74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
SA to SB 329
LC 1631/SB 329-6
SENATE AMENDMENTS TO
SENATE BILL 329
By SPECIAL COMMITTEE ON HEALTH CARE REFORM
May 2
On page 1 of the printed bill, line 2, delete '192.519' and
insert '414.312, 414.314, 414.316, 414.318, 414.320 and 442.011
and sections 2 and 3, chapter 314, Oregon Laws 2005'.
Delete lines 4 through 19 and insert:
' Whereas improving and protecting the health of all Oregonians
must be a primary issue and an important goal of the state; and
' Whereas the objective of Oregon's 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 the medical system; and
' Whereas persons with disabilities and other ongoing
conditions can live long and healthy lives; and
' Whereas Oregonians cannot achieve the objective of health
unless all individuals have timely access to a defined set of
essential health services; and
' Whereas Oregonians cannot achieve the objective of health
unless the state invests not only in health care, but also in
education, economic opportunity, housing, sustainable
environmental stewardship, full participation and other areas
that are important contributing factors to health; and
' Whereas the escalating cost of health care is compromising
the ability to invest in those other areas that contribute to the
health of the population; and
' Whereas Oregon cannot achieve its objective of health unless
Oregonians control costs in the health care system; and
' Whereas Oregon cannot control costs unless Oregonians:
' (1) Develop effective strategies through education of
individuals and health care providers, development of policies
and practices as well as financial incentives and disincentives
to empower individuals to assume more personal responsibility for
their own health status through the choices they make; and
' (2) Reevaluate the structure of Oregon's financing and
eligibility system in light of the realities and circumstances of
the 21st century and of what Oregonians want the system to
achieve from the standpoint of a healthy population; and
' (3) Rethink how Oregonians 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 on what should and
should not be financed with public resources; and
' Whereas those priorities must be based on publicly debated
criteria, that reflect a consensus of social values and that
consider the good of individuals across their lifespans; 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 society is responsible for ensuring equitable
financing for the defined set of essential health services for
those Oregonians who cannot afford that care; and
' Whereas health care policies should emphasize public health
and encourage the use of quality services and evidence-based
treatment that is appropriate and safe and that discourages
unnecessary treatment; and
' Whereas health care providers and informed patients must be
the primary decision makers in the health care system; and
' Whereas access, cost, transparency and quality are
intertwined and must be simultaneously addressed for health care
reform to be sustainable; and
' Whereas health is the shared responsibility of individual
consumers, government, employers, providers and health plans; and
' Whereas individual consumers, government, employers,
providers and health plans must be part of the solution and share
in the responsibility for both the financing and delivery of
health care; 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, which were
built around 'categories' rather than a commitment to ensure all
citizens have timely access to essential health services; and
' Whereas the economic and demographic environment in which
state and federal policies were created has changed dramatically
over the past 50 years, while the programs continue to reflect a
set of circumstances that existed in the mid-20th century; and
' Whereas any strategies for financing, mandating or developing
new programs to expand access must address what will be covered
with 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 incremental changes will not solve Oregon's health
care crisis and comprehensive reform is required; now,
therefore,'.
On page 2, delete lines 1 through 13.
Delete lines 15 through 45 and delete pages 3 through 11 and
insert:
' { + SECTION 1. + } { + Sections 2 to 16 of this 2007 Act
shall be known and may be cited as the Healthy Oregon Act. + }
' { + SECTION 2. + } { + As used in sections 2 to 16 of this
2007 Act, except as otherwise specifically provided or unless the
context requires otherwise:
' (1) 'Accountable health plan' means a prepaid managed care
health services organization described in ORS 414.725 or an
entity that contracts with the Oregon Health Trust Board to
provide a health benefit plan, as defined in ORS 743.730, through
the Oregon Health Fund program.
' (2) 'Defined set of essential health services' means the
services:
' (a) Identified by the Health Services Commission using the
methodology in ORS 414.720, or an alternative methodology
developed pursuant to section 11 (3)(c) of this 2007 Act; and
' (b) Approved by the Oregon Health Trust Board.
' (3) 'Employer' has the meaning given that term in ORS
657.025.
' (4) 'Oregon Health Card' means the card issued by the Oregon
Health Trust Board that verifies the eligibility of the holder to
participate in the Oregon Health Fund program.
' (5) 'Oregon Health Fund' means the fund established in
section 10 of this 2007 Act.
' (6) 'Oregon Health Trust Board' means the board established
in section 5 of this 2007 Act.
' (7) 'Safety net providers' means providers that deliver
health services to persons experiencing cultural, linguistic,
geographic, financial or other barriers to accessing appropriate,
timely, affordable and continuous health care services. 'Safety
net providers' includes health care safety net providers, core
health care safety net providers, tribal and federal health care
organizations and local nonprofit organizations, government
agencies, hospitals and individual providers. + }
' { + SECTION 3. + } { + The Healthy Oregon Act is based on
the following principles:
' (1) Equity. All individuals must be eligible for and have
timely access to at least the same set of essential and effective
health services.
