74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
 
SA to SB 27
 
LC 2679/SB 27-2
 
                      SENATE AMENDMENTS TO
                         SENATE BILL 27
 
               By COMMITTEE ON HEALTH CARE REFORM
 
                              May 8
 
  On page 1 of the printed bill, line 2, after 'ORS' delete the
rest of the line and insert '414.720;'.
  In line 3, delete '414.745; repealing ORS 414.709;'.
  Delete lines 4 through 23 and insert:
  ' Whereas the objective of our health care system is health,
not just the financing and delivery of health care services; and
  ' Whereas health is more than just the absence of physical and
mental disease; it is the product of a number of factors, only
one of which is access to our medical system; and
  ' Whereas persons with disabilities and other ongoing
conditions can also live long and healthy lives; and
  ' Whereas we cannot achieve the objective of health unless all
individuals have timely access to the effective treatment of a
defined set of essential and effective health conditions; and
  ' Whereas we cannot achieve the objective of health unless we
invest not only in health care, but also in education, economic
opportunity, housing, sustainable environmental stewardship and
other areas that are important contributing factors to health;
and
  ' Whereas the escalating cost of health care is compromising
our ability to invest in those other areas that contribute to the
health of the population; and
  ' Whereas we cannot achieve our objective of health unless we
can control costs in the health care system; and
  ' Whereas we cannot control costs unless we:
  ' (1) Develop effective strategies to empower individuals
through education as well as financial incentives and
disincentives to assume more personal responsibility for their
own health status through the choices they make;
  ' (2) Reevaluate the structure of our 50-year federal financing
and eligibility system in light of the realities and
circumstances of the 21st century and of what we want the system
to achieve from the standpoint of the health of our population;
and
  ' (3) Rethink how we define a 'benefit' and restructure the
misaligned financial incentives and inefficient system through
which health care is currently delivered; and
  ' Whereas public resources are finite and therefore the public
resources available for health care are also finite; and
  ' Whereas finite resources require that explicit priorities be
set through an open process, with public input, to determine what
should and should not be financed with public resources; and
  ' Whereas those with more disposable private income will always
be able to purchase more health care than those who depend solely
on public resources; and
  ' Whereas the current health care system is unsustainable in
large part because of outdated federal policies that reflect the
realities of the last century instead of the realities of today
and that are based on assumptions that are no longer valid; and
 
