Bill Text: OR SB204 | 2011 | Regular Session | Enrolled
Bill Title: Relating to health care; and declaring an emergency.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2011-06-22 - Effective date, June 17, 2011. [SB204 Detail]
Download: Oregon-2011-SB204-Enrolled.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
Enrolled
Senate Bill 204
Sponsored by Senator BATES, Representative KOTEK (Presession
filed.)
CHAPTER ................
AN ACT
Relating to health care; creating new provisions; amending ORS
243.125 and 243.864; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2011 Act is added to and made
a part of ORS 192.518 to 192.529. + }
SECTION 2. { + (1) As used in this section, 'entity' means a
health care provider or a prepaid managed care health services
organization, as defined in ORS 414.736, that provides health
care to an individual, if the care is paid for by a state health
plan.
(2) Notwithstanding ORS 179.505, an entity may disclose the
identity of an individual who receives health care from the
entity without obtaining an authorization from the individual, or
a personal representative of the individual, to another entity
for the purpose of coordinating the health care and treatment
provided to the individual by either entity. + }
SECTION 3. { + (1) The Oregon Health Authority shall prescribe
by rule a uniform payment methodology for hospital and ambulatory
surgical center services that:
(a) Incorporates the most recent Medicare payment methodologies
established by the Centers for Medicare and Medicaid Services, or
similar payment methodologies, for hospital and ambulatory
surgical center services;
(b) Includes payment methodologies for services and equipment
that are not fully addressed by Medicare payment methodologies;
and
(c) Allows for the use of alternative payment methodologies,
including but not limited to pay-for-performance, bundled
payments and capitation.
(2) In developing the payment methodologies described in this
section, the authority shall convene and be advised by a work
group consisting of providers, insurers and consumers of the
types of health care services that are subject to the
methodologies. + }
SECTION 4. { + (1) A hospital or ambulatory surgical center
shall bill and accept as payment in full an amount determined in
accordance with the payment methodology prescribed by the Oregon
Health Authority under section 3 of this 2011 Act.
(2) This section does not apply to type A or type B hospitals
as described in ORS 442.470 or rural critical access hospitals as
defined in ORS 315.613. + }
Enrolled Senate Bill 204 (SB 204-B) Page 1
SECTION 5. { + Section 6 of this 2011 Act is added to and made
a part of ORS 243.105 to 243.285. + }
SECTION 6. { + (1) A hospital that provides services or
supplies under a benefit plan offered by the Public Employees'
Benefit Board shall be reimbursed using the methodology
prescribed by the Oregon Health Authority under section 3 of this
2011 Act and may not be reimbursed for each service or supply
provided.
(2) This section applies to hospital payments made by a carrier
under a contract with the board and to hospital payments made
under a self-insurance program administered by a third party
administrator on behalf of the board.
(3) This section does not apply to reimbursements paid by a
carrier or third party administrator to a hospital that is not
subject to the methodology prescribed by the authority under
section 3 of this 2011 Act. + }
SECTION 7. { + Section 8 of this 2011 Act is added to and made
a part of ORS 243.860 to 243.886. + }
SECTION 8. { + (1) A hospital that provides services or
supplies under a benefit plan offered by the Oregon Educators
Benefit Board shall be reimbursed using the methodology
prescribed by the Oregon Health Authority under section 3 of this
2011 Act and may not be reimbursed for each service or supply
provided.
(2) This section applies to hospital payments made by a carrier
under a contract with the board and to hospital payments made
under a self-insurance program administered by a third party
administrator on behalf of the board.
(3) This section does not apply to reimbursements paid by a
carrier or third party administrator to a hospital that is not
subject to the methodology prescribed by the authority under
section 3 of this 2011 Act. + }
SECTION 9. { + An insurer, as defined in ORS 731.106, that
contracts with the Oregon Health Authority, including with the
Public Employees' Benefit Board and the Oregon Educators Benefit
Board, to provide health insurance coverage for state employees,
educators or medical assistance recipients must annually attest,
on a form and in a manner prescribed by the authority, to its
compliance with sections 3, 4, 6 and 8 of this 2011 Act. A
contract with an insurer subject to the requirements of this
section may not be renewed without the attestation required by
this section. + }
SECTION 10. ORS 243.125 is amended to read:
243.125. (1) The Public Employees' Benefit Board shall
prescribe rules for the conduct of its business { + and for
carrying out section 6 of this 2011 Act + }. The board shall
study all matters connected with the providing of adequate
benefit plan coverage for eligible state employees on the best
basis possible with relation both to the welfare of the employees
and to the state. The board shall design benefits, devise
specifications, analyze carrier responses to advertisements for
bids and decide on the award of contracts. Contracts shall be
signed by the chairperson on behalf of the board.
