deceit.
However, if the division finds that a person is offering or
developing a project that is not within the scope of the
certificate of need, the division may limit the project as
specified in the issued certificate of need or reconsider the
application. A certificate of need is not transferable.
' (7) Nothing in this section applies to any hospital, skilled
nursing or intermediate care service or facility that seeks to
replace equipment with equipment of similar basic technological
function or an upgrade that improves the quality or
cost-effectiveness of the service provided. Any person acquiring
such replacement or upgrade shall file a letter of intent for the
project in accordance with the rules of the division if the price
of the replacement equipment or upgrade exceeds $1 million.
' (8) Except as required in subsection (1) of this section for
a new hospital or new skilled nursing or intermediate care
service or facility not operating as a Medicare swing bed
program, nothing in this section requires a rural hospital as
defined in ORS 442.470 { - (5)(a) and (b) - } { + (5)(a)(A)
and (B) + } to obtain a certificate of need.
' (9) Nothing in this section applies to basic health services,
but basic health services do not include:
' (a) Magnetic resonance imaging scanners;
' (b) Positron emission tomography scanners;
' (c) Cardiac catheterization equipment;
' (d) Megavoltage radiation therapy equipment;
' (e) Extracorporeal shock wave lithotriptors;
' (f) Neonatal intensive care;
' (g) Burn care;
' (h) Trauma care;
' (i) Inpatient psychiatric services;
' (j) Inpatient chemical dependency services;
' (k) Inpatient rehabilitation services;
' (L) Open heart surgery; or
' (m) Organ transplant services.
' (10) In addition to any other remedy provided by law,
whenever it appears that any person is engaged in, or is about to
engage in, any acts which constitute a violation of this section,
or any rule or order issued by the division under this section,
the division may institute proceedings in the circuit courts to
enforce obedience to such statute, rule or order by injunction or
by other processes, mandatory or otherwise.
' (11) As used in this section, 'basic health services' means
health services offered in or through a hospital licensed under
ORS chapter 441, except skilled nursing or intermediate care
nursing facilities or services and those services specified in
subsection (9) of this section.
' { + SECTION 4. + } { + This 2001 Act being necessary for
the immediate preservation of the public peace, health and
safety, an emergency is declared to exist, and this 2001 Act
takes effect on its passage. + } ' .
----------