  ' Whereas the ability of states to maintain the public's health
is increasingly constrained by those federal policies that were
built around 'categories' rather than a commitment to ensure that
all citizens have timely access to the effective treatment of
essential health conditions; and
  ' Whereas public subsidies of employer-sponsored health
coverage under the Tax Reform Act of 1954, Medicaid and Medicare,
which were established through three specific acts of Congress in
the last century, were enacted separately at different times for
different reasons and reflect no sense of common purpose; and
  ' Whereas the economic and demographic environment in which
those federal programs were created has changed dramatically over
the past 50 years, while the programs themselves continue to
reflect a set of circumstances that existed in the mid-20th
century; and
  ' Whereas any reform effort that fails to address the
contradictions and inequities embodied in the federal programs
and fails to bring them into alignment with the realities of the
21st century will also fail to achieve meaningful reform,
perpetuating the status quo and the contradictions, inequities
and consequences existing in the current system; and
  ' Whereas any strategies for financing, mandating or developing
new programs to expand access must address what will be covered
by public resources and how those services will be delivered,
otherwise those strategies will do little to stem escalating
medical costs, make health care more affordable or create a
sustainable system; and
  ' Whereas Oregon must take immediate action to develop, for
consideration by the United State Congress, a proposed
alternative to the way public dollars are currently being spent
on health care within the state in order to create a sustainable
system that will optimize the health of Oregonians; now,
therefore,'.
  On page 2, delete lines 1 through 32.
  Delete lines 34 through 45 and delete pages 3 through 11 and
insert:
  '  { +  SECTION 1. + }  { + Sections 1 to 16 of this 2007 Act
and ORS 414.720 shall be known as the Oregon Better Health
Act. + }
  '  { +  SECTION 2. + }  { + It is the intent and the goal of
the Legislative Assembly in enacting the Oregon Better Health Act
to:
  ' (1) Ensure that all Oregonians have timely access to
treatment for a defined set of essential health conditions;
  ' (2) Offer a blueprint for national health care reform;
  ' (3) Recognize that clinging to the system of
employer-sponsored coverage as it is currently structured is not
an option and to:
  ' (a) Recognize that the current structure makes much less
sense now than it did when the economic forces and incentives
that created it were put in place over 50 years ago;
  ' (b) Rethink the structure of the current system of
employer-sponsored coverage in light of the realities of a highly
competitive global economy, the increased mobility of the
workforce and the changing structure of the workplace; and
  ' (c) Develop a way to finance the treatment of a defined set
of essential health conditions that are not tied to employment,
relieving employers and employees of this cost while still
leaving employers the option of offering secondary coverage
designed to best serve the specific needs of their particular
workforce;
  ' (4) Recognize that clinging to the current structure of
Medicaid, including the Medicaid health care benefit, is not an
option and to:
  ' (a) Eliminate the need for a special program for the poor by
ensuring that all Oregonians, including the most vulnerable
members of our society, have access to treatment for at least the
same defined set of essential health conditions;
  ' (b) Ensure that the medical and health needs of persons who
are blind and persons with other disabilities and special needs
are met in a timely and cost-effective manner with treatments
that are physically and cognitively accessible and that produce
quality outcomes; and
  ' (c) Eliminate the complexity and administrative cost of
assigning equally impoverished and vulnerable groups of
Oregonians into dozens of different eligibility categories to
determine how their care will be financed;
  ' (5) Reconsider the current structure of the Medicare program,
but not to dismantle it, and to:
  ' (a) Recognize that clinging to the current structure of
Medicare is not an option;
  ' (b) Rethink the current structure of Medicare in light of the
huge demographic trends and advances in medical technology that
have taken place since Medicare was created in 1965;
  ' (c) More rationally and honestly identify the medical and
health needs of an aging population and to ensure that those
needs are met in a timely and cost-effective manner with
treatments that are physically and cognitively accessible and
that produce quality outcomes; and
  ' (d) Balance, in an equitable and sustainable manner, the
medical and health needs of the elderly with those of the
nonelderly and ensure that this balance is reflected in the
allocation of public resources for health care; and
  ' (6) Reconsider the workforce capacity in the current system
in order to move to more effective and efficient delivery models
that will produce quality outcomes. + }
  '  { +  SECTION 3. + }  { + The Oregon Better Health Act is
based on the following principles:
  ' (1) Equity. All individuals must be eligible for and have
timely access to treatment for at least the same set of essential
and effective health conditions.
  ' (2) Financing. Financing of the health care system must be
equitable, broadly based and affordable.
  ' (3) Population benefit. The public must set priorities to
optimize the health of Oregonians.
  ' (4) Responsibility. Responsibility for optimizing health must
be shared by individuals, employers, health systems and
communities.
  ' (5) Education. Education is a powerful tool for health
promotion. The health care system must promote and engage in
education activities for individuals, health systems and
communities.
  ' (6) Choice and dignity. Health care and health promotion
systems must provide services in ways that support choice and
dignity for individuals.
  ' (7) Effectiveness. The relationship between specific health
interventions and their desired health outcomes must be backed by
unbiased, objective medical evidence.
  ' (8) Efficiency. The administration and delivery of health
services must use the fewest resources necessary to produce the
most effective health outcomes.
  ' (9) Explicit decision-making. Decision-making will be clearly
defined and accessible to the public, including lines of
accountability, opportunities for public engagement and how
public input will be used in decision-making.
  ' (10) Transparency. The evidence used to support decisions
must be clear, understandable and observable to the public.
  ' (11) Economic sustainability. Health service expenditures
must be managed to ensure sustainability over the long term,
using efficient planning, budgeting and coordination of resources
and reserves, based on public values that respect the inherent
 
