Bill Text: OR SB413 | 2013 | Regular Session | Engrossed

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

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Bill Title: Relating to health insurance rate review; declaring an emergency.

Spectrum: Partisan Bill (Democrat 16-0)

Status: (Enrolled - Dead) 2013-07-08 - In conference committee upon adjournment. [SB413 Detail]

Download: Oregon-2013-SB413-Engrossed.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

HA to A-Eng. SB 413

LC 1299/SB 413-A9

                       HOUSE AMENDMENTS TO
                   A-ENGROSSED SENATE BILL 413

                   By COMMITTEE ON HEALTH CARE

                             June 3

  On page 1 of the printed A-engrossed bill, line 5, delete '
Section 2' and insert 'Sections 2 and 3' and delete 'is ' and
insert 'are'.
  Delete lines 6 through 19 and insert:
  '  { +  SECTION 2. + }  { +  (1) The Department of Consumer and
Business Services and the Oregon Health Authority shall jointly
develop standards and metrics for evaluating health insurers'
cost containment strategies and shall incorporate the standards
into the premium rate approval process under ORS 743.018.
  ' (2) In evaluating whether to approve a premium rate, the
department shall conduct a comprehensive review of the insurer's
cost containment and quality improvement strategies. The
comprehensive review shall include, but is not limited to:
  ' (a) An evaluation of the insurer's strategies in key areas in
which evidence-based and experience-tested strategies are
available; and
  ' (b) A determination of whether the insurer's strategies are
feasible, comprehensive and sufficient to contain costs and
improve quality.
  ' (3) The department and the authority shall also establish a
process for jointly expanding or refining the cost containment
strategies that may be considered in reviewing a rate filing.
  ' (4) In determining whether a proposed premium rate meets the
criteria of ORS 743.018, the department shall consider:
  ' (a) An insurer's specific, quantifiable goals for reducing
upward trends in medical costs as well as the insurer's detailed
rationale for choosing those particular goals;
  ' (b) Whether an insurer met or exceeded the goals for reducing
upward trends in medical costs set forth in its previous rate
filing for the same category of health plan; and
  ' (c) If the insurer's upward trends in medical costs failed to
meet the goals, the insurer's assessment of the causes of failure
and the insurer's plans to improve cost containment performance
in the future.
  ' (5) The department and the authority shall regularly report
to the appropriate interim committees of the Legislative Assembly
on their progress toward implementation of this section and on
any recommended legislative changes to improve the review of cost
containment strategies in the rate review process. + }
  '  { +  SECTION 3. + }  { + (1) The Department of Consumer and
Business Services shall establish by rule a methodology for
projecting anticipated changes in medical costs. Insurers must
apply the methodology in calculating proposed premium rates. The
methodology shall include:
  ' (a) The adoption of a rate of inflation or deflation in
medical costs projected from the current year to the year to
which a rate filing applies; and
  ' (b) Exceptions to the rate of inflation or deflation adopted
under paragraph (a) of this subsection based on special factors
including, but not limited to:
  ' (A) Unique characteristics of the policyholders or
certificate holders of a health benefit plan; or
  ' (B) Utilization controls used in a health benefit plan that
would cause the rate of change in medical costs to vary from a
state average.
  ' (2) An insurer is required to use the rate of inflation or
deflation established under subsection (1)(a) of this section
unless the insurer provides the department with compelling
evidence that the insurer qualifies for an exception adopted by
the department under subsection (1)(b) of this section.
  ' (3) The department shall adopt the rate and the methodology
described in subsection (1) of this section using a public
process. The department shall convene a group that includes
actuaries and other relevant experts to advise the department in
the adoption of the rate and methodology. All proceedings
conducted and documents produced or considered under this section
are subject to open meetings and public records laws under ORS
192.410 to 192.505 and 192.610 to 192.690. + } ' .
  In line 20, delete '3' and insert '4'.
  On page 2, after line 5, insert:
  ' (2) Each calendar year, on a date prescribed by the
department that is designed to coincide with the rate filing
deadline for qualified health plans offered through the health
insurance exchange, an insurer that offers a health benefit plan
to an individual or to a small employer shall send a written
notice to the policyholders of the individual or small employer
health benefit plans that contains:
  ' (a) Information about the rate review process in this state
and how to provide public comments and participate in public
hearings on rate filings;
  ' (b) The address of the department's rate review website;
  ' (c) Instructions for how to sign up to receive rate filing
notifications through the department's electronic mailing list;
and
  ' (d) Instructions for how to receive rate filing notifications
in formats other than the department's electronic mailing list.
  ' (3) All enrollment forms and renewal notices provided to
enrollees in individual or small employer health benefit plans
must include, in a prominent manner, information about:
  ' (a) The rate review process in this state;
  ' (b) The rate review website maintained by the department;
  ' (c) Enrollees' right to participate in the rate review
process; and
  ' (d) How to elect to receive rate filing notifications through
the department's electronic mailing list.
  ' (4) Insurers offering individual or small employer health
benefit plans shall provide, in a prominent location on the
enrollment and renewal forms, an opportunity for enrollees to
elect to receive rate filing notifications through the
department's electronic mailing list system. Insurers shall
subscribe enrollees who elect to receive rate filing
notifications, using the department's electronic notification
system.
  ' (5) All explanations of benefits and all printed marketing
materials, newsletters and communications with insurance brokers
from an insurer offering individual or small employer health
benefit plans must include the information described in
subsection (3)(a), (b) and (c) of this section.'.
  In line 6, delete '(2)' and insert '(6)'.
  In line 10, delete '(3)' and insert '(7)'.
  In line 16, delete '4' and insert '5'.
  In line 44, after 'expenses' insert 'using the methodology for
projecting anticipated changes in medical costs adopted by the
Department of Consumer and Business Services under section 3 of
this 2013 Act'.
  On page 3, line 16, delete '5' and insert '6'.
  After line 41, insert:
  '  { +  SECTION 7. + }  { + Sections 2 and 3 of this 2013 Act
apply to premium rate filings for individual and small group
health benefit plan coverage beginning on or after January 1,
2015. + } ' .
  In line 42, delete '6' and insert '8'.
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