73rd OREGON LEGISLATIVE ASSEMBLY--2005 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 3089
B-Engrossed
House Bill 3108
Ordered by the House July 28
Including House Amendments dated May 17 and July 28
Sponsored by Representative TOMEI (at the request of Beckie
Child)
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.
{ - Defines 'general assistance' and 'medical assistance '
for purposes of claims against estate of deceased recipient. - }
Directs Department of Human Services to adopt rules
establishing timelines for payment of health services under
medical assistance provisions.
Specifies that rules adopted by department establish timelines
for executing prepaid managed care health services contracts for
health services funded by Legislative Assembly.
{ - Provides that person receiving mental health or
developmental disability services has right to be informed that
family member has contacted department to determine location of
person and to be informed of name and contact information, if
known, of family member. Directs department to establish process
to implement reconnection of family members. - }
{ + Modifies reimbursement requirements for rural hospitals
under medical assistance program.
Directs Department of Human Services to adopt rules
implementing health services provided under medical assistance
program funded in legislatively adopted budget.
Directs Department of Human Services to establish program
regulating cross connections and backflow assemblies that are
part of water system. Authorizes department to assess annual fee
on community water systems for program. + }
Declares emergency, effective { - July 1, 2005 - } { + on
passage + }.
A BILL FOR AN ACT
Relating to human services; creating new provisions; amending ORS
414.065, 414.725, 414.727 and 448.279; repealing ORS 442.525;
and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 414.065 is amended to read:
414.065. (1) { + (a) + } 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 { + and paragraph (b) of this
subsection + }:
{ - (a) - } { + (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) - } { + (B) + } Standards to be observed in the
provision of medical and remedial care and services.
{ - (c) - } { + (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) - } { + (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) - } { + (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) - } { + (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.
{ + (b) Notwithstanding ORS 414.720 (8), the department shall
adopt rules establishing timelines for payment of health services
under paragraph (a) of this subsection. + }
(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) - } { + (1)(a)(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, Type B hospitals and
rural critical access hospitals, as described in ORS 442.470,
identified by the Office of Rural Health as rural hospitals 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. - }
SECTION 2. ORS 414.727 is amended to read:
414.727. (1) A { - health care provider - } { + prepaid
managed care health services organization, as defined in ORS
414.736, + }that contracts with the Department of Human Services
under ORS 414.725 (1) to provide prepaid managed care health
services { + , including hospital services, + } shall reimburse
Type A and Type B hospitals { + and rural critical access
hospitals + }, as { - defined - } { + described + } in ORS
442.470 and identified by the Office of Rural Health as rural
hospitals, 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 - } { + prepaid managed care health services
organization + } for the contract period.
{ + (2) The department shall base the capitation rates
described in subsection (1) of this section on the most recent
audited Medicare cost report for Oregon hospitals adjusted to
reflect the Medicaid mix of services. + }
{ - (2) - } { + (3) + } { - Nothing in - } This section
{ - shall - } { + may not + } be construed to prohibit a
{ - health care provider - } { + prepaid managed care health
services organization + } and { + a + } hospital from mutually
agreeing to reimbursement other than the reimbursement specified
in subsection (1) of this section.
