Bill Text: OR HB3420 | 2013 | Regular Session | Introduced

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Bill Title: Relating to medical assistance.

Spectrum: Partisan Bill (Republican 4-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [HB3420 Detail]

Download: Oregon-2013-HB3420-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 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 3565

                         House Bill 3420

Sponsored by Representative WEIDNER; Representatives THOMPSON,
  WHISNANT, Senator KNOPP

                             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 investigate possibility of
receiving federal approval to implement copayments or other
mechanisms to encourage medical assistance recipients to take
personal responsibility for their own health and health care.
Requires authority to report conclusions from investigation to
2014 regular session of Legislative Assembly.
  Requires authority to reimburse physicians who are paid on
fee-for-service basis at rate equal to 110 percent of Medicare
rate.

                        A BILL FOR AN ACT
Relating to medical assistance; creating new provisions; and
  amending ORS 414.065.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + (1) The Oregon Health Authority shall
investigate the possibility of obtaining federal approval to
impose copayments in the medical assistance program that exceed
the nominal amounts adopted by the United States Secretary of
Health and Human Services under 42 U.S.C. 1396o or to implement
other financial mechanisms designed to encourage medical
assistance recipients to take personal responsibility for their
health and health care.
  (2) The authority shall report to the 2014 regular session of
the Legislative Assembly the conclusions from its investigation
and shall recommend options that are likely to receive federal
approval. + }
  SECTION 2. ORS 414.065, as amended by section 19, chapter 8,
Oregon Laws 2012, is amended to read:
  414.065. (1)(a) With respect to health care and services to be
provided in medical assistance during any period, the Oregon
Health Authority shall determine, subject to such revisions as it
may make from time to time and subject to legislative funding and
paragraph (b) of this subsection:
  (A) The types and extent of health care and services to be
provided to each eligible group of recipients of medical
assistance.
  (B) Standards, including outcome and quality measures, to be
observed in the provision of health care and services.

  (C) The number of days of health care and services toward the
cost of which public assistance funds will be expended in the
care of any person.
  (D) Reasonable fees, charges, daily rates and global payments
for meeting the costs of providing health services to an
applicant or recipient.
  (E)  { + Subject to subsection (7) of this section, + }
reasonable fees for professional medical and dental services
which may be based on usual and customary fees in the locality
for similar services.
  (F) The amount and application of any copayment or other
similar cost-sharing payment that the authority may require a
recipient to pay toward the cost of health care or services.
  (b) The authority shall adopt rules establishing timelines for
payment of health services under paragraph (a) of this
subsection.
  (2) The types and extent of health care and services and the
amounts to be paid in meeting the costs thereof, as determined
and fixed by the authority and within the limits of funds
available therefor, shall be the total available for medical
assistance and payments for such medical assistance shall be the
total amounts from public assistance funds available to providers
of health care and services in meeting the costs thereof.
  (3) Except for payments under a cost-sharing plan, payments
made by the authority for medical assistance shall constitute
payment in full for all health care and services for which such
payments of medical assistance were made.
  (4) Notwithstanding subsections (1) and (2) of this section,
the Department of Human Services shall be responsible for
determining the payment for Medicaid-funded long term care
services and for contracting with the providers of long term care
services.
  (5) In determining a global budget for a coordinated care
organization:
  (a) The allocation of the payment, the risk and any cost
savings shall be determined by the governing body of the
organization; and
  (b) The authority shall consider the community health
assessment conducted by the organization and reviewed annually,
and the organization's health care costs.
  (6) Under the supervision of the Governor, the authority may
work with the Centers for Medicare and Medicaid Services to
develop, in addition to global budgets, payment streams:
  (a) To support improved delivery of health care to recipients
of medical assistance; and
  (b) That are funded by coordinated care organizations, counties
or other entities other than the state whose contributions
qualify for federal matching funds under Title XIX or XXI of the
Social Security Act.
   { +  (7) Fees for physician services shall be paid at a rate
that is equal to 110 percent of the Medicare rate for the same
services. This applies to physicians who are reimbursed on a
fee-for-service basis. + }
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