75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
Enrolled
House Bill 2116
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski)
CHAPTER ................
AN ACT
Relating to health care assessment; creating new provisions;
amending ORS 192.519, 291.055, 411.708, 414.025, 414.042,
414.428, 414.706, 414.707, 414.710, 414.712, 414.736, 414.839,
731.036, 731.292, 731.840 and 735.701 and sections 2, 5, 9, 10,
12, 13, 14 and 51, 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 funding the Health Care for All Oregon Children program
established in section 27 of this 2009 Act, health services
described in ORS 414.705 (1)(a) to (j) and other health services.
Moneys in the fund may also be used by the department to:
(a) Provide grants to community health centers and safety net
clinics under section 33 of this 2009 Act.
(b) Pay refunds due under section 41, chapter 736, Oregon Laws
2003, and under section 11 of this 2009 Act.
(c) Pay administrative costs incurred by the department to
administer the assessment in section 9 of this 2009 Act.
(3) The department 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 30 of this 2009
Act. + }
SECTION 2. { + Sections 3 to 7 of this 2009 Act are added to
and made a part of the Insurance Code. + }
SECTION 3. { + (1) As used in this section:
(a) 'Insured' means an eligible employee or family member, as
defined in ORS 243.105, who is covered by a self-insured health
benefit plan under ORS 243.105 to 243.285.
(b) 'Medical claim' means a request to a self-insured health
benefit plan for payment for a health care item or service
provided to an insured, other than a dental or vision care item
or service.
Enrolled House Bill 2116 (HB 2116-C) Page 1
(2) No later than 45 days following the end of a calendar
quarter, the Public Employees' Benefit Board shall pay an
assessment at the rate of one percent of all medical claims
received and the administrative costs associated with the claims
received during the calendar quarter.
(3) 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, together with any
information required by the department.
(4) The assessment imposed under this section is in addition to
and not in lieu of any tax, surcharge or other assessment imposed
on the board.
(5) If the department determines that the assessment paid by
the board under this section is incorrect, the department shall
charge or credit to the board the difference between the correct
amount of the assessment and the amount paid by the board.
(6) The board is entitled to notice and an opportunity for a
contested case hearing under ORS chapter 183 to contest an
action + }. { + of the department taken pursuant to subsection
(5) of this section.
(7) The assessment paid by the board under this section shall
be considered part of the board's administrative expenses. + }
SECTION 3a. { + Section 3 of this 2009 Act applies to medical
claims received by the Public Employees' Benefit Board, or a
person that contracts with the board to pay medical claims under
a self-insured health benefit plan, during the period from
October 1, 2009, through September 30, 2013. + }
SECTION 4. { + As used in this section and section 5 of this
2009 Act:
(1) 'Gross amount of premiums' has the meaning given that term
in ORS 731.808.
(2) 'Health plan' means health insurance and insurance provided
by a health care service contractor as defined in ORS 750.005,
excluding:
(a) Insurance policies covering vision only or dental only
benefits;
(b) Medicare advantage plans;
(c) Medicare Part D plans;
(d) Long term care insurance;
(e) Health insurance issued to federal employees that is exempt
from state taxes under federal law;
(f) A policy of stop-loss coverage that meets the requirements
of ORS 742.065;
(g) Insurance policies issued to supplement liability insurance
coverage;
(h) Automobile medical payment insurance or insurance under
which benefits are payable with or without regard to fault and
that is required by law to be contained in a liability insurance
policy or equivalent self-insurance;
(i) Reinsurance as defined in ORS 731.126;
(j) Workers compensation insurance; and
(k) Disability insurance. + }
SECTION 5. { + (1) No later than 45 days following the end of
a calendar quarter, an insurer shall pay an assessment at the
rate of one percent of the gross amount of premiums earned by the
insurer during that calendar quarter that were derived from
health plan policies:
(a) Insuring Oregon residents; or
(b) Delivered or issued for delivery in Oregon.
