75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
HA to HB 3418
LC 2506/HB 3418-2
HOUSE AMENDMENTS TO
HOUSE BILL 3418
By COMMITTEE ON HEALTH CARE
May 4
On page 1 of the printed bill, delete lines 4 through 29.
On page 2, delete lines 1 through 20 and insert:
' Whereas the Legislative Assembly directs the purchase of
billions of dollars of health care and state government is the
biggest consumer of health care in Oregon, and it is time for the
state to pay for health care in an intelligent way; and
' Whereas starting with primary care, we need to reform what
and how we pay for health services, and it is time to see primary
care as an investment with a financial return of fewer visits to
hospital emergency rooms and episodes of acute care; and
' Whereas it is time to buy primary care that is focused on
prevention and case management that will promote good health; and
' Whereas it is time to reward culturally competent,
patient-centered health coordination; and
' Whereas it is time to integrate physical, behavioral and oral
health; and
' Whereas it is time to include public health, school-based
health centers and mental health services in our insurance-based
payment system; and
' Whereas people will make most of their health choices at
home, but payment for health care ends at the clinic door; and
' Whereas active case management is a way to maintain a
connection between clinics and patients, from assisting patients
in making choices as significant as follow-up on medication or
physical therapy, to coaching patients on good eating habits and
coping with depression, encouraging exercise and providing
support for anger management; and
' Whereas effective case management brings health care into its
most timely and appropriate setting, namely the home and
community, and reduces the costs associated with any health care
visit; and
' Whereas the current reimbursement structure rewards medical
interventions as revenue generators and discourages primary and
preventive care services by nonpayment or underpayment; and
' Whereas the current primary care workforce is in crisis, due
in part to the reimbursement levels for primary care; and
' Whereas reforming this system to reward primary and
preventive care as revenue generators will translate into better
health outcomes, fewer medical interventions and a system with
less overall expense; and
' Whereas we have the research and evidence to know what works
well, and Oregon has examples of primary care successes at the
local level; and
' Whereas when primary care is well organized, a patient visit
is an opportunity to spend time assessing and addressing all of a
patient's needs, not just the need that prompted the visit,
thereby reducing the incidents of delayed care, which add cost to
the system; and
' Whereas it is time to set a clear direction for the state to
expect quality care to become the norm; and
' Whereas any transition will take some time, as these reforms
will need to be phased into any purchasing strategy; and
' Whereas the current health care system in the United States
is not sustainable due to rising costs and an increasing number
of uninsured individuals; and
' Whereas the number of visits to hospital emergency rooms
continues to grow, and a significant number of these visits are
for nonurgent or preventable conditions; and
' Whereas the health care system is fragmented, access to care
is episodic and relationships between patients and providers are
strained; and
' Whereas current systems for financing primary care emphasize
10- to 15-minute office visits and fail to support
patient-centered care that could improve patients' health status
and lower overall costs to the broader health care system; now,
therefore,'.
Delete lines 22 through 45 and delete pages 3 and 4 and insert:
' { + SECTION 1. + } { + (1) As used in this section,
'primary care home ' means a primary care delivery system,
including, but not limited to, health care safety net clinics,
private practice clinics and clinics owned by hospitals that
promote at least the following elements:
' (a) The patient and the patient-provider relationship are at
the center of all health care activities.
' (b) The patient may access care when and in the manner the
patient needs in a variety of ways, including by telephone,
electronically and same-day visits.
' (c) A team approach to patient-centered care is maximized,
supporting all provider team members to utilize the full scope of
the provider team members' licenses.
' (d) Behavioral health providers are integrated into the
primary care delivery system, but are not necessarily in the same
location as physical health services.
' (e) Provider teams provide care in a culturally competent
manner. Translation and other services that reflect cultural
sensitivity are provided as needed.
' (f) The care is managed and coordinated across the system of
community services, when feasible, so that all of the patient's
health needs are met, including, but not limited to, facilitating
access to necessary specialty and hospital care, nutrition and
homeless services.
' (g) Proactive, comprehensive care is provided for the
populations served.
' (h) Nursing services have an expanded role in the delivery of
primary care, including, but not limited to, care coordination,
telephone outreach, school-based health, home visits, telephone
triage and clinical case management, and coordination of
information-sharing among various providers in communities.
' (i) Strategies designed to hold patients accountable for
adhering to the patients' health goals are implemented.
' (j) Case management for managing chronic diseases, behavioral
health and end-of-life care is efficient and timely and is both
population based and patient centered.
' (2) No later than June 30, 2010, the Department of Human
Services shall report to the appropriate interim committees of
the Legislative Assembly on the feasiblity of implementation of a
system for reimbursement for health care delivered through
primary care homes in the Medicaid program. If feasible, the
reimbursement system shall include:
' (a) Use of the existing Medicare codes or development of
unique payment codes, including valuing services performed by
nurses and behaviorists;
' (b) Payment for the establishment and use of team-based care
that links the patient to a personal health care provider who
identifies the patient's health needs, helps the patient access
appropriate care and works with a team of health professionals to
address all of the patient's health care needs;
' (c) Preventive, educational, diagnostic care, care management
and follow-up social services coordination; and
' (d) Home visits for case management services and the use of
technologies to allow patients to access to personal health care
from remote locations.
' (3) The department may develop additional incentive
improvement payments for managed care capitation rates and
payments for fee-for-service that are based on the goal of
transforming the current primary care delivery system to improve
the population's health outcomes, including:
' (a) Incentives to encourage the integration of primary, oral
and behavioral health care;
' (b) Performance payments that are based on the health of the
entire patient population of the provider or system;
' (c) Incentives to enable providers to utilize evidence-based
best practices;
' (d) Incentives to enable and reward improved health outcomes;
and
' (e) Incentives to participate in a learning
collaborative. + }
' { + SECTION 2. + } { + 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 section 1 of this 2009 Act. + }
' { + SECTION 3. + } { + Sections 1 and 2 of this 2009 Act
are repealed on January 2, 2012. + }
' { + SECTION 4. + } { + 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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