75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
HA to HB 2116
LC 921/HB 2116-4
HOUSE AMENDMENTS TO
HOUSE BILL 2116
By COMMITTEE ON HEALTH CARE
April 27
On page 1 of the printed bill, line 2, delete '731.292 and
731.840' and insert '414.047, 414.536, 414.706, 414.839, 731.292,
731.840 and 735.701'.
In line 3, delete '1,' and delete '5,' and delete '4,'.
In line 12, after the second comma insert 'funding the private
health option described in section 29 of this 2009 Act'.
After line 19, insert:
' (3) The Department of Human Services shall develop a system
for reimbursement by the department to the Office of Private
Health Partnerships out of the Health System Fund for costs
associated with administering the private health option pursuant
to section 29 of this 2009 Act.'.
On page 3, delete lines 22 through 45.
On page 4, delete lines 1 through 37 and insert:
' { + NOTE: + } Section 11 was deleted by amendment.
Subsequent sections were not renumbered.
' { + SECTION 12. + } 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 each
hospital in this state that is not a waivered hospital. The
assessment shall be imposed at 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) The assessment shall be reported on a form prescribed by
the Department of Human Services and shall contain the
information required to be reported by the department. The
assessment form shall be filed with the department 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) 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 - } { +
section 1 (2) of this 2009 Act + }.
' (5) 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) Hospitals operated by the United States Department of
Veterans Affairs and pediatric specialty hospitals providing care
to children at no charge 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) - } { + (7) + } The Department of Human Services
shall prescribe by rule criteria for late payment of assessments.
' { + NOTE: + } Section 13 was deleted by amendment.
Subsequent sections were not renumbered.'.
On page 5, delete lines 44 and 45.
On page 6, delete lines 1 through 9 and insert:
' { + SECTION 19. + } { + (1) 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.
' (2) Section 12, chapter 736, Oregon Laws 2003, as amended by
section 4, chapter 780, Oregon Laws 2007, is repealed.
' (3) Section 13, chapter 736, Oregon Laws 2003, as amended by
section 5, chapter 780, Oregon Laws 2007, is repealed. + }
' { + SECTION 20. + } { + Sections 1 to 9 of this 2009 Act,
the amendments to ORS 731.292 and 731.840 and sections 2, 8, 10,
14 and 51, chapter 736, Oregon Laws 2003, by sections 10, 12 and
14 to 18 of this 2009 Act and the repeal of sections 9, 12 and
13, chapter 736, Oregon Laws 2003, by section 19 of this 2009 Act
become operative on October 1, 2009. + } ' .
In line 15, after the second comma insert 'funding the private
health option described in section 29 of this 2009 Act'.
After line 22, insert:
' (3) The Department of Human Services shall develop a system
for reimbursement by the department to the Office of Private
Health Partnerships out of the Health System Fund for costs
associated with administering the private health option pursuant
to section 29 of this 2009 Act.'.
After line 24, insert:
' { + SECTION 23. Sections 24, 25, 27 and 28 of this 2009 Act
are added to and made a part of ORS chapter 414. + }
' { + SECTION 24. + } { + As used in sections 25 and 27 of
this 2009 Act:
' (1) 'Child' means a person under 19 years of age.
' (2) 'Health benefit plan' has the meaning given that term in
ORS 735.720. + }
' { + SECTION 25. + } { + (1) The Health Care for All Oregon
Children program is established to make affordable, accessible
health care available to all of Oregon's children. The program is
composed of:
' (a) Medical assistance funded in whole or in part by Title
XIX of the Social Security Act, by the State Children's Health
Insurance Program under Title XXI of the Social Security Act and
by moneys appropriated or allocated for that purpose by the
Legislative Assembly; and
' (b) A private health option administered by the Office of
Private Health Partnerships under section 29 of this 2009 Act.
' (2) A child is eligible for the program if the child is
lawfully present in this state and the income of the child's
family is at or below 200 percent of the federal poverty
guidelines. There is no asset limit to qualify for the program.
' (3)(a) A child receiving medical assistance under the program
is continuously eligible for a minimum period of 12 months.