Enrolled House Bill 2116 (HB 2116-C) Page 2
(2) The assessment shall be paid to the Department of Consumer
and Business Services and shall be accompanied by a verified form
prescribed by the department together with any information
required by the department, that reports:
(a) All health 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 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) Any rate filed for the department's approval may include
amounts paid by the insurer under this section as a valid element
of administrative expense or retention. + }
SECTION 6. { + (1) If the Public Employees' Benefit Board or
an insurer fails to timely file a verified form or to pay an
assessment required under section 3 or 5 of this 2009 Act, the
insurer or the board 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 sections 3 and 5
of this 2009 Act. + }
SECTION 7. { + (1) If the Department of Consumer and Business
Services determines that the assessment paid by the insurer under
section 5 of this 2009 Act 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.
(2) An insurer that is aggrieved by an action of the department
taken pursuant to subsection (1) of this section shall be
entitled to notice and an opportunity for a contested case
hearing under ORS chapter 183. + }
SECTION 8. { + (1) Sections 5 and 6 of this 2009 Act apply to
premiums earned by an insurer during the period from October 1,
2009, through September 30, 2013.
(2) Notwithstanding any provision of contract or statute,
including ORS 743.737 and 743.767, beginning October 1, 2009,
insurers may include in their rates an additional one percent of
the existing rate. To the extent the existing rate was approved
by the Department of Consumer and Business Services, the
resulting rate, including the additional one percent, shall be
considered an approved rate. If an insurer increases its rates
under this subsection, the insurer shall include in all consumer
billings a notice explaining the increase in a form prescribed by
the department. This subsection applies to any rate approved by
or filed for the department's approval prior to the effective
date of this 2009 Act and to any contract of insurance not
subject to the department's rate approval authority. + }
SECTION 9. { + (1) As used in this section, 'Medicaid managed
care organization' means the following entities defined in or
referred to in ORS 414.736:
(a) A fully capitated health plan.
(b) A physician care organization.
(c) A mental health organization.
(2) No later than 45 days following the end of a calendar
quarter, a Medicaid managed care organization shall pay an
Enrolled House Bill 2116 (HB 2116-C) Page 3
assessment at a rate of one percent of the gross amount of
capitation payments received by the Medicaid managed care
organization 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.
(5) The assessment imposed under this section is in addition to
and not in lieu of any tax, surcharge or other assessment imposed
on a Medicaid managed care organization. + }
SECTION 10. { + (1) A Medicaid managed care organization that
fails to timely pay an assessment under section 9 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 9 of this
2009 Act. + }
SECTION 11. { + (1) A Medicaid managed care organization that
has paid an amount that is not required under section 9 of this
2009 Act may file a claim for refund with the Department of Human
Services.
(2) Any Medicaid managed care organization that is aggrieved by
an action of the department taken pursuant to subsection (1) of
this section shall be entitled to notice and an opportunity for a
contested case hearing under ORS chapter 183. + }
SECTION 12. { + Sections 9, 10 and 11 of this 2009 Act apply
to capitation payments earned by a Medicaid managed care
organization during the period from October 1, 2009, through
September 30, 2013. + }
SECTION 13. 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 sections
3 and 5 of this 2009 Act and penalties received by the department
under sections 6 and 10 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 3 to 7 of this 2009 Act; and
Enrolled House Bill 2116 (HB 2116-C) Page 4
(b) Amounts needed to reimburse the General Fund for reductions
in revenue caused by the effect of section 5 of this 2009 Act on
the retaliatory tax imposed under ORS 731.854 and 731.859. + }
SECTION 14. { + Sections 15 and 16 of this 2009 Act are added
to and made a part of ORS 414.705 to 414.750. + }
SECTION 15. { + (1) The Department of Human Services shall
establish an adjustment to the capitation rate paid to a Medicaid
managed care organization defined in section 9 of this 2009 Act.
(2) The contracts entered into between the department and
Medicaid managed care organizations must include provisions that
ensure that the adjustment to the capitation rate established
under subsection (1) of this section is distributed by the
Medicaid managed care organizations to hospitals located in
Oregon that receive Medicare reimbursement based upon diagnostic
related groups.
