75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 1590
House Bill 2009
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of House Interim Committee on
Health Care)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Establishes Oregon Health Authority Board and Oregon Health
Authority and specifies duties, functions and powers. Transfers
health and health insurance functions to authority from
Department of Human Services and Department of Consumer and
Business Services.
Creates Quality Care Institute and Oregon Health Insurance
Exchange in Oregon Health Authority.
Requires authority to implement premium assistance program.
Requires authority to streamline application process for medical
assistance and premium assistance programs. Requires authority to
increase reimbursement rates for health services providers
participating in medical assistance programs. Requires authority
to conduct outreach for and marketing of medical assistance and
premium assistance programs.
Creates tax on health insurance and managed care plans. Sets
fixed rate for hospital assessment and removes sunset. Creates
new cigarette tax. Establishes Oregon Health Authority Fund.
Deposits moneys from taxes and assessments into fund.
Continuously appropriates moneys in fund to authority for purpose
of carrying out functions of authority.
Takes effect on 91st day following adjournment sine die.
A BILL FOR AN ACT
Relating to health care; creating new provisions; amending ORS
25.323, 65.800, 107.092, 127.646, 192.410, 192.502, 192.519,
192.527, 192.535, 192.547, 192.549, 192.630, 238.410, 243.105,
243.860, 244.050, 291.055, 291.371, 315.604, 315.613, 323.505,
343.499, 343.507, 408.305, 408.310, 408.320, 408.325, 408.380,
408.570, 408.580, 409.720, 414.025, 414.033, 414.034, 414.042,
414.049, 414.051, 414.065, 414.109, 414.115, 414.125, 414.135,
414.145, 414.153, 414.211, 414.221, 414.225, 414.227, 414.312,
414.314, 414.316, 414.318, 414.320, 414.325, 414.327, 414.329,
414.340, 414.342, 414.344, 414.346, 414.348, 414.350, 414.355,
414.360, 414.365, 414.375, 414.380, 414.390, 414.410, 414.426,
414.428, 414.534, 414.536, 414.538, 414.630, 414.640, 414.707,
414.708, 414.709, 414.710, 414.712, 414.720, 414.725, 414.727,
414.728, 414.735, 414.736, 414.737, 414.738, 414.739, 414.740,
414.741, 414.742, 414.743, 414.750, 414.751, 414.805, 414.807,
414.815, 414.839, 431.035, 431.045, 431.110, 431.120, 431.150,
431.155, 431.157, 431.170, 431.175, 431.180, 431.190, 431.195,
431.210, 431.220, 431.230, 431.250, 431.260, 431.262, 431.264,
431.270, 431.290, 431.310, 431.330, 431.335, 431.340, 431.345,
431.350, 431.375, 431.380, 431.385, 431.415, 431.416, 431.418,
431.530, 431.550, 431.607, 431.609, 431.611, 431.613, 431.619,
431.623, 431.627, 431.633, 431.671, 431.705, 431.710, 431.715,
431.720, 431.725, 431.730, 431.735, 431.740, 431.745, 431.750,
431.760, 431.825, 431.827, 431.830, 431.831, 431.832, 431.834,
431.836, 431.853, 431.890, 431.915, 431.920, 431.940, 431.945,
431.950, 431.955, 431.990, 432.500, 442.011, 442.015, 442.700,
442.800, 442.807, 678.730, 731.016, 731.036, 731.042, 731.072,
731.096, 731.142, 731.216, 731.228, 731.232, 731.236, 731.240,
731.244, 731.248, 731.252, 731.256, 731.258, 731.260, 731.264,
731.268, 731.272, 731.276, 731.280, 731.282, 731.288, 731.296,
731.300, 731.302, 731.304, 731.308, 731.312, 731.314, 731.316,
731.324, 731.328, 731.354, 731.356, 731.362, 731.363, 731.364,
731.365, 731.367, 731.369, 731.370, 731.380, 731.385, 731.386,
731.398, 731.402, 731.406, 731.410, 731.414, 731.418, 731.422,
731.426, 731.428, 731.430, 731.434, 731.466, 731.470, 731.486,
731.488, 731.504, 731.508, 731.509, 731.510, 731.511, 731.512,
731.554, 731.570, 731.574, 731.608, 731.616, 731.620, 731.636,
731.640, 731.642, 731.644, 731.648, 731.652, 731.730, 731.731,
731.735, 731.737, 731.750, 731.752, 731.754, 731.762, 731.764,
731.812, 731.822, 731.836, 731.840, 731.842, 731.854, 731.859,
731.988, 732.521, 732.531, 733.080, 733.630, 733.770, 734.760,
734.770, 734.800, 734.805, 734.810, 734.815, 734.820, 734.825,
734.830, 734.835, 734.850, 734.870, 735.610, 735.612, 735.614,
735.630, 735.700, 735.701, 735.706, 735.722, 735.734, 735.754,
735.756, 742.003, 742.005, 742.041, 742.420, 742.434, 743.013,
743.015, 743.018, 743.028, 743.106, 743.378, 743.405, 743.408,
743.447, 743.459, 743.462, 743.465, 743.472, 743.498, 743.522,
743.524, 743.526, 743.527, 743.529, 743.534, 743.537, 743.546,
743.655, 743.684, 743.685, 743.687, 743.730, 743.731, 743.736,
743.737, 743.745, 743.748, 743.754, 743.758, 743.760, 743.761,
743.766, 743.767, 743.769, 743.790, 743.804, 743.807, 743.814,
743.817, 743.823, 743.827, 743.831, 743.857, 743.858, 743.862,
743.863, 743.874, 743.876, 743.878, 743.911, 743A.144,
743A.168, 744.062, 744.063, 744.067, 744.088, 744.091, 744.338,
744.531, 744.626, 744.702, 744.704, 744.714, 744.718, 746.230,
746.600, 746.608, 746.650, 748.211, 748.403, 750.045, 750.055,
750.085, 750.303, 750.309 and 750.323 and section 5, chapter
318, Oregon Laws 2001, section 2, chapter 76, Oregon Laws 2003,
sections 1, 2, 5, 8, 10, 14 and 51, chapter 736, Oregon Laws
2003, section 18, chapter 810, Oregon Laws 2003, section 2,
chapter 460, Oregon Laws 2007, and section 2a, chapter 872,
Oregon Laws 2007; repealing ORS 414.019, 414.021, 414.022,
414.023, 414.024, 414.031, 414.032, 414.036, 414.038, 414.039,
414.085, 414.107, 414.660, 414.670, 414.744, 414.747, 445.270,
731.076 and 735.706 and sections 4, 9, 12 and 13, chapter 736,
Oregon Laws 2003, and sections 10 and 13, chapter 810, Oregon
Laws 2003; appropriating money; prescribing an effective date;
and providing for revenue raising that requires approval by a
three-fifths majority.
Be It Enacted by the People of the State of Oregon:
{ +
HEALTH AUTHORITY LAW + }
{ +
ESTABLISHING OREGON HEALTH AUTHORITY BOARD + }
{ +
(Establishment; Appointment; Term; Confirmation; Per Diem) + }
SECTION 1. { + (1) There is established the Oregon Health
Authority Board, consisting of nine members appointed by the
Governor.
(2) The term of office of each member is four years, but a
member serves at the pleasure of the Governor. Before the
expiration of the term of a member, the Governor shall appoint a
successor whose term begins on January 1 next following. A member
is eligible for reappointment. If there is a vacancy for any
cause, the Governor shall make an appointment to become
immediately effective for the unexpired term.
(3) The appointment of the board is subject to confirmation by
the Senate in the manner prescribed in ORS 171.562 and 171.565.
(4) A member of the board is entitled to compensation and
expenses as provided in ORS 292.495 for their attendance at board
meetings and subcommittee meetings. + }
SECTION 2. { + Notwithstanding the term of office specified by
section 1 of this 2009 Act, of the members first appointed to the
Oregon Health Authority Board:
(1) Two shall serve for terms ending December 31, 2011.
(2) Two shall serve for terms ending December 31, 2012.
(3) Two shall serve for terms ending December 31, 2013.
(4) Three shall serve for terms ending December 31, 2014. + }
SECTION 3. { + The members of the Oregon Health Authority
Board may be appointed before the operative date specified in
section 468 of this 2009 Act and may take any action before that
date that is necessary to enable the board to exercise, on and
after the operative date specified in section 468 of this 2009
Act, the duties, functions and powers of the board pursuant to
section 10 of this 2009 Act. + }
{ +
(Qualification of Members) + }
SECTION 4. { + (1) The members of the Oregon Health Authority
Board must be residents of this state:
(a) Who have demonstrated leadership skills in their
professional and civic lives.
(b) A majority of whom have not been gainfully employed in
health care delivery or health care finance within 12 months
prior to appointment.
(2) The membership of the board shall include a physician
licensed to practice medicine in this state. + }
{ +
(Officers of Oregon Health Authority Board; Quorum; Meetings) + }
SECTION 5. { + (1) The Governor shall select from the
membership of the Oregon Health Authority Board, the chairperson
and vice chairperson who are subject to confirmation by the
Senate in the manner prescribed in ORS 171.562 and 171.565.
(2) A majority of the members of the board constitutes a quorum
for the transaction of business.
(3) The board shall meet at least once every month and at least
once every two years in each congressional district in this
state, at a place, day and hour determined by the board. The
board may also meet at other times and places specified by the
call of the chairperson or a majority of the members of the
board, or as specified in bylaws adopted by the board. + }
{ +
(Employees) + }
SECTION 6. { + The Oregon Health Authority Board, subject to
any applicable provisions of ORS chapter 240 and within the
budgetary authority approved by the Legislative Assembly, shall
appoint all subordinate officers and employees of the board,
prescribe their duties and fix their compensation. + }
{ +
(Authority to Adopt Rules) + }
SECTION 7. { + In accordance with applicable provisions of ORS
chapter 183, the Oregon Health Authority Board may adopt rules
necessary for the administration of the laws that the board is
charged with administering. + }
{ +
(Subcommittees) + }
SECTION 8. { + (1) + } { + The Oregon Health Authority Board
shall establish subcommittees composed of individuals, appointed
by the board, who are qualified by experience or training to
perform the duties of the subcommittees, and of individuals who
are members of the board. The subcommittees shall include, but
are not limited to:
(a) The Public Employer Health Coalition that shall include the
leadership of the Public Employees' Benefit Board, the Oregon
Educators Benefits Board, cities, counties and other local
government entities.
(b) The Payment Reform Council to investigate opportunities in
both public and private sector programs to develop and implement
new methodologies of reimbursing health care providers to reward
comprehensive management of diseases, quality outcomes and the
efficient use of resources.
(c) The Health Care Workforce Council to ensure that Oregon's
health care workforce is sufficient in numbers and training to
meet the demand that will be created by the expansion in health
coverage, system transformations and an increasingly diverse
population.
(2) Members of subcommittees who are not members of the board
are not entitled to compensation but shall be reimbursed from
funds available to the board for actual and necessary travel and
other expenses incurred by them by their attendance at
subcommittee meetings, in the manner and amount provided in ORS
292.495. + }
{ +
(Advisory and Technical Committees) + }
SECTION 9. { + (1) The Oregon Health Authority Board may
establish such advisory and technical committees as it considers
necessary to aid and advise the board in the performance of its
functions. These committees may be continuing or temporary
committees. The board shall determine the representation,
membership, terms and organization of the committees and shall
appoint their members.
(2) Members of the committees are not entitled to compensation,
but at the discretion of the board may be reimbursed from funds
available to the board for actual and necessary travel and other
expenses incurred by them in the performance of their official
duties, in the manner and amount provided in ORS 292.495. + }
{ +
(Duties of Oregon Health Authority Board) + }
SECTION 10. { + (1) The duties of the Oregon Health Authority
Board are to:
(a) Be the policy-making and oversight body for the Oregon
Health Authority established in section 11 of this 2009 Act and
all of the authority's departmental divisions, including the
Quality Care Institute and the Oregon Health Insurance Exchange
described in sections 17 and 18 of this 2009 Act.
(b) Implement a program to provide health insurance premium
assistance to all low and moderate income families residing in
Oregon.
(c) Establish health benefit plans for individuals who are
covered under the Public Employees' Benefit Board and the Oregon
Educators Benefit Board that will achieve optimal coordination
among state agencies that provide health care benefits.
(d) Establish and continuously refine uniform, statewide health
care quality standard for use by all purchasers of health care,
third party payers and health care providers as quality
performance benchmarks.
(e) Establish clinical standards and guidelines described in
section 18 (3)(f)(B) of this 2009 Act.
(f) Approve and monitor community-centered health initiatives
described in section 11 of this 2009 Act that are consistent with
public health goals, strategies, programs and performance
standards adopted by the board to improve the health of all
Oregonians and shall regularly report to the Legislative Assembly
on the accomplishments and needed changes to the initiatives.
(g) Establish cost control mechanisms to limit increases in
health care costs in this state to an amount no greater than the
U.S. City Average Consumer Price Index for medical care as
published by the Bureau of Labor Statistics of the United States
Department of Labor minus one percent, by the year 2015.
(h) Work with the Oregon congressional delegation to advance
the adoption of or changes in federal policy to promote Oregon's
comprehensive health reform plan.
(i) Establish an essential benefit package for all insurance
offered through the Oregon Health Insurance Exchange.
(j) Investigate and report to the Legislative Assembly on the
feasibility and advisability of future changes to the health
insurance market in Oregon including, but not limited to:
(A) A requirement for every resident to have health insurance
coverage;
(B) A state program to subsidize health insurance premiums for
all low and moderate income Oregon families;
(C) A payroll tax tied to the provision of health insurance by
employers;
(D) Expansion of the Oregon Health Insurance Exchange to
administer a program of premium assistance and advance reforms of
the insurance market;
(E) The creation of a publicly owned health insurance plan to
be offered through the Oregon Health Insurance Exchange;
(F) The development of an essential benefits package for all
insurance offered through the Oregon Health Insurance Exchange;
and
(G) The implementation of a system of interoperable electronic
health records utilized by all health care providers in this
state.
(2) The board is authorized to:
(a) Undertake joint contracting for health care services on
behalf of the public entities participating in the Public Health
Employer Coalition; and
(b) Subject to the approval of the Governor, organize and
reorganize the Oregon Health Authority as the board considers
necessary to properly conduct the work of the authority.
(3) If the board or the Oregon Health Authority is unable to
perform in whole or in part, any of the duties listed in sections
1 to 25 of this 2009 Act without legislative authority, the board
shall submit to the Legislative Counsel, no later than October 1,
a measure request which shall be introduced at the next regular
session of the Legislative Assembly. The board shall implement
any portions of the duties not requiring legislative authority,
to the extent practicable.
(4) If the board or the Oregon Health Authority is unable to
perform in whole or in part, any of the duties listed in sections
1 to 25 of this 2009 Act without federal approval, the board is
authorized to request waivers or other approval necessary to
implement this section. The board shall implement any portions of
the duties not requiring legislative authority or federal
approval, to the extent practicable.
(5) Except as provided in subsections (3) and (4) of this
section, the enumeration of duties, functions and powers in this
section is not intended to be exclusive nor to limit the duties,
functions and powers imposed on or vested in the board by other
statutes. + }
{ +
ESTABLISHING OREGON HEALTH AUTHORITY + }
SECTION 11. { + (1) The Oregon Health Authority is
established. The Oregon Health Authority shall:
(a) Carry out policies adopted by the Oregon Health Authority
Board;
(b) Establish the Quality Care Institute and the Oregon Health
Insurance Exchange;
(c) Administer the Oregon Prescription Drug Program;
(d) Provide regular reports to the board with respect to the
performance of health services contractors serving recipients of
medical assistance including reports of trends in health services
and enrollee satisfaction;
(e) Guide and support with the authorization of the board,
community-centered health initiatives designed to address
critical behavioral risk factors, especially those that
contribute to chronic disease; and
(f) Be the state Medicaid agency for the administration of
funds from Titles XIX and XXI of the Social Security Act and
administer medical assistance under ORS chapter 414.
(2) The Oregon Health Authority is authorized to:
(a) Create a health care data collection program to work with
insurers and other state agencies to access insurer, health plan
and health plan network information in order to provide
comparative + } { + information to consumers; and
(b) Acquire healthcare facilities as a means to provide
stability in the health care market and to ensure adequate health
care facility coverage in all areas of the state.
(3) The enumeration of duties, functions and powers in this
section is not intended to be exclusive nor to limit the duties,
functions and powers imposed on or vested in the department by
other statutes. + }
{ +
(Director) + }
SECTION 12. { + (1) The Oregon Health Authority is under the
supervision and control of a director, who is responsible for the
performance of the duties, functions and powers of the authority.
(2) The Governor shall appoint the Director of the Oregon
Health Authority, who holds office at the pleasure of the
Governor. The appointment of the director shall be subject to
confirmation by the Senate in the manner provided by ORS 171.562
and 171.565. + }
SECTION 13. { + The Director of the Oregon Health Authority
may be appointed before the operative date specified in section
468 of this 2009 Act and may take any action before that date
that is necessary to enable the director to exercise, on and
after the operative date specified in section 468 of this 2009
Act, the duties, functions and powers of the director pursuant to
sections 1 to 25 of this 2009 Act. + }
{ +
(Deputy Directors) + }
SECTION 14. { + (1) The Director of the Oregon Health
Authority may, by written order filed with the Secretary of
State, appoint deputy directors. A deputy director serves at the
pleasure of the director, has authority to act for the director
in the absence of the director and is subject to the control of
the director at all times.
(2) The director and any deputy directors shall receive such
salary as may be provided by law or as fixed by the Governor. In
addition to salaries, the director and deputy directors, subject
to the limitations otherwise provided by law, shall be reimbursed
for all reasonable expenses necessarily incurred in the
performance of official duties.
(3) Subject to any applicable provisions of ORS chapter 240,
the director shall appoint all subordinate officers and employees
of the Oregon Health Authority, prescribe their duties and fix
their compensation. + }
{ +
(General Authority to Adopt Rules) + }
SECTION 15. { + In accordance with applicable provisions of
ORS chapter 183, the Director of the Oregon Health Authority may
adopt rules necessary for the administration of the laws that the
authority is charged with administering. + }
{ +
(Oaths, Depositions and Subpoenas) + }
SECTION 16. { + The Director of the Oregon Health Authority,
each deputy director and authorized representatives of the
director may administer oaths, take depositions and issue
subpoenas to compel the attendance of witnesses and the
production of documents or other written information necessary to
carry out the provisions of sections 1 to 25 of this 2009 Act. If
any person fails to comply with a subpoena issued under this
section or refuses to testify on matters on which the person
lawfully may be interrogated, the director, deputy director or
authorized representative may follow the procedure set out in ORS
183.440 to compel obedience. + }
{ +
ESTABLISHING DEPARTMENTAL ENTITIES WITHIN THE + }
{ +
OREGON HEALTH AUTHORITY + }
{ +
(Quality Care Institute) + }
SECTION 17. { + (1) The Quality Care Institute is created
within the Oregon Health Authority.
(2) The institute shall develop for the Oregon Health Authority
Board, uniform statewide health care quality standards to be used
by all purchases, third-party payers and health care providers as
the quality performance benchmarks in Oregon. + }
{ +
(Oregon Health Insurance Exchange) + }
SECTION 18. { + (1) The Oregon Health Insurance Exchange is
created in the Oregon Health Authority.
(2) The exchange shall regulate the sale and transaction of all
policies of health insurance in this state including but not
limited to:
(a) Approval of rates;
(b) Enforcement of rating rules; and
(c) Enforcement of market conduct rules.
(3) Under the guidance of the Oregon Health Authority Board,
the exchange shall develop a plan for the exchange to serve as
the conduit for the purchase of all individual and small employer
group health insurance in Oregon. The plan shall also describe
how all insurance purchased by the state will be administered
through the exchange. The plan must contain all of the following
elements:
(a) All individual and small employer group health insurance
must be purchased through the exchange.
(b) Participating insurers shall be selected based upon
requests for proposals that ensure:
(A) A range of plan options specified by the exchange;
(B) Community rating;
(C) No denial of enrollment based on pre-existing medical
conditions;
(D) Adequate provider networks as prescribed by the exchange;
(E) Adherence to standardized contract requirements prescribed
by the Oregon Health Authority by rule;
(F) Adherence to cost transparency rules prescribed by the
exchange;
(G) The use of a medical screening tool and common rejection
rules;
(H) Adherence to standards prescribed by the exchange with
respect to administrative costs and rating; and
(I) Other contract standards approved by the board and
prescribed by the exchange by rule.
(c) The future expansion of health insurance coverage through
premium assistance, tax credits or other means.
(4) The exchange may, with the approval of the board:
(a) Develop and implement a reinsurance program available to
all participating insurers.
(b) Evaluate the need for and, if warranted, the development of
a publicly-owned health plan option to be administered by the
exchange.
(c) Work with insurers and state agencies to obtain insurer,
health plan and health plan network information and use the
information to provide comparative information to consumers of
health care.
(d) Develop methodologies and standards for reviewing the
administrative expenses of health insurers and deny rate
increases based upon excessive administrative expense portions of
premiums.
(e) Establish annual maximum limits on price increases charged
by health care providers within established categories of
services to amounts no more than:
(A) The U.S. City Average Consumer Price Index for medical care
as published by the Bureau of Labor Statistics of the United
States Department of Labor minus one percent; or
(B) A multiple, established by the exchange, of the Medicare
reimbursement rate for the service.
(f) Develop uniform contracting standards for the purchase of
health care services by state agencies including:
(A) Uniform quality performance measures;
(B) Evidence-based guidelines for major chronic diseases,
health care services with unexplained variations in frequency or
cost; and
(C) Comparative effectiveness guidelines for select new
technologies. + }
{ +
(Establishment of Oregon Health Authority Fund) + }
SECTION 19. { + The Oregon Health Authority Fund is
established in the State Treasury, separate and distinct from the
General Fund. Moneys in the fund are continuously appropriated to
the Oregon Health Authority for the purposes of sections 1 to 25
of this 2009 Act. + }
{ +
TRANSFER OF FUNCTIONS TO OREGON HEALTH AUTHORITY + }
SECTION 20. { + (1) All of the duties, functions and powers of
the Department of Human Services with respect to health are
imposed upon, transferred to and vested in the Oregon Health
Authority, including but not limited to:
(a) Developing the policies for and the provision of medical
assistance and premium assistance in this state, except for
long-term care, home- and community-based care and residential
facility care for seniors.
(b) Ensuring the promotion and protection of public health and
the licensing of health care facilities.
(c) Developing the policies for and the provision of mental
health treatment and treatment for substance use disorders, but
not for health services to individuals with developmental
disabilities.
(d) The administration of the Oregon Prescription Drug Program.
(e) Responsibility for the Office for Oregon Health Policy and
Research and all of the functions of the office.
(f) Collecting and enforcing the hospital assessment
established in section 2, chapter 736, Oregon Laws 2003.
(2) All of the duties, functions and powers of the Department
of Consumer and Business Services with respect to health
insurance, health benefit plans, health care service contractors
and multiple employer welfare arrangements are imposed upon,
transferred to and vested in the Oregon Health Authority,
including but not limited to:
(a) Licensing and regulation of health insurance offered in
this state.
(b) The responsibility for the Office of Private Health
Partnerships and the Family Health Insurance Assistance Program.
(c) The responsibility for the Oregon Medical Insurance Pool
Board and the operation of the Oregon Medical Insurance Pool.
(d) Collecting and enforcing assessments imposed by law upon
health insurers and third party administrators of health
benefits, including but not limited to the assessments
established in sections 131 and 134 of this 2009 Act.
(3) The Oregon Health Policy Commission is abolished. On the
operative date of this section, the tenure of office of the
members of the Oregon Health Policy Commission ceases. All the
duties, functions and powers of the Oregon Health Policy
Commission are imposed upon, transferred to and vested in the
Oregon Health Authority. + }
{ +
(Records, Property, Employees) + }
SECTION 21. { + (1) The Department of Human Services and the
Department of Consumer and Business Services shall:
(a) Deliver to the Oregon Health Authority all records and
property within the jurisdiction of the commission that relate to
the duties, functions and powers transferred by section 20 of
this 2009 Act; and
(b) Transfer to the Oregon Health Authority those employees
engaged primarily in the exercise of the duties, functions and
powers transferred by section 20 of this 2009 Act.
(2) The Director of the Oregon Health Authority shall take
possession of the records and property, and shall take charge of
the employees and employ them in the exercise of the duties,
functions and powers transferred by section 20 of this 2009 Act,
without reduction of compensation but subject to change or
termination of employment or compensation as provided by law.
(3) The Governor shall resolve any dispute between the
Department of Human Services or the Department of Consumer and
Business Services and the Oregon Health Authority relating to
transfers of records, property and employees under this section,
and the Governor's decision is final. + }
{ +
(Action, Proceeding, Prosecution) + }
SECTION 22. { + The transfer of duties, functions and powers
to the Oregon Health Authority by section 20 of this 2009 Act
does not affect any action, proceeding or prosecution involving
or with respect to such duties, functions and powers begun before
and pending at the time of the transfer, except that the Oregon
Health Authority is substituted for the Department of Human
Services, the Department of Consumer and Business Services or
Oregon Health Policy Commission in the action, proceeding or
prosecution. + }
{ +
(Liability, Duty, Obligation) + }
SECTION 23. { + (1) Nothing in sections 20 to 22 of this 2009
Act relieves a person of a liability, duty or obligation accruing
under or with respect to the duties, functions and powers
transferred by section 20 of this 2009 Act. The Oregon Health
Authority may undertake the collection or enforcement of any such
liability, duty or obligation.
(2) The rights and obligations of the Department of Human
Services and the Department of Consumer and Business Services
legally incurred under contracts, leases and business
transactions executed, entered into or begun before the operative
date of section 20 of this 2009 Act and with respect to the
duties, functions and powers transferred by section 20 of this
2009 Act are transferred to the Oregon Health Authority. For the
purpose of succession to these rights and obligations, the Oregon
Health Authority is a continuation of the Department of Human
Services and the Department of Consumer and Business Services and
not a new authority. + }
SECTION 24. { + Whenever, in any uncodified law or resolution
of the Legislative Assembly or in any rule, document, record or
proceeding authorized by the Legislative Assembly, reference is
made to the Department of Human Services, the Department of
Consumer and Business Services or the Oregon Health Policy
Commission or an executive, officer or employee of the
departments or commission, with respect to the duties, functions
and powers transferred by section 20 of this 2009 Act, the
reference is considered to be a reference to the Oregon Health
Authority Board or an executive, officer or employee of the
Oregon Health Authority. + }
{ +
NO RESTRAINT OF TRADE + }
SECTION 25. { + (1) The collaboration of insurers under the
direction of the Oregon Health Authority, including the Oregon
Health Insurance Exchange, is intended to displace current market
forces based on the legislative finding that existing health
insurance market forces do not permit the market to operate in a
cost-efficient manner or to ensure the availability of health
care throughout the state.
(2) Activities carried on under sections 1 to 20 of this 2009
Act do not constitute a conspiracy or a combination in restraint
of trade or an illegal monopoly, nor are they carried out for the
purposes of lessening competition or fixing prices arbitrarily,
as long as the activities carry out sections 1 to 20 of this 2009
Act.
(3) A contract entered into between the Oregon Health Insurance
Exchange and an insurer relating to premium rates or provider
reimbursement is not an unlawful restraint in trade or part of a
conspiracy or combination to accomplish an improper or illegal
purpose or act so long as the Oregon Health Insurance Exchange,
subject to the approval by the board, establishes the rates and
reimbursement. + }
SECTION 26. { + Section 27 of this 2009 Act is added to and
made a part of the Insurance Code. + }
SECTION 27. { + ' Regulator' means:
(1) With respect to the regulation of health insurance, health
benefit plans, health care service contractors and multiple
employer welfare arrangements, the Oregon Health Authority; and
(2) With respect to the regulation all other insurance, the
Department of Consumer and Business Services. + }
{ +
CONFORMING AMENDMENTS + }
SECTION 28. ORS 414.839 is amended to read:
414.839. (1) Subject to funds available, the { - Department
of Human Services - } { + Oregon Health Authority + } may
provide public subsidies for the purchase of health insurance
coverage provided by public programs or private insurance,
including but not limited to the Family Health Insurance
Assistance Program, for currently uninsured individuals
{ - based on - } { + :
(a) Under 19 years of age with family + } incomes up to 200
percent of the federal poverty { - level. - } { + guidelines;
and
(b) 19 years of age and older with incomes at or below 185
percent of the federal poverty guidelines. + } { - The
objective is to create a transition from dependence on public
programs to privately financed health insurance. - }
(2) Public subsidies shall apply only to health benefit plans
that meet or exceed the basic benchmark health benefit plan or
plans established under ORS 735.733.
(3) Cost sharing shall be permitted and structured in such a
manner to encourage appropriate use of preventive care and
avoidance of unnecessary services.
(4) Cost sharing shall be based on an individual's ability to
pay and may not exceed the cost of purchasing a plan.
(5) The state may pay a portion of the cost of the subsidy,
based on the individual's income and other resources.
SECTION 29. ORS 244.050 is amended to read:
244.050. (1) On or before April 15 of each year the following
persons shall file with the Oregon Government Ethics Commission a
verified statement of economic interest as required under this
chapter:
(a) The Governor, Secretary of State, State Treasurer, Attorney
General, Commissioner of the Bureau of Labor and Industries,
Superintendent of Public Instruction, district attorneys and
members of the Legislative Assembly.
(b) Any judicial officer, including justices of the peace and
municipal judges, except any pro tem judicial officer who does
not otherwise serve as a judicial officer.
(c) Any candidate for a public office designated in paragraph
(a) or (b) of this subsection.
(d) The Deputy Attorney General.
(e) The Legislative Administrator, the Legislative Counsel, the
Legislative Fiscal Officer, the Secretary of the Senate and the
Chief Clerk of the House of Representatives.
(f) The Chancellor and Vice Chancellors of the Oregon
University System and the president and vice presidents, or their
administrative equivalents, in each institution under the
jurisdiction of the State Board of Higher Education.
(g) The following state officers:
(A) Adjutant General.
(B) Director of Agriculture.
(C) Manager of State Accident Insurance Fund Corporation.
(D) Water Resources Director.
(E) Director of Department of Environmental Quality.
(F) Director of Oregon Department of Administrative Services.
(G) State Fish and Wildlife Director.
(H) State Forester.
(I) State Geologist.
(J) Director of Human Services.
(K) Director of the Department of Consumer and Business
Services.
(L) Director of the Department of State Lands.
(M) State Librarian.
(N) Administrator of Oregon Liquor Control Commission.
(O) Superintendent of State Police.
(P) Director of the Public Employees Retirement System.
(Q) Director of Department of Revenue.
(R) Director of Transportation.
(S) Public Utility Commissioner.
(T) Director of Veterans' Affairs.
(U) Executive Director of Oregon Government Ethics Commission.
(V) Director of the State Department of Energy.
(W) Director and each assistant director of the Oregon State
Lottery.
{ + (X) Director of the Oregon Health Authority. + }
(h) Any assistant in the Governor's office other than personal
secretaries and clerical personnel.
(i) Every elected city or county official.
(j) Every member of a city or county planning, zoning or
development commission.
(k) The chief executive officer of a city or county who
performs the duties of manager or principal administrator of the
city or county.
(L) Members of local government boundary commissions formed
under ORS 199.410 to 199.519.
(m) Every member of a governing body of a metropolitan service
district and the executive officer thereof.
(n) Each member of the board of directors of the State Accident
Insurance Fund Corporation.
(o) The chief administrative officer and the financial officer
of each common and union high school district, education service
district and community college district.
(p) Every member of the following state boards and commissions:
(A) Board of Geologic and Mineral Industries.
(B) Oregon Economic and Community Development Commission.
(C) State Board of Education.
(D) Environmental Quality Commission.
(E) Fish and Wildlife Commission of the State of Oregon.
(F) State Board of Forestry.
(G) Oregon Government Ethics Commission.
(H) Oregon Health { - Policy Commission - } { + Authority
Board + }.
(I) State Board of Higher Education.
(J) Oregon Investment Council.
(K) Land Conservation and Development Commission.
(L) Oregon Liquor Control Commission.
(M) Oregon Short Term Fund Board.
(N) State Marine Board.
(O) Mass transit district boards.
(P) Energy Facility Siting Council.
(Q) Board of Commissioners of the Port of Portland.
(R) Employment Relations Board.
(S) Public Employees Retirement Board.
(T) Oregon Racing Commission.
(U) Oregon Transportation Commission.
(V) Wage and Hour Commission.
(W) Water Resources Commission.
(X) Workers' Compensation Board.
(Y) Oregon Facilities Authority.
(Z) Oregon State Lottery Commission.
(AA) Pacific Northwest Electric Power and Conservation Planning
Council.
(BB) Columbia River Gorge Commission.
(CC) Oregon Health and Science University Board of Directors.
(q) The following officers of the State Treasurer:
(A) Chief Deputy State Treasurer.
(B) Chief of staff for the office of the State Treasurer.
(C) Director of the Investment Division.
(r) Every member of the board of commissioners of a port
governed by ORS 777.005 to 777.725 or 777.915 to 777.953.
(s) Every member of the board of directors of an authority
created under ORS 441.525 to 441.595.
(2) By April 15 next after the date an appointment takes
effect, every appointed public official on a board or commission
listed in subsection (1) of this section shall file with the
Oregon Government Ethics Commission a statement of economic
interest as required under ORS 244.060, 244.070 and 244.090.
(3) By April 15 next after the filing deadline for the primary
election, each candidate for public office described in
subsection (1) of this section shall file with the commission a
statement of economic interest as required under ORS 244.060,
244.070 and 244.090.
(4) Within 30 days after the filing deadline for the general
election, each candidate for public office described in
subsection (1) of this section who was not a candidate in the
preceding primary election, or who was nominated for public
office described in subsection (1) of this section at the
preceding primary election by write-in votes, shall file with the
commission a statement of economic interest as required under ORS
244.060, 244.070 and 244.090.
(5) Subsections (1) to (4) of this section apply only to
persons who are incumbent, elected or appointed public officials
as of April 15 and to persons who are candidates for public
office on April 15. Subsections (1) to (4) of this section also
apply to persons who do not become candidates until 30 days after
the filing deadline for the statewide general election.
(6) If a statement required to be filed under this section has
not been received by the commission within five days after the
date the statement is due, the commission shall notify the public
official or candidate and give the public official or candidate
not less than 15 days to comply with the requirements of this
section. If the public official or candidate fails to comply by
the date set by the commission, the commission may impose a civil
penalty as provided in ORS 244.350.
SECTION 30. ORS 414.025, as amended by section 18a, chapter
861, Oregon Laws 2007, is amended to read:
414.025. As used in this chapter, unless the context or a
specially applicable statutory definition requires otherwise:
(1) 'Category of aid' means assistance provided by the Oregon
Supplemental Income Program, aid granted under ORS 412.001 to
412.069 and 418.647 or federal Supplemental Security Income
payments.
(2) 'Categorically needy' means, insofar as funds are available
for the category, a person who is a resident of this state and
who:
(a) Is receiving a category of aid.
(b) Would be eligible for, but is not receiving a category of
aid.
(c) Is in a medical facility and, if the person left such
facility, would be eligible for a category of aid.
(d) Is under the age of 21 years and would be a dependent child
as defined in ORS 412.001 except for age and regular attendance
in school or in a course of professional or technical training.
(e)(A) Is a caretaker relative, as defined in ORS 412.001, who
cares for a child who would be a dependent child except for age
and regular attendance in school or in a course of professional
or technical training; or
(B) Is the spouse of the caretaker relative.
(f) Is under the age of 21 years, is in a foster family home or
licensed child-caring agency or institution under a purchase of
care agreement and is one for whom a public agency of this state
is assuming financial responsibility, in whole or in part.
(g) Is a spouse of an individual receiving a category of aid
and who is living with the recipient of a category of aid, whose
needs and income are taken into account in determining the cash
needs of the recipient of a category of aid, and who is
determined by the Department of Human Services to be essential to
the well-being of the recipient of a category of aid.
(h) Is a caretaker relative as defined in ORS 412.001 who cares
for a dependent child receiving aid granted under ORS 412.001 to
412.069 and 418.647 or is the spouse of the caretaker relative.
(i) Is under the age of 21 years, is in a youth care center and
is one for whom a public agency of this state is assuming
financial responsibility, in whole or in part.
(j) Is under the age of 21 years and is in an intermediate care
facility which includes institutions for persons with mental
retardation; or is under the age of 22 years and is in a
psychiatric hospital.
(k) Is under the age of 21 years and is in an independent
living situation with all or part of the maintenance cost paid by
the Department of Human Services.
(L) Is a member of a family that received aid in the preceding
month under ORS 412.006 or 412.014 and became ineligible for aid
due to increased hours of or increased income from employment. As
long as the member of the family is employed, such families will
continue to be eligible for medical assistance for a period of at
least six calendar months beginning with the month in which such
family became ineligible for assistance due to increased hours of
employment or increased earnings.
(m) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in
part.
(n) Is an individual or is a member of a group who is required
by federal law to be included in the state's medical assistance
program in order for that program to qualify for federal funds.
(o) Is an individual or member of a group who, subject to the
rules of the department and within available funds, may
optionally be included in the state's medical assistance program
under federal law and regulations concerning the availability of
federal funds for the expenses of that individual or group.
(p) Is a pregnant woman who would be eligible for aid granted
under ORS 412.001 to 412.069 and 418.647, whether or not the
woman is eligible for cash assistance.
(q) Except as otherwise provided in this section and to the
extent of available funds, is a pregnant woman or child for whom
federal financial participation is available under Title XIX of
the federal Social Security Act.
(r) Is not otherwise categorically needy and is not eligible
for care under Title XVIII of the federal Social Security Act or
is not a full-time student in a post-secondary education program
as defined by the Department of Human Services by rule, but whose
family income is less than the federal poverty level and whose
family investments and savings equal less than the investments
and savings limit established by the department by rule.
(s) Would be eligible for a category of aid but for the receipt
of qualified long term care insurance benefits under a policy or
certificate issued on or after January 1, 2008. As used in this
paragraph, 'qualified long term care insurance' means a policy or
certificate of insurance as defined in ORS 743.652 (6).
(3) 'Income' has the meaning given that term in ORS 411.704.
(4) 'Investments and savings' means cash, securities as defined
in ORS 59.015, negotiable instruments as defined in ORS 73.0104
and such similar investments or savings as the Department of
Human Services may establish by rule that are available to the
applicant or recipient to contribute toward meeting the needs of
the applicant or recipient.
(5) 'Medical assistance' means so much of the following medical
and remedial care and services as may be prescribed by the
{ - Department of Human Services - } { + Oregon Health
Authority + } according to the standards established pursuant to
{ - ORS 414.065 - } { + section 10 of this 2009 Act + },
including payments made for services provided under an insurance
or other contractual arrangement and money paid directly to the
recipient for the purchase of medical care:
(a) Inpatient hospital services, other than services in an
institution for mental diseases;
(b) Outpatient hospital services;
(c) Other laboratory and X-ray services;
(d) Skilled nursing facility services, other than services in
an institution for mental diseases;
(e) Physicians' services, whether furnished in the office, the
patient's home, a hospital, a skilled nursing facility or
elsewhere;
(f) Medical care, or any other type of remedial care recognized
under state law, furnished by licensed practitioners within the
scope of their practice as defined by state law;
(g) Home health care services;
(h) Private duty nursing services;
(i) Clinic services;
(j) Dental services;
(k) Physical therapy and related services;
(L) Prescribed drugs, including those dispensed and
administered as provided under ORS chapter 689;
(m) Dentures and prosthetic devices; and eyeglasses prescribed
by a physician skilled in diseases of the eye or by an
optometrist, whichever the individual may select;
(n) Other diagnostic, screening, preventive and rehabilitative
services;
(o) Inpatient hospital services, skilled nursing facility
services and intermediate care facility services for individuals
65 years of age or over in an institution for mental diseases;
(p) Any other medical care, and any other type of remedial care
recognized under state law;
(q) Periodic screening and diagnosis of individuals under the
age of 21 years to ascertain their physical or mental
impairments, and such health care, treatment and other measures
to correct or ameliorate impairments and chronic conditions
discovered thereby;
(r) Inpatient hospital services for individuals under 22 years
of age in an institution for mental diseases; and
(s) Hospice services.
(6) 'Medical assistance' includes any care or services for any
individual who is a patient in a medical institution or any care
or services for any individual who has attained 65 years of age
or is under 22 years of age, and who is a patient in a private or
public institution for mental diseases. 'Medical assistance '
includes 'health services' as defined in ORS 414.705. 'Medical
assistance' does not include care or services for an inmate in a
nonmedical public institution.
(7) 'Medically needy' means a person who is a resident of this
state and who is considered eligible under federal law for
medically needy assistance.
(8) 'Resources' has the meaning given that term in ORS 411.704.
For eligibility purposes, 'resources' does not include charitable
contributions raised by a community to assist with medical
expenses.
SECTION 31. ORS 414.033 is amended to read:
414.033. The { - Department of Human Services - }
{ + Oregon Health Authority + } may:
(1) Subject to the allotment system provided for in ORS 291.234
to 291.260, expend such sums as are required to be expended in
this state to provide medical assistance. Expenditures for
medical assistance include, but are not limited to, expenditures
for deductions, cost sharing, enrollment fees, premiums or
similar charges imposed with respect to hospital insurance
benefits or supplementary health insurance benefits, as
established by federal law.
(2) Enter into agreements with, join with or accept grants
from, the federal government for cooperative research and
demonstration projects for public welfare purposes, including,
but not limited to, any project which determines the cost of
providing medical assistance to the medically needy and evaluates
service delivery systems.
SECTION 32. ORS 414.034 is amended to read:
414.034. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall accept federal Centers for
Medicare and Medicaid Services billing, reimbursement and
reporting forms instead of department billing, reimbursement and
reporting forms if the federal forms contain substantially the
same information as required by the department forms.
SECTION 33. { + ORS 414.105 and 414.106 are added to and made
a part of ORS chapter 416. + }
SECTION 34. { + ORS 414.042 is added to and made a part of ORS
chapter 411. + }
SECTION 35. ORS 414.042 is amended to read:
414.042. { - (1) The need for and the amount of medical
assistance to be made available for each eligible group of
recipients of medical assistance shall be determined, in
accordance with the rules of the Department of Human Services,
taking into account: - }
{ - (a) The requirements and needs of the person, the spouse
and other dependents; - }
{ - (b) The income, resources and maintenance available to
the person but, except as provided in ORS 414.025 (2)(r),
resources shall be disregarded for those eligible by reason of
having income below the federal poverty level and who are
eligible for medical assistance only because of the enactment of
chapter 836, Oregon Laws 1989; - }
{ - (c) The responsibility of the spouse and, with respect to
a person who is blind or is permanently and totally disabled or
is under 21 years of age, the responsibility of the parents;
and - }
{ - (d) The report of the Health Services Commission as
funded by the Legislative Assembly and such other programs as the
Legislative Assembly may authorize. However, medical assistance,
including health services, shall not be provided to persons
described in ORS 414.025 (2)(r) unless the Legislative Assembly
specifically appropriates funds to provide such assistance. - }
{ - (2) Such amounts of income and resources may be
disregarded as the department may prescribe by rules, except
that - } The Department { + of Human Services + } may not
require any needy person over 65 years of age, as a condition of
entering or remaining in a hospital, nursing home or other
congregate care facility, to sell any real property normally used
as such person's home. Any rule of the department inconsistent
with this section is to that extent invalid. { - The amounts to
be disregarded shall be within the limits required or permitted
by federal law, rules or orders applicable thereto. - }
{ - (3) In the determination of the amount of medical
assistance available to a medically needy person, all income and
resources available to the person in excess of the amounts
prescribed in ORS 414.038, within limits prescribed by the
department, shall be applied first to costs of needed medical and
remedial care and services not available under the medical
assistance program and then to the costs of benefits under the
medical assistance program. - }
SECTION 36. { + ORS 414.047, 414.049, 414.051, 414.055,
414.057, 414.073, 414.151, 414.420, 414.422 and 414.424 are added
to and made a part of ORS chapter 411. + }
SECTION 37. ORS 414.049 is amended to read:
414.049. For each person applying for { - health services
under ORS 414.705 to 414.750 - } { + medical assistance + },
the Department of Human Services shall fully document:
(1) The category of aid as defined in ORS 414.025 that makes
the person eligible for medical assistance or the way in which
the person qualifies as categorically needy as defined in ORS
414.025;
(2) The status of the person as a resident of this state; and
(3) The financial income and resources of the person.
SECTION 38. ORS 414.051 is amended to read:
414.051. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall approve or deny prior
authorization requests for dental services not later than 30 days
after submission thereof by the provider, and shall make payments
to providers of prior authorized dental services not later than
30 days after receipt of the invoice of the provider.
SECTION 39. ORS 414.065 is amended to read:
414.065. (1)(a) With respect to medical and remedial care and
services to be provided in medical assistance during any period,
and within the limits of funds available therefor, the
{ - Department of Human Services - } { + Oregon Health
Authority + } shall determine, subject to such revisions as it
may make from time to time and with respect to the 'health
services' defined in ORS 414.705, subject to legislative funding
in response to the report of the Health Services Commission and
paragraph (b) of this subsection:
(A) The types and extent of medical and remedial care and
services to be provided to each eligible group of recipients of
medical assistance.
(B) Standards to be observed in the provision of medical and
remedial care and services.
(C) The number of days of medical and remedial care and
services toward the cost of which public assistance funds will be
expended in the care of any person.
(D) Reasonable fees, charges and daily rates to which public
assistance funds will be applied toward meeting the costs of
providing medical and remedial care and services to an applicant
or recipient.
(E) Reasonable fees for professional medical and dental
services which may be based on usual and customary fees in the
locality for similar services.
(F) The amount and application of any copayment or other
similar cost-sharing payment that the { - department - }
{ + authority + } may require a recipient to pay toward the cost
of medical and remedial care or services.
(b) Notwithstanding ORS 414.720 (8), the { - department - }
{ + authority + } shall adopt rules establishing timelines for
payment of health services under paragraph (a) of this
subsection.
(2) The types and extent of medical and remedial care and
services and the amounts to be paid in meeting the costs thereof,
as determined and fixed by the { - department - }
{ + authority + } and within the limits of funds available
therefor, shall be the total available for medical assistance and
payments for such medical assistance shall be the total amounts
from public assistance funds available to providers of medical
and remedial care and services in meeting the costs thereof.
(3) Except for payments under a cost-sharing plan, payments
made by the { - department - } { + authority + } for medical
assistance shall constitute payment in full for all medical and
remedial care and services for which such payments of medical
assistance were made.
(4) Medical benefits, standards and limits established pursuant
to subsection (1)(a)(A), (B) and (C) of this section for the
eligible medically needy, except for persons receiving assistance
under ORS 411.706, may be less than but may not exceed medical
benefits, standards and limits established for the eligible
categorically needy, except that, in the case of a research and
demonstration project entered into under ORS 411.135, medical
benefits, standards and limits for the eligible medically needy
may exceed those established for specific eligible groups of the
categorically needy.
SECTION 40. ORS 414.109 is amended to read:
414.109. (1) The Oregon Health Plan Fund is established,
separate and distinct from the General Fund. Interest earned by
the Oregon Health Plan Fund shall be retained by the Oregon
Health Plan Fund.
(2) Moneys in the Oregon Health Plan Fund are continuously
appropriated to the Department of Human Services for the purposes
of funding the maintenance and expansion of the number of persons
eligible for medical assistance under the Oregon Health Plan and
funding the maintenance of the benefits available under the
Oregon Health Plan.
{ + (3) On the effective date of this 2009 Act, all moneys in
the Oregon Health Plan Fund shall be transferred to the Oregon
Health Authority Fund established in section 19 of this 2009
Act. + }
SECTION 41. ORS 414.115 is amended to read:
414.115. (1) In lieu of providing one or more of the medical
and remedial care and services available under medical assistance
by direct payments to providers thereof and in lieu of providing
such medical and remedial care and services made available
pursuant to ORS 414.065, the { - Department of Human
Services - } { + Oregon Health Authority + } shall use
available medical assistance funds to purchase and pay premiums
on policies of insurance, or enter into and pay the expenses on
health care service contracts, or medical or hospital service
contracts that provide one or more of the medical and remedial
care and services available under medical assistance for the
benefit of the categorically needy { - or the medically needy,
or both - } . Notwithstanding other specific provisions, the use
of available medical assistance funds to purchase medical or
remedial care and services may provide the following insurance or
contract options:
(a) Differing services or levels of service among groups of
eligibles as defined by rules of the { - department - }
{ + authority + }; and
(b) Services and reimbursement for these services may vary
among contracts and need not be uniform.
(2) The policy of insurance or the contract by its terms, or
the insurer or contractor by written acknowledgment to the
{ - department - } { + authority + } must guarantee:
(a) To provide medical and remedial care and services of the
type, within the extent and according to standards prescribed
under ORS 414.065;
(b) To pay providers of medical and remedial care and services
the amount due, based on the number of days of care and the fees,
charges and costs established under ORS 414.065, except as to
medical or hospital service contracts which employ a method of
accounting or payment on other than a fee-for-service basis;
(c) To provide medical and remedial care and services under
policies of insurance or contracts in compliance with all laws,
rules and regulations applicable thereto; and
(d) To provide such statistical data, records and reports
relating to the provision, administration and costs of providing
medical and remedial care and services to the
{ - department - } { + authority + } as may be required by the
{ - department - } { + authority + } for its records, reports
and audits.
SECTION 42. ORS 414.125 is amended to read:
414.125. (1) Any payment of available medical assistance funds
for policies of insurance or service contracts shall be according
to such uniform area-wide rates as the { - Department of Human
Services - } { + Oregon Health Authority + } shall have
established and which it may revise from time to time as may be
necessary or practical, except that, in the case of a research
and demonstration project entered into under ORS 411.135 special
rates may be established.
(2) No premium or other periodic charge on any policy of
insurance, health care service contract, or medical or hospital
service contract shall be paid from available medical assistance
funds unless the insurer or contractor issuing such policy or
contract is by law authorized to transact business as an
insurance company, health care service contractor or hospital
association in this state.
