Chapter 810 Oregon Laws 2003

AN ACT

HB 3624

Relating to medical assistance program of Department of Human Services; creating new provisions; amending ORS 414.325, 414.705, 414.720 and 414.725; appropriating money; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

SECTION 1. Sections 2, 3, 5, 5a, 6, 9, 10, 11, 12, 12a and 13 of this 2003 Act are added to and made a part of ORS 414.705 to 414.750.

SECTION 2. As used in this section and sections 3, 5, 5a, 6, 9, 10, 11, 12, 12a and 13 of this 2003 Act and ORS 414.725:

(1) “Designated area” means a geographic area of the state defined by the Department of Human Services by rule that is served by a prepaid managed care health services organization.

(2) “Fully capitated health plan” means an organization that contracts with the Department of Human Services on a prepaid capitated basis under ORS 414.725 to provide an adequate network of providers to ensure that the health services provided under the contract are reasonably accessible to enrollees.

(3) “Physician care organization” means an organization that contracts with the Department of Human Services on a prepaid capitated basis under ORS 414.725 to provide an adequate network of providers to ensure that the health services described in ORS 414.705 (1)(b), (c), (d), (e), (g) and (j) are reasonably accessible to enrollees. A physician care organization may also contract with the department on a prepaid capitated basis to provide the health services described in ORS 414.705 (1)(k) and (L).

(4) “Prepaid managed care health services organization” means a managed physical health, dental, mental health or chemical dependency organization that contracts with the Department of Human Services on a prepaid capitated basis under ORS 414.725. A prepaid managed care health services organization may be a dental care organization, fully capitated health plan, physician care organization, mental health organization or chemical dependency organization.

SECTION 3. (1) Except as provided in subsections (2) and (3) of this section, a person who is eligible for or receiving physical health, dental, mental health or chemical dependency services under ORS 414.705 to 414.750 must be enrolled in the prepaid managed care health services organizations to receive the health services for which the person is eligible.

(2) Subsection (1) of this section does not apply to:

(a) A person who is a noncitizen and who is eligible only for labor and delivery services and emergency treatment services;

(b) A person who is an American Indian and Alaskan Native beneficiary; and

(c) A person whom the department may by rule exempt from the mandatory enrollment requirement of subsection (1) of this section, including but not limited to:

(A) A person who is also eligible for Medicare;

(B) A woman in her third trimester of pregnancy at the time of enrollment;

(C) A person under 19 years of age who has been placed in adoptive or foster care out of state;

(D) A person under 18 years of age who is medically fragile and who has special health care needs; and

(E) A person with major medical coverage.

(3) Subsection (1) of this section does not apply to a person who resides in a designated area in which a prepaid managed care health services organization providing physical health, dental, mental health or chemical dependency services is not able to assign an enrollee to a person or entity that is primarily responsible for coordinating the physical health, dental, mental health or chemical dependency services provided to the enrollee.

(4) As used in this section, “American Indian and Alaskan Native beneficiary” means:

(a) A member of a federally recognized Indian tribe, band or group;

(b) An Eskimo or Aleut or other Alaskan Native enrolled by the United States Secretary of the Interior pursuant to the Alaska Native Claims Settlement Act, 43 U.S.C. 1601; or

(c) A person who is considered by the United States Secretary of the Interior to be an Indian for any purpose.

SECTION 4. ORS 414.725 is amended to read:

414.725. [Upon meeting the requirements of section 9, chapter 836, Oregon Laws 1989:]

(1)(a) Pursuant to rules adopted by the Department of Human Services, the department shall execute prepaid managed care health services contracts for [the] health services [funded pursuant to section 9, chapter 836, Oregon Laws 1989] funded by the Legislative Assembly. The contract must require that all services are provided to the extent and scope of the Health Services Commission’s report for each service provided under the contract. Such contracts are not subject to ORS 279.011 to 279.063.

(b) It is the intent of ORS 414.705 to 414.750 that the state [move toward utilizing full service managed care health service providers for providing health] use, to the greatest extent possible, prepaid managed care health services organizations to provide physical health, dental, mental health and chemical dependency services under ORS 414.705 to 414.750.

(c) The department shall solicit qualified providers or plans to be reimbursed [at rates which cover the costs of providing] for providing the covered services. [Such] The contracts may be with hospitals and medical organizations, health maintenance organizations, managed health care plans and any other qualified public or private [entities] prepaid managed care health services organization. The department [shall] may not discriminate against any contractors [which] that offer services within their providers’ lawful scopes of practice.