' (2) 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 for optimizing health must be shared by
individuals, employers, health care systems and communities.
' (5) Education is a powerful tool for health promotion. The
health care system, health plans, providers and government must
promote and engage in education activities for individuals,
communities and providers.
' (6) Effectiveness. The relationship between specific health
interventions and their desired health outcomes must be backed by
unbiased, objective medical evidence.
' (7) Efficiency. The administration and delivery of health
services must use the fewest resources necessary to produce the
most effective health outcome.
' (8) 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.
' (9) Transparency. The evidence used to support decisions must
be clear, understandable and observable to the public.
' (10) Economic sustainability. Health service expenditures
must be managed to ensure long-term sustainability, using
efficient planning, budgeting and coordination of resources and
reserves, based on public values and recognizing the impact that
public and private health expenditures have on each other.
' (11) Aligned financial incentives. Financial incentives must
be aligned to support and invest in activities that will achieve
the goals of the Healthy Oregon Act.
' (12) Wellness. Health and wellness promotion efforts must be
emphasized and strengthened.
' (13) Community-based. The delivery of care and distribution
of resources must be organized to take place at the community
level to meet the needs of the local population, unless outcomes
or cost can be improved at regional or statewide levels.
' (14) Coordination. Collaboration, coordination and
integration of care and resources must be emphasized throughout
the health care system. + }
' { + SECTION 4. + } { + There is established the Oregon
Health Fund program. The goals of the program are to:
' (1) Ensure that all Oregonians have timely access to and
participate in a health benefit plan that provides high quality,
effective, safe, patient-centered, evidence-based and affordable
health care delivered at the lowest cost;
' (2) Develop a method to finance the coverage of a defined set
of essential health services for Oregonians that is not
necessarily tied directly to employment;
' (3) Allow employees, employers, individuals and unions the
option of participating in the program, or of purchasing primary
coverage or offering, purchasing or bargaining for coverage of
benefits beyond the defined set of essential health services;
' (4) Shift to a system of public and private health care
partnerships that integrate public involvement and oversight,
consumer choice and competition within the private market;
' (5) Use proven models of health care benefits, service
delivery and payments that control costs and overutilization,
with emphasis on preventive care and chronic disease management
using evidence-based outcomes and a health benefit model that
promotes a primary care medical home;
' (6) Ensure that health care delivery reform maximizes federal
and other public resources without compromising proven programs
supported by federal law that ensure access to efficient and high
quality care for vulnerable populations;
' (7) Provide services for dignified end-of-life care;
' (8) Restructure the health care system so that payments for
services are fair and proportionate among various populations,
health care programs and providers;
' (9) Fund a high quality and transparent health care delivery
system that will be held to high standards of transparency and
accountability and allows users and purchasers to know what they
are receiving for their money;
' (10) Ensure that funding for health care is equitable and
affordable for all Oregon residents and small and large
businesses; and
' (11) Ensure, to the greatest extent possible, that annual
inflation in the cost of providing all Oregonians access to
essential health care services does not exceed the increase in
the cost of living for the previous calendar year, based on the
Portland-Salem, OR-WA, Consumer Price Index for All Urban
Consumers for All Items, as published by the Bureau of Labor
Statistics of the United States Department of Labor. + }
' { + SECTION 5. + } { + (1) There is established the Oregon
Health Trust Board to administer the Oregon Health Fund program.
The board shall consist of seven 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 shall be selected based upon their ability to represent
the best interests of Oregon as a whole. Members of the board
shall have expertise, knowledge and experience in the areas of
consumer advocacy, management, finance, labor and health care,
and to the extent possible shall represent the geographic and
ethnic diversity of the state. A majority of the board members
may not receive or have received a substantial portion of their
own income or their family's income from the health care industry
or health insurance industry.
' (2) Each board member shall serve for a term of four years.
However, a board member shall serve until a successor has been
appointed and qualified. A member is eligible for reappointment.
' (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) 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.
' (5) A majority of the members of the board constitutes a
quorum for the transaction of business.
' (6) Official action by the board requires the approval of a
majority of the members of the board. + }
' { + SECTION 6. + } { + Notwithstanding the term of office
specified by section 5 of this 2007 Act, the terms of the members
first appointed to the Oregon Health Trust Board shall expire on
January 1, 2010, but each member may serve until a successor is
appointed by the Governor. Of the members appointed to the board
on or after January 1, 2010:
' (1) Two shall serve for terms ending January 1, 2012.
' (2) Two shall serve for terms ending January 1, 2013.
