Bill Text: OR HB3650 | 2011 | Regular Session | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to health; appropriating money; and declaring an emergency.

Spectrum: Committee Bill

Status: (Passed) 2011-07-07 - Chapter 602, (2011 Laws): Effective date July 1, 2011. [HB3650 Detail]

Download: Oregon-2011-HB3650-Engrossed.html

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     76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session

SA to B-Eng. HB 3650 (A to RC)

LC 4105/HB 3650-B49

                      SENATE AMENDMENTS TO
                   B-ENGROSSED HOUSE BILL 3650
           (INCLUDING AMENDMENTS TO RESOLVE CONFLICTS)

              By JOINT COMMITTEE ON WAYS AND MEANS

                             June 29

  On page 1 of the printed B-engrossed bill, line 6, delete the
second 'and'.
  In line 7, after '2009' insert ', and section 10, chapter ___,
Oregon Laws 2011 (Enrolled Senate Bill 101)'.
  In line 8, after '414.741' insert 'and section 8, chapter ___,
Oregon Laws 2011 (Enrolled Senate Bill 101), and sections 128,
129, 131, 142 and 147, chapter ___, Oregon Laws 2011 (Enrolled
House Bill 2100)'.
  On page 36, delete lines 3 through 45 and insert:
  '  { +  NOTE: + } Section 44 was deleted by amendment.
Subsequent sections were not renumbered.
  '  { +  SECTION 45. + } ORS 414.736, as amended by section 6,
chapter 886, Oregon Laws 2009, and section 4, chapter 417, Oregon
Laws 2011 (Enrolled Senate Bill 201), is amended to read:
  ' 414.736. As used in  { + ORS 192.493, + } this 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 on a
prepaid capitated basis under ORS   { - 414.725 - }  { +
414.630 + }.
  ' (3) 'Physician care organization' means an organization that
contracts with the   { - Oregon Health - }  authority on a
prepaid capitated basis under ORS   { - 414.725 - }  { +
414.630 + } to provide the health services described in ORS
 { - 414.705 (1)(b) - }  { +  414.025 (8)(b) + }, (c), (d), (e),
 { + (f), + } (g) and (j). A physician care organization may also
contract with the authority on a prepaid capitated basis to
provide the health services described in ORS   { - 414.705
(1)(k) - }  { +  414.025 (8)(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 on a prepaid capitated basis under ORS
 { - 414.725 - }  { +  414.630 + }. 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.'.
  On page 42, delete lines 28 through 45.
  On page 43, delete lines 1 through 24 and insert:
  '  { +  SECTION 57. + } ORS 735.615, as amended by section 20,
chapter 70, Oregon Laws 2011 (Enrolled Senate Bill 104), is
amended to read:
  ' 735.615. (1) Except as provided in subsection (3) of this
section, a person who is a resident of this state, as defined by
the Oregon Medical Insurance Pool Board, is eligible for medical
pool coverage if:
  ' (a) An insurer, or an insurance company with a certificate of
authority in any other state, has made within a time frame
established by the board an adverse underwriting decision, as
defined in ORS 746.600 (1)(a)(A), (B) or (D), on individual
medical insurance for health reasons while the person was a
