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
House Bill 2519
Sponsored by Representative KRUSE (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 as
introduced.
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.
Declares emergency, effective July 1, 2001.
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. { + (1) Not later than July 1, 2002, the Office of
Medical Assistance Programs shall convene a meeting of the
administrators and medical and dental directors of prepaid
managed health care contractors to:
(a) Study appropriate benefit limitations on ancillary services
provided under the Oregon Health Plan; and
(b) Make recommendations to the office for use by the office in
further rulemaking relating to ancillary services.
(2) The office may seek assistance in establishing benefit
limitations from the Medicaid Advisory Committee, the Health
Services Commission and the Office for Oregon Health Plan Policy
and Research.
(3) Not later than January 1, 2003, the Office of Medical
Assistance Programs shall establish benefit limitations on
ancillary services provided under the plan.
(4) Benefit limitations established under subsection (3) of
this section:
(a) May not be less restrictive than the benefit limitations on
public employees under the Public Employees' Benefit Board basic
health care plan; and
(b) Do not apply to clients determined to be eligible for
disability insurance benefits under Title II of the federal
Social Security Act or Supplemental Security Income benefits
under Title XVI of the federal Social Security Act.
(5) For purposes of this section, 'ancillary services ' means
vision examinations, medical supplies and equipment, speech and
language therapy, hearing therapy and aids, physical therapy and
occupational therapy. + }
SECTION 2. { + (1) The Office for Oregon Health Plan Policy
and Research shall establish an Advisory Committee on the
Prioritized List of Health Services consisting of seven members.
The Administrator of the Office for Oregon Health Plan Policy and
Research shall appoint the following members of the committee:
(a) Two members of the Health Services Commission, of whom one
person may be a former member of the Health Services Commission
involved with the development of the original prioritized list of
health services;
(b) One member of the Oregon Health Council;
(c) One member of the Medicaid Advisory Committee;
(d) One physician who is familiar with the Oregon Health Plan
and who is licensed by the Board of Medical Examiners;
(e) One representative of a managed care organization under
contract with the Department of Human Services to provide medical
assistance to persons enrolled in the Oregon Health Plan; and
(f) One member of the faculty of a public institution of higher
education located in Oregon who is trained in health services
research, public health or a discipline related to health care.
(2) The administrator, in consultation with the advisory
committee appointed under subsection (1) of this section, shall
review and evaluate the assumptions, principles, policies,
methodologies and processes employed in the development and
maintenance of the prioritized list of health services created
under ORS 414.720. The purposes of this review and evaluation are
to:
(a) Determine the effectiveness of the prioritized list in
managing the Oregon Health Plan since its implementation; and
(b) Provide recommendations to the Legislative Assembly
concerning possible modifications to the methods used to develop
and maintain the prioritized list that can improve the management
and long-term sustainability of the Oregon Health Plan.
(3)(a) The administrator shall report the recommendations
developed under subsection (2) of this section to the Interim
Task Force on the Oregon Health Plan created by section 8 of this
2001 Act no later than November 30, 2002.
(b) The administrator shall provide periodic written and oral
reports to the interim task force.
(4) A member of the advisory committee is not entitled to
compensation or payment of expenses as provided in ORS 292.495.
(5) The advisory committee shall select one of its members as
chairperson and another as vice chairperson, for such terms and
with duties and powers necessary for the performance of the
functions of such offices as the committee determines.
(6) A majority of the members of the advisory committee
constitutes a quorum for the transaction of business.
(7) The advisory committee may meet at a place, day and hour
determined by the committee. The committee also may meet at other
times and places specified by the call of the chair or of a
majority of the members of the committee. + }
SECTION 3. { + The Department of Human Services shall require
that a person, or an agent acting on the person's behalf, who is
entitled to receive services under the Oregon Health Plan receive
prior authorization, from either the department or the prepaid
managed health care contractor with which the person is enrolled,
for use of nonemergency ambulance or transportation services. In
determining whether the use of an ambulance service is emergent
or nonemergent, 'emergency' means an event such that a prudent
layperson possessing an average knowledge of health and medicine
would reasonably believe that the time required to seek
nonemergency services would place the health of the person, or a
fetus in the case of a pregnant woman, in serious jeopardy. + }
SECTION 4. { + (1) The Office of Medical Assistance Programs
shall vigorously pursue, in conjunction with other state and
local agencies, as appropriate, third party payment of claims
made under the Oregon Health Plan.
