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 2506
 
                           A-Engrossed
 
                         House Bill 3418
                   Ordered by the House May 4
             Including House Amendments dated May 4
 
Sponsored by Representative MAURER, Senators BATES, MORSE;
  Representatives BAILEY, BRUUN, GREENLICK, STIEGLER, Senators
  MONNES ANDERSON, TELFER
 
 
                             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.
 
    { - Requires Department of Human Services to develop payment
system to promote health care delivery through integrated health
homes for medical assistance recipients. Requires department to
create Integrated Health Home Collaborative Program pilot project
for testing new system for payment to fee-for-service primary
care providers. - }
   { +  Requires Department of Human Services to report to
appropriate interim committees of Legislative Assembly on
feasibility of implementation of system for reimbursement for
health care delivered through primary care homes in Medicaid
program. Directs department to apply to Centers for Medicare and
Medicaid Services for purpose of obtaining federal financing for
system.
  Authorizes department to develop specified means of payment to
improve current primary care delivery system. + }
  Declares emergency, effective on passage.
 
                        A BILL FOR AN ACT
Relating to reimbursement for health care delivered through an
  integrated health home model; and declaring an emergency.
  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,
Be It Enacted by the People of the State of Oregon:
  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 feasibility 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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