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 994
House Bill 2117
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 as
introduced.
Creates Healthy Kids Plan, which includes private health option
to provide affordable, accessible health care to children.
Imposes duties on Department of Human Services and Office of
Private Health Partnerships to carry out plan.
Requires prepaid managed care health services organization to
reimburse community health center or safety net clinic for
services provided by center or clinic to enrollee of
organization.
Establishes Private Health Option Program Account.
Continuously appropriates moneys in account to Office of Private
Health Partnerships for purposes of administering private health
option.
Establishes Healthy Kids Plan Fund. Continuously appropriates
moneys in fund to Department of Human Services for purposes of
Healthy Kids Plan.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to health; creating new provisions; amending ORS
414.025, 414.725, 414.839, 735.701 and 735.710; appropriating
money; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Sections 2 and 3 of this 2009 Act are added to
and made a part of ORS chapter 414. + }
SECTION 2. { + (1) The Healthy Kids Plan is created to provide
affordable, accessible health care for Oregon's children. The
plan is composed of:
(a) Medical assistance administered by the Department of Human
Services under the state programs funded by Title XIX of the
Social Security Act, under the State Children's Health Insurance
Program funded by Title XXI of the Social Security Act and under
state programs funded by the Legislative Assembly; and
(b) A private health option administered by the Office of
Private Health Partnerships under sections 9, 10, 11 and 12 of
this 2009 Act.
(2) A child or a person authorized to act on behalf of a child
may apply to the department for a determination of the child's
eligibility for the Healthy Kids Plan.
(3) When an application is received by the department under
subsection (2) of this section, the department shall determine
whether the child is eligible for medical assistance. If an
eligible child's family income is at or below 200 percent of the
federal poverty guidelines, the department shall enroll the child
in the appropriate medical assistance program referred to in
subsection (1)(a) of this section.
(4) If the department determines that a child for whom
application has been made under subsection (2) of this section is
not eligible for medical assistance but is eligible for
enrollment in the private health option described in section 10
of this 2009 Act, the department shall transfer the application
to the office to complete the enrollment process.
(5) The department shall adopt rules for annually renewing
enrollment in the Healthy Kids Plan.
(6) The department and the office shall streamline and simplify
the application process for the Healthy Kids Plan, by means
including the development and implementation of an online
application process for the plan. + }
SECTION 3. { + (1) A child is eligible for enrollment in the
Healthy Kids Plan only if the income of the child's family is at
or below 200 percent of the federal poverty guidelines.
(2)(a) The Department of Human Services may by rule require a
period of uninsurance prior to enrollment.
(b) The department may adopt rules specifying exceptions to any
period of uninsurance required pursuant to paragraph (a) of this
subsection.
(c) As used in this subsection, 'period of uninsurance ' means
a time during which a person is not enrolled in an unsubsidized
or privately funded health benefit plan.
(3) The department may not impose an asset requirement for
enrollment in the Healthy Kids Plan. + }
SECTION 4. Section 3 of this 2009 Act is amended to read:
{ + Sec. 3. + } (1) A child is eligible for enrollment in the
Healthy Kids Plan only if the income of the child's family is at
or below
{ - 200 - } { + 300 + } percent of the federal poverty
guidelines.
(2)(a) The Department of Human Services may by rule require a
period of uninsurance prior to enrollment.
(b) The department may adopt rules specifying exceptions to any
period of uninsurance required pursuant to paragraph (a) of this
subsection.
(c) As used in this subsection, 'period of uninsurance ' means
a time during which a person is not enrolled in an unsubsidized
or privately funded health benefit plan.
{ + (3) Notwithstanding subsection (1) of this section, a
child whose family's income is above 300 percent of the federal
poverty guidelines shall be offered the opportunity to purchase a
private insurance product offered through the Health Kids
Plan. + }
{ - (3) - } { + (4) + } The department may not impose an
asset requirement for enrollment in the Healthy Kids Plan.
