76th OREGON LEGISLATIVE ASSEMBLY--2011 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 653
 
                         Senate Bill 99
 
Printed pursuant to Senate Interim Rule 213.28 by order of the
  President of the Senate in conformance with presession filing
  rules, indicating neither advocacy nor opposition on the part
  of the President (at the request of Governor John A. Kitzhaber
  for Oregon Health Authority)
 
 
                             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.
 
  Requires Oregon Health Authority to establish Oregon Health
Insurance Exchange as public corporation to be governed by board
of directors. Specifies functions and duties.
  Declares emergency, effective on passage.
 
                        A BILL FOR AN ACT
Relating to Oregon Health Insurance Exchange; appropriating
  money; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
 
                               { +
 OREGON HEALTH INSURANCE EXCHANGE + }
                               { +
(Establishment) + }
 
  SECTION 1.  { + (1) By January 1, 2014, the Oregon Health
Authority shall develop and establish the Oregon Health Insurance
Exchange under sections 2 and 5 to 9 of this 2011 Act to ensure
conformance with the requirements of the Patient Protection and
Affordable Care Act, P.L. 111-148, as amended by the Health Care
and Education Reconciliation Act of 2010, P.L. 111-152.
  (2) The authority may apply for and accept federal grants,
other federal funds and grants from nongovernment organizations
for the purpose of developing and implementing the exchange.
Moneys received by the authority under this subsection shall be
deposited in or to the credit of the Oregon Health Insurance
Exchange Fund established under section 11 of this 2011 Act and
are continuously appropriated to the authority for developing and
implementing the exchange. + }
  SECTION 2.  { + (1) The Oregon Health Authority shall establish
the Oregon Health Insurance Exchange as a public corporation that
shall exercise and carry out all powers, rights and privileges
that are expressly conferred upon it, are implied by law or are
incident to such powers. The exchange shall be a governmental
entity performing governmental functions and exercising
governmental powers. The exchange shall be an independent public
corporation with statewide purposes and missions and without
territorial boundaries. The exchange shall be a governmental
entity but shall not be considered a unit of local or municipal
government or a state agency for purposes of state statutes or
constitutional provisions.
  (2) ORS 279.835 to 279.855 and ORS chapters 240, 279A, 279B,
279C, 283, 291, 292 and 293 do not apply to the exchange.
  (3) The exchange shall be governed by a board of directors
consisting of three ex officio members and six members who are
appointed by the Governor and subject to confirmation by the
Senate in the manner prescribed by ORS 171.562 and 171.565.
  (4) The ex officio voting members of the board of directors
are:
  (a) The Director of the Oregon Health Authority;
  (b) The Director of the Department of Consumer and Business
Services; and
  (c) The chairperson of the Oregon Health Policy Board.
  (5) The term of office of each member is four years. The
Governor may remove any member at any time for cause after notice
and hearing that shall be open to the public, but the Governor
may not remove more than three members within any four-year
period except for corrupt conduct in office. Before the
expiration of the term of a member, the Governor shall appoint a
successor whose term begins on January 1 next following. A member
is eligible for no more than two reappointments. If there is a
vacancy for any cause, the Governor shall make an appointment to
become immediately effective for the unexpired term.
  (6) A member of the board of directors is entitled to
compensation and expenses as provided in ORS 292.495. + }
  SECTION 3. Section 2 of this 2011 Act is amended to read:
  (1)   { - The Oregon Health Authority shall establish - }  The
Oregon Health Insurance Exchange  { + is established + } as a
public corporation that shall exercise and carry out all powers,
rights and privileges that are expressly conferred upon it, are
implied by law or are incident to such powers. The exchange shall
be a governmental entity performing governmental functions and
exercising governmental powers. The exchange shall be an
independent public corporation with statewide purposes and
missions and without territorial boundaries. The exchange shall
be a governmental entity but shall not be considered a unit of
local or municipal government or a state agency for purposes of
state statutes or constitutional provisions.
  (2) ORS 279.835 to 279.855 and ORS chapters 240, 279A, 279B,
279C, 283, 291, 292 and 293 do not apply to the exchange.
  (3) The exchange shall be governed by a board of directors
consisting of three ex officio members and six members who are
appointed by the Governor and subject to confirmation by the
Senate in the manner prescribed by ORS 171.562 and 171.565.
  (4) The ex officio voting members of the board of directors
are:
  (a) The Director of the Oregon Health Authority;
  (b) The Director of the Department of Consumer and Business
Services; and
  (c) The chairperson of the Oregon Health Policy Board.
  (5) The term of office of each member is four years. The
Governor may remove any member at any time for cause after notice
and hearing that shall be open to the public, but the Governor
may not remove more than three members within any four-year
period except for corrupt conduct in office. Before the
expiration of the term of a member, the Governor shall appoint a
successor whose term begins on January 1 next following. A member
is eligible for no more than two reappointments. If there is a
vacancy for any cause, the Governor shall make an appointment to
become immediately effective for the unexpired term.
  (6) A member of the board of directors is entitled to
compensation and expenses as provided in ORS 292.495.
 
