Bill Text: OR SB1522 | 2012 | Regular Session | Introduced

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Bill Title: Relating to health equities; declaring an emergency.

Sponsorship: Unknown

Status: (Failed) 2012-03-05 - In committee upon adjournment. [SB1522 Detail]

Download: Oregon-2012-SB1522-Introduced.html

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     76th OREGON LEGISLATIVE ASSEMBLY--2012 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 137

                        Senate Bill 1522

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 Senate Interim Committee on
  General Government, Consumer and Small Business Protection)

                             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 take into account
psychological and social factors facing members of coordinated
care organization in establishing quality measures and global
budgets.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to health equities; amending ORS 414.065 and 414.638;
  and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 414.065 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
 { + budget + } payments for meeting the costs of providing
health services to an applicant or recipient. { +  Global budget
payments must reflect the resources needed to serve patients with
greater medical needs and with psychological, social and physical
barriers to receiving quality care. + }
  (E) Reasonable fees for professional medical and dental
services   { - which - }  { +  that + } 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 { + , using an advisory committee as provided in ORS
183.333. The advisory committee membership must represent
community providers that serve recipients of medical
assistance + }.
  (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.
  SECTION 2. ORS 414.638 is amended to read:
  414.638. (1) The Oregon Health Authority through a public
process shall identify objective outcome and quality measures and
benchmarks, including measures of outcome and quality for
ambulatory care, inpatient care, chemical dependency and mental
health treatment, oral health care and all other health services
provided by coordinated care organizations.  { + The measures
must take into account the psychological and social factors
affecting the members of the organization, including but not
limited to:
  (a) Urban or rural geographic distribution;
  (b) Incidence of substance abuse;
  (c) Incidence of severe and persistent mental illness;
  (d) Cultural or language barriers to accessing care; and
  (e) Homelessness.
  (2) + } The authority shall incorporate these measures into
coordinated care organization contracts to hold the organizations
accountable for performance and customer satisfaction
requirements. { +  The authority may not enter into or renew a
contract with a coordinated care organization unless the
organization demonstrates how the organization will:
  (a) Ensure access and appropriate service delivery using best
practices for members experiencing psychological or social
barriers to care; and
  (b) Measure the extent to which members have access to
providers who possess the expertise necessary to mitigate or
remove the psychological and social barriers to care. + }
    { - (2) - }  { +  (3) + } The authority shall evaluate on a
regular and ongoing basis key quality measures, including health
status, experience of care and patient activation, along with key
demographic variables including race and ethnicity, for members
in each coordinated care organization and for members statewide.
    { - (3) - }  { +  (4) + } Quality measures identified by the
authority under this section must be consistent with existing
state and national quality measures. The authority shall utilize
available data systems for reporting and take actions to
eliminate any redundant reporting or reporting of limited value.
    { - (4) - }  { +  (5) + } The authority shall publish the
information collected under this section at aggregate levels that
do not disclose information otherwise protected by law. The
information published must report, by coordinated care
organization:
  (a) Quality measures;
  (b) Costs;
  (c) Outcomes; and
  (d) Other information, as specified by the contract between the
coordinated care organization and the authority, that is
necessary for the authority, members and the public to evaluate
the value of health services delivered by a coordinated care
organization.
  SECTION 3.  { + This 2012 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2012 Act takes effect on its
passage. + }
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