(2) [In the event that there is an insufficient number of qualified entities to provide for prepaid managed health services contracts in certain areas of the state,] The department may institute a fee-for-service case management system [where possible] or [may continue] a fee-for-service payment system [for those areas that pay] for the same physical health, dental, mental health or chemical dependency services provided under the health services contracts for persons eligible for health services under ORS 414.705 to 414.750 in designated areas of the state in which a prepaid managed care health services organization is not able to assign an enrollee to a person or entity that is primarily responsible for coordinating the physical health, dental, mental health or chemical dependency services provided to the enrollee. In addition, the department may make other special arrangements as necessary to increase the interest of providers in participation in the state’s managed care system, including but not limited to the provision of stop-loss insurance for providers wishing to limit the amount of risk they wish to underwrite.

(3) As provided in subsections (1) and (2) of this section, the aggregate expenditures by the department for health services provided pursuant to ORS 414.705 to 414.750 [shall] may not exceed the total dollars appropriated for health services under ORS 414.705 to 414.750.

(4) Actions taken by providers, potential providers, contractors and bidders in specific accordance with ORS 414.705 to 414.750 in forming consortiums or in otherwise entering into contracts to provide health care services shall be performed pursuant to state supervision and shall be considered to be conducted at the direction of this state, shall be considered to be lawful trade practices and [shall] may not be considered to be the transaction of insurance for purposes of the Insurance Code.

(5) Health care providers contracting to provide services under ORS 414.705 to 414.750 shall advise a patient of any service, treatment or test that is medically necessary but not covered under the contract if an ordinarily careful practitioner in the same or similar community would do so under the same or similar circumstances.

(6) A prepaid managed care health services organization shall provide information on contacting available providers to an enrollee in writing within 30 days of assignment to the health services organization.

(7) Each prepaid managed care health services organization shall provide upon the request of an enrollee or prospective enrollee annual summaries of the organization’s aggregate data regarding:

(a) Grievances and appeals; and

(b) Availability and accessibility of services provided to enrollees.

(8) A prepaid managed care health services organization may not limit enrollment in a designated area based on the zip code of an enrollee or prospective enrollee.

SECTION 5. (1) If the Department of Human Services has not been able to contract with the fully capitated health plan or plans in a designated area, the department may contract with a physician care organization in the designated area.

(2) The Office for Oregon Health Policy and Research shall develop criteria that the department shall consider when determining the circumstances under which the department may contract with a physician care organization. The criteria developed by the office shall include but not be limited to the following:

(a) The physician care organization must be able to assign an enrollee to a person or entity that is primarily responsible for coordinating the physical health services provided to the enrollee;

(b) The contract with a physician care organization does not threaten the financial viability of other fully capitated health plans in the designated area; and

(c) The contract with a physician care organization must be consistent with the legislative intent of using prepaid managed care health services organizations to provide services under ORS 414.705 to 414.750.

SECTION 5a. (1) A fully capitated health plan may apply to the Department of Human Services to contract with the department as a physician care organization rather than as a fully capitated health plan to provide services under ORS 414.705 to 414.750.

(2) The Office for Oregon Health Policy and Research shall develop the criteria that the department must use to determine the circumstances under which the department may accept an application by a fully capitated health plan to contract as a physician care organization. The criteria developed by the office shall include but not be limited to the following:

(a) The fully capitated health plan must show documented losses due to hospital risk and must show due diligence in managing those risks; and

(b) Contracting as a physician care organization is financially viable for the fully capitated health plan.

SECTION 6. (1) Notwithstanding section 5 (1) of this 2003 Act, the Department of Human Services shall contract under ORS 414.725 with a prepaid group practice health plan that serves at least 200,000 members in this state and that has been issued a certificate of authority by the Department of Consumer and Business Services as a health care service contractor to provide health services as described in ORS 414.705 (1)(b), (c), (d), (e), (g) and (j). A health plan may also contract with the Department of Human Services on a prepaid capitated basis to provide the health services described in ORS 414.705 (1)(k) and (L). The Department of Human Services may accept financial contributions from any public or private entity to help implement and administer the contract. The Department of Human Services shall seek federal matching funds for any financial contributions received under this section.

