74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
Enrolled
House Bill 3501
Sponsored by Representative KOTEK; Senators BATES, MORRISETTE
CHAPTER ................
AN ACT
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 Oregon:
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 + }.
Enrolled House Bill 3501 (HB 3501-B) Page 1
(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. + }
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Enrolled House Bill 3501 (HB 3501-B) Page 2
Passed by House May 16, 2007
Repassed by House June 18, 2007
...........................................................
Chief Clerk of House
...........................................................
Speaker of House
Passed by Senate June 14, 2007
...........................................................
President of Senate
Enrolled House Bill 3501 (HB 3501-B) Page 3
Received by Governor:
......M.,............., 2007
Approved:
......M.,............., 2007
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2007
...........................................................
Secretary of State
Enrolled House Bill 3501 (HB 3501-B) Page 4