  SECTION 4.  { + Notwithstanding the term of office specified by
section 2 of this 2011 Act, of the members first appointed to the
Oregon Health Insurance Exchange board of directors:
  (1) Two shall serve for terms ending December 31, 2013.
  (2) Two shall serve for terms ending December 31, 2014.
  (3) Two shall serve for terms ending on the earlier of four
years after appointment or December 31, 2015. + }
 
                               { +
(Functions) + }
 
  SECTION 5.  { + The functions of the Oregon Health Insurance
Exchange are to:
  (1) Provide uniform information to consumers of health care on
costs, benefits, provider networks and other information to
assist individuals and small businesses in making informed health
care decisions. At a minimum, the exchange shall provide:
  (a) Information on:
  (A) The average costs of licensing, regulatory fees and other
payments required by the exchange;
  (B) Exchange administrative costs; and
  (C) Costs attributable to waste, fraud and abuse.
  (b) An electronic calculator that allows individuals to
determine the cost of coverage after deducting any applicable tax
credit or cost-sharing reduction.
  (2) Screen, certify and recertify health plans as qualified to
participate in the exchange according to federal guidelines and
to ensure that qualified health plans provide meaningful coverage
choices.
  (3) Decertify plans to preclude further participation in the
exchange by plans that fail to meet federal standards.
  (4) Ensure fair competition of carriers in and outside the
exchange by establishing:
  (a) Standardized health benefit plan options; and
  (b) An Internet-based clearinghouse and a toll-free telephone
hotline for information about plans in and outside the exchange,
including standardized comparisons of plan coverage and costs.
  (5) Make qualified health plans available to individuals and
employers and assist individual and group enrollment in qualified
health plans.
  (6) Facilitate community-based assistance with enrollment in
qualified health plans, certify entities to be navigators as
described in 42 U.S.C. 18031(i) and fund navigators to provide
education and perform eligibility determination and enrollment
functions.
  (7) Provide employers with the names of any of their employees
who end coverage under a qualified health plan during a plan
year.
  (8) Grade health plans in accordance with criteria established
by the Secretary of the United States Department of Health and
Human Services and distribute the information through the
Internet-based clearinghouse and toll-free telephone hotline.
  (9) Certify that an individual meets the criteria for an
exemption from the individual responsibility requirement of
section 5000A of the Internal Revenue Code.
  (10) Establish open, special and monthly enrollment periods for
Native American individuals.
  (11) Provide information to individuals and employers regarding
the eligibility requirements for all publicly funded programs
providing medical assistance and assist individuals in applying
for the programs.
  (12) Provide information to the federal government necessary
for enrollees to receive tax credits and reduced cost-sharing.
  (13) Provide information to the federal government regarding:
 
 
  (a) Individuals determined to be exempt from the individual
responsibility requirement of section 5000A of the Internal
Revenue Code;
  (b) Employees who have reported a change in employer; and
  (c) Individuals who have ended coverage during a plan year.
  (14) Enter into contracts to carry out the functions of and to
provide the services offered by the exchange. + }
 
                               { +
(Officers of Board of Directors; Quorum; Meetings) + }
 
  SECTION 6.  { + (1) The Oregon Health Insurance Exchange board
of directors shall select one of its members as chairperson and
another as vice chairperson, for such terms and with duties and
powers necessary for the performance of the functions of such
offices as the board determines.
  (2) A majority of the members of the board of directors
constitutes a quorum for the transaction of business.
  (3) The board of directors shall meet at least once every three
months at a place, day and hour determined by the board. The
board may also meet at other times and places specified by the
call of the chairperson or of a majority of the members of the
board. + }
 
                               { +
(Employees) + }
 
  SECTION 7.  { + (1) The Oregon Health Insurance Exchange board
of directors shall appoint an executive director to serve at the
pleasure of the board.
  (2) The designation of the executive director must be by
written order, filed with the Secretary of State.
  (3) The executive director shall appoint all subordinate
officers and employees of the Oregon Health Insurance Exchange,
prescribe their duties and fix their compensation.
  (4) The executive director shall appoint and consult with:
  (a) An advisory group consisting of no fewer than five
consumers of health care;
  (b) An advisory group consisting of no fewer than five small
business owners; and
  (c) An advisory group consisting of representatives of five
carriers participating in the Oregon Health Insurance Exchange.
  (5) Members of the advisory groups are not entitled to
compensation, but at the discretion of the executive director may
be reimbursed from funds available to the executive director for
actual and necessary travel and other expenses incurred by them
in the performance of their official duties. + }
 