(2) In a designated area, in addition to the contract described in subsection (1) of this section, the Department of Human Services shall contract with prepaid managed care health services organizations to provide health services under ORS 414.705 to 414.750.

SECTION 7. ORS 414.705 is amended to read:

414.705. (1) As used in ORS 414.705 to 414.750, “health services” means at least so much of each of the following as are approved and funded by the Legislative Assembly:

[(1) Provider services and supplies;]

[(2) Outpatient services;]

[(3) Inpatient hospital services; and]

[(4) Health promotion and disease prevention services.]

(a) Services required by federal law to be included in the state’s medical assistance program in order for the program to qualify for federal funds;

(b) Services provided by a physician as defined in ORS 677.010, a nurse practitioner certified under ORS 678.375 or other licensed practitioner within the scope of the practitioner’s practice as defined by state law, and ambulance services;

(c) Prescription drugs;

(d) Laboratory and X-ray services;

(e) Medical supplies;

(f) Mental health services;

(g) Chemical dependency services;

(h) Emergency dental services;

(i) Nonemergency dental services;

(j) Provider services, other than services described in paragraphs (a) to (i), (k), (L) and (m) of this subsection, defined by federal law that may be included in the state’s medical assistance program;

(k) Emergency hospital services;

(L) Outpatient hospital services; and

(m) Inpatient hospital services.

(2) Health services approved and funded under subsection (1) of this section are subject to the prioritized list of health services required in ORS 414.720.

SECTION 8. ORS 414.720 is amended to read:

414.720. (1) The Health Services Commission shall conduct public hearings prior to making the report described in subsection (3) of this section. The commission shall solicit testimony and information from advocates [for] representing seniors[;],[handicapped] persons[;] with disabilities, mental health services consumers[;] and low-income Oregonians[;], representatives of commercial carriers, representatives of small and large Oregon employers and providers of health care, including but not limited to physicians licensed to practice medicine, dentists, oral surgeons, chiropractors, naturopaths, hospitals, clinics, pharmacists, nurses and allied health professionals.

(2) The commission shall actively solicit public involvement in a community meeting process to build a consensus on the values to be used to guide health resource allocation decisions.

(3) The commission shall report to the Governor a list of health services[, including health care services of the aged, blind and disabled pursuant to section 14, chapter 753, Oregon Laws 1991, including one list into which those mental health and chemical dependency services recommended pursuant to ORS 414.730 are integrated,] ranked by priority, from the most important to the least important, representing the comparative benefits of each service to the entire population to be served. [The report shall be accompanied by a report of an independent actuary retained for the commission to determine rates necessary to cover the costs of the services. Until federal waiver approval is obtained and funding authorized for the integrated list including mental health and chemical dependency services, the coverage for mental health and chemical dependency services shall not be considered to be mandated.] The list submitted by the commission pursuant to this subsection is not subject to alteration by any other state agency. The recommendation may include practice guidelines reviewed and adopted by the commission pursuant to subsection (4) of this section.

(4) In order to encourage effective and efficient medical evaluation and treatment, the commission:

(a) May include clinical practice guidelines in its prioritized list of services. The commission shall actively solicit testimony and information from the medical community and the public to build a consensus on clinical practice guidelines developed by the commission.

(b) Shall consider both the clinical effectiveness and cost-effectiveness of health services in determining their relative importance using peer-reviewed medical literature as defined in ORS 743.695.

(5) The commission shall make its report by July 1 of the year preceding each regular session of the Legislative Assembly and shall submit a copy of its report to the Governor, the Speaker of the House of Representatives and the President of the Senate.

(6) The commission may alter the list during interim only under the following conditions:

(a) Technical changes due to errors and omissions; and

(b) Changes due to advancements in medical technology or new data regarding health outcomes.

(7) If a service is deleted or added and no new funding is required, the commission shall report to the Speaker of the House of Representatives and the President of the Senate. However, if a service to be added requires increased funding to avoid discontinuing another service, the commission must report to the Emergency Board to request the funding.

(8) The report listing services to be provided pursuant to ORS 414.036, 414.042, 414.065, 414.107, 414.705 to 414.725 and 414.735 to 414.750 shall remain in effect from October 1 of the odd-numbered year through September 30 of the next odd-numbered year.

SECTION 9. (1) The Health Services Commission shall retain an actuary to determine the benchmark for setting per capita rates necessary to reimburse prepaid managed care health services organizations and fee-for-service providers for the cost of providing health services under ORS 414.705 to 414.750.

