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 686
House Bill 2128
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski for Department of Human Services)
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.
Eliminates sunset of Oregon Health Fund Board. Authorizes
Office for Oregon Health Policy and Research to require reporting
of health-related information from health insurers, third party
administrators and other specified entities.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to health planning; creating new provisions; amending
ORS 442.011 and 731.988 and sections 1 and 27, chapter 697,
Oregon Laws 2007; repealing section 28, chapter 697, Oregon
Laws 2007; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Section 1, chapter 697, Oregon Laws 2007, is amended
to read:
{ + Sec. 1. + } Sections 2 to { - 13 of this 2007 Act - }
{ + 8, chapter 697, Oregon Laws 2007, + } shall be known and
may be cited as the Healthy Oregon Act.
SECTION 2. Section 27, chapter 697, Oregon Laws 2007, is
amended to read:
{ + Sec. 27. + } Sections { - 1 to 13 of this 2007 Act - }
{ + 9 to 12, chapter 697, Oregon Laws 2007, + } are repealed on
January 2, 2010.
SECTION 3. { + Sections 4 and 5 of this 2009 Act are added to
and made a part of sections 2 to 8, chapter 697, Oregon Laws
2007. + }
SECTION 4. { + (1) To aid and advise the Oregon Health Fund
Board in the performance of its functions, the board may
establish such advisory and technical committees as the board
considers necessary for the development, implementation or
refinement of the Oregon Health Fund program comprehensive plan
in the following areas:
(a) Health care payment systems.
(b) Evidence-based health care practice guidelines and
comparative effectiveness of health treatments.
(c) A health insurance exchange.
(d) Medical malpractice insurance.
(2) The committees may be continuing or temporary. The board
shall determine the membership, terms and organization of the
committees and shall appoint their members.
(3) Members of the committees are not entitled to compensation,
but in the discretion of the board may be reimbursed from funds
available to the board for actual and necessary travel and other
expenses incurred by them in the performance of their official
duties in the manner and amount provided in ORS 292.495. + }
SECTION 5. { + (1) Upon legislative approval of the Oregon
Health Fund program comprehensive plan, the Oregon Health Fund
Board is authorized to request federal waivers deemed necessary
and appropriate to implement the comprehensive plan.
(2) Upon legislative approval of the comprehensive plan, the
board is authorized immediately to implement any elements
necessary to implement the plan that do not require legislative
changes or federal approval. + }
SECTION 6. ORS 442.011, as amended by section 15, chapter 697,
Oregon Laws 2007, is amended to read:
442.011. (1) There is created in the Department of Human
Services the Office for Oregon Health Policy and Research. The
Administrator of the Office for Oregon Health Policy and Research
shall be appointed by the Governor and the appointment shall be
subject to Senate confirmation in the manner prescribed in ORS
171.562 and 171.565. The administrator shall be an individual
with demonstrated proficiency in planning and managing programs
with complex public policy and fiscal aspects such as those
involved in the Oregon Health Plan. Before making the
appointment, the Governor must advise the President of the Senate
and the Speaker of the House of Representatives of the names of
at least three finalists and shall consider their recommendation
in appointing the administrator.
(2) In carrying out the responsibilities and duties of the
administrator, the administrator shall consult with and be
advised by the Oregon Health Policy Commission { + and the
Oregon Health Fund Board + }.
SECTION 7. { + As used in this section and section 8 of this
2009 Act, 'reporting entity' means:
(1) An insurer as defined in ORS 731.106 or fraternal benefit
society as described in ORS 748.106 required to have a
certificate of authority to transact health insurance business in
this state.
(2) A health care service contractor as defined in ORS 750.005
that issues medical insurance in this state.
(3) A third party administrator required to obtain a license
under ORS 744.702.
(4) A pharmacy benefit manager or fiscal intermediary, or other
person that is by statute, contract or agreement legally
responsible for payment of a claim for a health care item or
service.
(5) A prepaid managed care health services organization as
defined in ORS 414.736.
(6) An insurer providing coverage funded under Part A, Part B
or Part D of Title XVIII of the Social Security Act, subject to
approval by the United States Department of Health and Human
Services. + }
SECTION 8. { + (1) The Administrator of the Office for Oregon
Health Policy and Research shall establish and maintain a program
that requires reporting entities to report health care data for
the following purposes:
(a) Determining the maximum capacity and distribution of
existing resources allocated to health care.
(b) Identifying the demands for health care.
(c) Allowing health care policymakers to make informed choices.
(d) Evaluating the effectiveness of intervention programs in
improving health outcomes.
(e) Comparing the costs and effectiveness of various treatment
settings and approaches.
(f) Providing information to consumers and purchasers of health
care.
(g) Improving the quality and affordability of health care and
health care coverage.
(h) Assisting the administrator in furthering the health
policies expressed by the Legislative Assembly in ORS 442.025.
(2) The administrator shall adopt rules establishing the time,
place, form and manner of reporting information under this
section, including but not limited to:
(a) Requiring the use of unique patient and provider
identifiers; and
(b) Specifying a uniform coding system that reflects all health
care utilization, costs and resources in this state, and health
care utilization and costs for health care services provided to
Oregon residents in other states.