' (3) Three shall serve for terms ending January 1, 2014. + }
' { + SECTION 7. + } { + (1) Within 30 days after the
effective date of this 2007 Act, the Governor shall appoint an
executive director of the Oregon Health Trust Board who will be
responsible for establishing the administrative framework and
setting up the physical space for the operation of the Oregon
Health Fund program.
' (2) The executive director appointed under this section may
employ and shall fix the duties and amounts of compensation of
persons necessary to carry out the provisions of this section.
Those persons shall serve at the pleasure of the executive
director.
' (3) The term of the executive director appointed under this
section expires 30 days after all members of the board have been
appointed by the Governor and confirmed by the Senate. + }
' { + SECTION 8. + } { + (1) The Oregon Health Trust 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 9. + } { + Except as otherwise provided by
law, and except for ORS 279A.250 to 279A.290, the provisions of
ORS chapters 279A, 279B and 279C do not apply to the Oregon
Health Trust Board. + }
' { + SECTION 10. + } { + (1) The Oregon Health Fund is
established separate and distinct from the General Fund. Interest
earned from the investment of moneys in the Oregon Health Fund
shall be credited to the fund. The Oregon Health Fund may
include:
' (a) Employer and employee health care contributions.
' (b) Individual health care premium contributions.
' (c) Federal funds from Title XIX or XXI of the Social
Security Act, and state matching funds, that are made available
to the fund, excluding Title XIX funds for long term care
supports, services and administration, and reimbursements for
graduate medical education costs pursuant to 42 U.S.C. 1395ww(h)
and disproportionate share adjustments made pursuant to 42 U.S.C.
1396a(a)(13)(A)(iv).
' (d) Contributions from the United States Government and its
agencies for which the state is eligible, or from any other
source, public or private, provided for purposes that are
consistent with the goals of the Oregon Health Fund program.
' (e) Moneys appropriated to the Oregon Health Trust Board by
the Legislative Assembly for carrying out the provisions of the
Healthy Oregon Act.
' (f) Interest earnings from the investment of moneys in the
fund.
' (2)(a) All moneys in the Oregon Health Fund are continuously
appropriated to the Oregon Health Trust Board to carry out the
provisions of the Healthy Oregon Act.
' (b) The Oregon Health Fund shall be segregated into
subaccounts as required by federal law. + }
' { + SECTION 11. + } { + (1)(a) The Oregon Health Trust
Board shall establish a committee to examine the impact of
federal law requirements on achieving the goals of the Healthy
Oregon Act, including but not limited to:
' (A) Medicaid requirements such as eligibility categories and
household income limits;
' (B) Federal tax code policies regarding self-insurance and
portability of health insurance;
' (C) Emergency Medical Treatment and Active Labor Act
regulations that make the delivery of health care more costly and
less efficient; and
' (D) Medicare policies that result in Oregon's health care
providers receiving significantly less than the national average
Medicare reimbursement rate. The committee shall survey
providers, consumers and administrators and determine how this
and other Medicare policies and procedures affect costs, quality
and access. The committee shall assess how an increase in
Medicare reimbursement rates to Oregon providers would benefit
Oregon in health care costs, quality and access to services
including access for persons with disabilities and long term
care.
' (b) With the approval of the Oregon Health Trust Board, the
committee shall report its findings to the Oregon congressional
delegation no later than July 31, 2008.
' (c) The committee shall request that the Oregon congressional
delegation:
' (A) Participate in at least one hearing in each congressional
district in this state on the impacts of federal policies on
health care services; and
' (B) Request congressional hearings in Washington, D.C.
' (2) The Oregon Health Trust Board shall develop a
comprehensive plan to achieve the Oregon Health Fund program
goals listed in section 4 of this 2007 Act. The board shall
establish subcommittees, organized to maximize efficiency and
effectiveness and staffed, in the manner the board deems
appropriate, by the Oregon Health Policy Commission, the Office
for Oregon Health Policy and Research, the Health Services
Commission and the Medicaid Advisory Committee, to develop
proposals for the comprehensive plan that may include but are not
limited to the following:
' (a) Financing the Oregon Health Fund program, including but
not limited to proposals for:
' (A) A model for rate setting that ensures providers will
receive fair and adequate compensation for health care services.
' (B) Collecting employer and employee contributions and
individual health care premium contributions, and redirecting
them to the Oregon Health Fund.
' (C) Implementing a health insurance exchange to serve as a
central forum for individuals and businesses to purchase
affordable health insurance.
' (D) Taking best advantage of health savings accounts and
similar vehicles for making health insurance more affordable.
' (E) Addressing the issue of medical liability including, but
not limited to, a consideration of the implementation of a
medical review panel or a patient's compensation fund, and
providing liability protection for those providers who adhere to
established best-practice standards and guidelines.
