74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
 
SA to SB 153
 
LC 387/SB 153-1
 
                      SENATE AMENDMENTS TO
                         SENATE BILL 153
 
        By COMMITTEE ON HEALTH POLICY AND PUBLIC AFFAIRS
 
                              May 9
 
  On page 1 of the printed bill, delete line 20 and insert:
  ' (4) An employee benefit plan, self-insured plan, managed care
organization or group health plan, a third party administrator,
fiscal intermediary or pharmacy benefit manager of the plan or
organization, or other party that is, by statute, contract or
agreement legally responsible for payment of a claim for a health
care item or service, may not deny a claim submitted by the'.
  Delete lines 28 and 29 and insert:
  ' (5) An employee benefit plan, self-insured plan, managed care
organization or group health plan, a third party administrator,
fiscal intermediary or pharmacy benefit manager of the plan or
organization, or other party that is, by statute, contract or
agreement legally responsible for payment of a claim for a health
care item or service, must provide to the state Medicaid agency
or prepaid managed care health services organization described in
ORS 414.725, upon the request of the agency or contractor, the
following information:'.
  On page 2, line 2, after 'plan' insert 'or organization'.
  In line 3, after 'plan' insert 'or organization'.
  In line 4, delete 'number' and insert 'numbers' and after '
plan' insert 'or organization'.
  Delete lines 16 and 17 and insert:
  ' (c) Make payments on claims submitted in accordance with
paragraph (b) of this subsection directly to the custodial
parent, to the provider or, if a claim is filed by the state
Medicaid agency, directly to the state Medicaid agency.'.
  On page 3, line 11, after 'means' delete the rest of the line
and lines 12 and 13 and insert 'an employee benefit plan,
self-insured plan, managed care organization or group health
plan, a third party administrator, fiscal intermediary or
pharmacy benefit manager of the plan or organization, or other
party that is by statute, contract or agreement legally
responsible for payment of a claim for a health care item or
service. '
  In line 24, after 'agency' insert ', or a prepaid managed care
health services organization described in ORS 414.725,'.
  In line 32, delete ', upon the agency's request' and insert '
or a prepaid managed care health services organization, upon
request'.
  In line 37, delete 'number' and insert 'numbers'.
  On page 4, line 5, after 'or' delete the rest of the line and
insert ', if a claim is filed by the state Medicaid agency or a
prepaid managed health care services organization, directly to
the agency or the organization.'.
  In line 25, after 'agency' insert 'or a prepaid managed care
health services organization described in ORS 414.725'.
  In line 26, after 'agency' insert 'or organization'.
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