resident;
  ' (b) The person has a history of any medical or health
conditions on the list adopted by the board under subsection (2)
of this section;
  ' (c) The person is a spouse or dependent of a person described
in paragraph (a) or (b) of this subsection; or
  ' (d) The person is eligible for the credit for health
insurance costs under section 35 of the federal Internal Revenue
Code, as amended and in effect on December 31, 2004.
  ' (2) The board may adopt a list of medical or health
conditions for which a person is eligible for pool coverage
without applying for individual medical insurance pursuant to
this section.
  ' (3) A person is not eligible for coverage under ORS 735.600
to 735.650 if:
  ' (a) Except as provided in ORS 735.625 (3) and subsection (5)
of this section, the person is eligible for Medicare;
  ' (b) The person is eligible to receive health services as
defined in ORS   { - 414.705 - }  { +  414.025 + } that meet or
exceed those adopted by the board;
  ' (c) The person has terminated coverage in the pool within the
last 12 months and the termination was for:
  ' (A) A reason other than becoming eligible to receive health
services as defined in ORS   { - 414.705 - }  { +  414.025 + };
or
  ' (B) A reason that does not meet exception criteria
established by the board;
  ' (d) The person has exceeded the maximum lifetime benefit
established by the board;
  ' (e) The person is an inmate of or a patient in a public
institution named in ORS 179.321;
  ' (f) The person has, on the date of issue of coverage by the
board, coverage under health insurance or a self-insurance
arrangement that is substantially equivalent to coverage under
ORS 735.625; or
  ' (g) The person has the premiums paid or reimbursed by a
public entity or a health care provider, reducing the financial
loss or obligation of the payer.
  ' (4) A person applying for coverage shall establish initial
eligibility by providing evidence that the board requires.
  ' (5)(a) Notwithstanding ORS 735.625 (4)(c), if a person:
  ' (A) Becomes eligible for Medicare after being enrolled in the
pool for a period of time as determined by the board by rule,
that person may continue coverage within the pool as secondary
coverage to Medicare.
  ' (B) Is eligible for Medicare but is not yet eligible to
enroll in Medicare Parts B and D, the individual may receive
coverage under the pool until enrolled in Medicare Parts B and D.
  ' (b) The board may adopt rules concerning the terms and
conditions for the coverage provided under paragraph (a) of this
subsection.
  ' (6) The board may adopt rules to establish additional
eligibility requirements for a person described in subsection
  { - (1)(e) - }  { +  (1)(d) + } of this section.'.
  On page 46, after line 29, insert:
  '  { +  SECTION 68. + }  { + If House Bill 2100 becomes law,
sections 128 (amending ORS 414.025), 129 (amending ORS 414.033),
131 (amending ORS 414.065), 142 (amending ORS 414.705) and 147
(amending ORS 414.725), chapter ___, Oregon Laws 2011 (Enrolled
House Bill 2100), are repealed. + }