' (F) Requesting federal waivers to maximize federal matching
funds under Titles XIX and XXI of the Social Security Act, or
other federal matching funds that may be made available to
implement the comprehensive plan.
' (G) Evaluating statutory and regulatory barriers to the
provision of cost-effective services, including limitations on
access to information that would enable providers to fairly
evaluate contract reimbursement, the regulatory effectiveness of
the certificate of need process, consideration of a statewide
uniform credentialing process and the cost and benefits of
improving the transparency of costs of hospital services and
health benefit plans.
' (b) Delivering health services in the Oregon Health Fund
program, including but not limited to proposals for:
' (A) An efficient and effective delivery system model that
ensures the continued viability of existing prepaid managed care
health services organizations, as described in ORS 414.725, to
serve Medicaid populations.
' (B) The design and implementation of a program to create a
public partnership with accountable health plans to provide,
through the use of an Oregon Health Card, health insurance
coverage of the defined set of essential health services that
meets standards of affordability based upon a calculation of how
much individuals and families can be expected to spend for health
insurance and still afford to pay for housing, food and other
necessities. The proposal must ensure that each accountable
health plan:
' (i) Does not deny enrollment to an Oregonian with an Oregon
Health Card;
' (ii) Provides coverage of the entire defined set of essential
health services;
' (iii) Will develop an information system to provide written
information, and telephone and Internet access to information,
necessary to connect enrollees with appropriate medical and
dental services and health care advice;
' (iv) Offers a simple and timely complaint process;
' (v) Provides enrollees with information about the cost and
quality of services offered by health plans and procedures
offered by medical and dental providers;
' (vi) Provides advance disclosure of the estimated
out-of-pocket costs of a service or procedure;
' (vii) Has contracts with a sufficient network of providers,
including but not limited to hospitals and physicians, with the
capacity to provide culturally appropriate, timely health
services and that operate during hours that allow optimal access
to health services;
' (viii) Ensures that all enrollees have a primary care medical
home;
' (ix) Includes in its network safety net providers and local
community collaboratives;
' (x) Regularly evaluates its services, surveys patients and
conducts other assessments to ensure patient satisfaction;
' (xi) Has strategies to encourage enrollees to utilize
preventive services and engage in healthy behaviors;
' (xii) Has simple and uniform procedures for enrollees to
report claims and for accountable health plans to make payments
to enrollees and providers;
' (xiii) Provides enrollment, encounter and outcome data to the
Oregon Health Trust Board for evaluation and monitoring purposes;
and
' (xiv) Meets established standards for loss ratios, rating
structures and profit or nonprofit status.
' (C) Using information technology that is cost-neutral or has
a positive return on investment to deliver efficient, safe and
quality health care and a voluntary program to provide every
Oregonian with a personal electronic health record that is within
the individual's control, use and access and that is portable.
' (D) Empowering individuals through education as well as
financial incentives to assume more personal responsibility for
their own health status through the choices they make.
' (E) Establishing and maintaining a registry of advance
directives and Physician Orders for Life-Sustaining Treatment
Paradigm (POLST) forms and a process for assisting a person who
chooses to execute an advance directive in accordance with ORS
127.531 or a POLST Paradigm form.
' (F) Designing a system for regional health delivery.
' (G) Combining, reorganizing or eliminating state agencies
involved in health planning and policy, health insurance and the
delivery of health care services and integrating and streamlining
their functions and programs to maximize their effectiveness and
efficiency. The subcommittee may consider, but is not limited to
considering, the following state agencies, functions or programs:
' (i) The Office for Oregon Health Policy and Research;
' (ii) The Health Services Commission;
' (iii) The Oregon Health Policy Commission;
' (iv) The Health Resources Commission;
' (v) The Medicaid Advisory Committee;
' (vi) The Department of Human Services, including but not
limited to the state Medicaid agency, offices involved in health
systems planning, offices involved in carrying out the duties of
the department with respect to certificates of need under ORS
443.305 to 443.350 and the functions of the department under ORS
chapter 430;
' (vii) The Department of Consumer and Business Services;
' (viii) The Oregon Patient Safety Commission;
' (ix) The Office of Private Health Partnerships;
' (x) The Public Employees' Benefit Board;
' (xi) The State Accident Insurance Fund Corporation; and
' (xii) The Office of Rural Health.
' (c) Establishing the defined set of essential health
services, including but not limited to proposals for a
methodology, consistent with the principles in section 3 of this
2007 Act, for determining and continually updating the defined
set of essential health services. The Oregon Health Trust Board
may delegate this function to the Health Services Commission
established under ORS 414.715.
' (d) The eligibility requirements and enrollment procedures
for the Oregon Health Fund program, including but not limited to
proposals for:
' (A) Public subsidies of premiums or other costs under the
program.
