Chapter 886
AN ACT
HB 3501
Relating to rates for payments to noncontracting hospitals; creating
new provisions; and amending ORS 414.743.
Be It Enacted by the People of
the State of
SECTION 1.
ORS 414.743 is amended to read:
414.743. (1) As used in
this section, “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
all health services described in ORS 414.705 are reasonably accessible to
enrollees.
(2) 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] at 80 percent of the Medicare rate for the
noncontracting hospital.
[(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.]
(3) 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:]
[(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] as payment in full
the rates described in subsection (2) of this section.
(4) 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 315.613.
(5) The Department of
Human Services shall adopt rules to implement and administer this section.
SECTION 2.
ORS 414.743, as amended by section 1 of this 2007 Act, is amended to read:
414.743. (1) As used in
this section, “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
all health services described in ORS 414.705 are reasonably accessible to
enrollees.
(2) 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 [at 80 percent of the
Medicare rate for the noncontracting hospital] 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.
(3) 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 [as payment in full the rates described in
subsection (2) of this section] as payment in full for hospital
services, rates:
(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.
(4) 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 315.613.
(5) The Department of
Human Services shall adopt rules to implement and administer this section.
SECTION 3. The
amendments to ORS 414.743 by section 2 of this 2007 Act become operative on
January 2, 2010.
Approved by the Governor August 3, 2007
Filed in the office of Secretary of State August 3, 2007
Effective date January 1, 2008
__________