Bill Text: OR SB724 | 2013 | Regular Session | Enrolled
Bill Title: Relating to payments for health services; and declaring an emergency.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Passed) 2013-07-03 - Effective date, June 26, 2013. [SB724 Detail]
Download: Oregon-2013-SB724-Enrolled.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
Enrolled
Senate Bill 724
Sponsored by Senator BATES; Representatives CLEM, FREEMAN
CHAPTER ................
AN ACT
Relating to payments for health services; creating new
provisions; amending ORS 414.065; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 414.065, as amended by section 19, chapter 8,
Oregon Laws 2012, 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 payments
for meeting the costs of providing health services to an
applicant or recipient.
(E) Reasonable fees for professional medical and dental
services which 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.
(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.
Enrolled Senate Bill 724 (SB 724-C) Page 1
(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.
(5) In determining a global budget for a coordinated care
organization:
(a) The allocation of the payment, the risk and any cost
savings shall be determined by the governing body of the
organization; { - and - }
(b) The authority shall consider the community health
assessment conducted by the organization and reviewed annually,
and the organization's health care costs { - . - } { + ; and
(c) The authority shall take into account the organization's
provision of innovative, nontraditional health services. + }
(6) Under the supervision of the Governor, the authority may
work with the Centers for Medicare and Medicaid Services to
develop, in addition to global budgets, payment streams:
(a) To support improved delivery of health care to recipients
of medical assistance; and
(b) That are funded by coordinated care organizations, counties
or other entities other than the state whose contributions
qualify for federal matching funds under Title XIX or XXI of the
Social Security Act.
SECTION 2. { + In consultation with coordinated care
organizations, the Oregon Health Authority shall, not later than
August 1, 2013, develop a method for accounting for the provision
of innovative, nontraditional health services in determining a
global budget for a coordinated care organization. + }
SECTION 3. { + Section 4 of this 2013 Act is added to and made
a part of ORS chapter 414. + }
SECTION 4. { + (1) If the Oregon Health Authority or the
Department of Human Services requires a coordinated care
organization to provide a service, paid for out of the
organization's global budget, that was previously reimbursed by
the authority or the department on a fee-for-service basis, the
authority or the department must provide the organization with a
statement of the costs incurred by the authority or the
department in reimbursing the service during the three-year
period prior to the organization's assumption of the cost of the
service.
(2) If the authority or the department requires a coordinated
care organization to assume the cost of a service as described in
subsection (1) of this section, the authority or the department
shall report to the Legislative Assembly, not later than February
1 of the following year, a statement of the increased cost to the
coordinated care organization of providing the service,
calculated as the average annual cost incurred by the authority
or the department in reimbursing the service during the
three-year period prior to the organization's assumption of the
cost of the service. + }
SECTION 5. { + Section 6 of this 2013 Act is added to and made
a part of the Insurance Code. + }
SECTION 6. { + (1) As used in this section, 'ambulatory
surgical center' has the meaning given that term in ORS 442.015.
(2) An insurer or a third party administrator for a
self-insured plan shall reimburse an out-of-network ambulatory
surgical center for a service covered under a policy or
certificate of health insurance by:
(a) Paying the center directly; or
Enrolled Senate Bill 724 (SB 724-C) Page 2
(b) Issuing a check made payable to both the center and to the
insured or beneficiary who received the service or, if the
insured or beneficiary who received the service is a dependent,
to the policyholder or certificate holder.
(3) The insurer or administrator shall pay the center the
reimbursement amount allowed under the terms of the policy or
certificate. + }
SECTION 7. { + The amendments to ORS 414.065 by section 1 of
this 2013 Act become operative July 1, 2013. + }
SECTION 8. { + Section 2 of this 2013 Act is repealed January
2, 2014. + }
SECTION 9. { + Section 6 of this 2013 Act applies to payments
made on claims presented on or after January 1, 2014. + }
SECTION 10. { + 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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Passed by Senate April 23, 2013
Repassed by Senate June 18, 2013
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House June 14, 2013
.............................................................
Tina Kotek, Speaker of House
Enrolled Senate Bill 724 (SB 724-C) 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 724 (SB 724-C) Page 4