' (B) Streamlined enrollment procedures, including:
' (i) A standardized application process;
' (ii) Requirements to ensure that enrollees demonstrate Oregon
residency;
' (iii) A process to enable a provider to enroll an individual
in the Oregon Health Fund program at the time the individual
presents for treatment to ensure coverage as of the date of the
treatment; and
' (iv) Permissible waiting periods, preexisting condition
limitations or other administrative requirements for enrollment.
' (C) A grievance and appeal process for enrollees.
' (D) Standards for disenrollment and changing enrollment in
accountable health plans.
' (E) An outreach plan to educate the public about the program
and the program's eligibility requirements and enrollment
procedures.
' (F) Allowing employers to offer health insurance coverage by
insurers of the employer's choice or to contract for coverage of
benefits beyond the defined set of essential health services.
' (3) On the effective date of this 2007 Act, the Oregon Health
Policy Commission, the Office for Oregon Health Policy and
Research, the Health Services Commission and the Medicaid
Advisory Committee are directed to begin compiling data and
conducting research to inform the decision-making of the
subcommittees when they are convened. No later than December 1,
2007, the Oregon Health Policy Commission, the Office for Oregon
Health Policy and Research, the Health Services Commission and
the Medicaid Advisory Committee shall present reports containing
data and recommendations to the subcommittees as follows:
' (a) The Oregon Health Policy Commission shall report on the
financing mechanism for the comprehensive plan;
' (b) The Administrator of the Office for Oregon Health Policy
and Research shall report on the health care delivery model of
the comprehensive plan;
' (c) The Health Services Commission shall report on the
methodology for establishing the defined set of essential health
services under the comprehensive plan; and
' (d) The Medicaid Advisory Committee shall report on
eligibility and enrollment requirements under the comprehensive
plan.
' (4) The membership of the subcommittees shall, to the extent
possible, represent the geographic and ethnic diversity of the
state and include individuals with actuarial and financial
management experience, individuals who are providers of health
care, including safety net providers, and individuals who are
consumers of health care, including seniors, persons with
disabilities and individuals with complex medical needs.
' (5) Each subcommittee shall select one of its members as
chairperson for such terms and with such duties and powers
necessary for performance of the functions of those offices. Each
chairperson shall serve as an ex officio member of the Oregon
Health Trust Board. Chairpersons shall collaborate to integrate
the committee recommendations to the extent possible.
' (6) The committee and the subcommittees are public bodies for
purposes of ORS chapter 192 and must provide reasonable
opportunity for public testimony at each meeting.
' (7) All agencies of state government, as defined in ORS
174.111, are directed to assist the committee, the subcommittees
and the Oregon Health Trust Board in the performance of their
duties and, to the extent permitted by laws relating to
confidentiality, to furnish such information and advice as the
members of the committees, the subcommittees and the Oregon
Health Trust Board consider necessary to perform their duties.
' (8) The executive director of the Oregon Health Trust Board
may employ and shall fix the duties and amounts of compensation
of persons necessary to staff the committee and the
subcommittees.
' (9) The Oregon Health Trust Board shall report to an interim
legislative committee on health not later than February 29, 2008.
The report must describe the progress of the subcommittees and
the board towards developing a comprehensive plan to:
' (a) Ensure universal access to health care;
' (b) Contain health care costs; and
' (c) Address issues regarding the quality of health care
services. + }
' { + SECTION 12. + } { + The Oregon Health Trust Board
shall conduct public hearings on the comprehensive plan developed
under section 11 of this 2007 Act and solicit testimony and input
from advocates representing seniors, persons with disabilities,
tribes, consumers of mental health services, low-income
Oregonians, employers, employees, insurers, health plans and
providers of health care including, but not limited to,
physicians, dentists, oral surgeons, chiropractors, naturopaths,
hospitals, clinics, pharmacists, nurses and allied health
professionals. + }
' { + SECTION 13. + } { + (1) The Oregon Health Trust Board
shall finalize the comprehensive plan developed under section 11
of this 2007 Act with due consideration to the information
provided in the public hearings under section 12 of this 2007 Act
and shall present the finalized comprehensive plan to the
Governor, the Speaker of the House of Representatives and the
President of the Senate no later than October 1, 2008. The board
is authorized to submit the finalized comprehensive plan as a
measure request directly to the Legislative Counsel upon the
convening of the Seventy-fifth Legislative Assembly.
' (2) Upon legislative approval of the comprehensive plan, the
board is authorized to request federal waivers deemed necessary
and appropriate to implement the comprehensive plan.
