Bill Text: OR HB2280 | 2013 | Regular Session | Enrolled
Bill Title: Relating to community-based health care improvement programs.
Sponsorship: Slight Partisan Bill (Republican 2-1)
Status: (Passed) 2013-05-09 - Chapter 69, (2013 Laws): Effective date January 1, 2014. [HB2280 Detail]
Download: Oregon-2013-HB2280-Enrolled.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
Enrolled
House Bill 2280
Sponsored by Representatives CONGER, HOYLE, Senator KNOPP
(Presession filed.)
CHAPTER ................
AN ACT
Relating to community-based health care improvement programs;
amending ORS 735.721 and 735.723.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 735.721 is amended to read:
735.721. As used in ORS 735.721 to 735.727:
(1) 'Community' means the area of geographically contiguous
political subdivisions as determined by the Office for Oregon
Health Policy and Research in collaboration with the board of
directors of a community-based health care initiative.
(2) 'Qualified employee' means an individual who:
(a) Is employed by a qualified employer;
(b) Resides or works within a community;
(c) Does not have health insurance; and
(d) Does not qualify for publicly funded health care.
(3) 'Qualified employer' means an employer that:
(a) Employs 1 to 50 { + full-time equivalent + } employees;
(b) Pays a median wage to its employees that is equal to or
below an amount that is 300 percent of the federal poverty
guidelines;
(c) For { - 12 - } { + two + } months prior to enrollment
in a community-based health care improvement program, or for the
duration of the employer's operation if the employer has been in
operation less than { - 12 - } { + two + } months, has not
provided to employees employer-based health insurance coverage
for which the employer contributes at least 50 percent of the
cost of premiums;
(d) Offers community-based health care services through a
community-based health care improvement program to all qualified
employees and their dependents regardless of health status;
(e) Agrees to participate in a community-based health care
improvement program for at least 12 months; and
(f) Agrees to provide information that is deemed necessary by
the community-based health care initiative to determine
eligibility, assess dues and pay claims.
SECTION 2. ORS 735.723 is amended to read:
735.723. (1) The Administrator of the Office for Oregon Health
Policy and Research shall adopt rules for the approval of one
community-based health care initiative per community that meets
the requirements under subsection (2) of this section and of a
community-based health care improvement program that meets the
requirements under subsection (3) of this section. The office may
Enrolled House Bill 2280 (HB 2280-INTRO) Page 1
not approve community-based health care initiatives for more than
three communities during the period beginning with June 23, 2009,
and ending June 30, 2013.
(2) An approved community-based health care initiative shall:
(a) Be a nonprofit corporation governed by a board of directors
that includes, but is not limited to, representatives of
participating health care providers and qualified employers. At
least 80 percent of the board members must be residents of the
community.
(b) Contract with health care providers that offer health care
services in the community to provide services to enrollees in the
program.
(c) Recruit qualified employers to enroll in the program.
(d) Establish an operational structure for:
(A) Assisting employees of qualified employers or their
dependents to enroll in state medical assistance programs if
appropriate;
(B) Enrolling qualified employees and their dependents in the
community-based health care improvement program;
(C) Billing and collecting dues from qualified employers and
qualified employees; and
(D) Reimbursing participating health care providers for
services to enrollees.
(e) Establish a set of health care services that are covered in
the community-based health care improvement program, cost-sharing
requirements and incentives to encourage the utilization of
primary care, wellness and chronic disease management services.
(f) Maintain a liquid reserve account in an amount sufficient
to pay all claims that have been incurred but not yet charged for
a period of at least two months.
(g) Provide to each qualified employee enrolled in the program
a clear and concise written statement that describes the
community-based health care improvement program and that
includes:
(A) The health care services that are covered;
(B) Any exclusions or limitations on coverage of health care
services, including any requirements for prior authorization;
(C) Copayments, coinsurance, deductibles and any other
cost-sharing requirements;
(D) A list of participating health care providers;
(E) The complaint process described in subsection (3)(b) of
this section; and
(F) The conditions under which the program or coverage through
the program may be terminated.
(h) Comply with the requirements of ORS 735.725 and 735.727.
(3) An approved community-based health care improvement program
shall:
(a) Reimburse the cost of the set of health care services
established by the initiative and provided in the community to
qualified employers, qualified employees and their dependents.
(b) Include an enrollee complaint process that ensures the
resolution of complaints within 45 days.
{ + (4) An individual who is a qualified employee and whose
employment with a qualified employer terminates may elect to
continue enrollment of the individual and the individual's
dependents in an approved community-based health care improvement
program for no more than 18 months by paying the required dues.
The dues may not be greater than the amount that would be charged
if the individual remained a qualified employee. An approved
community-based health care initiative must notify an employee of
Enrolled House Bill 2280 (HB 2280-INTRO) Page 2
the opportunity to continue coverage upon the individual's
termination of coverage under the qualified employer's
program. + }
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Passed by House March 7, 2013
.............................................................
Ramona J. Line, Chief Clerk of House
.............................................................
Tina Kotek, Speaker of House
Passed by Senate April 30, 2013
.............................................................
Peter Courtney, President of Senate
Enrolled House Bill 2280 (HB 2280-INTRO) Page 3
Received by Governor:
......M.,............., 2013
Approved:
......M.,............., 2013
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2013
.............................................................
Kate Brown, Secretary of State
Enrolled House Bill 2280 (HB 2280-INTRO) Page 4