  '  { +  SECTION 69. + } If House Bill 2100 becomes law, ORS
414.025, as amended by section 1, chapter 73, Oregon Laws 2010,
and section 20 of this 2011 Act, is amended to read:
  ' 414.025.  { +  Definitions. + } As used in this chapter and
ORS
  { - chapter - }   { + chapters 411 and + } 413, unless the
context or a specially applicable statutory definition requires
otherwise:
  ' (1)(a) 'Alternative payment methodology' means a payment
other than a fee-for-services payment, used by coordinated care
organizations as compensation for the provision of integrated and
coordinated health care and services.
  ' (b) 'Alternative payment methodology' includes, but is not
limited to:
  ' (A) Shared savings arrangements;
  ' (B) Bundled payments; and
  ' (C) Payments based on episodes.
  ' (2) 'Category of aid' means assistance provided by the Oregon
Supplemental Income Program, aid granted under ORS 412.001 to
412.069 and 418.647 or federal Supplemental Security Income
payments.
  ' (3) 'Categorically needy' means, insofar as funds are
available for the category, a person who is a resident of this
state and who:
  ' (a) Is receiving a category of aid.
  ' (b) Would be eligible for a category of aid but is not
receiving a category of aid.
  ' (c) Is in a medical facility and, if the person left such
facility, would be eligible for a category of aid.
  ' (d) Is under the age of 21 years and would be a dependent
child as defined in ORS 412.001 except for age and regular
attendance in school or in a course of professional or technical
training.
  ' (e)(A) Is a caretaker relative, as defined in ORS 412.001,
who cares for a child who would be a dependent child except for
age and regular attendance in school or in a course of
professional or technical training; or
  ' (B) Is the spouse of the caretaker relative.
  ' (f) Is under the age of 21 years and:
  ' (A) Is in a foster family home or licensed child-caring
agency or institution and is one for whom a public agency of this
state is assuming financial responsibility, in whole or in part;
or
  ' (B) Is 18 years of age or older, is one for whom federal
financial participation is available under Title XIX or XXI of
the federal Social Security Act and who met the criteria in
subparagraph (A) of this paragraph immediately prior to the
person's 18th birthday.
  ' (g) Is a spouse of an individual receiving a category of aid
and who is living with the recipient of a category of aid, whose
needs and income are taken into account in determining the cash
needs of the recipient of a category of aid, and who is
determined by the Department of Human Services to be essential to
the well-being of the recipient of a category of aid.
  ' (h) Is a caretaker relative as defined in ORS 412.001 who
cares for a dependent child receiving aid granted under ORS
412.001 to 412.069 and 418.647 or is the spouse of the caretaker
relative.
  ' (i) Is under the age of 21 years, is in a youth care center
and is one for whom a public agency of this state is assuming
financial responsibility, in whole or in part.
  ' (j) Is under the age of 21 years and is in an intermediate
care facility which includes institutions for persons with
 { - mental retardation - }  { +  developmental disabilities + }.
  ' (k) Is under the age of 22 years and is in a psychiatric
hospital.
  ' (L) Is under the age of 21 years and is in an independent
living situation with all or part of the maintenance cost paid by
the Department of Human Services.
  ' (m) Is a member of a family that received aid in the
preceding month under ORS 412.006 or 412.014 and became
ineligible for aid due to increased hours of or increased income
from employment. As long as the member of the family is employed,
such families will continue to be eligible for medical assistance
for a period of at least six calendar months beginning with the
month in which such family became ineligible for assistance due
to increased hours of employment or increased earnings.
  ' (n) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in
part.
  ' (o) Is an individual or is a member of a group who is
required by federal law to be included in the state's medical
assistance program in order for that program to qualify for
federal funds.
  ' (p) Is an individual or member of a group who, subject to the
rules of the department { +  or the Oregon Health Authority + },
may optionally be included in the state's medical assistance
program under federal law and regulations concerning the
availability of federal funds for the expenses of that individual
or group.
  ' (q) Is a pregnant woman who would be eligible for aid granted
under ORS 412.001 to 412.069 and 418.647, whether or not the
woman is eligible for cash assistance.
  ' (r) Except as otherwise provided in this section, is a
pregnant woman or child for whom federal financial participation
is available under Title XIX or XXI of the federal Social
Security Act.
  ' (s) Is not otherwise categorically needy and is not eligible
for care under Title XVIII of the federal Social Security Act or
is not a full-time student in a post-secondary education program