SECTION 5. ORS 414.025, as amended by section 18a, chapter 861,
Oregon Laws 2007, is amended to read:
414.025. As used in this chapter, unless the context or a
specially applicable statutory definition requires otherwise:
(1) 'Category of aid' means assistance provided by the Oregon
Supplemental Income Program, aid granted under ORS 412.001 to
412.069 and 418.647 or federal Supplemental Security Income
payments.
(2) 'Categorically needy' means, insofar as funds are available
for the category, a person who is a resident of this state and
who:
(a) Is receiving a category of aid.
(b) Would be eligible for, but is not receiving a category of
aid.
(c) Is in a medical facility and, if the person left such
facility, would be eligible for a category of aid.
(d) Is under the age of 21 years and would be a dependent child
as defined in ORS 412.001 except for age and regular attendance
in school or in a course of professional or technical training.
(e)(A) Is a caretaker relative, as defined in ORS 412.001, who
cares for a child who would be a dependent child except for age
and regular attendance in school or in a course of professional
or technical training; or
(B) Is the spouse of the caretaker relative.
(f) Is under the age of 21 years, is in a foster family home or
licensed child-caring agency or institution under a purchase of
care agreement and is one for whom a public agency of this state
is assuming financial responsibility, in whole or in part.
(g) Is a spouse of an individual receiving a category of aid
and who is living with the recipient of a category of aid, whose
needs and income are taken into account in determining the cash
needs of the recipient of a category of aid, and who is
determined by the Department of Human Services to be essential to
the well-being of the recipient of a category of aid.
(h) Is a caretaker relative as defined in ORS 412.001 who cares
for a dependent child receiving aid granted under ORS 412.001 to
412.069 and 418.647 or is the spouse of the caretaker relative.
(i) Is under the age of 21 years, is in a youth care center and
is one for whom a public agency of this state is assuming
financial responsibility, in whole or in part.
(j) Is under the age of 21 years and is in an intermediate care
facility which includes institutions for persons with mental
retardation; or is under the age of 22 years and is in a
psychiatric hospital.
(k) Is under the age of 21 years and is in an independent
living situation with all or part of the maintenance cost paid by
the Department of Human Services.
(L) Is a member of a family that received aid in the preceding
month under ORS 412.006 or 412.014 and became ineligible for aid
due to increased hours of or increased income from employment. As
long as the member of the family is employed, such families will
continue to be eligible for medical assistance for a period of at
least six calendar months beginning with the month in which such
family became ineligible for assistance due to increased hours of
employment or increased earnings.
(m) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in
part.
(n) Is an individual or is a member of a group who is required
by federal law to be included in the state's medical assistance
program in order for that program to qualify for federal funds.
(o) Is an individual or member of a group who, subject to the
rules of the department and within available funds, may
optionally be included in the state's medical assistance program
under federal law and regulations concerning the availability of
federal funds for the expenses of that individual or group.
(p) Is a pregnant woman who would be eligible for aid granted
under ORS 412.001 to 412.069 and 418.647, whether or not the
woman is eligible for cash assistance.
(q) Except as otherwise provided in this section and to the
extent of available funds, is a pregnant woman or child for whom
federal financial participation is available under Title XIX of
the federal Social Security Act.
(r) Is not otherwise categorically needy and is not eligible
for care under Title XVIII of the federal Social Security Act or
is not a full-time student in a post-secondary education program
as defined by the Department of Human Services by rule, but whose
family income is less than the federal poverty level and whose
family investments and savings equal less than the investments
and savings limit established by the department by rule.
(s) Would be eligible for a category of aid but for the receipt
of qualified long term care insurance benefits under a policy or
certificate issued on or after January 1, 2010. As used in this
paragraph, 'qualified long term care insurance' means a policy or
certificate of insurance as defined in ORS 743.652 (6).
{ + (3) 'Child' means a person under 19 years of age.
(4) 'Health benefit plan' has the meaning given that term in
ORS 735.720. + }
{ - (3) - } { + (5) + } 'Income' has the meaning given that
term in ORS 411.704.