SECTION 43. ORS 414.135 is amended to read:
414.135. The { - Department of Human Services - }
{ + Oregon Health Authority + } may enter into nonexclusive
contracts under which funds available for medical assistance may
be administered and disbursed by the contractor to direct
providers of medical and remedial care and services available
under medical assistance in consideration of services rendered
and supplies furnished by them in accordance with the provisions
of this chapter. Payment shall be made according to the rules of
the { - department - } { + authority + } pursuant to the
number of days and the fees, charges and costs established under
ORS 414.065. The contractor must guarantee the
{ - department - } { + authority + } by written acknowledgment:
(1) To make all payments under this chapter promptly but not
later than 30 days after receipt of the proper evidence
establishing the validity of the provider's claim.
(2) To provide such data, records and reports to the
{ - department - } { + authority + } as may be required by
the { - department - } { + authority + }.
SECTION 44. ORS 414.145 is amended to read:
414.145. (1) The provisions of ORS 414.115, 414.125 or 414.135
shall be implemented whenever it appears to the
{ - Department of Human Services - } { + Oregon Health
Authority + } that such implementation will provide comparable
benefits at equal or less cost than provision thereof by direct
payments by the { - department - } { + authority + } to the
providers of medical assistance, but in no case greater than the
legislatively approved budgeted cost per eligible recipient at
the time of contracting.
(2) When determining comparable benefits at equal or less cost
as provided in subsection (1) of this section, the
{ - department - } { + authority + } must take into
consideration the recipients' need for reasonable access to
preventive and remedial care, and the contractor's ability to
assure continuous quality delivery of both routine and emergency
services.
SECTION 45. ORS 414.153 is amended to read:
414.153. In order to make advantageous use of the system of
public health services available through county health
departments and other publicly supported programs and to insure
access to public health services through contract under ORS
chapter 414, the state shall:
(1) Unless cause can be shown why such an agreement is not
feasible, require and approve agreements between prepaid health
plans and publicly funded providers for authorization of payment
for point of contact services in the following categories:
(a) Immunizations;
(b) Sexually transmitted diseases; and
(c) Other communicable diseases;
(2) Allow enrollees in prepaid health plans to receive from
fee-for-service providers:
(a) Family planning services;
(b) Human immunodeficiency virus and acquired immune deficiency
syndrome prevention services; and
(c) Maternity case management if the { - Department of Human
Services - } { + Oregon Health Authority + } determines that a
prepaid plan cannot adequately provide the services;
(3) Encourage and approve agreements between prepaid health
plans and publicly funded providers for authorization of and
payment for services in the following categories:
(a) Maternity case management;
(b) Well-child care;
(c) Prenatal care;
(d) School-based clinics;
(e) Health services for children provided through schools and
Head Start programs; and
(f) Screening services to provide early detection of health
care problems among low income women and children, migrant
workers and other special population groups; and
(4) Recognize the social value of partnerships between county
health departments and other publicly supported programs and
other health providers, and take appropriate measures to involve
publicly supported health care and service programs in the
development and implementation of managed health care programs in
their areas of responsibility.
SECTION 46. ORS 414.211 is amended to read:
414.211. (1) There is established a Medicaid Advisory Committee
consisting of not more than 15 members appointed by the Governor.
(2) The committee shall be composed of:
(a) A physician licensed under ORS chapter 677;
(b) Two members of health care consumer groups that include
Medicaid recipients;
(c) Two Medicaid recipients, one of whom shall be a person with
a disability;
(d) The Director of { - Human Services - } { + the Oregon
Health Authority + } or designee;
(e) Health care providers;
(f) Persons associated with health care organizations,
including but not limited to managed care plans under contract to
the Medicaid program; and
(g) Members of the general public.
(3) In making appointments, the Governor shall consult with
appropriate professional and other interested organizations. All
members appointed to the committee shall be familiar with the
medical needs of low income persons.
(4) The term of office for each member shall be two years, but
each member shall serve at the pleasure of the Governor.
(5) Members of the committee shall receive no compensation for
their services but, subject to any applicable state law, shall be
allowed actual and necessary travel expenses incurred in the
performance of their duties from the { - Public Welfare
Account - } { + Oregon Health Authority Fund + }.
SECTION 47. ORS 414.221 is amended to read:
414.221. The Medicaid Advisory Committee shall advise the
Administrator of the Office for Oregon Health Policy and Research
and the Director of { - Human Services - } { + the Oregon
Health Authority + } on:
(1) Medical care, including mental health and alcohol and drug
treatment and remedial care to be provided under ORS chapter 414;
and
(2) The operation and administration of programs provided under
ORS chapter 414.
SECTION 48. ORS 414.225 is amended to read:
414.225. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall consult with the Medicaid
Advisory Committee concerning the determinations required under
ORS 414.065.
SECTION 49. ORS 414.227 is amended to read:
414.227. (1) ORS 192.610 to 192.690 apply to any meeting of an
advisory committee with the authority to make decisions for,
conduct policy research for or make recommendations to the
{ - Department of Human Services - } { + Oregon Health
Authority or the Oregon Health Authority Board + } on
administration or policy related to the medical assistance
program operated under this chapter.
(2) Subsection (1) of this section applies only to advisory
committee meetings attended by two or more advisory committee
members who are not employed by a public body.
SECTION 50. 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
{ - Department of Human Services - } { + Oregon Health
Authority + }. 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 { - Human Services - } { + the Oregon
Health Authority + } 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 - }
{ + shall + } 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; { + and + }
(e) State agencies that directly or indirectly purchase
prescription drugs, including agencies that dispense prescription
drugs directly to persons in state-operated facilities { - ; - }
{ + . + }
{ + (5) The following individuals or entities may participate
in the program: + }
{ - (f) - } { + (a) + } Residents of this state who lack or
are underinsured for prescription drug coverage;
{ - (g) - } { + (b) + } Private entities; and
{ - (h) - } { + (c) + } Labor organizations.
{ - (5) - } { + (6) + } 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) - } { + (7) + } The administrator may establish
different reimbursement rates or prescription drug prices for
pharmacies in rural areas to maintain statewide access to the
program.
{ - (7) - } { + (8) + } 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) - } { + (9) + } Except as provided in subsection
{ - (9) - } { + (10) + } 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) - } { + (10) + } 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) - } { + (11) + } Notwithstanding subsection
{ - (4)(f) - } { + (5)(a) + } of this section, individuals who
are eligible for Medicare Part D prescription drug coverage may
participate in the program.
SECTION 51. ORS 414.314 is amended to read:
414.314. (1) An individual or entity described in ORS 414.312
{ - (4) - } { + (5) + } may apply to participate in the
Oregon Prescription Drug Program. Participants shall apply on an
application provided by the { - Department of Human
Services - } { + Oregon Health Authority + }. The
{ - department - } { + authority + } may charge participants
a nominal fee to participate in the program. The
{ - department - } { + authority + } shall issue a
prescription drug identification card to participants of the
program.
(2) The { - department - } { + authority + } 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 - } { +
authority + }.
(4) Prescription drug identification cards issued under this
section must contain the information necessary for proper claims
adjudication or transmission of price data.
SECTION 52. ORS 414.316 is amended to read:
414.316. The Office for Oregon Health Policy and Research shall
develop and recommend to the { - Department of Human
Services - } { + Oregon Health Authority + } 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 53. 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
{ - Department of Human Services - } { + Oregon Health
Authority + } 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
{ - department - } { + authority + } and shall be used to
purchase prescription drugs, reimburse pharmacies for
prescription drugs and reimburse the { - department - }
{ + authority + } 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 54. ORS 414.320 is amended to read:
414.320. The { - Department of Human Services - }
{ + Oregon Health Authority + } 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 55. ORS 414.325 is amended to read:
414.325. (1) As used in this section, 'legend drug' means any
drug requiring a prescription by a practitioner, as defined in
ORS 689.005.
(2) A licensed practitioner may prescribe such drugs under this
chapter as the practitioner in the exercise of professional
judgment considers appropriate for the diagnosis or treatment of
the patient in the practitioner's care and within the scope of
practice. Prescriptions shall be dispensed in the generic form
pursuant to ORS 689.515 and pursuant to rules of the
{ - Department of Human Services - } { + Oregon Health
Authority + } unless the practitioner prescribes otherwise and an
exception is granted by the
{ - department - } { + authority + }.
(3) Except as provided in subsections (4) and (5) of this
section, the { - department - } { + authority + } shall place
no limit on the type of legend drug that may be prescribed by a
practitioner, but the { - department - } { + authority + }
shall pay only for drugs in the generic form unless an exception
has been granted by the { - department - } { + authority + }.
(4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the
{ - department - } { + authority + } is required to pay for
minor tranquilizers and amphetamines and amphetamine derivatives,
as defined by rule of the { - department - } { +
authority + }.
(5)(a) Notwithstanding subsections (1) to (4) of this section
and except as provided in paragraph (b) of this subsection, the
{ - department - } { + authority + } is authorized to:
(A) Withhold payment for a legend drug when federal financial
participation is not available; and
(B) Require prior authorization of payment for drugs that the
{ - department - } { + authority + } has determined should be
limited to those conditions generally recognized as appropriate
by the medical profession.
(b) The { - department - } { + authority + } may not
require prior authorization for therapeutic classes of
nonsedating antihistamines and nasal inhalers, as defined by rule
by the
{ - department - } { + authority + }, when prescribed by an
allergist for treatment of any of the following conditions, as
described by the Health Services Commission on the funded portion
of its prioritized list of services:
(A) Asthma;
(B) Sinusitis;
(C) Rhinitis; or
(D) Allergies.
(6)(a) The { - department - } { + authority + } shall pay a
rural health clinic for a legend drug prescribed and dispensed
under this chapter by a licensed practitioner at the rural health
clinic for an urgent medical condition if:
(A) There is not a pharmacy within 15 miles of the clinic;
(B) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(C) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter.
(b) As used in this subsection, 'urgent medical condition '
means a medical condition that arises suddenly, is not
life-threatening and requires prompt treatment to avoid the
development of more serious medical problems.
(7) Notwithstanding ORS 414.334, the { - department - }
{ + authority + } may conduct prospective drug utilization
review prior to payment for drugs for a patient whose
prescription drug use exceeded 15 drugs in the preceding
six-month period.
(8) Notwithstanding subsection (3) of this section, the
{ - department - } { + authority + } may pay a pharmacy for a
particular brand name drug rather than the generic version of the
drug after notifying the pharmacy that the cost of the particular
brand name drug, after receiving discounted prices and rebates,
is equal to or less than the cost of the generic version of the
drug.
SECTION 56. ORS 414.327 is amended to read:
414.327. { - (1) The Department of Human Services shall seek
a waiver from the federal Centers for Medicare and Medicaid
Services to allow the department to communicate prescription drug
orders by electronic means from a practitioner authorized to
prescribe drugs directly to the dispensing pharmacist. - }
{ - (2) - } The { - Department of Human Services - }
{ + Oregon Health Authority + } shall adopt rules permitting
{ - the department - } { + a practitioner + } to communicate
prescription drug orders by electronic means { - from a
practitioner authorized to prescribe drugs - } directly to the
dispensing pharmacist.
SECTION 57. ORS 414.329 is amended to read:
414.329. (1) Notwithstanding ORS 414.705 to 414.750, the
{ - Department of Human Services - } { + Oregon Health
Authority + } shall adopt rules modifying the prescription drug
benefits for persons who are eligible for Medicare Part D
prescription drug coverage and who receive prescription drug
benefits under the state medical assistance program or Title XIX
of the Social Security Act. The rules shall include but need not
be limited to:
(a) Identification of the Part D classes of drugs for which
federal financial participation is not available and that are not
covered classes of drugs;
(b) Identification of the Part D classes of drugs for which
federal financial participation is not available and that are
covered classes of drugs;
(c) Identification of the classes of drugs not covered under
Medicare Part D prescription drug coverage for which federal
financial participation is available and that are covered classes
of drugs; and
(d) Cost-sharing obligations related to the provision of Part D
classes of drugs for which federal financial participation is not
available.
(2) As used in this section, 'covered classes of drugs ' means
classes of prescription drugs provided to persons eligible for
prescription drug coverage under the state medical assistance
program or Title XIX of the Social Security Act.
SECTION 58. ORS 414.340 is amended to read:
414.340. As used in this section and ORS 414.342 and 414.348:
(1) 'Eligible person' means a resident of this state who:
(a) Is 65 years of age or older;
(b) Has a gross annual income that does not exceed the lesser
of the maximum amount established by the { - Department of
Human Services - } { + Oregon Health Authority + } by rule or
{ - 185 - } { + 200 + } percent of the federal poverty
guidelines;
(c) Has not been covered under any public or private
prescription drug benefit program for the previous six months;
and
(d) Has less than $2,000 in resources.
(2) 'Enrollee' means a person who has been found to be eligible
for the Senior Prescription Drug Assistance Program, who has paid
an enrollment fee of up to $50 and who has a Senior Prescription
Drug Assistance Program enrollment card issued by the
{ - Department of Human Services - } { + Oregon Health
Authority + }.
(3) 'Federal poverty guidelines' means the most recent poverty
guidelines as published annually in the Federal Register by the
United States Department of Health and Human Services.
(4) 'Income' has the meaning given that term in ORS 411.704.
(5) 'Resources' includes but is not limited to cash, checking
and savings accounts, certificates of deposit, money market
funds, stocks and bonds. 'Resources' does not include the primary
residence or car of an eligible person.
(6) 'Senior Prescription Drug Assistance Program price ' means
the price of a prescription drug paid by an enrollee that is
equal to or less than the Medicaid price.
SECTION 59. ORS 414.342 is amended to read:
414.342. (1) The Senior Prescription Drug Assistance Program is
created in the { - Department of Human Services - } { +
Oregon Health Authority + }. The purpose of the program is to
provide financial assistance to eligible persons for the purchase
of prescription drugs.
(2) A pharmacy shall charge an enrollee the Senior Prescription
Drug Assistance Program price for a prescription drug upon
presentation of a Senior Prescription Drug Assistance Program
enrollment card.
(3) A pharmacy may charge the enrollee an amount established by
the { - Department of Human Services - } { + authority + } to
cover the professional dispensing fee, which may not exceed the
fee paid by the state Medicaid program.
(4) This section does not apply to over-the-counter
medications.
(5) The { - department - } { + authority + } shall provide
a mechanism to calculate and transmit the Senior Prescription
Drug Assistance Program price to the pharmacy.
(6) A person seeking to participate in the Senior Prescription
Drug Assistance Program shall apply annually by completing and
mailing a one-page application and including payment of an
enrollment fee established by the { - department - }
{ + authority + }, not to exceed $50. The { - department - }
{ + authority + } shall issue an enrollment card annually to
enrollees of the program. Each individual's application shall be
considered separately, regardless of the number of persons in the
individual's household.
(7) The maximum prescription drug assistance available annually
to an enrollee is $2,000.
(8) Subject to funds available, the { - Department of Human
Services - } { + Oregon Health Authority + } may adjust the
Senior Prescription Drug Assistance Program price to subsidize up
to 50 percent of the Medicaid price of the prescription drug,
using a sliding scale based on the income and resources of an
enrollee.
(9)(a) The { - department - } { + authority + } shall adopt
rules that:
(A) Identify critical access pharmacies; and
(B) Provide for additional reimbursement to critical access
pharmacies that participate in the Senior Prescription Drug
Assistance Program.
(b) In addition, a critical access pharmacy may charge an
enrollee a fee of not more than $2 per prescription. The $2
charge shall be annually adjusted for inflation using the U.S.
City Average Consumer Price Index, as defined in ORS 316.037.
SECTION 60. ORS 414.344 is amended to read:
414.344. The { - Department of Human Services - }
{ + Oregon Health Authority + } may contract with a pharmacy
provider or a pharmacy benefits manager to provide services under
the Senior Prescription Drug Assistance Program established under
ORS 414.342.
SECTION 61. ORS 414.346 is amended to read:
414.346. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall adopt rules necessary to
implement ORS 414.342.
SECTION 62. ORS 414.348 is amended to read:
414.348. The Senior Prescription Drug Assistance Fund is
established separate and distinct from the General Fund. The
Senior Prescription Drug Assistance Fund may receive any
appropriations, allocations, federal moneys or gifts designated
for the Senior Prescription Drug Assistance Program. The moneys
in the Senior Prescription Drug Assistance Fund are continuously
appropriated to the { - Department of Human Services - }
{ + Oregon Health Authority + } and shall be used to reimburse
retail pharmacies for subsidized prices provided to enrollees and
to reimburse the
{ - department - } { + authority + } for the costs of
administering the program, including contracted services costs,
computer costs, professional fees paid to retail pharmacies and
other reasonable program costs. Interest earned on the fund
accrues to the fund.
SECTION 63. ORS 414.350 is amended to read:
414.350. As used in ORS 414.350 to 414.415:
(1) 'Appropriate and medically necessary use' means drug
prescribing, drug dispensing and patient medication usage in
conformity with the criteria and standards developed under ORS
414.350 to 414.415.
(2) 'Board' means the Drug Use Review Board created under ORS
414.355.
(3) 'Compendia' means those resources widely accepted by the
medical profession in the efficacious use of drugs, including the
following sources:
(a) The American Hospital Formulary Services drug information.
(b) The United States Pharmacopeia drug information.
(c) The American Medical Association drug evaluations.
(d) The peer-reviewed medical literature.
(e) Drug therapy information provided by manufacturers of drug
products consistent with the federal Food and Drug Administration
requirements.
(4) 'Counseling' means the effective communication of
information by a pharmacist, as defined by rules of the State
Board of Pharmacy.
(5) 'Criteria' means the predetermined and explicitly accepted
elements based on the compendia that are used to measure drug use
on an ongoing basis to determine if the use is appropriate,
medically necessary and not likely to result in adverse medical
outcomes.
(6) 'Drug-disease contraindication' means the potential for, or
the occurrence of, an undesirable alteration of the therapeutic
effect of a given prescription because of the presence, in the
patient for whom it is prescribed, of a disease condition or the
potential for, or the occurrence of, a clinically significant
adverse effect of the drug on the patient's disease condition.
(7) 'Drug-drug interaction' means the pharmacological or
clinical response to the administration of at least two drugs
different from that response anticipated from the known effects
of the two drugs when given alone, which may manifest clinically
as antagonism, synergism or idiosyncrasy. Such interactions have
the potential to have an adverse effect on the individual or lead
to a clinically significant adverse reaction, or both, that:
(a) Is characteristic of one or any of the drugs present; or
(b) Leads to interference with the absorption, distribution,
metabolizing, excretion or therapeutic efficacy of one or any of
the drugs.
(8) 'Drug use review' means the programs designed to measure
and assess on a retrospective and a prospective basis, through an
evaluation of claims data, the proper utilization, quantity,
appropriateness as therapy and medical necessity of prescribed
medication in the medical assistance program.
(9) 'Intervention' means an action taken by the
{ - Department of Human Services - } { + Oregon Health
Authority + } with a prescriber or pharmacist to inform about or
to influence prescribing or dispensing practices or utilization
of drugs.
(10) 'Overutilization' means the use of a drug in quantities or
for durations that put the recipient at risk of an adverse
medical result.
(11) 'Pharmacist' means an individual who is licensed as a
pharmacist under ORS chapter 689.
(12) 'Prescriber' means any person authorized by law to
prescribe drugs.
(13) 'Prospective program' means the prospective drug use
review program described in ORS 414.375.
(14) 'Retrospective program' means the retrospective drug use
review program described in ORS 414.380.
(15) 'Standards' means the acceptable prescribing and
dispensing methods determined by the compendia, in accordance
with local standards of medical practice for health care
providers.
(16) 'Therapeutic appropriateness' means drug prescribing based
on scientifically based and clinically relevant drug therapy that
is consistent with the criteria and standards developed under ORS
414.350 to 414.415.
(17) 'Therapeutic duplication' means the prescribing and
dispensing of two or more drugs from the same therapeutic class
such that the combined daily dose puts the recipient at risk of
an adverse medical result or incurs additional program costs
without additional therapeutic benefits.
(18) 'Underutilization' means that a drug is used by a
recipient in insufficient quantity to achieve a desired
therapeutic goal.
SECTION 64. ORS 414.355 is amended to read:
414.355. (1) There is created a 12-member Drug Use Review Board
responsible for advising the { - Department of Human
Services - } { + Oregon Health Authority Board + } on the
implementation of the retrospective and prospective drug
utilization review programs.
(2) The members of the { + Drug Use Review + } Board shall be
appointed by the Director of { - Human Services - } { + the
Oregon Health Authority + } and shall serve a term of two years.
An individual appointed to the board may be reappointed upon
completion of the individual's term. The membership of the board
shall be composed of the following:
(a) Four persons licensed as physicians and actively engaged in
the practice of medicine or osteopathic medicine in Oregon, who
may be from among persons recommended by the Oregon Medical
Association, the Osteopathic Physicians and Surgeons of Oregon or
other organization representing physicians;
(b) One person licensed as a physician in Oregon who is
actively engaged in academic medicine;
(c) Three persons licensed and actively practicing pharmacy in
Oregon who may be from among persons recommended by the Oregon
State Pharmacists Association, the National Association of Chain
Drug Stores, the Oregon Society of Hospital Pharmacists, the
Oregon Society of Consultant Pharmacists or other organizations
representing pharmacists whether affiliated or unaffiliated with
any association;
(d) One person licensed as a pharmacist in Oregon who is
actively engaged in academic pharmacy;
(e) Two persons who shall represent persons receiving medical
assistance; and
(f) One person licensed and actively practicing dentistry in
Oregon who may be from among persons recommended by the Oregon
Dental Association or other organizations representing dentists.
(3) Board members must have expertise in one or more of the
following:
(a) Clinically appropriate prescribing of outpatient drugs
covered by the medical assistance program.
(b) Clinically appropriate dispensing and monitoring of
outpatient drugs covered by the medical assistance program.
(c) Drug use review, evaluation and intervention.
(d) Medical quality assurance.
(4) The director shall fill a vacancy on the board by
appointing a new member to serve the remainder of the unexpired
term based upon qualifications described in subsections (2) and
(3) of this section.
(5) A board member may be removed only by a vote of eight
members of the board and the removal must be approved by the
director. The director may remove a member, without board action,
if a member fails to attend two consecutive meetings unless such
member is prevented from attending by serious illness of the
member or in the member's family.
SECTION 65. ORS 414.360 is amended to read:
414.360. (1) The Drug Use Review Board shall advise the
{ - Department of Human Services - } { + Oregon Health
Authority Board + } on:
(a) Adoption of rules to implement ORS 414.350 to 414.415 in
accordance with the provisions of ORS 183.710 to 183.725, 183.745
and 183.750 and ORS chapter 183.
(b) Implementation of the medical assistance program
retrospective and prospective programs as described in ORS
414.350 to 414.415, including the type of software programs to be
used by the pharmacist for prospective drug use review and the
provisions of the contractual agreement between the state and any
entity involved in the retrospective drug use review program.
(c) Development of and application of the criteria and
standards to be used in retrospective and prospective drug
utilization review in a manner that insures that such criteria
and standards are based on the compendia, relevant guidelines
obtained from professional groups through consensus-driven
processes, the experience of practitioners with expertise in drug
therapy, data and experience obtained from drug utilization
review program operations. The { + Drug Use Review + } Board
shall have an open professional consensus process for
establishing and revising criteria and standards. Criteria and
standards shall be available to the public. In developing
recommendations for criteria and standards, the board shall
establish an explicit ongoing process for soliciting and
considering input from interested parties. The board shall make
timely revisions to the criteria and standards based upon this
input in addition to revisions based upon scheduled review of the
criteria and standards. Further, the drug utilization review
standards shall reflect the local practices of prescribers in
order to monitor:
(A) Therapeutic appropriateness.
(B) Overutilization or underutilization.
(C) Therapeutic duplication.
(D) Drug-disease contraindications.
(E) Drug-drug interactions.
(F) Incorrect drug dosage or drug treatment duration.
(G) Clinical abuse or misuse.
(H) Drug allergies.
(d) Development, selection and application of and assessment
for interventions for medical assistance program prescribers,
dispensers and patients that are educational and not punitive in
nature.
(2) In reviewing retrospective and prospective drug use, the
{ + Drug Use Review + } Board may consider only drugs that have
received final approval from the federal Food and Drug
Administration.
SECTION 66. ORS 414.365 is amended to read:
414.365. In addition to advising the { - Department of Human
Services - } { + Oregon Health Authority Board + }, the Drug
Use Review Board shall do the following subject to the approval
of the { - Director of Human Services - } { + Oregon Health
Authority Board + }:
(1) Publish an annual report, as described in ORS 414.415.
(2) Publish and disseminate educational information to
prescribers and pharmacists regarding the { + Drug Use
Review + } Board and the drug use review programs, including
information on the following:
(a) Identifying and reducing the frequency of patterns of
fraud, abuse or inappropriate or medically unnecessary care among
prescribers, pharmacists and recipients.
(b) Potential or actual severe or adverse reactions to drugs.
(c) Therapeutic appropriateness.
(d) Overutilization or underutilization.
(e) Appropriate use of generic products.
(f) Therapeutic duplication.
(g) Drug-disease contraindications.
(h) Drug-drug interactions.
(i) Drug allergy interactions.
(j) Clinical abuse and misuse.
(3) Adopt and implement procedures designed to insure the
confidentiality of any information collected, stored, retrieved,
assessed or analyzed by the { + Drug Use Review + } Board, staff
of the board or contractors to the drug use review programs that
identifies individual prescribers, pharmacists or recipients.
SECTION 67. ORS 414.375 is amended to read:
414.375. The prospective drug use review program must be based
on the guidelines established by the { - Department of Human
Services - } { + Oregon Health Authority Board + } in
consultation with the Drug Use Review Board. The program must
provide that prior to the prescription being filled or delivered
a review will be conducted by the pharmacist at the point of sale
to screen for potential drug therapy problems resulting from the
following:
(1) Therapeutic duplication.
(2) Drug-drug interactions, including serious interactions with
nonprescription or over-the-counter drugs.
(3) Incorrect dosage and duration of treatment.
(4) Drug-allergy interactions.
(5) Clinical abuse and misuse.
(6) Drug-disease contraindications.
SECTION 68. ORS 414.380 is amended to read:
414.380. The retrospective drug use review program must:
(1) Be based on the guidelines established by the
{ - Department of Human Services in consultation with - }
{ + Oregon Health Authority Board based upon recommendations
from + } the Drug Use Review Board; and
(2) Use the mechanized drug claims processing and information
retrieval system to analyze claims data on drug use against
explicit predetermined standards that are based on the compendia
and other sources to monitor the following:
(a) Therapeutic appropriateness.
(b) Overutilization or underutilization.
(c) Fraud and abuse.
(d) Therapeutic duplication.
(e) Drug-disease contraindications.
(f) Drug-drug interactions.
(g) Incorrect drug dosage or duration of drug treatment.
(h) Clinical abuse and misuse.
SECTION 69. ORS 414.390 is amended to read:
414.390. (1) Information collected under ORS 414.350 to 414.415
that identifies an individual is confidential and shall not be
disclosed by the Drug Use Review Board, the retrospective drug
use review program, { - or the Department of Human Services - }
{ + the Oregon Health Authority Board or the Oregon Health
Authority + } to any person other than a health care provider
appearing on a recipient's medication profile.
(2) The staff of the { + Drug Use Review + } Board may have
access to identifying information for purposes of carrying out
intervention activities. The identifying information shall not be
released to anyone other than a staff member of the board,
retrospective drug use review program, { - Department of Human
Services - } { + Oregon Health Authority Board, Oregon Health
Authority + } { - , - } or to any health care provider
appearing on a recipient's medication profile or, for purposes of
investigating potential fraud in programs administered by the
{ - Department of Human Services - } { + Oregon Health
Authority + }, to the Department of Justice.
(3) The { + Drug Use Review + } Board may release cumulative,
nonidentifying information for the purposes of legitimate
research and for educational purposes.
SECTION 70. ORS 414.410 is amended to read:
414.410. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall provide staff to the Drug
Use Review Board.
SECTION 71. ORS 414.426 is amended to read:
414.426. The { - Department of Human Services - }
{ + Oregon Health Authority + } is hereby authorized to pay the
cost of care for patients in institutions operated under ORS
179.321 under the medical assistance program established by ORS
chapter 414.
SECTION 72. ORS 414.428 is amended to read:
414.428. (1) An individual described in ORS 414.025 (2)(r) who
is eligible for or receiving medical assistance and who is an
American Indian and Alaskan Native beneficiary shall receive the
benefit package of health care services described in ORS
{ - 414.835 - } { + 414.707 (1) + } if:
(a) The { - Department of Human Services - } { + Oregon
Health Authority + } receives 100 percent federal medical
assistance percentage for payments made by the
{ - department - } { + authority + } for the health care
services provided as part of the benefit package described in ORS
{ - 414.835 that are not included in the benefit package
described in ORS 414.834 - } { + 414.707 (1) + }; or
(b) The { - department - } { + authority + } receives
funding from the Indian tribes for which federal financial
participation is available.
(2) As used in this section, 'American Indian and Alaskan
Native beneficiary' means:
(a) A member of a federally recognized Indian tribe, band or
group;
(b) An Eskimo or Aleut or other Alaskan native enrolled by the
United States Secretary of the Interior pursuant to the Alaska
Native Claims Settlement Act, 43 U.S.C. 1601; or
(c) A person who is considered by the United States Secretary
of the Interior to be an Indian for any purpose.
SECTION 73. Section 2, chapter 76, Oregon Laws 2003, is amended
to read:
{ + Sec. 2. + } (1) Section 1 { + , chapter 76, Oregon Laws
2003, + } { - of this 2003 Act - } becomes operative on the
day after the date the
{ - Department of Human Services - } { + Oregon Health
Authority + } receives approval from the federal Centers for
Medicare and Medicaid Services to amend Oregon's Medicaid waiver.
(2) The { - Department of Human Services - }
{ + authority + } shall notify the Legislative Counsel upon
receipt of approval or disapproval to amend Oregon's Medicaid
waiver.
SECTION 74. ORS 414.534 is amended to read:
414.534. (1) The { - Department of Human Services - }
{ + Oregon Health Authority + } shall provide medical assistance
to a woman who:
(a) Is screened for breast or cervical cancer through the
Oregon Breast and Cervical Cancer Program operated by the
{ - department - } { + authority + };
(b) As a result of a screening in accordance with paragraph (a)
of this subsection, is found by a provider to be in need of
treatment for breast or cervical cancer;
(c) Does not otherwise have creditable coverage, as defined in
42 U.S.C. 300gg(c); and
(d) Is 64 years of age or younger.
(2) The period of time a woman can receive medical assistance
based on the eligibility criteria of subsection (1) of this
section:
(a) Begins:
(A) On the date the Department { + of Human Services + } makes
a formal determination that the woman is eligible for medical
assistance in accordance with subsection (1) of this section; or
(B) Up to three months prior to the month in which the woman
applied for medical assistance if on the earlier date the woman
met the eligibility criteria of subsection (1) of this section.
(b) Ends when:
(A) The woman is no longer in need of treatment; or
(B) The department determines the woman no longer meets the
eligibility criteria of subsection (1) of this section.
SECTION 75. ORS 414.536 is amended to read:
414.536. (1) { + If + } the Department of Human Services
{ - shall provide medical assistance to a woman whom the
department determines is presumptively eligible for medical
assistance. As used in this section, a woman is 'presumptively
eligible for medical assistance' if the department determines
that the - } { + determines that a + } woman likely is eligible
for medical assistance under ORS 414.534 { + , the department
shall determine her to be presumptively eligible for medical
assistance until a formal determination on eligibility is
made + }.
(2) The period of time a woman may receive medical assistance
based on presumptive eligibility is limited. The period of time:
(a) Begins on the date that the department determines the woman
likely meets the eligibility criteria under ORS 414.534; and
(b) Ends on the earlier of the following dates:
(A) If the woman applies for medical assistance following the
determination by the department that the woman is presumptively
eligible for medical assistance, the date on which a formal
determination on eligibility is made by the department in
accordance with ORS 414.534; or
(B) If the woman does not apply for medical assistance
following the determination by the department that the woman is
presumptively eligible for medical assistance, the last day of
the month following the month in which presumptive eligibility
begins.
SECTION 76. ORS 414.538 is amended to read:
414.538. (1) The Department of Human Services { - shall
provide medical assistance under ORS 414.534 or 414.536 to a
woman who meets general coverage requirements applicable to
recipients of medical assistance. The department - } may not
impose income or resource limitations or a prior period of
uninsurance on a woman who otherwise qualifies for medical
assistance under ORS 414.534 or 414.536.
(2) In { - providing - } { + determining eligibility
for + } medical assistance under ORS 414.534 or 414.536, the
department { - of Human Services - } shall give priority to
low-income women.
SECTION 77. ORS 414.630 is amended to read:
414.630. (1) The { - Department of Human Services - }
{ + Oregon Health Authority + } shall execute prepaid capitated
health service contracts for at least hospital or physician
medical care, or both, with hospital and medical organizations,
health maintenance organizations and any other appropriate public
or private persons.
(2) For purposes of ORS 279A.025, 279A.140, 414.145 and 414.610
to 414.640, instrumentalities and political subdivisions of the
state are authorized to enter into prepaid capitated health
service contracts with the { - Department of Human Services - }
{ + Oregon Health Authority or the Oregon Health Authority
Board + } and shall not thereby be considered to be transacting
insurance.
(3) In the event that there is an insufficient number of
qualified bids for prepaid capitated health services contracts
for hospital or physician medical care, or both, in some areas of
the state, the { - department - } { + Oregon Health
Authority + } may continue a fee for service payment system.
(4) Payments to providers may be subject to contract provisions
requiring the retention of a specified percentage in an incentive
fund or to other contract provisions by which adjustments to the
payments are made based on utilization efficiency.
SECTION 78. ORS 414.640 is amended to read:
414.640. (1) Eligible persons shall select, to the extent
practicable as determined by the { - Department of Human
Services - } { + Oregon Health Authority + }, from among
available providers participating in the program.
(2) The { - department - } { + authority + } by rule shall
define the circumstances under which it may choose to reimburse
for any medical services not covered under the prepaid capitation
or costs of related services provided by or under referral from
any physician participating in the program in which the eligible
person is enrolled.
(3) The { - department - } { + authority + } shall
establish requirements as to the minimum time period that an
eligible person is assigned to specific providers in the system.
(4) Actions taken by providers, potential providers,
contractors and bidders in specific accordance with this chapter
in forming consortiums or in otherwise entering into contracts to
provide medical care shall be considered to be conducted at the
direction of this state, shall be considered to be lawful trade
practices and shall not be considered to be the transaction of
insurance for purposes of ORS 279A.025, 279A.140, 414.145 and
414.610 to 414.640.
SECTION 79. ORS 414.707 is amended to read:
414.707. { - (1) Subject to funds available: - }
{ - (a) - } { + (1) + } Persons { - who are categorically
needy as described in ORS 414.025 (2)(n) and (o), and persons
under 19 years of age and pregnant women who are eligible to
receive health services under ORS 414.706, - } { + described in
ORS 414.706 (1), (2), (3) and (5) + } are eligible to receive all
the health services approved and funded by the Legislative
Assembly.
{ - (b) - } { + (2) + } Persons described in ORS 414.708
are eligible to receive the health services described in ORS
414.705 (1)(c), (f) and (g).
{ - (c) Persons 19 years of age and older who are eligible to
receive health services under ORS 414.706 are eligible to receive
the health services described in ORS 414.705 (1)(b) to (m). - }
{ - (2) Persons who are categorically needy as described in
ORS 414.025 (2)(n) and (o), and persons under 19 years of age and
pregnant women who are eligible to receive health services under
ORS 414.706, must be provided, at a minimum, the health services
described in ORS 414.705 (1)(a) to (g). - }
{ - (3) Persons 19 years of age and older who are eligible to
receive health services under ORS 414.706 must be provided, at a
minimum, health services described in ORS 414.705 (1)(b) to
(h). - }
{ - (4) Persons described in ORS 414.708 must be provided, at
a minimum, the health services described in ORS 414.705
(1)(c). - }
{ - (5) The Department of Human Services shall: - }
{ - (a) Develop at least three benefit packages of provider
services to be offered under ORS 414.705 (1)(j); and - }
{ - (b) Define by rule the services to be offered under ORS
414.705 (1)(k). - }
{ - (6) Notwithstanding ORS 414.735, the Legislative Assembly
shall adjust health services funded under ORS 414.705 (1) by
increasing or reducing benefit packages or health services and,
subject to ORS 414.709, by increasing or reducing the population
of eligible persons. - }
SECTION 80. ORS 414.708 is amended to read:
414.708. (1) A person is eligible to receive the health
services described in ORS 414.707 { - (1)(b) - } { + (2) + }
when the person is a resident of this state who:
(a) Is 65 years of age or older, or is blind or has a
disability as those terms are defined in ORS 411.704;
(b) Has a gross annual income that does not exceed the standard
established by the { - Department of Human Services - }
{ + Oregon Health Authority Board + }; and
(c) Is not covered under any public or private prescription
drug benefit program.
(2) A person receiving prescription drug services under ORS
414.707 { - (1)(b) - } { + (2) + } shall pay up to a
percentage of the Medicaid price of the prescription drug
established by the { - department - } { + authority + } by
rule and the dispensing fee.
SECTION 81. ORS 414.709 is amended to read:
414.709. (1) Except as provided in subsection (2) of this
section, if insufficient resources are available during a
biennium, the population of eligible persons receiving health
services may not be reduced below the population of eligible
persons approved and funded in the legislatively adopted budget
for the { - Department of Human Services - } { + Oregon
Health Authority + } for the biennium.
(2) The { - Department of Human Services - } { + Oregon
Health Authority + } may periodically limit enrollment of persons
described in ORS 414.708 in order to stay within the
legislatively adopted budget for the { - department - } { +
authority + }.
SECTION 82. ORS 414.710 is amended to read:
414.710. The following services { - are available to persons
eligible for services under ORS 414.025, 414.036, 414.042,
414.065 and 414.705 to 414.750 but such services - } are not
subject to ORS 414.720:
(1) Nursing facilities and home- and community-based waivered
services funded through the Department of Human Services; { +
and + }
{ - (2) Medical assistance to eligible persons who receive
assistance under ORS 411.706 or to children described in ORS
414.025 (2)(f), (i), (j), (k) and (m), 418.001 to 418.034,
418.189 to 418.970 and 657A.020 to 657A.460; - }
{ - (3) Institutional, home- and community-based waivered
services or community mental health program care for persons with
mental retardation, developmental disabilities or severe mental
illness and for the treatment of alcohol and drug dependent
persons; and - }
{ - (4) - } { + (2) + } Services to children who are wards
of the Department of Human Services by order of the juvenile
court and services to children and families for health care or
mental health care through the department.
SECTION 83. ORS 414.712 is amended to read:
414.712. The { - Department of Human Services - }
{ + Oregon Health Authority + } shall provide medical assistance
under ORS 414.705 to 414.750 to eligible persons who
{ - receive assistance under - } { + are determined eligible
for medical assistance by the Department of Human Services
according to + } ORS 411.706 { + . + } { - and to children
described in ORS 414.025 (2)(f), (i), (j), (k) and (m), 418.001
to 418.034, 418.189 to 418.970 and 657A.020 to 657A.460 and those
mental health and chemical dependency services recommended
according to standards of medical assistance and according to the
schedule of implementation established by the Legislative
Assembly. In providing medical assistance services described in
ORS 414.018 to 414.024, 414.042, 414.107, 414.710, 414.720 and
735.712, the Department of Human Services - } { + The Oregon
Health Authority + } shall also provide the following:
(1) Ombudsman services for eligible persons who receive
assistance under ORS 411.706. With the concurrence of the
Governor { + and the Oregon Health Authority Board + }, the
Director of { - Human Services - } { + the Oregon Health
Authority + }shall appoint ombudsmen and may terminate an
ombudsman. Ombudsmen are under the supervision and control of the
director. An ombudsman shall serve as a patient's advocate
whenever the patient or a physician or other medical personnel
serving the patient is reasonably concerned about access to,
quality of or limitations on the care being provided by a health
care provider. Patients shall be informed of the availability of
an ombudsman. Ombudsmen shall report to the Governor { + and the
Oregon Health Authority Board + } in writing at least once each
quarter. A report shall include a summary of the services that
the ombudsman provided during the quarter and the ombudsman's
recommendations for improving ombudsman services and access to or
quality of care provided to eligible persons by health care
providers.
(2) Case management services in each health care provider
organization for those eligible persons who receive assistance
under ORS 411.706. Case managers shall be trained in and shall
exhibit skills in communication with and sensitivity to the
unique health care needs of people who receive assistance under
ORS 411.706. Case managers shall be reasonably available to
assist patients served by the organization with the coordination
of the patient's health care services at the reasonable request
of the patient or a physician or other medical personnel serving
the patient. Patients shall be informed of the availability of
case managers.
(3) A mechanism, established by rule, for soliciting consumer
opinions and concerns regarding accessibility to and quality of
the services of each health care provider.
(4) A choice of available medical plans and, within those
plans, choice of a primary care provider.
(5) Due process procedures for any individual whose request for
medical assistance coverage for any treatment or service is
denied or is not acted upon with reasonable promptness. These
procedures shall include an expedited process for cases in which
a patient's medical needs require swift resolution of a dispute.
SECTION 84. ORS 414.725 is amended to read:
414.725. (1)(a) Pursuant to rules adopted by the
{ - Department of Human Services - } { + Oregon Health
Authority + }, the { - department - } { + authority + } shall
execute prepaid managed care health services contracts for health
services funded by the Legislative Assembly. The contract must
require that all services are provided to the extent and scope of
the Health Services Commission's report for each service provided
under the contract. The contracts are not subject to ORS chapters
279A and 279B, except ORS 279A.250 to 279A.290 and 279B.235.
Notwithstanding ORS 414.720 (8), the rules adopted by the
{ - department - } { + authority + } shall establish timelines
for executing the contracts described in this paragraph.
(b) It is the intent of ORS 414.705 to 414.750 that the state
use, to the greatest extent possible, prepaid managed care health
services organizations to provide physical health, dental, mental
health and chemical dependency services under ORS 414.705 to
414.750.
(c) The { - department - } { + authority + } shall solicit
qualified providers or plans to be reimbursed for providing the
covered services. The contracts may be with hospitals and medical
organizations, health maintenance organizations, managed health
care plans and any other qualified public or private prepaid
managed care health services organization. The
{ - department - } { + authority + } may not discriminate
against any contractors that offer services within their
providers' lawful scopes of practice.
(d) The { - department - } { + authority + } shall
establish annual financial reporting requirements for prepaid
managed care health services organizations. The
{ - department - } { + authority + } shall prescribe a
reporting procedure that elicits sufficiently detailed
information for the { - department - } { + authority + } to
assess the financial condition of each prepaid managed care
health services organization and that includes information on the
three highest executive salary and benefit packages of each
prepaid managed care health services organization.
(e) The { - department - } { + authority + } shall require
compliance with the provisions of paragraph (d) of this
subsection as a condition of entering into a contract with a
prepaid managed care health services organization.
(2) The { - department - } { + authority + } may institute
a fee-for-service case management system or a fee-for-service
payment system for the same physical health, dental, mental
health or chemical dependency services provided under the health
services contracts for persons eligible for health services under
ORS 414.705 to 414.750 in designated areas of the state in which
a prepaid managed care health services organization is not able
to assign an enrollee to a person or entity that is primarily
responsible for coordinating the physical health, dental, mental
health or chemical dependency services provided to the enrollee.
In addition, the { - department - } { + authority + } may
make other special arrangements as necessary to increase the
interest of providers in participation in the state's managed
care system, including but not limited to the provision of
stop-loss insurance for providers wishing to limit the amount of
risk they wish to underwrite.
(3) As provided in subsections (1) and (2) of this section, the
aggregate expenditures by the { - department - }
{ + authority + } for health services provided pursuant to ORS
414.705 to 414.750 may not exceed the total dollars appropriated
for health services under ORS 414.705 to 414.750.
(4) Actions taken by providers, potential providers,
contractors and bidders in specific accordance with ORS 414.705
to 414.750 in forming consortiums or in otherwise entering into
contracts to provide health care services shall be performed
pursuant to state supervision and shall be considered to be
conducted at the direction of this state, shall be considered to
be lawful trade practices and may not be considered to be the
transaction of insurance for purposes of the Insurance Code.
(5) Health care providers contracting to provide services under
ORS 414.705 to 414.750 shall advise a patient of any service,
treatment or test that is medically necessary but not covered
under the contract if an ordinarily careful practitioner in the
same or similar community would do so under the same or similar
circumstances.
(6) A prepaid managed care health services organization shall
provide information on contacting available providers to an
enrollee in writing within 30 days of assignment to the health
services organization.
(7) Each prepaid managed care health services organization
shall provide upon the request of an enrollee or prospective
enrollee annual summaries of the organization's aggregate data
regarding:
(a) Grievances and appeals; and
(b) Availability and accessibility of services provided to
enrollees.
(8) A prepaid managed care health services organization may not
limit enrollment in a designated area based on the zip code of an
enrollee or prospective enrollee.
SECTION 85. ORS 414.727 is amended to read:
414.727. (1) A prepaid managed care health services
organization, as defined in ORS 414.736, that contracts with the
{ - Department of Human Services - } { + Oregon Health
Authority + } under ORS 414.725 (1) to provide prepaid managed
care health services, including hospital services, shall
reimburse Type A and Type B hospitals and rural critical access
hospitals, as described in ORS 442.470 and identified by the
Office of Rural Health as rural hospitals, fully for the cost of
covered services based on the cost-to-charge ratio used for each
hospital in setting the capitation rates paid to the prepaid
managed care health services organization for the contract
period.
(2) The { - department - } { + authority + } shall base the
capitation rates described in subsection (1) of this section on
the most recent audited Medicare cost report for Oregon hospitals
adjusted to reflect the Medicaid mix of services.
(3) This section may not be construed to prohibit a prepaid
managed care health services organization and a hospital from
mutually agreeing to reimbursement other than the reimbursement
specified in subsection (1) of this section.
(4) Hospitals reimbursed under subsection (1) of this section
are not entitled to any additional reimbursement for services
provided.
SECTION 86. ORS 414.728 is amended to read:
414.728. For services provided to persons who are entitled to
receive medical assistance and whose medical assistance benefits
are not administered by a prepaid managed care health services
organization, as defined in ORS 414.736, the { - Department of
Human Services - } { + Oregon Health Authority + } shall
reimburse Type A and Type B hospitals and rural critical access
hospitals, as described in ORS 442.470 and identified by the
Office of Rural Health as rural hospitals, fully for the cost of
covered services based on the most recent audited Medicare cost
report for Oregon hospitals adjusted to reflect the Medicaid mix
of services.
SECTION 87. ORS 414.735 is amended to read:
414.735. (1) If insufficient resources are available during a
contract period:
(a) The population of eligible persons determined by law shall
not be reduced.
(b) The reimbursement rate for providers and plans established
under the contractual agreement shall not be reduced.
(2) In the circumstances described in subsection (1) of this
section, reimbursement shall be adjusted by reducing the health
services for the eligible population by eliminating services in
the order of priority recommended by the Health Services
Commission, starting with the least important and progressing
toward the most important.
(3) The { - Department of Human Services - } { + Oregon
Health Authority Board + } shall obtain the approval of the
Legislative Assembly or Emergency Board, if the Legislative
Assembly is not in session, before instituting the reductions. In
addition, providers contracting to provide health services under
ORS 414.705 to 414.750 must be notified at least two weeks prior
to any legislative consideration of such reductions. Any
reductions made under this section shall take effect no sooner
than 60 days following final legislative action approving the
reductions.
SECTION 88. ORS 414.736 is amended to read:
414.736. As used in this section and ORS 414.725, 414.737,
414.738, 414.739, 414.740, 414.741, 414.742 { - , - }
{ + and + } 414.743 { - and 414.744 - } :
(1) 'Designated area' means a geographic area of the state
defined by the { - Department of Human Services - }
{ + Oregon Health Authority + } by rule that is served by a
prepaid managed care health services organization.
(2) 'Fully capitated health plan' means an organization that
contracts with the { - Department of Human Services - }
{ + Oregon Health Authority or the Oregon Health Authority
Board + } on a prepaid capitated basis under ORS 414.725 to
provide an adequate network of providers to ensure that the
health services provided under the contract are reasonably
accessible to enrollees.
(3) 'Physician care organization' means an organization that
contracts with the { - Department of Human Services - }
{ + Oregon Health Authority or the Oregon Health Authority
Board + } on a prepaid capitated basis under ORS 414.725 to
provide an adequate network of providers to ensure that the
health services described in ORS 414.705 (1)(b), (c), (d), (e),
(g) and (j) are reasonably accessible to enrollees. A physician
care organization may also contract with the { - department - }
{ + authority or the board + } on a prepaid capitated basis to
provide the health services described in ORS 414.705 (1)(k) and
(L).
(4) 'Prepaid managed care health services organization ' means
a managed physical health, dental, mental health or chemical
dependency organization that contracts with the { - Department
of Human Services - } { + authority or the board + } on a
prepaid capitated basis under ORS 414.725. A prepaid managed care
health services organization may be a dental care organization,
fully capitated health plan, physician care organization, mental
health organization or chemical dependency organization.
SECTION 89. ORS 414.737 is amended to read:
414.737. (1) Except as provided in subsections (2) and (3) of
this section, a person who is eligible for or receiving physical
health, dental, mental health or chemical dependency services
under ORS 414.705 to 414.750 must be enrolled in the prepaid
managed care health services organizations to receive the health
services for which the person is eligible.
(2) Subsection (1) of this section does not apply to:
(a) A person who is a noncitizen and who is eligible only for
labor and delivery services and emergency treatment services;
(b) A person who is an American Indian and Alaskan Native
beneficiary; and
(c) A person whom the { - department - } { + Oregon Health
Authority + } may by rule exempt from the mandatory enrollment
requirement of subsection (1) of this section, including but not
limited to:
(A) A person who is also eligible for Medicare;
(B) A woman in her third trimester of pregnancy at the time of
enrollment;
(C) A person under 19 years of age who has been placed in
adoptive or foster care out of state;
(D) A person under 18 years of age who is medically fragile and
who has special health care needs; and
(E) A person with major medical coverage.
(3) Subsection (1) of this section does not apply to a person
who resides in a designated area in which a prepaid managed care
health services organization providing physical health, dental,
mental health or chemical dependency services is not able to
assign an enrollee to a person or entity that is primarily
responsible for coordinating the physical health, dental, mental
health or chemical dependency services provided to the enrollee.