as defined by the department   { - of Human Services - }  { +  or
the authority + } by rule, but whose family income is less than
the federal poverty level and whose family investments and
savings equal less than the investments and savings limit
established by the department  { + or the authority + } by rule.
  ' (t) Would be eligible for a category of aid but for the
receipt of qualified long term care insurance benefits under a
policy or certificate issued on or after January 1, 2008. As used
in this paragraph, 'qualified long term care insurance' means a
policy or certificate of insurance as defined in ORS 743.652 (6).
  ' (u) Is eligible for the Health Care for All Oregon Children
program established in ORS 414.231.
  ' (v) Is dually eligible for Medicare and Medicaid and
receiving care through a coordinated care organization.
  ' (4) 'Community health worker' means an individual who:
  ' (a) Has expertise or experience in public health;
  ' (b) Works in an urban or rural community, either for pay or
as a volunteer in association with a local health care system;
  ' (c) To the extent practicable, shares ethnicity, language,
socioeconomic status and life experiences with the residents of
the community where the worker serves;
  ' (d) Assists members of the community to improve their health
and increases the capacity of the community to meet the health
care needs of its residents and achieve wellness;
  ' (e) Provides health education and information that is
culturally appropriate to the individuals being served;
  ' (f) Assists community residents in receiving the care they
need;
  ' (g) May give peer counseling and guidance on health
behaviors; and
  ' (h) May provide direct services such as first aid or blood
pressure screening.
  ' (5) 'Coordinated care organization' means an organization
meeting criteria adopted by the Oregon Health Authority under
section 4 of this 2011 Act.
  ' (6) 'Dually eligible for Medicare and Medicaid' means, with
respect to eligibility for enrollment in a coordinated care
organization, that an individual is eligible for health services
funded by Title XIX of the Social Security Act and is:
  ' (a) Eligible for or enrolled in Part A of Title XVIII of the
Social Security Act; or
  ' (b) Enrolled in Part B of Title XVIII of the Social Security
Act.
  ' (7) 'Global budget' means a total amount established
prospectively by the Oregon Health Authority to be paid to a
coordinated care organization for the delivery of, management of,
access to and quality of the health care delivered to members of
the coordinated care organization.
  ' (8) 'Health services' means at least so much of each of the
following as are funded by the Legislative Assembly based upon
the prioritized list of health services compiled by the Health
  { - Services Commission under ORS 414.720 - }  { +  Evidence
Review Commission under section 24, chapter ___, Oregon Laws 2011
(Enrolled House Bill 2100) + }:
  ' (a) Services required by federal law to be included in the
state's medical assistance program in order for the program to
qualify for federal funds;
  ' (b) Services provided by a physician as defined in ORS
677.010, a nurse practitioner certified under ORS 678.375 or
other licensed practitioner within the scope of the
practitioner's practice as defined by state law, and ambulance
services;
  ' (c) Prescription drugs;
  ' (d) Laboratory and X-ray services;
  ' (e) Medical equipment and supplies;
  ' (f) Mental health services;
  ' (g) Chemical dependency services;
  ' (h) Emergency dental services;
  ' (i) Nonemergency dental services;
  ' (j) Provider services, other than services described in
paragraphs (a) to (i), (k), (L) and (m) of this subsection,
defined by federal law that may be included in the state's
medical assistance program;
  ' (k) Emergency hospital services;
  ' (L) Outpatient hospital services; and
  ' (m) Inpatient hospital services.
  ' (9) 'Income' has the meaning given that term in ORS 411.704.
  ' (10) 'Investments and savings' means cash, securities as
defined in ORS 59.015, negotiable instruments as defined in ORS
73.0104 and such similar investments or savings as the department
  { - of Human Services - }  { +  or the authority + } may
establish by rule that are available to the applicant or
recipient to contribute toward meeting the needs of the applicant
or recipient.
  ' (11) 'Medical assistance' means so much of the medical,
mental health, preventive, supportive, palliative and remedial
care and services as may be prescribed by the   { - Oregon
Health - } authority according to the standards established
pursuant to ORS 414.065, including payments made for services
provided under an insurance or other contractual arrangement and
money paid directly to the recipient for the purchase of health
services and for services described in ORS 414.710.
  ' (12) 'Medical assistance' includes any care or services for
any individual who is a patient in a medical institution or any
care or services for any individual who has attained 65 years of
age or is under 22 years of age, and who is a patient in a
private or public institution for mental diseases. 'Medical