{ - (4) - } { + (6) + } '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) - } { + (7) + } '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:
(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) - } { + (8) + } '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) - } { + (9) + } '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) - } { + (10) + } '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 6. ORS 414.725 is amended to read:
414.725. (1)(a) Pursuant to rules adopted by the Department of
Human Services, the department shall execute prepaid managed care
health services contracts for health services funded by the
Legislative Assembly. The contract must require that all services
are provided to the extent and scope of the Health Services
Commission's report for each service provided under the contract.
The contracts are not subject to ORS chapters 279A and 279B,
except ORS 279A.250 to 279A.290 and 279B.235. Notwithstanding ORS
414.720 (8), the rules adopted by the department shall establish
timelines for executing the contracts described in this
paragraph.
(b) It is the intent of ORS 414.705 to 414.750 that the state
use, to the greatest extent possible, prepaid managed care health
services organizations to provide physical health, dental, mental
health and chemical dependency services under ORS 414.705 to
414.750.
(c) The department shall solicit qualified providers or plans
to be reimbursed for providing the covered services. The
contracts may be with hospitals and medical organizations, health
maintenance organizations, managed health care plans and any
other qualified public or private prepaid managed care health
services organization. The department may not discriminate
against any contractors that offer services within their
providers' lawful scopes of practice.
(d) The department shall establish annual financial reporting
requirements for prepaid managed care health services
organizations. The department shall prescribe a reporting
procedure that elicits sufficiently detailed information for the
department to assess the financial condition of each prepaid
managed care health services organization and that includes
information on the three highest executive salary and benefit
packages of each prepaid managed care health services
organization.
(e) The department shall require compliance with the provisions
of paragraph (d) of this subsection as a condition of entering
into a contract with a prepaid managed care health services
organization.
(2) The department may institute a fee-for-service case
management system or a fee-for-service payment system for the
same physical health, dental, mental health or chemical
dependency services provided under the health services contracts
for persons eligible for health services under ORS 414.705 to
414.750 in designated areas of the state in which a prepaid
managed care health services organization is not able to assign
an enrollee to a person or entity that is primarily responsible
for coordinating the physical health, dental, mental health or
chemical dependency services provided to the enrollee. In
addition, the department may make other special arrangements as
necessary to increase the interest of providers in participation
in the state's managed care system, including but not limited to
the provision of stop-loss insurance for providers wishing to
limit the amount of risk they wish to underwrite.
(3) As provided in subsections (1) and (2) of this section, the
aggregate expenditures by the department for health services
provided pursuant to ORS 414.705 to 414.750 may not exceed the
total dollars appropriated for health services under ORS 414.705
to 414.750.
(4) Actions taken by providers, potential providers,
contractors and bidders in specific accordance with ORS 414.705
to 414.750 in forming consortiums or in otherwise entering into
contracts to provide health care services shall be performed
pursuant to state supervision and shall be considered to be
conducted at the direction of this state, shall be considered to
be lawful trade practices and may not be considered to be the
transaction of insurance for purposes of the Insurance Code.
(5) Health care providers contracting to provide services under
ORS 414.705 to 414.750 shall advise a patient of any service,
treatment or test that is medically necessary but not covered
under the contract if an ordinarily careful practitioner in the
same or similar community would do so under the same or similar
circumstances.
(6) A prepaid managed care health services organization shall
provide information on contacting available providers to an
enrollee in writing within 30 days of assignment to the health
services organization.
(7) Each prepaid managed care health services organization
shall provide upon the request of an enrollee or prospective
enrollee annual summaries of the organization's aggregate data
regarding:
(a) Grievances and appeals; and
(b) Availability and accessibility of services provided to
enrollees.
(8) A prepaid managed care health services organization may not
limit enrollment in a designated area based on the zip code of an
enrollee or prospective enrollee.
{ + (9)(a) A prepaid managed care health services
organization shall reimburse a qualified community health center
or safety net clinic for covered services provided by the center
or clinic to an enrollee of the organization participating in the
Healthy Kids Plan established under section 2 of this 2009 Act.
