74th OREGON LEGISLATIVE ASSEMBLY--2007 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 733
House Bill 2174
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski for Department of Human Services)
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 as
introduced.
Requires Legislative Assembly to approve and fund separate
levels of health services on prioritized list for Oregon Health
Plan Plus and Oregon Health Plan Standard. Authorizes Department
of Human Services to adjust level of covered health services on
prioritized list for Oregon Health Plan Standard population when
insufficient resources are available during biennium.
A BILL FOR AN ACT
Relating to health services provided to persons eligible for
Oregon Health Plan Standard; creating new provisions; and
amending ORS 414.705, 414.707, 414.709, 414.735, 414.736 and
414.740.
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 - } { + as + } much
of each of the following as are { + on the prioritized list of
health services described in ORS 414.720 and are + }approved and
funded by the Legislative Assembly:
{ - (a) - } { + (1) + } 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) - } { + (2) + } 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) - } { + (3) + } Prescription drugs;
{ - (d) - } { + (4) + } Laboratory and X-ray services;
{ - (e) - } { + (5) + } Medical supplies;
{ - (f) - } { + (6) + } Mental health services;
{ - (g) - } { + (7) + } Chemical dependency services;
{ - (h) - } { + (8) + } Emergency dental services;
{ - (i) - } { + (9) + } Nonemergency dental services;
{ - (j) - } { + (10) + } Provider services, other than
services described in { - paragraphs (a) to (i), (k), (L) and
(m) of this subsection - } { + subsections (1) to (9), (11),
(12) and (13) of this section + }, defined by federal law that
may be included in the state's medical assistance program;
{ - (k) - } { + (11) + } Emergency hospital services;
{ - (L) - } { + (12) + } Outpatient hospital services; and
{ - (m) - } { + (13) + } 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. ORS 414.707 is amended to read:
414.707. (1) Subject to funds available:
(a) Persons who are categorically needy as described in ORS
414.025 (2)(n) and (o), and persons under 19 years of age and
pregnant women who are eligible to receive health services under
ORS 414.706 { + (2) and (3) + }, are eligible to receive all the
health services approved and funded by the Legislative
Assembly { + for those eligible populations + }.
(b) Persons described in ORS 414.708 are eligible to receive
the health services described in ORS 414.705 { - (1)(c), (f)
and (g) - } { + (3), (6) and (7) + }.
(c) Persons 19 years of age and older who are eligible to
receive health services under ORS 414.706 { + (5) + } are
eligible to receive { + all + } the health services
{ - described in ORS 414.705 (1)(b) to (m) - } { + approved
and funded by the Legislative Assembly for that eligible
population + }.
(2) Persons who are categorically needy as described in ORS
414.025 (2)(n) and (o), and persons under 19 years of age and
pregnant women who are eligible to receive health services under
ORS 414.706 { + (2) and (3) + }, must be provided, at a minimum,
the health services described in ORS 414.705 { - (1)(a) to
(g) - } { + (1) to (7) + }.
{ - (3) Persons 19 years of age and older who are eligible to
receive health services under ORS 414.706 must be provided, at a
minimum, health services described in ORS 414.705 (1)(b) to
(h). - }
{ - (4) - } { + (3) + } Persons described in ORS 414.708
must be provided, at a minimum, the health services described in
ORS 414.705
{ - (1)(c) - } { + (3) + }.
{ - (5) - } { + (4) + } The Department of Human Services
shall:
(a) Develop at least three benefit packages of provider
services to be offered under ORS 414.705 { - (1)(j) - } { +
(10) + }; and
(b) Define by rule the services to be offered under ORS 414.705
{ - (1)(k) - } { + (11) + }.
{ - (6) Notwithstanding ORS 414.735, the Legislative Assembly
shall adjust health services funded under ORS 414.705 (1) by
increasing or reducing benefit packages or health services and,
subject to ORS 414.709, by increasing or reducing the population
of eligible persons. - }
SECTION 3. ORS 414.709 is amended to read:
414.709. (1) Except as provided in subsection (2) of this
section, if insufficient resources are available during a
biennium, the population of eligible persons receiving health
services may not be reduced below the population of eligible
persons approved and funded in the legislatively adopted budget
for the Department of Human Services for the biennium.
(2) The Department of Human Services may { - periodically - }
limit enrollment of persons described in ORS { + 414.706 (5)
and + } 414.708 in order to stay within the legislatively adopted
budget for the department.
SECTION 4. ORS 414.735 is amended to read:
414.735. (1) If insufficient resources are available during
{ - a contract period - } { + the biennium + }:
(a) The population of eligible persons determined by law shall
not be reduced { + except as authorized in ORS 414.709 + }.
(b) The reimbursement rate for providers and plans established
under { - the - } { + a + } contractual agreement shall not
be reduced { + below the amount funded in the legislatively
adopted budget for the Department of Human Services for the
biennium + }.
(2) In the circumstances described in subsection (1) of this
section, { - reimbursement shall be adjusted - } { + cost
savings shall be achieved + } by { - reducing - }
{ + eliminating + } the health services for { - the - } { +
an + } eligible population { - by eliminating services - } in
the { + reverse + } order of priority recommended by the Health
Services Commission, starting with the { - least important and
progressing toward the most important - } { + level approved in
the legislatively adopted budget for the Department of Human
Services + }.
(3) The Department of Human Services shall obtain the approval
of the Legislative Assembly or Emergency Board, if the
Legislative Assembly is not in session, before instituting the
reductions. In addition, providers contracting to provide health
services under ORS 414.705 to 414.750 must be notified at least
two weeks prior to any legislative consideration of such
reductions. Any reductions made under this section shall take
effect no sooner than 60 days following final legislative action
approving the reductions.
SECTION 5. { + If the federal Centers for Medicare and
Medicaid Services must approve any changes required by the
amendments to ORS 414.707, 414.709 or 414.735 by sections 2 to 4
of this 2007 Act, the Department of Human Services shall adopt
rules implementing the amendments to ORS 414.707, 414.709 and
414.735 by sections 2 to 4 of this 2007 Act as soon as
practicable after the department receives the approval. + }
SECTION 6. ORS 414.736 is amended to read:
414.736. As used in this section and ORS 414.725, 414.737,
414.738, 414.739, 414.740, 414.741, 414.742, 414.743 and 414.744:
(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) - } { + (2),
(3), (4), (5), (7) and (10) + } 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) - } { +
(11) and (12) + }.
(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 7. ORS 414.740 is amended to read:
414.740. (1) Notwithstanding ORS 414.738 (1), 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) - } { +
(2), (3), (4), (5), (7) and (10) + }. 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) - } { + (11) and (12) + }. 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.
----------