(2) The actuary retained by the commission shall use the following information to determine the benchmark for setting per capita rates:

(a) For hospital services, the most recently available Medicare cost reports for Oregon hospitals;

(b) For services of physicians licensed under ORS chapter 677 and other health professionals using procedure codes, the Medicare Resource Based Relative Value system conversion rates for Oregon;

(c) For prescription drugs, the most recent payment methodologies in the fee-for-service payment system for the Oregon Health Plan;

(d) For durable medical equipment and supplies, 80 percent of the Medicare allowable charge for purchases and rentals;

(e) For dental services, the most recent payment rates obtained from dental care organization encounter data; and

(f) For all other services not listed in paragraphs (a) to (e) of this subsection:

(A) The Medicare maximum allowable charge, if available; or

(B) The most recent payment rates obtained from the data available under subsection (3) of this section.

(3) The actuary shall use the most current encounter data and the most current fee-for-service data that is available, reasonable trends for utilization and cost changes to the midpoint of the next biennium, appropriate differences in utilization and cost based on geography, state and federal mandates and other factors that, in the professional judgment of the actuary, are relevant to the fair and reasonable estimation of costs. The Department of Human Services shall provide the actuary with the data and information in the possession of the department or contractors of the department reasonably necessary to develop a benchmark for setting per capita rates.

(4) The commission shall report the benchmark per capita rates developed under this section to the Director of the Oregon Department of Administrative Services, the Director of Human Services and the Legislative Fiscal Officer no later than August 1 of every even-numbered year.

(5) The Department of Human Services shall retain an actuary to determine:

(a) Per capita rates for health services that the department shall use to develop the department’s proposed biennial budget; and

(b) Capitation rates to reimburse physician care organizations for the cost of providing health services under ORS 414.705 to 414.750 using the same methodologies used to develop capitation rates for fully capitated health plans. The rates may not advantage or disadvantage fully capitated health plans for similar services.

(6) The Department of Human Services shall submit to the Legislative Assembly no later than February 1 of every odd-numbered year a report comparing the per capita rates for health services on which the proposed budget of the department is based with the rates developed by the actuary retained by the Health Services Commission. If the rates differ, the department shall disclose, by provider categories described in subsection (2) of this section, the amount of and reason for each variance.

SECTION 10. (1) Subject to the provisions of subsections (2) to (6) of this section, the Department of Human Services shall contract with fully capitated health plans to provide administrative services as follows for eligible persons who receive one or more health services as defined in ORS 414.705 on a fee-for-service payment basis:

(a) Prescription drug management services for all prescription drugs except mental health drugs;

(b) Inpatient and outpatient hospital services;

(c) Utilization of nonemergency medical transportation in designated areas where transportation brokerage services are not available; and

(d) Durable medical equipment and supplies.

(2) The department shall contract with one or more fully capitated health plans in a designated area to provide administrative services to eligible persons who are receiving health services on a fee-for-service payment basis. If the department is not able to contract with a fully capitated health plan in a designated area, the department may contract with a plan that serves another designated area. If the department is not able to contract with any plan, the department may contract with a third party to provide administrative services.

(3) In awarding a contract, the department must ensure that the contract is cost-neutral to the department and that the contractor has the capacity and competence to provide administrative services for the additional persons.

(4) ORS 414.325 and 414.334 apply to prescription drug management services provided under subsection (1)(a) of this section.

(5) This section does not apply to institutional pharmacies that dispense prescription drugs on a fee-for-service payment basis to residents of nursing facilities and community-based residential facilities.

(6) Notwithstanding subsection (1)(a) of this section, the department may contract with a fully capitated health plan or a mental health organization to provide administrative services related to mental health drugs. A fully capitated health plan or a mental health organization that contracts with the department under this subsection shall develop and implement local or regional drug management strategies that require the collaboration of fully capitated health plans or mental health organizations in the designated area that are not a party to the contract.

(7) The department shall adopt rules to implement this section, including but not limited to defining eligible persons who are exempt from the provisions of this section.

SECTION 10a. Section 10 of this 2003 Act is repealed on January 2, 2008.

SECTION 11. The Department of Human Services may not establish capitation rates that include payment for mental health drugs. The department shall reimburse pharmacy providers for mental health drugs only on a fee-for-service payment basis.