' (b) The Department of Human Services shall reenroll a child
for successive 12-month periods as long as the child remains
eligible.
(4) Except for medical assistance funded by Title XIX of the
Social Security Act and except as provided in section 27 of this
2009 Act, the department may prescribe by rule a period of
uninsurance prior to enrollment in the program. + }
' { + SECTION 26. + } Section 25 of this 2009 Act is amended
to read:
' (1) The Health Care for All Oregon Children program is
established to make affordable, accessible health care available
to all of Oregon's children. The program is composed of:
' (a) Medical assistance funded in whole or in part by Title
XIX of the Social Security Act, by the State Children's Health
Insurance Program under Title XXI of the Social Security Act and
by moneys appropriated or allocated for that purpose by the
Legislative Assembly; and
' (b) A private health option administered by the Office of
Private Health Partnerships under section 29 of this 2009 Act.
' (2) A child is eligible for the program if the child is
lawfully present in this state and the income of the child's
family is at or below { - 200 - } { + 300 + } percent of the
federal poverty guidelines. There is no asset limit to qualify
for the program.
' (3)(a) A child receiving medical assistance under the program
is continuously eligible for a minimum period of 12 months.
' (b) The Department of Human Services shall reenroll a child
for successive 12-month periods as long as the child remains
eligible.
' (4) Except for medical assistance funded by Title XIX of the
Social Security Act and except as provided in section 27 of this
2009 Act, the department may prescribe by rule a period of
uninsurance prior to enrollment in the program.
' { + SECTION 27. + } { + (1) A child qualifies for the
Health Care for All Oregon Children program if the child has:
' (a) A disability as defined in the federal Supplemental
Security Income program;
' (b) Family income or resources that exceed the allowable
limits for federal Supplemental Security Income; and
' (c) Family income at or below 300 percent of the federal
poverty guidelines.
' (2) A child who qualifies for the program pursuant to this
section who has access to coverage under an employer sponsored
health benefit plan for which the employer pays 40 percent or
more of the total cost of premiums, must enroll in the employer
sponsored health benefit plan.
' (3) The Department of Human Services may not require a period
of uninsurance prior to enrollment of a child who meets the
requirements of this section.
' (4) If the family income of the child is at or below 200
percent of the federal poverty guidelines, the department shall:
' (a) Pay the employee share of the premium for an employer
sponsored health benefit plan and shall pay copayments,
deductibles and other employee cost-sharing in full; or
' (b) If the child does not have access to coverage under an
employer sponsored health benefit plan, the child shall be
enrolled in medical assistance.
' (5) If the family income of the child is above 200 percent
but at or below 300 percent of the federal poverty guidelines,
the department shall:
' (a) Pay a portion of the employee cost of the premium on a
sliding scale basis for an employer sponsored health benefit plan
available to the child and shall pay the copayments, deductibles
and other cost sharing in full; or
' (b) If the child does not have access to coverage under an
employer sponsored health benefit plan, the child shall be
enrolled in medical assistance and shall pay a monthly premium to
the department. The department shall prescribe by rule the amount
of the premium, which may not exceed five percent of the family
income. + }
' { + SECTION 28. The Department of Human Services shall
provide medical assistance to a person under 21 years of age who,
on the person's 18th birthday, was in a foster family home or
licensed child-caring agency or institution under a purchase of
care agreement and, at that time, was a person for whom a public
agency of this state assumed financial responsibility, in whole
or in part, for medical assistance provided under ORS 414.706 and
414.707. + }
' { + SECTION 29. + } { + (1) As used in this section:
' (a) 'Child' means a person under 19 years of age.
' (b) 'Health benefit plan' has the meaning given that term in
ORS 735.720.
' (2) The Office of Private Health Partnerships shall
administer a private health option to expand access to private
health insurance for Oregon's children.
' (3) The office shall adopt by rule criteria for health
benefit plans to qualify for premium assistance under the private
health option. The criteria may include, but are not limited to,
the following:
' (a) The health benefit plan meets or exceeds the requirements
for a basic benchmark health benefit plan under ORS 735.733.