(3) The adjustment to the capitation rate paid to Medicaid
managed care organizations shall be established in an amount
consistent with the legislatively adopted budget and the
aggregate assessment imposed pursuant to section 2, chapter 736,
Oregon Laws 2003. + }
SECTION 16. { + The Department of Human Services shall
promptly seek federal approval necessary to obtain federal
financial participation in the costs of programs and services
funded with assessments paid under sections 3, 5 and 9 of this
2009 Act. + }
SECTION 17. 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 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 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) - } { + (6) + } 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) - } { + (3)(a) + } To the extent permitted by
federal law, aggregate { - taxes levied - } { + assessments
imposed + } under this section may not exceed { - payments
under section 9 (2), chapter 736, Oregon Laws 2003. - } { + the
total of the following amounts received by the hospitals that are
reimbursed by Medicare based on diagnostic related groups:
(A) The adjustment to the capitation rate paid to Medicaid
managed care organizations under section 15 of this 2009 Act;
(B) 30 percent of payments made to hospitals on a
fee-for-service basis by the department for inpatient hospital
services; and
Enrolled House Bill 2116 (HB 2116-C) Page 5
(C) 41 percent of payments made to hospitals on a
fee-for-service basis by the department for outpatient hospital
services.
(b) Notwithstanding paragraph (a) of this subsection, aggregate
assessments imposed for the biennium beginning July 1, 2009, may
exceed the total of the amounts described in paragraph (a) of
this subsection to the extent necessary to compensate for any
reduction of funding in the legislatively adopted budget for that
biennium for hospital services under ORS 414.705 to 414.750. + }
{ - (5) - } { + (4) + } Notwithstanding subsection
{ - (4) - } { + (3) + } 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) - } { + (5) + } 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) - } { + (6)(a) + } The Department of Human
Services shall develop a schedule for collection of the
assessment for the calendar quarter ending September 30,
{ - 2009 - } { + 2013 + }, that will result in the collection
occurring between December 15, { - 2009 - } { + 2013 + }, and
the time all Medicaid cost settlements are finalized for that
calendar quarter.
(b) The Department of Human Services shall prescribe by rule
criteria for late payment of assessments.
SECTION 18. 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 and deposited in the Department
of Human Services Account established under ORS 409.060.
(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 19. Section 9, chapter 736, Oregon Laws 2003, as
amended by section 3, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 9. + } (1) The Hospital Quality Assurance Fund is
established in the State Treasury, separate and distinct from the
General Fund. Interest earned by the Hospital Quality Assurance
Fund shall be credited to the Hospital Quality Assurance Fund.
(2) Amounts in the Hospital Quality Assurance Fund are
continuously appropriated to the Department of Human Services for
the purpose of paying refunds due under section 6, chapter 736,
Oregon Laws 2003, and funding { - hospital - } services under
ORS 414.705 to 414.750, including but not limited to:
(a) Increasing reimbursement rates for inpatient and outpatient
hospital services under ORS 414.705 to 414.750 { - above the
rates that were in effect for those services on February 29,
2004 - } ;
Enrolled House Bill 2116 (HB 2116-C) Page 6
(b) { + Maintaining, + } expanding { - , continuing - } or
modifying
{ - hospital - } services for persons described in ORS
{ - 414.706 (5) - } { + 414.025 (2)(s) + };
{ + (c) Maintaining or increasing the number of persons
described in ORS 414.025 (2)(s) who are enrolled in the medical
assistance program; + } and
{ - (c) - } { + (d) + } Paying administrative costs
incurred by the department to administer the assessments imposed
under section 2, chapter 736, Oregon Laws 2003.
(3) { + Except for assessments imposed pursuant to section 2
(3)(b), chapter 736, Oregon Laws 2003, + } the department may not
use moneys from the Hospital Quality Assurance Fund to supplant,
directly or indirectly, other moneys made available to fund
services described in subsection (2) of this section.
SECTION 20. 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 { + during a
period beginning October 1, 2009, and ending the earlier of
September 30, 2013, or the date on which the assessment + }
{ - 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.
SECTION 21. Section 12, chapter 736, Oregon Laws 2003, as
amended by section 4, chapter 780, Oregon Laws 2007 is amended to
read:
{ + Sec. 12. + } Sections 1 to 9, chapter 736, Oregon Laws
2003, are repealed on January 2, { - 2012 - } { + 2015 + }.
SECTION 22. Section 13, chapter 736, Oregon Laws 2003, as
amended by section 5, chapter 780, Oregon Laws 2007, is amended
to read:
{ + Sec. 13. + } Nothing in the repeal of sections 1 to 9,
chapter 736, Oregon Laws 2003, by section 12, chapter 736, Oregon
Laws 2003, affects the imposition and collection of a hospital
assessment under sections 1 to 9, chapter 736, Oregon Laws 2003,
for a calendar quarter beginning before September 30,
{ - 2009 - } { + 2013 + }.