(4) As used in this section, 'American Indian and Alaskan
Native beneficiary' means:
(a) A member of a federally recognized Indian tribe, band or
group;
(b) An Eskimo or Aleut or other Alaskan Native enrolled by the
United States Secretary of the Interior pursuant to the Alaska
Native Claims Settlement Act, 43 U.S.C. 1601; or
(c) A person who is considered by the United States Secretary
of the Interior to be an Indian for any purpose.
SECTION 90. ORS 414.737, as amended by section 8, chapter 751,
Oregon Laws 2007, is amended to read:
414.737. (1) Except as provided in subsections (2) and (3) of
this section, a person who is eligible for or receiving physical
health, dental, mental health or chemical dependency services
under ORS 414.705 to 414.750 must be enrolled in the prepaid
managed care health services organizations to receive the health
services for which the person is eligible.
(2) Subsection (1) of this section does not apply to:
(a) A person who is a noncitizen and who is eligible only for
labor and delivery services and emergency treatment services;
(b) A person who is an American Indian and Alaskan Native
beneficiary; and
(c) A person whom the { - department - } { + Oregon Health
Authority + } may by rule exempt from the mandatory enrollment
requirement of subsection (1) of this section, including but not
limited to:
(A) A person who is also eligible for Medicare;
(B) A woman in her third trimester of pregnancy at the time of
enrollment;
(C) A person under 19 years of age who has been placed in
adoptive or foster care out of state;
(D) A person under 18 years of age who is medically fragile and
who has special health care needs;
(E) A person receiving services under the Medically Involved
Home-Care Program created by ORS 417.345 (1); and
(F) A person with major medical coverage.
(3) Subsection (1) of this section does not apply to a person
who resides in a designated area in which a prepaid managed care
health services organization providing physical health, dental,
mental health or chemical dependency services is not able to
assign an enrollee to a person or entity that is primarily
responsible for coordinating the physical health, dental, mental
health or chemical dependency services provided to the enrollee.
(4) As used in this section, 'American Indian and Alaskan
Native beneficiary' means:
(a) A member of a federally recognized Indian tribe, band or
group;
(b) An Eskimo or Aleut or other Alaskan Native enrolled by the
United States Secretary of the Interior pursuant to the Alaska
Native Claims Settlement Act, 43 U.S.C. 1601; or
(c) A person who is considered by the United States Secretary
of the Interior to be an Indian for any purpose.
SECTION 91. ORS 414.738 is amended to read:
414.738. (1) If the { - Department of Human Services - }
{ + Oregon Health Authority + } has not been able to contract
with the fully capitated health plan or plans in a designated
area, the
{ - department - } { + authority + } may contract with a
physician care organization in the designated area.
(2) The Office for Oregon Health Policy and Research shall
develop criteria that the { - department - }
{ + authority + } shall consider when determining the
circumstances under which the { - department - }
{ + authority + } may contract with a physician care
organization. The criteria developed by the office shall include
but not be limited to the following:
(a) The physician care organization must be able to assign an
enrollee to a person or entity that is primarily responsible for
coordinating the physical health services provided to the
enrollee;
(b) The contract with a physician care organization does not
threaten the financial viability of other fully capitated health
plans in the designated area; and
(c) The contract with a physician care organization must be
consistent with the legislative intent of using prepaid managed
care health services organizations to provide services under ORS
414.705 to 414.750.
SECTION 92. ORS 414.739 is amended to read:
414.739. (1) A fully capitated health plan may apply to the
{ - Department of Human Services - } { + Oregon Health
Authority + } to contract with the { - department - }
{ + authority + } as a physician care organization rather than
as a fully capitated health plan to provide services under ORS
414.705 to 414.750.
(2) The Office for Oregon Health Policy and Research shall
develop the criteria that the { - department - }
{ + authority + } must use to determine the circumstances under
which the { - department - } { + authority + } may accept an
application by a fully capitated health plan to contract as a
physician care organization. The criteria developed by the office
shall include but not be limited to the following:
(a) The fully capitated health plan must show documented losses
due to hospital risk and must show due diligence in managing
those risks; and
(b) Contracting as a physician care organization is financially
viable for the fully capitated health plan.
SECTION 93. ORS 414.740 is amended to read:
414.740. (1) Notwithstanding ORS 414.738 (1), the
{ - Department of Human Services - } { + Oregon Health
Authority + } shall contract under ORS 414.725 with a prepaid
group practice health plan that serves at least 200,000 members
in this state and that has been issued a certificate of authority
by the { - Department of Consumer and Business Services - }
{ + authority + } as a health care service contractor to provide
health services as described in ORS 414.705 (1)(b), (c), (d),
(e), (g) and (j). A health plan may also contract with the
{ - Department of Human Services - } { + authority + } on a
prepaid capitated basis to provide the health services described
in ORS 414.705 (1)(k) and (L). The { - Department of Human
Services - } { + authority + } may accept financial
contributions from any public or private entity to help implement
and administer the contract. The
{ - Department of Human Services - } { + authority + } shall
seek federal matching funds for any financial contributions
received under this section.
(2) In a designated area, in addition to the contract described
in subsection (1) of this section, the { - Department of Human
Services - } { + authority + } shall contract with prepaid
managed care health services organizations to provide health
services under ORS 414.705 to 414.750.
SECTION 94. ORS 414.741 is amended to read:
414.741. (1) The Health Services Commission shall retain an
actuary to determine the benchmark for setting per capita rates
necessary to reimburse prepaid managed care health services
organizations and fee-for-service providers for the cost of
providing health services under ORS 414.705 to 414.750.
(2) The actuary retained by the commission shall use the
following information to determine the benchmark for setting per
capita rates:
(a) For hospital services, the most recently available Medicare
cost reports for Oregon hospitals;
(b) For services of physicians licensed under ORS chapter 677
and other health professionals using procedure codes, the
Medicare Resource Based Relative Value system conversion rates
for Oregon;
(c) For prescription drugs, the most recent payment
methodologies in the fee-for-service payment system for the
Oregon Health Plan;
(d) For durable medical equipment and supplies, 80 percent of
the Medicare allowable charge for purchases and rentals;
(e) For dental services, the most recent payment rates obtained
from dental care organization encounter data; and
(f) For all other services not listed in paragraphs (a) to (e)
of this subsection:
(A) The Medicare maximum allowable charge, if available; or
(B) The most recent payment rates obtained from the data
available under subsection (3) of this section.
(3) The actuary shall use the most current encounter data and
the most current fee-for-service data that is available,
reasonable trends for utilization and cost changes to the
midpoint of the next biennium, appropriate differences in
utilization and cost based on geography, state and federal
mandates and other factors that, in the professional judgment of
the actuary, are relevant to the fair and reasonable estimation
of costs. The Department of Human Services shall provide the
actuary with the data and information in the possession of the
department or contractors of the department reasonably necessary
to develop a benchmark for setting per capita rates.
(4) The commission shall report the benchmark per capita rates
developed under this section to the Director of the Oregon
Department of Administrative Services, the Director of
{ - Human Services - } { + the Oregon Health Authority + } and
the Legislative Fiscal Officer no later than August 1 of every
even-numbered year.
(5) The { - Department of Human Services - } { + Oregon
Health Authority + } shall retain an actuary to determine:
(a) Per capita rates for health services that the
{ - department - } { + authority + } shall use to develop the
{ - department's - } { + authority's + } proposed biennial
budget; and
(b) Capitation rates to reimburse physician care organizations
for the cost of providing health services under ORS 414.705 to
414.750 using the same methodologies used to develop capitation
rates for fully capitated health plans. The rates may not
advantage or disadvantage fully capitated health plans for
similar services.
(6) The { - Department of Human Services - } { + Oregon
Health Authority + } shall submit to the Legislative Assembly no
later than February 1 of every odd-numbered year a report
comparing the per capita rates for health services on which the
proposed budget of the { - department - } { + authority + }
is based with the rates developed by the actuary retained by the
Health Services Commission. If the rates differ, the
{ - department - } { + authority + } shall disclose, by
provider categories described in subsection (2) of this section,
the amount of and reason for each variance.
SECTION 95. ORS 414.742 is amended to read:
414.742. The { - Department of Human Services - }
{ + Oregon Health Authority + } may not establish capitation
rates that include payment for mental health drugs. The
{ - department - } { + authority + } shall reimburse pharmacy
providers for mental health drugs only on a fee-for-service
payment basis.
SECTION 96. ORS 414.743 is amended to read:
414.743. (1) As used in this section, 'fully capitated health
plan' means an organization that contracts with the
{ - Department of Human Services - } { + Oregon Health
Authority + } on a prepaid capitated basis under ORS 414.725 to
provide an adequate network of providers to ensure that all
health services described in ORS 414.705 are reasonably
accessible to enrollees.
(2) A fully capitated health plan that does not have a contract
with a hospital to provide inpatient or outpatient hospital
services under ORS 414.705 to 414.750 must pay for hospital
services at 80 percent of the Medicare rate for the
noncontracting hospital.
(3) A hospital that does not have a contract with a fully
capitated health plan to provide inpatient or outpatient hospital
services under ORS 414.705 to 414.750 must accept as payment in
full the rates described in subsection (2) of this section.
(4) This section does not apply to type A and type B hospitals,
as described in ORS 442.470, and rural critical access hospitals,
as defined in ORS 315.613.
(5) The { - Department of Human Services - } { + Oregon
Health Authority + } shall adopt rules to implement and
administer this section.
SECTION 97. ORS 414.743, as amended by section 2, chapter 886,
Oregon Laws 2007, is amended to read:
414.743. (1) As used in this section, 'fully capitated health
plan' means an organization that contracts with the
{ - Department of Human Services - } { + Oregon Health
Authority + } on a prepaid capitated basis under ORS 414.725 to
provide an adequate network of providers to ensure that all
health services described in ORS 414.705 are reasonably
accessible to enrollees.
(2) A fully capitated health plan that does not have a contract
with a hospital to provide inpatient or outpatient hospital
services under ORS 414.705 to 414.750 must pay for hospital
services as follows:
(a) For inpatient hospital services, based on the capitation
rates developed for the budget period, at the level of the
statewide average unit cost, multiplied by the geographic factor,
the payment discount factor and an adjustment factor of 0.925.
(b) For outpatient hospital services, based on the capitation
rates developed for the budget period, at the level of charges
multiplied by the statewide average cost-to-charge ratio, the
geographic factor, the payment discount factor and an adjustment
factor of 0.925.
(3) A hospital that does not have a contract with a fully
capitated health plan to provide inpatient or outpatient hospital
services under ORS 414.705 to 414.750 must accept as payment in
full for hospital services, rates:
(a) For inpatient hospital services, based on the capitation
rates developed for the budget period, at the level of the
statewide average unit cost, multiplied by the geographic factor,
the payment discount factor and an adjustment factor of 0.925.
(b) For outpatient hospital services, based on the capitation
rates developed for the budget period, at the level of charges
multiplied by the statewide average cost-to-charge ratio, the
geographic factor, the payment discount factor and an adjustment
factor of 0.925.
(4) This section does not apply to type A and type B hospitals,
as described in ORS 442.470, and rural critical access hospitals,
as defined in ORS 315.613.
(5) The { - Department of Human Services - } { + Oregon
Health Authority + } shall adopt rules to implement and
administer this section.
SECTION 98. Section 18, chapter 810, Oregon Laws 2003, is
amended to read:
{ + Sec. 18. + } { - (1) - } Except as provided in section
19 { - of this 2003 Act - } , { + chapter 810, Oregon Laws
2003, + } sections 2, 3, 5, 5a, 11, 12, 12a, 14 and 15 { - of
this 2003 Act - } , { + chapter 810, Oregon Laws 2003, + } and
the amendments to ORS 414.705 and 414.725 by sections 4 and 7
{ - of this 2003 Act - } { + , chapter 810, Oregon Laws
2003, + } become operative on October 1, 2003.
{ - (2) Sections 10 and 13 of this 2003 Act become operative
on the day after the date the Department of Human Services
receives the necessary waivers from the Centers for Medicare and
Medicaid Services. - }
{ - (3) The Director of Human Services shall notify the
Legislative Counsel upon receipt of the waivers or denial of the
waiver request. - }
SECTION 99. ORS 414.750 is amended to read:
414.750. Nothing in ORS { - 414.036 and - } 414.705 to
414.750 is intended to limit the authority of the Legislative
Assembly to authorize services for persons whose income exceeds
100 percent of the federal poverty level for whom federal medical
assistance matching funds are available if state funds are
available therefor.
SECTION 100. ORS 414.751 is amended to read:
414.751. (1) There is established in the { - Office for
Oregon Health Policy and Research - } { + Oregon Health
Authority + } the Office for Oregon Health Policy and Research
Advisory Committee composed of members appointed by the Governor.
Members shall include:
(a) Representatives of managed care health services
organizations under contract with the { - Department of Human
Services - } { + Oregon Health Authority + } pursuant to ORS
414.725 and serving primarily rural areas of the state;
(b) Representatives of managed care health services
organizations under contract with the { - Department of Human
Services - } { + Oregon Health Authority + } pursuant to ORS
414.725 and serving primarily urban areas of the state;
(c) Representatives of medical organizations representing
health care providers under contract with managed care health
services organizations pursuant to ORS 414.725 who serve patients
in both rural and urban areas of the state; { + and + }
(d) One representative from Type A hospitals and one
representative from Type B hospitals { + . + } { - ; and - }
{ - (e) Representatives of the Department of Human
Services. - }
(2) Members of the advisory committee shall not be entitled to
compensation or per diem.
SECTION 101. ORS 414.805 is amended to read:
414.805. (1) An individual who receives medical services while
in the custody of a law enforcement officer is liable:
(a) To the provider of the medical services for the charges and
expenses therefor; and
(b) To the { - Department of Human Services - } { + Oregon
Health Authority + } for any charges or expenses paid by the
{ - Department of Human Services - } { + authority + } out of
the Law Enforcement Medical Liability Account for the medical
services.
(2) A person providing medical services to an individual
described in subsection (1)(a) of this section shall first make
reasonable efforts to collect the charges and expenses thereof
from the individual before seeking to collect them from the
{ - Department of Human Services - } { + authority + } out of
the Law Enforcement Medical Liability Account.
(3)(a) If the provider has not been paid within 45 days of the
date of the billing, the provider may bill the { - Department
of Human Services - } { + authority + } who shall pay the
account out of the Law Enforcement Medical Liability Account.
(b) A bill submitted to the { - Department of Human
Services - } { + authority + } under this subsection must be
accompanied by evidence documenting that:
(A) The provider has billed the individual or the individual's
insurer or health care service contractor for the charges or
expenses owed to the provider; and
(B) The provider has made a reasonable effort to collect from
the individual or the individual's insurer or health care service
contractor the charges and expenses owed to the provider.
(c) If the provider receives payment from the individual or the
insurer or health care service contractor after receiving payment
from the { - Department of Human Services - }
{ + authority + }, the provider shall repay the
{ - department - } { + authority + } the amount received from
the public agency less any difference between payment received
from the individual, insurer or contractor and the amount of the
billing.
(4) As used in this section:
(a) 'Law enforcement officer' means an officer who is
commissioned and employed by a public agency as a peace officer
to enforce the criminal laws of this state or laws or ordinances
of a public agency.
(b) 'Public agency' means the state, a city, port, school
district, mass transit district or county.
SECTION 102. ORS 414.807 is amended to read:
414.807. (1)(a) When charges and expenses are incurred for
medical services provided to an individual for injuries related
to law enforcement activity and subject to the availability of
funds in the account, the cost of such services shall be paid by
the
{ - Department of Human Services - } { + Oregon Health
Authority + } out of the Law Enforcement Medical Liability
Account established in ORS 414.815 if the provider of the medical
services has made all reasonable efforts to collect the amount,
or any part thereof, from the individual who received the
services.
(b) When a law enforcement agency involved with an injury
certifies that the injury is related to law enforcement activity,
the { - Department of Human Services - } { + Oregon Health
Authority + } shall pay the provider:
(A) If the provider is a hospital, in accordance with current
fee schedules established by the Director of the Department of
Consumer and Business Services for purposes of workers'
compensation under ORS 656.248; or
(B) If the provider is other than a hospital, 75 percent of the
customary and usual rates for the services.
(2) After the injured person is incarcerated and throughout the
period of incarceration, the { - Department of Human
Services - } { + Oregon Health Authority + } shall continue to
pay, out of the Law Enforcement Medical Liability Account,
charges and expenses for injuries related to law enforcement
activities as provided in subsection (1) of this section. Upon
release of the injured person from actual physical custody, the
Law Enforcement Medical Liability Account is no longer liable for
the payment of medical expenses of the injured person.
(3) If the provider of medical services has filed a medical
services lien as provided in ORS 87.555, the { - Department of
Human Services - } { + Oregon Health Authority + } shall be
subrogated to the rights of the provider to the extent of
payments made by the
{ - Department of Human Services - } { + authority + } to the
provider for the medical services. The { - Department of Human
Services - } { + authority + } may foreclose the lien as
provided in ORS 87.585.
(4) The { - Department of Human Services - }
{ + authority + } shall deposit in the Law Enforcement Medical
Liability Account all moneys received by the { - department - }
{ + authority + } from:
(a) Providers of medical services as repayment;
(b) Individuals whose medical expenses were paid by the
{ - department - } { + authority + } under this section; and
(c) Foreclosure of a lien as provided in subsection (3) of this
section.
(5) As used in this section:
(a) 'Injuries related to law enforcement activity' means
injuries sustained prior to booking, citation in lieu of arrest
or release instead of booking that occur during and as a result
of efforts by a law enforcement officer to restrain or detain, or
to take or retain custody of, the individual.
(b) 'Law enforcement officer' has the meaning given that term
in ORS 414.805.
SECTION 103. ORS 414.815 is amended to read:
414.815. (1) The Law Enforcement Medical Liability Account is
established separate and distinct from the General Fund. Interest
earned, if any, shall inure to the benefit of the account. The
moneys in the Law Enforcement Medical Liability Account are
appropriated continuously to the { - Department of Human
Services - } { + Oregon Health Authority + } to pay expenses in
administering the account and paying claims out of the account as
provided in ORS 414.807.
(2) The liability of the Law Enforcement Medical Liability
Account is limited to funds accrued to the account from
assessments collected under ORS 137.309 (6), (8) or (9), or
collected from individuals under ORS 414.805.
(3) The { - Department of Human Services - }
{ + authority + } may contract with persons experienced in
medical claims processing to provide claims processing for the
account.
(4) The { - Department of Human Services - }
{ + authority + } shall adopt rules to implement administration
of the Law Enforcement Medical Liability Account including, but
not limited to, rules that establish reasonable deadlines for
submission of claims.
(5) Each biennium, the { - Department of Human Services - }
{ + Oregon Health Authority + } shall submit a report to the
Legislative Assembly regarding the status of the Law Enforcement
Medical Liability Account. Within 30 days of the convening of
each regular legislative session, the { - department - }
{ + authority + } shall submit the report to the chair of the
Senate Judiciary Committee and the chair of the House Judiciary
Committee. The report shall include, but is not limited to, the
number of claims submitted and paid during the biennium and the
amount of money in the fund at the time of the report.
SECTION 104. ORS 442.011 is amended to read:
442.011. (1) There is created in the { - Department of Human
Services - } { + Oregon Health Authority + } 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 Fund Board.
SECTION 105. ORS 442.011, as amended by section 15, chapter
697, Oregon Laws 2007, is amended to read:
442.011. { - (1) - } There is created in the
{ - Department of Human Services - } { + Oregon Health
Authority + } 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. - }
SECTION 106. ORS 442.015 is amended to read:
442.015. As used in ORS chapter 441 and this chapter, unless
the context requires otherwise:
(1) 'Acquire' or 'acquisition' means obtaining equipment,
supplies, components or facilities by any means, including
purchase, capital or operating lease, rental or donation, with
intention of using such equipment, supplies, components or
facilities to provide health services in Oregon. When equipment
or other materials are obtained outside of this state,
acquisition is considered to occur when the equipment or other
materials begin to be used in Oregon for the provision of health
services or when such services are offered for use in Oregon.
(2) 'Adjusted admission' means the sum of all inpatient
admissions divided by the ratio of inpatient revenues to total
patient revenues.
(3) 'Affected persons' has the same meaning as given to '
party' in ORS 183.310.
(4) 'Ambulatory surgical center' means a facility that performs
outpatient surgery not routinely or customarily performed in a
physician's or dentist's office, and is able to meet health
facility licensure requirements.
(5) 'Audited actual experience' means data contained within
financial statements examined by an independent, certified public
accountant in accordance with generally accepted auditing
standards.
(6) 'Budget' means the projections by the hospital for a
specified future time period of expenditures and revenues with
supporting statistical indicators.
(7) 'Case mix' means a calculated index for each hospital,
based on financial accounting and case mix data collection as set
forth in ORS 442.425, reflecting the relative costliness of that
hospital's mix of cases compared to a state or national mix of
cases.
{ - (8) 'Commission' means the Oregon Health Policy
Commission. - }
{ - (9) 'Department' means the Department of Human Services
of the State of Oregon. - }
{ - (10) - } { + (8) + } 'Develop' means to undertake those
activities that on their completion will result in the offer of a
new institutional health service or the incurring of a financial
obligation, as defined under applicable state law, in relation to
the offering of such a health service.
{ - (11) 'Director' means the Director of Human Services. - }
{ - (12) - } { + (9) + } 'Expenditure' or 'capital
expenditure' means the actual expenditure, an obligation to an
expenditure, lease or similar arrangement in lieu of an
expenditure, and the reasonable value of a donation or grant in
lieu of an expenditure but not including any interest thereon.
{ - (13) - } { + (10) + } 'Freestanding birthing center'
means a facility licensed for the primary purpose of performing
low risk deliveries.
{ - (14) - } { + (11) + } ' Governmental unit' means the
state, or any county, municipality or other political
subdivision, or any related department, division, board or other
agency.
{ - (15) - } { + (12) + } ' Gross revenue' means the sum
of daily hospital service charges, ambulatory service charges,
ancillary service charges and other operating revenue. 'Gross
revenue' does not include contributions, donations, legacies or
bequests made to a hospital without restriction by the donors.
{ - (16)(a) - } { + (13)(a) + } ' Health care facility'
means a hospital, a long term care facility, an ambulatory
surgical center, a freestanding birthing center or an outpatient
renal dialysis facility.
(b) 'Health care facility' does not mean:
(A) An establishment furnishing residential care or treatment
not meeting federal intermediate care standards, not following a
primarily medical model of treatment, prohibited from admitting
persons requiring 24-hour nursing care and licensed or approved
under the rules of the Department of Human Services or the
Department of Corrections; or
(B) An establishment furnishing primarily domiciliary care.
{ - (17) - } { + (14) + } ' Health maintenance
organization' or 'HMO ' means a public organization or a private
organization organized under the laws of any state that:
(a) Is a qualified HMO under section 1310 (d) of the U.S.
Public Health Services Act; or
(b)(A) Provides or otherwise makes available to enrolled
participants health care services, including at least the
following basic health care services:
(i) Usual physician services;
(ii) Hospitalization;
(iii) Laboratory;
(iv) X-ray;
(v) Emergency and preventive services; and
(vi) Out-of-area coverage;
(B) Is compensated, except for copayments, for the provision of
the basic health care services listed in subparagraph (A) of this
paragraph to enrolled participants on a predetermined periodic
rate basis; and
(C) Provides physicians' services primarily directly through
physicians who are either employees or partners of such
organization, or through arrangements with individual physicians
or one or more groups of physicians organized on a group practice
or individual practice basis.
{ - (18) - } { + (15) + } 'Health services' means
clinically related diagnostic, treatment or rehabilitative
services, and includes alcohol, drug or controlled substance
abuse and mental health services that may be provided either
directly or indirectly on an inpatient or ambulatory patient
basis.
{ - (19) - } { + (16) + } ' Hospital' means a facility
with an organized medical staff, with permanent facilities that
include inpatient beds and with medical services, including
physician services and continuous nursing services under the
supervision of registered nurses, to provide diagnosis and
medical or surgical treatment primarily for but not limited to
acutely ill patients and accident victims, to provide treatment
for patients with mental illness or to provide treatment in
special inpatient care facilities.
{ - (20) - } { + (17) + } ' Institutional health services'
means health services provided in or through health care
facilities and includes the entities in or through which such
services are provided.
{ - (21) - } { + (18) + } ' Intermediate care facility'
means a facility that provides, on a regular basis,
health-related care and services to individuals who do not
require the degree of care and treatment that a hospital or
skilled nursing facility is designed to provide, but who because
of their mental or physical condition require care and services
above the level of room and board that can be made available to
them only through institutional facilities.
{ - (22) - } { + (19) + } ' Long term care facility' means
a facility with permanent facilities that include inpatient beds,
providing medical services, including nursing services but
excluding surgical procedures except as may be permitted by the
rules of the Director { + of Human Services + }, to provide
treatment for two or more unrelated patients. 'Long term care
facility' includes skilled nursing facilities and intermediate
care facilities but may not be construed to include facilities
licensed and operated pursuant to ORS 443.400 to 443.455.
{ - (23) - } { + (20) + } ' Major medical equipment' means
medical equipment that is used to provide medical and other
health services and that costs more than $1 million. 'Major
medical equipment' does not include medical equipment acquired by
or on behalf of a clinical laboratory to provide clinical
laboratory services, if the clinical laboratory is independent of
a physician's office and a hospital and has been determined under
Title XVIII of the Social Security Act to meet the requirements
of paragraphs (10) and (11) of section 1861(s) of that Act.
{ - (24) - } { + (21) + } ' Net revenue' means gross
revenue minus deductions from revenue.
{ - (25) - } { + (22) + } ' New hospital' means a facility
that did not offer hospital services on a regular basis within
its service area within the prior 12-month period and is
initiating or proposing to initiate such services. 'New hospital'
also includes any replacement of an existing hospital that
involves a substantial increase or change in the services
offered.
{ - (26) - } { + (23) + } ' New skilled nursing or
intermediate care service or facility' means a service or
facility that did not offer long term care services on a regular
basis by or through the facility within the prior 12-month period
and is initiating or proposing to initiate such services. 'New
skilled nursing or intermediate care service or facility' also
includes the rebuilding of a long term care facility, the
relocation of buildings that are a part of a long term care
facility, the relocation of long term care beds from one facility
to another or an increase in the number of beds of more than 10
or 10 percent of the bed capacity, whichever is the lesser,
within a two-year period.
{ - (27) - } { + (24) + } ' Offer' means that the health
care facility holds itself out as capable of providing, or as
having the means for the provision of, specified health services.
{ - (28) - } { + (25) + } ' Operating expenses' means the
sum of daily hospital service expenses, ambulatory service
expenses, ancillary expenses and other operating expenses,
excluding income taxes.
{ - (29) - } { + (26) + } ' Outpatient renal dialysis
facility' means a facility that provides renal dialysis services
directly to outpatients.
{ - (30) - } { + (27) + } ' Person' means an individual, a
trust or estate, a partnership, a corporation (including
associations, joint stock companies and insurance companies), a
state, or a political subdivision or instrumentality, including a
municipal corporation, of a state.
{ - (31) - } { + (28) + } 'Skilled nursing facility' means
a facility or a distinct part of a facility, that is primarily
engaged in providing to inpatients skilled nursing care and
related services for patients who require medical or nursing
care, or an institution that provides rehabilitation services for
the rehabilitation of individuals who are injured or sick or who
have disabilities.
{ - (32) - } { + (29) + } 'Special inpatient care facility'
means a facility with permanent inpatient beds and other
facilities designed and utilized for special health care
purposes, including but not limited to a rehabilitation center, a
college infirmary, a chiropractic facility, a facility for the
treatment of alcoholism or drug abuse, an inpatient care facility
meeting the requirements of ORS 441.065, and any other
establishment falling within a classification established by the
{ - Department of Human Services - } { + Oregon Health
Authority + }, after determination of the need for such
classification and the level and kind of health care appropriate
for such classification.
{ - (33) - } { + (30) + } 'Total deductions from gross
revenue' or ' deductions from revenue' means reductions from
gross revenue resulting from inability to collect payment of
charges. Such reductions include bad debts, contractual
adjustments, uncompensated care, administrative, courtesy and
policy discounts and adjustments and other such revenue
deductions. The deduction shall be net of the offset of
restricted donations and grants for indigent care.
SECTION 107. ORS 735.610 is amended to read:
735.610. (1) There is created in the { - Department of
Consumer and Business Services - } { + Oregon Health
Authority + } the Oregon Medical Insurance Pool Board. The board
shall establish the Oregon Medical Insurance Pool and otherwise
carry out the responsibilities of the board under ORS 735.600 to
735.650.
(2) The board shall consist of nine individuals, eight of whom
shall be appointed by the Director of the { - Department of
Consumer and Business Services - } { + Oregon Health
Authority + }. The Director of the { - Department of Consumer
and Business Services - } { + Oregon Health Authority + } or the
director's designee shall be a member of the board. The chair of
the board shall be elected from among the members of the board.
The board shall at all times, to the extent possible, include at
least one representative of a domestic insurance company licensed
to transact health insurance, one representative of a domestic
not-for-profit health care service contractor, one representative
of a health maintenance organization, one representative of
reinsurers and two members of the general public who are not
associated with the medical profession, a hospital or an insurer.
(3) The director may fill any vacancy on the board by
appointment.
(4) The board shall have the general powers and authority
granted under the laws of this state to insurance companies with
a certificate of authority to transact health insurance and the
specific authority to:
(a) Enter into such contracts as are necessary or proper to
carry out the provisions and purposes of ORS 735.600 to 735.650
including the authority to enter into contracts with similar
pools of other states for the joint performance of common
administrative functions, or with persons or other organizations
for the performance of administrative functions;
(b) Recover any assessments for, on behalf of, or against
insurers;
(c) Take such legal action as is necessary to avoid the payment
of improper claims against the pool or the coverage provided by
or through the pool;
(d) Establish appropriate rates, rate schedules, rate
adjustments, expense allowances, insurance producers' referral
fees, claim reserves or formulas and perform any other actuarial
function appropriate to the operation of the pool. Rates may not
be unreasonable in relation to the coverage provided, the risk
experience and expenses of providing the coverage. Rates and rate
schedules may be adjusted for appropriate risk factors such as
age and area variation in claim costs and shall take into
consideration appropriate risk factors in accordance with
established actuarial and underwriting practices;
(e) Issue policies of insurance in accordance with the
requirements of ORS 735.600 to 735.650;
(f) Appoint from among insurers appropriate actuarial and other
committees as necessary to provide technical assistance in the
operation of the pool, policy and other contract design, and any
other function within the authority of the board;
(g) Seek advances to effect the purposes of the pool; and
(h) Establish rules, conditions and procedures for reinsuring
risks under ORS 735.600 to 735.650.
(5) Each member of the board is entitled to compensation and
expenses as provided in ORS 292.495.
(6) The Director of the { - Department of Consumer and
Business Services - } { + Oregon Health Authority + } shall
adopt rules, as provided under ORS chapter 183, implementing
policies recommended by the board for the purpose of carrying out
ORS 735.600 to 735.650.
(7) In consultation with the board, the director shall employ
such staff and consultants as may be necessary for the purpose of
carrying out responsibilities under ORS 735.600 to 735.650.
SECTION 108. ORS 735.612 is amended to read:
735.612. (1) There is established in the State Treasury, the
Oregon Medical Insurance Pool Account, which shall consist of:
(a) Moneys appropriated to the account by the Legislative
Assembly to obtain the coverage described in ORS 735.625.
(b) Interest earnings from the investment of moneys in the
account.
(c) Assessments and other revenues collected or received by the
Oregon Medical Insurance Pool Board.
(2) All moneys in the Oregon Medical Insurance Pool Account are
continuously appropriated to the Oregon Medical Insurance Pool
Board to carry out the provisions of ORS 735.600 to 735.650.
(3) The Oregon Medical Insurance Pool Board shall transfer to
the { - Consumer and Business Services Fund created by ORS
705.145 - } { + Oregon Health Authority Fund established in
section 19 of this 2009 Act + } an amount equal to the operating
budget authorized by the Legislative Assembly or as that budget
may be modified by the Emergency Board or the Oregon Department
of Administrative Services, for operation of the Oregon Medical
Insurance Pool Board.
SECTION 109. ORS 735.614 is amended to read:
735.614. (1) If the Oregon Medical Insurance Pool Board
determines at any time that funds in the Oregon Medical Insurance
Pool Account are or will become insufficient for payment of
expenses of the pool in a timely manner, the board shall
determine the amount of funds needed and shall impose and collect
assessments against insurers, as provided in this section, in the
amount of the funds determined to be needed.
(2) Each insurer's assessment shall be determined by
multiplying the total amount to be assessed by a fraction, the
numerator of which equals the number of Oregon insureds and
certificate holders insured or reinsured by each insurer, and the
denominator of which equals the total of all Oregon insureds and
certificate holders insured or reinsured by all insurers, all
determined as of March 31 each year.
(3) The board shall ensure that each insured and certificate
holder is counted only once with respect to any assessment. For
that purpose, the board shall require each insurer that obtains
reinsurance for its insureds and certificate holders to include
in its count of insureds and certificate holders all insureds and
certificate holders whose coverage is reinsured in whole or part.
The board shall allow an insurer who is a reinsurer to exclude
from its number of insureds those that have been counted by the
primary insurer or the primary reinsurer for the purpose of
determining its assessment under this subsection.
(4) Each insurer shall pay its assessment as required by the
board.
(5) If assessments exceed the amounts actually needed, the
excess shall be held and invested and, with the earnings and
interest, used by the board to offset future net losses or to
reduce pool premiums. For purposes of this subsection, 'future
net losses' includes reserves for claims incurred but not
reported.
(6) Each insurer's proportion of participation in the pool
shall be determined by the board based on annual statements and
other reports deemed necessary by the board and filed by the
insurer with the board. The board may use any reasonable method
of estimating the number of insureds and certificate holders of
an insurer if the specific number is unknown. With respect to
insurers that are reinsurers, the board may use any reasonable
method of estimating the number of persons insured by each
reinsurer.
(7) The board may abate or defer, in whole or in part, the
assessment of an insurer if, in the opinion of the board, payment
of the assessment would endanger the ability of the insurer to
fulfill the insurer's contractual obligations. In the event an
assessment against an insurer is abated or deferred in whole or
in part, the amount by which the assessment is abated or deferred
may be assessed against the other insurers in a manner consistent
with the basis for assessments set forth in this section. The
insurer receiving the abatement or deferment shall remain liable
to the board for the deficiency for four years.
(8) The board shall abate or defer assessments authorized by
this section if a court orders that assessments cannot be made
applicable to reinsurers. However, if a court orders that
assessments cannot be made applicable to reinsurers, the board
may continue to assess insurers to the end of the biennium in
which the determination is made.
(9) Subject to the approval of the Director of the
{ - Department of Consumer and Business Services - } { +
Oregon Health Authority + }, the board may develop a program for
adjusting the assessment of an insurer in the individual health
benefits market based on that insurer's contribution to reducing
the enrollment in the Oregon Medical Insurance Pool. When
developing the program, the board may consider, but is not
limited to, the following factors:
(a) The insurer's level of participation;
(b) Level of health benefit plan coverage offered; and
(c) Assumption of risk in the individual health benefits
market.
SECTION 110. ORS 735.630 is amended to read:
735.630. Neither participation in the pool as members, the
establishment of rates, forms or procedures, nor any other action
taken in the performance of the powers and duties under ORS
735.600 to 735.650 shall be the basis of any legal action,
criminal or civil liability or penalty against the Oregon Medical
Insurance Pool Board, any members, the Director of the
{ - Department of Consumer and Business Services - }
{ + Oregon Health Authority + } or any of their agents or
employees.
SECTION 111. ORS 735.700 is amended to read:
735.700. As used in ORS 735.700 to 735.714, unless the context
requires otherwise:
(1) 'Carrier' means an insurance company or health care service
contractor holding a valid certificate of authority from the
Director of the { - Department of Consumer and Business
Services - } { + Oregon Health Authority + }, or two or more
companies or contractors acting together pursuant to a joint
venture, partnership or other joint means of operation.
(2) 'Eligible employee' means an employee of an employer who is
employed by the employer for an average of at least 17.5 hours
per week who elects to participate in one of the group benefit
plans provided through action of the Office of Private Health
Partnerships, and sole proprietors, business partners, and
limited partners. The term does not include individuals:
(a) Engaged as independent contractors.
(b) Whose periods of employment are on an intermittent or
irregular basis.
(c) Who have been employed by the employer for a period of time
established by the employer or for fewer than 90 days, whichever
is less.
(3) 'Family member' means an eligible employee's spouse, any
unmarried child or stepchild within age limits and other
conditions imposed by the office with regard to unmarried
children or stepchildren, or any other dependents eligible under
the terms of the health benefit plan selected by the employee's
employer.
(4) 'Health benefit plan' means a contract for group medical,
surgical, hospital or any other remedial care recognized by state
law and related services and supplies.
(5) 'Premium' means the monthly or other periodic charge for a
health benefit plan.
(6) 'Small employer' means a person, firm, corporation,
partnership or association actively engaged in business that, on
at least 50 percent of its working days during the preceding
year, employed no more than 50 eligible employees and no fewer
than two eligible employees, the majority of whom are employed
within this state, and in which a bona fide partnership or
employer-employee relationship exists. 'Small employer' includes
corporations that are eligible to file a consolidated tax return
pursuant to ORS 317.715.
SECTION 112. ORS 735.701 is amended to read:
735.701. (1) The Office of Private Health Partnerships is
established { + in the Oregon Health Authority + }.
(2) The office shall carry out the duties described under ORS
{ - 414.831, - } 735.700 to 735.714 and 735.720 to 735.740.
SECTION 113. ORS 735.706 is amended to read:
735.706. { + (1) + } The Office of Private Health Partnerships
Account is established separate and distinct from the General
Fund. All moneys received by the Office of Private Health
Partnerships, other than appropriations from the General Fund and
except for moneys in the account established by ORS 735.736,
shall be deposited into the account and are continuously
appropriated to the office to carry out the duties, functions and
powers of the office.
{ + (2) On the effective date of this 2009 Act, all moneys in
the Office of Private Health Partnerships Account shall be
transferred to the Oregon Health Authority Fund established in
section 19 of this 2009 Act. + }
SECTION 114. ORS 735.722 is amended to read:
735.722. (1) There is established the Family Health Insurance
Assistance Program in the Office of Private Health Partnerships.
The purpose of the program is to remove economic barriers to
health insurance coverage for residents of the State of Oregon
with family income less than 200 percent of the federal poverty
level, and investment and savings less than the limit established
by the office, while encouraging individual responsibility,
promoting health benefit plan coverage of children, building on
the private sector health benefit plan system and encouraging
employer and employee participation in employer-sponsored health
benefit plan coverage.
(2) The Office of Private Health Partnerships shall be
responsible for the implementation and operation of the Family
Health Insurance Assistance Program. The Administrator of the
Office for Oregon Health Policy and Research, in consultation
with the Oregon Health { - Policy Commission - } { +
Authority Board + }, shall make recommendations to the Office of
Private Health Partnerships regarding program policy, including
but not limited to eligibility requirements, assistance levels,
benefit criteria and carrier participation.
(3) The Office of Private Health Partnerships may contract with
one or more third-party administrators to administer one or more
components of the Family Health Insurance Assistance Program.
Duties of a third-party administrator may include but are not
limited to:
(a) Eligibility determination;
(b) Data collection;
(c) Assistance payments;
(d) Financial tracking and reporting; and
(e) Such other services as the office may deem necessary for
the administration of the program.
(4) If the office decides to enter into a contract with a
third-party administrator pursuant to subsection (3) of this
section, the office shall engage in competitive bidding. The
office shall evaluate bids according to criteria established by
the office, including but not limited to:
(a) The bidder's proven ability to administer a program of the
size of the Family Health Insurance Assistance Program;
(b) The efficiency of the bidder's payment procedures;
(c) The estimate provided of the total charges necessary to
administer the program; and
(d) The bidder's ability to operate the program in a
cost-effective manner.
SECTION 115. ORS 735.734 is amended to read:
735.734. The Office of Private Health Partnerships, in
consultation with the Administrator of the Office for Oregon
Health Policy and Research and the { - Department of Human
Services - } { + Oregon Health Authority + }, shall adopt all
rules necessary for the implementation and operation of the
Family Health Insurance Assistance Program.
SECTION 116. ORS 735.754 is amended to read:
735.754. (1) In order to increase public subsidies for the
purchase of health insurance coverage provided by public programs
or private insurance described by ORS 414.839, the Office of
Private Health Partnerships, the Oregon Medical Insurance Pool
Board and the { - Department of Human Services - } { + Oregon
Health Authority + } shall work cooperatively to obtain federal
matching dollars. The office, the Oregon Medical Insurance Pool
Board and the { - department - } { + authority + } shall
develop a system for payment or reimbursement of other costs and
subsidies provided to subsidized members.
(2) For each subsidized member, the Oregon Medical Insurance
Pool Board shall determine:
(a) The full cost of administering the benefits plan of the
subsidized member; and
(b) The amount of other costs.
(3) The Oregon Medical Insurance Pool Board shall bill the
Family Health Insurance Assistance Program for the total amount
of the premium received by the Oregon Medical Insurance Pool
Board and for the amount of other costs. The program shall
forward the bill to the { - department - } { + authority + }.
(4) The { - department - } { + authority + } shall pay the
program an amount equal to the portion of the premium that is a
subsidy and for other costs. The program shall forward the
payment to the Oregon Medical Insurance Pool Board.
SECTION 117. ORS 735.756 is amended to read:
735.756. (1) Of payments made to the Family Health Insurance
Assistance Program by the { - Department of Human Services - }
{ + Oregon Health Authority + } under ORS 735.754 (4), the
{ - department - } { + authority + } shall determine:
(a) The portion of a subsidy of a subsidized member that is
from the General Fund; and
(b) The portion of other costs that is from the General Fund.
(2) The { - department - } { + authority + } shall bill the
program for the amounts determined under subsection (1) of this
section. The program shall forward the bill for the amount
determined under subsection (1)(b) of this section to the Oregon
Medical Insurance Pool Board.
(3) The board shall:
(a) Determine the amount of funds needed for the payment of
other costs under subsection (1)(b) of this section; and
(b) Impose and collect assessments in that amount against
insurers, using the methodology described in ORS 735.614 (2), (6)
and (9).
(4) The board shall pay the program for the amounts determined
under subsection (1)(b) of this section.
(5) The program shall forward to the { - department - }
{ + authority + } the amounts determined under subsection (1) of
this section.
(6) ORS 735.614 (3), (4), (5), (7) and (8) applies to
assessments collected under this section.
SECTION 118. ORS 743.767 is amended to read:
743.767. Premium rates for individual health benefit plans
shall be subject to the following provisions:
(1) Each carrier must file the geographic average rate for its
individual health benefit plans for a rating period with the
Director of the { - Department of Consumer and Business
Services - } { + Oregon Health Authority + } on or before March
15 of each year.
(2) The premium rates charged during a rating period for
individual health benefit plans issued to individuals shall not
vary from the individual geographic average rate, except that the
premium rate may be adjusted to reflect differences in benefit
design, family composition and age. For age adjustments to the
individual plans, a carrier shall apply uniformly its schedule of
age adjustments for individual health benefit plans as approved
by the director.
(3) A carrier may not increase the rates of an individual
health benefit plan more than once in a 12-month period except as
approved by the director. Annual rate increases shall be
effective on the anniversary date of the individual health
benefit plan's issuance. The percentage increase in the premium
rate charged for an individual health benefit plan for a new
rating period may not exceed the sum of the following:
(a) The percentage change in the carrier's geographic average
rate for its individual health benefit plan measured from the
first day of the prior rating period to the first day of the new
period; and
(b) Any adjustment attributable to changes in age and
differences in benefit design and family composition.
(4) Notwithstanding any other provision of this section, a
carrier that imposes an individual coverage waiting period
pursuant to ORS 743.766 may impose a monthly premium rate
surcharge for a period not to exceed six months and in an amount
not to exceed the percentage by which the rates for coverage
under the Oregon Medical Insurance Pool exceed the rates
established by the Oregon Medical Insurance Pool Board as
applicable for individual risks under ORS 735.625. The surcharge
shall be approved by the Director of the { - Department of
Consumer and Business Services - } { + Oregon Health
Authority + } and, in combination with the waiting period, shall
not exceed the actuarial value of a six-month preexisting
conditions provision.
SECTION 119. Section 2a, chapter 872, Oregon Laws 2007, is
amended to read:
{ + Sec. 2a. + } The Health Resources Commission shall:
(1) Conduct a review of available medical and behavioral health
evidence on the treatment of pervasive developmental disorders.
(2) In conducting its review, work with the Public Employees'
Benefit Board, the Health Services Commission, the
{ - Department of Human Services - } { + Oregon Health
Authority + } and the Department of Education.
(3) Report its findings and recommendations to the
Seventy-fifth Legislative Assembly in the manner provided in ORS
192.245.
{ +
REPEALS + }
SECTION 120. { + (1) ORS 414.019, 414.021, 414.022, 414.023,
414.024, 414.031, 414.032, 414.036, 414.038, 414.039, 414.085,
414.107, 414.660, 414.670, 414.744, 414.747, 445.270 and 731.076
and sections 10 and 13, chapter 810, Oregon Laws 2003, are
repealed.
(2) ORS 735.706 is repealed on January 2, 2011. + }
{ + NOTE: + } Sections 121 through 123 were deleted.
Subsequent sections were not renumbered.
{ +
EXPANSION OF MEDICAL ASSISTANCE + }
SECTION 124. { + (1) The Oregon Health Authority is
responsible for statewide outreach and marketing of the medical
assistance and premium assistance programs administered by the
authority with the goal of enrolling in those programs all
eligible individuals residing in this state.
(2) To maximize the enrollment and retention of eligible
children in the medical assistance and premium assistance
programs, the authority shall develop and administer a grant
program to provide funding to organizations and community-based
groups to deliver culturally-specific and targeted outreach and
direct application assistance to:
(a) Members of racial, ethnic and language minority
communities;
(b) Individuals living in geographic isolation; and
(c) Individuals with additional barriers to accessing health
care such as individuals with cognitive, mental health or sensory
disorders, physical disabilities, chemical dependency or
individuals experiencing homelessness. + }
SECTION 125. { + The Oregon Health Authority shall implement a
streamlined and simple application process for the medical
assistance and premium assistance programs administered by the
authority. The process shall include, but not be limited to:
(1) An online application that may be submitted via the
internet;
(2) Application forms that are readable at a 6th grade level
and request the minimum amount of information necessary to begin
processing the application; and
(3) Application assistance from qualified staff to aid
individuals who have language, cognitive, physical or geographic
barriers to applying for medical assistance. + }
SECTION 126. { + (1) The Oregon Health Authority shall
implement a premium assistance program to provide subsidies, on a
sliding scale basis, to individuals with incomes at or below 300
percent of the federal poverty guidelines to enable them to
purchase employer sponsored health insurance or private market
health insurance products that offer the essential benefits
package established by the Oregon Health Authority Board for
insurance offered through the Oregon Health Insurance Exchange.
(2) The authority shall offer for purchase, without subsidy,
the products described in subsection (1) of this section for the
enrollment of children in families with incomes above 300 percent
of the federal poverty guidelines. + }
SECTION 127. { + The Oregon Health Authority is authorized to
apply for approval from the Centers for Medicaid and Medicare
Services to obtain federal financial participation in the
provision of medical assistance and premium assistance to
children with family incomes at or below 300 percent of the
federal poverty guidelines. + }
SECTION 128. { + Of the moneys in the Oregon Health Authority
Fund established in section 19 of this 2009 Act, the authority
shall use $100 million to increase the reimbursement rates paid
to health services providers participating in the medical
assistance program, to levels above the reimbursement rates
existing on the effective date of this 2009 Act. + }
{ +
HEALTH CARE ASSESSMENTS + }
SECTION 129. { + Sections 130 to 132 of this 2009 Act are
added to and made a part of the Insurance Code. + }
SECTION 130. { + As used in this section and sections 131 and
132 of this 2009 Act:
(1) 'Gross amount of premiums' has the meaning given that term
in ORS 731.808.
(2) 'Health benefit plan' has the meaning given that term in
ORS 743.730.
(3) 'Insurer' means an authorized insurer that issues or renews
a health benefit plan in this state. + }
SECTION 131. { + (1) No later than 45 days following the end
of a calendar quarter, an insurer shall pay an assessment at the
rate of ___ percent of the gross amount of premiums that were
derived from health benefit plans covering direct domestic risks
during that calendar quarter.
(2) The assessment shall be paid to the Oregon Health Authority
and shall be accompanied by a verified report, on a form
prescribed by the authority, of:
(a) All health benefit plans issued or renewed by the insurer
during the calendar quarter for which the assessment is paid; and
(b) The gross amount of premiums by line of insurance, derived
by the insurer from all health benefit plans issued or renewed by
the insurer during the calendar quarter for which the assessment
is paid.
(3) The assessment imposed under this section is in addition to
and not in lieu of any tax, surcharge or other assessment imposed
on an insurer.
(4) An insurer may not offset the assessment under this section
against corporate excise taxes imposed under ORS chapter 317.
(5) Assessments under this section may not be considered in the
gross amount of premiums for any purpose.
(6) If the authority determines that the assessment paid by the
insurer under this section is incorrect, the authority shall
charge or credit to the insurer the difference between the
correct amount of the assessment and the amount paid by the
insurer. + }
SECTION 132. { + (1) An insurer that fails to timely + } { +
file a verified report or to pay an assessment under section 131
of this 2009 Act shall be subject to a penalty of up to $500 per
day of delinquency. The total amount of penalties imposed under
this section for a calendar quarter may not exceed five percent
of the assessment due for that calendar quarter.
(2) Any penalty imposed under this section is in addition to
and not in lieu of the assessment imposed under section 131 of
this 2009 Act. + }
SECTION 133. { + Sections 131 and 132 of this 2009 Act apply
to premiums received by an insurer on or after the calendar
quarter ending December 31, 2009. + }
SECTION 134. { + (1) As used in this section, 'managed care
plan' includes a prepaid capitated health service contractor
described in ORS 414.630, a prepaid managed care health services
organization described in ORS 414.725 and a health care service
contractor as defined in ORS 750.005.