' (3) Upon legislative approval of the comprehensive plan, the
board is authorized immediately to implement any elements
necessary to implement the plan that do not require legislative
changes or federal approval. + }
' { + SECTION 14. + } { + (1) The comprehensive plan
developed under section 11 of this 2007 Act and approved by the
Oregon Health Trust Board must ensure, except as provided in
subsection (2) of this section, that a resident of Oregon who is
not a beneficiary of a health benefit plan providing coverage of
the defined set of essential health services and who is not
eligible to be enrolled in a publicly funded medical assistance
program providing primary care and hospital services participates
in the Oregon Health Fund program. A resident of Oregon who is a
beneficiary of a health benefit plan or enrolled in a medical
assistance program described in this subsection may choose to
participate in the program. An employee of an employer located in
this state may participate in the program if Oregon is the
location of the employee's physical worksite, regardless of the
employee's state of residence.
' (2) Oregon residents who are enrolled in commercial health
insurance plans, self-insured programs, health plans funded by a
Taft-Hartley trust, or state or local government health insurance
pools may not be required to participate in the Oregon Health
Fund Program. + }
' { + SECTION 15. + } { + (1) No later than July 1, 2009,
the Administrator of the Office for Oregon Health Policy and
Research, in collaboration with the Oregon Health Research and
Evaluation Collaborative and other persons with relevant
expertise, shall develop a plan for evaluating the implementation
and outcomes of the legislation described in section 13 of this
2007 Act to the extent that the legislation is enacted in whole
or in part. The evaluation plan shall include measures of:
' (a) Access to care;
' (b) Access to health insurance coverage;
' (c) Quality of care;
' (d) Consumer satisfaction;
' (e) Health status;
' (f) Provider capacity;
' (g) Population demand;
' (h) Provider and consumer participation;
' (i) Utilization patterns;
' (j) Health outcomes;
' (k) Health disparities;
' (L) Financial impacts, including impacts on medical debt;
' (m) The extent to which employers discontinue coverage due to
the availability of publicly financed coverage or other employer
responses;
' (n) Impacts on the financing of health care and uncompensated
care;
' (o) Adverse selection, including migration to Oregon
primarily for access to health care;
' (p) Use of technology;
' (q) Transparency of costs; and
' (r) Impact on health care costs.
' (2) The administrator shall develop a model for a quality
institute that shall:
' (a) Develop and promote methods for improving collection,
measurement and reporting of information on quality in health
care;
' (b) Provide leadership and support to further the development
of widespread and shared electronic health records;
' (c) Develop the capacity of the workforce to capitalize on
health information technology;
' (d) Encourage purchasers, providers and state agencies to
improve system transparency and public understanding of quality
in health care;
' (e) Support the Oregon Patient Safety Commission's efforts to
increase collaboration and state leadership to improve health
care safety; and
' (f) Coordinate an effort among all state purchasers of health
care and insurers to support delivery models and reimbursement
strategies that will more effectively support infrastructure
investments, integrated care and improved health outcomes. + }
' { + SECTION 16. + } { + (1) The Oregon Health Trust Board
shall establish a statewide toll-free telephone number that
persons experiencing barriers to accessing appropriate health
care may call for information about available:
' (a) Primary care services offered by federally qualified
health centers, school-based health centers and safety net
providers;
' (b) Mental health services; and
' (c) Substance abuse treatment.
' (2) As used in this section, 'federally qualified health
center' means:
' (a) A health center funded under 42 U.S.C. 254b;
' (b) An entity that meets the definition of 'health center '
under 42 U.S.C. 254b but that does not receive grant funding
under the Public Health Service Act; or
' (c) An outpatient health program or facility operated by a
tribal organization under the Indian Self-Determination Act, 25
U.S.C. 450 et seq., or an urban Indian organization under the
Indian Health Care Improvement Act, 25 U.S.C. 1601 et seq. + }
' { + SECTION 17. + } ORS 442.011 is amended to read:
' 442.011. (1) There is created in the { - Oregon Department
of Administrative Services - } { + Oregon Health Trust Board
established under section 5 of this 2007 Act + } the Office for
Oregon Health Policy and Research. The Administrator of the
Office for Oregon Health Policy and Research shall be appointed
by the Governor and the appointment shall be subject to Senate
confirmation in the manner prescribed in ORS 171.562 and 171.565.
The administrator shall be an individual with demonstrated
proficiency in planning and managing programs with complex public
policy and fiscal aspects such as those involved in the Oregon
Health Plan. Before making the appointment, the Governor must
advise the President of the Senate and the Speaker of the House
of Representatives of the names of at least three finalists and
shall consider their recommendation in appointing the
administrator.
' (2) In carrying out the responsibilities and duties of the
administrator, the administrator shall consult with and be
advised by the Oregon Health Policy Commission { + and the
Oregon Health Trust Board + }.