(2) In carrying out its duties under subsection (1) of this
section, the goal of the board shall be to provide a high quality
plan of health and other benefits for state employees at a cost
affordable to both the employer and the employees.
(3) Subject to ORS chapter 183, the board may make rules not
inconsistent with ORS 243.105 to 243.285 and 292.051 to determine
Enrolled Senate Bill 204 (SB 204-B) Page 2
the terms and conditions of eligible employee participation and
coverage.
(4) The board shall prepare specifications, invite bids and do
acts necessary to award contracts for health benefit plan and
dental benefit plan coverage of eligible employees in accordance
with the criteria set forth in ORS 243.135 (1).
(5) The board may retain consultants, brokers or other advisory
personnel when necessary and, subject to the State Personnel
Relations Law, shall employ such personnel as are required to
perform the functions of the board.
SECTION 11. ORS 243.864 is amended to read:
243.864. (1) The Oregon Educators Benefit Board:
(a) Shall adopt rules for the conduct of its business { + and
for carrying out section 8 of this 2011 Act + }; and
(b) May adopt rules not inconsistent with ORS 243.860 to
243.886 to determine the terms and conditions of eligible
employee participation in and coverage under benefit plans.
(2) The board shall study all matters connected with the
provision of adequate benefit plan coverage for eligible
employees on the best basis possible with regard to the welfare
of the employees and affordability for the districts. The board
shall design benefits, prepare specifications, analyze carrier
responses to advertisements for bids and award contracts.
Contracts shall be signed by the chairperson on behalf of the
board.
(3) In carrying out its duties under subsections (1) and (2) of
this section, the goal of the board is to provide high-quality
health, dental and other benefit plans for eligible employees at
a cost affordable to the districts, the employees and the
taxpayers of Oregon.
(4) The board shall prepare specifications, invite bids and
take actions necessary to award contracts for health and dental
benefit plan coverage of eligible employees in accordance with
the criteria set forth in ORS 243.866 (1). The Public Contracting
Code does not apply to contracts for benefit plans provided under
ORS 243.860 to 243.886. The board may not exclude from
competition to contract for a benefit plan an Oregon carrier
solely because the carrier does not serve all counties in Oregon.
(5) The board may retain consultants, brokers or other advisory
personnel when necessary and shall employ such personnel as are
required to perform the functions of the board.
SECTION 12. { + (1) Except as provided in subsection (2) of
this section, sections 3 to 8 of this 2011 Act and the amendments
to ORS 243.125 and 243.864 by sections 10 and 11 of this 2011 Act
apply to:
(a) Claims by a hospital for reimbursement of services provided
by the hospital on or after January 1, 2012; and
(b) Claims by an ambulatory surgical center for reimbursement
of services provided by the ambulatory surgical center on or
after January 1, 2013.
(2) Sections 3 to 9 of this 2011 Act and the amendments to ORS
243.125 and 243.864 by sections 10 and 11 of this 2011 Act apply
to reimbursement paid under contracts entered into or renewed on
or after the effective date of this 2011 Act. + }
SECTION 13. { + (1) Crook, Deschutes and Jefferson Counties
may form a Central Oregon Health Council when the governing body
of each of the counties adopts a resolution signifying the body's
intention to do so.
Enrolled Senate Bill 204 (SB 204-B) Page 3
(2) Subsequent to the formation of the Central Oregon Health
Council, a county that is adjacent to Crook, Deschutes or
Jefferson County may join the council if:
(a) The governing body of the county seeking to join the
council adopts a resolution signifying the body's intention to
include a portion of that county in the region served by the
council;
(b) The portion of the county to be included in the region is
part of a natural health care referral pattern with the other
counties on the council; and
(c) The Oregon Health Authority and the council approve. + }
SECTION 14. { + (1) The Central Oregon Health Council shall
consist of no more than 11 members, including:
(a) A formative council consisting of:
(A) One member each from the governing bodies of Crook,
Deschutes and Jefferson Counties, appointed by each body;
(B) The chief executive officer, or a designee of the chief
executive officer, of the health care system serving the region;
and
(C) The chief executive officer, or a designee of the chief
executive officer, of the Medicaid contractor serving the region;
and
(b) At least three members appointed by the formative council
established under paragraph (a) of this subsection. Members
appointed under this paragraph shall be representatives of:
(A) Consumers of physical and behavioral health services;
(B) Health care professionals;
(C) School districts or educational service districts;
(D) The business community; or
(E) A member from the governing body of each county that joins
the council under section 13 (2) of this 2011 Act.