The department by rule shall adopt standards for qualifying
community health centers and safety net clinics to receive
reimbursement under this subsection.
(b) As used in this subsection, '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 fee scale based on the income
of the patient. + }
SECTION 7. ORS 414.839 is amended to read:
414.839. (1) Subject to funds available, the Department of
Human Services may provide public subsidies for the purchase of
health insurance coverage provided by public programs or private
insurance, including but not limited to the Family Health
Insurance Assistance Program, for currently uninsured individuals
{ - based on incomes up to 200 - } { + whose incomes are at
or below 200 + } percent of the federal poverty { - level - }
{ + guidelines and currently uninsured children whose family
incomes are at or below 300 percent of the federal poverty
guidelines + }. The objective is to create a transition from
dependence on public programs to privately financed health
insurance.
(2) Public subsidies shall apply only to health benefit plans
that meet or exceed the basic benchmark health benefit plan or
plans established under ORS 735.733.
(3) Cost sharing shall be permitted and structured in such a
manner to encourage appropriate use of preventive care and
avoidance of unnecessary services.
(4) Cost sharing shall be based on an individual's ability to
pay and may not exceed the cost of purchasing a plan.
(5) The state may pay a portion of the cost of the subsidy,
based on the individual's income and other resources.
SECTION 8. { + (1) The Department of Human Services is
responsible for statewide outreach and marketing related to the
Healthy Kids Plan established under section 2 of this 2009 Act in
coordination with the Office of Private Health Partnerships.
(2) In addition to the duties described in subsection (1) of
this section, to maximize the enrollment and retention of
eligible children in the Healthy Kids Plan, the department shall
develop and administer a grant program to provide funding to
organizations and local groups for outreach and enrollment
activities.
(3) The department shall develop and administer an application
assistance program to pay fees to entities that assist
individuals with the application process, resulting in successful
eligibility and enrollment outcomes, as determined by the
department.
(4) The criteria to award grants and pay fees under subsections
(2) and (3) of this section shall include, but are not limited
to, the extent to which a grantee or entity:
(a) Provides information and assistance within diverse
geographic areas or to culturally diverse communities in this
state, including communities that need the information and
assistance provided in alternative formats and languages other
than English;
(b) Provides assistance with the application process;
(c) Provides assistance to individuals and families in
enrolling and maintaining enrollment in the Healthy Kids Plan;
and
(d) Is successful in enrolling children in the Healthy Kids
Plan. + }
SECTION 9. { + As used in sections 10, 11 and 12 of this 2009
Act:
(1) 'Carrier' has the meaning given that term in ORS 735.700.
(2) 'Child' means a person under 19 years of age.
(3) 'Health benefit plan' has the meaning given that term in
ORS 735.720. + }
SECTION 10. { + (1) The Office of Private Health Partnerships
shall administer a private health option to expand private health
care coverage for Oregon's children.
(2) The office shall contract with carriers to provide health
benefit plans approved under section 11 of this 2009 Act. The
office shall manage the collection and the payment of premiums
for children participating in the plans.
(3) A child whose family income is more than 200 percent but
not more than 300 percent of the federal poverty guidelines
qualifies for a subsidy to enable the child to enroll in:
(a) A health benefit plan offered through the private health
option under subsection (2) of this section; or
(b) An employer-sponsored health benefit plan that is available
to the child and that meets or exceeds the requirements for a
basic benchmark health benefit plan under ORS 735.733.
(4) The office shall adopt rules for determining the subsidies
to be paid under this section based upon the following factors:
(a) The income of the child's family;
(b) Family size; and
(c) Other factors established by the office.
(5) The office shall adopt rules under which families whose
incomes are more than 300 percent of the federal poverty
guidelines may purchase for their children health benefit plans
offered through the private health option. + }
SECTION 11. { + (1) The Office of Private Health Partnerships
must approve health benefit plans before they may be offered
through the private health option described in section 10 (3)(a)
of this 2009 Act. To be approved, health benefit plans must offer
benefit packages comparable to those provided under section 2
(1)(a) of this 2009 Act and must cover mental health, vision and
dental services.