worth of all Oregonians and recognizing the impact that public
and private health expenditures have on each other.
  ' (12) Aligned financial incentives. Financial incentives must
be aligned to support and invest in activities that will achieve
the goals of the Act.
  ' (13) Wellness. Health and wellness promotion efforts must be
emphasized and strengthened.
  ' (14) Community-based. The delivery of care and distribution
of resources must be organized to take place at the community
level, unless outcomes or cost can be improved at regional or
statewide levels.
  ' (15) Coordination. Collaboration, coordination and
integration of care and resources must be emphasized throughout
the health system. + }
  '  { +  SECTION 4. + }  { + (1) The Oregon Better Health Trust
Fund is established separate and distinct from the General Fund.
Interest earned from the investment of moneys in the Oregon
Better Health Trust Fund shall be credited to the fund. The
Oregon Better Health Trust Fund shall include, but is not limited
to:
  ' (a) State funds made available by the Legislative Assembly
for purposes that are consistent with section 2 of this 2007 Act;
  ' (b) Federal funds from Title XVVIII, XIX or XXI of the Social
Security Act that may be made available to the fund by the
federal government; and
  ' (c) Contributions from any other source, public or private,
transferred to the fund by the Legislative Assembly for the
purpose of administering the Oregon Better Health Act.
  ' (2) All moneys in the Oregon Better Health Trust Fund are
continuously appropriated to the Oregon Better Health Board for
the purpose of providing health services to all Oregon
residents. + }
  '  { +  SECTION 5. + }  { + (1) There is established the Oregon
Better Health Design Board to develop a blueprint for national
reform.  The board shall consist of 11 members appointed by the
Governor, subject to confirmation by the Senate pursuant to
section 4, Article III of the Oregon Constitution. The members of
the board must include individuals with actuarial and financial
management experience, individuals who are providers of health
care and individuals who are consumers of health care, including
seniors, people with disabilities and people with complex medical
needs.
  ' (2) The terms of the board members shall expire on July 1,
2009.
  ' (3) If there is a vacancy for any cause, the Governor shall
make an appointment to become effective immediately for the
balance of the unexpired term.
  ' (4) Members of the board are in the exempt service under ORS
chapter 240, and the Governor shall fix their salaries in
accordance with ORS 240.245.
  ' (5) The board shall select one of its members as chairperson
and another as vice chairperson, for such terms and with duties
and powers necessary for the performance of the functions of such
offices as the board determines.
  ' (6) A majority of the members of the board constitutes a
quorum for the transaction of business.
  ' (7) Official action by the board requires the approval of a
majority of the members of the board.
  ' (8) The Oregon Better Health Design Fund is established
separate and distinct from the General Fund. All moneys in the
Oregon Better Health Design Fund are continuously appropriated to
the Oregon Better Health Design Board for the purpose of carrying
out the provisions of sections 5 to 15 of this 2007 Act. + }
  '  { +  SECTION 5a. + }  { + The unexpended balances of amounts
authorized to be expended by the Oregon Better Health Design
Board for the biennium beginning July 1, 2007, from revenues
dedicated, continuously appropriated, appropriated or otherwise
made available for the purpose of administering and enforcing the
duties, functions and powers under sections 5 to 15 of this 2007
Act, shall revert to the General Fund on June 30, 2009. + }
  '  { +  SECTION 6. + }  { + (1) The Oregon Better Health Design
Board shall appoint an executive director to serve at the
pleasure of the board.
  ' (2) The designation of the executive director must be by
written order filed with the Secretary of State.
  ' (3) Subject to any applicable provisions of ORS chapter 240,
the executive director is authorized to hire, supervise and
terminate the employees of the board, prescribe their duties and
fix their compensation. + }
  '  { +  SECTION 7. + }  { + The Oregon Better Health Design
Board shall:
  ' (1) Develop a plan to ensure that all Oregonians have access
to treatment for a defined set of essential health conditions;
  ' (2) Offer a proposal to implement the plan for consideration
by the United States Congress as the basis for national health
care reform;
  ' (3) Oversee the actuarial process to create the defined set
of essential health conditions in accordance with ORS 414.720 and
section 10 of this 2007 Act; and
  ' (4) Conduct public hearings to determine the adequacy of the
defined set of essential health conditions in meeting the goals
of the Oregon Better Health Act. + }
  '  { +  SECTION 8. + }  { + In developing the plan described in
section 14 of this 2007 Act, the Oregon Better Health Design
Board shall make the following assumptions:
  ' (1) The Oregon Better Health Board, described in section 13
of this 2007 Act, will enter into contracts with privately and
publicly sponsored health care organizations for the treatment of
the defined set of essential health conditions developed under
ORS 414.720. The health care organizations shall include, but are
not limited to, private health plans and insurers, health care
service contractors, independent practice associations, managed
care health services organizations, community clinics, community
health centers, rural health clinics and federally qualified
health centers.
  ' (2) The contracts described in subsection (1) of this section
will include standards for quality, performance and transparency,
including transparency in costs, charges and outcomes.
  ' (3) All Oregonians will be covered for the treatment of the
same defined set of essential health conditions and the
capitation rate must be the same for all contracting health care
organizations.
  ' (4) A health care provider or health care organization may
not be subject to criminal prosecution, civil liability or
professional disciplinary action for failing to provide a service
that the Legislative Assembly does not fund or the Oregon Better
Health Board has eliminated from coverage.
  ' (5) The health care organizations will be community-rated and
will compete with each other to enroll Oregonians on the basis of
outcomes, service and the secondary coverage described in
subsection (10) of this section.
  ' (6) There will be no underwriting. Instead, each contract
will contain a risk-adjusted formula.
  ' (7) The Oregon Better Health Board will establish a minimum
medical loss ratio for the health care organizations.
  ' (8) The Oregon Better Health Board may create a high-risk
pool spread over the entire population to help subsidize those
health care organizations that assume more risk.
  ' (9) Individuals will be permitted to choose their own health
care organization and employers will be permitted to continue to
serve as health insurance distributors for their employees.
 
