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 1957
Senate Bill 435
Printed pursuant to Senate Interim Rule 213.28 by order of the
President of the Senate in conformance with presession filing
rules, indicating neither advocacy nor opposition on the part
of the President (at the request of Governor John A. Kitzhaber,
M.D., for Office of the Governor)
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.
Establishes task force to develop criteria for determining
which Type B hospitals receive full reimbursement for cost of
covered services. Directs Office of Rural Health to designate
which Type B hospitals meet criteria.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to Type B hospitals; creating new provisions; amending
ORS 414.065 and 414.727; repealing ORS 442.525; and declaring
an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + (1) There is created the Type B Hospital Task
Force consisting of six members appointed by the Governor. Within
30 days after the effective date of this 2001 Act, the Governor
shall appoint one member from each of the following:
(a) Office of Rural Health.
(b) Oregon Health Council.
(c) Office of Medical Assistance Programs.
(d) Office for Oregon Health Plan Policy and Research.
(e) An organization representing Oregon hospitals and health
systems.
(f) An organization representing physicians licensed to
practice medicine in this state.
(2) The task force shall develop measurable and objective
criteria for determining which Type B hospitals will be fully
reimbursed for the cost of covered services. The task force shall
report its recommended criteria to the Governor not later than
October 31, 2001. The Governor shall review the recommended
criteria, and if the Governor approves the recommended criteria,
the Governor shall submit the criteria to the Office of Rural
Health.
(3) All meetings of the task force shall be open to the public
and shall include opportunities for public comment. The task
force shall give reasonable public notice of its meetings.
(4) 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. + }
SECTION 2. { + The Office of Rural Health shall be responsible
for designating which Type B hospitals meet the criteria
determined by the Type B Hospital Task Force and approved by the
Governor under section 1 of this 2001 Act. The office shall make
its initial designations of Type B hospitals that meet the
criteria not later than December 1, 2001. The designations become
effective January 1, 2002. + }
SECTION 3. { + The Office of Rural Health shall determine not
later than January 1 of every odd-numbered year the Type B
hospitals that meet the criteria determined by the Type B
Hospital Task Force under section 1 of this 2001 Act for full
reimbursement for the cost of covered services. Type B hospitals
meeting the criteria shall be eligible for full reimbursement for
the cost of covered services for a two-year period beginning on
October 1 of every odd-numbered year. + }
SECTION 4. 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 { - , as defined in ORS 442.470, - } identified by
the Office of Rural Health
{ - as rural hospitals - } { + as meeting the criteria
developed by the Type B Hospital Task Force under section 1 of
this 2001 Act, + } 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.
{ + (6) Only Type B hospitals that the Office of Rural Health
determines meet the criteria developed by the Type B Hospital
Task Force under section 1 of this 2001 Act are entitled to full
reimbursement for the cost of covered services. + }
SECTION 5. ORS 414.727 is amended to read:
414.727. (1) A health care provider that contracts with the
Department of Human Services under ORS 414.725 (1) to provide
prepaid managed care health services shall reimburse Type A { +
hospitals, + } and Type B hospitals { - , as defined in ORS
442.470 and - } identified by the Office of Rural Health as
{ - rural hospitals - } { + meeting the criteria developed by
the Type B Hospital Task Force under section 1 of this 2001
Act + }, fully for the cost of covered services based on the
cost-to-charge ratio used for each hospital in setting the
capitation rates paid to the contracting health care provider for
the contract period.
(2) Nothing in this section shall be construed to prohibit a
health care provider and hospital from mutually agreeing to
reimbursement other than the reimbursement specified in
subsection (1) of this section.
SECTION 6. { + ORS 442.525 is repealed. + }
SECTION 7. { + The amendments to ORS 414.065 and 414.727 by
sections 4 and 5 of this 2001 Act and the repeal of ORS 442.525
by section 6 of this 2001 Act become operative on January 1,
2002. + }
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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