(2) No later than 45 days following the end of a calendar
quarter, a managed care plan shall pay an assessment at a rate
of ___ percent of the gross amount of capitation payments
received by the managed care plan during that calendar quarter
for providing coverage of health services under ORS 414.705 to
414.750.
(3) The assessment shall be paid to the Oregon Health Authority
in a manner and form prescribed by the authority.
(4) Assessments received by the authority under this section
shall be deposited in the Oregon Health Authority Fund
established in section 19 of this 2009 Act. + }
SECTION 135. { + (1) A managed care plan that fails to timely
pay an assessment under section 134 of this 2009 Act shall be
subject to a penalty of up to $500 per day of delinquency. The
total amount of penalties imposed under this section for a
calendar quarter may not exceed five percent of the assessment
due for that calendar quarter.
(2) Any penalty imposed under this section is in addition to
and not in lieu of the assessment imposed under section 134 of
this 2009 Act. + }
SECTION 136. { + Sections 134 and 135 of this 2009 Act apply
to capitation payments received by a managed care plan on or
after October 1, 2009. + }
SECTION 136a. { + Sections 136b to 136d of this 2009 Act are
added to and made a part of the Insurance Code. + }
SECTION 136b. { + As used in this section and sections 136c
and 136d of this 2009 Act, 'third party administrator' means any
person required to obtain a license pursuant to ORS 744.702 or
any person required to register with the Oregon Health Authority
pursuant to ORS 744.714. + }
SECTION 136c. { + (1) No later than 45 days following the end
of a calendar quarter, a third party administrator shall pay an
assessment at the rate of ___ percent of the gross amount of
premiums and charges collected by the administrator during that
calendar quarter.
(2) The assessment shall be paid to the Oregon Health Authority
in the form and manner prescribed by the authority.
(3) The assessment imposed under this section is in addition to
and not in lieu of any tax, surcharge or other assessment imposed
on a third party administrator.
(4) A third party administrator may not offset the assessment
under this section against corporate excise taxes imposed under
ORS chapter 317.
(5) If the authority determines that the assessment paid by the
third party administrator under this section is incorrect, the
authority shall charge or credit to the third party administrator
the difference between the correct amount of the assessment and
the amount paid by the third party administrator. + }
SECTION 136d. { + (1) A third party administrator that fails
to timely + } { + report or to pay an assessment under section
136c of this 2009 Act shall be subject to a penalty of up to $500
per day of delinquency. The total amount of penalties imposed
under this section for a calendar quarter may not exceed five
percent of the assessment due for that calendar quarter.
(2) Any penalty imposed under this section is in addition to
and not in lieu of the assessment imposed under section 136c of
this 2009 Act. + }
SECTION 136e. { + Sections 136c and 136d of this 2009 Act
apply to premiums and charges collected by a third party
administrator on or after the calendar quarter ending December
31, 2009. + }
SECTION 136f. { + Assessments collected by the Oregon Health
Authority under sections 131, 134 and 136c of this 2009 Act shall
be paid into the Oregon Health Authority Fund established in
section 19 of this 2009 Act. + }
SECTION 136g. { + Penalties collected by the Oregon Health
Authority under sections 132, 135 and 136d of this 2009 Act shall
be paid to the State Treasurer to be deposited in the General
Fund for general governmental expenses. + } { - - }
SECTION 137. Section 1, chapter 736, Oregon Laws 2003, is
amended to read:
{ + Sec. 1. + } As used in sections 1 to 9 { + , chapter 736,
Oregon Laws 2003 + } { - of this 2003 Act - } :
(1) 'Charity care' means costs for providing inpatient or
outpatient care services free of charge or at a reduced charge
because of the indigence or lack of health insurance of the
patient receiving the care services.
(2) 'Contractual adjustments' means the difference between the
amounts charged based on the hospital's full established charges
and the amount received or due from the payor.
(3) 'Hospital' has the meaning given that term in ORS 442.015
but does not include special inpatient care facilities.
(4) 'Net revenue':
(a) Means the total amount of charges for inpatient or
outpatient care provided by the hospital to patients, less
{ + the cost to the hospital of + } charity care { - , bad
debts - } and contractual adjustments;
(b) Does not include revenue derived from sources other than
inpatient or outpatient operations, including but not limited to
interest and guest meals; and
(c) Does not include any revenue that is taken into account in
computing a long term care facility assessment under sections 15
to 22 { + , chapter 736, Oregon Laws 2003 + } { - of this 2003
Act - } .
{ - (5) 'Waivered hospital' means a type A or type B
hospital, as described in ORS 442.470, a hospital that provides
only psychiatric care or a hospital identified by the Department
of Human Services as appropriate for inclusion in the application
described in section 4 of this 2003 Act. - }
SECTION 138. Section 2, chapter 736, Oregon Laws 2003, as
amended by section 1, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 2. + } (1) An assessment is imposed on the net
revenue of each hospital in this state { - that is not a
waivered hospital - } . The assessment shall be imposed at
{ + the rate of ___ percent. + } { - a rate determined by the
Director of Human Services by rule that is the director's best
estimate of the rate needed to fund the services and costs
identified in section 9, chapter 736, Oregon Laws 2003. The rate
of assessment shall be imposed on the net revenue of each
hospital subject to assessment. The director shall consult with
representatives of hospitals before setting the assessment. - }
{ - (2) Notwithstanding subsection (1) of this section, the
rate of assessment may not exceed 1.5 percent. - }
{ - (3) - } { + (2) + } The assessment shall be reported on
a form prescribed by the { - Department of Human Services - }
{ + Oregon Health Authority + } and shall contain the
information required to be reported by the { - department - }
{ + authority + }. The assessment form shall be filed with the
{ - department - } { + authority + } on or before the 75th day
following the end of the calendar quarter for which the
assessment is being reported. Except as provided in subsection
{ - (7) - } { + (5) + } of this section, the hospital shall
pay the assessment at the time the hospital files the assessment
report. The payment shall accompany the report.
{ - (4) To the extent permitted by federal law, aggregate
taxes levied under this section may not exceed payments under
section 9 (2), chapter 736, Oregon Laws 2003. - }
{ - (5) - } { + (3) + } { - Notwithstanding subsection
(4) of this section, - } A hospital is not guaranteed that any
additional moneys paid to the hospital in the form of payments
for services shall equal or exceed the amount of the assessment
paid by the hospital.
{ - (6) - } { + (4) + } Hospitals operated by the United
States Department of Veterans Affairs { + , + } { - and - }
pediatric specialty hospitals providing care to children at no
charge { + and hospitals designated by the Office of Rural
Health as type A or type B hospitals + } are exempt from the
assessment imposed under this section.
{ - (7)(a) The Department of Human Services shall develop a
schedule for collection of the assessment for the calendar
quarter ending September 30, 2009, that will result in the
collection occurring between December 15, 2009, and the time all
Medicaid cost settlements are finalized for that calendar
quarter. - }
{ - (b) - } { + (5) + } The { - Department of Human
Resources - } { + Oregon Health Authority + } shall prescribe
by rule criteria for late payment of assessments.
SECTION 139. Section 5, chapter 736, Oregon Laws 2003, is
amended to read:
{ + Sec. 5. + } (1) A hospital that fails to file a report or
pay an assessment under section 2 { + , chapter 736, Oregon Laws
2003, + } { - of this 2003 Act - } by the date the report or
payment is due shall be subject to a penalty of { + up to + }
$500 per day of delinquency. The total amount of penalties
imposed under this section for each reporting period may not
exceed five percent of the assessment for the reporting period
for which penalties are being imposed.
(2) Penalties imposed under this section shall be collected by
the { - Department of Human Services - } { + Oregon Health
Authority + } and deposited in the { - Department of Human
Services Account established under ORS 409.060. - } { + Oregon
Health Authority Fund established in section 19 of this 2009
Act. + }
(3) Penalties paid under this section are in addition to and
not in lieu of the assessment imposed under section 2 { + ,
chapter 736, Oregon Laws 2003 + } { - of this 2003 Act - } .
SECTION 140. Section 8, chapter 736, Oregon Laws 2003, as
amended by section 1, chapter 757, Oregon Laws 2005, is amended
to read:
{ + Sec. 8. + } Amounts collected by the { - Department of
Human Services - } { + Oregon Health Authority + } from the
assessments imposed under section 2, chapter 736, Oregon Laws
2003, shall be deposited in the { - Hospital Quality Assurance
Fund established under section 9, chapter 736, Oregon Laws
2003. - } { + Oregon Health Authority Fund established in
section 19 of this 2009 Act. + }
SECTION 141. Section 10, chapter 736, Oregon Laws 2003, as
amended by section 3, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 10. + } Sections 1 to 9, chapter 736, Oregon Laws
2003, apply to net revenues earned by hospitals on or after
{ - January 1, 2004, and before the earlier of October 1, 2009,
or when the assessment described in sections 37 to 44, chapter
736, Oregon Laws 2003, no longer qualifies for federal matching
funds under Title XIX of the Social Security Act. - } { +
October 1, 2009. + }
SECTION 142. Section 14, chapter 736, Oregon Laws 2003, as
amended by section 6, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 14. + } Any moneys remaining in the Hospital Quality
Assurance Fund on { - December 31, 2013 - } { + October 1,
2009 + }, are transferred to the { - General Fund. - } { +
Oregon Health Authority Fund established in section 19 of this
2009 Act. + }
SECTION 143. Section 51, chapter 736, Oregon Laws 2003, as
amended by section 20, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 51. + } Any moneys { - remaining - } { +
deposited + } in the Medical Care Quality Assurance Fund { - on
December 31, 2011, are - } { + shall be + } transferred to the
{ - General Fund - } { + Oregon Health Authority Fund
established in section 19 of this 2009 Act + }.
SECTION 144. ORS 731.840 is amended to read:
731.840. (1) The retaliatory tax imposed upon a foreign or
alien insurer under ORS 731.854 and 731.859, or the corporate
excise tax imposed upon a foreign or alien insurer under ORS
chapter 317, is in lieu of all other state taxes upon premiums,
taxes upon income, franchise or other taxes measured by income
that might otherwise be imposed upon the foreign or alien insurer
except the fire insurance premiums tax imposed under ORS
731.820 { + , + }
{ - and - } the tax imposed upon wet marine and transportation
insurers under ORS 731.824 and 731.828 { + , and the assessment
imposed under section 131 of this 2009 Act + }. However, all real
and personal property, if any, of the insurer shall be listed,
assessed and taxed the same as real and personal property of like
character of noninsurers. Nothing in this subsection shall be
construed to preclude the imposition of the assessments imposed
under ORS 656.612 upon a foreign or alien insurer.
(2) Subsection (1) of this section applies to a reciprocal
insurer and its attorney in its capacity as such.
(3) Subsection (1) of this section applies to foreign or alien
title insurers and to foreign or alien wet marine and
transportation insurers issuing policies and subject to taxes
referred to in ORS 731.824 and 731.828.
(4) The State of Oregon hereby preempts the field of regulating
or of imposing excise, privilege, franchise, income, license,
permit, registration, and similar taxes, licenses and fees upon
insurers and their insurance producers and other representatives
as such, and:
(a) No county, city, district, or other political subdivision
or agency in this state shall so regulate, or shall levy upon
insurers, or upon their insurance producers and representatives
as such, any such tax, license or fee; except that whenever a
county, city, district or other political subdivision levies or
imposes generally on a nondiscriminatory basis throughout the
jurisdiction of the taxing authority a payroll, excise or income
tax, as otherwise provided by law, such tax may be levied or
imposed upon domestic insurers; and
(b) No county, city, district, political subdivision or agency
in this state shall require of any insurer, insurance producer or
representative, duly authorized or licensed as such under the
Insurance Code, any additional authorization, license, or permit
of any kind for conducting therein transactions otherwise lawful
under the authority or license granted under this code.
SECTION 145. { + (1) Section 4, chapter 736, Oregon Laws 2003,
is repealed.
(2) Section 9, chapter 736, Oregon Laws 2003, as amended by
section 2, chapter 757, Oregon Laws 2005, and section 2, chapter
780, Oregon Laws 2007, is repealed.
(3) Section 12, chapter 736, Oregon Laws 2003, as amended by
section 4, chapter 780, Oregon Laws 2007, is repealed.
(4) Section 13, chapter 736, Oregon Laws 2003, as amended by
section 5, chapter 780, Oregon Laws 2007, is repealed. + }
SECTION 146. { + Sections 129 to 136 of this 2009 Act, the
amendments to ORS 731.840 and sections 1, 2, 5, 8, 10, 14 and 51,
chapter 736, Oregon Laws 2003, by sections 137 to 144 of this
2009 Act and the repeal of sections 4, 9, 12 and 13, chapter 736,
Oregon Laws 2003, by section 145 of this 2009 Act become
operative on October 1, 2009. + }
{ +
TOBACCO TAX + }
SECTION 147. { + Sections 148, 149, 151 and 152 of this 2009
Act are added to and made a part of ORS 323.005 to 323.482. + }
SECTION 148. { + (1) Notwithstanding ORS 323.030 (2) and in
addition to and not in lieu of any other tax, every distributor
shall pay a tax upon distributions of cigarettes at the rate
of ___ mills for the distribution of each cigarette in this
state.
(2) Any cigarette for which a tax has once been imposed under
ORS 323.005 to 323.482 may not be subject upon a subsequent
distribution to the taxes imposed by ORS 323.005 to 323.482. + }
SECTION 149. { + All moneys received by the Department of
Revenue from the tax imposed under section 148 of this 2009 Act
shall be paid over to the State Treasurer to be held in a
suspense account established under ORS 293.445. After the payment
of refunds, the moneys shall be transferred to the Oregon Health
Authority Fund established in section 19 of this 2009 Act and are
continuously appropriated to the Oregon Health Authority for the
purpose of supporting public health system transformation and
funding public health programs as follows:
(1) Fifty percent shall be allocated to counties on a per
capita basis after a minimum payment to each county of $___.
(2) Fifty percent of the moneys shall be distributed in the
form of grants to counties meeting criteria established by the
authority by rule. + }
SECTION 150. { + Sections 148 and 149 of this 2009 Act apply
to cigarette distributions occurring on or after the later of
January 1, 2010, or the first day of the calendar month following
the effective date of this 2009 Act. + }
SECTION 151. { + (1) Notwithstanding ORS 323.030 (3) and in
addition to and not in lieu of any other tax, for the privilege
of holding or storing cigarettes for sale, use or consumption, a
floor tax is imposed upon every dealer at the rate of 30 mills
for each cigarette in the possession of or under the control of
the dealer in this state at 12:01 a.m. on the later of January 1,
2010, or the first day of the calendar month following the
effective date of this 2009 Act.
(2) The tax imposed by this section is due and payable on or
before 20 days after the later of January 1, 2010, or the first
day of the calendar month following the effective date of this
2009 Act. Any amount of tax that is not paid within the time
required shall bear interest at the rate established under ORS
305.220 per month, or fraction of a month, from the date on which
the tax is due to be paid, until paid.
(3) On or before 20 days after the later of January 1, 2010, or
the first day of the calendar month following the effective date
of this 2009 Act, every dealer must file a report with the
Department of Revenue in such form as the department may
prescribe. The report must state the number of cigarettes in the
possession of or under the control of the dealer in this state at
12:01 a.m. on the later of January 1, 2010, or the first day of
the calendar month following the effective date of this 2009 Act
and the amount of tax due. Each report must be accompanied by a
remittance payable to the department for the amount of tax
due. + }
SECTION 152. { + Notwithstanding ORS 323.030 (3) and in
addition to and not in lieu of any other tax, for the privilege
of distributing cigarettes as a distributor and for holding or
storing cigarettes for sale, use or consumption, a floor tax and
cigarette adjustment indicia tax is imposed upon every
distributor in the amount of 75 cents for each Oregon cigarette
tax stamp bearing the designation '25,' in the amount of 60 cents
for each Oregon cigarette tax stamp bearing the designation '20,'
in the amount of 30 cents for each Oregon cigarette tax stamp
bearing the designation '10' and in the amount of 3 cents for
each Oregon cigarette tax stamp bearing the designation '1' that
is affixed to any package of cigarettes in the possession of or
under the control of the distributor at 12:01 a.m. on the later
of January 1, 2010, or the first day of the calendar month
following the effective date of this 2009 Act. + }
SECTION 153. { + (1) Every distributor must take an inventory
as of 12:01 a.m. on the later of January 1, 2010, or the first
day of the calendar month following the effective date of this
2009 Act of all packages of cigarettes to which are affixed
Oregon cigarette tax stamps and of all unaffixed Oregon cigarette
tax stamps in the possession of or under the control of the
distributor.
(2) Every distributor must file a report with the Department of
Revenue on or before 20 days after the later of January 1, 2010,
or the first day of the calendar month following the effective
date of this 2009 Act in such form as the department may
prescribe, showing:
(a) The number of Oregon cigarette tax stamps, with the
designations of the stamps, that were affixed to packages of
cigarettes in the possession of or under the control of the
distributor at 12:01 a.m. on the later of January 1, 2010, or the
first day of the calendar month following the effective date of
this 2009 Act; and
(b) The number of unaffixed Oregon cigarette tax stamps, with
the designations of the stamps, that were in the possession of or
under the control of the distributor at 12:01 a.m. on the later
of January 1, 2010, or the first day of the calendar month
following the effective date of this 2009 Act.
(3) The amount of tax required to be paid with respect to the
affixed Oregon cigarette tax stamps shall be computed pursuant to
section 151 of this 2009 Act and remitted with the distributor's
report. Any amount of tax not paid within the time specified for
the filing of the report shall bear interest at the rate
established under ORS 305.220 per month, or fraction of a month,
from the due date of the report until paid.
(4) Notwithstanding ORS 323.320, the department may establish a
date after which the value of stamps sold prior to the effective
date of this 2009 Act will not be refunded or credited to a
distributor. + }
SECTION 154. { + All moneys received by the Department of
Revenue from the taxes imposed by sections 151 and 152 of this
2009 Act shall be paid over to the State Treasurer to be held in
a suspense account established under ORS 293.445. After the
payment of refunds, the net amount of revenues remaining shall be
distributed as prescribed in section 149 of this 2009 Act. + }
SECTION 155. ORS 323.505 is amended to read:
323.505. (1) A tax is hereby imposed upon the distribution of
all tobacco products in this state. The tax imposed by this
section is intended to be a direct tax on the consumer, for which
payment upon distribution is required to achieve convenience and
facility in the collection and administration of the tax. The tax
shall be imposed on a distributor at the time the distributor
distributes tobacco products.
(2) The tax imposed under this section shall be imposed at the
rate of:
(a) { - Sixty-five - } { + ___ + } percent of the
wholesale sales price of cigars, but not to exceed 50 cents per
cigar; or
(b) { - Sixty-five - } { + ___ + } percent of the
wholesale sales price of all tobacco products that are not
cigars.
(3) If the tax imposed under this section does not equal an
amount calculable to a whole cent, the tax shall be equal to the
next higher whole cent. However, the amount remitted to the
Department of Revenue by the taxpayer for each quarter shall be
equal only to 98.5 percent of the total taxes due and payable by
the taxpayer for the quarter.
(4) No tobacco product shall be subject to the tax if the base
product or other intermediate form thereof has previously been
taxed under this section.
SECTION 156. { + The Department of Revenue may take
administrative actions it considers necessary to implement
sections 148, 149, 151, 152 and 153 of this 2009 Act and the
amendments to ORS 323.505 by section 155 of this 2009 Act,
including but not limited to:
(1) Limiting sales of stamps prior to the effective date of
this 2009 Act;
(2) Selling stamps at the increased rate prior to the effective
date of this 2009 Act; or
(3) Establishing a date after which stamps sold prior to the
effective date of this 2009 Act will not be redeemed. + }
SECTION 157. { + The amendments to ORS 323.505 by section 155
of this 2009 Act apply to tobacco products tax reporting periods
beginning on or after the later of January 1, 2010, or the first
day of the calendar month following the effective date of this
2009 Act. + }
{ +
CONFORMING AMENDMENTS + }
SECTION 158. ORS 408.305 is amended to read:
408.305. As used in ORS 408.305 to 408.340, unless the context
requires otherwise:
(1) 'Agent Blue' means the herbicide composed primarily of
cacodylic acid (organic arsenic) and inorganic arsenic.
(2) 'Agent Orange' means the herbicide composed primarily of
trichlorophenoxyacetic acid and dichlorophenoxyacetic acid.
(3) 'Agent White' means any herbicide composed primarily of 2,
4, D and picloram.
(4) 'Causative agent' includes Agent Blue, Agent Orange, Agent
White and any other combination of chemicals consisting primarily
of 2, 4, D or 2, 4, 5, T or any other chemical or biological
agent used by any government involved in the Vietnam Conflict, or
diseases endemic to Southeast Asia, including, but not limited
to, the disease known as melioidosis.
{ - (5) 'Department' means the Department of Human
Services. - }
{ - (6) - } { + (5) + } 'Veteran' means any individual who
resides in this state, who served on active duty in the Armed
Forces of the United States for a period of not less than 180
days any part of which occurred between January 1, 1962, and May
7, 1975, within the borders of Vietnam, Cambodia, Laos or
Thailand, and who was either a resident of this state at the time
of enlistment, induction or other entry into the Armed Forces or
became a bona fide resident of Oregon prior to April 1, 1981.
SECTION 159. ORS 408.310 is amended to read:
408.310. (1) A physician who has primary responsibility for the
treatment of a veteran who may have been exposed to causative
agents while serving in the Armed Forces of the United States or
for the treatment of a veteran's spouse, surviving spouse or
minor child who may be exhibiting symptoms or conditions that may
be attributable to the veteran's exposure to causative agents
shall, at the request and direction of the veteran, veteran's
spouse or surviving spouse or the parent or guardian of such
minor child, submit a report to the { - Department of Human
Services - } { + Oregon Health Authority + }. The report shall
be made on a form adopted by the department and made available to
physicians and hospitals in this state.
(2) If there is no physician having primary responsibility for
the treatment of a veteran, veteran's spouse, surviving spouse or
minor child, then the senior medical supervisor of the hospital
or clinic treating the veteran, veteran's spouse, surviving
spouse or minor child shall submit the report described in this
section to the { - department - } { + authority + } at the
request and direction of the veteran, veteran's spouse or
surviving spouse or the parent or legal guardian of a veteran's
minor child.
(3) The form adopted by the { - department - } { +
authority + } under this section shall list the symptoms commonly
attributed to exposure to causative agents, and shall require the
following information:
(a) Symptoms of the patient which may be related to exposure to
causative agents.
(b) A diagnosis of the patient's condition.
(c) Methods of treatment prescribed.
(d) Any other information required by the department.
(4) The { - department - } { + authority + }, after
receiving a report from a physician, hospital or clinic under
this section, may require the veteran, veteran's spouse,
surviving spouse or minor child to provide such other information
as may be required by the
{ - department - } { + authority + }.
SECTION 160. ORS 408.320 is amended to read:
408.320. The Oregon Public Health Advisory Board created under
ORS 431.195 shall:
(1) Order the compilation of statistical data from information
obtained under ORS 408.310 and determine the use and
dissemination of that data.
(2) Make recommendations to the Director of { - Human
Services - } { + the Oregon Health Authority + } or the Director
of Veterans' Affairs concerning the implementation and operation
of programs authorized by ORS 408.300 to 408.340.
(3) Assess programs of federal agencies operating for the
benefit of veterans exposed to causative agents and their
families, and make recommendations to the appropriate agencies
for the improvement of those programs.
(4) Suspend or terminate specific programs or duties required
under ORS 408.300 to 408.340 when necessary to prevent
duplication of those programs or duties by other governmental
agencies.
(5) Apply for, receive and accept any grants or contributions
available from the United States or any of its agencies for the
purpose of carrying out ORS 408.300 to 408.340.
(6) When the advisory board considers it necessary for the
health and welfare of veterans and the spouses, surviving spouses
and minor children of veterans, ask the Attorney General to
initiate proceedings as provided under ORS 408.335.
(7) Report biennially to the Legislative Assembly or to the
Emergency Board, as appropriate, as necessary to accomplish the
objectives of ORS 408.300 to 408.340 concerning the programs
instituted under ORS 408.300 to 408.340.
SECTION 161. ORS 408.325 is amended to read:
408.325. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } and the Oregon Public Health Advisory
Board shall institute a cooperative program to refer veterans to
appropriate state and federal agencies for the purpose of filing
claims to remedy medical and financial problems caused by
exposure to causative agents.
(2) The Director of { - Human Services - } { + the Oregon
Health Authority + }, after receiving the recommendations of the
advisory board, shall adopt rules to provide for the
administration and operation of programs authorized by ORS
408.300 to 408.340. The director { - of Human Services - }
shall cooperate with appropriate state and federal agencies in
providing services under ORS 408.300 to 408.340.
SECTION 162. ORS 408.380 is amended to read:
408.380. (1) The Oregon Veterans' Home authorized by section 1,
chapter 591, Oregon Laws 1995, is subject to all state laws and
administrative rules and all federal laws and administrative
regulations to which long term care facilities operated by
nongovernmental entities are subject, except for the requirement
to obtain a certificate of need under ORS 442.315 from the
{ - Department of Human Services - } { + Oregon Health
Authority + }.
(2) As used in this section, 'long term care facility' has the
meaning given that term in ORS 442.015.
SECTION 163. ORS 408.570 is amended to read:
408.570. When a veteran who has been adjudged mentally ill is
eligible for treatment in a United States veterans facility and
commitment is necessary for the proper care and treatment of such
veteran, the { - Department of Human Services - } { + Oregon
Health Authority + } or community mental health and developmental
disabilities program director, as provided under ORS 426.060,
may, upon receipt of a certificate of eligibility from the United
States Department of Veterans Affairs, assign the person to the
United States Department of Veterans Affairs for care, custody
and treatment in a United States veterans facility. Upon
admission to any such facility, the veteran shall be subject to
the rules and regulations of the United States Department of
Veterans Affairs and provisions of ORS 426.060 to 426.395 and
related rules and regulations of the { - Department of Human
Services - } { + Oregon Health Authority + }. The chief officer
of such facility shall be vested with the same powers exercised
by superintendents of state hospitals for persons with mental
illness within this state with reference to the retention,
transfer, trial visit or discharge of the veteran so assigned.
The commitment of a veteran to a veterans facility within this
state by a court of another state under a similar provision of
law has the same force and effect as if the veteran was committed
to a veterans facility within that other state.
SECTION 164. ORS 408.580 is amended to read:
408.580. Upon receipt of a certificate of eligibility and
available facilities, the { - Department of Human Services - }
{ + Oregon Health Authority + } may cause to be transferred any
veteran from any facility to which the veteran has been assigned
to a United States veterans facility. No veteran under sentence
by any court, or committed by any court after having been charged
with any crime and acquitted on the ground of mental disease or
defect, may be transferred without an order of such court
authorizing the transfer. Whenever any veteran, not a convict,
has been committed by order of a court and is transferred as
provided in this section, the order of commitment shall be held
to apply to the facility to which the veteran is transferred as
to any other facility to which the veteran could be assigned or
transferred under ORS 426.060.
SECTION 165. ORS 431.035 is amended to read:
431.035. (1) The Director of { - Human Services - } { + the
Oregon Health Authority + } may delegate to any of the officers
and employees of the { - Department of Human Services - } { +
Oregon Health Authority + } the exercise or discharge in the
director's name of any power, duty or function of whatever
character vested in or imposed upon the director by the laws of
Oregon. However, the power to administer oaths and affirmations,
subpoena witnesses, take evidence and require the production of
books, papers, correspondence, memoranda, agreements or other
documents or records may be exercised by an officer or employee
of the { - department - } { + authority + } only when
specifically delegated in writing by the director.
(2) The official act of any such person so acting in the
director's name and by the authority of the director shall be
deemed to be an official act of the director.
(3)(a) The Director of { - Human Services - } { + the
Oregon Health Authority + } shall appoint a Public Health
Director to perform the duties and exercise authority over public
health emergency matters in the state and other duties as
assigned by the director { - of Human Services - } . The
director { - of Human Services - } may appoint the same person
to serve as both the Public Health Director and the Public Health
Officer appointed under ORS 431.045.
(b) The Public Health Director shall be an assistant director
appointed by the Director of { - Human Services - } { + the
Oregon Health Authority + } in accordance with ORS 409.130.
(c) The Public Health Director shall delegate to an employee of
the { - department - } { + authority + } the duties, powers
and functions granted to the Public Health Director by ORS
431.264 and 433.443 in the event of the absence from the state or
the unavailability of the director. The delegation must be in
writing.
SECTION 166. ORS 431.045 is amended to read:
431.045. The Director of { - Human Services - } { + the
Oregon Health Authority + } shall appoint a physician licensed by
the Oregon Medical Board and certified by the American Board of
Preventive Medicine who shall serve as the Public Health Officer
and be responsible for the medical and paramedical aspects of the
health programs within the { - Department of Human Services - }
{ + Oregon Health Authority + }.
SECTION 167. ORS 431.110 is amended to read:
431.110. Subject to ORS 417.300 and 417.305, the
{ - Department of Human Services - } { + Oregon Health
Authority + } shall:
(1) Have direct supervision of all matters relating to the
preservation of life and health of the people of the state.
(2) Keep the vital statistics and other health related
statistics of the state.
(3) Make sanitary surveys and investigations and inquiries
respecting the causes and prevention of diseases, especially of
epidemics.
(4) Investigate, conduct hearings and issue findings in
connection with annexations proposed by cities as provided in ORS
222.840 to 222.915.
(5) Have full power in the control of all communicable
diseases.
(6) Have authority to send a representative of the
{ - department - } { + authority + } to any part of the state
when deemed necessary.
(7) From time to time, publish and distribute to the public in
such form as the { - department - } { + authority + }
determines, such information as in its judgment may be useful in
carrying on the work or purposes for which the
{ - department - } { + authority + } was established.
(8) Carry out the duties imposed on the { - department - }
under ORS chapter 690.
SECTION 168. ORS 431.120 is amended to read:
431.120. The { - Department of Human Services - } { +
Oregon Health Authority + } shall:
(1) Enforce state health policies and rules.
(2) Have the custody of all books, papers, documents and other
property belonging to the State Health Commission, which may be
deposited in the { - department's - } { + authority's + }
office.
(3) Give any instructions that may be necessary, and forward
them to the various local public health administrators throughout
the state.
(4) Routinely conduct epidemiological investigations for each
case of sudden infant death syndrome including, but not limited
to, the identification of risk factors such as birth weight,
maternal age, prenatal care, history of apnea and socioeconomic
characteristics. The { - department - } { + authority + } may
conduct the investigations through local health departments only
upon adoption by rule of a uniform epidemiological data
collection method.
(5) Adopt rules related to loans and grants awarded under ORS
285B.560 to 285B.599 or 541.700 to 541.855 for the improvement of
drinking water systems for the purpose of maintaining compliance
with applicable state and federal drinking water quality
standards. In adopting rules under this subsection, the
{ - Department of Human Services - } { + authority + } shall
coordinate the
{ - department's - } { + authority's + } rulemaking process
with the Water Resources Department and the Economic and
Community Development Department in order to ensure that rules
adopted under this subsection are consistent with rules adopted
under ORS 285B.563 and 541.845.
(6) Control health care capital expenditures by administering
the state certificate of need program pursuant to ORS 442.325 to
442.344.
SECTION 169. ORS 431.150 is amended to read:
431.150. (1) The local public health administrators are charged
with the strict and thorough enforcement of the public health
laws of this state in their districts, under the supervision and
direction of the { - Department of Human Services - }
{ + Oregon Health Authority + }. They shall make an immediate
report to the { - department - } { + authority + } of any
violation of such laws coming to their notice by observation, or
upon the complaint of any person, or otherwise.
(2) The { - department - } { + authority + } is charged
with the thorough and efficient execution of the public health
laws of this state in every part of the state, and with
supervisory powers over all local public health administrators,
to the end that all the requirements are complied with.
(3) The { - department - } { + authority + } may
investigate cases of irregularity or violation of law. All local
public health administrators shall aid the { - department - }
{ + authority + }, upon request, in such investigation.
(4) When any case of violation of the public health laws of
this state is reported to any district attorney or official
acting in said capacity, such official shall forthwith initiate
and promptly follow up the necessary proceedings against the
parties responsible for the alleged violations of law.
(5) Upon request of the { - department - } { +
authority + }, the Attorney General shall likewise assist in the
enforcement of the public health laws of this state.
SECTION 170. ORS 431.155 is amended to read:
431.155. (1) Whenever it appears to the { - Department of
Human Services - } { + Oregon Health Authority + } that any
person is engaged or about to engage in any acts or practices
that constitute a violation of any statute relating to public
health administered by the { - department - } { +
authority + }, or any rule or order issued thereunder, the
{ - department - } { + authority + } may institute proceedings
in the circuit courts to enforce obedience thereto by injunction,
or by other processes, mandatory or otherwise, restraining such
person, or its officers, agents, employees and representatives
from further violation of such statute, rule or order, and
enjoining upon them obedience thereto.
(2) The provisions of this section are in addition to and not
in substitution of any other enforcement provisions contained in
any statute administered by the { - department - } { +
authority + }.
SECTION 171. ORS 431.157 is amended to read:
431.157. Pursuant to ORS 448.100 (1) and 446.425 (1), the
county is delegated the authority granted to the Director of
{ - Human Services - } { + the Oregon Health Authority + } in
ORS 431.155.
SECTION 172. ORS 431.170 is amended to read:
431.170. (1) The Director of { - Human Services - } { + the
Oregon Health Authority + } shall take direct charge of the
functions that are necessary to preserve the public health in any
county or district whenever any county or district official fails
or refuses to administer or enforce the public health laws or
rules that the director or board is charged to enforce.
(2) The director may call to the aid of the director such
assistance as is necessary for the enforcement of such statutes
and rules, the expense of which shall be borne by the county or
district making the use of this procedure necessary, to be paid
out of the respective county or district treasury upon vouchers
properly certified by the director.
SECTION 173. ORS 431.175 is amended to read:
431.175. If necessary, the Director of { - Human Services - }
{ + the Oregon Health Authority + } or a designee thereof, the
State Fire Marshal or a designee thereof or an officer of a law
enforcement agency may appear before any magistrate empowered to
issue warrants in criminal cases, and require such magistrate to
issue a warrant, directing it to any sheriff or deputy or any
constable or police officer, to enter the described property or
to remove any person or obstacle, or to defend any threatened
violence to the director or a designee thereof, the State Fire
Marshal or a designee thereof or an officer, upon entering
private property, or to assist the director in any way.
SECTION 174. ORS 431.180 is amended to read:
431.180. Nothing in the public health laws shall be construed
to empower or authorize the { - Department of Human
Services - } { + Oregon Health Authority + } or its
representatives, or any county or district board of health or its
representatives to interfere in any manner with the individual's
right to select the physician or mode of treatment of the choice
of the individual, nor interfere with the practice of any person
whose religion treats or administers to people who are sick or
suffering by purely spiritual means. However, sanitary laws and
rules must be complied with.
SECTION 175. ORS 431.190 is amended to read:
431.190. The Director of { - Human Services - } { + the
Oregon Health Authority + } shall appoint, not later than 60 days
after October 4, 1977, an advisory board to study the practices
and procedures of the health care professions in this state and
to recommend rules relating to the auditing of health care
practices in hospitals which will:
(1) Promote standard record keeping by hospitals and persons
practicing any of the healing arts in hospitals;
(2) Establish those criteria most appropriate for determining
the proper objects of such auditing; and
(3) Insure auditing of those practices and procedures most
relevant to the causes and occurrence of professional negligence
in hospitals.
SECTION 176. ORS 431.195 is amended to read:
431.195. (1) There is established the Oregon Public Health
Advisory Board to serve as an advisory body to the { - Director
of Human Services - } { + Oregon Health Authority Board + }.
(2) The members of the { - board - } { + Oregon Public
Health Advisory Board + } shall be residents of this state and
shall be appointed by the Governor. The { - board - } { +
Oregon Public Health Advisory Board + } shall consist of 15
members at least one-half of whom shall be public members broadly
representing the state as a whole and the others to include
representatives of local government and public and private health
providers.
(3) The Oregon Public Health Advisory Board shall:
(a) Advise the { - director - } { + Oregon Health Authority
Board + } on policy matters related to the operation of the
{ - Department of Human Services - } { + Oregon Health
Authority + }.
(b) Provide a review of statewide public health issues and make
recommendations to the { - director - } { + Oregon Health
Authority Board + }.
(c) Participate in public health policy development.
(4) Members shall be appointed for four-year terms. No person
shall serve more than two consecutive terms.
(5) The { - board - } { + Oregon Public Health Advisory
Board + } shall meet at least quarterly.
(6) Members of the { - board - } { + Oregon Public Health
Advisory Board + } shall be entitled to compensation and expenses
as provided in ORS 292.495.
(7) Vacancies on the { - board - } { + Oregon Public Health
Advisory Board + } shall be filled by appointments of the
Governor for the unexpired term.
SECTION 177. ORS 431.210 is amended to read:
431.210. (1) There is established in the General Fund the
Public Health Account, classified separately as to federal and
other moneys.
(2) All fines, fees, penalties, federal apportionments or
contributions and other moneys received by the { - Department
of Human Services - } { + Oregon Health Authority + } relating
to public health shall be turned over to the State Treasurer not
later than the 10th day of the calendar month next succeeding
their receipt by the department and shall be credited to the
Public Health Account.
(3) All moneys credited to the Public Health Account are
continuously appropriated to the { - department - } { +
authority + } for the payment of expenses of the
{ - department - } { + authority + }.
SECTION 178. ORS 431.220 is amended to read:
431.220. The { - Department of Human Services - } { +
Oregon Health Authority + } shall keep a record of all moneys
deposited in the Public Health Account. This record shall
indicate by separate cumulative accounts the source from which
the moneys are derived and the individual activity or program
against which each withdrawal is charged.
SECTION 179. ORS 431.230 is amended to read:
431.230. (1) The { - Director of Human Services - } { +
Oregon Health Authority + } may request the Oregon Department of
Administrative Services to, and when so requested, the Oregon
Department of Administrative Services shall, draw a payment on
the Public Health Account in favor of the Director of { - Human
Services - } { + the Oregon Health Authority + } in a sum not
exceeding $25,000, which sum shall be used by the director as an
emergency or revolving fund.
(2) The emergency or revolving fund shall be deposited with the
State Treasurer, and shall be at the disposal of the director
{ - of Human Services - } . It may be used to pay advances for
salaries, travel expenses or any other proper claim against, or
expense of, the { - Department of Human Services - }
{ + authority + } or the health-related licensing boards for
whom the { - department - } { + authority + } provides
accounting services.
(3) Claims for reimbursement of advances paid from the
emergency or revolving fund shall be submitted to the
{ - department - } { + authority + } for approval. When such
claims are so approved, payments covering them shall be drawn in
favor of the director { - of Human Services - } and charged
against the appropriate fund or account, and shall be used to
reimburse the emergency or revolving fund.
(4) The { - department - } { + authority + } may establish
petty cash funds within the emergency or revolving fund by
drawing checks upon the emergency or revolving fund payable to
the custodians of the petty cash funds.
SECTION 180. ORS 431.250 is amended to read:
431.250. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } hereby is designated as the state
agency to apply to and receive from the federal government or any
agency thereof such grants for promoting public health and the
prevention of disease, including grants for cancer control and
industrial hygiene programs, as may be available to this state or
any of its political subdivisions or agencies.
(2) For the purposes of subsection (1) of this section, the
{ - department - } { + authority + } shall:
(a) Disburse or supervise the disbursement of all funds made
available at any time by the federal government or this state for
those purposes.
(b) Adopt, carry out and administer plans for those purposes.
Plans so adopted shall be made statewide in application insofar
as reasonably feasible, possible or permissible, and shall be so
devised as to meet the approval of the federal government or any
of its agencies, not inconsistent with the laws of the state.
SECTION 181. ORS 431.260 is amended to read:
431.260. As used in ORS 431.035 to 431.530:
(1) 'Children's facility' has the meaning given that term in
ORS 433.235.
(2) 'Communicable disease' means a disease or condition, the
infectious agent of which may be transmitted by any means from
one person or from an animal to another person, that may result
in illness, death or severe disability.
(3) 'Condition of public health importance' means a disease,
syndrome, symptom, injury or other threat to public health that
is identifiable on an individual or community level.
(4) 'Disease outbreak' means a significant or notable increase
in the number of cases of a disease or other condition of public
health importance.
(5) 'Epidemic' means the occurrence in a community or region of
a group of similar conditions of public health importance that
are in excess of normal expectancy and derived from a common or
propagated source.
(6) 'Local public health administrator' means the public health
administrator of a county or health district appointed under ORS
431.418 or the authorized representative of that public health
administrator.
(7) 'Local public health authority' means a county government,
or a health district created under ORS 431.414 or a person or
agency a county or health district has contracted with to act as
the local public health authority.
(8) 'Public health law' means any statute, rule or local
ordinance that has the purpose of promoting or protecting the
public health and that establishes the authority of the
{ - Department of Human Services - } { + Oregon Health
Authority + }, the Public Health Director, the Public Health
Officer, a local public health authority or local public health
administrator to enforce the statute, rule or local ordinance.
(9) 'Public health measure' means a test, medical examination,
treatment, isolation, quarantine or other measure imposed on an
individual or group of individuals in order to prevent the spread
of or exposure to a communicable disease, toxic substance or
transmissible agent.
(10) 'Reportable disease' means a disease or condition, the
reporting of which enables a public health authority to take
action to protect or to benefit the public health.
(11) 'School' has the meaning given that term in ORS 433.235.
(12) 'Specimen' means blood, sputum, urine, stool or other
bodily fluids and wastes, tissues, and cultures necessary to
perform required tests.
(13) 'Test' means any diagnostic or investigative analyses or
medical procedures that determine the presence or absence of, or
exposure to, a condition of potential public health importance,
or its precursor in an individual.
(14) 'Toxic substance' means a substance that may cause
illness, disability or death to persons who are exposed to it.
SECTION 182. ORS 431.262 is amended to read:
431.262. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } and local public health
administrators shall have the power to enforce public health
laws. The enforcement powers authorized by this section include,
but are not limited to, the authority to:
(a) Investigate possible violations of public health laws;
(b) Issue subpoenas requiring testimony or the production of
physical or other evidence;
(c) Issue administrative orders to enforce compliance with
public health laws;
(d) Issue a notice of violation of a public health law and
impose a civil penalty as established by rule not to exceed $500
a day per violation;
(e) Enter private property at any reasonable time with consent
of the owner or custodian of the property to inspect,
investigate, evaluate or conduct tests, or take specimens or
samples for testing, as may be reasonably necessary to determine
compliance with any public health law;
(f) Enter a public place to inspect, investigate, evaluate,
conduct tests, or take specimens or samples for testing as may be
reasonably necessary to determine compliance with the provisions
of any public health law;
(g) Seek an administrative warrant from an appropriate court
authorizing the inspection, investigation, evaluation or testing,
or taking of specimens or samples for testing, if denied entry to
property;
(h) Restrict access to contaminated property;
(i) Require removal or abatement of a toxic substance on any
property and prescribe the proper measures for the removal or
abatement;
(j) Maintain a civil action to enforce compliance with public
health laws, including a petition to a court for an order
imposing a public health measure appropriate to the public health
threat presented;
(k) Refer any possible criminal violations of public health
laws to a district attorney or other appropriate law enforcement
official; and
(L) Request the Attorney General to assist in the enforcement
of the public health laws.
(2) Any administrative actions undertaken by the state under
this section shall comply with the provisions of ORS chapter 183.
(3) State and local law enforcement officials, to the extent
resources are available, must assist the { - Department of
Human Services - } { + Oregon Health Authority + } and local
public health administrators in ensuring compliance with
administrative or judicial orders issued pursuant to this
section.
(4) Nothing in this section shall be construed to limit any
other enforcement authority granted by law to a local public
health authority or to the state.
SECTION 183. ORS 431.264 is amended to read:
431.264. (1) Unless the Governor has declared a public health
emergency under ORS 433.441, the Public Health Director may, upon
approval of the Governor or the designee of the Governor, take
the public health actions described in subsection (2) of this
section if the Public Health Director determines that:
(a)(A) A communicable disease, reportable disease, disease
outbreak, epidemic or other condition of public health importance
has affected more than one county;
(B) There is an immediate need for a consistent response from
the state in order to adequately protect the public health;
(C) The resources of the local public health authority or
authorities are likely to be quickly overwhelmed or unable to
effectively manage the required response; and
(D) There is a significant risk to the public health; or
(b) A communicable disease, reportable disease, disease
outbreak, epidemic or other condition of public health importance
is reported in Oregon and is an issue of significant regional or
national concern or is an issue for which there is significant
involvement from federal authorities requiring state-federal
coordination.
(2) The Public Health Director, after making the determinations
required under subsection (1) of this section, may take the
following public health actions:
(a) Coordinate the public health response across jurisdictions.
(b) Prescribe measures for the:
(A) Identification, assessment and control of the communicable
disease or reportable disease, disease outbreak, epidemic or
other condition of public health importance; and
(B) Allocation and distribution of antitoxins, serums,
vaccines, immunizing agents, antibiotics, antidotes and other
pharmaceutical agents, medical supplies or personal protective
equipment.
(c) After consultation with appropriate medical experts, create
and require the use of diagnostic and treatment guidelines and
provide notice of those guidelines to health care providers,
institutions and facilities.
(d) Require a person to obtain treatment and use appropriate
prophylactic measures to prevent the introduction or spread of a
communicable disease or reportable disease, unless:
(A) The person has a medical diagnosis for which a vaccination
is contraindicated; or
(B) The person has a religious or conscientious objection to
the required treatments or prophylactic measures.
(e) Notwithstanding ORS 332.075, direct a district school board
to close a children's facility or school under the jurisdiction
of the board. The authority granted to the Public Health Director
under this paragraph supersedes the authority granted to the
district school board under ORS 332.075 to the extent the
authority granted to the board is inconsistent with the authority
granted to the director.
(f) Issue guidelines for private businesses regarding
appropriate work restrictions.
(g) Organize public information activities regarding the public
health response to circumstances described in subsection (1) of
this section.
(h) Adopt reporting requirements for, and provide notice of
those reporting requirements to, health care providers,
institutions and facilities for the purpose of obtaining
information directly related to the public health threat
presented.
(i) Take control of antitoxins, serums, vaccines, immunizing
agents, antibiotics, antidotes and other pharmaceutical agents,
medical supplies or personal protective equipment.
(3) The authority granted to the Public Health Director under
this section is not intended to override the general authority
provided to a local public health authority except as already
permitted by law, or under the circumstances described in
subsection (1) of this section.
(4) If the { - Department of Human Services - } { + Oregon
Health Authority + } adopts temporary rules to implement
subsection (2) of this section, the rules adopted are not subject
to the provisions of ORS 183.335 (6)(a). The { - department - }
{ + authority + } may amend the temporary rules adopted under
this subsection as often as is necessary to respond to the public
health threat.
(5) If it is necessary for the { - department - } { +
authority + } to purchase antitoxins, serums, vaccines,
immunizing agents, antibiotics, antidotes or other pharmaceutical
agents, medical supplies or personal protective equipment, the
purchases are not subject to the provisions of ORS chapter 279A,
279B or 279C.
(6) If property is taken under the authority granted to the
Public Health Director under subsection (2) of this section, the
owner of the property is entitled to reasonable compensation from
the state.
SECTION 184. ORS 431.270 is amended to read:
431.270. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } shall educate residents of this state
about:
(a) The need for bone marrow donors;
(b) The procedures required to become registered as a potential
bone marrow donor, including procedures for determining a
person's tissue type; and
(c) The medical procedures a donor must undergo to donate bone
marrow or other sources of blood stem cells.
(2) The { - Department of Human Services - } { + Oregon
Health Authority + } shall make special efforts to educate and
recruit citizens of Oregon with a special emphasis on minority
populations to volunteer as potential bone marrow donors. Means
of communication may include use of press, radio and television,
and placement of educational materials in appropriate health care
facilities, blood banks and state and local agencies. The
{ - Department of Human Services - } { + Oregon Health
Authority + } in conjunction with the Department of
Transportation shall make educational materials available at all
places where driver licenses are issued or renewed.
SECTION 185. ORS 431.290 is amended to read:
431.290. (1) There is established a Spinal Cord Injury Research
Board consisting of 11 members appointed by the Governor.
(2) The term of office of each member is four years, but a
member serves at the pleasure of the Governor. A member is
eligible for reappointment. If there is a vacancy for any cause,
the Governor shall make an appointment to become immediately
effective for the unexpired term.
(3) The appointment of a member to the board is subject to
confirmation by the Senate in the manner prescribed in ORS
171.562 and 171.565.
(4) The members of the Spinal Cord Injury Research Board shall
be citizens of this state who are well informed on the issues
relating to spinal cord injuries and related disabilities.
Members may include, but are not limited to:
(a) A minimum of five health professionals with clinical
practice experience in each of the practice fields of
neuroscience, neurology, neurosurgery, neuropharmacology and
spinal cord rehabilitative medicine;
(b) A representative of the Oregon Disabilities Commission;
(c) A representative of a disabilities advocacy organization or
an individual who advocates on behalf of persons with spinal cord
injuries;
(d) A representative of the { - Department of Human
Services - } { + Oregon Health Authority + };
(e) Members of the Legislative Assembly; and
(f) A person with a spinal cord injury.
(5) The board shall elect one of its members as chairperson and
another as vice chairperson, for such terms and with such duties
and powers necessary for the performance of the functions of such
offices as the board determines.
(6) The board shall meet at least once every three months at a
place, day and hour determined by the chairperson. The board also
shall meet at other times and places specified by the call of the
chairperson or of a majority of the members of the board.
(7) In accordance with applicable provisions of ORS chapter
183, the board may adopt rules necessary for the administration
of the grant program and fund described in ORS 431.292 and
431.294.
SECTION 186. ORS 431.310 is amended to read:
431.310. (1) For the better protection of the public health the
laboratory of the { - Department of Human Services - } { +
Oregon Health Authority + } shall make bacteriological and other
examinations of water, milk, blood, secretions or tissues
required by any state, county or city institution, or officer,
and may make such examinations for any licensed physician in
accordance with the rules of the { - department - } { +
authority + }.