(2) The term of office of the members of the council is four
years.
(3) A majority of the members of the council constitutes a
quorum for the transaction of business.
(4) The council shall elect a member of the council to serve as
the chairperson.
(5) If there is a vacancy for any cause, the appointing
authority shall make an appointment to the vacated position to
become effective immediately.
(6) The council may enter into necessary contracts, apply for
and receive grants, hold and dispose of property and take other
actions necessary to carry out the activities, services and
responsibilities assumed by the council.
(7) The council may adopt rules necessary for the operation of
the council. + }
SECTION 15. { + The Central Oregon Health Council shall
appoint an advisory committee to advise the council in the
performance of the duties of the council. The members of the
advisory committee may include representatives of:
(1) Public health agencies serving the region;
(2) Behavioral health agencies for mental health authorities
serving the region represented on the council;
(3) Hospital or integrated delivery systems serving the region
represented on the council;
(4) Medicaid contractors in each region served by the council;
(5) Safety net clinics;
(6) Health collaboratives;
(7) The dental profession;
(8) School and educational service districts;
Enrolled Senate Bill 204 (SB 204-B) Page 4
(9) The business community;
(10) Primary care clinics; and
(11) Independent physician associations. + }
SECTION 16. { + (1) As used in this section, 'regional health
improvement plan' means a four-year comprehensive, coordinated
regional plan incorporating and replacing all health and human
service plans prescribed by the Oregon Health Authority,
including but not limited to plans required under ORS 430.630,
430.640, 431.385 and 624.510 and plans required by the State
Commission on Children and Families under ORS 417.705 to 417.801.
(2)(a) The Central Oregon Health Council shall conduct a
regional health assessment and adopt a regional health
improvement plan to serve as a strategic population health and
health care system service plan for the region served by the
council. The plan must define the scope of the activities,
services and responsibilities that the council proposes to assume
upon implementation of the plan.
(b) The activities, services and responsibilities that the
council proposes to assume under the plan may include, but are
not limited to:
(A) Analysis and development of public and private resources,
capacities and metrics based on ongoing regional health
assessment activities and population health priorities;
(B) Health policy;
(C) System design;
(D) Outcome and quality improvement;
(E) Integration of service delivery; and
(F) Workforce development.
(3) The council shall submit the plan adopted under subsection
(2) of this section to the authority for approval. The authority
may approve the plan or return it to the council for modification
prior to approval.
(4) The regional health improvement plan adopted under this
section shall serve as a guide for entities serving medical
assistance recipients, public health authorities, mental health
authorities, health care systems, payer groups, provider groups
and health coalitions in the counties served by the council. + }
SECTION 17. { + (1) By September 1, 2011, the Oregon Health
Authority shall adopt by rule requirements for the regional
health improvement plan adopted under section 16 of this 2011
Act.
(2) The Oregon Health Authority shall adopt rules:
(a) Necessary to implement sections 13 to 16 of this 2011 Act;
and
(b) That allow for the consolidation of planning and reporting
requirements of the authority under section 16 of this 2011
Act. + }
SECTION 18. { + No later than the dates of the convening of
the 2013 and of the 2015 Legislative Assemblies as specified in
ORS 171.010, the Central Oregon Health Council shall report to
the Seventy-seventh and Seventy-eighth Legislative Assemblies in
the manner provided by ORS 192.245 about the results of the
implementation of the regional health improvement plan adopted
under section 16 of this 2011 Act. The report shall include, but
is not limited to, performance measures of improvement of health
outcomes, improvement in care and reductions in the cost of
care. + }
SECTION 19. { + Sections 13 to 18 of this 2011 Act are
repealed on January 2, 2016. + }
Enrolled Senate Bill 204 (SB 204-B) Page 5
SECTION 20. { + This 2011 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2011 Act takes effect on
its passage. + }
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Passed by Senate May 2, 2011
Repassed by Senate June 9, 2011
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House June 2, 2011
.............................................................
Bruce Hanna, Speaker of House
.............................................................
Arnie Roblan, Speaker of House
Enrolled Senate Bill 204 (SB 204-B) Page 6
Received by Governor:
......M.,............., 2011
Approved:
......M.,............., 2011
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2011
.............................................................
Kate Brown, Secretary of State
Enrolled Senate Bill 204 (SB 204-B) Page 7