(3) The administrator shall adopt rules establishing the types
of information to be reported under this section, including but
not limited to:
(a) Health care claims and enrollment information used by
reporting entities and paid health care claims data; and
(b) Reports, data, schedules, statistics or other information
relating to health care costs, prices, quality, utilization or
resources determined by the administrator to be necessary to
carry out the purposes of this section.
(4) The administrator shall use data collected under this
section to provide information to consumers of health care to
empower the consumers to make economically sound and medically
appropriate decisions. The information must include, but not be
limited to, the prices and quality of health care services.
(5) The administrator may contract with a third party to
collect and process the health care data reported under this
section. The contract must prohibit the collection of Social
Security numbers and must prohibit the disclosure or use of the
data for any purpose other than those specifically authorized by
the contract. The contract must require the third party to
transmit all data collected and processed under the contract to
the Office for Oregon Health Policy and Research.
(6) The administrator shall facilitate a collaboration between
the Department of Human Services, the Department of Consumer and
Business Services and interested stakeholders to develop a
comprehensive health care information system using the
information reported under this section and collected by the
office under ORS 442.120 and 442.400 to 442.463. The
administrator, in consultation with interested stakeholders,
shall:
(a) Formulate the data sets that will be included in the
system;
(b) Establish the criteria and procedures for the development
of limited use data sets;
(c) Establish the criteria and procedures to ensure that
limited use data sets are accessible and compliant with federal
and state privacy laws; and
(d) Establish a time frame for the creation of the
comprehensive health care information system.
(7) Information disclosed through the comprehensive health care
information system described in subsection (6) of this section:
(a) Shall be available as a resource to insurers, employers,
providers, purchasers of health care and state agencies to allow
for continuous review of health care utilization, expenditures
and performance in this state;
(b) Shall be available to Oregon programs for quality in health
care for use in improving health care in Oregon, subject to rules
prescribed by the administrator conforming to state and federal
privacy laws or limiting access to limited use data sets;
(c) Shall be presented to allow for comparisons of geographic,
demographic and economic factors and institutional size;
(d) May not disclose any data that contains direct personal
identifiers such as names, addresses, electronic mail addresses,
telephone numbers or Social Security numbers; and
(e) May not disclose trade secrets of reporting entities.
(8) The collection, storage and release of health care data and
other information under this section is subject to the
requirements of the federal Health Insurance Portability and
Accountability Act. + }
SECTION 9. { + (1) Any reporting entity that fails to report
as required in section 8 of this 2009 Act or rules of the Office
for Oregon Health Policy and Research adopted pursuant to section
8 of this 2009 Act may be subject to a civil penalty.
(2) The Administrator of the Office for Oregon Health Policy
and Research shall adopt a schedule of penalties not to exceed
$500 per day of violation, determined by the severity of the
violation.
(3) Civil penalties under this section shall be imposed as
provided in ORS 183.745.
(4) Civil penalties imposed under this section may be remitted
or mitigated upon such terms and conditions as the administrator
considers proper and consistent with the public health and
safety.
(5) Civil penalties incurred under any law of this state are
not allowable as costs for the purpose of rate determination or
for reimbursement by a third-party payer. + }
SECTION 10. ORS 731.988 is amended to read:
731.988. (1) { - Any person who violates any provision of the
Insurance Code, any lawful rule or final order of the Director of
the Department of Consumer and Business Services or any judgment
made by any court upon application of the director, shall forfeit
and pay to the General Fund of the State Treasury a civil penalty
in an amount determined by the director of not more than $10,000
for each offense. In the case of individual insurance producers,
adjusters or insurance consultants, the civil penalty shall be
not more than $1,000 for each offense. Each violation shall be
deemed a separate offense. - } { + A person shall forfeit and
pay to the General Fund of the State Treasury a civil penalty in
an amount determined by the Director of the Department of
Consumer and Business Services of not more than $10,000 for each
violation of:
(a) Any provision of the Insurance Code;
(b) Any lawful rule or final order of the director;
(c) Any judgment made by a court upon application made by the
director; or
(d) Any rule adopted by the Administrator of the Office for
Oregon Health Policy and Research for the reporting of
information pursuant to section 8 of this 2009 Act. + }
(2) In addition to the civil penalty set forth in subsection
(1) of this section, any person who violates any provision of the
Insurance Code, any lawful rule or final order of the director or
any judgment made by any court upon application of the director,
may be required to forfeit and pay to the General Fund of the
State Treasury a civil penalty in an amount determined by the
director but not to exceed the amount by which such person
profited in any transaction which violates any such provision,
rule, order or judgment.
(3) In addition to the civil penalties set forth in subsections
(1) and (2) of this section, any insurer that is required to make
a report under ORS 742.400 and that fails to do so within the
specified time may be required to pay to the General Fund of the
State Treasury a civil penalty in an amount determined by the
director but not to exceed $10,000.
(4) A civil penalty imposed under this section may be recovered
either as provided in subsection (5) of this section or in an
action brought in the name of the State of Oregon in any court of
appropriate jurisdiction.
(5) Civil penalties under this section shall be imposed and
enforced in the manner provided by ORS 183.745.
(6) The provisions of this section are in addition to and not
in lieu of any other enforcement provisions contained in the
Insurance Code.
SECTION 11. { + Section 28, chapter 697, Oregon Laws 2007, is
repealed. + }
SECTION 12. { + 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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