Bill Text: OR SB101 | 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 care; and declaring an emergency.

Spectrum: Unknown

Status: (Passed) 2011-08-03 - Effective date, August 2, 2011. [SB101 Detail]

Download: Oregon-2011-SB101-Engrossed.html

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     76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session

SA to A-Eng. SB 101

LC 660/SB 101-A15

                      SENATE AMENDMENTS TO
                   A-ENGROSSED SENATE BILL 101

              By JOINT COMMITTEE ON WAYS AND MEANS

                             June 21

  On page 1 of the printed A-engrossed bill, line 2, after '
414.025,' insert '414.743,'.
  In line 3, after '414.851' insert '; repealing sections 6, 7
and 8, chapter 886, Oregon Laws 2009'.
  On page 7, after line 34, insert:
  '  { +  SECTION 7. + }  { + (1) As used in this section, 'fully
capitated health plan' has the meaning given that term in ORS
414.736.
  ' (2) The Oregon Health Authority shall proceed with all due
diligence and speed to obtain the appropriate authorization to
implement on September 1, 2011, a new Medicaid fee schedule that
is based upon the legislatively approved budget.
  ' (3) Before September 1, 2011, a hospital and a fully
capitated health plan shall maintain their existing contract for
the provision of inpatient or outpatient hospital services under
ORS 414.705 to 414.750, unless the hospital and the plan mutually
agree upon a change to the contract. During this time, the
hospital and the plan shall work in good faith to negotiate a new
contract in anticipation of the implementation of a new Medicaid
fee schedule on September 1, 2011.
  ' (4) On or after September 1, 2011, a fully capitated health
plan that does not have a contract with a hospital that provides
10 percent or more of hospital admissions and outpatient hospital
services to enrollees of the plan may, when mutually agreed to by
the plan and the hospital, engage in binding arbitration. The
binding arbitration must be completed no later than December 1,
2011. The hospital and the plan shall agree upon the arbitrator.
  ' (5) The authority shall report to the Legislative Assembly no
later than February 1, 2012, the results of the contracting
carried out under this section. + }
  '  { +  SECTION 8. + } ORS 414.743 is amended to read:
  ' 414.743. (1)  { + Except as provided in subsection (2) of
this section, + } a fully capitated health plan 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 fully capitated health plan 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 plan, 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 plan, excluding any supplemental
payments.
  ' (b) This subsection is not intended to discourage a fully
capitated health plan 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 plan. + }
  '  { - (2) - }  { +  (3) + } A hospital that does not have a
contract with a fully capitated health plan 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 9. + }  { + (1) Sections 7 and 8, chapter 886,
Oregon Laws 2009, are repealed.
  ' (2) The amendments to ORS 414.736 by section 6, chapter 886,
Oregon Laws 2009, are repealed. + } ' .
  In line 35, delete '7.' and insert '10. (1)'.
  After line 36, insert:
  ' (2) The amendments to ORS 414.743 by section 8 of this 2011
Act become operative September 1, 2011.'.
  In line 37, delete '8' and insert '11'.
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