' (b) The health benefit plan offers a benefit package
comparable to the health services provided to children receiving
medical assistance, including mental health, vision and dental
services, and without any exclusion of or delay of coverage for
preexisting conditions.
' (c) The health benefit plan imposes copayments or other cost
sharing that is based upon a family's ability to pay.
' (d) Expenditures for the health benefit plan qualify for
federal financial participation.
' (4) The amount of premium assistance provided under this
section shall be:
' (a) Equal to the full cost of the premium for children whose
family income is at or below 200 percent of the federal poverty
guidelines and who have access to employer sponsored health
insurance; and
' (b) Based on a sliding scale under criteria established by
the office by rule for children whose family income is above 200
percent but at or below 300 percent of the federal poverty
guidelines, regardless of whether the child has access to
coverage under an employer sponsored health benefit plan.
' (5) A child whose family income is more than 300 percent of
the federal poverty guidelines shall be offered the opportunity
to purchase a health benefit plan through the private health
option but may not receive premium assistance. + }
' { + SECTION 30. + } { + Notwithstanding eligibility
criteria and premium assistance amounts determined pursuant to
section 29 of this 2009 Act, the Office of Private Health
Partnerships shall provide premium assistance under the private
health option to eligible children to the extent the Legislative
Assembly appropriates funds for that purpose or establishes
expenditure limitations to provide such premium assistance. + }
' { + SECTION 31. + } { + (1) The Department of Human
Services shall apply to the Centers for Medicare and Medicaid
Services for any approval necessary to obtain federal financial
participation in the costs of programs described in sections 25,
27, 28 and 29 of this 2009 Act.
' (2) The department and the Office of Private Health
Partnerships shall adopt rules implementing the Health Care for
All Oregon Children program as soon as practicable after receipt
of the necessary federal approval and may provide for
implementation in stages in accordance with the availability of
funding.
' (3) Section 25 of this 2009 Act becomes operative on the
later of October 1, 2009, or the date the Department of Human
Services receives any federal approval required to secure federal
financial participation under subsection (1) of this section.
' (4) Sections 26 and 28 of this 2009 Act become operative on
the later of January 1, 2010, or the date the Department of Human
Services receives any federal approval required to secure federal
financial participation under subsection (1) of this section.
' (5) Section 27 of this 2009 Act becomes operative on the
later of January 1, 2011, or the date the Department of Human
Services receives any federal approval required to secure federal
financial participation under subsection (1) of this section. + }
' { + SECTION 32. + } { + (1) There is established in the
State Treasury, separate and distinct from the General Fund the
Private Health Option Program Fund. The Private Health Option
Program Fund consists of moneys transferred to the Office of
Private Health Partnerships by the Department of Human Services
under section 1 (3) of this 2009 Act. Interest earned by the fund
shall be credited to the fund.
' (2) Moneys in the Private Health Option Program Fund are
continuously appropriated to the Office of Private Health
Partnerships for carrying out sections 25 and 29 of this 2009
Act. + }
' { + SECTION 33. + } { + (1) A prepaid managed care health
services organization shall contract with a community health
center or safety net clinic for the provision of covered services
by the center or clinic to an enrollee of the organization
participating in the Health Care for All Oregon Children program
established under section 25 of this 2009 Act if the center or
clinic agrees to similar contractual terms, conditions and
reimbursement rates negotiated with subcontractors providing the
same or similar services to the organization.
' (2) As used in this section, 'community health center or
safety net clinic' means a nonprofit medical clinic that provides
primary physical health, vision, dental or mental health services
to low-income patients without charge or using a sliding fee
scale based on the income of the patient. 'Community health
center or safety net clinic' includes a school-based health
center. + }
' { + SECTION 34. + } { + (1) The Department of Human
Services shall award grants to community health centers and
safety net clinics, as defined in section 33 of this 2009 Act, to
ensure the capacity of each grantee to provide health care
services to underserved or vulnerable populations, within the
limits of funds provided by the Legislative Assembly for this
purpose.