SECTION 12. (1) A fully capitated health plan that does not have a contract with a hospital to provide inpatient or outpatient hospital services under ORS 414.705 to 414.750 must pay for hospital services as follows:

(a) For inpatient hospital services, based on the capitation rates developed for the budget period, at the level of the statewide average unit cost, multiplied by the geographic factor, the payment discount factor and an adjustment factor of 0.925.

(b) For outpatient hospital services, based on the capitation rates developed for the budget period, at the level of charges multiplied by the statewide average cost-to-charge ratio, the geographic factor, the payment discount factor and an adjustment factor of 0.925.

(2) A hospital that does not have a contract with a fully capitated health plan to provide inpatient or outpatient hospital services under ORS 414.705 to 414.750 must accept payment for hospital services as follows:

(3) This section does not apply to type A and type B hospitals, as described in ORS 442.470, and rural critical access hospitals, as defined in ORS 316.143.

(4) The Department of Human Services shall adopt rules to implement and administer this section.

SECTION 12a. A fully capitated health plan or a physician care organization that offers enrollees the option of obtaining prescription drugs through a mail order pharmacy may use the same mail order pharmacy used by the Department of Human Services for the department’s mail order pharmacy program.

SECTION 12b. Section 12a of this 2003 Act is repealed on January 2, 2008.

SECTION 13. (1) Subject to the provisions of subsection (4) of this section, the Department of Human Services shall contract with a pharmacy benefit manager to manage prescription drug benefits for the medical assistance program. The pharmacy benefit manager shall purchase prescription drugs in bulk or reimburse pharmacies for prescription drugs prescribed for eligible persons in the medical assistance program.

(2) The pharmacy benefit manager shall establish two programs for the medical assistance program. One program shall purchase prescription drugs for or reimburse fully capitated health plans that use the pharmacy benefit manager under contract with the department. The second program shall reimburse fee-for-service pharmacy providers directly or provide for payment by the Department of Human Services.

(3) Fully capitated health plans may use the pharmacy benefit manager under contract with the department under subsection (1) of this section.

(4) In awarding a contract under this section, the department must ensure that the contractor has the capacity and competence to administer the services and that the contract is cost-neutral to the department.

(5) ORS 414.325 and 414.334 apply to the management of prescription drug benefits under this section.

SECTION 14. (1) The Department of Human Services, in consultation with representatives of fully capitated health plans, shall:

(a) Develop a request for proposal for the pharmacy benefit manager contract described in section 13 of this 2003 Act; and

(b) Review administrative requirements for fully capitated health plan contracts and implement changes that would decrease the costs of administering the contracts. The department shall report to the Emergency Board and the Joint Legislative Audit Committee by November 30, 2003, on the department’s findings.

(2) As used in this section, “fully capitated health plan” has the meaning given that term in section 2 of this 2003 Act.

SECTION 15. (1) The Department of Human Services shall negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates that are in addition to the discount required under federal law to participate in the medical assistance program.

(2) The department may participate in a multistate prescription drug purchasing pool for the purpose of negotiating supplemental rebates.

(3) ORS 414.325 and 414.334 apply to prescription drugs purchased for the medical assistance program under this section.

NOTE: Section 16 was deleted by amendment. Subsequent sections were not renumbered.

SECTION 17. For each person applying for health services under ORS 414.705 to 414.750, the Department of Human Services shall fully document:

(1) The category of aid as defined in ORS 414.025 that makes the person eligible for medical assistance or the way in which the person qualifies as categorically needy as defined in ORS 414.025;

(2) The status of the person as a resident of this state; and

(3) The financial income and resources of the person.

SECTION 18. (1) Except as provided in section 19 of this 2003 Act, sections 2, 3, 5, 5a, 11, 12, 12a, 14 and 15 of this 2003 Act and the amendments to ORS 414.705 and 414.725 by sections 4 and 7 of this 2003 Act become operative on October 1, 2003.

(2) Sections 10 and 13 of this 2003 Act become operative on the day after the date the Department of Human Services receives the necessary waivers from the Centers for Medicare and Medicaid Services.

(3) The Director of Human Services shall notify the Legislative Counsel upon receipt of the waivers or denial of the waiver request.

