71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 2227
A-Engrossed
House Bill 2519
Ordered by the House May 4
Including House Amendments dated May 4
Sponsored by Representative KRUSE; Representative LEE (at the
request of Interim House Health and Human Services Committee)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure.
{ - Directs Office of Medical Assistance Programs to
establish benefit limitations on ancillary services. - }
{ - Creates Advisory Committee on Prioritized List of Health
Services. Directs committee to review and evaluate effectiveness
of prioritized list of services. - }
{ - Requires that nonemergency transportation provided to
Oregon Health Plan recipient be approved in advance. - }
{ - Requires, where appropriate, that state vigorously pursue
third party payment of claims against Oregon Health Plan. - }
{ - Declares Oregon Health Plan advisory committees are
public bodies for purposes of public meetings law. - }
{ - Creates Interim Task Force on Oregon Health Plan. Direct
task force to determine adjustments to plan that may improve
efficiency and sustainability. - }
{ - Requires Legislative Assembly to approve continuation of
Oregon Health Plan. - } { + Provides that State of Oregon shall
increase access to standard level of health care services for
uninsured Oregonians with income up to 200 percent of federal
poverty guidelines. Provides that subsidies for health care
services shall be on sliding scale based upon income. Adopts
related provisions. Directs Department of Human Services to seek
federal waivers necessary to carry out provisions of Act. + }
Declares emergency, effective { - July 1, 2001 - } { + on
passage + }.
A BILL FOR AN ACT
Relating to the Oregon Health Plan; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Preamble. (1) The Legislative Assembly finds
that the Oregon Health Plan:
(a) Has provided access to health care services to over one
million Oregonians who would otherwise not have been able to
afford health care services; and
(b) Has improved health outcomes by expanding access to timely
preventive services and primary health care services.
(2) In spite of its important achievements, thousands of
Oregonians still do not have health insurance coverage, often
seeking health care services through the emergency department
late in the course of their illness when costs are higher and
outcomes are less favorable.
(3) The costs incurred by the health care delivery system by
providing health care services through emergency departments are
shifted to patients with health insurance coverage, driving up
the costs of health care services and health insurance for all
Oregonians.
(4) The lack of flexibility in current federal Medicaid policy
forces the state into 'one-size-fits-all' benefit packages and
'all-or-nothing' coverage decisions, and this prevents the state
from using federal resources to develop a system of public
subsidies based on the relative medical and financial
vulnerability of those being served. + }
SECTION 2. { + Policy. It is the policy of the State of Oregon
that:
(1) The state move toward providing a system of universal
access to health care services;
(2) All Oregonians have access, at a minimum, to a standard
basic level of health care services;
(3) The state provide subsidies, using federal and state
resources, to make health care services affordable to all
Oregonians and that those subsidies should encourage the shared
responsibility of employers and individuals in a public-private
partnership;
(4) The respective roles and responsibilities of government,
employers, individuals and the health care delivery system be
clearly and explicitly defined;
(5) All subsidies be explicit and based on an individual's
ability to pay, not exceeding the cost of purchasing a standard
basic level of health care, except for those with special
vulnerabilities; and
(6) The health care delivery system encourage the use of health
care services, including appropriate education, early
intervention and prevention, and procedures that are effective
and appropriate in producing good health. + }
SECTION 3. { + Increased Access for Uninsured Individuals. In
order to carry out the policy established in section 2 of this
2001 Act, the State of Oregon shall increase access to a standard
basic level of health care services for uninsured Oregonians with
an income of up to 200 percent of the federal poverty
guidelines. + }
SECTION 4. { + Levels of Coverage. (1) The standard basic
level of health care services provided under section 3 of this
2001 Act shall be:
(a) Referred to as 'OHP Standard';
(b) Developed by the Health Services Commission using the
process outlined in ORS 414.720 as a guide; and
(c) At least actuarially equivalent to the minimum level of
care mandated by current federal Medicaid law.
(2) For Oregonians who are medically vulnerable, including but
not limited to children, pregnant women, the frail elderly, the
blind and persons with disabilities, supplemental health care
services that are clinically appropriate to their medical needs
shall be provided in addition to OHP Standard and shall be
referred to as 'OHP Plus.' This augmented level of health care
services shall be determined by the Health Services Commission
under the process outlined in ORS 414.720. + }
SECTION 5. { + Subsidies. (1) Subsidies for health care
services shall be based on family income and other personal
resources.
(2) To the extent possible, subsidies from public resources
shall apply to health care services provided through both public
programs and private insurance coverage.
(3) The State of Oregon shall seek federal matching funds to
assist in covering the cost of all subsidies, whether health care
coverage is provided by public programs or private insurance.
(4) For uninsured Oregonians with an income below 200 percent
of the federal poverty guidelines, the state shall pay a portion
of the cost of OHP Standard on a sliding scale based on income,
with the greatest subsidy at the lowest income level.
(5) Oregonians receiving subsidies for OHP Standard may be
required to pay premiums and copayments based on an individual's
ability to pay and structured in a manner that encourages the use
of preventive services.
(6) The subsidies and levels of health care services shall be
structured with the objective of creating a seamless continuum of
health care coverage from full public subsidy to coverage and
health care services that are financed entirely by personal
income and other resources. + }
SECTION 6. { + Waivers. The Legislative Assembly directs the
Department of Human Services to seek federal waivers from the
federal Health Care Financing Administration necessary to carry
out sections 1 to 5 of this 2001 Act. + }
SECTION 7. { + The section captions used in this 2001 Act are
provided only for convenience in locating provisions of this 2001
Act and do not become part of the statutory law of this state or
express any legislative intent in the enactment of this 2001
Act. + }
SECTION 8. { + 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. + }
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