(2) The { - department - } { + authority + } shall
establish by rule and collect fees for tests performed in the
state public health laboratory, not to exceed:
(a) $50 per test for tests other than newborn screening tests;
and
(b) $30 per specimen for newborn screening tests.
(3) All money received for such tests shall be deposited in the
Public Health Account to be used for expenses of the state public
health laboratory.
SECTION 187. ORS 431.330 is amended to read:
431.330. (1) The Conference of Local Health Officials is
created. The conference shall consist of all local health
officers and public health administrators, appointed pursuant to
ORS 431.418 and such other local health personnel as may be
included by the rules of the conference.
(2) The Conference of Local Health Officials shall select one
of its members as chairperson, another as vice chairperson and
another as secretary with such powers and duties necessary to the
performance of the functions of such offices as the conference
shall determine. The chairperson, after consultation with the
Director of { - Human Services - } { + the Oregon Health
Authority + }, shall appoint from the conference membership an
executive committee. The executive committee with the chairperson
shall advise the director in the administration of ORS 431.330 to
431.350.
SECTION 188. ORS 431.335 is amended to read:
431.335. (1) The Conference of Local Health Officials shall
meet at least annually at a place, day and hour determined by the
executive committee and the Director of { - Human Services - }
{ + the Oregon Health Authority + }. The conference may meet
specially at such other times as the director or the executive
committee considers necessary.
(2) The director shall cause at least 10 days' notice of each
meeting date to be given to the members. The chairperson or an
authorized representative of the chairperson shall preside at all
meetings of the conference.
(3) Each conference member shall receive from the local board
which the conference member represents from funds available under
ORS 431.510, the actual and necessary travel and other expenses
incurred by the conference member in attendance at no more than
two meetings of the conference per year. Additionally, subject to
applicable law regulating travel and other expenses for state
officers, a local health official who is a member of the
executive committee of the conference or who is the chairperson
shall receive from funds available to the { - Department of
Human Services - } { + Oregon Health Authority + }, actual and
necessary travel and other expenses for attendance at no more
than six meetings per year of the executive committee called by
the { - department - } { + authority + }.
SECTION 189. ORS 431.340 is amended to read:
431.340. The Conference of Local Health Officials may submit to
the { - Department of Human Services - } { + Oregon Health
Authority + } such recommendations on the rules and standards
specified in ORS 431.345 and 431.350.
SECTION 190. ORS 431.345 is amended to read:
431.345. In order to establish criteria for local boards of
health to qualify for such financial assistance as may be made
available, the { - Department of Human Services - } { +
Oregon Health Authority + }, upon receipt of written approval
from the Conference of Local Health Officials shall adopt minimum
standards governing:
(1) Education and experience for professional and technical
personnel employed in local health departments, such standards to
be consistent with any applicable merit system.
(2) Organization, operation and extent of activities which are
required or expected of local health departments to carry out
their responsibilities in implementing the public health laws of
this state and the rules of the { - Department of Human
Services - } { + Oregon Health Authority + }.
SECTION 191. ORS 431.350 is amended to read:
431.350. Upon receipt of written approval from the Conference
of Local Health Officials the { - Department of Human
Services - } { + Oregon Health Authority + } shall adopt rules
necessary for the administration of ORS 431.330 to 431.350.
SECTION 192. ORS 431.375 is amended to read:
431.375. (1) The Legislative Assembly of the State of Oregon
finds that each citizen of this state is entitled to basic public
health services which promote and preserve the health of the
people of Oregon. To provide for basic public health services the
state, in partnership with county governments, shall maintain and
improve public health services through county or district
administered public health programs.
(2) County governments or health districts established under
ORS 431.414 are the local public health authority responsible for
management of local public health services unless the county
contracts with private persons or an agency to act as the local
public health authority or the county relinquishes authority to
the state. If authority is relinquished, the state may then
contract with private persons or an agency or perform the
services.
(3) All expenditure of public funds utilized to provide public
health services on the local level must be approved by the local
public health authority unless the county has relinquished
authority to the state or an exception has been approved by the
{ - Department of Human Services - } { + Oregon Health
Authority + } with the concurrence of the Conference of Local
Health Officials.
(4) The { - Department of Human Services - } { + Oregon
Health Authority + }:
(a) Shall contract for the provision of maternal and child
public health services with any tribal governing council of a
federally recognized Indian tribe that requests to receive
funding and to deliver services under the federal Title V
Maternal and Child Health Services Block Grant Program.
(b) May contract directly with any tribal governing council of
a federally recognized Indian tribe for provision of public
health services and programs not required under paragraph (a) of
this subsection.
(5) Contracts authorized by subsection (4) of this section must
specify that:
(a) Payments will be made to the tribe on a per capita or other
equitable formula basis;
(b) The tribe must provide services that are comparable to the
services provided by a local public health authority; and
(c) The tribe must comply with any state or federal
requirements with which a local public health authority providing
the same services must comply.
SECTION 193. ORS 431.380 is amended to read:
431.380. (1) From funds available to the { - Department of
Human Services - } { + Oregon Health Authority + } for local
public health purposes, regardless of the source, the
{ - department - } { + authority + } shall provide payments to
the local public health authority on a per capita or other
equitable formula basis to be used for public health services.
Funding formulas shall be determined by the
{ - department - } { + authority + } with the concurrence of
the Conference of Local Health Officials.
(2) With respect to counties that have established joint public
health services with another county, either by agreement or the
formation of a district board of health, distribution of funds
made available under the provisions of this section shall be
prorated to such counties as provided by agreement or under ORS
431.510.
SECTION 194. ORS 431.385 is amended to read:
431.385. (1) The local public health authority shall submit an
annual plan to the { - Department of Human Services - } { +
Oregon Health Authority + } for performing services pursuant to
ORS 431.375 to 431.385 and 431.416. The annual plan shall be
submitted no later than May 1 of each year or on a date mutually
agreeable to the
{ - department - } { + authority + } and the local public
health authority.
(2) If the local public health authority decides not to submit
an annual plan under the provisions of ORS 431.375 to 431.385 and
431.416, the { - department - } { + authority + } shall
become the local public health authority for that county or
health district.
(3) The { - department - } { + authority + } shall review
and approve or disapprove each plan. Variances to the local
public health plan must be approved by the { - department - }
{ + authority + }. In consultation with the Conference of Local
Health Officials, the { - department - } { + authority + }
shall establish the elements of a plan and an appeals process
whereby a local health authority may obtain a hearing if its plan
is disapproved.
(4) Each local commission on children and families shall
reference the local public health plan in the local coordinated
comprehensive plan created pursuant to ORS 417.775.
SECTION 195. ORS 431.415 is amended to read:
431.415. (1) The district or county board of health is the
policymaking body of the county or district in implementing the
duties of local departments of health under ORS 431.416.
(2) The district or county board of health shall adopt rules
necessary to carry out its policies under subsection (1) of this
section. The county or district board of health shall adopt no
rule or policy which is inconsistent with or less strict than any
public health law or rule of the { - Department of Human
Services - } { + Oregon Health Authority + }.
(3) With the permission of the county governing body, a county
board may, and with the permission of the governing bodies of the
counties involved, a district board may, adopt schedules of fees
for public health services reasonably calculated not to exceed
the cost of the services performed. The health department shall
charge fees in accordance with such schedule or schedules
adopted.
SECTION 196. ORS 431.416 is amended to read:
431.416. The local public health authority or health district
shall:
(1) Administer and enforce the rules of the local public health
authority or the health district and public health laws and rules
of the { - Department of Human Services - } { + Oregon Health
Authority + }.
(2) Assure activities necessary for the preservation of health
or prevention of disease in the area under its jurisdiction as
provided in the annual plan of the authority or district are
performed. These activities shall include but not be limited to:
(a) Epidemiology and control of preventable diseases and
disorders;
(b) Parent and child health services, including family planning
clinics as described in ORS 435.205;
(c) Collection and reporting of health statistics;
(d) Health information and referral services; and
(e) Environmental health services.
SECTION 197. ORS 431.418 is amended to read:
431.418. (1) Each district board of health shall appoint a
qualified public health administrator to supervise the activities
of the district in accordance with law. Each county governing
body in a county that has created a county board of health under
ORS 431.412 shall appoint a qualified public health administrator
to supervise the activities of the county health department in
accordance with law. In making such appointment, the district or
county board of health shall consider standards for selection of
administrators prescribed by the { - Department of Human
Services - } { + Oregon Health Authority + }.
(2) When the public health administrator is a physician
licensed by the Oregon Medical Board, the administrator shall
serve as health officer for the district or county board of
health. When the public health administrator is not a physician
licensed by the Oregon Medical Board, the administrator will
employ or otherwise contract for services with a health officer
who shall be a licensed physician and who will perform those
specific medical responsibilities requiring the services of a
physician and shall be responsible to the public health
administrator for the medical and paramedical aspects of the
health programs.
(3) The public health administrator shall:
(a) Serve as the executive secretary of the district or county
health board, act as the administrator of the district or county
health department and supervise the officers and employees
appointed under paragraph (b) of this subsection.
(b) Appoint with the approval of the health board,
administrators, medical officers, public health nurses,
environmental health specialists and such other employees as are
necessary to carry out the duties and responsibilities of the
office.
(c) Provide the board at appropriate intervals information
concerning the activities of the county health department and
submit an annual budget for the approval of the county governing
body except that, in the case of the district public health
administrator, the budget shall be submitted to the governing
bodies of the participating counties for approval.
(d) Act as the agent of the { - Department of Human
Services - } { + Oregon Health Authority + } in enforcing state
public health laws and rules of the { - Department of Human
Services - } { + authority + }, including such sanitary
inspection of hospitals and related institutions as may be
requested by the { - Department of Human Services - } { +
authority + }.
(e) Perform such other duties as may be required by law.
(4) The public health administrator shall serve until removed
by the appointing board. The public health administrator shall
engage in no occupation which conflicts with official duties and
shall devote sufficient time to duties as public health
administrator as may be necessary to fulfill the requirements of
subsection (3) of this section. However, if the board of health
is not created under ORS 431.412, it may, with the approval of
the Director of Human Services, require less than full-time
service of the public health administrator.
(5) The public health administrator shall receive a salary
fixed by the appointing board and shall be reimbursed for actual
and necessary expenses incurred in the performance of duties.
SECTION 198. ORS 431.530 is amended to read:
431.530. (1) The local public health administrator may take any
action which the { - Department of Human Services - } { +
Oregon Health Authority + } or its director could have taken, if
an emergency endangering the public health occurs within the
jurisdiction of any local public health administrator and:
(a) The circumstances of the emergency are such that the
{ - department - } { + authority + } or its director cannot
take action in time to meet the emergency; and
(b) Delay in taking action to meet the emergency will increase
the hazard to public health.
(2) Any local public health administrator who acts under
subsection (1) of this section shall report the facts
constituting the emergency and any action taken under the
authority granted by subsection (1) of this section to the
Director of { - Human Services - } { + the Oregon Health
Authority + } by the fastest possible means.
SECTION 199. ORS 431.550 is amended to read:
431.550. Nothing in ORS 431.412, 431.418 and this section shall
be construed to limit the authority of the { - Department of
Human Services - } { + Oregon Health Authority + } to require
facts and statistics from local public health administrators
under its general supervisory power over all matters relating to
the preservation of life and health of the people of the state.
SECTION 200. ORS 431.607 is amended to read:
431.607. In cooperation with representatives of the emergency
medical services professions, the { - Department of Human
Services - } { + Oregon Health Authority + } shall develop a
comprehensive emergency medical services and trauma system. The
{ - department - } { + authority + } shall report progress on
the system to the Legislative Assembly.
SECTION 201. ORS 431.609 is amended to read:
431.609. (1) With the advice of the State Trauma Advisory
Board, the { - Department of Human Services - } { + Oregon
Health Authority + } shall:
(a) Develop and monitor a statewide trauma system; and
(b) Designate within the state, trauma areas consistent with
local resources, geography and current patient referral patterns.
(2) Each trauma area shall have:
(a) Central medical control for all field care and
transportation consistent with geographic and current
communications capability.
(b) The development of triage protocols.
(c) One or more hospitals categorized according to trauma care
capabilities using standards adopted by the { - department - }
{ + authority + } by rule. Such rules shall be modeled after the
American College of Surgeons Committee on Trauma standards.
(d) The establishment of area trauma advisory boards to develop
trauma system plans for each trauma area.
(3) On and after July 1, 1986, the { - department - } { +
authority + } may designate trauma system hospitals in accordance
with area trauma advisory board plans which meet state objectives
and standards.
(4) Trauma system plans shall be implemented by June 30, 1987,
in Health Systems Area I, and June 30, 1988, in Health Systems
Areas II and III.
SECTION 202. ORS 431.611 is amended to read:
431.611. (1) Prior to approval and implementation of area
trauma plans submitted to the { - Department of Human
Services - } { + Oregon Health Authority + } by area trauma
advisory boards, the
{ - department - } { + authority + } shall adopt rules
pursuant to ORS chapter 183 which specify state trauma objectives
and standards, hospital categorization criteria and criteria and
procedures to be utilized in designating trauma system hospitals.
(2) For approved area trauma plans recommending designation of
trauma system hospitals, the { - department - } { +
authority + } rules shall provide for:
(a) The transport of a member of a health maintenance
organization, or other managed health care system, as defined by
rule, to a hospital that contracts with the health maintenance
organization when central medical control determines that the
condition of the member permits such transport; and
(b) The development and utilization of protocols between
designated trauma hospitals and health maintenance organizations,
or other managed health care systems, as defined by rule,
including notification of admission of a member to a designated
trauma hospital within 48 hours of admission, and coordinated
discharge planning between a designated trauma hospital and a
hospital that contracts with a health maintenance organization to
facilitate transfer of the member when the medical condition of
the member permits.
SECTION 203. ORS 431.613 is amended to read:
431.613. (1) Area trauma advisory boards shall meet as often as
necessary to identify specific trauma area needs and problems and
propose to the { - Department of Human Services - } { +
Oregon Health Authority + } area trauma system plans and changes
that meet state standards and objectives. The
{ - department - } { + authority + } acting with the advice of
the State Trauma Advisory Board will have the authority to
implement these plans.
(2) In concurrence with the Governor, the { - department - }
{ + authority + } shall select members for each area from lists
submitted by local associations of emergency medical technicians,
emergency nurses, emergency physicians, surgeons, hospital
administrators, emergency medical services agencies and citizens
at large. Members shall be broadly representative of the trauma
area as a whole and shall consist of at least 15 members per area
trauma advisory board, including:
(a) Three surgeons;
(b) Two physicians serving as emergency physicians;
(c) Two hospital administrators from different hospitals;
(d) Two nurses serving as emergency nurses;
(e) Two emergency medical technicians serving different
emergency medical services;
(f) Two representatives of the public at large selected from
among those submitting letters of application in response to
public notice by the { - department - } { + authority + }.
Public members shall not have an economic interest in any
decision of the health care service areas;
(g) One representative of any bordering state which is included
within the patient referral area;
(h) One anesthesiologist; and
(i) One ambulance service owner or operator or both.
SECTION 204. ORS 431.619 is amended to read:
431.619. The { - Department of Human Services - } { +
Oregon Health Authority + } shall continuously identify the
causes of trauma in Oregon, and propose programs of prevention
thereof for consideration by the Legislative Assembly or others.
SECTION 205. ORS 431.623 is amended to read:
431.623. (1) The Emergency Medical Services and Trauma Systems
Program is created within the { - Department of Human
Services - } { + Oregon Health Authority + } for the purpose of
administering and regulating ambulances, training and certifying
emergency medical technicians, establishing and maintaining
emergency medical systems including trauma systems and obtaining
appropriate data from the Oregon Injury Registry as necessary for
trauma reimbursement, system quality assurance and assuring cost
efficiency.
(2) For purposes of ORS 431.607 to 431.619 and ORS chapter 682,
the duties vested in the { - department - } { + authority + }
shall be performed by the Emergency Medical Services and Trauma
Systems Program.
(3) The program shall be administered by a director.
(4) With moneys transferred to the program by ORS 442.625, the
program shall apply those moneys to:
(a) Developing state and regional standards of care;
(b) Developing a statewide educational curriculum to teach
standards of care;
(c) Implementing quality improvement programs;
(d) Creating a statewide data system for prehospital care; and
(e) Providing ancillary services to enhance Oregon's emergency
medical service system.
SECTION 206. ORS 431.627 is amended to read:
431.627. (1) In addition to and not in lieu of ORS 431.607 to
431.617, the { - Department of Human Services - } { + Oregon
Health Authority + } shall designate trauma centers in areas that
are within the jurisdiction of trauma advisory boards other than
in the area within the jurisdiction of area trauma advisory board
1.
(2) The { - department - } { + authority + } shall enter
into contracts with designated trauma centers and monitor and
assure quality of care and appropriate costs for trauma patients
meeting trauma system entry criteria.
(3) All findings and conclusions, interviews, reports, studies,
communications and statements procured by or furnished to the
{ - department - } { + authority + }, the State Trauma
Advisory Board or an area trauma advisory board in connection
with obtaining the data necessary to perform patient care quality
assurance functions shall be confidential pursuant to ORS 192.501
to 192.505.
(4)(a) All data received or compiled by the State Trauma
Advisory Board or any area trauma advisory board in conjunction
with { - department - } { + authority + } monitoring and
assuring quality of trauma patient care shall be confidential and
privileged, nondiscoverable and inadmissible in any proceeding.
No person serving on or communicating information to the State
Trauma Advisory Board or an area trauma advisory board shall be
examined as to any such communications or to the findings or
recommendations of such board. A person serving on or
communicating information to the State Trauma Advisory Board or
an area trauma advisory board shall not be subject to an action
for civil damages for actions taken or statements made in good
faith. Nothing in this section affects the admissibility in
evidence of a party's medical records not otherwise confidential
or privileged dealing with the party's medical care. The
confidentiality provisions of ORS 41.675 and 41.685 shall also
apply to the monitoring and quality assurance activities of the
State Trauma Advisory Board, area trauma advisory boards and the
{ - department - } { + authority + }.
(b) As used in this section, 'data' includes but is not limited
to written reports, notes, records and recommendations.
(5) Final reports by the { - department - } { +
authority + }, the State Trauma Advisory Board and area trauma
advisory boards shall be available to the public.
(6) The { - department - } { + authority + } shall publish
a biennial report of the Emergency Medical Services and Trauma
Systems Program and trauma systems activities.
SECTION 207. ORS 431.633 is amended to read:
431.633. (1) Designated trauma centers and providers, physical
rehabilitation centers, alcohol and drug rehabilitation centers
and ambulances shall develop a monthly log of all unsponsored,
inadequately insured trauma system patients determined by the
hospital to have an injury severity score greater than or equal
to 13, and submit monthly to the Emergency Medical Services and
Trauma Systems Program the true costs and unpaid balance for the
care of these patients.
(2) No reimbursement for these patients shall occur until:
(a) All information required by the Emergency Medical Services
and Trauma Systems Program rules is submitted to the Oregon
Injury Registry; and
(b) The Emergency Medical Services and Trauma Systems Program
confirms that the injury severity score, as defined by the
{ - Department of Human Services - } { + Oregon Health
Authority + } by rule, is greater than or equal to 13.
(3) The Emergency Medical Services and Trauma Systems Program
shall cause providers to be reimbursed in the following
decreasing order of priority:
(a) Designated trauma centers and providers;
(b) Physical rehabilitation centers;
(c) Alcohol and drug rehabilitation centers; and
(d) Ambulances.
(4) Subject to the availability of funds, the Emergency Medical
Services and Trauma Systems Program shall cause the designated
trauma centers and providers to be paid first in full.
Subsequent providers shall be paid from the balance remaining
according to priority.
(5) Any matching funds, available pursuant to the federal
Trauma Care Systems and Development Act of 1990 (H.R. 1602), that
are available for purposes of the Emergency Medical Services and
Trauma Systems Program may be used for related studies and
projects and reimbursement for uncompensated care.
SECTION 208. ORS 431.671 is amended to read:
431.671. (1) Subject to available funding from gifts, grants or
donations, the Emergency Medical Services for Children Program is
established in the { - Department of Human Services - } { +
Oregon Health Authority + }. The Emergency Medical Services for
Children Program shall operate in cooperation with the Emergency
Medical Services and Trauma Systems Program to promote the
delivery of emergency medical and trauma services to the children
of Oregon.
(2) The { - Department of Human Services - } { + Oregon
Health Authority + } shall:
(a) Employ or contract with professional, technical, research
and clerical staff as required to implement this section.
(b) Provide technical assistance to the State Trauma Advisory
Board on the integration of an emergency medical services for
children program into the statewide emergency medical services
and trauma system.
(c) Provide advice and technical assistance to area trauma
advisory boards on the integration of an emergency medical
services for children program into area trauma system plans.
(d) Establish an Emergency Medical Services for Children
Advisory Committee.
(e) Establish guidelines for:
(A) The approval of emergency and critical care medical service
facilities for pediatric care, and for the designation of
specialized regional pediatric critical care centers and
pediatric trauma care centers.
(B) Referring children to appropriate emergency or critical
care medical facilities.
(C) Necessary prehospital and other pediatric emergency and
critical care medical service equipment.
(D) Developing a coordinated system that will allow children to
receive appropriate initial stabilization and treatment with
timely provision of, or referral to, the appropriate level of
care, including critical care, trauma care or pediatric
subspecialty care.
(E) Protocols for prehospital and hospital facilities
encompassing all levels of pediatric emergency services,
pediatric critical care and pediatric trauma care.
(F) Rehabilitation services for critically ill or injured
children.
(G) An interfacility transfer system for critically ill or
injured children.
(H) Initial and continuing professional education programs for
emergency medical services personnel, including training in the
emergency care of infants and children.
(I) A public education program concerning the Emergency Medical
Services for Children Program including information on emergency
access telephone numbers.
(J) The collection and analysis of statewide pediatric
emergency and critical care medical services data from emergency
and critical care medical service facilities for the purpose of
quality improvement by such facilities, subject to relevant
confidentiality requirements.
(K) The establishment of cooperative interstate relationships
to facilitate the provision of appropriate care for pediatric
patients who must cross state borders to receive emergency and
critical care services.
(L) Coordination and cooperation between the Emergency Medical
Services for Children Program and other public and private
organizations interested or involved in emergency and critical
care for children.
SECTION 209. ORS 431.705 is amended to read:
431.705. As used in ORS 431.705 to 431.760, unless the context
requires otherwise:
(1) 'Affected territory' means an area that is the subject of a
proceedings under ORS 431.705 to 431.760 where there is a danger
to public health or an alleged danger to public health.
(2) 'Boundary commission' means a local government boundary
commission created under ORS 199.410 to 199.430, 199.435 to
199.464, 199.480 to 199.505 and 199.510.
(3) 'Commission' means the Environmental Quality Commission.
(4) 'Danger to public health' means a condition which is
conducive to the propagation of communicable or contagious
disease-producing organisms and which presents a reasonably clear
possibility that the public generally is being exposed to
disease-caused physical suffering or illness, including a
condition such as:
(a) Impure or inadequate domestic water.
(b) Inadequate installations for the disposal or treatment of
sewage, garbage or other contaminated or putrefying waste.
(c) Inadequate improvements for drainage of surface water and
other fluid substances.
{ - (5) 'Department' means the Department of Human
Services. - }
{ - (6) 'Director' means the Director of Human Services. - }
{ - (7) - } { + (5) + } 'District' means any one of the
following:
(a) A metropolitan service district formed under ORS chapter
268.
(b) A county service district formed under ORS chapter 451.
(c) A sanitary district formed under ORS 450.005 to 450.245.
(d) A sanitary authority, water authority or joint water and
sanitary authority formed under ORS 450.600 to 450.989.
(e) A domestic water supply district formed under ORS chapter
264.
{ - (8) - } { + (6) + } 'Requesting body' means the county
court, or local or district board of health that makes a request
under ORS 431.715.
{ - (9) - } { + (7) + } 'Service facilities' means water or
sewer installations or works.
SECTION 210. ORS 431.710 is amended to read:
431.710. (1) ORS 431.705 to 431.760 shall not apply if the
affected territory could be subject to an annexation proceeding
under ORS 222.840 to 222.915.
(2) If the { - Department of Human Services - } { + Oregon
Health Authority + }, in accordance with ORS 431.705 to 431.760,
finds that a danger to public health exists within the affected
territory and that such danger could be removed or alleviated by
the construction, maintenance and operation of service
facilities, the
{ - department - } { + authority + } shall initiate
proceedings for the formation of or annexation to a district to
serve the affected territory. If the affected territory is
located within a district that has the authority to provide the
service facilities, the
{ - department - } { + authority + } shall order the district
to provide service facilities in the affected territory.
SECTION 211. ORS 431.715 is amended to read:
431.715. (1) The county court or the local or district board of
health having jurisdiction over territory where it believes
conditions dangerous to the public health exist shall adopt a
resolution requesting the { - Department of Human Services - }
{ + Oregon Health Authority + } to initiate proceedings for the
formation of a district or annexation of territory to, or
delivery of appropriate water or sewer services by, an existing
district without vote or consent in the affected territory. The
resolution shall:
(a) Describe the boundaries of the affected territory;
(b) Describe the conditions alleged to be causing a danger to
public health;
(c) Request the { - department - } { + authority + } to
ascertain whether conditions dangerous to public health exist in
the affected territory and whether such conditions could be
removed or alleviated by the provision of service facilities; and
either
(d) Recommend a district that the affected territory could be
included in or annexed to for the purpose of providing the
requested service facilities; or
(e) Recommend that an existing district provide service
facilities in the affected territory.
(2) The requesting body shall cause a certified copy of the
resolution, together with the time schedule and preliminary plans
and specifications, prepared in accordance with subsection (3) of
this section, to be forwarded to the { - department - } { +
authority + }.
(3) The requesting body shall cause a study to be made and
preliminary plans and specifications prepared for the service
facilities considered necessary to remove or alleviate the
conditions causing a danger to public health. The requesting body
shall prepare a schedule setting out the steps necessary to put
the facilities into operation and the time required for each step
in implementation of the plans.
(4) If the preliminary plans involve facilities that are
subject to the jurisdiction of the Environmental Quality
Commission, a copy of the documents submitted to the
{ - department - } { + authority + } under subsection (2) of
this section shall be submitted to the commission for review, in
accordance with ORS 431.725, of those facilities that are subject
to its jurisdiction. No order or findings shall be adopted under
ORS 431.735 or 431.756 until the plans of the requesting body for
such facilities, if any, have been approved by the commission.
SECTION 212. ORS 431.720 is amended to read:
431.720. (1) Upon receipt of the documents submitted under ORS
431.715 (4), the Environmental Quality Commission shall review
them to determine whether the conditions dangerous to public
health within the affected territory could be removed or
alleviated by the provision of service facilities that are
subject to the jurisdiction of the commission.
(2) If the commission considers such proposed facilities and
the time schedule for installation of such facilities adequate to
remove or alleviate the dangerous conditions, it shall approve
the part of the plans that are subject to its jurisdiction and
certify its approval to the { - Department of Human
Services - } { + Oregon Health Authority + }.
(3) If the commission considers the proposed facilities or time
schedule inadequate, it shall disapprove the part of the plans
that are subject to its jurisdiction and certify its disapproval
to the { - department - } { + authority + }. The commission
shall also inform the requesting body of its approval or
disapproval and, in case of disapproval, of the particular
matters causing the disapproval. The requesting body may then
submit additional or revised plans.
SECTION 213. ORS 431.725 is amended to read:
431.725. (1) Upon receipt of the certified copy of a resolution
adopted under ORS 431.715, the { - Department of Human
Services - } { + Oregon Health Authority + } shall contact the
requesting body within 30 days of receipt of the request and
schedule the review and investigation of conditions in the
affected territory. The { - department - } { + authority + }
shall review and investigate conditions in the affected territory
in accordance with the agreed upon schedule unless both parties
agree to an extension. If it finds substantial evidence that a
danger to public health exists in the territory, it shall issue
an order setting a time and place for a hearing on the
resolution. The hearing shall be held within the affected
territory, or at a place near the territory if there is no
suitable place within the territory at which to hold the hearing,
not less than 30 or more than 50 days after the date of the
order.
(2) Upon issuance of an order for a hearing, the
{ - department - } { + authority + } shall immediately give
notice of the time and place of the hearing on the resolution by
publishing the order and resolution in a newspaper of general
circulation within the territory once each week for two
successive weeks and by posting copies of the order in four
public places within the territory prior to the hearing.
SECTION 214. ORS 431.730 is amended to read:
431.730. (1) At the hearing on the resolution, any interested
person shall be given a reasonable opportunity to be heard or to
present written statements. The hearing shall be for the sole
purpose of determining whether a danger to public health exists
due to conditions in the affected territory and whether such
conditions could be removed or alleviated by the provision of
service facilities. Hearings under this section shall be
conducted by an administrative law judge assigned from the Office
of Administrative Hearings established under ORS 183.605. It
shall be conducted in accordance with the provisions of ORS
chapter 183. The { - Department of Human Services - } { +
Oregon Health Authority + } shall publish a notice of the
issuance of said findings and recommendations in the newspaper
utilized for the notice of hearing under ORS 431.725 (2) advising
of the opportunity for presentation of a petition under
subsection (2) of this section.
(2) Within 15 days after the publication of notice of issuance
of findings in accordance with subsection (1) of this section,
any person who may be affected by the findings, or the affected
district, may petition the Director of { - Human Services - }
{ + the Oregon Health Authority + } according to rules of the
{ - department - } { + authority + } to present written or oral
arguments relative to the proposal. If a petition is received,
the director may set a time and place for receipt of argument.
SECTION 215. ORS 431.735 is amended to read:
431.735. (1) If the Director of { - Human Services - } { +
the Oregon Health Authority + } after investigation finds that no
danger to public health exists because of conditions within the
affected territory, or that such a danger does exist but the
conditions causing it could not be removed or alleviated by the
provision of service facilities, the director shall issue an
order terminating the proceedings under ORS 431.705 to 431.760
with reference to the affected territory.
(2) If the director finds, after investigation and the hearing
required by ORS 431.725, that a danger to public health exists
because of conditions within the territory, and that such
conditions could be removed or alleviated by the provisions of
service facilities in accordance with the plans and
specifications and the time schedule proposed, the director shall
enter findings in an order, directed to the officers described by
ORS 431.740, setting out the service facilities to be provided.
(3) If the director determines that a danger to public health
exists because of conditions within only part of the affected
territory, or that such conditions could be removed or alleviated
in only part of the affected territory by the provision of
service facilities, the director may, subject to conditions
stated in ORS 431.705 to 431.760, reduce the boundaries of the
affected territory to that part which presents a danger or in
which the conditions could be removed or alleviated if the area
to be excluded would not be surrounded by the territory remaining
to be annexed and would not be directly served by the sanitary,
water or other facilities necessary to remove or alleviate the
danger to public health existing within the territory remaining
to be annexed. The findings shall describe the boundaries of the
area as reduced by the director.
(4) In determining whether to exclude any area the director may
consider whether or not such exclusion would unduly interfere
with the removal or alleviation of the danger to public health in
the area remaining to be annexed and whether the exclusion would
result in an illogical boundary for the provision of services.
(5) The requesting body or the boundary commission shall, when
requested, aid in the determinations made under subsections (3)
and (4) of this section and, if necessary, cause a study to be
made.
SECTION 216. ORS 431.740 is amended to read:
431.740. (1) If a boundary commission has jurisdiction of the
affected territory, the Director of { - Human Services - }
{ + the Oregon Health Authority + } shall file the findings and
order with such boundary commission. If the affected territory is
not within the jurisdiction of a boundary commission, the
director shall file the findings and order with the county court
of the county having jurisdiction of the territory.
(2) The { - Department of Human Services - } { + Oregon
Health Authority + } and the Environmental Quality Commission
shall use their applicable powers of enforcement to insure that
the service facilities are constructed or installed in
conformance with the approved plans and schedules.
SECTION 217. ORS 431.745 is amended to read:
431.745. (1) At any time after the adoption of a resolution
under ORS 431.715, a petition, signed by not less than 51 percent
of the electors registered in the affected territory, may be
filed with the { - Department of Human Services - } { +
Oregon Health Authority + }. The petition shall suggest an
alternative plan to the proposed formation or annexation for
removal or alleviation of the conditions dangerous to public
health. The petition shall state the intent of the residents to
seek annexation to an existing city or special district
authorized by law to provide service facilities necessary to
remove or alleviate the dangerous conditions. The petition shall
be accompanied by a proposed plan which shall state the type of
facilities to be constructed, a proposed means of financing the
facilities and an estimate of the time required to construct such
facilities and place them in operation.
(2) Upon receipt of the petition, the { - department - }
{ + authority + } shall immediately forward a copy of the
petition to the Environmental Quality Commission, if the plan
accompanying the petition involves facilities that are subject to
the jurisdiction of the commission. The { - department - }
{ + authority + } also shall forward a copy of the petition to
the requesting body and to the county court or boundary
commission where the { - department - } { + authority + }
filed its findings under ORS 431.740 and direct the county court
or boundary commission to stay the proceedings pending the review
permitted under this section and ORS 431.750.
SECTION 218. ORS 431.750 is amended to read:
431.750. (1) If the alternative plan submitted under ORS
431.745 (1) involves service facilities that are subject to the
jurisdiction of the commission, the alternative plan shall be
submitted to and reviewed by the Environmental Quality Commission
and shall be approved or rejected by the commission within 30
days from the date of filing with the { - Department of Human
Services - } { + Oregon Health Authority + }. In reviewing the
alternative plan, the commission shall consider whether, in its
judgment, the plan contains a preferable alternative for the
alleviation or removal of the conditions dangerous to public
health. If the commission determines that the original plan
provides the better and most expeditious method of removing or
alleviating the dangerous conditions, it shall disapprove the
alternative plan and inform the { - department - } { +
authority + } of its decision. The { - department - }
{ + authority + } shall order the proceedings on the finding
filed under ORS 431.740 to resume.
(2) If the commission finds that the alternative plan provides
a preferable method of alleviating or removing the dangerous
conditions, the petitioners shall be granted six months within
which to present to the commission information showing:
(a) That the affected territory has annexed to a city or
special district authorized by law to provide the service
facilities necessary to remove or alleviate the dangerous
conditions, and that the financing of the extension of such
facilities to the territory has been assured.
(b) Detailed plans and specifications for the construction of
such facilities.
(c) A time schedule for the construction of such facilities.
(d) That such facilities, if constructed, will remove or
alleviate the conditions dangerous to public health in a manner
as satisfactory and expeditious as would be accomplished by the
formation or annexation proposed by the original plans.
(3) The commission shall review the plan presented to it by the
petitioners under subsection (2) of this section and shall
promptly certify to the { - department - } { + authority + }
whether the requirements of subsection (2) of this section have
been met. If the requirements have been met, the
{ - department - } { + authority + } shall certify the
alternative plan to the county court or boundary commission
having jurisdiction and direct it to proceed in accordance with
the alternative plan and in lieu of the plans filed under ORS
431.740. If the requirements of subsection (2) of this section
are not met by the petitioners, the { - department - }
{ + authority + } shall certify that fact to the county court or
boundary commission having jurisdiction and direct it to continue
the proceedings on the plans filed under ORS 431.740.
SECTION 219. ORS 431.760 is amended to read:
431.760. (1) A person who owns property or resides within
affected territory that is subject to proceedings under the
provisions of ORS 431.705 to 431.760 shall not participate in an
official capacity in any investigation, hearing or recommendation
relating to such proceedings. If the Director of { - Human
Services - } { + the Oregon Health Authority + } is such a
person, the director shall so inform the Governor, who shall
appoint another person to fulfill the duties of the director in
any investigation, hearing or recommendation relating to the such
proceeding.
(2) Subsection (1) of this section does not excuse a member of
a county court from voting on the order required by ORS 198.792
(2) or 451.445 (1).
SECTION 220. Section 2, chapter 460, Oregon Laws 2007, is
amended to read:
{ + Sec. 2. + } (1) The { - Department of Human
Services - } { + Oregon Health Authority + } shall develop, by
the year 2009, a strategic plan to start to slow the rate of
diabetes caused by obesity and other environmental factors by the
year 2010.
(2) The { - department - } { + authority + } shall
collaborate with the American Diabetes Association, the Oregon
Diabetes Coalition and others such as:
(a) Health care professionals and researchers specializing in
diabetes and obesity prevention, treatment or research;
(b) Diabetes educators;
(c) Representatives of medical schools or schools of public
health;
(d) High school and post-secondary institution health
educators;
(e) Representatives from geographic areas and other population
groups at higher risk of diabetes;
(f) Representatives of community-based organizations involved
in providing education about or awareness of diabetes; and
(g) Other individuals the { - department - } { +
authority + } determines are necessary.
(3) The plan developed by the department shall include but not
be limited to:
(a) Identification of environmental factors that encourage or
support physical activity and healthy eating habits;
(b) Identification of preventative strategies that are
effective and culturally competent and that meet the populations
most at risk for developing diabetes;
(c) Recommendations for evidence-based screening;
(d) Recommendations for redesigning and financing primary care
practices that would facilitate adoption of the Chronic Care
Model for screening for diabetes, support for patient
self-management and regular reporting of preventative clinical
screening results;
(e) Identification of actions to be taken to reduce the
morbidity and mortality from diabetes by the year 2015 and a time
frame for taking those actions; and
(f) Recommendations to the Seventy-fifth Legislative Assembly
on statutory changes and funding needed to achieve the
{ - department's - } { + authority's + } plan.
SECTION 221. ORS 431.825 is amended to read:
431.825. The { - Department of Human Services - } { +
Oregon Health Authority + } shall provide to the counties of this
state pamphlets described in ORS 106.081. The
{ - department - } { + authority + } may produce such
pamphlets with moneys available for the purpose or may accept a
gift of such pamphlets from any public or private source if the
content is acceptable to the { - department - } { +
authority + }.
SECTION 222. ORS 431.827 is amended to read:
431.827. The { - Department of Human Services - } { +
Oregon Health Authority + } shall establish and implement
appropriate education, prevention and outreach activities in
communities that traditionally practice female circumcision,
excision or infibulation for the purpose of informing:
(1) Those communities of the health risks and emotional trauma
inflicted by the practices;
(2) Those communities and the medical community as to the
existence and ramifications of ORS 163.207; and
(3) Those communities that the practices constitute physical
injuries to a child for purposes of ORS 419B.005.
SECTION 223. ORS 431.830 is amended to read:
431.830. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } shall establish an acquired immune
deficiency syndrome program:
(a) To provide education and prevention services to its
clients; and
(b) To provide education and prevention services to the public.
(2) Programs authorized by this section may be operated by the
{ - department - } { + authority + } directly or under
contract with public and private agencies.
SECTION 224. ORS 431.831 is amended to read:
431.831. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } shall develop a program to reimburse
smoking cessation program providers for services provided to
residents of this state who are not insured for smoking cessation
costs.
(2) The { - department - } { + authority + } shall adopt
rules for the program established under subsection (1) of this
section that include but are not limited to criteria for provider
and participant eligibility and other program specifications. The
rules shall establish a maximum reimbursement limit for each
participant.
(3) Costs for smoking cessation programs funded under
subsection (1) of this section are eligible for reimbursement
from funds received by the State of Oregon from tobacco products
manufacturers under the Master Settlement Agreement of 1998.
SECTION 225. ORS 431.832 is amended to read:
431.832. (1) There is established in the General Fund the
Tobacco Use Reduction Account.
(2) Amounts credited to the Tobacco Use Reduction Account are
continuously appropriated to the { - Department of Human
Services - } { + Oregon Health Authority + } for the funding of
prevention and education programs designed to reduce cigarette
and tobacco use.
SECTION 226. ORS 431.834 is amended to read:
431.834. The { - Department of Human Services - } { +
Oregon Health Authority + } shall develop and adopt rules for
awarding grants to programs for educating the public on the risk
of tobacco use, including but not limited to:
(1) Educating children on the health hazards and consequences
of tobacco use; and
(2) Promoting enrollment in smoking cessation programs and
programs that prevent smoking-related diseases including cancer
and other diseases of the heart, lungs and mouth.
SECTION 227. ORS 431.836 is amended to read:
431.836. During each biennium, the { - Department of Human
Services - } { + Oregon Health Authority + } shall prepare a
report regarding the awarding of grants from the Tobacco Use
Reduction Account and the formation of public-private
partnerships in connection with the receipt of funds from the
account. The { - department - } { + authority + } shall
present the report to the Governor and to those committees of the
Legislative Assembly to which matters of public health are
assigned.
SECTION 228. ORS 431.853 is amended to read:
431.853. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } shall:
(a) Coordinate with law enforcement agencies to conduct random,
unannounced inspections of Oregon wholesalers and retailers of
tobacco products to insure compliance with Oregon laws designed
to discourage the use of tobacco by minors including ORS 163.575,
163.580, 167.400, 167.402 and 431.840; and
(b) Submit a report describing:
(A) The activities carried out to enforce the laws listed in
paragraph (a) of this subsection during the previous fiscal year;
(B) The extent of success achieved in reducing the availability
of tobacco products to minors; and
(C) The strategies to be utilized for enforcing the laws listed
in paragraph (a) of this subsection during the year following the
report.
(2) The { - Department of Human Services - } { + Oregon
Health Authority + } shall adopt rules concerning random
inspections of places that sell tobacco products consistent with
section 1921, Public Law 102-321, 1992. The rules shall provide
that inspections may take place:
(a) Only in areas open to the public;
(b) Only during hours that tobacco products are sold or
distributed; and
(c) No more frequently than once a month in any single
establishment unless a compliance problem exists or is suspected.
SECTION 229. ORS 431.890 is amended to read:
431.890. (1) The Poison Prevention Task Force is created in the
Poison Center of the Oregon Health and Science University and
consists of five members as follows:
(a) The Medical Director of the Oregon Poison Center or
designee, who shall serve as chairperson.
(b) The Director of { - Human Services - } { + the Oregon
Health Authority + } or a designee.
(c) A pediatrician licensed under ORS chapter 677, appointed by
the Governor.
(d) A chemist from an academic institution, appointed by the
Governor.
(e) A representative of a manufacturer of toxic household
products, appointed by the Governor.
(2) Each member shall serve without compensation.
(3) The task force shall meet as considered necessary by the
chairperson or on the call of three members of the task force.
(4) The task force shall meet for the purposes of reviewing,
granting or denying requests for exemptions from and extensions
of the requirements of ORS 431.870 to 431.915.
(5) The task force shall obtain and evaluate statewide
poisoning incidence and severity data over a period of every two
years for the purpose of making recommendations for the addition
or deletion of products to ORS 431.885.
SECTION 230. ORS 431.915 is amended to read:
431.915. (1) Any person who violates any provision of ORS
431.870 to 431.915 shall be liable for a civil penalty not to
exceed $5,000 for each day of violation, which shall be assessed
and recovered in a civil action brought by the { - Department
of Human Services - } { + Oregon Health Authority + }.
(2) All civil penalties collected pursuant to subsection (1) of
this section shall be deposited in the General Fund.
SECTION 231. ORS 431.920 is amended to read:
431.920. The { - Department of Human Services - } { +
Oregon Health Authority + } shall:
(1) Develop accreditation programs for training providers;
(2) Prescribe the requirements for and the manner of testing
the competency of license applicants for the protection of the
public and as required by federal law;
(3) Prescribe those actions or circumstances that constitute
failure to achieve or maintain competency, or that otherwise are
contrary to the public interest, for which the agency may refuse
to issue or renew or may suspend or revoke a certification;
(4) Develop and conduct programs to screen blood lead levels,
to identify hazards and to educate the public, including parents,
residential dwelling owners and child care facility operators,
about the dangers of lead-based paint hazards and of appropriate
precautions that should be taken to reduce the possibility of
childhood lead poisoning; and
(5) Impose fees to the extent necessary to pay the costs of the
following:
(a) Certification of training curriculums, up to $1,500;
(b) Annual renewal of training providers and curriculums, up to
$500;
(c) Certification of trainers, up to $500;
(d) Annual renewal of trainer's certification, up to $250; and
(e) Certification test, up to $85.
SECTION 232. ORS 431.940 is amended to read:
431.940. (1) The { - Department of Human Services - } { +
Oregon Health Authority + } shall adopt by rule standards and a
system of registration for tanning devices. Any entity doing
business in this state as a tanning facility shall register the
tanning devices with the { - department - } { + authority + }
in a manner prescribed by rule.
(2) The registration shall include payment of an annual
registration fee, not to exceed $100 per tanning device,
prescribed by rule in an amount sufficient to cover the costs of
administering the regulatory program.
(3) The { - department - } { + authority + } may conduct
inspections of tanning facilities to ensure compliance with ORS
431.925 to 431.955.
SECTION 233. ORS 431.945 is amended to read:
431.945. (1) A tanning facility shall give each customer a
written statement warning that:
(a) Not wearing the protective eye wear provided to each
customer by the tanning facility may cause damage to the eyes.
(b) Overexposure to the tanning process causes burns.
(c) Repeated exposure to the tanning process may cause skin
cancer or premature aging of the skin, or both.
(d) Abnormal skin sensitivity or burning may result from the
tanning process if the customer is also consuming or using
certain:
(A) Foods.
(B) Cosmetics.
(C) Medications such as tranquilizers, antibiotics, diuretics,
high blood pressure medication, antineoplastics or birth control
pills.
(e) Any person taking a prescription or over-the-counter drug
should consult a physician before using a tanning device.
(2) In addition to giving customers the written statement
required by subsection (1) of this section, the tanning facility
shall post a warning sign in any area where a tanning device is
used. The { - Department of Human Services - } { + Oregon
Health Authority + } shall adopt by rule the language for the
warning sign.
SECTION 234. ORS 431.950 is amended to read:
431.950. The { - Department of Human Services - } { +
Oregon Health Authority + } may impose a civil penalty in an
amount not to exceed $500 for a violation of ORS 431.925 to
431.955 or rules of the
{ - department - } { + authority + } adopted pursuant to ORS
431.925 to 431.955. Civil penalties under this section shall be
imposed in the manner provided by ORS 183.745.
SECTION 235. ORS 431.955 is amended to read:
431.955. Except as otherwise provided by law, all fees and
other moneys received by the { - Department of Human
Services - } { + Oregon Health Authority + } pursuant to ORS
431.925 to 431.955 shall be paid into the State Treasury and
placed to the credit of the Public Health Account and are
continuously appropriated to the
{ - department - } { + authority + } for the purposes of
carrying out the provisions of ORS 431.925 to 431.955. If moneys
received under ORS 431.925 to 431.955 are in excess of moneys
required to administer the program authorized by ORS 431.925 to
431.955, the moneys may be used by the { - department - } { +
authority + } to meet expenses of other programs administered by
the { - department - } { + authority + } if an appropriate
expenditure increase is approved by the Emergency Board.
SECTION 236. ORS 431.990 is amended to read:
431.990. Unless otherwise specifically provided by any other
statute, failure to obey any rules relating to public health of
the { - Department of Human Services - } { + Oregon Health
Authority + } or failure to obey any lawful written order
relating to public health issued by the Director of { - Human
Services - } { + the Oregon Health Authority + } or any
district or county public health administrator is a Class A
misdemeanor.
SECTION 237. ORS 192.410 is amended to read:
192.410. As used in ORS 192.410 to 192.505:
(1) 'Custodian' means:
(a) The person described in ORS 7.110 for purposes of court
records; or
(b) A public body mandated, directly or indirectly, to create,
maintain, care for or control a public record. ' Custodian' does
not include a public body that has custody of a public record as
an agent of another public body that is the custodian unless the
public record is not otherwise available.
(2) 'Person' includes any natural person, corporation,
partnership, firm, association or member or committee of the
Legislative Assembly.
(3) 'Public body' includes every state officer, agency,
department, division, bureau, board and commission; every county
and city governing body, school district, special district,
municipal corporation, and any board, department, commission,
council, or agency thereof; and any other public agency of this
state.
(4)(a) 'Public record' includes any writing that contains
information relating to the conduct of the public's business,
including but not limited to court records, mortgages, and deed
records, prepared, owned, used or retained by a public body
regardless of physical form or characteristics.
(b) 'Public record' does not include any writing that does not
relate to the conduct of the public's business and that is
contained on a privately owned computer.
{ + (5) 'Regulator' means:
(a) With respect to the regulation of health insurance, health
benefit plans, health care service contractors, multiple employer
welfare arrangements and third party administrators of health and
prescription benefits, the Oregon Health Authority; and
(b) With respect to the regulation of workers' compensation
insurance and all other insurance not described in paragraph (a)
of this subsection, the Department of Consumer and Business
Services. + }
{ - (5) - } { + (6) + } 'State agency' means any state
officer, department, board, commission or court created by the
Constitution or statutes of this state but does not include the
Legislative Assembly or its members, committees, officers or
employees insofar as they are exempt under section 9, Article IV
of the Oregon Constitution.
{ - (6) - } { + (7) + } 'Writing' means handwriting,
typewriting, printing, photographing and every means of
recording, including letters, words, pictures, sounds, or
symbols, or combination thereof, and all papers, maps, files,
facsimiles or electronic recordings.
SECTION 238. ORS 192.502 is amended to read:
192.502. The following public records are exempt from
disclosure under ORS 192.410 to 192.505:
(1) Communications within a public body or between public
bodies of an advisory nature to the extent that they cover other
than purely factual materials and are preliminary to any final
agency determination of policy or action. This exemption shall
not apply unless the public body shows that in the particular
instance the public interest in encouraging frank communication
between officials and employees of public bodies clearly
outweighs the public interest in disclosure.
(2) Information of a personal nature such as but not limited to
that kept in a personal, medical or similar file, if public
disclosure would constitute an unreasonable invasion of privacy,
unless the public interest by clear and convincing evidence
requires disclosure in the particular instance. The party seeking
disclosure shall have the burden of showing that public
disclosure would not constitute an unreasonable invasion of
privacy.
(3) Public body employee or volunteer addresses, Social
Security numbers, dates of birth and telephone numbers contained
in personnel records maintained by the public body that is the
employer or the recipient of volunteer services. This exemption:
(a) Does not apply to the addresses, dates of birth and
telephone numbers of employees or volunteers who are elected
officials, except that a judge or district attorney subject to
election may seek to exempt the judge's or district attorney's
address or telephone number, or both, under the terms of ORS
192.445;
(b) Does not apply to employees or volunteers to the extent
that the party seeking disclosure shows by clear and convincing
evidence that the public interest requires disclosure in a
particular instance;
(c) Does not apply to a substitute teacher as defined in ORS
342.815 when requested by a professional education association of
which the substitute teacher may be a member; and
(d) Does not relieve a public employer of any duty under ORS
243.650 to 243.782.
