Chapter 417
Oregon Laws 2011
AN ACT
SB 201
Relating to
medical assistance; creating new provisions; amending ORS 414.736 and 416.510;
repealing section 8, chapter 886, Oregon Laws 2009; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Sections 2 and 3 of
this 2011 Act are added to and made a part of ORS chapter 414.
SECTION 2. (1) A prepaid managed
care health services organization that contracts with the Oregon Health
Authority must maintain a network of providers sufficient in numbers and areas
of practice and geographically distributed in a manner to ensure that the
health services provided under the contract are reasonably accessible to
enrollees.
(2) An enrollee may transfer from one
organization to another organization no more than once during each enrollment
period.
SECTION 3. (1) The Oregon Health
Authority may approve the transfer of 500 or more enrollees from one prepaid
managed care health services organization to another prepaid managed care health
services organization if:
(a) The enrollees’ provider has
contracted with the receiving organization and has stopped accepting patients
from or has terminated providing services to enrollees in the transferring
organization; and
(b) Enrollees are offered the choice
of remaining enrolled in the transferring organization.
(2) Enrollees may not be transferred
under this section until the authority has evaluated the receiving organization
and determined that the organization meets criteria established by the
authority by rule, including but not limited to criteria that ensure that the
organization meets the requirements of section 2 (1) of this 2011 Act.
(3) The authority shall provide notice
of a transfer under this section to enrollees that will be affected by the
transfer at least 90 days before the scheduled date of the transfer.
SECTION 4. ORS 414.736, as amended by
section 6, chapter 886, Oregon Laws 2009, 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 and 414.742] chapter, ORS chapter 416 and
section 9, chapter 867, Oregon Laws 2009:
(1) “Designated area” means a
geographic area of the state defined by the Oregon Health Authority 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 Oregon Health Authority [or the Oregon Health Policy Board] 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 Oregon Health Authority [or the Oregon Health Policy Board] 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 authority [or the board] 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 authority [or the board] 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 5. Section 8, chapter 886,
Oregon Laws 2009, is repealed.
SECTION 6. ORS 416.510 is amended to
read:
416.510. As used in ORS 416.510 to
416.610, unless the context requires otherwise:
(1) “Action” means an action, suit or
proceeding.
(2) “Applicant” means an applicant for
assistance.
(3) “Assistance” means moneys paid by
the Department of Human Services to persons directly and moneys paid by the Oregon
Health Authority or by a prepaid managed care health services organization for
services provided under contract pursuant to ORS 414.725 to others for the
benefit of such persons.
(4) “Authority” means the Oregon
Health Authority.
(5) “Claim” means a claim of a
recipient of assistance for damages for personal injuries against any person or
public body, agency or commission other than the State Accident Insurance Fund
Corporation or Workers’ Compensation Board.
(6) “Compromise” means a compromise
between a recipient and any person or public body, agency or commission against
whom the recipient has a claim.
(7) “Judgment” means a judgment in any
action or proceeding brought by a recipient to enforce the claim of the
recipient.
(8) “Prepaid managed care health
services organization” [means a managed
health, dental or mental health care organization that contracts with the
authority on a prepaid capitated basis pursuant to ORS 414.725. Prepaid managed
care health services organizations may be dental care organizations, fully
capitated health plans, mental health organizations or chemical dependency
organizations] has the meaning given that term in ORS 414.736.
(9) “Recipient” means a recipient of
assistance.
(10) “Settlement” means a settlement
between a recipient and any person or public body, agency or commission against
whom the recipient has a claim.
SECTION 7. Section 3 of this 2011
Act becomes operative on January 1, 2012.
SECTION 8. This 2011 Act being
necessary for the immediate preservation of the public peace, health and
safety, an emergency is declared to exist, and this 2011 Act takes effect on
its passage.
Approved by
the Governor June 17, 2011
Filed in the
office of Secretary of State June 17, 2011
Effective date
June 17, 2011
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