Chapter 51 Oregon Laws 2008 Special Session
AN ACT
SB 1093
Relating to health; amending sections 5, 9, 24 and 25, chapter 697,
Oregon Laws 2007; appropriating money; limiting expenditures; and declaring an
emergency.
Be It Enacted by the People of
the State of
SECTION 1.
Section 5, chapter 697, Oregon Laws 2007, is amended to read:
Sec. 5. (1) There
is established within the Department of Human Services the Oregon Health Fund
Board that shall be responsible for developing the Oregon Health Fund program
comprehensive plan. 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
(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.
(7) A member of the
board is not entitled to compensation for services as a member, but is entitled
to expenses as provided in ORS 292.495 (2).
(8) The board may
adopt rules necessary for the administration of sections 2 to 13, chapter 697,
SECTION 2. Section 9, chapter 697, Oregon
Laws 2007, is amended to read:
Sec. 9. (1)(a)
The Oregon Health Fund Board shall establish a committee to examine the impact
of federal law requirements on reducing the number of Oregonians without health
insurance, improving Oregonians’ access to health care and achieving the goals
of the Healthy Oregon Act, focusing particularly on barriers to reducing the
number of uninsured Oregonians, including but not limited to:
(A) Medicaid
requirements such as eligibility categories and household income limits;
(B) Federal tax code
policies regarding the impact on accessing health insurance or self-insurance
and the affect on the 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
(b) With the approval of
the Oregon Health Fund Board, the committee shall report its findings to the
(c) The committee shall
request that the
(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
(2) The Oregon Health
Fund Board shall develop a comprehensive plan to achieve the Oregon Health Fund
program goals listed in section 4, chapter 697, Oregon Laws 2007 [of this 2007 Act]. The board shall
establish subcommittees, organized to maximize efficiency and effectiveness and
assisted, 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 Oregon Health Fund program comprehensive plan. The proposals may
address, 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 uninsured individuals
and businesses to purchase affordable health insurance.
(D) Taking best
advantage of health savings accounts and similar vehicles for making health
insurance more accessible to uninsured individuals.
(E) Addressing the issue
of medical liability and medical errors including, but not limited to,
consideration of a patients’ compensation fund.
(F) Requesting federal
waivers 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
and increase access to health care.
(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 costs 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, particularly the uninsured, 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 qualified Oregonians eligible for Medicaid;
(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 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 (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 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 Health Services
Commission;
(ii) The Oregon Health
Policy Commission;
(iii) The Health
Resources Commission;
(iv) The Medicaid Advisory
Committee;
(v) The Department of
Human Services, including but not limited to the state Medicaid agency, the
Office for Oregon Health Policy and Research, 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;
(vi) The Department of
Consumer and Business Services;
(vii) The Oregon Patient
Safety Commission;
(viii) The Office of
Private Health Partnerships;
(ix) The Public
Employees’ Benefit Board;
(x) The State Accident
Insurance Fund Corporation; and
(xi) 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,
chapter 697, Oregon Laws 2007 [of
this 2007 Act], for determining and continually updating the defined set of
essential health services. The Oregon Health Fund 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
(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 general public, particularly uninsured and underinsured persons, 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] June
28, 2007, 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 February 1, 2008, 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 Fund
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 Fund 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 Fund Board consider
necessary to perform their duties.
(8) The Oregon Health
Fund Board shall report to the Legislative Assembly not later than February 29,
2008. The report must describe the progress of the subcommittees and the board
toward developing a comprehensive plan to:
(a) Decrease the number
of children and adults without health insurance;
(b) Ensure universal
access to health care;
(c) Contain health care
costs; and
(d) Address issues
regarding the quality of health care services.
(9) The Oregon Health
Fund Board shall present a plan to the Legislative Assembly not later than
February 1, 2008, for the design and implementation of the health insurance
exchange described in subsection (2)(a)(C) of this section.
SECTION 3. Section 24, chapter 697, Oregon
Laws 2007, is amended to read:
Sec. 24. [(1) There is appropriated to the Oregon
Health Fund Board, for the biennium beginning July 1, 2007, out of the General
Fund, the amount of $1 for the purpose of carrying out the provisions of
sections 2 to 13 of this 2007 Act.]
[(2)] Notwithstanding any other law limiting expenditures, the
amount of $1 is established for the biennium beginning July 1, 2007, as the
maximum limit for payment of expenses from fees, moneys or other revenues,
including Miscellaneous Receipts, but excluding lottery funds and federal
funds, collected or received by the Oregon Health Fund Board.
SECTION 4.
Section 25, chapter 697, Oregon Laws 2007, is amended to read:
Sec. 25. (1)
There is appropriated to the [Department
of Human Services] Oregon Health Fund Board, for the biennium
beginning July 1, 2007, out of the General Fund, the amount of [$1,215,350] $1,215,351 for the
purpose of carrying out the provisions of sections 2 to 13, chapter 697,
Oregon Laws 2007 [of this 2007 Act].
(2) Notwithstanding any
other law limiting expenditures, the amount of $671,971 is established for the
biennium beginning July 1, 2007, as the maximum limit for payment of expenses
from federal funds collected or received by the [Department of Human Services] Oregon Health Fund Board, for
the purpose of carrying out sections 2 to 13, chapter 697, Oregon Laws 2007
[of this 2007 Act].
SECTION 5. This
2008 Act being necessary for the immediate preservation of the public peace,
health and safety, an emergency is declared to exist, and this 2008 Act takes
effect on its passage.
Approved by the Governor March 11, 2008
Filed in the office of Secretary of State March 11, 2008
Effective date March 11, 2008
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