                               { +
(Authority to Adopt Rules and Collect Assessments) + }
 
  SECTION 8.  { + (1) In accordance with applicable provisions of
ORS chapter 183, the Oregon Health Insurance Exchange may:
  (a) Adopt rules necessary for the administration of the
exchange; and
  (b) Establish, impose and collect assessments on insurance
carriers as permitted or required by federal law for the
operation of the exchange.
  (2) All assessments received by or to the credit of the
exchange shall be deposited in the Oregon Health Insurance
Exchange Fund established under section 11 of this 2011 Act. + }
 
                               { +
(Operation) + }
 
 
  SECTION 9.  { + (1) The following individuals and groups may
purchase qualified health plans through the Oregon Health
Insurance Exchange:
  (a) Beginning January 1, 2014, individuals and employers with
no more than 50 employees.
  (b) Beginning January 1, 2016, employers with 51 to 100
employees.
  (c) Groups meeting additional criteria established by the
exchange for qualified purchasers.
  (2)(a) Only individuals who purchase health plans through the
exchange may be eligible to receive premium tax credits under
section 36B of the Internal Revenue Code and reduced cost-sharing
under 42 U.S.C. 18071.
  (b) Only employers that purchase health plans through the
exchange may be eligible to receive small employer health
insurance credits under section 45R of the Internal Revenue Code.
  (3) The exchange shall certify a health plan as qualified if:
  (a) The plan provides coverage on terms established by the
exchange by rule that, at a minimum, includes the essential
health benefits established by the United States Secretary of
Health and Human Services pursuant to 42 U.S.C. 18022; and
  (b) The exchange determines that making the health plan
available through the exchange is in the interests of individuals
and employers in this state.
  (4) The exchange is authorized to limit the number of qualified
health plans available in each level of coverage described in 42
U.S.C. 18022(d) as bronze, silver, gold and platinum.
  (5) The exchange shall establish a streamlined and seamless
application and enrollment process for both the exchange and the
state medical assistance program.
  (6) The exchange, in collaboration with the department, shall
coordinate federal and state risk mediation programs including:
  (a) The reinsurance program established pursuant to 42 U.S.C.
18061;
  (b) The federal program of risk corridors established pursuant
to 42 U.S.C. 18062; and
  (c) The state risk adjustment program administered pursuant to
42 U.S.C. 18063.
  (7) The exchange shall define the role of insurance agents and
brokers within the operation of the exchange in accordance with
federal guidelines and policies adopted by the exchange by rule.
  (8) The exchange shall ensure parity in premiums for plans sold
within and outside the exchange.
  (9) The exchange is authorized to combine risk pools as
permitted by federal law to best serve the interests of
individuals and small employers in this state.
  (10) The exchange is authorized to enter into contracts for the
performance of duties and functions of the exchange including,
but not limited to, contracting with:
  (a) Insurance carriers to offer coverage through the exchange;
and
  (b) Navigators certified by the exchange under section 5 of
this 2011 Act.
  (11) The exchange is authorized to apply for and accept federal
grants, other federal funds and grants from nongovernment
organizations for the purpose of developing, implementing or
administering the exchange. Moneys received by the exchange under
this subsection shall be deposited in or to the credit of the
Oregon Health Insurance Exchange Fund established under section
11 of this 2011 Act and are continuously appropriated to the
exchange for developing, implementing or administering the
exchange.
  (12) The exchange, in coordination with the Oregon Health
Authority and the Department of Consumer and Business Services,
shall plan and coordinate the phasing out of the Oregon Medical
Insurance Pool by January 1, 2014. + }
  SECTION 10. Section 9 of this 2011 Act is amended to read:
   { +  Sec. 9. + } (1) The following individuals and groups may
purchase qualified health plans through the Oregon Health
Insurance Exchange:
    { - (a) Beginning January 1, 2014, individuals and employers
with no more than 50 employees. - }
    { - (b) - }  { +  (a) + }   { - Beginning January 1, 2016,
employers with 51 to - }  { +  Individuals and employers with no
more than + } 100 employees.
    { - (c) - }  { +  (b) + } Groups meeting additional criteria
established by the exchange for qualified purchasers.
  (2)(a) Only individuals who purchase health plans through the
exchange may be eligible to receive premium tax credits under
section 36B of the Internal Revenue Code and reduced cost-sharing
under 42 U.S.C. 18071.
  (b) Only employers that purchase health plans through the
exchange may be eligible to receive small employer health
insurance credits under section 45R of the Internal Revenue Code.
  (3) The exchange shall certify a health plan as qualified if:
  (a) The plan provides coverage on terms established by the
exchange by rule that, at a minimum, includes the essential
health benefits established by the United States Secretary of
Health and Human Services pursuant to 42 U.S.C. 18022; and
  (b) The exchange determines that making the health plan
available through the exchange is in the interests of individuals
and employers in this state.
  (4) The exchange is authorized to limit the number of qualified
health plans available in each level of coverage described in 42
U.S.C. 18022(d) as bronze, silver, gold and platinum.
  (5) The exchange shall establish a streamlined and seamless
application and enrollment process for both the exchange and the
state medical assistance program.
  (6) The exchange, in collaboration with the department, shall
coordinate federal and state risk mediation programs including:
  (a) The reinsurance program established pursuant to 42 U.S.C.
18061;
  (b) The federal program of risk corridors established pursuant
to 42 U.S.C. 18062; and
  (c) The state risk adjustment program administered pursuant to
42 U.S.C. 18063.
  (7) The exchange shall define the role of insurance agents and
brokers within the operation of the exchange in accordance with
federal guidelines and policies adopted by the exchange by rule.
  (8) The exchange shall ensure parity in premiums for plans sold
within and outside the exchange.
  (9) The exchange is authorized to combine risk pools as
permitted by federal law to best serve the interests of
individuals and small employers in this state.
  (10) The exchange is authorized to enter into contracts for the
performance of duties and functions of the exchange including,
but not limited to, contracting with:
  (a) Insurance carriers to offer coverage through the exchange;
and
  (b) Navigators certified by the exchange under section 5 of
this 2011 Act.
  (11) The exchange is authorized to apply for and accept federal
grants, other federal funds and grants from nongovernment
organizations for the purpose of developing, implementing or
administering the exchange. Moneys received by the exchange under
this subsection shall be deposited in or to the credit of the
Oregon Health Insurance Exchange Fund established under section
11 of this 2011 Act and are continuously appropriated to the
exchange for developing, implementing or administering the
exchange.
    { - (12) The exchange, in coordination with the Oregon Health
Authority and the Department of Consumer and Business Services,
shall plan and coordinate the phasing out of the Oregon Medical
Insurance Pool by January 1, 2014. - }
 