SECTION 23. 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 - } { + 2017 + }, are
transferred to the General Fund.
SECTION 24. 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 - } in the
Medical Care Quality Assurance Fund { - on December 31, 2011,
are - } { + on or after October 1, 2009, shall be + }
transferred to the { - General Fund - } { + Health System
Fund established in section 1 of this 2009 Act + }.
SECTION 25. 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,
Enrolled House Bill 2116 (HB 2116-C) Page 7
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 5 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 26. { + Sections 27 and 29 of this 2009 Act are added
to and made a part of ORS chapter 414. + }
SECTION 27. { + (1) As used in this section, 'child' means a
person under 19 years of age.
(2) 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 30 of this 2009 Act.
(3) 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.
(4)(a) A child receiving medical assistance under the program
is continuously eligible for a minimum period of 12 months.
Enrolled House Bill 2116 (HB 2116-C) Page 8
(b) The Department of Human Services shall reenroll a child for
successive 12-month periods of enrollment as long as the child 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 child's eligibility for medical assistance
using information and sources available to the department or
documentation readily available.
(5) Except for medical assistance funded by Title XIX of the
Social Security Act, the department may prescribe by rule a
period of uninsurance prior to enrollment in the program. + }
SECTION 28. Section 27 of this 2009 Act is amended to read:
{ + Sec. 27. + } (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 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 30 of this 2009 Act.
(3) 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.
(4)(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 of enrollment as long as the child 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.
(5) Except for medical assistance funded by Title XIX of the
Social Security Act, the department may prescribe by rule a
period of uninsurance prior to enrollment in the program.
SECTION 29. { + The Department of Human Services shall
establish fee-for-service reimbursement rates for inpatient
hospital services provided by hospitals that receive Medicare
reimbursement on the basis of diagnostic related groups as
follows:
(1) For the period from October 1, 2009, through September 30,
2013, at the same rate paid by Medicare on the date of the
service.
(2) For the period beginning October 1, 2013, at a rate that is
70 percent of the rate paid by Medicare on the date of the
service. + }
SECTION 30. { + (1) As used in this section:
(a) 'Child' means a person under 19 years of age who is
lawfully present in this state.
(b) 'Health benefit plan' has the meaning given that term in
ORS 735.720.
Enrolled House Bill 2116 (HB 2116-C) Page 9
(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 31. { + Notwithstanding eligibility criteria and
premium assistance amounts determined pursuant to section 30 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 32. { + (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 27 and 30 of this
2009 Act, and in implementing the amendment to section 27 of this
2009 Act by section 28 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 27 of this 2009 Act becomes operative on the later
of October 1, 2009, or the date on which the Department of Human
Services receives any federal approval required to secure federal
financial participation under subsection (1) of this section.
(4) Section 30 of this 2009 Act and the amendments to section
27 of this 2009 Act by section 28 of this 2009 Act become
operative on the later of January 1, 2010, or the date on which
the Department of Human Services receives any federal approval
Enrolled House Bill 2116 (HB 2116-C) Page 10
required to secure federal financial participation under
subsection (1) of this section. + }
SECTION 33. { + (1) As used in this section, 'community health
center or safety net clinic' means a nonprofit medical clinic or
school-based health center that provides primary physical health,
vision, dental or mental health services to low-income patients
without charge or using a sliding scale based on the income of
the patient.
(2) The Department of Human Services shall award grants to
community health centers or safety net clinics 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.
(3) 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.
(4) Notwithstanding subsections (2) and (3) of this section,
the department shall provide funds for expansion and continuation
of school-based health centers.
(5) The department shall by rule adopt criteria for awarding
grants and providing funds under this section.
(6) The department shall analyze and evaluate the
implementation of the Health Care for All Oregon Children
program. + }
SECTION 34. { + (1) The Department of Human Services is
responsible for statewide outreach and marketing of the Health
Care for All Oregon Children program established in section 27 of
this 2009 Act and administered by the department and the Office
of Private Health Partnerships with the goal of enrolling in
those programs all eligible children residing in this state.