assistance ' does not include care or services for an inmate in a
nonmedical public institution.
  ' (13) 'Patient centered primary care home' means a health care
team or clinic that is organized in accordance with the standards
established by the Oregon Health Authority under section 6 of
this 2011 Act and that incorporates the following core
attributes:
  ' (a) Access to care;
  ' (b) Accountability to consumers and to the community;
  ' (c) Comprehensive whole person care;
  ' (d) Continuity of care;
  ' (e) Coordination and integration of care; and
  ' (f) Person and family centered care.
  ' (14) 'Peer wellness specialist' means an individual who is
responsible for assessing mental health service and support needs
of the individual's peers through community outreach, assisting
individuals with access to available services and resources,
addressing barriers to services and providing education and
information about available resources and mental health issues in
order to reduce stigmas and discrimination toward consumers of
mental health services and to provide direct services to assist
individuals in creating and maintaining recovery, health and
wellness.
  ' (15) 'Person centered care' means care that:
  ' (a) Reflects the individual patient's strengths and
preferences;
  ' (b) Reflects the clinical needs of the patient as identified
through an individualized assessment; and
  ' (c) Is based upon the patient's goals and will assist the
patient in achieving the goals.
  ' (16) 'Personal health navigator' means an individual who
provides information, assistance, tools and support to enable a
patient to make the best health care decisions in the patient's
particular circumstances and in light of the patient's needs,
lifestyle, combination of conditions and desired outcomes.
  ' (17) 'Quality measure' means the measures and benchmarks
identified by the authority in accordance with section 10 of this
2011 Act.
  ' (18) 'Resources' has the meaning given that term in ORS
411.704. For eligibility purposes, 'resources' does not include
charitable contributions raised by a community to assist with
medical expenses.
  '  { +  SECTION 70. + } If House Bill 2100 becomes law, section
64 of this 2011 Act is amended to read:
  '  { +  Sec. 64. + } (1) ORS 414.705 is repealed.
  ' (2) Sections 13, 14 and 17 of this 2011 Act are repealed
January 2, 2014.
  ' (3) ORS 414.610, 414.630, 414.640, 414.736, 414.738, 414.739
 { - , - }  { +  and + } 414.740   { - and 414.741 - }  are
repealed July 1, 2017.
  '  { +  SECTION 71. + }  { + If Senate Bill 101 becomes law,
section 8, chapter ___, Oregon Laws 2011 (Enrolled Senate Bill
101) (amending ORS 414.743), is repealed and ORS 414.743, as
amended by section 47 of this 2011 Act, is amended to read: + }
  ' 414.743. (1)  { + Except as provided in subsection (2) of
this section, + } a coordinated care organization that does not
have a contract with a hospital to provide inpatient or
outpatient hospital services under ORS 414.705 to 414.750 must,
using   { - a - } Medicare payment methodology, reimburse the
noncontracting hospital for services provided to an enrollee of
the plan at a rate no less than a percentage of the Medicare
reimbursement rate for those services. The percentage of the
Medicare reimbursement rate that is used to determine the
reimbursement rate under this subsection is equal to
 { - two - }  { +  four + } percentage points less than the
percentage of Medicare cost used by the authority in calculating
the base hospital capitation payment to the plan, excluding any
supplemental payments.
  '  { +  (2)(a) If a coordinated care organization does not have
a contract with a hospital, and the hospital provides less than
10 percent of the hospital admissions and outpatient hospital
services to enrollees of the organization, the percentage of the
Medicare reimbursement rate that is used to determine the
reimbursement rate under subsection (1) of this section is equal
to two percentage points less than the percentage of Medicare
cost used by the Oregon Health Authority in calculating the base
hospital capitation payment to the organization, excluding any
supplemental payments.
  ' (b) This subsection is not intended to discourage a
coordinated care organization and a hospital from entering into a
contract and is intended to apply to hospitals that provide
primarily, but not exclusively, specialty and emergency care to
enrollees of the organization. + }
  '  { - (2) - }  { +  (3) + } A hospital that does not have a
contract with a coordinated care organization to provide
inpatient or outpatient hospital services under ORS 414.705 to
414.750 must accept as payment in full for hospital services the
rates described in
  { - subsection (1) - }  { +  subsections (1) and (2) + } of
this section.
  '  { - (3) - }  { +  (4) + } This section does not apply to
type A and type B hospitals, as described in ORS 442.470, and
rural critical access hospitals, as defined in ORS 315.613.
  '  { - (4) - }  { +  (5) + } The Oregon Health Authority shall
adopt rules to implement and administer this section.
  '  { +  SECTION 72. + } If Senate Bill 101 becomes law, section
10, chapter ___, Oregon Laws 2011 (Enrolled Senate Bill 101), is
amended to read:
  '  { +  Sec. 10. + } (1) The amendments to ORS 414.826, 414.841
and 414.851 by sections 1 to 4   { - of this 2011 Act - }  { + ,
chapter ___, Oregon Laws 2011 (Enrolled Senate Bill 101), + }
become operative January 1, 2012.
  ' (2) The amendments to ORS 414.743 by   { - section 8 of this
2011 Act - }  { +  section 71 of this 2011 Act + } become
operative September 1, 2011.'.
  In line 30, delete '68' and insert '73'.
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