' (2) The department shall provide outreach for the Health Care
for All Oregon Children program, including development and
administration of an application assistance program, and
including grants to provide funding to organizations and local
groups for outreach and enrollment activities for the program,
within the limits of funds provided by the Legislative Assembly
for this purpose.
' (3) Notwithstanding subsections (1) and (2) of this section,
the department shall provide funds for expansion and continuation
of school-based health centers.
' (4) The department shall by rule adopt criteria for awarding
grants and providing funds under this section.
' (5) The department shall analyze and evaluate the
implementation of the Health Care for All Oregon Children
program. + }
' { + SECTION 35. + } { + (1) The Department of Human
Services is responsible for statewide outreach and marketing of
the medical assistance and premium assistance programs
administered by the department and the Office of Private Health
Partnerships with the goal of enrolling in those programs all
eligible individuals residing in this state.
' (2) To maximize the enrollment and retention of eligible
individuals in the medical assistance and premium assistance
programs, the department 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 or chemical dependency
and individuals experiencing homelessness. + }
' { + SECTION 36. + } { + (1) The Department of Human
Services shall implement a streamlined and simple application
process for the medical assistance and premium assistance
programs administered by the department and the Office of Private
Health Partnerships. The process shall include, but not be
limited to:
' (a) An online application that may be submitted via the
Internet;
' (b) Application forms that are readable at a sixth grade
level and that request the minimum amount of information
necessary to begin processing the application; and
' (c) Application assistance from qualified staff to aid
individuals who have language, cognitive, physical or geographic
barriers to applying for medical assistance or premium
assistance.
' (2) In developing the simplified application forms, the
department shall consult with persons not employed by the
department who have experience in serving vulnerable and
hard-to-reach populations.
' (3) The department shall facilitate outreach and enrollment
efforts to connect eligible individuals with all available
publicly funded health programs, including but not limited to the
Family Health Insurance Assistance Program. + }
' { + SECTION 37. + } { + (1) As used in this section,
'qualified provider' means a person that:
' (a) Is eligible for payment by the Department of Human
Services for health services provided to recipients of medical
assistance as defined in ORS 414.025;
' (b)(A) Provides outpatient hospital services or other health
services, as defined in ORS 414.705, that are offered by a rural
health clinic in:
' (i) A rural health clinic;
' (ii) A federally-qualified health center; or
' (iii) An Indian Health Service facility, a tribal health
clinic or an urban Indian health center; or
' (B) Provides clinic services under the direction of a
physician, without regard to whether a physician is the
administrator of the clinic;
' (c) Is authorized by the department to make presumptive
eligibility determinations; and
' (d)(A) Receives funding from one or more of the following
sources:
' (i) Section 330 or 330A of the Public Health Service Act, 42
U.S.C. 254b or 254c;
' (ii) Title V of the Social Security Act, 42 U.S.C. 701 et
seq.; or
' (iii) Title V of the Indian Health Care Improvement Act, 25
U.S.C. 1601 et seq.;
' (B) Participates in a program established under:
' (i) Section 17 of the Child Nutrition Act of 1966, 42 U.S.C.
1786; or
' (ii) Section 4(a) of the Agriculture and Consumer Protection
Act of 1973, 7 U.S.C. 612c;
' (C) Provides prenatal services paid for with funding from
Title XIX or XXI of the Social Security Act; or
' (D) Is the Indian Health Service or a health program or
facility operated by a tribal organization under the Indian
Self-Determination and Education Assistance Act, 25 U.S.C. 450f
et seq.
' (2) The department shall provide medical assistance to a
pregnant woman, residing in this state, who is presumptively
eligible for medical assistance as determined under ORS 414.536
or this section.
' (3) A woman is presumptively eligible for medical assistance
under this section if a qualified provider determines that the
woman is pregnant and that her income does not exceed the limits
established by the department by rule.
' (4) The presumptive eligibility period for medical assistance
begins on the date a qualified provider makes the determination
under subsection (3) of this section and ends on the earlier of
the following dates:
' (a) If the woman timely files an application for medical
assistance, the date the department determines eligibility for
medical assistance in accordance with ORS 414.047.