(2) In any report made to the Legislative Assembly within the
biennial budgetary process, the office shall report the amount of
moneys collected through third party payment of claims. + }
SECTION 5. { + (1) As used in this section, 'advisory
committee' means two or more individuals appointed by an agency
with administrative, policy research or decision-making powers
related to a program of medical assistance established under ORS
chapter 414, including but not limited to the Office for Oregon
Health Plan Policy and Research, the Office of Medical Assistance
Programs, the Department of Human Services and the Mental Health
and Developmental Disability Services Division.
(2) An advisory committee appointed to complete research for,
or make recommendations on, administration or policy related to a
program of medical assistance established under ORS chapter 414
is a public body for purposes of ORS 192.610 to 192.690. + }
SECTION 6. { + Section 5 of this 2001 Act is added to and made
a part of ORS chapter 414. + }
SECTION 7. { + (1) Notwithstanding an approval from the
federal Health Care Financing Administration for the extension of
time for the Oregon Health Plan to operate past January 31, 2002,
the Legislative Assembly must approve the continuation of the
operation of the Oregon Health Plan past January 31, 2002.
(2) The Speaker of the House of Representatives and the
President of the Senate shall communicate to the Director of
Human Services by September 1, 2001, the Legislative Assembly's
approval or disapproval of the continuation of the operation of
the Oregon Health Plan. + }
SECTION 8. { + (1) There is created an Interim Task Force on
the Oregon Health Plan consisting of seven members of the
Legislative Assembly. The President of the Senate and the Speaker
of the House of Representatives shall jointly appoint the
members. The task force shall select one of its members as
chairperson.
(2) The task force shall undertake a broad based review of the
Oregon Health Plan and determine program components and
adjustments that may be made to improve efficiency and ensure the
sustainability of the Oregon Health Plan. In doing so, the task
force shall, at a minimum:
(a) Seek input from interested parties;
(b) Determine the positive and negative outcomes of instituting
a competitive bidding structure for managed care health service
providers;
(c) Review the benefit package offered to plan participants;
(d) Examine provider payment methods; and
(e) Monitor the actions of the Office of Medical Assistance
Programs in the office's pursuit of any Medicaid demonstration
project waiver extension prior to the submission of an extension
application to the federal Health Care Financing Administration.
(3) The task force shall report the recommendations of the
review to the Seventy-second Legislative Assembly.
(4) The task force is subject to the provisions of ORS 171.605
to 171.635 and has the authority contained in ORS 171.505 and
171.510. The task force may file its written report at any time
within 30 days after its final meeting, or at such later time as
the appointing authorities may designate.
(5) A work plan consisting of a list of subjects for review by
the task force and the duration of the review shall be developed
by the appointing authorities in consultation with the task force
chairperson. The work plan developed for the task force shall be
filed with the Legislative Administrator.
(6) The task force shall use the services of permanent
legislative staff to the greatest extent practicable.
(7) Members of the Legislative Assembly serving on the task
force shall be entitled to an allowance as authorized by ORS
171.072 from funds appropriated to the Legislative Assembly.
Claims for expenses incurred in performing functions of the task
force shall be paid out of funds available for that purpose.
(8) All agencies, departments and officers of this state are
directed to assist the task force in the performance of its
functions, and to furnish such information and advice as the
members of the task force consider necessary to perform their
functions.
(9) The task force may accept contributions of funds and
assistance from the United States Government, its agencies or
from any other source, public or private, and agree to conditions
thereon not inconsistent with the purposes of the task force. All
such funds are to aid in financing the functions of the task
force and shall be deposited in the General Fund of the State
Treasury to the credit of separate accounts for the task force
and shall be disbursed for the purpose for which contributed in
the same manner as funds appropriated for the task force.
(10) Official action by the task force established pursuant to
this section shall require the approval of a majority of the
quorum of the members. All legislation recommended by official
action of the task force must indicate that it is introduced at
the request of the task force. Such legislation shall be prepared
in time for presession filing pursuant to ORS 171.130, for
presentation to the regular session of the Seventy-second
Legislative Assembly. + }
SECTION 9. { + 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 July 1,
2001. + }
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