Relating to Department of Human Services; creating new provisions; amending ORS 414.705 and 414.839; repealing ORS 414.821, 414.823, 414.827, 414.829, 414.833, 414.834, 414.835 and 414.837; and declaring an emergency.

 
 
 
     72nd OREGON LEGISLATIVE ASSEMBLY--2003 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 2083
 
                           A-Engrossed
 
                         House Bill 2511
                  Ordered by the House June 26
            Including House Amendments dated June 26
 
Sponsored by Representative KRUSE
 
 
                             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 Department of Human Services to establish
demonstration project to integrate delivery of human services and
workforce development services. - }
   { +  Prioritizes participation and benefits for certain
persons receiving health services through Department of Human
Services.
  Repeals certain provisions related to Oregon Health Plan.
  Declares emergency, effective July 1, 2003. + }
 
                        A BILL FOR AN ACT
Relating to Department of Human Services; creating new
  provisions; amending ORS 414.705 and 414.839; repealing ORS
  414.821, 414.823, 414.827, 414.829, 414.833, 414.834, 414.835
  and 414.837; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. 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) Primary care services provided by a physician as defined in
ORS 677.010 or a nurse practitioner certified under ORS 678.375;
  (c) Prescription drugs;
  (d) Laboratory and X-ray services;
  (e) Medical supplies;
  (f) Mental health services;
  (g) Chemical dependency services;
  (h) Dental services;
  (i) Provider services, other than services described in
paragraphs (a) to (h), (j) and (k) of this subsection, defined by
 
federal law that may be included in the state's medical
assistance program;
  (j) Outpatient hospital services; and
  (k) 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 2.  { + Sections 3 and 4 of this 2003 Act are added to
and made a part of ORS 414.705 to 414.750. + }
  SECTION 3.  { + The Legislative Assembly shall approve and fund
health services to the following persons in the following order:
  (1) Persons who are categorically needy as described in ORS
414.025 (2)(n) and (o);
  (2) Persons under 19 years of age and pregnant women with
incomes no more than 185 percent of the federal poverty
guidelines;
  (3) Persons 19 years of age or older with incomes no more than
25 percent of the federal poverty guidelines;
  (4) Persons 19 years of age or older with incomes above 25
percent of the federal poverty guidelines and no more than 50
percent of the federal poverty guidelines;
  (5) Pregnant women with incomes above 185 percent of the
federal poverty guidelines and no more than 200 percent of the
federal poverty guidelines;
  (6) Persons 19 years of age or older living with one or more
dependent children and with incomes no more than 75 percent of
the federal poverty guidelines;
  (7) Persons who are medically needy as defined in ORS 414.025;
  (8) Persons 19 years of age or older with incomes above 50
percent of the federal poverty guidelines and no more than 75
percent of the federal poverty guidelines; and
  (9) Persons 19 years of age or older with incomes above 75
percent of the federal poverty guidelines and no more than 100
percent of the federal poverty guidelines who do not have federal
Medicare coverage. + }
  SECTION 4.  { + (1) Subject to funds available:
  (a) Persons described in section 3 (1), (2) and (5) of this
2003 Act shall receive the health services described in ORS
414.705 (1).
  (b) Persons described in section 3 (7) of this 2003 Act shall
receive the health services described in ORS 414.705 (1)(c), (f),
(g) and (i).
  (c) Persons described in section 3 (3), (4), (6), (8) and (9)
of this 2003 Act shall receive the health services described in
ORS 414.705 (1)(b) to (k).
  (2) Health services described in ORS 414.705 (1)(a) to (g) must
be provided as a single benefit package for persons described in
section 3 (1), (2) and (5) of this 2003 Act.
  (3) Health services described in ORS 414.705 (1)(b) to (g) must
be provided as a single benefit package for persons described in
section 3 (3), (4), (6), (8) and (9) of this 2003 Act.
  (4) Health services described in ORS 414.705 (1)(c) must be
provided as a single benefit package for persons described in
section 3 (7) of this 2003 Act.
  (5) The Department of Human Services shall develop at least
three benefit packages of dental services to be offered under ORS
414.705 (1)(h), including but not limited to full dental
coverage, emergency dental services and emergency extraction
services.
  (6) The department shall develop at least three benefit
packages of provider services to be offered under ORS 414.705
(1)(i).
  (7) Notwithstanding ORS 414.735, the Legislative Assembly may
adjust health services funded under ORS 414.705 (1) by increasing
or reducing benefit packages, health services or the population
of eligible persons.
  (8) If insufficient resources are available during a biennium,
the population of eligible persons receiving health services may
not be reduced below the population funded to receive services on
July 1 of the first year of the biennium. + }
  SECTION 5.  { + ORS 414.821, 414.823, 414.827, 414.829,
414.833, 414.834, 414.835 and 414.837 are repealed. + }
  SECTION 6.  { + (1) Except as provided in section 7 of this
2003 Act, sections 3 and 4 of this 2003 Act and the amendments to
ORS 414.705 by section 1 of this 2003 Act become operative the
day after the date the Department of Human Services is notified
by the Centers for Medicare and Medicaid Services that the
request by the department to amend the necessary waivers has been
approved.
  (2) The Director of Human Services shall notify the Legislative
Counsel upon receipt of the approval or disapproval of the
request to amend the necessary waivers. + }
  SECTION 7.  { + The Director of Human Services may take any
action before the operative date of sections 3 and 4 of this 2003
Act and the amendments to ORS 414.705 by section 1 of this 2003
Act that is necessary to enable the director to exercise, on and
after the operative date of sections 3 and 4 of this 2003 Act and
the amendments to ORS 414.705 by section 1 this 2003 Act, all the
duties, functions and powers conferred on the director by
sections 3 and 4 of this 2003 Act and the amendments to ORS
414.705 by section 1 of this 2003 Act. + }
  SECTION 8.  { + For the biennium beginning July 1, 2003, the
health services provided to persons currently receiving services
under ORS 414.705 to 414.750 shall be the services provided on
June 30, 2003, until sections 3 and 4 of this 2003 Act and the
amendments to ORS 414.705 by section 1 of this 2003 Act become
operative. + }
  SECTION 9. 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 - }   { + Department of Human
Services may + } 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 - }   { + 200 + } 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 the
basic benchmark health benefit plan or the approved equivalent
established in ORS 414.829. - }
    { - (3) - }   { + (2) + } Cost-sharing shall be permitted and
structured in such a manner to encourage appropriate use of
preventive care and avoidance of unnecessary services.
    { - (4) - }   { + (3) + } 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) - }   { + (4) + } The state may pay a portion of the
cost of the subsidy, based on the individual's income and other
resources.
  SECTION 10.  { + 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
July 1, 2003. + }
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