(2) Approved health benefit plans may impose copayments or
co-insurance amounts that are based upon a family's ability to
pay as determined according to criteria adopted by the office by
rule.
(3) Approved health benefit plans may not exclude coverage of
pre-existing conditions. + }
SECTION 12. { + Notwithstanding eligibility criteria and
subsidy amounts determined pursuant to section 10 of this 2009
Act, the Office of Private Health Partnerships shall provide
subsidies 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
subsidies. + }
SECTION 13. { + The Office for Oregon Health Policy and
Research shall analyze and evaluate the implementation of the
Healthy Kids Plan established under section 2 of this 2009 Act
and report its findings to the Legislative Assembly every two
years in the manner provided by ORS 192.245. The report must
include at least the following information for the preceding
two-year period:
(1) An estimate of the number of children who are eligible for
but not enrolled in the plan;
(2) The number of children enrolled in the plan;
(3) The number of children disenrolled from the plan and the
reasons for disenrollment;
(4) A description of any identified barriers to enrolling or
maintaining enrollment of children in the plan and a description
of the strategies developed by the office and the Department of
Human Services to overcome the barriers;
(5) An estimate of the number of families who have voluntarily
discontinued employer-sponsored dependent health coverage and
enrolled their children in the plan; and
(6) The results of a survey conducted by or contracted for by
the office that assesses the accessibility of health care for
individuals under 19 years of age, the experience of such
individuals with their health care and the health status of such
individuals. + }
SECTION 14. { + There is established in the State Treasury,
separate and distinct from the General Fund, the Private Health
Option Program Account, which consists of moneys appropriated to
the account by the Legislative Assembly and all moneys
transferred as reimbursements to the account by the Department of
Human Services under section 17 of this 2009 Act. Interest earned
by the Private Health Option Program Account shall be credited to
the account. All moneys in the Private Health Option Program
Account are continuously appropriated to the Office of Private
Health Partnerships to carry out the provisions of sections 10,
11 and 12 of this 2009 Act. + }
SECTION 15. { + (1) Except as otherwise provided in this
section and ORS 735.710, the Office of Private Health
Partnerships and the Department of Human Services may not
disclose information provided as part of an application for
enrollment in the Healthy Kids Plan established under section 2
of this 2009 Act except for purposes directly connected with the
administration of the plan.
(2) The office and the department may exchange applicant
information with other state and federal agencies for the
purposes of determining eligibility for and administering the
Healthy Kids Plan, identifying economic trends relevant to
administration of the plan and providing the report required by
section 13 of this 2009 Act.
(3) In accordance with applicable state and federal law, the
office or the department may request that applicants provide
their Social Security numbers and may use those numbers in the
administration of the Healthy Kids Plan. + }
SECTION 16. { + (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 for
implementing sections 2, 3, 10 and 11 of this 2009 Act, the
amendments to section 3 of this 2009 Act by section 4 of this
2009 Act and the amendments to ORS 414.725 and 414.839 by
sections 6 and 7 of this 2009 Act.
(2) The department shall adopt rules implementing sections 2
and 3 of this 2009 Act as soon as practicable after receipt of
the necessary federal approval. The Office of Private Health
Partnerships shall adopt rules implementing sections 9, 10, 11
and 12 of this 2009 Act as soon as practicable after receipt of
the necessary federal approval. + }
SECTION 17. { + (1) The Healthy Kids Plan Fund is established
in the State Treasury, separate and distinct from the General
Fund. Interest earned by the Healthy Kids Plan Fund shall be
credited to the fund.
(2) Moneys in the Healthy Kids Plan Fund are continuously
appropriated to the Department of Human Services for purposes of
the Healthy Kids Plan established under section 2 of this 2009
Act.
(3) Notwithstanding subsection (2) of this section, if and to
the extent that the Legislative Assembly determines that the
Healthy Kids Plan is fully funded, moneys in the Healthy Kids
Plan Fund established by this section may be used, in amounts
determined by the Legislative Assembly, to fund other health
services provided by the department with funds from Titles XIX
and XXI of the Social Security Act.
