72nd OREGON LEGISLATIVE ASSEMBLY--2003 Regular Session
HA to HB 2189
LC 669/HB 2189-1
HOUSE AMENDMENTS TO
HOUSE BILL 2189
By COMMITTEE ON HEALTH AND HUMAN SERVICES
June 3
On page 1 of printed bill, line 2, after 'ORS' delete '
735.625' and insert '414.831, 414.839, 735.625, 735.720 and
735.740'.
On page 3, after line 41, insert:
' { + SECTION 6. + } ORS 414.831 is amended to read:
' 414.831. { - Family Health Insurance Assistance Program.
Upon receipt of the waiver, - } The Insurance Pool Governing
Board shall focus on expanding group coverage provided by the
Family Health Insurance Assistance Program { - , with the goal
of having available funds equally distributed between providing
group coverage and individual coverage - } .
' { + SECTION 7. + } ORS 414.839 is amended to read:
' 414.839. { - Subsidies for health insurance coverage. - }
(1) Subject to funds available, the waiver program described by
ORS 414.829 shall provide public subsidies for the purchase of
health insurance coverage provided by public programs or private
insurance, including but not limited to the Family Health
Insurance Assistance Program, for currently uninsured individuals
based on incomes up to 185 percent of the federal poverty level.
The objective is to create a transition from dependence on public
programs to privately financed health insurance.
' (2) Public subsidies shall apply only to { - the cost
of - } { + health benefit plans that meet or exceed + } the
basic benchmark health benefit plan { - or the approved
equivalent established in ORS 414.829 - } { + or plans
established under section 11 of this 2003 Act + }.
' (3) Cost-sharing shall be permitted and structured in such a
manner to encourage appropriate use of preventive care and
avoidance of unnecessary services.
' (4) Cost-sharing shall be based on an individual's ability to
pay and may not exceed the cost of purchasing a plan approved as
provided under subsection (2) of this section.
' (5) The state may pay a portion of the cost of the subsidy,
based on the individual's income and other resources.
' { + SECTION 8. + } ORS 735.720 is amended to read:
' 735.720. For purposes of ORS 735.720 to 735.740:
' (1) 'Eligible individual' means an individual who:
' (a) Is a resident of the State of Oregon;
' (b) Is not eligible for Medicare;
' (c) Either has been without health benefit plan coverage for
a period of time established by the Insurance Pool Governing
Board, or meets exception criteria established by the board;
' (d) Except as otherwise provided by the board, has family
income less than 200 percent of the federal poverty level;
' (e) Has investments and savings less than the limit
established by the board; and
' (f) Meets other eligibility criteria established by the
board.
' (2) 'Family' means:
' (a) A single individual { - who is not claimed as a
dependent for state income tax purposes - } ;
' (b) An adult and the adult's spouse;
' (c) An adult and the adult's spouse { + , + } { - and - }
all unmarried, dependent children under 23 years of age,
including adopted children { + , + } { - and - } children
placed for adoption { + and children under the legal
guardianship of the adult or the adult's spouse, and all
dependent children of a dependent child + }; or
' (d) An adult and the adult's unmarried, dependent children
under 23 years of age, including adopted children { + , + }
{ - and - } children placed for adoption { + and children
under the legal guardianship of the adult, and all dependent
children of a dependent child + }.
' (3)(a) 'Health benefit plan' means a policy or certificate of
group or individual health insurance, as defined in ORS 731.162,
providing payment or reimbursement for hospital, medical and
surgical expenses. 'Health benefit plan' includes a medical
savings account, health care service contractor or health
maintenance organization subscriber contract, the Oregon Medical
Insurance Pool and any plan provided by a less than fully insured
multiple employer welfare arrangement or by another benefit
arrangement defined in the federal Employee Retirement Income
Security Act of 1974, as amended.
' (b) 'Health benefit plan' does not include coverage for
accident only, specific disease or condition only, credit,
disability income, coverage of Medicare services pursuant to
contracts with the federal government, Medicare supplement
insurance, student accident and health insurance, long term care
insurance, hospital indemnity only, dental only, vision only,
coverage issued as a supplement to liability insurance, insurance
arising out of a workers' compensation or similar law, automobile
medical payment insurance { + , + } { - or - } insurance under
which the benefits are payable with or without regard to fault
and that is legally required to be contained in any liability
insurance policy or equivalent self-insurance { + or coverage
obtained or provided in another state but not available in
Oregon + }.
' (4) 'Income' means gross income in cash or kind available to
the applicant or recipient.
' (5) 'Investment and savings' means cash, securities as
defined in ORS 59.015, negotiable instruments as defined in ORS
73.0104 and such similar investments or savings as the board may
establish that are available to the applicant or recipient to
contribute toward meeting the needs of an applicant or eligible
individual.
' (6) 'Medicaid' means medical assistance provided under 42
U.S.C. section 1396a (section 1902 of the Social Security Act).
' (7) 'Medical savings account' means a trust that is created
exclusively for the purpose of paying qualified medical expenses
of the account holder and that qualifies for tax deduction under
section 220 of the Internal Revenue Code. 'Medical savings
account' includes an associated high deductible health benefit
plan.
' (8) 'Resident' means an individual who demonstrates to the
Insurance Pool Governing Board that the individual is lawfully
residing in Oregon and intends to reside in Oregon
{ - permanently - } .
' (9) 'Subsidy' means payment or reimbursement to an eligible
individual toward the purchase of a health benefit plan, and may
include a net billing arrangement with insurance carriers or a
prospective or retrospective payment for health benefit plan
premiums and eligible copayments or deductible expenses directly
related to the eligible individual.
' (10) 'Third-party administrator' means any insurance company
or other entity licensed under the Insurance Code to administer
health insurance benefit programs.
' { + SECTION 9. + } ORS 735.740 is amended to read:
' 735.740. (1) The Insurance Pool Governing Board may impose
sanctions against an individual who violates any provision of ORS
735.720 to 735.740 or rules adopted thereto, including but not
limited to suspension or termination from the Family Health
Insurance Assistance Program and repayment of any subsidy amounts
paid due to the { + omission or + } { - fraudulent - }
misrepresentation of an applicant or enrolled individual.
Sanctions allowed under this subsection shall be imposed in the
manner prescribed in ORS 183.310 to 183.550.
' (2) In addition to the sanctions available pursuant to
subsection (1) of this section, the board may impose a civil
penalty not to exceed $1,000 against any individual who violates
any provision of ORS 735.720 to 735.740 or rules adopted pursuant
thereto. Civil penalties imposed pursuant to this section shall
be imposed pursuant to ORS 183.090.
' { + SECTION 10. + } { + Section 11 of this 2003 Act is
added to and made a part of ORS 735.720 to 735.740. + }
' { + SECTION 11. + } { + Notwithstanding ORS 414.829, the
Insurance Pool Governing Board shall establish at least one basic
benchmark health benefit plan that qualifies for a subsidy
described by ORS 414.839. In establishing a basic benchmark plan,
the board shall consider employer-sponsored health benefit plans
offered to employees and dependents of employees in Oregon. + }
' { + SECTION 12. + } { + Not later than 180 days after the
effective date of this 2003 Act, the Department of Human
Services, in conjunction with the Insurance Pool Governing Board,
shall submit to the Centers for Medicare and Medicaid Services
for approval a basic benchmark for health benefit plans offered
by the Family Health Insurance Assistance Program that considers
employer-sponsored health benefit plans offered to employees and
dependents of employees in Oregon. + } ' .
In line 42, delete '6' and insert '13'.
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