(2) To maximize the enrollment and retention of eligible
children in the Health Care for All Oregon Children program, 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) Children living in geographic isolation; and
(c) Children and family members with additional barriers to
accessing health care, such as cognitive, mental health or
sensory disorders, physical disabilities or chemical dependency,
and children experiencing homelessness. + }
SECTION 35. { + (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
Enrolled House Bill 2116 (HB 2116-C) Page 11
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 36. 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 { - , - } { + a category of
aid + } 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 - } { + .
(k) + } Is under the age of 22 years and is in a psychiatric
hospital.
{ - (k) - } { + (L) + } 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) - } { + (m) + } Is a member of a family that
received aid in the preceding month under ORS 412.006 or 412.014
Enrolled House Bill 2116 (HB 2116-C) Page 12
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) - } { + (n) + } Is an adopted person under 21 years
of age for whom a public agency is assuming financial
responsibility in whole or in part.
{ - (n) - } { + (o) + } 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) - } { + (p) + } 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) - } { + (q) + } 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) - } { + (r) + } 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 { + or XXI + } of the
federal Social Security Act.
{ - (r) - } { + (s) + } 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) - } { + (t) + } 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).
{ + (u) Is eligible for the Health Care for All Oregon
Children program established in section 27 of this 2009 Act. + }
(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 according to the standards
established pursuant to ORS 414.065, 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:
Enrolled House Bill 2116 (HB 2116-C) Page 13
(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 37. 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)(o) and (p) + };
(2) Pregnant women with incomes no more than 185 percent of the
federal poverty guidelines;
Enrolled House Bill 2116 (HB 2116-C) Page 14
(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 38. ORS 414.839 is amended to read:
414.839. { - (1) - } Subject to funds available, the
Department of Human Services may provide { - public
subsidies - } { + medical assistance in the form of 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 27 of this 2009 Act. + }
SECTION 39. 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;
Enrolled House Bill 2116 (HB 2116-C) Page 15
(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;
Enrolled House Bill 2116 (HB 2116-C) Page 16
(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;
Enrolled House Bill 2116 (HB 2116-C) Page 17
(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 - } { + Medical
assistance as defined in ORS 414.025 + };
(b) The { - Oregon State Children's Health Insurance
Program - } { + Health Care for All Oregon Children
program + }; or
(c) The Family Health Insurance Assistance Program established
in ORS 735.720 to 735.740.
(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 40. 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,
Enrolled House Bill 2116 (HB 2116-C) Page 18
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) Assessments paid to the Department of Consumer and
Business Services under sections 3 and 5 of this 2009 Act. + }
(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 pursuant to
ORS 731.804 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
Enrolled House Bill 2116 (HB 2116-C) Page 19
(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 41. ORS 411.708 is amended to read:
411.708. (1) The amount of any assistance paid under ORS
411.706 is a claim against the property or interest in the
property belonging to and a part of the estate of any deceased
recipient. If the deceased recipient has no estate, the estate of
the surviving spouse of the deceased recipient, if any, shall be
charged for assistance granted under ORS 411.706 to the deceased
recipient or the surviving spouse. There shall be no adjustment
or recovery of assistance correctly paid on behalf of any
deceased recipient under ORS 411.706 except after the death of
the surviving spouse of the deceased recipient, if any, and only
at a time when the deceased recipient has no surviving child who
is under 21 years of age or who is blind or has a disability.
Transfers of real or personal property by recipients of
assistance without adequate consideration are voidable and may be
set aside under ORS 411.620 (2).
(2) Except when there is a surviving spouse, or a surviving
child who is under 21 years of age or who is blind or has a
disability, the amount of any assistance paid under ORS 411.706
is a claim against the estate in any conservatorship proceedings
and may be paid pursuant to ORS 125.495.
(3) A claim under this section shall exclude benefits paid to
or on behalf of a beneficiary under a policy of qualified long
term care insurance, as defined in ORS 414.025 { - (2)(s) - }
{ + (2)(t) + }.
(4) Nothing in this section authorizes the recovery of the
amount of any assistance from the estate or surviving spouse of a
recipient to the extent that the need for assistance resulted
from a crime committed against the recipient.