SECTION 19. The Director of Human Services may take any action before the operative dates of sections 2, 3, 5, 5a, 10, 11, 12, 12a, 13, 14 and 15 of this 2003 Act and the amendments to ORS 414.705 and 414.725 by sections 4 and 7 of this 2003 Act that is necessary to enable the director to exercise, on and after the operative dates of sections 2, 3, 5, 5a, 10, 11, 12, 12a, 13, 14 and 15 of this 2003 Act and the amendments to ORS 414.705 and 414.725 by sections 4 and 7 of this 2003 Act, all the duties, functions and powers conferred on the director by this 2003 Act.

SECTION 20. ORS 414.325 is amended to read:

414.325. (1) As used in this section, “legend drug” means any drug requiring a prescription by a practitioner, as defined in ORS 689.005.

(2) A licensed practitioner may prescribe such drugs under this chapter as the practitioner in the exercise of professional judgment considers appropriate for the diagnosis or treatment of the patient in the practitioner’s care and within the scope of practice. Prescriptions shall be dispensed in the generic form pursuant to ORS 689.515, 689.854 and 689.857 and pursuant to rules of the Department of Human Services unless the practitioner prescribes otherwise and an exception is granted by the department.

(3) The department shall pay only for drugs in the generic form if the federal Food and Drug Administration has approved a generic version of a particular brand name drug that is chemically identical to the brand name drug according to federal Food and Drug Administration rating standards, unless an exception has been granted by the department.

(4) An exception must be applied for and granted before the department is required to pay for minor tranquilizers and amphetamines and amphetamine derivatives, as defined by rule of the department.

(5) Notwithstanding subsections (1) to (4) of this section, the department is authorized to:

(a) Withhold payment for a legend drug when federal financial participation is not available; and

(b) Require prior authorization of payment for drugs that the department has determined should be limited to those conditions generally recognized as appropriate by the medical profession.

(6) Notwithstanding subsection (3) of this section, the department may not limit legend drugs when used as approved by the federal Food and Drug Administration to treat mental illness, HIV and AIDS, and cancer.

(7) Notwithstanding ORS 414.334, the department may conduct prospective drug utilization review prior to payment for drugs for a patient whose prescription drug use exceeded 15 drugs in the preceding six-month period.

SECTION 21. ORS 414.325, as amended by section 6, chapter 897, Oregon Laws 2001, is amended to read:

414.325. (1) As used in this section, “legend drug” means any drug requiring a prescription by a practitioner, as defined in ORS 689.005.

(3) Except as provided in subsections (4) and (5) of this section, the department shall place no limit on the type of legend drug that may be prescribed by a practitioner, but the department shall pay only for drugs in the generic form unless an exception has been granted by the department.

(4) Notwithstanding subsection (3) of this section, an exception must be applied for and granted before the department is required to pay for minor tranquilizers and amphetamines and amphetamine derivatives, as defined by rule of the department.

(5)(a) Notwithstanding subsections (1) to (4) of this section and except as provided in paragraph (b) of this subsection, the department is authorized to:

(A) Withhold payment for a legend drug when federal financial participation is not available; and

(B) Require prior authorization of payment for drugs that the department has determined should be limited to those conditions generally recognized as appropriate by the medical profession.

(b) The department may not require prior authorization for therapeutic classes of nonsedating antihistamines and nasal inhalers, as defined by rule by the department, when prescribed by an allergist for treatment of any of the following conditions, as described by the Health Services Commission on the funded portion of its prioritized list of services:

(A) Asthma;

(B) Sinusitis;

(D) Allergies.

(6) Notwithstanding ORS 414.334, the department may conduct prospective drug utilization review prior to payment for drugs for a patient whose prescription drug use exceeded 15 drugs in the preceding six-month period.

SECTION 22. The Department of Human Services may not adopt or amend any rule that requires a prescribing practitioner to contact the department to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug list for that class of drugs adopted under ORS 414.334, unless otherwise authorized by enabling legislation setting forth the requirement for prior authorization.

SECTION 23. Section 22 of this 2003 Act applies to rules adopted or amended by the Department of Human Services before, on or after the effective date of this 2003 Act.

SECTION 24. In addition to and not in lieu of any other appropriation, there is appropriated to the Oregon Department of Administrative Services for the biennium ending June 30, 2005, out of the General Fund, the amount of $275,000, for the Office for Oregon Health Policy and Research for the purpose of the Health Services Commission carrying out the provisions of section 9 (1) of this 2003 Act.

SECTION 25. This 2003 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2003 Act takes effect on its passage.

Approved by the Governor September 24, 2003

Filed in the office of Secretary of State September 24, 2003

Effective date September 24, 2003

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