Bill Text: OR SB568 | 2013 | Regular Session | Enrolled
Bill Title: Relating to health care contracting; and declaring an emergency.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-04-12 - Effective date, April 2, 2013. [SB568 Detail]
Download: Oregon-2013-SB568-Enrolled.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
Enrolled
Senate Bill 568
Sponsored by Senators MONNES ANDERSON, COURTNEY, FERRIOLI,
Representatives MCLANE, KOTEK; Senators BATES, JOHNSON, KNOPP,
KRUSE, STEINER HAYWARD, WINTERS, Representatives CONGER,
FREEMAN, GREENLICK, HOYLE, KENY-GUYER, NATHANSON, THOMPSON
CHAPTER ................
AN ACT
Relating to health care contracting; amending ORS 414.635 and
section 7, chapter 886, Oregon Laws 2009; and declaring an
emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 414.635, as amended by section 9, chapter 602,
Oregon Laws 2011, and section 5, chapter 8, Oregon Laws 2012, is
amended to read:
414.635. (1) The Oregon Health Authority shall adopt by rule
safeguards for members enrolled in coordinated care organizations
that protect against underutilization of services and
inappropriate denials of services. In addition to any other
consumer rights and responsibilities established by law, each
member:
(a) Must be encouraged to be an active partner in directing the
member's health care and services and not a passive recipient of
care.
(b) Must be educated about the coordinated care approach being
used in the community and how to navigate the coordinated health
care system.
(c) Must have access to advocates, including qualified peer
wellness specialists where appropriate, personal health
navigators, and qualified community health workers who are part
of the member's care team to provide assistance that is
culturally and linguistically appropriate to the member's need to
access appropriate services and participate in processes
affecting the member's care and services.
(d) Shall be encouraged within all aspects of the integrated
and coordinated health care delivery system to use wellness and
prevention resources and to make healthy lifestyle choices.
(e) Shall be encouraged to work with the member's care team,
including providers and community resources appropriate to the
member's needs as a whole person.
(2) The authority shall establish and maintain an enrollment
process for individuals who are dually eligible for Medicare and
Medicaid that promotes continuity of care and that allows the
member to disenroll from a coordinated care organization that
fails to promptly provide adequate services and:
(a) To enroll in another coordinated care organization of the
member's choice; or
Enrolled Senate Bill 568 (SB 568-INTRO) Page 1
(b) If another organization is not available, to receive
Medicare-covered services on a fee-for-service basis.
(3) Members and their providers and coordinated care
organizations have the right to appeal decisions about care and
services through the authority in an expedited manner and in
accordance with the contested case procedures in ORS chapter 183.
(4) A health care entity may not unreasonably refuse to
contract with an organization seeking to form a coordinated care
organization if the participation of the entity is necessary for
the organization to qualify as a coordinated care organization.
(5) A health care entity may refuse to contract with a
coordinated care organization if the reimbursement established
for a service provided by the entity under the contract is below
the reasonable cost to the entity for providing the service.
(6) A health care entity that unreasonably refuses to contract
with a coordinated care organization may not receive
fee-for-service reimbursement from the authority for services
that are available through a coordinated care organization either
directly or by contract.
(7) { + (a) + } The authority shall adopt by rule a process for
resolving disputes involving { - an - } { + :
(A) A health care + } entity's refusal to contract with a
coordinated care organization under subsections (4) and (5) of
this section.
{ + (B) The termination, extension or renewal of a health
care entity's contract with a coordinated care organization.
(b) + } The { - process - } { + processes adopted under
this subsection + } must include the use of an independent third
party arbitrator.
(8) A coordinated care organization may not unreasonably refuse
to contract with a licensed health care provider.
(9) The authority shall:
(a) Monitor and enforce consumer rights and protections within
the Oregon Integrated and Coordinated Health Care Delivery System
and ensure a consistent response to complaints of violations of
consumer rights or protections.
(b) Monitor and report on the statewide health care
expenditures and recommend actions appropriate and necessary to
contain the growth in health care costs incurred by all sectors
of the system.
SECTION 2. Section 7, chapter 886, Oregon Laws 2009, is amended
to read:
{ + Sec. 7. + } ORS 414.743 is repealed on January 2,
{ - 2014 - } { + 2016 + }.
SECTION 3. { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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Enrolled Senate Bill 568 (SB 568-INTRO) Page 2
Passed by Senate March 6, 2013
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House March 26, 2013
.............................................................
Tina Kotek, Speaker of House
Enrolled Senate Bill 568 (SB 568-INTRO) Page 3
Received by Governor:
......M.,............., 2013
Approved:
......M.,............., 2013
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2013
.............................................................
Kate Brown, Secretary of State
Enrolled Senate Bill 568 (SB 568-INTRO) Page 4