SECTION 42. 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) - }
{ + (2)(s) + }, 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) - } { + (2)(s) + } 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
Enrolled House Bill 2116 (HB 2116-C) Page 20
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 43. ORS 414.428 is amended to read:
414.428. (1) An individual described in ORS 414.025
{ - (2)(r) - } { + (2)(s) + } 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)(a) + } if:
(a) The Department of Human Services receives 100 percent
federal medical assistance percentage for payments made by the
department for the health care services provided as part of the
benefit package described in ORS { - 414.835 - } { + 414.707
(1)(a) + } that are not included in the benefit package described
in ORS { - 414.834 - } { + 414.707 (3) + }; or
(b) The department 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 44. ORS 414.707 is amended to read:
414.707. (1) Subject to funds available:
(a) Persons who are categorically needy as described in ORS
414.025 { - (2)(n) and (o) - } { + (2)(o) and (p) + }, and
persons under 19 years of age and pregnant women who are eligible
to receive health services under ORS 414.706, are eligible to
receive all the health services approved and funded by the
Legislative Assembly.
(b) 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) - } { + (2)(o) and (p) + }, 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).
Enrolled House Bill 2116 (HB 2116-C) Page 21
(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 45. 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;
(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) { + , (L) + } and { - (m) - }
{ + (n) + }, 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) 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 46. ORS 414.712 is amended to read:
414.712. The Department of Human Services shall provide medical
assistance under ORS 414.705 to 414.750 to eligible persons who
receive assistance under ORS 411.706 and to children described in
ORS 414.025 (2)(f), (i), (j), (k) { + , (L) + } and { - (m) - }
{ + (n) + }, 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 shall also provide the following:
(1) Ombudsman services for eligible persons who receive
assistance under ORS 411.706. With the concurrence of the
Governor, the Director of Human Services 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 in writing at least once each quarter. A
report shall include a summary of the services that the ombudsman
Enrolled House Bill 2116 (HB 2116-C) Page 22
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 47. 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, 414.743 and 414.744
{ + and section 9 of this 2009 Act + }:
(1) 'Designated area' means a geographic area of the state
defined by the Department of Human Services 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 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 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 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 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 48. 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,
Enrolled House Bill 2116 (HB 2116-C) Page 23
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;
Enrolled House Bill 2116 (HB 2116-C) Page 24
(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;
(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
section 3 of this 2009 Act + } 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 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.
Enrolled House Bill 2116 (HB 2116-C) Page 25
(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 49. 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
section 30 of this 2009 Act + }.
SECTION 50. { + Notwithstanding section 9 (3), chapter 736,
Oregon Laws 2003, moneys in the Hospital Quality Assurance Fund
established under section 9, chapter 736, Oregon Laws 2003, that
were received by the Department of Human Services prior to
January 1, 2010, or if received on or after January 1, 2010, were
derived from an assessment liability incurred prior to October 1,
2009, may be used by the department:
(1) During the biennium beginning July 1, 2009, to supplant,
directly or indirectly, moneys appropriated to fund health
services by the Seventy-fifth Legislative Assembly during the
regular legislative session;
(2) To fund increased fee-for-service reimbursement rates for
inpatient and outpatient hospital services provided prior to
October 1, 2009; and
(3) To fund Medicaid cost settlements owed to hospitals due to
the increase in fee-for-service rates under subsection (2) of
this section. + }
SECTION 51. { + Sections 1 to 12, 15 and 29 of this 2009 Act,
the amendments to ORS 731.292 and 731.840 by sections 13 and 25
of this 2009 Act and the amendments to sections 2, 5, 9, 10, 12,
13, 14 and 51, chapter 736, Oregon Laws 2003, by sections 17, 18,
19, 20, 21, 22, 23 and 24 of this 2009 Act become operative on
October 1, 2009. + }
SECTION 52. { + 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. + }
----------
Passed by House June 8, 2009
...........................................................
Chief Clerk of House
...........................................................
Speaker of House
Passed by Senate June 11, 2009
...........................................................
President of Senate
Enrolled House Bill 2116 (HB 2116-C) Page 26
Received by Governor:
......M.,............., 2009
Approved:
......M.,............., 2009
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2009
...........................................................
Secretary of State
Enrolled House Bill 2116 (HB 2116-C) Page 27