(4) Information submitted to a public body in confidence and
not otherwise required by law to be submitted, where such
information should reasonably be considered confidential, the
public body has obliged itself in good faith not to disclose the
information, and when the public interest would suffer by the
disclosure.
(5) Information or records of the Department of Corrections,
including the State Board of Parole and Post-Prison Supervision,
to the extent that disclosure would interfere with the
rehabilitation of a person in custody of the department or
substantially prejudice or prevent the carrying out of the
functions of the department, if the public interest in
confidentiality clearly outweighs the public interest in
disclosure.
(6) Records, reports and other information received or compiled
by the { - Director of the Department of Consumer and Business
Services - } { + regulator + } in the administration of ORS
chapters 723 and 725 not otherwise required by law to be made
public, to the extent that the interests of lending institutions,
their officers, employees and customers in preserving the
confidentiality of such information outweighs the public interest
in disclosure.
(7) Reports made to or filed with the court under ORS 137.077
or 137.530.
(8) Any public records or information the disclosure of which
is prohibited by federal law or regulations.
(9)(a) Public records or information the disclosure of which is
prohibited or restricted or otherwise made confidential or
privileged under Oregon law.
(b) Subject to ORS 192.423, paragraph (a) of this subsection
does not apply to factual information compiled in a public record
when:
(A) The basis for the claim of exemption is ORS 40.225;
(B) The factual information is not prohibited from disclosure
under any applicable state or federal law, regulation or court
order and is not otherwise exempt from disclosure under ORS
192.410 to 192.505;
(C) The factual information was compiled by or at the direction
of an attorney as part of an investigation on behalf of the
public body in response to information of possible wrongdoing by
the public body;
(D) The factual information was not compiled in preparation for
litigation, arbitration or an administrative proceeding that was
reasonably likely to be initiated or that has been initiated by
or against the public body; and
(E) The holder of the privilege under ORS 40.225 has made or
authorized a public statement characterizing or partially
disclosing the factual information compiled by or at the
attorney's direction.
(10) Public records or information described in this section,
furnished by the public body originally compiling, preparing or
receiving them to any other public officer or public body in
connection with performance of the duties of the recipient, if
the considerations originally giving rise to the confidential or
exempt nature of the public records or information remain
applicable.
(11) Records of the Energy Facility Siting Council concerning
the review or approval of security programs pursuant to ORS
469.530.
(12) Employee and retiree address, telephone number and other
nonfinancial membership records and employee financial records
maintained by the Public Employees Retirement System pursuant to
ORS chapters 238 and 238A.
(13) Records of or submitted to the State Treasurer, the Oregon
Investment Council or the agents of the treasurer or the council
relating to active or proposed publicly traded investments under
ORS chapter 293, including but not limited to records regarding
the acquisition, exchange or liquidation of the investments. For
the purposes of this subsection:
(a) The exemption does not apply to:
(A) Information in investment records solely related to the
amount paid directly into an investment by, or returned from the
investment directly to, the treasurer or council; or
(B) The identity of the entity to which the amount was paid
directly or from which the amount was received directly.
(b) An investment in a publicly traded investment is no longer
active when acquisition, exchange or liquidation of the
investment has been concluded.
(14)(a) Records of or submitted to the State Treasurer, the
Oregon Investment Council, the Oregon Growth Account Board or the
agents of the treasurer, council or board relating to actual or
proposed investments under ORS chapter 293 or 348 in a privately
placed investment fund or a private asset including but not
limited to records regarding the solicitation, acquisition,
deployment, exchange or liquidation of the investments including
but not limited to:
(A) Due diligence materials that are proprietary to an
investment fund, to an asset ownership or to their respective
investment vehicles.
(B) Financial statements of an investment fund, an asset
ownership or their respective investment vehicles.
(C) Meeting materials of an investment fund, an asset ownership
or their respective investment vehicles.
(D) Records containing information regarding the portfolio
positions in which an investment fund, an asset ownership or
their respective investment vehicles invest.
(E) Capital call and distribution notices of an investment
fund, an asset ownership or their respective investment vehicles.
(F) Investment agreements and related documents.
(b) The exemption under this subsection does not apply to:
(A) The name, address and vintage year of each privately placed
investment fund.
(B) The dollar amount of the commitment made to each privately
placed investment fund since inception of the fund.
(C) The dollar amount of cash contributions made to each
privately placed investment fund since inception of the fund.
(D) The dollar amount, on a fiscal year-end basis, of cash
distributions received by the State Treasurer, the Oregon
Investment Council, the Oregon Growth Account Board or the agents
of the treasurer, council or board from each privately placed
investment fund.
(E) The dollar amount, on a fiscal year-end basis, of the
remaining value of assets in a privately placed investment fund
attributable to an investment by the State Treasurer, the Oregon
Investment Council, the Oregon Growth Account Board or the agents
of the treasurer, council or board.
(F) The net internal rate of return of each privately placed
investment fund since inception of the fund.
(G) The investment multiple of each privately placed investment
fund since inception of the fund.
(H) The dollar amount of the total management fees and costs
paid on an annual fiscal year-end basis to each privately placed
investment fund.
(I) The dollar amount of cash profit received from each
privately placed investment fund on a fiscal year-end basis.
(15) The monthly reports prepared and submitted under ORS
293.761 and 293.766 concerning the Public Employees Retirement
Fund and the Industrial Accident Fund may be uniformly treated as
exempt from disclosure for a period of up to 90 days after the
end of the calendar quarter.
(16) Reports of unclaimed property filed by the holders of such
property to the extent permitted by ORS 98.352.
(17) The following records, communications and information
submitted to the Oregon Economic and Community Development
Commission, the Economic and Community Development Department,
the State Department of Agriculture, the Oregon Growth Account
Board, the Port of Portland or other ports, as defined in ORS
777.005, by applicants for investment funds, loans or services
including, but not limited to, those described in ORS 285A.224:
(a) Personal financial statements.
(b) Financial statements of applicants.
(c) Customer lists.
(d) Information of an applicant pertaining to litigation to
which the applicant is a party if the complaint has been filed,
or if the complaint has not been filed, if the applicant shows
that such litigation is reasonably likely to occur; this
exemption does not apply to litigation which has been concluded,
and nothing in this paragraph shall limit any right or
opportunity granted by discovery or deposition statutes to a
party to litigation or potential litigation.
(e) Production, sales and cost data.
(f) Marketing strategy information that relates to applicant's
plan to address specific markets and applicant's strategy
regarding specific competitors.
(18) Records, reports or returns submitted by private concerns
or enterprises required by law to be submitted to or inspected by
a governmental body to allow it to determine the amount of any
transient lodging tax payable and the amounts of such tax payable
or paid, to the extent that such information is in a form which
would permit identification of the individual concern or
enterprise. Nothing in this subsection shall limit the use which
can be made of such information for regulatory purposes or its
admissibility in any enforcement proceedings. The public body
shall notify the taxpayer of the delinquency immediately by
certified mail. However, in the event that the payment or
delivery of transient lodging taxes otherwise due to a public
body is delinquent by over 60 days, the public body shall
disclose, upon the request of any person, the following
information:
(a) The identity of the individual concern or enterprise that
is delinquent over 60 days in the payment or delivery of the
taxes.
(b) The period for which the taxes are delinquent.
(c) The actual, or estimated, amount of the delinquency.
(19) All information supplied by a person under ORS 151.485 for
the purpose of requesting appointed counsel, and all information
supplied to the court from whatever source for the purpose of
verifying the financial eligibility of a person pursuant to ORS
151.485.
(20) Workers' compensation claim records of the Department of
Consumer and Business Services, except in accordance with rules
adopted by the Director of the Department of Consumer and
Business Services, in any of the following circumstances:
(a) When necessary for insurers, self-insured employers and
third party claim administrators to process workers' compensation
claims.
(b) When necessary for the director, other governmental
agencies of this state or the United States to carry out their
duties, functions or powers.
(c) When the disclosure is made in such a manner that the
disclosed information cannot be used to identify any worker who
is the subject of a claim.
(d) When a worker or the worker's representative requests
review of the worker's claim record.
(21) Sensitive business records or financial or commercial
information of the Oregon Health and Science University that is
not customarily provided to business competitors.
(22) Records of Oregon Health and Science University regarding
candidates for the position of president of the university.
(23) The records of a library, including:
(a) Circulation records, showing use of specific library
material by a named person;
(b) The name of a library patron together with the address or
telephone number of the patron; and
(c) The electronic mail address of a patron.
(24) The following records, communications and information
obtained by the Housing and Community Services Department in
connection with the department's monitoring or administration of
financial assistance or of housing or other developments:
(a) Personal and corporate financial statements and
information, including tax returns.
(b) Credit reports.
(c) Project appraisals.
(d) Market studies and analyses.
(e) Articles of incorporation, partnership agreements and
operating agreements.
(f) Commitment letters.
(g) Project pro forma statements.
(h) Project cost certifications and cost data.
(i) Audits.
(j) Project tenant correspondence.
(k) Personal information about a tenant.
(L) Housing assistance payments.
(25) Raster geographic information system (GIS) digital
databases, provided by private forestland owners or their
representatives, voluntarily and in confidence to the State
Forestry Department, that is not otherwise required by law to be
submitted.
(26) Sensitive business, commercial or financial information
furnished to or developed by a public body engaged in the
business of providing electricity or electricity services, if the
information is directly related to a transaction described in ORS
261.348, or if the information is directly related to a bid,
proposal or negotiations for the sale or purchase of electricity
or electricity services, and disclosure of the information would
cause a competitive disadvantage for the public body or its
retail electricity customers. This subsection does not apply to
cost-of-service studies used in the development or review of
generally applicable rate schedules.
(27) Sensitive business, commercial or financial information
furnished to or developed by the City of Klamath Falls, acting
solely in connection with the ownership and operation of the
Klamath Cogeneration Project, if the information is directly
related to a transaction described in ORS 225.085 and disclosure
of the information would cause a competitive disadvantage for the
Klamath Cogeneration Project. This subsection does not apply to
cost-of-service studies used in the development or review of
generally applicable rate schedules.
(28) Personally identifiable information about customers of a
municipal electric utility or a people's utility district or the
names, dates of birth, driver license numbers, telephone numbers,
electronic mail addresses or Social Security numbers of customers
who receive water, sewer or storm drain services from a public
body as defined in ORS 174.109. The utility or district may
release personally identifiable information about a customer, and
a public body providing water, sewer or storm drain services may
release the name, date of birth, driver license number, telephone
number, electronic mail address or Social Security number of a
customer, if the customer consents in writing or electronically,
if the disclosure is necessary for the utility, district or other
public body to render services to the customer, if the disclosure
is required pursuant to a court order or if the disclosure is
otherwise required by federal or state law. The utility, district
or other public body may charge as appropriate for the costs of
providing such information. The utility, district or other public
body may make customer records available to third party credit
agencies on a regular basis in connection with the establishment
and management of customer accounts or in the event such accounts
are delinquent.
(29) A record of the street and number of an employee's address
submitted to a special district to obtain assistance in promoting
an alternative to single occupant motor vehicle transportation.
(30) Sensitive business records, capital development plans or
financial or commercial information of Oregon Corrections
Enterprises that is not customarily provided to business
competitors.
(31) Documents, materials or other information submitted to the
Director of the Department of Consumer and Business Services in
confidence by a state, federal, foreign or international
regulatory or law enforcement agency or by the National
Association of Insurance Commissioners, its affiliates or
subsidiaries under ORS 646A.250 to 646A.270, 697.005 to 697.095,
697.602 to 697.842, 705.137, 717.200 to 717.320, 717.900 or
717.905, ORS chapter 59, 722, 723, 725 or 726, the Bank Act or
the Insurance Code when:
(a) The document, material or other information is received
upon notice or with an understanding that it is confidential or
privileged under the laws of the jurisdiction that is the source
of the document, material or other information; and
(b) The director has obligated the Department of Consumer and
Business Services not to disclose the document, material or other
information.
(32) A county elections security plan developed and filed under
ORS 254.074.
(33) Information about review or approval of programs relating
to the security of:
(a) Generation, storage or conveyance of:
(A) Electricity;
(B) Gas in liquefied or gaseous form;
(C) Hazardous substances as defined in ORS 453.005 (7)(a), (b)
and (d);
(D) Petroleum products;
(E) Sewage; or
(F) Water.
(b) Telecommunication systems, including cellular, wireless or
radio systems.
(c) Data transmissions by whatever means provided.
(34) The information specified in ORS 25.020 (8) if the Chief
Justice of the Supreme Court designates the information as
confidential by rule under ORS 1.002.
SECTION 239. ORS 192.519 is amended to read:
192.519. As used in ORS 192.518 to 192.529:
(1) 'Authorization' means a document written in plain language
that contains at least the following:
(a) A description of the information to be used or disclosed
that identifies the information in a specific and meaningful way;
(b) The name or other specific identification of the person or
persons authorized to make the requested use or disclosure;
(c) The name or other specific identification of the person or
persons to whom the covered entity may make the requested use or
disclosure;
(d) A description of each purpose of the requested use or
disclosure, including but not limited to a statement that the use
or disclosure is at the request of the individual;
(e) An expiration date or an expiration event that relates to
the individual or the purpose of the use or disclosure;
(f) The signature of the individual or personal representative
of the individual and the date;
(g) A description of the authority of the personal
representative, if applicable; and
(h) Statements adequate to place the individual on notice of
the following:
(A) The individual's right to revoke the authorization in
writing;
(B) The exceptions to the right to revoke the authorization;
(C) The ability or inability to condition treatment, payment,
enrollment or eligibility for benefits on whether the individual
signs the authorization; and
(D) The potential for information disclosed pursuant to the
authorization to be subject to redisclosure by the recipient and
no longer protected.
(2) 'Covered entity' means:
(a) A state health plan;
(b) A health insurer;
(c) A health care provider that transmits any health
information in electronic form to carry out financial or
administrative activities in connection with a transaction
covered by ORS 192.518 to 192.529; or
(d) A health care clearinghouse.
(3) 'Health care' means care, services or supplies related to
the health of an individual.
(4) 'Health care operations' includes but is not limited to:
(a) Quality assessment, accreditation, auditing and improvement
activities;
(b) Case management and care coordination;
(c) Reviewing the competence, qualifications or performance of
health care providers or health insurers;
(d) Underwriting activities;
(e) Arranging for legal services;
(f) Business planning;
(g) Customer services;
(h) Resolving internal grievances;
(i) Creating de-identified information; and
(j) Fundraising.
(5) 'Health care provider' includes but is not limited to:
(a) A psychologist, occupational therapist, clinical social
worker, professional counselor or marriage and family therapist
licensed under ORS chapter 675 or an employee of the
psychologist, occupational therapist, clinical social worker,
professional counselor or marriage and family therapist;
(b) A physician, podiatric physician and surgeon, physician
assistant or acupuncturist licensed under ORS chapter 677 or an
employee of the physician, podiatric physician and surgeon,
physician assistant or acupuncturist;
(c) A nurse or nursing home administrator licensed under ORS
chapter 678 or an employee of the nurse or nursing home
administrator;
(d) A dentist licensed under ORS chapter 679 or an employee of
the dentist;
(e) A dental hygienist or denturist licensed under ORS chapter
680 or an employee of the dental hygienist or denturist;
(f) A speech-language pathologist or audiologist licensed under
ORS chapter 681 or an employee of the speech-language pathologist
or audiologist;
(g) An emergency medical technician certified under ORS chapter
682;
(h) An optometrist licensed under ORS chapter 683 or an
employee of the optometrist;
(i) A chiropractic physician licensed under ORS chapter 684 or
an employee of the chiropractic physician;
(j) A naturopathic physician licensed under ORS chapter 685 or
an employee of the naturopathic physician;
(k) A massage therapist licensed under ORS 687.011 to 687.250
or an employee of the massage therapist;
(L) A direct entry midwife licensed under ORS 687.405 to
687.495 or an employee of the direct entry midwife;
(m) A physical therapist licensed under ORS 688.010 to 688.201
or an employee of the physical therapist;
(n) A radiologic technologist licensed under ORS 688.405 to
688.605 or an employee of the radiologic technologist;
(o) A respiratory care practitioner licensed under ORS 688.800
to 688.840 or an employee of the respiratory care practitioner;
(p) A pharmacist licensed under ORS chapter 689 or an employee
of the pharmacist;
(q) A dietitian licensed under ORS 691.405 to 691.585 or an
employee of the dietitian;
(r) A funeral service practitioner licensed under ORS chapter
692 or an employee of the funeral service practitioner;
(s) A health care facility as defined in ORS 442.015;
(t) A home health agency as defined in ORS 443.005;
(u) A hospice program as defined in ORS 443.850;
(v) A clinical laboratory as defined in ORS 438.010;
(w) A pharmacy as defined in ORS 689.005;
(x) A diabetes self-management program as defined in ORS
743A.184; and
(y) Any other person or entity that furnishes, bills for or is
paid for health care in the normal course of business.
(6) 'Health information' means any oral or written information
in any form or medium that:
(a) Is created or received by a covered entity, a public health
authority, an employer, a life insurer, a school, a university or
a health care provider that is not a covered entity; and
(b) Relates to:
(A) The past, present or future physical or mental health or
condition of an individual;
(B) The provision of health care to an individual; or
(C) The past, present or future payment for the provision of
health care to an individual.
(7) 'Health insurer' means:
(a) An insurer as defined in ORS 731.106 who offers:
(A) A health benefit plan as defined in ORS 743.730;
(B) A short term health insurance policy, the duration of which
does not exceed six months including renewals;
(C) A student health insurance policy;
(D) A Medicare supplemental policy; or
(E) A dental only policy.
(b) The Oregon Medical Insurance Pool operated by the Oregon
Medical Insurance Pool Board under ORS 735.600 to 735.650.
(8) 'Individually identifiable health information' means any
oral or written health information in any form or medium that is:
(a) Created or received by a covered entity, an employer or a
health care provider that is not a covered entity; and
(b) Identifiable to an individual, including demographic
information that identifies the individual, or for which there is
a reasonable basis to believe the information can be used to
identify an individual, and that relates to:
(A) The past, present or future physical or mental health or
condition of an individual;
(B) The provision of health care to an individual; or
(C) The past, present or future payment for the provision of
health care to an individual.
(9) 'Payment' includes but is not limited to:
(a) Efforts to obtain premiums or reimbursement;
(b) Determining eligibility or coverage;
(c) Billing activities;
(d) Claims management;
(e) Reviewing health care to determine medical necessity;
(f) Utilization review; and
(g) Disclosures to consumer reporting agencies.
(10) 'Personal representative' includes but is not limited to:
(a) A person appointed as a guardian under ORS 125.305,
419B.370, 419C.481 or 419C.555 with authority to make medical and
health care decisions;
(b) A person appointed as a health care representative under
ORS 127.505 to 127.660 or a representative under ORS 127.700 to
127.737 to make health care decisions or mental health treatment
decisions;
(c) A person appointed as a personal representative under ORS
chapter 113; and
(d) A person described in ORS 192.526.
(11)(a) 'Protected health information' means individually
identifiable health information that is maintained or transmitted
in any form of electronic or other medium by a covered entity.
(b) 'Protected health information' does not mean individually
identifiable health information in:
(A) Education records covered by the federal Family Educational
Rights and Privacy Act (20 U.S.C. 1232g);
(B) Records described at 20 U.S.C. 1232g(a)(4)(B)(iv); or
(C) Employment records held by a covered entity in its role as
employer.
(12) 'State health plan' means:
(a) The state Medicaid program;
(b) The Oregon State Children's Health Insurance Program;
{ - or - }
(c) The Family Health Insurance Assistance Program established
in ORS 735.720 to 735.740 { - . - } { + ; or
(d) Any medical assistance or premium assistance program
operated by the Oregon Health Authority. + }
(13) 'Treatment' includes but is not limited to:
(a) The provision, coordination or management of health care;
and
(b) Consultations and referrals between health care providers.
SECTION 240. ORS 192.527 is amended to read:
192.527. (1) Notwithstanding ORS 179.505, a state health plan
or a prepaid managed care health services organization may
disclose the protected health information of an individual listed
in subsection (2) of this section, without obtaining an
authorization from the individual or a personal representative of
the individual, to another prepaid managed care health services
organization for treatment activities of a prepaid managed care
health services organization when the prepaid managed care health
services organization is providing behavioral or physical health
care services to the individual.
(2) The protected health information that may be disclosed
pursuant to subsection (1) of this section includes the
following, as defined by the { - Department of Human
Services - } { + Oregon Health Authority + } by rule:
(a) Oregon Health Plan member name;
(b) Medicaid recipient number;
(c) Performing provider number;
(d) Hospital provider name;
(e) Attending physician;
(f) Diagnosis;
(g) Date or dates of service;
(h) Procedure code;
(i) Revenue code;
(j) Quantity of units of service provided; or
(k) Medication prescription and monitoring.
(3) As used in this section, 'prepaid managed care health
services organization' has the meaning given that term in ORS
414.736.
SECTION 241. ORS 192.535 is amended to read:
192.535. (1) A person may not obtain genetic information from
an individual, or from an individual's DNA sample, without first
obtaining informed consent of the individual or the individual's
representative, except:
(a) As authorized by ORS 181.085 or comparable provisions of
federal criminal law relating to the identification of persons,
or for the purpose of establishing the identity of a person in
the course of an investigation conducted by a law enforcement
agency, a district attorney, a medical examiner or the Criminal
Justice Division of the Department of Justice;
(b) For anonymous research or coded research conducted under
conditions described in ORS 192.537 (2), after notification
pursuant to ORS 192.538 or pursuant to ORS 192.547 (7)(b);
(c) As permitted by rules of the { - Department of Human
Services - } { + Oregon Health Authority + } for identification
of deceased individuals;
(d) As permitted by rules of the { - Department of Human
Services - } { + Oregon Health Authority + } for newborn
screening procedures;
(e) As authorized by statute for the purpose of establishing
paternity; or
(f) For the purpose of furnishing genetic information relating
to a decedent for medical diagnosis of blood relatives of the
decedent.
(2) Except as provided in subsection (3) of this section, a
physician licensed under ORS chapter 677 shall seek the informed
consent of the individual or the individual's representative for
the purposes of subsection (1) of this section in the manner
provided by ORS 677.097. Except as provided in subsection (3) of
this section, any other licensed health care provider or facility
must seek the informed consent of the individual or the
individual's representative for the purposes of subsection (1) of
this section in a manner substantially similar to that provided
by ORS 677.097 for physicians.
(3) A person conducting research shall seek the informed
consent of the individual or the individual's representative for
the purposes of subsection (1) of this section in the manner
provided by ORS 192.547.
(4) Except as provided in ORS 746.135 (1), any person not
described in subsection (2) or (3) of this section must seek the
informed consent of the individual or the individual's
representative for the purposes of subsection (1) of this section
in the manner provided by rules adopted by the { - Department
of Human Services - } { + Oregon Health Authority + }.
(5) The { - Department of Human Services - } { + Oregon
Health Authority + } may not adopt rules under subsection (1)(d)
of this section that would require the providing of a DNA sample
for the purpose of obtaining complete genetic information used to
screen all newborns.
SECTION 242. ORS 192.547 is amended to read:
192.547. (1)(a) The { - Department of Human Services - }
{ + Oregon Health Authority + } shall adopt rules for
conducting research using DNA samples, genetic testing and
genetic information. Rules establishing minimum research
standards shall conform to the Federal Policy for the Protection
of Human Subjects, 45 C.F.R. 46, that is current at the time the
rules are adopted. The rules may be changed from time to time as
may be necessary.
(b) The rules adopted by the { - Department of Human
Services - } { + Oregon Health Authority + } shall address the
operation and appointment of institutional review boards. The
rules shall conform to the compositional and operational
standards for such boards contained in the Federal Policy for the
Protection of Human Subjects that is current at the time the
rules are adopted. The rules must require that research conducted
under paragraph (a) of this subsection be conducted with the
approval of the institutional review board.
(c) Persons proposing to conduct anonymous research, coded
research or genetic research that is otherwise thought to be
exempt from review must obtain from an institutional review board
prior to conducting such research a determination that the
proposed research is exempt from review.
(2) A person proposing to conduct research under subsection (1)
of this section, including anonymous research or coded research,
must disclose to the institutional review board the proposed use
of DNA samples, genetic testing or genetic information.
(3) The { - Department of Human Services - } { + Oregon
Health Authority + } shall adopt rules requiring that all
institutional review boards operating under subsection (1)(b) of
this section register with the department. The Advisory Committee
on Genetic Privacy and Research shall use the registry to educate
institutional review boards about the purposes and requirements
of the genetic privacy statutes and administrative rules relating
to genetic research.
(4) The { - Department of Human Services - } { + Oregon
Health Authority + } shall consult with the Advisory Committee on
Genetic Privacy and Research before adopting the rules required
under subsections (1) and (3) of this section, including rules
identifying those parts of the Federal Policy for the Protection
of Human Subjects that are applicable to this section.
(5) Genetic research in which the DNA sample or genetic
information is coded shall satisfy the following requirements:
(a)(A) The subject has granted informed consent for the
specific research project;
(B) The subject has consented to genetic research generally; or
(C) The DNA sample or genetic information is derived from a
biological specimen or from clinical individually identifiable
health information that was obtained or retained in compliance
with ORS 192.537 (2).
(b) The research has been approved by an institutional review
board after disclosure by the investigator to the board of risks
associated with the coding.
(c) The code is:
(A) Not derived from individual identifiers;
(B) Kept securely and separately from the DNA samples and
genetic information; and
(C) Not accessible to the investigator unless specifically
approved by the institutional review board.
(d) Data is stored securely in password protected electronic
files or by other means with access limited to necessary
personnel.
(e) The data is limited to elements required for analysis and
meets the criteria in 45 C.F.R 164.514(e) for a limited data set.
(f) The investigator is a party to the data use agreement as
provided by 45 C.F.R. 164.514(e) for limited data set recipients.
(6) Research conducted in accordance with this section is
rebuttably presumed to comply with ORS 192.535 and 192.539.
(7)(a) Notwithstanding ORS 192.535, a person may use a DNA
sample or genetic information obtained, with blanket informed
consent, before June 25, 2001, for genetic research.
(b) Notwithstanding ORS 192.535, a person may use a DNA sample
or genetic information obtained without specific informed consent
and derived from a biological specimen or clinical individually
identifiable health information for anonymous research or coded
research if an institutional review board operating under
subsection (1)(b) of this section:
(A) Waives or alters the consent requirements pursuant to the
Federal Policy for the Protection of Human Subjects; and
(B) Waives authorization pursuant to the federal Health
Insurance Portability and Accountability Act privacy regulations,
45 C.F.R. parts 160 and 164.
(c) Except as provided in subsection (5)(a) of this section or
paragraph (b) of this subsection, a person must have specific
informed consent from an individual to use a DNA sample or
genetic information of the individual obtained on or after June
25, 2001, for genetic research.
(8) Except as otherwise allowed by rule of the { - Department
of Human Services - } { + Oregon Health Authority + }, if DNA
samples or genetic information obtained for either clinical or
research purposes is used in research, a person may not recontact
the individual or the individual's physician by using research
information that is identifiable or coded. The { - Department
of Human Services - } { + Oregon Health Authority + } shall
adopt by rule criteria for recontacting an individual or an
individual's physician. In adopting the criteria, the department
shall consider the recommendations of national organizations such
as those created by executive order by the President of the
United States and the recommendations of the Advisory Committee
on Genetic Privacy and Research.
(9) The requirements for consent to, or notification of,
obtaining a DNA sample or genetic information for genetic
research are governed by the provisions of ORS 192.531 to 192.549
and the administrative rules that were in effect on the effective
date of the institutional review board's most recent approval of
the study.
SECTION 243. ORS 192.630, as amended by section 21, chapter
100, Oregon Laws 2007, is amended to read:
192.630. (1) All meetings of the governing body of a public
body shall be open to the public and all persons shall be
permitted to attend any meeting except as otherwise provided by
ORS 192.610 to 192.690.
(2) A quorum of a governing body may not meet in private for
the purpose of deciding on or deliberating toward a decision on
any matter except as otherwise provided by ORS 192.610 to
192.690.
(3) A governing body may not hold a meeting at any place where
discrimination on the basis of race, color, creed, sex, sexual
orientation, national origin, age or disability is practiced.
However, the fact that organizations with restricted membership
hold meetings at the place does not restrict its use by a public
body if use of the place by a restricted membership organization
is not the primary purpose of the place or its predominate use.
(4) Meetings of the governing body of a public body shall be
held within the geographic boundaries over which the public body
has jurisdiction, or at the administrative headquarters of the
public body or at the other nearest practical location. Training
sessions may be held outside the jurisdiction as long as no
deliberations toward a decision are involved. A joint meeting of
two or more governing bodies or of one or more governing bodies
and the elected officials of one or more federally recognized
Oregon Indian tribes shall be held within the geographic
boundaries over which one of the participating public bodies or
one of the Oregon Indian tribes has jurisdiction or at the
nearest practical location. Meetings may be held in locations
other than those described in this subsection in the event of an
actual emergency necessitating immediate action.
(5)(a) It is discrimination on the basis of disability for a
governing body of a public body to meet in a place inaccessible
to persons with disabilities, or, upon request of a person who is
deaf or hard of hearing, to fail to make a good faith effort to
have an interpreter for persons who are deaf or hard of hearing
provided at a regularly scheduled meeting. The sole remedy for
discrimination on the basis of disability shall be as provided in
ORS 192.680.
(b) The person requesting the interpreter shall give the
governing body at least 48 hours' notice of the request for an
interpreter, shall provide the name of the requester, sign
language preference and any other relevant information the
governing body may request.
(c) If a meeting is held upon less than 48 hours' notice,
reasonable effort shall be made to have an interpreter present,
but the requirement for an interpreter does not apply to
emergency meetings.
(d) If certification of interpreters occurs under state or
federal law, the { - Department of Human Services - } { +
Oregon Health Authority + } or other state or local agency shall
try to refer only certified interpreters to governing bodies for
purposes of this subsection.
(e) As used in this subsection, 'good faith effort ' includes,
but is not limited to, contacting the department or other state
or local agency that maintains a list of qualified interpreters
and arranging for the referral of one or more qualified
interpreters to provide interpreter services.
SECTION 244. ORS 192.549 is amended to read:
192.549. (1) The Advisory Committee on Genetic Privacy and
Research is established consisting of 15 members. The President
of the Senate and the Speaker of the House of Representatives
shall each appoint one member and one alternate. The Director of
{ - Human Services - } { + the Oregon Health Authority + }
shall appoint one representative and one alternate from each of
the following categories:
(a) Academic institutions involved in genetic research;
(b) Physicians licensed under ORS chapter 677;
(c) Voluntary organizations involved in the development of
public policy on issues related to genetic privacy;
(d) Hospitals;
{ - (e) The Department of Human Services; - }
{ - (f) - } { + (e) + } The { - Department of Consumer
and Business Services - } { + Oregon Health Authority + };
{ - (g) - } { + (f) + } Health care service contractors
involved in genetic and health services research;
{ - (h) - } { + (g) + } The biosciences industry;
{ - (i) - } { + (h) + } The pharmaceutical industry;
{ - (j) - } { + (i) + } Health care consumers;
{ - (k) - } { + (j) + } Organizations advocating for
privacy of medical information;
{ - (L) - } { + (k) + } Public members of institutional
review boards; and
{ - (m) - } { + (L) + } Organizations or individuals
promoting public education about genetic research and genetic
privacy and public involvement in policymaking related to genetic
research and genetic privacy.
(2) Organizations and individuals representing the categories
listed in subsection (1) of this section may recommend nominees
for membership on the advisory committee to the President, the
Speaker and the director.
(3) Members and alternate members of the advisory committee
serve two-year terms and may be reappointed.
(4) Members and alternate members of the advisory committee
serve at the pleasure of the appointing entity.
(5) The { - Department of Human Services - } { + Oregon
Health Authority + } shall provide staff for the advisory
committee.
(6) The advisory committee shall report biennially to the
Legislative Assembly in the manner provided by ORS 192.245. The
report shall include the activities and the results of any
studies conducted by the advisory committee. The advisory
committee may make any recommendations for legislative changes
deemed necessary by the advisory committee.
(7) The advisory committee shall study the use and disclosure
of genetic information and shall develop and refine a legal
framework that defines the rights of individuals whose DNA
samples and genetic information are collected, stored, analyzed
and disclosed.
(8) The advisory committee shall create opportunities for
public education on the scientific, legal and ethical development
within the fields of genetic privacy and research. The advisory
committee shall also elicit public input on these matters. The
advisory committee shall make reasonable efforts to obtain public
input that is representative of the diversity of opinion on this
subject. The advisory committee's recommendations to the
Legislative Assembly shall take into consideration public
concerns and values related to these matters.
SECTION 245. ORS 238.410 is amended to read:
238.410. (1) As used in this section:
(a) 'Carrier' means an insurance company or health care service
contractor holding a valid certificate of authority from the
Director of the Department of Consumer and Business Services
{ + or the Oregon Health Authority + }, an insurance company or
health care service contractor licensed or certified in another
state that is operating under the laws of that state, or two or
more of those companies or contractors acting together pursuant
to a joint venture, partnership or other joint means of
operation.
(b) 'Eligible person' means:
(A) A member of the Public Employees Retirement System who is
retired for service or disability and is receiving a retirement
allowance or benefit under the system, and a spouse or dependent
of that member;
(B) A person who is a surviving spouse or dependent of a
deceased retired member of the system or the surviving spouse or
dependent of a member of the system who had not retired but who
had reached earliest retirement age at the time of death;
(C) A person who is receiving retirement pay or a pension
calculated under ORS 1.314 to 1.380 (1989 Edition), and a spouse
or dependent of that person; or
(D) A surviving spouse or dependent of a deceased retired
member of the system or of a person who was receiving retirement
pay or a pension calculated under ORS 1.314 to 1.380 (1989
Edition) if the surviving spouse or dependent was covered at the
time of the decedent's death by a health care insurance plan
contracted for under this section.
(c) 'Health care' means medical, surgical, hospital or any
other remedial care recognized by state law and related services
and supplies and includes comparable benefits for persons who
rely on spiritual means of healing.
(2) The Public Employees Retirement Board shall conduct a
continuing study and investigation of all matters connected with
the providing of health care insurance protection to eligible
persons. The board shall design benefits, devise specifications,
invite proposals, analyze carrier responses to advertisements for
proposals and do acts necessary to award contracts to provide
health care insurance, including insurance that provides coverage
supplemental to federal Medicare coverage, with emphasis on
features based on health care cost containment principles, for
eligible persons. The board is not subject to the provisions of
ORS chapters 279A and 279B, except ORS 279B.235, in awarding
contracts under the provisions of this section. The board shall
establish procedures for inviting proposals and awarding
contracts under this section.
(3) The board shall enter into a contract with a carrier to
provide health care insurance for eligible persons for a one or
two-year period. The board may enter into more than one contract
with one or more carriers, contracting jointly or severally, if
in the opinion of the board it is necessary to do so to obtain
maximum coverage at minimum cost and consistent with the health
care insurance needs of eligible persons. The board periodically
shall review a current contract or contracts and make suitable
study and investigation for the purpose of determining whether a
different contract or contracts can and should, in the best
interest of eligible persons, be entered into. If it would be
advantageous to eligible persons to do so, the board shall enter
into a different contract or contracts. Contracts shall be signed
by the chairperson on behalf of the board.
(4) Except as provided in ORS 238.415 and 238.420, the board
may deduct monthly from the retirement allowance or benefit,
retirement pay or pension payable to an eligible person who
elects to participate in a health care insurance plan the monthly
cost of the coverage for the person under a health care insurance
contract entered into under this section and the administrative
costs incurred by the board under this section, and shall pay
those amounts into the Standard Retiree Health Insurance Account
established under subsection (7) of this section. The board by
rule may establish other procedures for collecting the monthly
cost of the coverage and the administrative costs incurred by the
board under this section if the board does not deduct those costs
from the retirement allowance or benefit, retirement pay or
pension payable to an eligible person.
(5) Subject to applicable provisions of ORS chapter 183, the
board may make rules not inconsistent with this section to
determine the terms and conditions of eligible person
participation and coverage and otherwise to implement and carry
out the purposes and provisions of this section and ORS 238.420.
(6) The board may retain consultants, brokers or other advisory
personnel, organizations specializing in health care cost
containment or other administrative services when it determines
the necessity and, subject to the State Personnel Relations Law,
shall employ such personnel as are required to assist in
performing the functions of the board under this section.
(7) Pursuant to section 401(h) of the Internal Revenue Code,
the Standard Retiree Health Insurance Account is established
within the Public Employees Retirement Fund, separate and
distinct from the General Fund. All payments made by eligible
persons for health insurance coverage provided under this section
shall be held in the account. Interest earned by the account
shall be credited to the account. All moneys in the account are
continuously appropriated to the Public Employees Retirement
Board and may be used by the board only to pay the cost of health
insurance coverage under this section and to pay the
administrative costs incurred by the board under this section.
(8) The sum of all amounts paid by eligible persons into the
Standard Retiree Health Insurance Account, by participating
public employers into the Retiree Health Insurance Premium
Account under ORS 238.415, and by participating public employers
into the Retirement Health Insurance Account under ORS 238.420,
may not exceed 25 percent of the aggregate contributions made by
participating public employers to the Public Employees Retirement
Fund on or after July 11, 1987, not including contributions made
by participating public employers to fund prior service credits.
(9) Until all liabilities for health benefits under the system
are satisfied, contributions and earnings in the Standard Retiree
Health Insurance Account, the Retiree Health Insurance Premium
Account under ORS 238.415 and the Retirement Health Insurance
Account under ORS 238.420 may not be diverted or otherwise put to
any use other than providing health benefits and payment of
reasonable costs incurred in administering this section and ORS
238.415 and 238.420. Upon satisfaction of all liabilities for
providing health benefits under this section, any amount
remaining in the Standard Retiree Health Insurance Account shall
be returned to the participating public employers who have made
contributions to the account. The distribution shall be made in
such equitable manner as the board determines appropriate.
SECTION 246. ORS 243.105 is amended to read:
243.105. As used in ORS 243.105 to 243.285, unless the context
requires otherwise:
(1) 'Benefit plan' includes, but is not limited to:
(a) Contracts for insurance or other benefits, including
medical, dental, vision, life, disability and other health care
recognized by state law, and related services and supplies;
(b) Comparable benefits for employees who rely on spiritual
means of healing; and
(c) Self-insurance programs managed by the Public Employees'
Benefit Board.
(2) 'Board' means the Public Employees' Benefit Board.
(3) 'Carrier' means an insurance company or health care service
contractor holding a valid certificate of authority from the
Director of the Department of Consumer and Business Services
{ + or the Oregon Health Authority + }, or two or more
companies or contractors acting together pursuant to a joint
venture, partnership or other joint means of operation, or a
board-approved guarantor of benefit plan coverage and
compensation.
(4)(a) 'Eligible employee' means an officer or employee of a
state agency who elects to participate in one of the group
benefit plans described in ORS 243.135. The term includes state
officers and employees in the exempt, unclassified and classified
service, and state officers and employees, whether or not
retired, who:
(A) Are receiving a service retirement allowance, a disability
retirement allowance or a pension under the Public Employees
Retirement System or are receiving a service retirement
allowance, a disability retirement allowance or a pension under
any other retirement or disability benefit plan or system offered
by the State of Oregon for its officers and employees;
(B) Are eligible to receive a service retirement allowance
under the Public Employees Retirement System and have reached
earliest retirement age under ORS chapter 238;
(C) Are eligible to receive a pension under ORS 238A.100 to
238A.245, and have reached earliest retirement age as described
in ORS 238A.165; or
(D) Are eligible to receive a service retirement allowance or
pension under another retirement benefit plan or system offered
by the State of Oregon and have attained earliest retirement age
under the plan or system.
(b) 'Eligible employee' does not include individuals:
(A) Engaged as independent contractors;
(B) Whose periods of employment in emergency work are on an
intermittent or irregular basis;
(C) Who are employed on less than half-time basis unless the
individuals are employed in positions classified as job-sharing
positions, unless the individuals are defined as eligible under
rules of the board or unless the individuals are employed as
nurses or nursing educators;
(D) Appointed under ORS 240.309;
(E) Provided sheltered employment or make-work by the state in
an employment or industries program maintained for the benefit of
such individuals; or
(F) Provided student health care services in conjunction with
their enrollment as students at the state institutions of higher
education.
(5) 'Family member' means an eligible employee's spouse and any
unmarried child or stepchild within age limits and other
conditions imposed by the board with regard to unmarried children
or stepchildren.
(6) 'Payroll disbursing officer' means the officer or official
authorized to disburse moneys in payment of salaries and wages of
employees of a state agency.
(7) 'Premium' means the monthly or other periodic charge for a
benefit plan.
(8) 'State agency' means every state officer, board,
commission, department or other activity of state government.
SECTION 247. ORS 243.860 is amended to read:
243.860. As used in ORS 243.860 to 243.886, unless the context
requires otherwise:
(1) 'Benefit plan' includes but is not limited to:
(a) Contracts for insurance or other benefits, including
medical, dental, vision, life, disability and other health care
recognized by state law, and related services and supplies;
(b) Self-insurance programs managed by the Oregon Educators
Benefit Board; and
(c) Comparable benefits for employees who rely on spiritual
means of healing.
(2) 'Carrier' means an insurance company or health care service
contractor holding a valid certificate of authority from the
Director of the Department of Consumer and Business Services
{ + or the Oregon Health Authority + }, or two or more
companies or contractors acting together pursuant to a joint
venture, partnership or other joint means of operation, or a
board-approved provider or guarantor of benefit plan coverage and
compensation.
(3) 'District' means a common school district, a union high
school district, an education service district, as defined in ORS
334.003, or a community college district, as defined in ORS
341.005.
(4)(a) 'Eligible employee' includes:
(A) An officer or employee of a district who elects to
participate in one of the benefit plans described in ORS 243.864
to 243.874; and
(B) An officer or employee of a district, whether or not
retired, who:
(i) Is receiving a service retirement allowance, a disability
retirement allowance or a pension under the Public Employees
Retirement System or is receiving a service retirement allowance,
a disability retirement allowance or a pension under any other
retirement or disability benefit plan or system offered by the
district for its officers and employees;
(ii) Is eligible to receive a service retirement allowance
under the Public Employees Retirement System and has reached
earliest service retirement age under ORS chapter 238;
(iii) Is eligible to receive a pension under ORS 238A.100 to
238A.245 and has reached earliest retirement age as described in
ORS 238A.165; or
(iv) Is eligible to receive a service retirement allowance or
pension under any other retirement benefit plan or system offered
by the district and has attained earliest retirement age under
the plan or system.
(b) Except as provided in paragraph (a)(B) of this subsection,
'eligible employee' does not include an individual:
(A) Engaged as an independent contractor;
(B) Whose periods of employment in emergency work are on an
intermittent or irregular basis; or
(C) Who is employed on less than a half-time basis unless the
individual is employed in a position classified as a job-sharing
position or unless the individual is defined as eligible under
rules of the Oregon Educators Benefit Board or under a collective
bargaining agreement.
(5) 'Family member' means an eligible employee's spouse or
domestic partner and any unmarried child or stepchild of an
eligible employee within age limits and other conditions imposed
by the Oregon Educators Benefit Board with regard to unmarried
children or stepchildren.
(6) 'Payroll disbursing officer' means the officer or official
authorized to disburse moneys in payment of salaries and wages of
officers and employees of a district.
(7) 'Premium' means the monthly or other periodic charge,
including administrative fees of the Oregon Educators Benefit
Board, for a benefit plan.
SECTION 248. ORS 291.055 is amended to read:
291.055. (1) Notwithstanding any other law that grants to a
state agency the authority to establish fees, all new state
agency fees or fee increases adopted after July 1 of any
odd-numbered year:
(a) Are not effective for agencies in the executive department
of government unless approved in writing by the Director of the
Oregon Department of Administrative Services;
(b) Are not effective for agencies in the judicial department
of government unless approved in writing by the Chief Justice of
the Supreme Court;
(c) Are not effective for agencies in the legislative
department of government unless approved in writing by the
President of the Senate and the Speaker of the House of
Representatives;
(d) Shall be reported by the state agency to the Oregon
Department of Administrative Services within 10 days of their
adoption; and
(e) Are rescinded on July 1 of the next following odd-numbered
year, or on adjournment sine die of the regular session of the
Legislative Assembly meeting in that year, whichever is later,
unless otherwise authorized by enabling legislation setting forth
the approved fees.
(2) This section does not apply to:
(a) Any tuition or fees charged by the State Board of Higher
Education and state institutions of higher education.
(b) Taxes or other payments made or collected from employers
for unemployment insurance required by ORS chapter 657 or premium
assessments required by ORS 656.612 and 656.614 or contributions
and assessments calculated by cents per hour for workers'
compensation coverage required by ORS 656.506.
(c) Fees or payments required for:
(A) Health care services provided by the Oregon Health and
Science University, by the Oregon Veterans' Homes and by other
state agencies and institutions pursuant to ORS 179.610 to
179.770.
(B) Assessments and premiums paid to the Oregon Medical
Insurance Pool established by ORS 735.614 and 735.625.
(C) Copayments and premiums paid to the Oregon medical
assistance program.
(d) Fees created or authorized by statute that have no
established rate or amount but are calculated for each separate
instance for each fee payer and are based on actual cost of
services provided.
(e) State agency charges on employees for benefits and
services.
(f) Any intergovernmental charges.
(g) Forest protection district assessment rates established by
ORS 477.210 to 477.265 and the Oregon Forest Land Protection Fund
fees established by ORS 477.760.
(h) State Department of Energy assessments required by ORS
469.421 (8) and 469.681.
(i) Any charges established by the State Parks and Recreation
Director in accordance with ORS 565.080 (3).
(j) Assessments on premiums charged by the Insurance Division
of the Department of Consumer and Business Services { + or the
Oregon Health Authority + } pursuant to ORS 731.804 { + or
sections 131, 134 and 136c of this 2009 Act, + } or fees charged
by the Division of Finance and Corporate Securities of the
Department of Consumer and Business Services to banks, trusts and
credit unions pursuant to ORS 706.530 and 723.114.
(k) Public Utility Commission operating assessments required by
ORS 756.310 or charges paid to the Residential Service Protection
Fund required by chapter 290, Oregon Laws 1987.
(L) Fees charged by the Housing and Community Services
Department for intellectual property pursuant to ORS 456.562.
(m) New or increased fees that are anticipated in the
legislative budgeting process for an agency, revenues from which
are included, explicitly or implicitly, in the legislatively
adopted budget for the agency.
(n) Tolls approved by the Oregon Transportation Commission
pursuant to ORS 383.004.
(3)(a) Fees temporarily decreased for competitive or
promotional reasons or because of unexpected and temporary
revenue surpluses may be increased to not more than their prior
level without compliance with subsection (1) of this section if,
at the time the fee is decreased, the state agency specifies the
following:
(A) The reason for the fee decrease; and
(B) The conditions under which the fee will be increased to not
more than its prior level.
(b) Fees that are decreased for reasons other than those
described in paragraph (a) of this subsection may not be
subsequently increased except as allowed by ORS 291.050 to
291.060 and 294.160.
SECTION 249. ORS 291.371 is amended to read:
291.371. (1) As used in this section, 'legislative review
agency' means the Joint Committee on Ways and Means during the
period when the Legislative Assembly is in session and the
Emergency Board during the interim period between sessions.
(2) Prior to making any changes in a salary plan, the Oregon
Department of Administrative Services shall submit the proposed
changes to the legislative review agency.
(3)(a) The Oregon Department of Administrative Services may
approve the reallocation of positions or the establishment of new
positions not specifically provided for in the budget of the
affected agency if it finds that the proposed change:
(A) Can be financed by the agency within the limits of its
biennial budget and legislatively approved program;
(B) Will not produce future budgetary increases; and
(C) Conforms to legislatively approved salary policies.
(b) Proposed changes not meeting the requirements of paragraph
(a) of this subsection shall be presented to the legislative
review agency.
(4) Agencies within the Department of Human Services { + , the
Oregon Health Authority + } and the Department of Corrections
shall report on a biennial basis to the legislative review
agency. Each report shall include the number of vacant budgeted
positions, including all job categories and classifications,
within the agency. The legislative review agency shall order the
reporting agency to show cause why the budgeted positions have
not been filled and shall assess fully the impact the vacancies
have on:
(a) The agency's delivery of services, accounting for any
seasonal fluctuation in the need for those services;
(b) The agency's budget due to increased use of overtime;
(c) The agency's use of temporary employees; and
(d) Employee workload.
(5) It is declared to be the policy of this state that the
total personal services, budget and full-time equivalent
positions approved for any state agency shall be the maximum
amount necessary to meet the requirements of the agency for the
biennium. Notwithstanding ORS 291.232 to 291.260, the Governor
and the Oregon Department of Administrative Services may transfer
vacant position authority among and within state agencies to
achieve maximum utilization of authorized positions within
agencies.
SECTION 250. ORS 315.604 is amended to read:
315.604. (1) As used in this section:
(a) 'Bone marrow donor expense' means the sum of the amounts
paid or incurred during the tax year by an employer for the
following:
(A) Development of an employee bone marrow donation program.
(B) Employee education related to bone marrow donation,
including but not limited to the need for donors and an
explanation of the procedures used to determine tissue type and
donate bone marrow.
(C) Payments to a health care provider for determining the
tissue type of an employee who agrees to register or registers as
a bone marrow donor.
(D) Wages paid to an employee for time reasonably related to
tissue typing and bone marrow donation.
(E) Transportation of an employee to the site of a donation or
any other service which is determined by the { - Department of
Human Services - } { + Oregon Health Authority + } by rule as
essential for a successful bone marrow donation.
(b) 'Employee' means an individual who:
(A) Is regularly employed by the taxpayer for more than 20
hours per week;
(B) Who is not a temporary or seasonal employee; and
(C) Whose wages are subject to withholding under ORS 316.162 to
316.221.