  ' (10) Health care organizations will be permitted to offer
secondary coverage for services not included in the treatment of
the defined set of essential health conditions, as long as they
also offer coverage for the treatment of the defined set of
essential health conditions. The secondary coverage must be
separate and distinct from coverage for the treatment of the
defined set of essential health conditions. The cost of secondary
coverage purchased under this subsection may not be allowed as a
deduction against state income taxes. + }
  '  { +  SECTION 9. + }  { + In developing the plan described in
section 14 of this 2007 Act, the Oregon Better Health Design
Board shall:
  ' (1) Encourage the use of information technology that is
cost-neutral or has a positive return on investment, to deliver
efficient, safe, quality care; and
  ' (2) Implement a voluntary program to provide every Oregonian
with a personal electronic health record. The personal electronic
health record must be owned by the individual who will control
the use of and access to the information stored in it. The
personal electronic health record must be portable and not tied
to a health care organization, employer or governmental
entity. + }
  '  { +  SECTION 10. + }  { + (1) Within 60 days after the
effective date of this 2007 Act, the Oregon Better Health Design
Board shall begin the benefit design process, in accordance with
ORS 414.720, to create the defined set of essential health
conditions for which coverage will be provided. For the purposes
of the benefit design process, the Oregon Better Health Design
Board shall assume that the resources available to the Oregon
Better Health Trust Fund will be the total of the following funds
currently being spent on health care each year in Oregon:
  ' (a) Medicare funds under Title XVIII of the Social Security
Act, based on the national average for reimbursement rates;
  ' (b) Medicaid funds under Title XIX of the Social Security Act
used to fund the Oregon Health Plan, other medical services and
administration;
  ' (c) General Fund moneys that would otherwise be spent in the
Medicaid program; and
  ' (d) The value of state and federal tax expenditures for
employer-sponsored health insurance coverage.
  ' (2) The funds described in subsection (1) of this section do
not include moneys currently spent on long term care services.
  ' (3) The Oregon Better Health Design Board shall further
assume that:
  ' (a) If moneys accumulate in excess of the legislatively
adopted budget for the Oregon Better Health Trust Fund during a
biennium, the Oregon Better Health Board may authorize coverage
for the treatment of additional health conditions from the list
developed under ORS 414.720;
  ' (b) If moneys in the Oregon Better Health Trust Fund are
insufficient to provide coverage for the treatment of the defined
set of essential health conditions to all eligible persons during
a biennium, the number, types or categories of persons eligible
for coverage will not be reduced by restricting eligibility
requirements and the reimbursement rates for providers and health
care organizations will not be reduced;
  ' (c) In the circumstances described in paragraph (b) of this
subsection, the Oregon Better Health Board, with the approval of
the Legislative Assembly or Emergency Board and after two weeks'
notice to providers prior to any legislative consideration, may
eliminate or modify coverage for treatment of the defined set of
essential health conditions or request an additional General Fund
appropriation or an amount from the reserve fund of the Emergency
Board. + }
 