                               { +
OREGON HEALTH INSURANCE EXCHANGE FUND + }
 
  SECTION 11.  { + The Oregon Health Insurance Exchange Fund is
established in the State Treasury, separate and distinct from the
General Fund. The Oregon Health Insurance Exchange Fund consists
of moneys received by the Oregon Health Authority as grants under
section 1 of this 2011 Act, moneys received by the Oregon Health
Insurance Exchange through the imposition of assessments under
section 8 of this 2011 Act and moneys received as gifts or grants
under section 9 (11) of this 2011 Act. Moneys in the fund are
continuously appropriated to the Oregon Health Authority for
carrying out the purposes of sections 1, 2 and 5 to 9 of this
2011 Act. + }
  SECTION 12. Section 11 of this 2011 Act is amended to read:
   { +  Sec. 11. + } The Oregon Health Insurance Exchange Fund is
established in the State Treasury, separate and distinct from the
General Fund. The Oregon Health Insurance Exchange Fund consists
of   { - moneys received by the Oregon Health Authority as grants
under section 1 of this 2011 Act, - }  moneys received by the
Oregon Health Insurance Exchange through the imposition of
assessments under section 8 of this 2011 Act and moneys received
as gifts or grants under section 9 (11) of this 2011 Act. Moneys
in the fund are continuously appropriated to the Oregon Health
 { - Authority - }  { +  Insurance Exchange + } for carrying out
the purposes of sections   { - 1, - } 2 and 5 to 9 of this 2011
Act.
  SECTION 13.  { + There is appropriated to the Oregon Health
Authority, for the biennium beginning July 1, 2011, out of the
General Fund, the amount of $___ for the purpose of developing
and implementing the Oregon Health Insurance Exchange in
accordance with sections 1, 2 and 5 to 9 of this 2011 Act. + }
 
                               { +
DELAYED OPERATIVE DATES AND REPEAL + }
 
  SECTION 14.  { + (1) The amendments to sections 2 and 11 of
this 2011 Act by sections 3 and 12 of this 2011 Act become
operative January 2, 2014.
  (2) Section 1 of this 2011 Act is repealed January 2, 2014.
  (3) The amendments to section 9 of this 2011 Act by section 10
of this 2011 Act become operative January 1, 2016. + }
 
                               { +
CAPTIONS + }
 
  SECTION 15.  { + The unit captions used in this 2011 Act are
provided only for the convenience of the reader and do not become
part of the statutory law of this state or express any
legislative intent in the enactment of this 2011 Act. + }
 
                               { +
EMERGENCY CLAUSE + }
 
  SECTION 16.  { + 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. + }
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