' (b) If the woman does not timely file an application for
medical assistance, the last day of the month following the month
in which the presumptive eligibility period begins.
' (5) An application is timely filed under subsection (4) of
this section if it is filed with the department on or before the
last day of the month following the month in which the
presumptive eligibility determination is made by a qualified
provider under subsection (3) of this section.
' (6) The department shall furnish to qualified providers
medical assistance application forms and information about how to
assist an applicant in completing and filing the forms.
' (7) A qualified provider that makes a presumptive eligibility
determination under subsection (3) of this section shall:
' (a) Immediately inform the woman that she must file an
application for medical assistance with the department on or
before the last day of the month following the month in which the
presumptive eligibility determination is made by a qualified
provider;
' (b) Provide a medical assistance application form to the
woman;
' (c) With the woman's consent, assist her in completing the
application;
' (d) Within five working days of the determination, notify the
department; and
' (e) Submit the completed application to the department. + }
' { + SECTION 38. + } ORS 414.047 is amended to read:
' 414.047. (1) Application for any category of aid shall also
constitute application for medical assistance.
' (2) Except as { - otherwise - } provided in this section,
each person requesting medical assistance shall { - make
application therefor - } { + apply + } to the Department of
Human Services. The department shall determine { + the
person's + } eligibility for { + assistance + } and fix the date
on which { - such - } { + the + } assistance { - may
begin, - } { + begins + } and shall obtain { - such - }
other information required by { - the rules of - } { + rules
adopted by + } the department.
' (3) If { - an applicant - } { + a person + } is unable to
make application for medical assistance, an application may be
made by someone acting responsibly for { - the applicant - }
{ + that person + }.
' { + (4)(a) The department shall adopt rules establishing a
minimum 12-month period of enrollment for persons described in 42
U.S.C. 1396a(l)(1)(C) or (D) who are determined eligible for
medical assistance.
' (b) The department shall reenroll a person immediately
following the initial 12-month period of enrollment for
successive 12-month periods of enrollment as long as the person
meets the description in 42 U.S.C. 1396a(l)(1)(C) or (D) and is
eligible for medical assistance on the date of reenrollment.
' (c) The department may not require a new application as a
condition of reenrollment under paragraph (b) of this subsection
and must determine the person's eligibility for medical
assistance using information and sources available to the
department or documentation readily available to the person. + }
' { + SECTION 39. + } 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 { + under this section + } 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 40. + } ORS 414.706 is amended to read:
' 414.706. The Legislative Assembly shall approve and fund
health services to the following persons:
' (1) Persons who are categorically needy as described in ORS
414.025 (2)(n) and (o);
' (2) Pregnant women with incomes no more than { - 185 - }
{ + 200 + } percent of the federal poverty guidelines;
' (3) Persons under 19 years of age with incomes no more than
200 percent of the federal poverty guidelines;
' (4) Persons described in ORS 414.708; and
' (5) Persons 19 years of age or older with incomes no more
than 100 percent of the federal poverty guidelines who do not
have federal Medicare coverage.
' { + SECTION 41. + } ORS 414.839 is amended to read:
' 414.839. { - (1) - } Subject to funds available, the
Department of Human Services may provide { - public
subsidies - } { + premium assistance + } for the purchase of
health insurance coverage provided by public programs or private
insurance, including but not limited to { + :
' (1) + } The Family Health Insurance Assistance
Program { + ; + } { - , for currently uninsured individuals
based on incomes up to 200 percent of the federal poverty level.
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. - }
' { + (2) Medical assistance described in ORS 414.115; and
' (3) The Health Care for All Oregon Children program
established in section 25 of this 2009 Act. + }
' { + SECTION 42. + } ORS 735.701 is amended to read:
' 735.701. (1) The Office of Private Health Partnerships is
established.
' (2) The office shall carry out the duties described under ORS
414.831, 735.700 to 735.714 and 735.720 to 735.740 { + and
sections 25 and 29 of this 2009 Act + }.'.
In line 25, delete '23' and insert '43'.
----------