 
  '  { +  SECTION 11. + }  { + Within 60 days after the effective
date of this 2007 Act, the Oregon Better Health Design Board
shall:
  ' (1) Establish a subcommittee to develop options, using the
criteria described in section 12 of this 2007 Act, for a
collection mechanism to transfer the value of the public subsidy
of employer-sponsored coverage through state and federal tax
expenditures to the Oregon Better Health Trust Fund. The
subcommittee must include both small and large business
interests, including those offering coverage, those not offering
coverage and those that are self-insured, employees of those
businesses, including those belonging to Taft-Hartley trusts, and
self-employed individuals;
  ' (2) Establish a subcommittee to make recommendations on the
most efficient and effective delivery system models producing
quality outcomes for consideration in the actuarial process
described in ORS 414.720 (6). The subcommittee must include, but
not be limited to, primary care physicians, specialists, nurses,
advanced practice nurses, mental health and chemical dependency
treatment providers, dentists and providers from community health
organizations, rural public health clinics, individuals with
community-based health promotion and prevention programs and
consumers of health care;
  ' (3) Establish a subcommittee to make recommendations on how
best to maximize the integration of health services with
community-based long term care services to avoid disruptions in
care. The subcommittee shall include, but is not limited to,
providers of community-based long term care services, seniors,
people with developmental disabilities, people with physical
disabilities, people with chronic health conditions and people
with complex medical needs.
  ' (4) Establish a subcommittee to develop options to finance
and implement the health information technology services and
infrastructure described in section 9 of this 2007 Act;
  ' (5) Establish a subcommittee to develop options to promote
healthy behaviors through strategies that focus on both
individual choices and environmental influences. These strategies
shall include empowering individuals through education as well as
financial incentives and disincentives to assume more
responsibility for their own health status. Recognizing the
powerful role that the social environment plays in health
outcomes, the subcommittee also shall make recommendations
regarding strategies to create environments that support,
reinforce and enable health behaviors. The subcommittee shall
include, but not be limited to, consumers of health care
including seniors, people with disabilities and people with
complex medical needs. The subcommittee shall consider the
recommendations of the Health Services Commission concerning
investments in nonclinical services and programs that have a
bearing on the health of the population as required in ORS
414.720 (4)(e). The Oregon Better Health Design Board shall
submit these options to an independent actuary to determine the
costs of implementation and incorporate the costs into the plan
developed under section 14 of this 2007 Act; and
  ' (6) Establish a subcommittee to make recommendations
concerning how to address the issue of medical liability
including, but not limited to, a consideration of the
implementation of a Medical Review Panel and a Patient's
Compensation Fund, and providing liability protection for those
health care organizations and providers that adhere to
established best-practice standards and guidelines. + }
  '  { +  SECTION 12. + }  { + The mechanism to transfer the
value of the public subsidy of employer-sponsored coverage
described in section 11 of this 2007 Act must:
  ' (1) Not create an incentive for employers to discontinue
coverage through the workplace;
  ' (2) Address the inequities between employers that do and do
not offer coverage;
  ' (3) Recognize that small employers may have less margin with
which to contribute to the cost of their employees' health care;
and
  ' (4) Take into account the global economy, the mobility of the
workforce and the changing structure of the workplace. + }
  '  { +  SECTION 13. + }  { + (1) The plan developed under
section 14 of this 2007 Act shall include recommendations for the
appointment of a permanent Oregon Better Health Board. The
recommendations shall detail the structure, membership and
responsibilities of the permanent board. The responsibilities of
the board shall include, but are not limited to:
  ' (a) Managing the Oregon Better Health Trust Fund;
  ' (b) Overseeing the actuarial process, described in ORS
414.720, to define the set of essential health conditions;
  ' (c) Conducting public hearings to determine the adequacy of
the defined set of essential health conditions in meeting the
goals of the Oregon Better Health Act described in section 2 of
this 2007 Act; and
  ' (d) Contracting with privately and publicly sponsored health
care organizations in accordance with section 8 of this 2007 Act.
  ' (2) The board shall be modeled after the Federal Reserve
Board, to ensure the greatest amount of independence
possible. + }
  '  { +  SECTION 14. + }  { + (1) Based upon the recommendations
of the subcommittees described in section 11 of this 2007 Act,
the Oregon Better Health Design Board shall offer a plan to
implement the goals and principles described in sections 2 and 3
of this 2007 Act. The plan shall detail:
  ' (a) The administrative and governing structures of the new
system on both the state and community levels;
  ' (b) The structure of the delivery system, including standards
for quality transparency and accountability as well as
performance measures; and
  ' (c) The actuarial process used to determine the cost of
treating the defined set of essential health conditions to
produce quality outcomes and to align the financial incentives in
the system with the goals and principles of the Oregon Better
Health Act.
  ' (2) The board shall develop a transition plan that details
the changes, resources and time frames necessary to make an
orderly transition from the current system to the new system. + }
  '  { +  SECTION 15. + }  { + In developing the plan under
section 14 of this 2007 Act, the Oregon Better Health Design
Board shall conduct public hearings and solicit testimony and
information from advocates representing seniors, persons with
disabilities, consumers of mental health services, low-income
Oregonians, employers, employees, insurers and health plans and
providers of health care including, but not limited to, primary
care physicians, specialists, nurses, advanced practice nurses,
mental health and chemical dependency treatment providers,
dentists, oral surgeons, chiropractors, naturopaths, hospitals,
clinics, pharmacists, nurses and allied health professionals. + }
  '  { +  SECTION 16. + }  { + The Governor shall present the
plan developed under section 14 of this 2007 Act as a legislative
proposal to the regular or special session of the Legislative
Assembly next following the Governor's approval of the plan. The
legislative proposal shall:
  ' (1) Request that the Oregon Congressional delegation sponsor
federal legislation to support the plan; and
  ' (2) Request federal authority to implement portions of the
plan as pilot projects including, but not limited to:
  ' (a) Medicare pilot projects that do not request state
administration of Medicare funds but that do request waivers of
 