(c) 'Wages' has the meaning given the term for purposes of ORS
316.162 to 316.221.
(2) A business tax credit against the taxes otherwise due under
ORS chapter 316 for the tax year is allowed to a resident
employer, or if the employer is a corporation, to the employer
against the taxes otherwise due under ORS chapter 317. The amount
of the credit is equal to 25 percent of the bone marrow donor
expense paid or incurred during the tax year by an employer to
provide a program for employees who are potential bone marrow
donors or who actually become bone marrow donors.
(3)(a) Except as provided under paragraph (b) of this
subsection, the allowance of a credit under this section shall
not affect the computation of taxable income for purposes of ORS
chapter 316 or 317.
(b) If in determining the amount of the credit for any tax year
an amount allowed as a deduction under section 170 of the
Internal Revenue Code is included in bone marrow donation
expense, the amount allowed as a deduction shall be added to
federal taxable income.
(4) The credit allowed under this section shall be allowed to a
nonresident employer in the same manner as the credit is allowed
to a resident employer.
(5) Any tax credit otherwise allowable under this section which
is not used by the taxpayer in a particular tax year may be
carried forward and offset against the taxpayer's tax liability
for the next succeeding tax year. Any credit remaining unused in
such next succeeding tax year may be carried forward and used in
the second succeeding tax year. Any credit remaining unused in
such second succeeding tax year may be carried forward and used
in the third succeeding tax year. Any credit remaining unused in
such third succeeding tax year may be carried forward and used in
the fourth succeeding tax year. Any credit remaining unused in
such fourth succeeding tax year may be carried forward and used
in the fifth succeeding tax year, but may not be used in any tax
year thereafter.
SECTION 251. ORS 315.613 is amended to read:
315.613. (1) A resident or nonresident individual certified as
eligible under ORS 442.563, licensed under ORS chapter 677, who
is engaged in the practice of medicine, and who has a rural
practice that amounts to 60 percent of the individual's practice,
shall be allowed an annual credit against taxes otherwise due
under this chapter in the sum of $5,000 during the time in which
the individual retains such practice and membership if the
individual is actively practicing in and is a member of the
medical staff of one of the following hospitals:
(a) A type A hospital designated as such by the Office of Rural
Health;
(b) A type B hospital designated as such by the Office of Rural
Health if the hospital is:
(A) Not within the boundaries of a metropolitan statistical
area;
(B) Located 30 or more highway miles from the closest hospital
within the major population center in a metropolitan statistical
area; or
(C) Located in a county with a population of less than 75,000;
(c) A type C rural hospital, if the Office of Rural Health
makes the findings required by ORS 315.619; or
(d) A rural critical access hospital.
(2) A nonresident shall be allowed the credit under this
section in the proportion provided in ORS 316.117. If a change in
the status of a taxpayer from resident to nonresident or from
nonresident to resident occurs, the credit allowed by this
section shall be determined in a manner consistent with ORS
316.117.
(3) For purposes of this section, an 'individual's practice'
shall be determined on the basis of actual time spent in practice
each week in hours or days, whichever is considered by the Office
of Rural Health to be more appropriate. In the case of a
shareholder of a corporation or a member of a partnership, only
the time of the individual shareholder or partner shall be
considered and the full amount of the credit shall be allowed to
each shareholder or partner who qualifies in an individual
capacity.
(4) As used in this section:
(a) 'Type A hospital,' 'type B hospital' and 'type C hospital'
have the meaning for those terms provided in ORS 442.470.
(b) 'Rural critical access hospital' means a facility that
meets the criteria set forth in 42 U.S.C. 1395i-4 (c)(2)(B) and
that has been designated a critical access hospital by the Office
of Rural Health and the { - Department of Human Services - }
{ + Oregon Health Authority + }.
SECTION 252. ORS 343.499 is amended to read:
343.499. (1)(a) There is created the State Interagency
Coordinating Council.
(b) The Governor shall appoint members of the council from a
list of eligible appointees provided by the council and agencies
described in subsection (2) of this section and shall ensure that
the membership of the council reasonably represents the
population of this state.
(c) The Governor shall designate one member of the council to
serve as the chairperson, or if the Governor chooses not to name
a chairperson, the council may elect one of its members to serve
as chairperson. However, any member of the council who represents
the Department of Education may not serve as the chairperson of
the council.
(2) The membership of the council shall be composed as follows:
(a) At least 20 percent of the council members shall be
parents, including minority parents, of preschool children with
disabilities or of children with disabilities who are 12 years of
age or younger who have knowledge of or experience with programs
for infants and toddlers with disabilities. At least one council
member shall be a parent of an infant or toddler with a
disability or of a child with a disability who is six years of
age or younger.
(b) At least 20 percent of the council members shall be public
or private providers of early intervention and early childhood
special education services.
(c) At least one council member shall be a member of the
Legislative Assembly.
(d) At least one council member shall be involved in personnel
preparation.
(e) At least one council member shall represent the Department
of Human Services.
(f) At least one council member shall represent the federal
Head Start program.
(g) At least one council member shall represent the Child Care
Division of the Employment Department.
(h) At least one council member shall represent the Department
of Education.
(i) At least one council member shall represent the
{ - Department of Consumer and Business Services - } { +
Oregon Health Authority + }.
(j) At least one council member shall represent the State
Commission on Children and Families.
(k) At least one council member shall represent the Child
Development and Rehabilitation Center of the Oregon Health and
Science University.
(L) At least one council member shall be a member of the State
Advisory Council for Special Education created under ORS 343.287.
(m) At least one council member shall be a representative
designated by the state coordinator for homeless education.
(n) At least one council member shall represent the state child
welfare agency responsible for foster care.
(o) At least one council member shall represent the state
agency responsible for children's mental health.
{ - (p) At least one council member shall be from the agency
responsible for the state Medicaid program. - }
{ - (q) - } { + (p) + } The council may include other
members appointed by the Governor, including but not limited to
one representative from the United States Bureau of Indian
Affairs or, where there is no school operated or funded by the
bureau, from the Indian Health Service or the tribe or tribal
council.
(3) An individual appointed to represent a state agency that is
involved in the provision of or payment for services for
preschool children with disabilities under subsection (2)(e) and
(h) to (k) of this section shall have sufficient authority to
engage in making and implementing policy on behalf of the agency.
(4) The State Interagency Coordinating Council shall:
(a) Advise the Superintendent of Public Instruction and the
State Board of Education on unmet needs in the early childhood
special education and early intervention programs for preschool
children with disabilities, review and comment publicly on any
rules proposed by the State Board of Education and the
distribution of funds for the programs and assist the state in
developing and reporting data on and evaluations of the programs
and services.
(b) Advise and assist the represented public agencies regarding
the services and programs they provide to preschool children with
disabilities and their families, including public comments on any
proposed rules affecting the target population and the
distribution of funds for such services, and assist each agency
in developing services that reflect the overall goals for the
target population as adopted by the council.
(c) Advise and assist the Department of Education and other
state agencies in the development and implementation of the
policies that constitute the statewide system.
(d) Assist all appropriate public agencies in achieving the
full participation, coordination and cooperation for
implementation of a statewide system that includes but is not
limited to:
(A) Seeking information from service providers, service
coordinators, parents and others about any federal, state or
local policies that impede timely service delivery; and
(B) Taking steps to ensure that any policy problems identified
under subparagraph (A) of this paragraph are resolved.
(e) Advise and assist the Department of Education in
identifying the sources of fiscal and other support for preschool
services, assigning financial responsibility to the appropriate
agencies and ensuring that the provisions of interagency
agreements under ORS 343.511 are carried out.
(f) Review and comment on each agency's services and policies
regarding services for preschool children with disabilities, or
preschool children who are at risk of developing disabling
conditions, and their families to the maximum extent possible to
assure cost-effective and efficient use of resources.
(g) To the extent appropriate, assist the Department of
Education in the resolution of disputes.
(h) Advise and assist the Department of Education in the
preparation of applications and amendments thereto.
(i) Advise and assist the Department of Education regarding the
transition of preschool children with disabilities.
(j) Prepare and submit an annual report to the Governor and to
the United States Secretary of Education on the status of early
intervention programs operated within this state.
(5) The council may advise appropriate agencies about
integration of services for preschool children with disabilities
and at-risk preschool children.
(6) Terms of office for council members shall be three years,
except that:
(a) The representative from the State Advisory Council for
Special Education shall serve a one-year term; and
(b) The representatives from other state agencies and the
representative from the Legislative Assembly shall serve
indefinite terms.
(7) Subject to approval by the Governor, the council may use
federal funds appropriated for this purpose and available to the
council to:
(a) Conduct hearings and forums;
(b) Reimburse nonagency council members pursuant to ORS 292.495
for attending council meetings, for performing council duties,
and for necessary expenses, including child care for parent
members;
(c) Pay compensation to a council member if the member is not
employed or if the member must forfeit wages from other
employment when performing official council business;
(d) Hire staff; and
(e) Obtain the services of such professional, technical and
clerical personnel as may be necessary to carry out its
functions.
(8) Except as provided in subsection (7) of this section,
council members shall serve without compensation.
(9) The Department of Education shall provide clerical and
administrative support, including staff, to the council to carry
out the performance of the council's function as described in
this section.
(10) The council shall meet at least quarterly. The meetings
shall be announced publicly and, to the extent appropriate, be
open and accessible to the general public.
(11) No member of the council shall cast a vote on any matter
that would provide direct financial benefit to that member or
otherwise give the appearance of a conflict of interest under
state law.
SECTION 253. ORS 343.507 is amended to read:
343.507. (1) Each contractor for early childhood special
education and early intervention services shall assist in the
development of a local early intervention interagency advisory
council in every county within the contractor's service area.
(2) Each local early intervention interagency advisory council
shall include as members at least 20 percent parents of preschool
children with disabilities, 20 percent providers of early
childhood special education and early intervention services or
other services to preschool children with disabilities, a
representative of the State Commission on Children and Families
and representatives from public and private agencies that serve
young children and their families, including but not limited to
Head Start and Oregon prekindergartens, community child care, the
Child Care Division of the Employment Department, local school
districts, education service districts, Department of Education
regional special education programs, community mental health and
developmental disabilities programs, { - Department of Human
Services - } { + Oregon Health Authority + } health programs,
child welfare programs and public assistance programs, Indian
education agencies, migrant programs serving young children and
community colleges.
(3) Each local early intervention interagency advisory council
shall select its own chairperson and vice chairperson and fix the
duties of its officers.
(4) The department shall establish procedures pursuant to rules
of the State Board of Education for seeking and considering local
council advice regarding the selection of contractors,
coordination of services and procedures for local resolution of
disputes.
SECTION 254. ORS 442.800 is amended to read:
442.800. (1) The Advisory Committee on Physician Credentialing
Information is established within the Office for Oregon Health
Policy and Research. The committee consists of nine members
appointed by the Administrator of the Office for Oregon Health
Policy and Research as follows:
(a) Three members who are physicians licensed by the Oregon
Medical Board or representatives of physician organizations doing
business within the State of Oregon;
(b) Three representatives of hospitals licensed by the
{ - Department of Human Services - } { + Oregon Health
Authority + }; and
(c) Three representatives of health care service contractors
that have been issued a certificate of authority to transact
health insurance in this state by the { - Department of
Consumer and Business Services - } { + Oregon Health
Authority + }.
(2) All members appointed pursuant to subsection (1) of this
section shall be knowledgeable about national standards relating
to physician credentialing.
(3) The term of appointment for each member of the committee is
three years. If, during a member's term of appointment, the
member no longer qualifies to serve as designated by the criteria
of subsection (1) of this section, the member must resign. If
there is a vacancy for any cause, the administrator shall make an
appointment to become immediately effective for the unexpired
term.
(4) Members of the committee are not entitled to compensation
or reimbursement of expenses.
SECTION 255. ORS 442.807 is amended to read:
442.807. (1) Within 30 days of receiving the recommendations of
the Advisory Committee on Physician Credentialing Information,
the Administrator of the Office for Oregon Health Policy and
Research shall forward the recommendations to the Director of the
{ - Department of Consumer and Business Services and to the
Director of Human Services - } { + Oregon Health Authority + }.
The administrator shall request that the { - Department of
Consumer and Business Services and the Department of Human
Services - } { + Oregon Health Authority + } adopt rules to
carry out the efficient implementation and enforcement of the
recommendations of the committee.
(2) The { - Department of Consumer and Business Services and
the Department of Human Services - } { + Oregon Health
Authority + } shall:
(a) Adopt administrative rules in a timely manner, as required
by the Administrative Procedures Act, for the purpose of
effectuating the provisions of ORS 442.800 to 442.807; and
(b) Consult with each other and with the administrator to
ensure that the rules adopted by the { - Department of Consumer
and Business Services and the Department of Human Services - }
{ + Oregon Health Authority + } are identical and are consistent
with the recommendations developed pursuant to ORS 442.805 for
affected hospitals and health care service contractors.
(3) The uniform credentialing information required pursuant to
the administrative rules of the { - Department of Consumer and
Business Services and the Department of Human Services - }
{ + Oregon Health Authority + } represent the minimum uniform
credentialing information required by the affected hospitals and
health care service contractors. Nothing in ORS 442.800 to
442.807 shall be interpreted to prevent an affected hospital or
health care service contractor from requesting additional
credentialing information from a licensed physician for the
purpose of completing physician credentialing procedures used by
the affected hospital or health care service contractor.
SECTION 256. { + + } ORS 731.016 is amended to read:
731.016. The Insurance Code shall be liberally construed and
shall be administered and enforced by the Director of the
Department of Consumer and Business Services { + and the
Director of the Oregon Health Authority + } to give effect to the
policy stated in ORS 731.008.
SECTION 257. ORS 731.036 is amended to read:
731.036. The Insurance Code does not apply to any of the
following to the extent of the subject matter of the exemption:
(1) A bail bondsman, other than a corporate surety and its
agents.
(2) A fraternal benefit society that has maintained lodges in
this state and other states for 50 years prior to January 1,
1961, and for which a certificate of authority was not required
on that date.
(3) A religious organization providing insurance benefits only
to its employees, which organization is in existence and exempt
from taxation under section 501(c)(3) of the federal Internal
Revenue Code on September 13, 1975.
(4) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
tort liability in accordance with ORS 30.282.
(5) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
property damage in accordance with ORS 30.282.
(6) Cities, counties, school districts, community college
districts, community college service districts or districts, as
defined in ORS 198.010 and 198.180, that either individually or
jointly insure for health insurance coverage, excluding
disability insurance, their employees or retired employees, or
their dependents, or students engaged in school activities, or
combination of employees and dependents, with or without employee
or student contributions, if all of the following conditions are
met:
(a) The individual or jointly self-insured program meets the
following minimum requirements:
(A) In the case of a school district, community college
district or community college service district, the number of
covered employees and dependents and retired employees and
dependents aggregates at least 500 individuals;
(B) In the case of an individual public body program other than
a school district, community college district or community
college service district, the number of covered employees and
dependents and retired employees and dependents aggregates at
least 500 individuals; and
(C) In the case of a joint program of two or more public
bodies, the number of covered employees and dependents and
retired employees and dependents aggregates at least 1,000
individuals;
(b) The individual or jointly self-insured health insurance
program includes all coverages and benefits required of group
health insurance policies under ORS chapters 743 and 743A;
(c) The individual or jointly self-insured program must have
program documents that define program benefits and
administration;
(d) Enrollees must be provided copies of summary plan
descriptions including:
(A) Written general information about services provided, access
to services, charges and scheduling applicable to each enrollee's
coverage;
(B) The program's grievance and appeal process; and
(C) Other group health plan enrollee rights, disclosure or
written procedure requirements established under ORS chapters 743
and 743A;
(e) The financial administration of an individual or jointly
self-insured program must include the following requirements:
(A) Program contributions and reserves must be held in separate
accounts and used for the exclusive benefit of the program;
(B) The program must maintain adequate reserves. Reserves may
be invested in accordance with the provisions of ORS chapter 293.
Reserve adequacy must be calculated annually with proper
actuarial calculations including the following:
(i) Known claims, paid and outstanding;
(ii) A history of incurred but not reported claims;
(iii) Claims handling expenses;
(iv) Unearned contributions; and
(v) A claims trend factor; and
(C) The program must maintain adequate reinsurance against the
risk of economic loss in accordance with the provisions of ORS
742.065 unless the program has received written approval for an
alternative arrangement for protection against economic loss from
the Director of the { - Department of Consumer and Business
Services - } { + Oregon Health Authority + };
(f) The individual or jointly self-insured program must have
sufficient personnel to service the employee benefit program or
must contract with a third party administrator licensed under ORS
chapter 744 as a third party administrator to provide such
services;
(g) The individual or jointly self-insured program shall be
subject to assessment in accordance with ORS 735.614 and former
enrollees shall be eligible for portability coverage in
accordance with ORS 735.616;
(h) The public body, or the program administrator in the case
of a joint insurance program of two or more public bodies, files
with the Director of the { - Department of Consumer and
Business Services - } { + Oregon Health Authority + } copies of
all documents creating and governing the program, all forms used
to communicate the coverage to beneficiaries, the schedule of
payments established to support the program and, annually, a
financial report showing the total incurred cost of the program
for the preceding year. A copy of the annual audit required by
ORS 297.425 may be used to satisfy the financial report filing
requirement; and
(i) Each public body in a joint insurance program is liable
only to its own employees and no others for benefits under the
program in the event, and to the extent, that no further funds,
including funds from insurance policies obtained by the pool, are
available in the joint insurance pool.
(7) All ambulance services.
(8) A person providing any of the services described in this
subsection. The exemption under this subsection does not apply to
an authorized insurer providing such services under an insurance
policy. This subsection applies to the following services:
(a) Towing service.
(b) Emergency road service, which means adjustment, repair or
replacement of the equipment, tires or mechanical parts of a
motor vehicle in order to permit the motor vehicle to be operated
under its own power.
(c) Transportation and arrangements for the transportation of
human remains, including all necessary and appropriate
preparations for and actual transportation provided to return a
decedent's remains from the decedent's place of death to a
location designated by a person with valid legal authority under
ORS 97.130.
(9)(a) A person described in this subsection who, in an
agreement to lease or to finance the purchase of a motor vehicle,
agrees to waive for no additional charge the amount specified in
paragraph (b) of this subsection upon total loss of the motor
vehicle because of physical damage, theft or other occurrence, as
specified in the agreement. The exemption established in this
subsection applies to the following persons:
(A) The seller of the motor vehicle, if the sale is made
pursuant to a motor vehicle retail installment contract.
(B) The lessor of the motor vehicle.
(C) The lender who finances the purchase of the motor vehicle.
(D) The assignee of a person described in this paragraph.
(b) The amount waived pursuant to the agreement shall be the
difference, or portion thereof, between the amount received by
the seller, lessor, lender or assignee, as applicable, which
represents the actual cash value of the motor vehicle at the date
of loss, and the amount owed under the agreement.
SECTION 258. ORS 731.042 is amended to read:
731.042. (1) An exempt insurer who holds a certificate of
exemption issued by the { - Director of the Department of
Consumer and Business Services - } { + regulator + } before
January 1, 2003, may continue transacting insurance.
(2) In order to continue a certificate of exemption, an exempt
insurer to whom subsection (1) of this section applies must file
its annual statement and pay the fees established by the
{ - director - } { + regulator + } by March 1 of each year.
(3) An exempt insurer shall be subject to ORS 731.296 to
731.316, 731.414, 731.418, 731.574, 731.988, 731.992, 733.010 to
733.115, 733.140 to 733.210, 743A.040, 746.075 and 746.110.
SECTION 259. ORS 731.072 is amended to read:
731.072. (1) A 'certificate of authority' is one issued by the
{ - Director of the Department of Consumer and Business
Services - } { + regulator + } pursuant to the Insurance Code
evidencing the authority of an insurer to transact insurance in
this state.
(2) A 'license' is authority granted by the { - director - }
{ + regulator + } pursuant to the Insurance Code for the
licensee to engage in a business or operation of insurance in
this state other than as an insurer, and the certificate by which
such authority is evidenced.
SECTION 260. ORS 731.096 is amended to read:
731.096. (1) The domicile of an alien insurer, other than
insurers formed under the laws of Canada or a province thereof,
shall be that state designated by the insurer in writing filed
with the { - Director of the Department of Consumer and
Business Services - } { + regulator + } at time of admission to
this state or before January 1, 1962, whichever date is the
later, and may be any one of the following states:
(a) The state in which the insurer was first authorized to
transact insurance;
(b) The state in which is located the insurer's principal place
of business in the United States; or
(c) The state in which is held the largest deposit of assets of
the insurer in trust for the protection of its policyholders and
creditors in the United States.
(2) If the insurer makes no such designation its domicile shall
be deemed to be that state in which is located its principal
place of business in the United States.
SECTION 261. ORS 731.142 is amended to read:
731.142. (1) 'Stock insurer' means an incorporated insurer
whose capital is divided into shares and owned by its
stockholders.
(2) 'Mutual insurer' means an incorporated insurer without
capital stock and the governing body of which is elected by its
policyholders. This definition does not exclude as a 'mutual
insurer' a foreign insurer found by the { - Director of the
Department of Consumer and Business Services - } { +
regulator + } to be organized on the mutual plan under the laws
of its domicile, but having temporary share capital or providing
for election of the insurer's governing body on a reasonable
basis by policyholders and others.
(3) 'Reciprocal insurer' means an unincorporated aggregation of
persons known as 'subscribers,' operating individually and
collectively through an attorney in fact common to all such
persons, interexchanging among themselves reciprocal agreements
of indemnity.
SECTION 262. ORS 731.216 is amended to read:
731.216. The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall have the power to:
(1) Contract for and procure, on a fee or part-time basis, or
both, such actuarial, technical or other professional services as
may be required for the discharge of duties.
(2) Obtain such other services as the director considers
necessary or desirable, including participation in organizations
of state insurance supervisory officials and appointment of
advisory committees. A member of an advisory committee so
appointed shall receive no compensation for services as a member,
but, subject to any other applicable law regulating travel and
other expenses of state officers, shall receive actual and
necessary travel and other expenses incurred in the performance
of official duties.
(3) Establish within the Department of Consumer and Business
Services a workers' compensation rating bureau to provide rating
information that is based upon and relevant to activities
conducted in this state, to enable the director to carry out the
provisions of ORS chapter 737. In lieu of creating a rating
bureau within the department, the director may contract with any
rating organization in other states if the director finds that
such a contract would provide the information required by this
section.
SECTION 263. ORS 731.228 is amended to read:
731.228. (1) No officer or employee of the Department of
Consumer and Business Services { + or the Oregon Health
Authority + } delegated responsibilities in the enforcement of
the Insurance Code shall:
(a) Be a director, officer, or employee of or be financially
interested in any person regulated by the department or office of
the department that is delegated responsibility in the
enforcement of the Insurance Code, except as a policyholder or
claimant under an insurance policy or by reason of rights vested
in commissions, fees, or retirement benefits related to services
performed prior to affiliation with the department; or
(b) Be engaged in any other business or occupation interfering
with or inconsistent with the duties of the office or employment.
(2) No person shall directly or indirectly give or pay, or
offer to give or pay, to the Director of the Department of
Consumer and Business Services, { + the Director of the Oregon
Health Authority + } or any officer or employee of the
department { + or authority + }, and the director or such
officer or employee shall not directly or indirectly solicit,
receive or accept any fee, compensation, loan, gift or other
thing of value in addition to the compensation and expense
allowance provided by law, for:
(a) Any service rendered or to be rendered as such director,
officer or employee, or in connection therewith;
(b) Services rendered or to be rendered in relation to
legislation;
(c) Extra services rendered or to be rendered; or
(d) Any cause whatsoever related to any person regulated by the
department or office of the department that is delegated
responsibility in the enforcement of the Insurance Code.
(3) This section does not permit any conduct, affiliation or
interest that is otherwise prohibited by public policy.
SECTION 264. ORS 731.232 is amended to read:
731.232. (1) For the purpose of an investigation or proceeding
under the Insurance Code, the Director of the Department of
Consumer and Business Services { + and the Director of the
Oregon Health Authority + } may administer oaths and
affirmations, subpoena witnesses, compel their attendance, take
evidence and require the production of books, papers,
correspondence, memoranda, agreements or other documents or
records which the director considers relevant or material to the
inquiry. Each witness who appears before the director under a
subpoena shall receive the fees and mileage provided for
witnesses in ORS 44.415 (2).
(2) If a person fails to comply with a subpoena so issued or a
party or witness refuses to testify on any matters, the judge of
the circuit court for any county, on the application of the
director, shall compel obedience by proceedings for contempt as
in the case of disobedience of the requirements of a subpoena
issued from such court or a refusal to testify therein.
SECTION 265. ORS 731.236 is amended to read:
731.236. (1) The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall enforce the provisions of the Insurance Code
for the public good, and shall execute the duties imposed by the
code.
(2) The director has the powers and authority expressly
conferred by or reasonably implied from the provisions of the
Insurance Code.
(3) The director may conduct such examinations and
investigations of insurance matters, in addition to examinations
and investigations expressly authorized, as the director
considers proper to determine whether any person has violated any
provision of the Insurance Code or to secure information useful
in the lawful administration of any such provision. The cost of
such additional examinations and investigations shall be borne by
the state.
(4) The director has such additional powers and duties as may
be provided by other laws of this state.
SECTION 266. ORS 731.240 is amended to read:
731.240. (1) The Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + } shall hold a hearing upon written demand for a
hearing by a person aggrieved by any act, threatened act or
failure of the director to act. The demand must state the grounds
therefor.
(2) To the extent applicable and not inconsistent with
subsection (1) of this section, the provisions of ORS chapter 183
shall govern the hearing procedure and any judicial review
thereof.
SECTION 267. ORS 731.244 is amended to read:
731.244. In accordance with the applicable provisions of ORS
chapter 183, the Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } may make reasonable rules necessary for or as an
aid to the effectuation of the Insurance Code. No such rule shall
extend, modify or conflict with the Insurance Code or the
reasonable implications thereof.
SECTION 268. ORS 731.248 is amended to read:
731.248. (1) Orders of the Director of the Department of
Consumer and Business Services { + and the Director of the
Oregon Health Authority + } shall be effective only when in
writing and signed by the director or by the authority of the
director. Orders shall be filed in the Department of Consumer and
Business Services { + and the Oregon Health Authority + }.
(2) Every such order shall state:
(a) Its effective date;
(b) Its intent or purpose;
(c) The grounds on which based; and
(d) The provisions of the Insurance Code pursuant to which
action is taken or proposed to be taken.
(3) Except as may be provided in the Insurance Code respecting
particular procedures, an order or notice may be given by
delivery to the person to be ordered or notified or by mailing it
by certified or registered mail, return receipt requested,
postage prepaid, addressed to the person at the residence or
principal place of business of the person as last of record in
the department. Notice so mailed shall be deemed to have been
given when deposited in a letter depository of a United States
post office.
SECTION 269. ORS 731.252 is amended to read:
731.252. (1) Whenever the Director of the Department of
Consumer and Business Services { + or the Director of the Oregon
Health Authority + } has reason to believe that any person has
been engaged or is engaging or is about to engage in any
violation of the Insurance Code, the director may issue an order,
directed to such person, to discontinue or desist from such
violation or threatened violation. The copy of the order
forwarded to the person involved shall set forth a statement of
the specific charges and the fact that the person may request a
hearing within 20 days of the date of mailing. Where a hearing is
requested, the director shall set a date for the hearing to be
held within 30 days after receipt of the request, and shall give
the person involved written notice of the hearing date at least
seven days prior thereto. The person requesting the hearing must
establish to the satisfaction of the director that such order
should not be complied with. The order shall become final 20 days
after the date of mailing unless within such 20-day period the
person to whom it is directed files with the director a written
request for a hearing. To the extent applicable and not
inconsistent with the foregoing, the provisions of ORS chapter
183 shall govern the hearing procedure and any judicial review
thereof. Where the hearing has been requested, the director's
order shall become final at such time as the right to further
hearing or review has expired or been exhausted.
(2) No order of the director under this section or order of a
court to enforce the same shall in any way relieve or absolve any
person affected by such order from any liability under any other
laws of this state.
(3) The powers vested in the director pursuant to this section
are supplementary and not in lieu of any other powers to suspend
or revoke certificates of authority or licenses or to enforce any
penalties, fines or forfeitures, authorized by law with respect
to any violation for which an order of discontinuance has been
issued.
SECTION 270. ORS 731.256 is amended to read:
731.256. (1) The Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + } may institute such actions or other lawful
proceedings as the director may deem necessary for the
enforcement of any provision of the Insurance Code or any order
or action made or taken by the director in pursuance of law.
(2) If the director has reason to believe that any person has
violated any provision of the Insurance Code or other law
applicable to insurance operations, for which criminal
prosecution is provided and in the opinion of the director would
be in order, the director shall give the information relative
thereto to the Attorney General or district attorney having
jurisdiction of any such violation. The Attorney General or
district attorney promptly shall institute such action or
proceedings against such person as the information requires or
justifies.
SECTION 271. ORS 731.258 is amended to read:
731.258. (1) The Attorney General { + , + } upon request of the
Director of the Department of Consumer and Business Services
{ + or the Director of the Oregon Health Authority, + } may
proceed in the courts of this state or any reciprocal state to
enforce an order or decision in any court proceeding or in any
administrative proceeding before the director.
(2) As used in this section:
(a) 'Reciprocal state' means any state the laws of which
contain procedures substantially similar to those specified in
this section for the enforcement of decrees or orders in equity
issued by courts located in other states, against any insurer
incorporated or authorized to do business in such state.
(b) 'Foreign decree' means any decree or order in equity of a
court located in a reciprocal state, including a court of the
United States located therein, against any insurer incorporated
or authorized to do business in this state.
(c) 'Qualified party' means a state regulatory agency acting in
its capacity to enforce the insurance laws of its state.
(3) The Director of the Department of Consumer and Business
Services of this state { + or the Director of the Oregon Health
Authority + } shall determine which states qualify as reciprocal
states and shall maintain at all times an up-to-date list of such
states.
(4) A copy of any foreign decree authenticated in accordance
with the statutes of this state may be filed in the office of the
clerk of any circuit court of this state. The clerk, upon
verifying with the director that the decree or order qualifies as
a foreign decree shall treat the foreign decree in the same
manner as a judgment of a circuit court of this state. A foreign
decree so filed has the same effect and shall be deemed as a
judgment of a circuit court of this state, and is subject to the
same procedures, defenses and proceedings for reopening,
vacating, or staying as a judgment of a circuit court of this
state and may be enforced or satisfied in like manner.
(5)(a) At the time of the filing of the foreign decree, the
Attorney General shall make and file with the clerk of the court
an affidavit setting forth the name and last-known post-office
address of the defendant.
(b) Promptly upon the filing of the foreign decree and the
affidavit, the clerk shall mail notice of the filing of the
foreign decree to the defendant at the address given and to the
director of this state and shall make a note of the mailing in
the register of the court. In addition, the Attorney General may
mail a notice of the filing of the foreign decree to the
defendant and to the director of this state and may file proof of
mailing with the clerk. Lack of mailing notice of filing by the
clerk shall not affect the enforcement proceedings if proof of
mailing by the Attorney General has been filed.
(c) No execution or other process for enforcement of a foreign
decree filed under subsection (4) of this section shall issue
until 30 days after the date the decree is filed.
(6)(a) If the defendant shows the circuit court that an appeal
from the foreign decree is pending or will be taken, or that a
stay of execution has been granted, the court shall stay
enforcement of the foreign decree until the appeal is concluded,
the time for appeal expires, or the stay of execution expires or
is vacated, upon proof that the defendant has furnished the
security for the satisfaction of the decree required by the state
in which it was rendered.
(b) If the defendant shows the circuit court any ground upon
which enforcement of a judgment of any circuit court of this
state would be stayed, the court shall stay enforcement of the
foreign decree for an appropriate period, upon requiring the same
security for satisfaction of the decree which is required in this
state for a judgment.
SECTION 272. ORS 731.260 is amended to read:
731.260. No person shall file or cause to be filed with the
Director of the Department of Consumer and Business Services
{ + or the Director of the Oregon Health Authority + } any
article, certificate, report, statement, application or any other
information required or permitted to be so filed under the
Insurance Code and known to such person to be false or misleading
in any material respect.
SECTION 273. ORS 731.264 is amended to read:
731.264. (1) A complaint made to the Director of the Department
of Consumer and Business Services { + or the Director of the
Oregon Health Authority + } against any person regulated by the
Insurance Code, and the record thereof, shall be confidential and
may not be disclosed except as provided in ORS 705.137. No such
complaint, or the record thereof, shall be used in any action,
suit or proceeding except to the extent considered necessary by
the director in the prosecution of apparent violations of the
Insurance Code or other law.
(2) Data gathered pursuant to an investigation by the director
of a complaint shall be confidential, may not be disclosed except
as provided in ORS 705.137 and may not be used in any action,
suit or proceeding except to the extent considered necessary by
the director in the investigation or prosecution of apparent
violations of the Insurance Code or other law.
(3) Notwithstanding subsections (1) and (2) of this section,
the director shall establish by rule a method for publishing an
annual statistical report containing the insurer's name and the
number, percentage, type and disposition of complaints received
by the Department of Consumer and Business Services { + and the
Oregon Health Authority + } against each insurer transacting
insurance within this state.
SECTION 274. ORS 731.268 is amended to read:
731.268. (1) Photographs or microphotographs in the form of
film or prints of documents and records made by the Director of
the Department of Consumer and Business Services { + or the
Director of the Oregon Health Authority + } for the files of the
director shall have the same force and effect as the originals
thereof, and duly certified or authenticated reproductions of
such photographs or microphotographs shall be as admissible in
evidence as are the originals.
(2) Upon request of any person and payment of the applicable
fee, the director shall furnish a certified copy of any record in
the office of the director which is then subject to public
inspection.
(3) Copies of original records or documents in the office of
the director certified by the director shall have the same force
and effect and be received in evidence in all courts equally and
in like manner as if they were originals.
SECTION 275. ORS 731.272 is amended to read:
731.272. (1) The { - Director of the Department of Consumer
and Business Services - } { + regulator + }shall prepare
annually, as soon after March 1 as is consistent with full and
accurate preparation, a report of the official transactions of
the director under the Insurance Code. The report shall include:
(a) In condensed form statements made to the director by every
insurer authorized to do business in this state.
(b) A statement of all insurers authorized to do business in
this state as of the date of the report.
(c) A list of insurers whose business in this state was
terminated and the reason for the termination. If the termination
was a result of liquidation or delinquency proceedings brought
against the insurer in this or any other state, the report shall
include the amount of the insurer's assets and liabilities so far
as those amounts are known to the director.
(d) A statement of the operating expenses of the
{ - Department of Consumer and Business Services - }
{ + regulator + } under the Insurance Code, including salaries,
transportation, communication, printing, office supplies, fixed
charges and miscellaneous expenses.
(e) A detailed statement of the moneys, fees and taxes received
by the department under the Insurance Code and from what source.
(f) Any other pertinent information and matters as the director
considers to be in the public interest.
(2) The director shall give notice of the publication of the
report to:
(a) The office of the Speaker of the House of Representatives;
(b) The office of the President of the Senate; and
(c) The chair or cochairs of the Joint Legislative Committee on
Ways and Means if the Legislative Assembly is in session or of
the Emergency Board if during the interim.
SECTION 276. ORS 731.276 is amended to read:
731.276. The Director of the Department of Consumer and
Business Services shall { + work with the Director of the Oregon
Health Authority to + } continuously review the Insurance Code
and may, from time to time, make recommendations for changes
therein.
SECTION 277. ORS 731.280 is amended to read:
731.280. The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall { + work together to + } publish:
(1) Pamphlet or booklet copies of the insurance laws of this
state;
(2) The director's annual report;
(3) Such copies of results of investigations or examinations of
insurers for public distribution as the director considers to be
in the public interest;
(4) Such compilations as the director considers advisable from
time to time of the general orders of the director then in force;
and
(5) Such other material as the director may compile and
consider relevant and suitable for the effective administration
of the Insurance Code.
SECTION 278. ORS 731.282 is amended to read:
731.282. The { - Director of the - } Department of Consumer
and Business Services { + and the Oregon Health Authority + }
may sell, at a price reasonably calculated to cover the costs of
preparation, any of the copies, compilations or materials
described in ORS 731.280.
SECTION 279. ORS 731.288 is amended to read:
731.288. The Department of Consumer and Business Services
{ + and the Oregon Health Authority + } shall record each
complaint the department receives, including the subsequent
disposition of the complaint. The record of a complaint shall be
maintained for a period of not less than seven years. The records
of complaints shall be indexed whenever applicable both by the
name of the insurer and by the name of the insurance producer
involved. The
{ - Director of the Department of Consumer and Business
Services - } { + department or authority + } shall consider such
complaints before issuing or continuing any certificate of
authority or license of an insurer or insurance producer named in
such complaints.
SECTION 280. ORS 731.296 is amended to read:
731.296. The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } may address any proper inquiries to any insurer,
licensee or its officers in relation to its activities or
condition or any other matter connected with its transactions.
Any such person so addressed shall promptly and truthfully reply
to such inquiries using the form of communication requested by
the director. The reply shall be verified by an officer of such
person, if the director so requires. A reply is subject to the
provisions of ORS 731.260.
SECTION 281. ORS 731.300 is amended to read:
731.300. (1) The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall examine every authorized insurer, including
an audit of the financial affairs of such insurer, as often as
the director determines an examination to be necessary but at
least once each five years. An examination shall be conducted for
the purpose of determining the financial condition of the
insurer, its ability to fulfill its obligations and its manner of
fulfillment, the nature of its operations and its compliance with
the Insurance Code. The director may also make such an
examination of any surplus lines insurance producer or any person
holding the capital stock of an authorized insurer or surplus
lines insurance producer for the purpose of controlling the
management thereof as a voting trustee or otherwise, or both.
(2) Instead of conducting an examination of an authorized
foreign or alien insurer, the director may accept an examination
report on the insurer that is prepared by the insurance
department for the state of domicile or state of entry of the
insurer if:
(a) At the time of the examination the insurance department of
the state was accredited under the Financial Regulation Standards
and Accreditation Program or successor program of the National
Association of Insurance Commissioners; or
(b) The examination was performed under the supervision of an
accredited insurance department or with the participation of one
or more examiners who are employed by such an accredited
insurance department and who, after a review of the examination
work papers and report, state under oath that the examination was
performed in a manner consistent with the standards and
procedures required by their insurance department.
(3) Examination of an alien insurer shall be limited to its
insurance transactions, assets, trust deposits and affairs in the
United States except as otherwise required by the director.
SECTION 282. ORS 731.302 is amended to read:
731.302. (1) When the Director of the Department of Consumer
and Business Services { + or the Director of the Oregon Health
Authority + } determines that an examination should be conducted,
the director shall appoint one or more examiners to perform the
examination and instruct them as to the scope of the examination.
In conducting the examination, each examiner shall consider the
guidelines and procedures in the examiner handbook, or its
successor publication, adopted by the National Association of
Insurance Commissioners. The director may prescribe the examiner
handbook or its successor publication and employ other guidelines
and procedures that the director determines to be appropriate.
(2) When making an examination, the director may retain
appraisers, independent actuaries, independent certified public
accountants or other professionals and specialists as needed. The
cost of retaining such professionals and specialists shall be
borne by the person that is the subject of the examination.
(3) At any time during the course of an examination, the
director may take other action pursuant to the Insurance Code.
(4) Facts determined and conclusions made pursuant to an
examination shall be presumptive evidence of the relevant facts
and conclusions in any judicial or administrative action.
SECTION 283. ORS 731.304 is amended to read:
731.304. The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + }, whenever the director deems it advisable in the
interest of policyholders or for the public good, shall
investigate into the affairs of any person engaged in, proposing
to engage in or claiming or advertising to engage in:
(1) Transacting insurance in this state;
(2) Organizing or receiving subscriptions for or disposing of
the stock of or in any manner taking part in the formation or
business of an insurer; or
(3) Holding capital stock of one or more insurers for the
purpose of controlling the management thereof as voting trustee
or otherwise.
SECTION 284. ORS 731.308 is amended to read:
731.308. (1) Upon an examination or investigation the Director
of the Department of Consumer and Business Services { + or the
Director of the Oregon Health Authority + } may examine under
oath all persons who may have material information regarding the
property or business of the person being examined or
investigated.
(2) Every person being examined or investigated shall produce
all books, records, accounts, papers, documents and computer and
other recordings in its possession or control relating to the
matter under examination or investigation, including, in the case
of an examination, the property, assets, business and affairs of
the person.
(3) With regard to an examination, the officers, directors and
agents of the person being examined shall provide timely,
convenient and free access at all reasonable hours at the offices
of the person being examined to all books, records, accounts,
papers, documents and computer and other recordings. The
officers, directors, employees and agents of the person must
facilitate the examination.
SECTION 285. ORS 731.312 is amended to read:
731.312. (1) Not later than the 60th day after completion of an
examination, the examiner in charge of the examination shall
submit to the Director of the Department of Consumer and Business
Services { + or the Director of the Oregon Health Authority + }
a full and true report of the examination, verified by the oath
of the examiner. The report shall comprise only facts appearing
upon the books, papers, records, accounts, documents or computer
and other recordings of the person, its agents or other persons
being examined or facts ascertained from testimony of individuals
concerning the affairs of such person, together with such
conclusions and recommendations as reasonably may be warranted
from such facts.
(2) The director shall make a copy of the report submitted
under subsection (1) of this section available to the person who
is the subject of the examination and shall give the person an
opportunity to review and comment on the report. The director may
request additional information or meet with the person for the
purpose of resolving questions or obtaining additional
information, and may direct the examiner to consider the
additional information for inclusion in the report.
(3) Before the director files the examination report as a final
examination report or makes the report or any matters relating
thereto public, the person being examined shall have an
opportunity for a hearing. A copy of the report must be mailed by
certified mail to the person being examined. The person may
request a hearing not later than the 30th day after the date on
which the report was mailed. This subsection does not limit the
authority of the director to disclose a preliminary or final
examination report as otherwise provided in this section.
(4) The director shall consider comments presented at a hearing
requested under subsection (3) of this section and may direct the
examiner to consider the comments or direct that the comments be
included in documentation relating to the report, although not as
part of the report itself. The director may file the report as a
final examination report at any time after consideration of the
comments or at any time after the period for requesting a hearing
has passed if a hearing is not requested.
(5) A report filed as a final examination report is subject to
public inspection. The director, after filing any report, if the
director considers it for the interest of the public to do so,
may publish any report or the result of any examination as
contained therein in one or more newspapers of the state without
expense to the person examined.
(6) All work papers, recorded information, documents and copies
thereof that are produced or obtained by or disclosed to the
director or any other person in the course of an examination or
in the course of analysis by the director of the financial
condition or market conduct of an insurer are confidential and
are exempt from public inspection as provided in ORS 705.137. If
the director, in the director's sole discretion, determines that
disclosure is necessary to protect the public interest, the
director may make available work papers, recorded information,
documents and copies thereof produced by, obtained by or
disclosed to the director or any other person in the course of
the examination.
(7) The director may disclose the content of an examination
report that has not yet otherwise been disclosed or may disclose
any of the materials described in subsection (6) of this section
as provided in ORS 705.137.
SECTION 286. ORS 731.314 is amended to read:
731.314. (1) No cause of action may arise and no liability may
be imposed against the Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + }, an authorized representative of the director or
any examiner appointed by the director for any statements made or
conduct performed in good faith pursuant to an examination or
investigation.
(2) No cause of action may arise and no liability may be
imposed against any person for communicating or delivering
information or data to the director or an authorized
representative of the director or examiner pursuant to an
examination or investigation if the communication or delivery was
performed in good faith and without fraudulent intent or an
intent to deceive.
(3) This section does not abrogate or modify in any way any
common law or statutory privilege or immunity otherwise enjoyed
by any person to which subsection (1) or (2) of this section
applies.
(4) The court may award reasonable attorney fees to the
prevailing party in a cause of action arising out of activities
of the director or an examiner in carrying out an examination or
investigation.
SECTION 287. ORS 731.316 is amended to read:
731.316. Any person examined under ORS 731.300 shall pay to the
Director of the Department of Consumer and Business Services
{ + and the Director of the Oregon Health Authority + } the
just and legitimate costs of the examination as determined by the
director, including actual necessary transportation and traveling
expenses.
SECTION 288. ORS 731.324 is amended to read:
731.324. (1) Any act set forth in ORS 731.146 by an
unauthorized insurer is equivalent to and shall constitute an
irrevocable appointment by such insurer, binding upon the
insurer, the executor of the insurer or administrator, or
successor in interest if a corporation, of the Secretary of State
or the successor in office, to be the true and lawful attorney of
such insurer. All lawful process in any action in any court by
the Director of the Department of Consumer and Business
Services { + , the Director of the Oregon Health Authority + } or
by the state and any notice, order, pleading or process in any
proceeding before the director which arises out of transacting
insurance in this state by such insurer may be served upon the
Secretary of State or the successor in office. Transacting
insurance in this state by an unauthorized insurer shall be
signification of its agreement that lawful process in a court
action and any notice, order, pleading, or process in an
administrative proceeding before the director so served shall be
of the same legal force and validity as personal service of
process in this state upon such insurer.
(2) Service of process in such action shall be made by
delivering to and leaving with the Secretary of State, or one of
the assistants, two copies of the document served and by payment
to the Secretary of State of the fee prescribed by law. Service
upon the Secretary of State shall be service upon the principal.
(3) The Secretary of State shall forward by certified mail one
of the copies of such process or such notice, order, pleading, or
process in proceedings before the director to the defendant in
such court proceeding or to whom the notice, order, pleading, or
process in such administrative proceeding is addressed or
directed at its last-known principal place of business and shall
keep a record of all process so served on the defendant. Such
record shall show the day and hour of service. Service is
sufficient, provided:
(a) Notice of service and a copy of the court process or the
notice, order, pleading, or process in the administrative
proceeding are sent within 10 days thereafter by certified mail
by the plaintiff or the plaintiff's attorney in the court
proceeding or by the director in the administrative proceeding to
the defendant at the last-known principal place of business of
the defendant.
(b) The defendant's receipt or receipts issued by the post
office with which the letter is certified or registered, showing
the name of the sender of the letter and the name and address of
the person or insurer to whom the letter is addressed, and an
affidavit of the plaintiff or the plaintiff's attorney in court
proceeding or of the director in administrative proceeding,
showing compliance therewith are filed with the clerk of the
court in which such action is pending or with the director in
administrative proceedings, on or before the date the defendant
in the court or administrative proceeding is required to appear
or respond thereto, or within such further time as the court or
director may allow.
(4) No plaintiff shall be entitled to a judgment or a
determination by default in any court or administrative
proceeding in which court process or notice, order, pleading, or
process in proceedings before the director is served under this
section until the expiration of 45 days after the date of filing
of the affidavit of compliance.
(5) Nothing in this section shall limit or affect the right to
serve any process, notice, order, or demand upon any person or
insurer in any other manner now or hereafter permitted by law.
SECTION 289. ORS 731.328 is amended to read:
731.328. (1) Before an unauthorized insurer files or causes to
be filed any pleading in any court action or any notice, order,
pleading, or process in an administrative proceeding before the
Director of the Department of Consumer and Business Services
{ + or the Director of the Oregon Health Authority + }
instituted against such person or insurer, by services made as
provided in ORS 731.324, such insurer shall deposit with the
clerk of the court in which such action is pending, or with the
director in administrative proceedings before the director, cash
or securities. The insurer may also file with such clerk or
director a bond with good and sufficient sureties, to be approved
by the clerk or director, or an irrevocable letter of credit
issued by an insured institution, as defined in ORS 706.008, in
an amount to be fixed by the court or director sufficient to
secure the payment of any final judgment which may be rendered in
such action or administrative proceeding.
(2) The director, in any administrative proceeding in which
service is made as provided in ORS 731.324, may order such
postponement as may be necessary to afford the defendant
reasonable opportunity to comply with the provisions of
subsection (1) of this section and to defend such action.
(3) Nothing in subsection (1) of this section shall be
construed to prevent an unauthorized insurer from filing a motion
to quash a writ or to set aside service thereof made in the
manner provided in ORS 731.324.
SECTION 290. ORS 731.354 is amended to read:
731.354. No person shall act as an insurer and no insurer shall
directly or indirectly transact insurance in this state except as
authorized by a subsisting certificate of authority issued to the
insurer by the Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + }.
SECTION 291. ORS 731.356 is amended to read:
731.356. When the Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + } believes, from evidence satisfactory to the
director, that any insurer is violating or about to violate the
provisions of ORS 731.354, the director may cause a complaint to
be filed in the Circuit Court of Marion County to enjoin and
restrain such insurer from continuing such violation. The court
shall have jurisdiction of the proceeding and shall have the
power to make and enter an order or judgment awarding such
preliminary or final injunctive relief as in its judgment is
proper.
SECTION 292. ORS 731.362 is amended to read:
731.362. (1) A foreign or alien insurer may be authorized to
transact insurance in this state when it has complied with the
following requirements:
(a) It shall file with the { - Director of the Department of
Consumer and Business Services - } { + regulator + } a
certified copy of its charter, articles of incorporation or deed
of settlement and a statement of its financial condition and
business in all states in such form and detail as the
{ - director - } { + regulator + } may require, signed and
sworn to by at least two of its executive officers or the United
States manager.
(b) It shall satisfy the { - director - } { + regulator + }
that it is fully and legally organized under the laws of its
state or government to do the business it proposes to transact.
(c) It shall satisfy the { - director - } { + regulator + }
that it is possessed of and will maintain at all times its
required capitalization.
(d) It shall make such deposits with the { - Department of
Consumer and Business Services - } { + regulator + } as are
required by the provisions of the Insurance Code.
(2) Upon compliance with the requirements of this section and
all other requirements imposed on such insurer by the Insurance
Code, the director shall issue to it a certificate of authority.
SECTION 293. ORS 731.363 is amended to read:
731.363. (1) An authorized foreign insurer may become a
domestic insurer:
(a) By complying with all of the requirements of law relating
to the organization and authorization of a domestic insurer of
the same type;
(b) By filing articles of incorporation that are amended to
comply with all of the requirements of law relating to the
organization and authorization of a domestic insurer of the same
type; and
(c) By designating its principal place of business at a place
in this state.
