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 921
A-Engrossed
House Bill 2116
Ordered by the House April 27
Including House Amendments dated April 27
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski)
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.
Creates Health System Fund to fund medical assistance and { +
private health option and to + } pay refunds of hospital
assessment. Modifies hospital assessment. Repeals sunset on
hospital assessment. Directs hospital assessment to be paid into
Health System Fund after October 1, 2009.
Creates assessment on insurance premiums to be administered by
Department of Consumer and Business Services. Directs assessments
minus specified amounts to be paid into Health System Fund.
Creates assessment on capitation payments to Medicaid managed
care plans to be administered by Department of Human Services.
Directs assessments to be deposited in Health System Fund.
Imposes penalties for failure to timely pay assessments.
{ + Establishes Health Care for All Oregon Children program
for purpose of providing affordable, accessible health care to
all Oregon children. Specifies qualifications for program.
Directs Department of Human Services to provide medical
assistance to specified persons for whom a public agency assumed
financial responsibility.
Directs Office of Private Health Partnerships to administer
private health option for purposes of expanding private health
insurance coverage of Oregon's children.
Directs Department of Human Services to seek federal financial
participation for programs relating to health care of Oregon's
children. Specifies other duties of department relating to
programs.
Establishes Private Health Option Program Fund. Continuously
appropriates moneys in fund to Office of Private Health
Partnerships for purposes of administering programs relating to
health care of Oregon's children. + }
Takes effect on 91st day following adjournment sine die.
A BILL FOR AN ACT
Relating to health care assessment; creating new provisions;
amending ORS 414.047, 414.536, 414.706, 414.839, 731.292,
731.840 and 735.701 and sections 2, 8, 10, 14 and 51, chapter
736, Oregon Laws 2003; repealing sections 9, 12 and 13, chapter
736, 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:
SECTION 1. { + (1) The Health System Fund is established in
the State Treasury, separate and distinct from the General
Fund. Interest earned by the Health System Fund shall be credited
to the fund.
(2) Amounts in the Health System Fund are continuously
appropriated to the Department of Human Services for the purpose
of paying refunds due under sections 6 and 41, chapter 736,
Oregon Laws 2003, funding the private health option described in
section 29 of this 2009 Act and funding medical assistance as
defined in ORS 414.025, which may include but is not limited to:
(a) Increasing reimbursement rates for providers of health
services under ORS 414.705 to 414.750 above the rates that were
in effect for those services on February 29, 2004;
(b) Expanding, continuing or modifying health services for
persons described in ORS 414.706 (5); and
(c) Paying administrative costs incurred by the department to
administer the assessments imposed under section 2, chapter 736,
Oregon Laws 2003.
(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. + }
SECTION 2. { + Sections 3 to 5 of this 2009 Act are added to
and made a part of the Insurance Code. + }
SECTION 3. { + As used in this section and sections 4 and 5 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 4. { + (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 Department of Consumer
and Business Services and shall be accompanied by a verified
report, on a form prescribed by the department, 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 department determines that the assessment paid by
the insurer under this section is incorrect, the department shall
charge or credit to the insurer the difference between the
correct amount of the assessment and the amount paid by the
insurer. + }
SECTION 5. { + (1) An insurer that fails to timely + } { +
file a verified report or to pay an assessment under section 4 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 4 of this
2009 Act. + }
SECTION 6. { + Sections 4 and 5 of this 2009 Act apply to
premiums received by an insurer on or after the calendar quarter
ending December 31, 2009. + }
SECTION 7. { + (1) As used in this section, 'Medicaid managed
care plan' includes a prepaid capitated health service contractor
described in ORS 414.630 and a prepaid managed care health
services organization described in ORS 414.725.
(2) No later than 45 days following the end of a calendar
quarter, a Medicaid managed care plan shall pay an assessment at
a rate of ___ percent of the gross amount of capitation payments
received by the Medicaid 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 Department of Human
Services in a manner and form prescribed by the department.
(4) Assessments received by the department under this section
shall be deposited in the Health System Fund established in
section 1 of this 2009 Act. + }
SECTION 8. { + (1) A Medicaid managed care plan that fails to
timely pay an assessment under section 7 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 7 of this
2009 Act. + }
SECTION 9. { + Section 7 of this 2009 Act applies to
capitation payments received by a Medicaid managed care plan on
or after October 1, 2009. + }
SECTION 10. ORS 731.292 is amended to read:
731.292. (1) Except as provided in subsections (2) { + , + }
{ - and - } (3) { + and (4) + } of this section, all fees,
charges and other moneys received by the Department of Consumer
and Business Services or the Director of the Department of
Consumer and Business Services under the Insurance Code shall be
deposited in the fund created by ORS 705.145 and are continuously
appropriated to the department for the payment of the expenses of
the department in carrying out the Insurance Code.
(2) All taxes, fines and penalties paid pursuant to the
Insurance Code shall be paid to the director and after deductions
of refunds shall be paid by the director to the State Treasurer,
at the end of every calendar month or more often in the
director's discretion, for deposit in the General Fund to become
available for general governmental expenses.
(3) All premium taxes received by the director pursuant to ORS
731.820 shall be paid by the director to the State Treasurer for
deposit in the State Fire Marshal Fund.
{ + (4) Assessments received by the department under section
4 of this 2009 Act shall be paid into the State Treasury and
credited to the Health System Fund established in section 1 of
this 2009 Act, after deducting the following amounts:
(a) Amounts needed to reimburse the department for expenses in
administering sections 4 and 5 of this 2009 Act; and
(b) Amounts needed to reimburse the General Fund for reductions
in revenue caused by the effect of section 4 of this 2009 Act on
the retaliatory tax imposed under ORS 731.854 and 731.859. + }
{ + 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.
SECTION 14. 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 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. - } { + Health System Fund established in
section 1 of this 2009 Act. + }
SECTION 15. 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 16. 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. - } { +
Health System Fund established in section 1 of this 2009 Act. + }
SECTION 17. 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 - } { + Health System Fund established in
section 1 of this 2009 Act + }.
SECTION 18. 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 4 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 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. + }
SECTION 21. Section 1 of this 2009 Act is amended to read:
{ + Sec. 1. + } (1) The Health System Fund is established in
the State Treasury, separate and distinct from the General Fund.
Interest earned by the Health System Fund shall be credited to
the fund.
(2) Amounts in the Health System Fund are continuously
appropriated to the Department of Human Services for the purpose
of paying refunds due under { - sections 6 and 41 - } { +
section 6 + }, chapter 736, Oregon Laws 2003, funding the private
health option described in section 29 of this 2009 Act and
funding medical assistance as defined in ORS 414.025, which may
include but is not limited to:
(a) Increasing reimbursement rates for providers of health
services under ORS 414.705 to 414.750 above the rates that were
in effect for those services on February 29, 2004;
(b) Expanding, continuing or modifying health services for
persons described in ORS 414.706 (5); and
(c) Paying administrative costs incurred by the department to
administer the assessments imposed under section 2, chapter 736,
Oregon Laws 2003.
(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.
SECTION 22. { + The amendments to section 1 of this 2009 Act
by section 21 of this 2009 Act become operative on January 1,
2012. + }
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 + }.
SECTION 43. { + This 2009 Act takes effect on the 91st day
after the date on which the regular session of the Seventy-fifth
Legislative Assembly adjourns sine die. + }
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