{ + (4) Hospitals reimbursed under subsection (1) of this
section are not entitled to any additional reimbursement for
services provided. + }
SECTION 3. { + Section 4 of this 2005 Act is added to and made
a part of ORS 414.705 to 414.750. + }
SECTION 4. { + For services provided to persons who are
entitled to receive medical assistance and whose medical
assistance benefits are not administered by a prepaid managed
care health services organization, as defined in ORS 414.736, the
Department of Human Services shall reimburse Type A and Type B
hospitals and rural critical access hospitals, as described in
ORS 442.470 and identified by the Office of Rural Health as rural
hospitals, fully for the cost of covered services based on the
most recent audited Medicare cost report for Oregon hospitals
adjusted to reflect the Medicaid mix of services. + }
SECTION 5. { + ORS 442.525 is repealed. + }
SECTION 6. { + The amendments to ORS 414.065 and 414.727 by
sections 1 and 2 of this 2005 Act apply to reimbursement for the
cost of covered services provided to a Type A or Type B hospital
or a rural critical access hospital by a prepaid managed care
health services organization on or after August 13, 2003. + }
SECTION 7. { + Section 4 of this 2005 Act applies to
reimbursement for the cost of covered services provided to a Type
A or Type B hospital or a rural critical access hospital by the
Department of Human Services on or after the effective date of
this 2005 Act. + }
SECTION 8. ORS 414.725, as amended by section 277, chapter 794,
Oregon Laws 2003, is amended to read:
414.725. (1)(a) Pursuant to rules adopted by the Department of
Human Services, the department shall execute prepaid managed care
health services contracts for health services 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 - } { + The + } contracts are not subject to ORS
chapters 279A and 279B, except ORS 279A.250 to 279A.290 and
279B.235. { + Notwithstanding ORS 414.720 (8), the rules adopted
by the department shall establish timelines for executing the
contracts described in this paragraph. + }
(b) It is the intent of ORS 414.705 to 414.750 that the state
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 for providing the covered services. The
contracts may be with hospitals and medical organizations, health
maintenance organizations, managed health care plans and any
other qualified public or private prepaid managed care health
services organization. The department may not discriminate
against any contractors that offer services within their
providers' lawful scopes of practice.
(2) The department may institute a fee-for-service case
management system or a fee-for-service payment system 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 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 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 9. { + (1) In accordance with ORS 414.707 (6), the
Department of Human Services is directed to adopt rules
implementing the adjustment of health services funded under ORS
414.705 (1) in the legislatively adopted budget for the
department for the 2005-2007 biennium.
(2) No later than 60 days after the effective date of this 2005
Act, the department shall apply for approval from the Centers for
Medicare and Medicaid Services to reduce the health services to
be offered under ORS 414.705 as described in subsection (1) of
this section.
(3) The department shall adopt rules implementing subsection
(1) of this section as soon as practicable after receipt of the
necessary approvals. + }
SECTION 10. { + Section 11 of this 2005 Act is added to and
made a part of ORS 448.119 to 448.285. + }
SECTION 11. { + (1) The Department of Human Services shall
establish a program for regulating cross connections and the
backflow assemblies that are part of a water system.
(2) The department may assess an annual fee on community water
systems for the purpose of implementing the cross connection and
backflow assembly program established pursuant to this section.
The fee may not exceed:
(a) $30 for a water system that has 15 to 99 service
connections;
(b) $75 for a water system that has 100 to 999 service
connections;
(c) $200 for a water system that has 1,000 to 9,999 service
connections; or
(d) $350 for a water system that has 10,000 or more service
connections. + }
SECTION 12. ORS 448.279 is amended to read:
448.279. (1) The Department of Human Services by rule shall
establish a certification program for persons who inspect cross
connections or test backflow { - prevention device - }
assemblies. The program shall include minimum qualifications
necessary for a person to be certified to:
(a) Conduct a cross connection inspection; and
(b) Test a backflow { - prevention device - } assembly.
(2) Except for an employee of a water supplier as defined in
ORS 448.115, a person certified under this section shall:
(a) Become licensed as a construction contractor with the
Construction Contractors Board as provided under ORS chapter 701;
or
(b) Become licensed as a landscape contractor as provided under
ORS 671.510 to 671.710.
(3) In conjunction with the certification program established
under subsection (1) of this section, the department may
establish and collect a fee from an individual requesting
certification under the program. A fee imposed under this
subsection shall:
(a) Not be refundable; and
(b) Not exceed the cost of administering the certification
program of the department for which purpose the fee is
established, as authorized by the Legislative Assembly within the
budget of the department and as the budget may be modified by the
Emergency Board.
(4) All moneys collected by the department under this section
shall be deposited in the General Fund to the credit of an
account of the department. Such moneys are continuously
appropriated to the department to pay the cost of administering
the certification program established pursuant to
{ - subsections (1) and (3) of - } this section { + and the
cost of administering water system cross connection and backflow
assembly programs + }.
SECTION 13. { + This 2005 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2005 Act takes effect on
its passage. + }
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