Medicare laws by the Secretary of the United States Department of
Health and Human Services; and
  ' (b) Medicaid demonstration projects based on the plan and
subject to approval of Medicaid waivers by the secretary. + }
  '  { +  SECTION 17. + } ORS 414.720 is amended to read:
  ' 414.720. (1) The Health Services Commission shall conduct
public hearings prior to making the report described in
subsection (3) of this section. The commission shall solicit
testimony and information from advocates representing seniors,
persons with disabilities, mental health services consumers and
low-income Oregonians, representatives of commercial carriers,
representatives of small and large Oregon employers and providers
of health care, including but not limited to physicians licensed
to practice medicine, dentists, oral surgeons, chiropractors,
naturopaths, hospitals, clinics, pharmacists, nurses and allied
health professionals.
  ' (2) The commission shall actively solicit public involvement
in a community meeting process to build a consensus on the values
to be used to guide health resource allocation decisions.
  '  { +  (3) Using a transparent process, the commission shall
establish priorities from among health conditions, including
physical, dental, vision, mental and chemical dependency, in 10
categories:
  ' (a) Prevention;
  ' (b) Pregnancy and childbirth;
  ' (c) Acute life-threatening conditions;
  ' (d) Acute non-life-threatening, self-limiting conditions;
  ' (e) Catastrophic conditions;
  ' (f) Chronic life-threatening conditions;
  ' (g) Chronic non-life-threatening conditions;
  ' (h) End of life;
  ' (i) Rehabilitation; and
  ' (j) Elective conditions.
  ' (4) The commission shall establish priorities among the
categories and within each category, from the most important to
the least important, based upon the comparative health benefit of
treating each condition for optimizing the health of the
population and based on criteria that have been publicly debated
and agreed upon by the Oregon Better Health Board, including, but
not limited to:
  ' (a) Social values;
  ' (b) Clinical effectiveness of the treatment of the condition
to produce quality outcomes;
  ' (c) The degree to which medical evidence exists to support
the relationship between the treatment and the desired quality
health outcome;
  ' (d) The relative cost-effectiveness of drugs, procedures and
technologies in terms of the health benefit for the entire
population served; and
  ' (e) Investments needed in nonclinical services and programs
that have a bearing on the health of the population. + }
  '  { - (3) - }  { +  (5) For the purpose of the benefit design
process described in section 11 of this 2007 Act,  + }the
commission shall report to the   { - Governor a - }   { + Oregon
Better Health Board the + } list of health   { - services ranked
by priority, from the most important to the least important,
representing the comparative benefits of each service to - }
 { + conditions ranked by priority from the most important to the
least important based upon the comparative health benefit of
treatment of each condition for optimizing the health of + } the
entire population to be served. The list submitted by the
commission pursuant to this subsection is not subject to
alteration by any other state agency.   { - The recommendation
may include practice guidelines reviewed and adopted by the
commission pursuant to subsection (4) of this section. - }
 