' { + SECTION 18. + } ORS 414.312 is amended to read:
' 414.312. (1) As used in ORS 414.312 to 414.318:
' (a) 'Pharmacy benefit manager' means an entity that, in
addition to being a prescription drug claims processor,
negotiates and executes contracts with pharmacies, manages
preferred drug lists, negotiates rebates with prescription drug
manufacturers and serves as an intermediary between the Oregon
Prescription Drug Program, prescription drug manufacturers and
pharmacies.
' (b) 'Prescription drug claims processor' means an entity that
processes and pays prescription drug claims, adjudicates pharmacy
claims, transmits prescription drug prices and claims data
between pharmacies and the Oregon Prescription Drug Program and
processes related payments to pharmacies.
' (c) 'Program price' means the reimbursement rates and
prescription drug prices established by the administrator of the
Oregon Prescription Drug Program.
' (2) The Oregon Prescription Drug Program is established in
the { - Oregon Department of Administrative Services - } { +
Oregon Health Trust Board + }. The purpose of the program is to:
' (a) Purchase prescription drugs or reimburse pharmacies for
prescription drugs in order to receive discounted prices and
rebates;
' (b) Make prescription drugs available at the lowest possible
cost to participants in the program; and
' (c) Maintain a list of prescription drugs recommended as the
most effective prescription drugs available at the best possible
prices.
' (3) The { - Director of the Oregon Department of
Administrative Services - } { + Oregon Health Trust Board + }
shall appoint an administrator of the Oregon Prescription Drug
Program. The administrator shall:
' (a) Negotiate price discounts and rebates on prescription
drugs with prescription drug manufacturers;
' (b) Purchase prescription drugs on behalf of individuals and
entities that participate in the program;
' (c) Contract with a prescription drug claims processor to
adjudicate pharmacy claims and transmit program prices to
pharmacies;
' (d) Determine program prices and reimburse pharmacies for
prescription drugs;
' (e) Adopt and implement a preferred drug list for the
program;
' (f) Develop a system for allocating and distributing the
operational costs of the program and any rebates obtained to
participants of the program; and
' (g) Cooperate with other states or regional consortia in the
bulk purchase of prescription drugs.
' (4) The following individuals or entities may participate in
the program:
' (a) Public Employees' Benefit Board;
' (b) Local governments as defined in ORS 174.116 and special
government bodies as defined in ORS 174.117 that directly or
indirectly purchase prescription drugs;
' (c) Enrollees in the Senior Prescription Drug Assistance
Program created under ORS 414.342;
' (d) Oregon Health and Science University established under
ORS 353.020;
' (e) State agencies that directly or indirectly purchase
prescription drugs, including agencies that dispense prescription
drugs directly to persons in state-operated facilities; and
' (f) Residents of this state who do not have prescription drug
coverage.
' (5) The state agency that receives federal Medicaid funds and
is responsible for implementing the state's medical assistance
program may not participate in the program.
' (6) The administrator may establish different reimbursement
rates or prescription drug prices for pharmacies in rural areas
to maintain statewide access to the program.
' (7) The administrator shall establish the terms and
conditions for a pharmacy to enroll in the program. A licensed
pharmacy that is willing to accept the terms and conditions
established by the administrator may apply to enroll in the
program.
' (8) Except as provided in subsection (9) of this section, the
administrator may not:
' (a) Contract with a pharmacy benefit manager;
' (b) Establish a state-managed wholesale or retail drug
distribution or dispensing system; or
' (c) Require pharmacies to maintain or allocate separate
inventories for prescription drugs dispensed through the program.
' (9) The administrator shall contract with one or more
entities to provide the functions of a prescription drug claims
processor. The administrator may also contract with a pharmacy
benefit manager to negotiate with prescription drug manufacturers
on behalf of the administrator.
' (10) Notwithstanding subsection (4)(f) of this section,
individuals who are eligible for Medicare Part D prescription
drug coverage may participate in the program.
' { + SECTION 19. + } ORS 414.314 is amended to read:
' 414.314. (1) An individual or entity described in ORS 414.312
(4) may apply to participate in the Oregon Prescription Drug
Program. Participants shall apply annually on an application
provided by the { - Oregon Department of Administrative
Services - } { + Oregon Health Trust Board + }. The
{ - department - } { + board + } may charge participants a
nominal fee to participate in the program. The
{ - department - } { + board + } shall issue a prescription
drug identification card annually to participants of the program.
' (2) The { - department - } { + board + } shall provide a
mechanism to calculate and transmit the program prices for
prescription drugs to a pharmacy. The pharmacy shall charge the
participant the program price for a prescription drug.
' (3) A pharmacy may charge the participant the professional
dispensing fee set by the { - department - } { + board + }.
' (4) Prescription drug identification cards issued under this
section must contain the information necessary for proper claims
adjudication or transmission of price data.