(2) If the Director of the Department of Consumer and Business
Services { + or the Director of the Oregon Health Authority + }
determines that an authorized foreign insurer has complied with
the requirements of subsection (1) of this section, the insurer
is entitled to a certificate of authority to transact insurance
in this state and shall be subject as a domestic insurer to the
authority and jurisdiction of this state.
SECTION 294. ORS 731.364 is amended to read:
731.364. A domestic insurer, upon the approval of the
{ - Director of the Department of Consumer and Business
Services - } { + regulator + }, may transfer its domicile to any
other state in which it is admitted to transact the business of
insurance. Upon such a transfer the insurer ceases to be a
domestic insurer and may be authorized in this state if qualified
as a foreign insurer. The
{ - director - } { + regulator + } shall approve such a
proposed transfer unless the { - director - } { +
regulator + } determines that the transfer is not in the interest
of the policyholders of this state.
SECTION 295. ORS 731.365 is amended to read:
731.365. (1) The certificate of authority, insurance producer
appointments and licenses, rates and other items allowed by the
{ - Director of the Department of Consumer and Business
Services - } { + regulator + } pursuant to the discretion of the
{ - director - } { + regulator + } that are in existence at
the time an authorized insurer transfers its domicile to this or
any other state as provided in ORS 731.363 or 731.367 or by
merger, consolidation or any other lawful method shall continue
in full force and effect upon the transfer if the insurer remains
authorized to transact insurance in this state.
(2) All outstanding policies of a transferring insurer shall
remain in full force and effect and need not be indorsed as to
the new name of the insurer or its new location unless so ordered
by the { - director - } { + regulator + }. A transferring
insurer shall file new policy forms with the { - director - }
{ + regulator + } on or before the effective date of the
transfer but may use existing policy forms with appropriate
indorsements if allowed by the { - director - }
{ + regulator + }, according to any conditions established by
the
{ - director - } { + regulator + }.
(3) Each transferring insurer shall notify the
{ - director - } { + regulator + } of the details of the
proposed transfer and shall file promptly any resulting
amendments to corporate or other organizational documents filed
or required to be filed with the
{ - director - } { + regulator + }.
(4) This section applies to a domestic insurer that transfers
its domicile to another state and to an authorized foreign
insurer that transfers its domicile either to this state or to
another state.
SECTION 296. ORS 731.367 is amended to read:
731.367. An unincorporated authorized foreign insurer transfers
its domicile to this state when the { - Director of the
Department of Consumer and Business Services - } { +
regulator + } determines that it has complied with all of the
requirements of law relating to the organization and
authorization of a domestic insurer of the same type as provided
in ORS 731.363. No merger, consolidation or other method shall be
required to effect a transfer of the domicile of the
unincorporated insurer to this state and no vote or approval of
the policyholders, members or subscribers of the unincorporated
insurer shall be required. Any agreement of indemnity,
appointment or governance or any similar agreement shall continue
in full force after the transfer if the unincorporated insurer
remains an authorized insurer. The laws of this state, however,
shall govern all such agreements regardless of any other law to
the contrary, and such agreements shall be considered to be
modified to reflect that this state is the principal place of
business and domicile of the unincorporated insurer.
SECTION 297. ORS 731.369 is amended to read:
731.369. (1) A reciprocal insurer, through its attorney, shall
file with the { - Director of the Department of Consumer and
Business Services - } { + regulator + } a declaration, verified
by the oath of such attorney, setting forth:
(a) The name or title of the reciprocal insurer.
(b) The location of the principal office of the reciprocal
insurer.
(c) The class or classes of insurance to be effected or
exchanged.
(d) A copy of the form of power of attorney or instrument under
which such insurance is to be effected or exchanged.
(e) A copy of the policy under or by which such contracts of
insurance are effected or exchanged among the subscribers.
(f) That applications have been made for insurance in the
amounts required by subsection (2) of this section, and that such
applications will be concurrently effective when the reciprocal
insurer is authorized to commence business by the
{ - director - } { + regulator + }.
(g) If a foreign or alien reciprocal insurer, that there has
been deposited and shall be maintained at all times with the
State Treasurer or other proper official of the state in which
the insurer is domiciled $50,000 in cash or securities, as a
general deposit for the benefit of subscribers wherever located.
Where the laws of the home state do not provide for the
acceptance of such a deposit, the deposit may be made with a bank
or trust company in escrow subject to the control of the
insurance commissioner of the home state, and such deposit shall
be released only upon the written order of such insurance
commissioner. A certification from the insurance director or
other proper state official of the state in which the reciprocal
insurer is domiciled shall be attached to the application for the
certificate of authority.
(2) The reciprocal insurer must have bona fide applications for
insurance aggregating not less than $3 million upon at least 200
risks, except in the case of wet marine hull insurance written by
a domestic reciprocal insurer for persons whose earned income, in
whole or in part, is derived from taking and selling food
resources living in an ocean, bay or river, the applications must
cover at least 25 hulls and the insurance must aggregate at least
$125,000.
(3) The applicant shall furnish any other relevant information
required by the { - director - } { + regulator + }, except no
reciprocal insurer shall be required to furnish or file the names
or addresses of its policyholders or subscribers.
SECTION 298. ORS 731.370 is amended to read:
731.370. (1) The application for a certificate of authority
shall be accompanied by a sworn statement of a reciprocal insurer
showing the financial condition of the insurer as of December 31
immediately preceding. The Director of the Department of Consumer
and Business Services { + or the Director of the Oregon Health
Authority + } may require a supplemental statement to be
furnished as of a later date.
(2) Concurrently with the filing of the declaration provided
for by the terms of ORS 731.369, the attorney shall file with the
director an instrument in writing executed for the subscribers
conditioned that upon the issuance of certificate of authority,
action may be brought in the county in which the property insured
thereunder is situated or where the injured person resides, and
service of process may be had as provided in ORS 731.434 in all
actions in this state arising out of policies issued by the
reciprocal insurer, which service shall be valid and binding upon
all subscribers exchanging at any time reciprocal or
interinsurance contracts through such attorney. Actions may be
brought against or defended in the name of the reciprocal insurer
adopted by the subscribers.
SECTION 299. ORS 731.380 is amended to read:
731.380. (1) Subject to subsection (2) of this section, any
foreign or alien insurer, without being authorized to transact
business in this state, may take, acquire, hold and enforce notes
secured by real estate mortgages or trust deeds and make
commitments to purchase such notes. A foreign or alien insurer
may foreclose the mortgages and trust deeds in the courts of this
state, acquire the mortgaged property, hold, own and operate the
property for a period not exceeding five years and dispose of the
property. The activities authorized under this subsection by such
a foreign or alien insurer shall not constitute transacting
business in this state for the purposes of ORS chapter 60.
(2) Before a foreign or alien insurer engages in any of the
activities described in subsection (1) of this section, the
foreign or alien insurer shall first file with the
{ - Department of Consumer and Business Services - } { +
regulator + } a statement signed by its president, secretary,
treasurer or general manager that it constitutes the director of
the { - Department of Consumer and Business Services - } { +
regulator + } its attorney for service of process, and shall pay
an initial filing fee of $200 and an annual license fee of $200.
The statement shall include the address of the principal place of
business of the foreign or alien insurer.
(3) The director, upon receiving service of process as
authorized by subsection (2) of this section, immediately shall
forward by registered mail or by certified mail with return
receipt all documents served upon the director to the principal
place of business of the foreign or alien insurer.
(4) A foreign or alien insurer that indirectly engages in the
activities described in subsection (1) of this section because of
its beneficial interest in a pool of notes secured by real estate
mortgages or trust deeds need not comply with subsection (2) of
this section.
SECTION 300. ORS 731.385 is amended to read:
731.385. (1) The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall establish standards by rule for determining
whether the continued operation of an authorized insurer may be
hazardous to the policyholders or to the insurance-buying public
generally, for the purpose of carrying out ORS chapter 734 and
other provisions of the Insurance Code that authorize the
director to take action against such an insurer. If the director
makes such a determination, the director may order the insurer to
take one or more of the following actions:
(a) Reduce the total amount of present and potential liability
for policy benefits by reinsurance.
(b) Reduce, suspend or limit the volume of business being
accepted or renewed.
(c) Reduce general insurance and commission expenses by methods
specified by the director.
(d) Increase the capital and surplus of the insurer.
(e) Suspend or limit the declaration and payment of dividends
by the insurer to its stockholders or to its policyholders.
(f) Limit or withdraw from certain investments or discontinue
certain investment practices to the extent the director
determines such action to be necessary.
(2) The director may exercise authority under subsection (1) of
this section in addition to or instead of any other authority
that the director may exercise under the Insurance Code.
(3) The director may issue an order under this section with or
without a hearing. An insurer subject to an order issued without
a hearing may file a written request for a hearing to review the
order. Such a request shall not stay the effect of the order. The
hearing shall be held within 30 days after the filing of the
request. The director shall complete the review within 30 days
after the record for the hearing is closed, and shall discontinue
the action taken under subsection (1) of this section if the
director determines that none of the conditions giving rise to
the action exists.
SECTION 301. ORS 731.386 is amended to read:
731.386. The Director of the Department of Consumer and
Business Services { - shall - } { + and the Director of the
Oregon Health Authority may + } not grant or continue authority
to transact insurance in this state for any insurer:
(1) The management of which is found by the director to be
untrustworthy or so lacking in insurance experience as to make
the proposed operation or the continued operation hazardous to
the insurance-buying public; or
(2) That the director has good reason to believe is affiliated
directly or indirectly through ownership, control, reinsurance
transactions or other insurance or business relations, with any
person whose business operations are or have been marked to the
detriment of policyholders, stockholders, investors, creditors or
the public, by manipulation or dissipation of assets,
manipulation of accounts or reinsurance, or by similar injurious
actions.
SECTION 302. ORS 731.398 is amended to read:
731.398. The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } at any time may amend an insurer's certificate of
authority to accord with lawful changes in the insurer's charter
or insuring powers.
SECTION 303. ORS 731.402 is amended to read:
731.402. (1) The Director of the Department of Consumer and
Business Services { + and the Director of the Oregon Health
Authority + } shall issue to an insurer a certificate of
authority if upon completion of the application for a certificate
of authority by the insurer the director finds, from the
application and such other investigation and information the
director may acquire, that the insurer is fully qualified and
entitled thereto under the Insurance Code.
(2) The director shall take all necessary action and shall
either issue or refuse to issue a certificate of authority within
a reasonable time after the completion of the application for
such authority.
(3) The certificate of authority, if issued, shall specify the
class or classes of insurance the insurer is authorized to
transact in this state. The director may issue authority limited
to particular subclasses of insurance or types of insurance
coverages within the scope of a class of insurance.
SECTION 304. ORS 731.406 is amended to read:
731.406. (1) An insurer's subsisting certificate of authority
is evidence of its authority to transact in this state the class
or classes of insurance specified therein, either as direct
insurer or as reinsurer or as both.
(2) Although issued to the insurer the certificate of authority
is at all times the property of this state. Upon any suspension,
revocation or termination thereof the insurer promptly shall
deliver the certificate of authority to the { - Director of the
Department of Consumer and Business Services. - } { +
regulator. + }
SECTION 305. ORS 731.410 is amended to read:
731.410. (1) A certificate of authority shall continue in force
as long as the insurer is entitled thereto under the Insurance
Code and until suspended or revoked by the Director of the
Department of Consumer and Business Services { + or the Director
of the Oregon Health Authority + }, or terminated at the request
of the insurer; subject, however, to continuance of the
certificate by the insurer each year by:
(a) Payment prior to April 1 of the continuation fee
established by the director;
(b) Due filing by the insurer of its annual statement for the
calendar year preceding;
(c) Due filing by the insurer of each annual statement
supplement; and
(d) Payment by the insurer of premium taxes with respect to the
preceding calendar year as required by ORS 731.808 to 731.828.
(2) A certificate of authority that is not continued by the
insurer under subsection (1) of this section expires on the 60th
day after the date on which the payment or filing is due.
(3) The director promptly shall notify the insurer of impending
expiration of its certificate of authority.
(4) The director, in the discretion of the director, upon the
insurer's request made not later than the 90th day after
expiration, may reinstate a certificate of authority which the
insurer has permitted to expire, after the insurer has cured all
its failures which resulted in the expiration and has paid the
fee for reinstatement established by the director. Otherwise the
insurer shall be granted another certificate of authority only
after filing application therefor and meeting all other
requirements as for an original certificate of authority in this
state.
SECTION 306. ORS 731.414 is amended to read:
731.414. (1) The Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + } shall refuse to continue, or shall suspend or
revoke, an insurer's certificate of authority if:
(a) As a foreign insurer, it no longer meets the requirements
for the authority; or as a domestic insurer, it has failed to
cure an impairment of required capitalization within the time
allowed therefor by the director under ORS 732.230;
(b) The insurer knowingly exceeds its charter powers or powers
granted under its certificate of authority; or
(c) As a foreign or alien insurer, its certificate of authority
to transact insurance is suspended or revoked by its domicile.
(2) Except in cases of impairment of required capitalization or
suspension or revocation by another domicile as referred to in
subsection (1)(c) of this section, the director shall refuse,
suspend or revoke the certificate of authority only after a
hearing granted to the insurer, unless the insurer waives such
hearing in writing.
SECTION 307. ORS 731.418 is amended to read:
731.418. (1) The Director of the Department of Consumer and
Business Services { + or the Director of the Oregon Health
Authority + } may refuse to continue or may suspend or revoke an
insurer's certificate of authority if the director finds after a
hearing that:
(a) The insurer has violated or failed to comply with any
lawful order of the director, or any provision of the Insurance
Code other than those for which suspension or revocation is
mandatory.
(b) The insurer is in unsound condition, or in such condition
or using such methods and practices in the conduct of its
business, as to render its further transaction of insurance in
this state hazardous or injurious to its policyholders or to the
public.
(c) The insurer has failed, after written request by the
director, to remove or discharge an officer or director who has
been convicted in any jurisdiction of an offense which, if
committed in this state, constitutes a misdemeanor involving
moral turpitude or a felony, or is punishable by death or
imprisonment under the laws of the United States, in any of which
cases the record of the conviction shall be conclusive evidence.
(d) The insurer is affiliated with and under the same general
management, interlocking directorate or ownership as another
insurer that transacts direct insurance in this state without
having a certificate of authority therefor, except as permitted
under the Insurance Code.
(e) The insurer or an affiliate or holding company of the
insurer refuses to be examined or any director, officer, employee
or representative of the insurer, affiliate or holding company
refuses to submit to examination relative to the affairs of the
insurer, or to produce its accounts, records, and files for
examination when required by the director or an examiner of the
Department of Consumer and Business Services, or refuse to
perform any legal obligation relative to the examination.
(f) The insurer has failed to pay any final judgment rendered
against it in this state upon any policy, bond, recognizance or
undertaking issued or guaranteed by it, within 30 days after the
judgment became final, or within 30 days after time for taking an
appeal has expired, or within 30 days after dismissal of an
appeal before final determination, whichever date is the later.
(g) The insurer fails to comply with ORS 742.534 (1).
(h) The insurer has failed to comply with ORS 476.270 (1), (2)
or (3) or 654.097 (1).
(2) Without advance notice or a hearing thereon, the director
may suspend immediately the certificate of authority of any
insurer as to which proceedings for receivership,
conservatorship, rehabilitation, or other delinquency
proceedings, have been commenced in any state by the public
insurance supervisory official of such state.
SECTION 308. ORS 731.422 is amended to read:
731.422. (1) All suspensions or revocations of, or refusals to
continue, an insurer's certificate of authority shall be by order
of the Director of the Department of Consumer and Business
Services { + or the Director of the Oregon Health Authority + }
order.
(2) Upon suspending, revoking or refusing to continue the
insurer's certificate of authority, the director forthwith shall
give notice thereof to the insurer's insurance producers in this
state of record in the Department of Consumer and Business
Services, and likewise shall suspend or revoke the authority of
such insurance producers to represent the insurer. The director
also shall give notice to the insurance supervisory authority in
jurisdictions in which the insurer is authorized, if a domestic
insurer, or in its domicile if a foreign or alien insurer.
(3) In the discretion of the director, the director may publish
notice of such suspension, revocation or refusal in one or more
newspapers of general circulation in this state.
SECTION 309. ORS 731.426 is amended to read:
731.426. (1) In an order suspending the certificate of
authority of an insurer, the { - Director of the Department of
Consumer and Business Services - } { + regulator + } may
provide that the suspension expires at the end of a specified
period or when the
{ - director - } { + regulator + } determines that the cause
or causes of the suspension have terminated. During the
suspension the { - director - } { + regulator + } may rescind
or shorten the suspension by further order.
(2) During the suspension period the insurer shall not solicit
or write any new business in this state, but shall file its
annual statement and pay fees, licenses and taxes as required
under the Insurance Code, and may service its business already in
force in this state, as if the certificate of authority had
continued in full force.
(3) Upon expiration of a specific suspension period, if within
such period the certificate of authority has not terminated, the
insurer's certificate of authority automatically shall reinstate
unless the { - director - } { + regulator + } finds that the
cause or causes of the suspension have not terminated, or that
the insurer is otherwise not in compliance with the requirements
of the Insurance Code, and of which the { - director - } { +
regulator + } shall give the insurer notice not less than 30 days
in advance of the expiration of the suspension period.
(4) When the { - director - } { + regulator + } determines
that a suspension should expire because the cause or causes have
terminated, the { - director - } { + regulator + } shall
reinstate the certificate of authority of the insurer unless the
certificate of authority has expired within the suspension
period.
(5) Upon reinstatement of the insurer's certificate of
authority, the authority of its insurance producers in this state
to represent the insurer shall likewise reinstate. The
{ - director - } { + regulator + } promptly shall notify the
insurer and its insurance producers in this state of record in
the Department of Consumer and Business Services, of such
reinstatement. If pursuant to ORS 731.422 the { - director - }
{ + regulator + } has published notice of suspension, in like
manner the { - director - } { + regulator + } shall publish
notice of the reinstatement.
SECTION 310. ORS 731.428 is amended to read:
731.428. (1) A person who is prohibited by 18 U.S.C. 1033 from
engaging or participating in the business of insurance because of
a conviction of a felony involving dishonesty or a breach of
trust or conviction of a crime under 18 U.S.C. 1033 may apply to
the { - Director of the Department of Consumer and Business
Services - } { + regulator + } for a written consent to engage
or participate in the business of insurance.
(2) The { - director - } { + regulator + } shall establish
by rule a procedure and standards by which the { - director - }
{ + regulator + } may issue a written consent to engage or
participate in the business of insurance to a person convicted of
a crime described in subsection (1) of this section.
(3) The { - director - } { + regulator + } shall not issue
a license under the Insurance Code to an applicant who has been
convicted of a crime referred to in subsection (1) of this
section unless the
{ - director - } { + regulator + } also issues a written
consent.
(4) If a person issued a license under the Insurance Code has
been convicted of a crime referred to in subsection (1) of this
section or is subsequently the subject of such a conviction, the
{ - director - } { + regulator + } shall revoke, suspend or
refuse to renew the license. The person may apply to the
{ - director - } { + regulator + } for a written consent as
provided in subsection (1) of this section.
SECTION 311. ORS 731.430 is amended to read:
731.430. (1) No insurer shall be formed or authorized to
transact insurance in this state which has or will have, or which
uses or will use as an assumed business name, a name or principal
identifying name factor:
(a) That is the same as or deceptively similar to:
(A) Any other insurer so formed or authorized;
(B) Any name reserved or registered as authorized by this
section;
(C) Any name on file with the Secretary of State pursuant to
ORS chapter 60, 65 or 648; or
(D) The name of any insurer that was authorized to transact
insurance in this state within the preceding 10 years if
insurance policies issued by such other insurer still are
outstanding in this state. With the consent of the insurer
issuing such policies, the { - Director of the Department of
Consumer and Business Services - } { + regulator + } may waive
this provision if the director { + of the regulator + } finds
that the waiver will not be detrimental to the public; or
(b) That is deceptive or misleading as to the type of
organization of the insurer or that does not indicate the insurer
is transacting insurance.
(2) Any insurer doing business in this state may file and
register with the director in writing, in its articles of
incorporation or otherwise, an assumed name that it will use in
transacting insurance in this state. Such name may not be a name
prohibited by subsection (1) of this section.
(3) Any person may reserve a name for use as a corporate name
or an assumed business name in transacting insurance in this
state by filing in writing with the director a reservation of
such name. Such name may not be a name prohibited by subsection
(1) of this section. Such reservation shall expire six months
after the date of filing unless:
(a) If filed by an insurer, it is using such name as an
authorized insurer; or
(b) If filed by a noninsurer, it has filed with the director a
formal application for a permit to form an insurer in this state.
If a valid reservation is on file, the director may accept the
filing of a same or deceptively similar name by another person
which filing shall become effective, in the order of filing, at
the expiration of the six-month provision unless the original
reservation does not expire pursuant to this subsection.
(4) When an insurer is merged as provided in the Insurance
Code, the surviving insurer may retain the use of the name for a
period of five years after the effective date of merger. If such
name is retained, use of the same or deceptively similar name by
other insurers shall be prohibited as specified under this
section during the five-year period.
SECTION 312. ORS 731.434 is amended to read:
731.434. (1) The provisions, procedures and requirements of ORS
chapter 60 relating to a registered office, registered agent and
to service of process, notice and demand shall govern all
insurers transacting insurance in this state, whether authorized
or unauthorized, except that the director of the { - Department
of Consumer and Business Services - } { + regulator + } shall
be substituted for the Secretary of State as the person with whom
all filings shall be made and upon whom, in the circumstances
specified by statute, such service may be effected.
(2) This section shall not apply to insurers for whom a
certificate of authority is not required under ORS 731.374.
SECTION 313. ORS 731.466 is amended to read:
731.466. (1) The rights and power of the attorney of a
reciprocal insurer shall be as provided in the power of attorney
given it by the subscribers.
(2) The power of attorney must set forth:
(a) The powers of the attorney.
(b) That the attorney may accept service of process on behalf
of the insurer.
(c) The services to be performed by the attorney in general.
(d) The maximum amount to be deducted from advance premiums or
deposits to be paid to the attorney.
(e) Except as to nonassessable policies, a provision for a
contingent several liability of each subscriber in a specified
amount not less than one nor more than 10 times the premium or
premium deposit stated in the policy.
(3) The power of attorney may:
(a) Provide for the right of substitution of the attorney and
revocation of the power of attorney and rights thereunder;
(b) Impose such restrictions upon the exercise of the power as
are agreed upon by the subscribers;
(c) Provide for the exercise of any right reserved to the
subscribers directly or through their advisory committee; and
(d) Contain other lawful provisions.
(4) The terms of any power of attorney or agreement collateral
thereto shall be reasonable and equitable, and no such power or
agreement or any amendment thereof, shall be used or be effective
in this state until approved by the Director of the Department of
Consumer and Business Services { + or the Director of the Oregon
Health Authority + }.
SECTION 314. ORS 731.470 is amended to read:
731.470. (1) Any instrument required to be verified by the oath
of the attorney for a reciprocal insurer may, in case of an
incorporated attorney, be verified by the oath of the president,
vice president, secretary or other executive officer of such
corporation.
(2) The certificate of authority of a reciprocal insurer shall
be issued to its attorney in the name of the insurer.
(3) The Director of the Department of Consumer and Business
Services { + or the Director of the Oregon Health Authority + }
may refuse, suspend or revoke the certificate of authority, in
addition to other grounds therefor, for failure of a reciprocal
insurer's attorney to comply with any provision of the Insurance
Code.
(4) The attorney for an authorized foreign or alien reciprocal
insurer shall not, by virtue of discharge of its duties as such
attorney with respect to the insurer's transactions in this
state, be thereby deemed to be doing business in this state
within the meaning of any laws of this state applying to foreign
persons.
SECTION 315. ORS 731.486 is amended to read:
731.486. (1) The exemption in ORS 731.146 (2)(b) does not apply
to an insurer that offers coverage under a group life insurance
policy in this state unless the Director of the Department of
Consumer and Business Services determines that the exemption
applies.
(2) The insurer shall submit evidence to the director that the
exemption applies. When a master policy for a policy of group
life insurance is delivered or issued for delivery outside this
state to trustees of a fund for two or more employers, for one or
more labor unions, for one or more employers and one or more
labor unions or for an association, the insurer shall also submit
evidence showing compliance with ORS 743.354.
(3) The director shall review the evidence submitted and may
request additional evidence as needed.
(4) An insurer shall submit to the director any changes in the
evidence submitted under subsection (2) of this section.
(5) The director may order an insurer to cease offering a
policy or coverage under a policy if the director determines that
the exemption under ORS 731.146 (2)(b) is no longer satisfied.
(6) Coverage under a master group life insurance policy
delivered or issued for delivery outside this state that does not
qualify for the exemption in ORS 731.146 (2)(b) may be offered in
this state if the director determines that the state in which the
policy was delivered or issued for delivery has requirements that
are substantially similar to those established under ORS 743.360
and that the policy satisfies those requirements.
(7) Coverage under a master group health insurance policy that
is delivered or issued for delivery outside this state to an
association or trust may be offered in this state if the Director
{ + of the Oregon Health Authority + } determines that the
association or trust meets applicable standards under ORS 743.522
(1)(b) or (c) or (2).
(8) This section does not apply to any master policy issued to
a multistate employer or labor union.
(9) The Director { + of the Department of Consumer and
Business Services and the Director of the Oregon Health
Authority + } may adopt rules to carry out this section.
SECTION 316. ORS 731.486, as amended by section 8, chapter 752,
Oregon Laws 2007, is amended to read:
731.486. (1) The exemption in ORS 731.146 (2)(b) does not apply
to an insurer that offers coverage under a group health insurance
policy or a group life insurance policy in this state unless the
director of the { - Department of Consumer and Business
Services - } { + regulator + } determines that the exemption
applies.
(2) The insurer shall submit evidence to the { - director - }
{ + regulator + } that the exemption applies. When a master
policy is delivered or issued for delivery outside this state to
trustees of a fund for two or more employers, for one or more
labor unions, for one or more employers and one or more labor
unions or for an association, the insurer shall also submit
evidence showing compliance with:
(a) ORS 743.526, for a policy of group health insurance; or
(b) ORS 743.354, for a policy of group life insurance.
(3) The { - director - } { + regulator + } shall review the
evidence submitted and may request additional evidence as needed.
(4) An insurer shall submit to the { - director - } { +
regulator + } any changes in the evidence submitted under
subsection (2) of this section.
(5) The { - director - } { + regulator + } may order an
insurer to cease offering a policy or coverage under a policy if
the { - director - } { + regulator + } determines that the
exemption under ORS 731.146 (2)(b) is no longer satisfied.
(6) Coverage under a master group life or health insurance
policy delivered or issued for delivery outside this state that
does not qualify for the exemption in ORS 731.146 (2)(b) may be
offered in this state if the { - director - } { +
regulator + } determines that the state in which the policy was
delivered or issued for delivery has requirements that are
substantially similar to those established under ORS 743.360 or
743.522 (2) and that the policy satisfies those requirements.
(7) This section does not apply to any master policy issued to
a multistate employer or labor union.
(8) The { - director - } { + regulator + } may adopt rules
to carry out this section.
SECTION 317. ORS 731.488 is amended to read:
731.488. (1) Each insurer shall have an annual audit conducted
by an independent certified public accountant and shall file an
audited financial report annually with the { - Director of the
Department of Consumer and Business Services - } { +
regulator + }. The annual audited financial report shall
disclose:
(a) The financial position of the insurer as of the end of the
most recent calendar year; and
(b) The results of the insurer's operations, cash flows and
changes in capital and surplus for the year then ended.
(2) The { - director - } { + regulator + } shall adopt
rules with respect to the following matters as needed for
carrying out the requirements of this section:
(a) Required contents and format of the audited financial
report.
(b) Requirements for filing the report.
(c) Requirements applicable to qualifications and designation
of certified public accountants for purposes of audits under this
section. The requirements may include limitations on length of
service for certified public accountants and may permit
recognition of accountants comparably qualified under the laws of
another country.
(d) Requirements applicable to evaluation of the accounting
procedures of an insurer and its system of internal control by a
certified public accountant.
(e) Standards governing the scope and preparation of the audit.
(f) Requirements and procedures relating to the reporting of
the adverse financial condition of an insurer by a certified
public accountant.
(g) Requirements and procedures relating to the reporting of
significant deficiencies for internal controls of an insurer.
(h) Exemptions.
(i) Any other matter that the { - director - } { +
regulator + } determines to be needed for preparation of or
inclusion in the financial report.
SECTION 318. ORS 731.504 is amended to read:
731.504. (1) No insurer shall retain any risk on any one
subject of insurance, whether a domestic risk or not, in an
amount exceeding 10 percent of its surplus to policyholders, or
in the case of title insurance, more than 50 percent of such
surplus, except that an insurance company, including a reciprocal
insurance company, comprised solely of 1,000 or more licensed
Oregon physicians organized for the purpose of insuring for
professional liability may consider aggregate insurance as
surplus to policyholders for purposes of this section and shall
not be allowed to retain the risk on any one subject of insurance
in excess of two and one-half percent of such aggregate
insurance.
(2) For purposes of this section, aggregate insurance is
insurance which provides coverage in the event that the total
fund of an insurance company, including a reciprocal insurance
company, which is available to pay claims for occurrences of any
one year, is exhausted. Aggregate insurance shall be in an amount
equal to at least five times the annual premium collected by the
insurance company.
(3) A 'subject of insurance' for the purposes of this section:
(a) As to insurance against fire and hazards other than
windstorm, earthquake and other catastrophic hazards, includes
all properties insured by the same insurer that customarily are
considered by underwriters to be subject to loss or damage from
the same fire or the same occurrence of any other hazard insured
against;
(b) As to group life and health insurance, refers individually
to each person benefited under the group policy as a separate
subject; and
(c) As to mortgage insurance, includes all obligations secured
by real property in a single tract, or in multiple tracts not
separated by at least one-half mile.
(4) Reinsurance ceded as authorized by ORS 731.508 shall be
deducted in determining risk retained. As to surety risks,
deduction also shall be made of the amount assumed by any
established incorporated cosurety and the value of any security
deposited, pledged, or held subject to the surety's consent and
for the surety's protection.
(5) As to alien insurers, this section relates only to risks
and surplus to policyholders of the insurer's United States
branch.
(6) As used in this section, 'surplus to policyholders,' in
addition to the insurer's capital and surplus, includes any
voluntary reserves that are not required pursuant to law,
includes the contingency reserve held for mortgage insurance as
required by ORS 733.100, and shall be determined from the last
sworn statement of the insurer on file with the { - Director of
the Department of Consumer and Business Services - }
{ + regulator + }, or by the last report of examination of the
insurer, whichever is the more recent at time of assumption of
risk.
(7) This section does not apply to wet marine and
transportation insurance or to any policy or type of coverage as
to which the maximum possible loss to the insurer is not readily
ascertainable on issuance of the policy.
SECTION 319. ORS 731.508 is amended to read:
731.508. (1) An insurer may accept reinsurance only of such
risks, and retain risk thereon within such limits, as it is
otherwise authorized to insure.
(2) Except as provided in ORS 731.512, 732.517 to 732.546 or
742.150 to 742.162, an insurer may reinsure risks with an insurer
authorized to transact such insurance in this state, or in any
other solvent insurer approved or accepted by the Director of the
Department of Consumer and Business Services { + or the Director
of the Oregon Health Authority + } for the purpose of such
reinsurance. The director shall not approve or accept any such
reinsurance by a ceding domestic insurer in an unauthorized
insurer which the director finds for good cause would be contrary
to the interests of the policyholders or stockholders of such
domestic insurer.
(3) Credit shall not be allowed, as an asset or as a deduction
from liability, to any ceding insurer for reinsurance unless the
reinsurance contract provides, in substance, that in the event of
the insolvency of the ceding insurer, the reinsurance shall be
payable under a contract or contracts reinsured by the assuming
insurer on the basis of reported claims allowed by the court
hearing the liquidation proceeding, without diminution because of
the insolvency of the ceding insurer. Such payments shall be made
directly to the ceding insurer or to its domiciliary liquidator
except:
(a) When the contract or other written agreement specifically
provides another payee of the reinsurance in the event of the
insolvency of the ceding insurer; or
(b) When the assuming insurer, with the consent of the direct
insured or insureds, has assumed the policy obligations of the
ceding insurer as direct obligations of the assuming insurer to
the payees under such policies and in substitution for the
obligations of the ceding insurer to such payees.
(4) For the purposes of subsection (3) of this section, the
reinsurance agreement may provide that the domiciliary liquidator
of an insolvent ceding insurer shall, within a reasonable time
after the claim is filed in the liquidation proceeding, give
written notice to the assuming insurer of the pendency of a claim
against the ceding insurer on the contract reinsured. During the
pendency of the claim, an assuming insurer may investigate the
claim and interpose, at its own expense, in the proceeding in
which the claim is to be adjudicated any defenses that the
assuming insurer determines to be available to the ceding insurer
or its liquidator. The expense may be filed as a claim against
the insolvent ceding insurer to the extent of a proportionate
share of the benefit that may accrue to the ceding insurer solely
as a result of the defense undertaken by the assuming insurer.
When two or more assuming insurers are involved in the same claim
and a majority in interest elect to interpose one or more
defenses to the claim, the expense shall be apportioned in
accordance with the terms of the reinsurance agreement as though
the expense had been incurred by the ceding insurer.
(5) The director may disallow credit that would otherwise be
allowed if the director determines that allowing credit would be
contrary to accurate financial reporting or proper financial
management, or may be hazardous to policyholders of the insurer
or the insurance-buying public generally. The director may make
such a determination only according to standards established by
the director by rule. This subsection applies only to insurers
who transact life insurance or health insurance, or both.
(6) Upon request of the director, a ceding insurer promptly
shall inform the director in writing of the cancellation or any
other material change of any of its reinsurance treaties or
arrangements.
(7) This section does not apply to wet marine and
transportation insurance.
SECTION 320. ORS 731.509 is amended to read:
731.509. (1) The purpose of ORS 731.509, 731.510, 731.511,
731.512 and 731.516 is to protect the interests of insureds,
claimants, ceding insurers, assuming insurers and the public
generally. The Legislative Assembly declares that its intent is
to ensure adequate regulation of insurers and reinsurers and
adequate protection for those to whom they owe obligations. In
furtherance of that state interest, the Legislative Assembly
mandates that upon the insolvency of an alien insurer or
reinsurer that provides security to fund its United States
obligations in accordance with ORS 731.509, 731.510, 731.511,
731.512 and 731.516, the assets representing the security shall
be maintained in the United States and claims shall be filed with
and valued by the state insurance commissioner with regulatory
oversight, and the assets shall be distributed in accordance with
the insurance laws of the state in which the trust is domiciled
that are applicable to the liquidation of domestic United States
insurers. The Legislative Assembly declares that the laws
contained in ORS 731.509, 731.510, 731.511, 731.512 and 731.516
are fundamental to the business of insurance in accordance with
15 U.S.C. 1011 and 1012.
(2) The Director of the Department of Consumer and Business
Services { - shall - } { + and the Director of the Oregon
Health Authority may + }not allow credit for reinsurance to a
domestic ceding insurer as either an asset or a reduction from
liability on account of reinsurance ceded unless credit is
allowed as provided under ORS 731.508 and unless the reinsurer
meets the requirements of:
(a) Subsection (3) of this section;
(b) Subsection (4) of this section;
(c) Subsections (5) and (8) of this section;
(d) Subsections (6) and (8) of this section; or
(e) Subsection (7) of this section.
(3) Credit shall be allowed when the reinsurance is ceded to an
authorized assuming insurer that accepts reinsurance of risks,
and retains risk thereon within such limits, as the assuming
insurer is otherwise authorized to insure in this state as
provided in ORS 731.508.
(4) Credit shall be allowed when the reinsurance is ceded to an
assuming insurer that is accredited as a reinsurer in this state
as provided in ORS 731.511. The director shall not allow credit
to a domestic ceding insurer if the accreditation of the assuming
insurer has been revoked by the director after notice and
opportunity for hearing.
(5) Credit shall be allowed when the reinsurance is ceded to a
foreign assuming insurer or a United States branch of an alien
assuming insurer meeting all of the following requirements:
(a) The foreign assuming insurer must be domiciled in a state
employing standards regarding credit for reinsurance that equal
or exceed the standards applicable under this section. The United
States branch of an alien assuming insurer must be entered
through a state employing such standards.
(b) The foreign assuming insurer or United States branch of an
alien assuming insurer must maintain a combined capital and
surplus in an amount not less than $20,000,000. The requirement
of this paragraph does not apply to reinsurance ceded and assumed
pursuant to pooling arrangements among insurers in the same
holding company system.
(c) The foreign assuming insurer or United States branch of an
alien assuming insurer must submit to the authority of the
director to examine its books and records.
(6) Credit shall be allowed when the reinsurance is ceded to an
assuming insurer that maintains a trust fund meeting the
requirements of this subsection and additionally complies with
other requirements of this subsection. The trust fund must be
maintained in a qualified United States financial institution, as
defined in ORS 731.510 (1), for the payment of the valid claims
of its United States policyholders and ceding insurers and their
assigns and successors in interest. The assuming insurer must
report annually to the director information substantially the
same as that required to be reported on the annual statement form
by ORS 731.574 by authorized insurers, in order to enable the
director to determine the sufficiency of the trust fund. The
following requirements apply to such a trust fund:
(a) In the case of a single assuming insurer, the trust fund
must consist of funds in trust in an amount not less than the
assuming insurer's liabilities attributable to reinsurance ceded
by United States ceding insurers. In addition, the assuming
insurer must maintain a trusteed surplus of not less than
$20,000,000.
(b) In the case of a group including incorporated and
individual unincorporated underwriters:
(A) For reinsurance ceded under reinsurance agreements with an
inception, amendment or renewal date on or after August 1, 1995,
the trust shall consist of a trusteed account in an amount not
less than the group's several liabilities attributable to
business ceded by United States domiciled ceding insurers to any
member of the group.
(B) For reinsurance ceded under reinsurance agreements with an
inception date on or before July 31, 1995, and not amended or
renewed after that date, notwithstanding the other provisions of
ORS 731.509, 731.510, 731.511, 731.512 and 731.516, the trust
shall consist of a trusteed account in an amount not less than
the group's several insurance and reinsurance liabilities
attributable to business written in the United States.
(C) In addition to the trusts described in subparagraphs (A)
and (B) of this paragraph, the group shall maintain in trust a
trusteed surplus of which $100,000,000 shall be held jointly for
the benefit of the United States domiciled ceding insurers of any
member of the group for all years of account.
(D) The incorporated members of the group shall not be engaged
in any business other than underwriting as a member of the group
and shall be subject to the same level of regulation and solvency
control by the group's domiciliary regulator as are the
unincorporated members.
(E) Within 90 days after the group's financial statements are
due to be filed with the group's domiciliary regulator, the group
shall provide to the director an annual certification by the
group's domiciliary regulator of the solvency of each underwriter
member or, if certification is unavailable, financial statements
of each underwriter member of the group prepared by independent
certified public accountants.
(c) In the case of a group of incorporated insurers described
in this paragraph, the trust must be in an amount equal to the
group's several liabilities attributable to business ceded by
United States ceding insurers to any member of the group pursuant
to reinsurance contracts issued in the name of the group. This
paragraph applies to a group of incorporated insurers under
common administration that complies with the annual reporting
requirements contained in this subsection and that has
continuously transacted an insurance business outside the United
States for at least three years immediately prior to making
application for accreditation. Such a group must have an
aggregate policyholders' surplus of $10,000,000,000 and must
submit to the authority of this state to examine its books and
records and bear the expense of the examination. The group shall
also maintain a joint trusteed surplus of which $100,000,000 must
be held jointly for the benefit of United States ceding insurers
of any member of the group as additional security for any such
liabilities. Each member of the group shall make available to the
director an annual certification of the member's solvency by the
member's domiciliary regulator and its independent certified
public accountant.
(d) The form of the trust and any amendment to the trust shall
have been approved by the insurance commissioner of the state in
which the trust is domiciled or by the insurance commissioner of
another state who, pursuant to the terms of the trust instrument,
has accepted principal regulatory oversight of the trust.
(e) The form of the trust and any trust amendments also shall
be filed with the insurance commissioner of every state in which
the ceding insurer beneficiaries of the trust are domiciled. The
trust instrument must provide that contested claims shall be
valid and enforceable upon the final order of any court of
competent jurisdiction in the United States. The trust must vest
legal title to its assets in its trustees for the benefit of the
assuming insurer's United States ceding insurers and their
assigns and successors in interest. The trust and the assuming
insurer are subject to examination as determined by the director.
The trust must remain in effect for as long as the assuming
insurer has outstanding obligations due under the reinsurance
agreements subject to the trust.
(f) Not later than March 1 of each year, the trustees of each
trust shall report to the director in writing the balance of the
trust and listing the trust's investments at the preceding year
end, and shall certify the date of termination of the trust, if
so planned, or certify that the trust will not expire prior to
the following December 31.
(7) Credit shall be allowed when the reinsurance is ceded to an
assuming insurer not meeting the requirements of subsection (3),
(4), (5) or (6) of this section, but only as to the insurance of
risks located in jurisdictions in which the reinsurance is
required by applicable law or regulation of that jurisdiction.
(8) If the assuming insurer is not authorized to transact
insurance in this state or accredited as a reinsurer in this
state, the director shall not allow the credit permitted by
subsections (5) and (6) of this section unless the assuming
insurer agrees in the reinsurance agreement to the provisions
stated in this subsection. This subsection is not intended to
conflict with or override the obligation of the parties to a
reinsurance agreement to arbitrate their disputes, if such an
obligation is created in the agreement. The assuming insurer must
agree in the reinsurance agreement:
(a) That in the event of the failure of the assuming insurer to
perform its obligations under the terms of the reinsurance
agreement, the assuming insurer, at the request of the ceding
insurer, shall submit to the jurisdiction of any court of
competent jurisdiction in any state of the United States, will
comply with all requirements necessary to give the court
jurisdiction and will abide by the final decision of the court or
of any appellate court in the event of an appeal; and
(b) To designate the director or a designated attorney as its
true and lawful attorney upon whom any lawful process in any
action, suit or proceeding instituted by or on behalf of the
ceding company may be served.
(9) If the assuming insurer does not meet the requirements of
subsection (3), (4) or (5) of this section, the credit permitted
by subsection (6) of this section shall not be allowed unless the
assuming insurer agrees in the trust agreements to the following
conditions:
(a) Notwithstanding any other provisions in the trust
instrument, if the trust fund is inadequate because it contains
an amount less than the applicable amount required by subsection
(6)(a), (b) or (c) of this section, or if the grantor of the
trust has been declared insolvent or placed into receivership,
rehabilitation, liquidation or similar proceedings under the laws
of the grantor's state or country of domicile, the trustee shall
comply with an order of the insurance commissioner with
regulatory oversight over the trust or with an order of a court
of competent jurisdiction directing the trustee to transfer to
the insurance commissioner with regulatory oversight all the
assets of the trust fund.
(b) The assets shall be distributed by and claims shall be
filed with and valued by the insurance commissioner with
regulatory oversight in accordance with the laws of the state in
which the trust is domiciled that are applicable to the
liquidation of domestic insurance companies.
(c) If the insurance commissioner with regulatory oversight
determines that the assets of the trust fund or any part thereof
are not necessary to satisfy the claims of the United States
ceding insurers of the grantor of the trust, the assets or part
thereof shall be returned by the insurance commissioner according
to the laws of that state and according to the terms of the trust
agreement not inconsistent with the laws of that state.
(d) The grantor shall waive any right otherwise available to it
under United States law that is inconsistent with this
subsection.
SECTION 321. ORS 731.510 is amended to read:
731.510. (1) Subject to the provisions of ORS 731.508 relating
to allowance of credit for reinsurance, the Director of the
Department of Consumer and Business Services { + and the
Director of the Oregon Health Authority + } shall allow a
reduction from liability for the reinsurance ceded by a domestic
insurer to a reinsurer not meeting the requirements of ORS
731.509 in an amount not exceeding the liabilities carried by the
ceding insurer, as provided in this section. The reduction shall
be in the amount of funds held by or on behalf of the ceding
insurer, including funds held in trust for the ceding insurer,
under a reinsurance contract with the reinsurer as security for
the payment of obligations thereunder, if the security:
(a) Is held in the United States subject to withdrawal solely
by and under the exclusive control of the ceding insurer; or
(b) In the case of a trust, is held in a qualified United
States financial institution. For purposes of this paragraph, a
qualified United States financial institution is an institution
that:
(A) Is organized, or, in the case of a United States branch or
agency office of a foreign banking organization, is licensed,
under the laws of the United States or any state thereof and has
been granted authority to operate with fiduciary powers; and
(B) Is regulated, supervised and examined by federal or state
authorities having regulatory authority over banks and trust
companies.
(2) The security for purposes of subsection (1) of this section
may be in any of the following forms:
(a) Cash.
(b) Securities listed by the Securities Valuation Office of the
National Association of Insurance Commissioners and qualifying as
allowed assets.
(c) Clean, irrevocable, unconditional letters of credit, issued
or confirmed by a qualified United States financial institution,
effective not later than December 31 of the year for which filing
is being made, and in the possession of, or in trust for, the
ceding company on or before the filing date of its annual
statement. Letters of credit issued or confirmed by an
institution meeting applicable standards of issuer acceptability
as of the dates of their issuance or confirmation shall continue
to be acceptable as security, notwithstanding the subsequent
failure of the issuing or confirming institution to meet
applicable standards of issuer acceptability, until their
expiration, extension, renewal, modification or amendment,
whichever occurs first. For purposes of this paragraph, a
qualified United States financial institution is an institution
that:
(A) Is organized or, in the case of a United States office of a
foreign banking organization, is licensed, under the laws of the
United States or any state thereof;
(B) Is regulated, supervised and examined by United States
federal or state authorities having regulatory authority over
banks and trust companies; and
(C) Has been determined by the director to meet such standards
of financial condition and standing as are considered necessary
and appropriate to regulate the quality of financial institutions
whose letters of credit will be acceptable to the director. For
the purpose of making a determination under this subparagraph,
the director shall consider and may accept determinations made by
the Securities Valuation Office of the National Association of
Insurance Commissioners as to whether a financial institution
meets its standards of financial conditions and standing.
(d) Any other form of security acceptable to the director.
SECTION 322. ORS 731.511 is amended to read:
731.511. (1) For purposes of allowing credit to a ceding
domestic insurer under ORS 731.509 when the reinsurance is ceded
to an assuming insurer that is accredited as a reinsurer in this
state, an insurer may be accredited as a reinsurer in this state
if the insurer:
(a) Files and maintains with the { - Director of the
Department of Consumer and Business Services - } { +
regulator + } evidence of its submission to the jurisdiction of
this state;
(b) Submits to the authority of the { - director - } { +
regulator + } to examine its books and records;
(c) Is authorized or licensed to transact insurance or
reinsurance in at least one state or, in the case of a United
States branch of an alien assuming insurer, is entered through
and authorized or licensed to transact insurance or reinsurance
in at least one state;
(d) Files annually with the { - director - } { +
regulator + } a copy of its annual statement filed with the
insurance department of its state of domicile and a copy of its
most recent audited financial statement; and
(e) Satisfies either of the following requirements:
(A) Maintains combined capital and surplus in an amount that is
not less than $20,000,000. An application for accreditation by an
insurer who maintains the amount of combined capital and surplus
specified in this subparagraph is considered to be approved if
the application is not disapproved on or before the 90th day
after the application is complete and is filed with the
{ - director - } { + regulator + }.
(B) Maintains combined capital and surplus in an amount less
than $20,000,000. An insurer applying for accreditation who
maintains the amount of combined capital and surplus specified in
this subparagraph is not accredited until the application for
accreditation is approved by the { - director - } { +
regulator + }.
(2) An insurer that is accredited as a reinsurer in this state
may accept reinsurance only of those risks and retain the risk
thereon within such limits as the accredited reinsurer is
otherwise authorized to insure directly in a state in which the
accredited reinsurer is authorized or licensed to transact
insurance.
(3) The { - director - } { + regulator + } may revoke the
accreditation of an assuming insurer if the { - director - }
{ + regulator + } determines that the assuming insurer has
failed to continue to meet any of the requirements of subsection
(1) of this section.
SECTION 323. ORS 731.512 is amended to read:
731.512. (1) No insurer shall withdraw from this state until
its direct liability to its policyholders and obligees under all
its insurance policies then in force in this state has been
assumed by another authorized insurer under an agreement approved
by the Director of the Department of Consumer and Business
Services { + or the Director of the Oregon Health Authority + }.
In the case of a life insurer, its liability pursuant to policies
issued in this state in settlement of proceeds under its policies
shall likewise be so assumed.
(2) The director may waive this requirement if the director
finds upon examination that a withdrawing insurer then is fully
solvent and that the protection to be given its policyholders in
this state will not be impaired by the waiver.
(3) The assuming insurer within a reasonable time shall replace
the assumed insurance policies with its own, or by indorsement
thereon acknowledge its liability thereunder.
(4) This section is in addition to the requirements of ORS
732.517 to 732.546 and 742.150 to 742.162.
SECTION 324. ORS 731.554 is amended to read:
731.554. (1) Except as provided in subsections (2) to (6) of
this section and ORS 731.562 and 731.566, to qualify for
authority to transact insurance in this state an insurer shall
possess and thereafter maintain capital or surplus, or any
combination thereof, of not less than $2.5 million.
(2) An insurer transacting any workers' compensation insurance
business shall possess and thereafter maintain capital or
surplus, or any combination thereof, of not less than $5 million.
(3) An insurer transacting mortgage insurance shall possess and
thereafter maintain capital or surplus, or any combination
thereof, of not less than $4 million.
(4) A home protection insurer shall possess and thereafter
maintain capital or surplus, or any combination thereof, of not
less than 10 percent of the aggregate of premiums charged on its
policies currently in force, but the required amount shall not be
less than $250,000 or more than $1 million.
(5) A domestic insurer applying for its original certificate of
authority in this state shall possess, when first so authorized,
additional capital or surplus, or any combination thereof, of not
less than $500,000. However, the additional amount in the case of
a home protection insurer shall be not less than $10,000.
(6) For the protection of the public, the Director of the
Department of Consumer and Business Services { + and the
Director of the Oregon Health Authority + } may require an
insurer t