  '  { - (4) In order to encourage effective and efficient
medical evaluation and treatment, the commission: - }
  '  { - (a) May include clinical practice guidelines in its
prioritized list of services. The commission shall actively
solicit testimony and information from the medical community and
the public to build a consensus on clinical practice guidelines
developed by the commission. - }
  '  { - (b) Shall consider both the clinical effectiveness and
cost-effectiveness of health services in determining their
relative importance using peer-reviewed medical literature as
defined in ORS 743.695. - }
  '  { - (5) The commission shall make its report by July 1 of
the year preceding each regular session of the Legislative
Assembly and shall submit a copy of its report to the Governor,
the Speaker of the House of Representatives and the President of
the Senate. - }
  '  { - (6) The commission may alter the list during interim
only under the following conditions: - }
  '  { - (a) Technical changes due to errors and omissions;
and - }
  '  { - (b) Changes due to advancements in medical technology or
new data regarding health outcomes. - }
  '  { - (7) If a service is deleted or added and no new funding
is required, the commission shall report to the Speaker of the
House of Representatives and the President of the Senate.
However, if a service to be added requires increased funding to
avoid discontinuing another service, the commission must report
to the Emergency Board to request the funding. - }
  '  { - (8) The report listing services to be provided pursuant
to ORS 414.036, 414.042, 414.065, 414.107, 414.705 to 414.725 and
414.735 to 414.750 shall remain in effect from October 1 of the
odd-numbered year through September 30 of the next odd-numbered
year. - }
  '  { +  (6)(a) The Oregon Better Health Board shall be
responsible for supervising an independent actuarial process to
determine the cost of treating each condition on the list to
produce quality outcomes.
  ' (b) The board must develop the assumptions used in the
actuarial process with the involvement and input of affected
persons including, but not limited to, consumers of health care,
employers, hospitals, primary care physicians, specialists,
nurses, advanced practice nurses, mental health providers,
dentists and providers from community health centers and rural
health clinics.
  ' (c) The board must base actuarial assumptions concerning
utilization of services upon the most efficient and effective
delivery system models producing quality outcomes, particularly
for the management of chronic conditions.
  ' (d) The actuarial assumptions developed by the board under
paragraph (b) of this subsection must include the following:
  ' (A) Providers must receive fair and reasonable payments that
are stable and predictable for treating the covered set of
essential health conditions to produce quality outcomes. Payments
may include payment for other than in-person encounters.
  ' (B) Payment levels must take into account the need to create
incentives that ensure adequate provider capacity to meet the
requirements of the most efficient and effective delivery system
models producing quality outcomes.
  ' (C) There must be value based cost-sharing for consumers,
with lower or not cost sharing for the treatment of conditions
that are higher on the priority list, particularly when the
treatment is highly effective in producing quality outcomes, and
with higher cost-sharing burdens for the treatment of elective,
discretionary conditions and conditions that are lower on the
priority list.
 
  ' (7) The Oregon Better Health Board shall determine payment
levels for the defined set of essential health conditions by:
  ' (a) Dividing the Oregon Better Health Trust Fund by the
eligible population to arrive at a capitation rate, adjusted for
population characteristics using standard actuarial principles;
and
  ' (b) Applying the capitation rate to the list described in
subsection (5) of this section. + }
  '  { +  SECTION 18. + }  { + Sections 5, 6 and 7 of this 2007
Act are repealed on July 1, 2009. + }
  '  { +  SECTION 19. + }  { + This 2007 Act being necessary for
the immediate preservation of the public peace, health and
safety, an emergency is declared to exist, and this 2007 Act
takes effect on its passage. + } ' .
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