' { + SECTION 20. + } ORS 414.316 is amended to read:
' 414.316. The Office for Oregon Health Policy and Research
shall develop and recommend to the { - Oregon Department of
Administrative Services - } { + Oregon Health Trust Board + } a
preferred drug list that identifies preferred choices of
prescription drugs within therapeutic classes for particular
diseases and conditions, including generic alternatives, for use
in the Oregon Prescription Drug Program. The office shall conduct
public hearings and use evidence-based evaluations on the
effectiveness of similar prescription drugs to develop the
preferred drug list.
' { + SECTION 21. + } ORS 414.318 is amended to read:
' 414.318. The Prescription Drug Purchasing Fund is established
separate and distinct from the General Fund. The Prescription
Drug Purchasing Fund shall consist of moneys appropriated to the
fund by the Legislative Assembly and moneys received by the
{ - Oregon Department of Administrative Services - } { + Oregon
Health Trust Board + } for the purposes established in this
section in the form of gifts, grants, bequests, endowments or
donations. The moneys in the Prescription Drug Purchasing Fund
are continuously appropriated to the { - Oregon Department of
Administrative Services - } { + Oregon Health Trust Board + }
and shall be used to purchase prescription drugs, reimburse
pharmacies for prescription drugs and reimburse the
{ - department - } { + board + } for the costs of
administering the Oregon Prescription Drug Program, including
contracted services costs, computer costs, professional
dispensing fees paid to retail pharmacies and other reasonable
program costs. Interest earned on the fund shall be credited to
the fund.
' { + SECTION 22. + } ORS 414.320 is amended to read:
' 414.320. The { - Oregon Department of Administrative
Services - } { + Oregon Health Trust Board + } shall adopt rules
to implement and administer ORS 414.312 to 414.318. The rules
shall include but are not limited to establishing procedures for:
' (1) Issuing prescription drug identification cards to
individuals and entities that participate in the Oregon
Prescription Drug Program; and
' (2) Enrolling pharmacies in the program.
' { + SECTION 23. + } Section 2, chapter 314, Oregon Laws
2005, is amended to read:
' { + Sec. 2. + } In addition to the notices required under
ORS 183.335 (15), the { - Oregon Department of Administrative
Services - } { + Oregon Health Trust Board + } shall give notice
to the individual members of any interim or session committee
with authority over the subject matter of the rule if the
{ - department - } { + board + } proposes to adopt a rule
under ORS 414.320.
' { + SECTION 24. + } Section 3, chapter 314, Oregon Laws
2005, is amended to read:
' { + Sec. 3. + } Section 2 { + , chapter 314, Oregon Laws
2005, + } { - of this 2005 Act - } applies to rules adopted by
the { - Oregon Department of Administrative Services - }
{ + Oregon Health Trust Board + } for the Oregon Prescription
Drug Program on or after { - the effective date of this 2005
Act - } { + June 28, 2005 + }.
' { + SECTION 25. + } { + (1) There is appropriated to the
Oregon Health Trust Board, for the biennium beginning July 1,
2007, out of the General Fund, the amount of $___ for the purpose
of carrying out the provisions of sections 2 to 16 of this 2007
Act.
' (2) The Oregon Health Fund established under section 10 of
this 2007 Act contains only appropriations from the General Fund
under this section, prior to July 1, 2009. + }
' { + SECTION 26. + } { + Sections 8, 11, 12, 13 and 16 of
this 2007 Act and the amendments to statutes and session laws by
sections 17 to 24 of this 2007 Act become operative on the date
that the members of the Oregon Health Trust Board have been
appointed by the Governor and confirmed by the Senate. The
executive director of the Oregon Health Trust Board shall notify
the Legislative Counsel when the members have been appointed and
confirmed. + }
' { + SECTION 27. + } { + The statewide toll-free telephone
line required by section 16 of this 2007 Act shall be in effect
no later than January 1, 2008. + }
' { + SECTION 28. + } { + Section 14 of this 2007 Act
becomes operative on January 2, 2010. + }
' { + SECTION 29. + } { + Section 11 of this 2007 Act is
repealed on the date of the convening of the next regular
biennial legislative session. + }
' { + SECTION 30. + } { + (1) The unexpended balances of
amounts authorized to be expended by the Oregon Department of
Administrative Services 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 transferred by the
amendments to statutes and session laws by sections 17 to 24 of
this 2007 Act are transferred to and are available for
expenditure by the Oregon Health Trust Board, for the purposes of
administering and enforcing the duties, functions and powers
transferred by the amendments to statutes and session laws by
sections 17 to 24 of this 2007 Act.
' (2) The expenditure classifications, if any, established by
Acts authorizing or limiting expenditures by the Oregon
Department of Administrative Services remain applicable to
expenditures by the Oregon Health Trust Board under this
section. + }
' { + SECTION 31. + } { + 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. + } ' .
----------