(4) The department shall develop a system for reimbursement by
the department to the Office of Private Health Partnerships for
costs associated with administering the private health option of
the Healthy Kids Plan. + }
SECTION 18. 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 2, 3, 8, 9, 10, 11, 12 and 15 of this 2009 Act + }.
SECTION 19. ORS 735.710 is amended to read:
735.710. (1) In carrying out its duties under ORS 735.700 to
735.714 and 735.720 to 735.740 { + and sections 2, 3, 8, 9, 10,
11, 12 and 15 of this 2009 Act + }, the Office of Private Health
Partnerships shall:
(a) Enter into contracts for administration of ORS 735.700 to
735.714 and 735.720 to 735.740 { + and sections 2, 3, 8, 9, 10,
11, 12 and 15 of this 2009 Act + }, including collection of
premiums and paying carriers.
(b) Retain consultants and employ staff.
(c) Enter into contracts with carriers or health care providers
for health benefit plans, including contracts where final payment
may be reduced if usage is below a level fixed in the contract.
(d) Set premium rates for eligible employees and small
employers.
(e) Perform other duties to provide low-cost health benefit
plans of types likely to be purchased by small employers.
(f) Establish contributions to be paid by small employers
toward the premiums incurred on behalf of covered eligible
employees.
(g) Establish procedures by rule for the publication or release
of aggregate data relating to:
(A) Applicants for enrollment and persons enrolled in the
Family Health Insurance Assistance Program;
(B) Health benefit plans for small employers offered by the
office; and
(C) Other programs operated by the office.
(2) Notwithstanding any other health benefit plan contracted
for and offered by the office, the office shall contract for a
health benefit plan or plans best designed to meet the needs and
provide for the welfare of eligible employees and small
employers.
(3) The office may approve more than one carrier for each type
of plan contracted for and offered, but the number of carriers
shall be held to a number consistent with adequate service to
eligible employees and family members.
(4) Where appropriate for a contracted and offered health
benefit plan, the office shall provide options under which an
eligible employee may arrange coverage for family members of the
employee.
(5) In developing any health benefit plan, the office may
provide an option of additional coverage for eligible employees
and family members at an additional cost or premium.
(6) Transfer of enrollment from one health benefit plan to
another shall be open to all eligible employees and family
members under rules adopted by the office.
(7) If the office requests less health care service or benefit
than is otherwise required by state law, a carrier is not
required to offer such service or benefit.
(8) Health benefit plans for small employers contracted for and
offered by the office must provide a sufficient level of benefits
to be eligible for a subsidy under ORS 735.724.
(9) The office may employ whatever means are reasonably
necessary to carry out the purposes of ORS 735.700 to 735.714 and
735.720 to 735.740 { + and sections 2, 3, 8, 9, 10, 11, 12 and
15 of this 2009 Act + }. Such authority includes but is not
limited to authority to seek clarification, amendment,
modification, suspension or termination of any agreement or
contract that in the office's judgment requires such action.
SECTION 20. { + Sections 1, 8, 13 and 15 of this 2009 Act
become operative on July 1, 2009. + }
SECTION 21. { + Sections 2, 3, 9, 11 and 12 of this 2009 Act
and the amendments to ORS 414.025, 414.725, 735.701 and 735.710
by sections 5, 6, 18 and 19 of this 2009 Act become 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 section 16 of this 2009 Act. + }
SECTION 22. { + Section 10 of this 2009 Act, the amendments to
section 3 of this 2009 Act by section 4 of this 2009 Act and the
amendments to ORS 414.839 by section 7 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 section
16 of this 2009 Act. + }
SECTION 23. { + The Department of Human Services shall notify
the Legislative Counsel upon receipt of approval or denial of any
federal authorization necessary to implement the Healthy Kids
Plan established under section 2 of this 2009 Act with federal
financial participation. + }
SECTION 24. { + This 2009 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2009 Act takes effect on
its passage. + }
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