Bill Text: OR SB725 | 2013 | Regular Session | Enrolled
Bill Title: Relating to coordinated care organizations; and declaring an emergency.
Spectrum: Slight Partisan Bill (Democrat 3-1)
Status: (Passed) 2013-07-03 - Effective date, June 26, 2013. [SB725 Detail]
Download: Oregon-2013-SB725-Enrolled.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
Enrolled
Senate Bill 725
Sponsored by Senator BATES, Representative GREENLICK;
Representatives CLEM, FREEMAN
CHAPTER ................
AN ACT
Relating to coordinated care organizations; creating new
provisions; amending ORS 414.625 and section 13, chapter 8,
Oregon Laws 2012; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2013 Act is added to and made
a part of ORS chapter 414. + }
SECTION 2. { + (1) A contract entered into between the Oregon
Health Authority and a coordinated care organization under ORS
414.625 (1):
(a) Shall be for a term of five years;
(b) Except as provided in subsection (3) of this section, may
not be amended more than once in each 12-month period; and
(c) May be terminated if a coordinated care organization fails
to meet outcome and quality measures specified in the contract or
is otherwise in breach of the contract.
(2) This section does not prohibit the authority from allowing
a coordinated care organization a reasonable amount of time in
which to cure any failure to meet outcome and quality measures
specified in the contract prior to the termination of the
contract.
(3) A contract entered into between the authority and a
coordinated care organization may be amended more than once in
each 12-month period if:
(a) The authority and the coordinated care organization
mutually agree to amend the contract; or
(b) Amendments are necessitated by changes in federal or state
law. + }
SECTION 3. ORS 414.625, as amended by section 20, chapter 8,
Oregon Laws 2012, is amended to read:
414.625. (1) The Oregon Health Authority shall adopt by rule
the qualification criteria and requirements for a coordinated
care organization and shall integrate the criteria and
requirements into each contract with a coordinated care
organization. Coordinated care organizations may be local,
community-based organizations or statewide organizations with
community-based participation in governance or any combination of
the two. Coordinated care organizations may contract with
counties or with other public or private entities to provide
services to members. The authority may not contract with only
one statewide organization. A coordinated care organization may
be a single corporate structure or a network of providers
Enrolled Senate Bill 725 (SB 725-B) Page 1
organized through contractual relationships. The criteria adopted
by the authority under this section must include, but are not
limited to, the coordinated care organization's demonstrated
experience and capacity for:
(a) Managing financial risk and establishing financial
reserves.
(b) Meeting the following minimum financial requirements:
(A) Maintaining restricted reserves of $250,000 plus an amount
equal to 50 percent of the coordinated care organization's total
actual or projected liabilities above $250,000.
(B) Maintaining a net worth in an amount equal to at least five
percent of the average combined revenue in the prior two quarters
of the participating health care entities.
(c) Operating within a fixed global budget.
(d) Developing and implementing alternative payment
methodologies that are based on health care quality and improved
health outcomes.
(e) Coordinating the delivery of physical health care, mental
health and chemical dependency services, oral health care and
covered long-term care services.
(f) Engaging community members and health care providers in
improving the health of the community and addressing regional,
cultural, socioeconomic and racial disparities in health care
that exist among the coordinated care organization's members and
in the coordinated care organization's community.
(2) In addition to the criteria specified in subsection (1) of
this section, the authority must adopt by rule requirements for
coordinated care organizations contracting with the authority so
that:
(a) Each member of the coordinated care organization receives
integrated person centered care and services designed to provide
choice, independence and dignity.
(b) Each member has a consistent and stable relationship with a
care team that is responsible for comprehensive care management
and service delivery.
(c) The supportive and therapeutic needs of each member are
addressed in a holistic fashion, using patient centered primary
care homes or other models that support patient centered primary
care and individualized care plans to the extent feasible.
(d) Members receive comprehensive transitional care, including
appropriate follow-up, when entering and leaving an acute care
facility or a long term care setting.
(e) Members receive assistance in navigating the health care
delivery system and in accessing community and social support
services and statewide resources, including through the use of
certified health care interpreters, as defined in ORS 413.550,
community health workers and personal health navigators who meet
competency standards established by the authority under ORS
414.665 or who are certified by the Home Care Commission under
ORS 410.604.
(f) Services and supports are geographically located as close
to where members reside as possible and are, if available,
offered in nontraditional settings that are accessible to
families, diverse communities and underserved populations.
(g) Each coordinated care organization uses health information
technology to link services and care providers across the
continuum of care to the greatest extent practicable and if
financially viable.
(h) Each coordinated care organization complies with the
safeguards for members described in ORS 414.635.
Enrolled Senate Bill 725 (SB 725-B) Page 2
(i) Each coordinated care organization convenes a community
advisory council that meets the criteria specified in section 13,
chapter 8, Oregon Laws 2012.
(j) Each coordinated care organization prioritizes working with
members who have high health care needs, multiple chronic
conditions, mental illness or chemical dependency and involves
those members in accessing and managing appropriate preventive,
health, remedial and supportive care and services to reduce the
use of avoidable emergency room visits and hospital admissions.
(k) Members have a choice of providers within the coordinated
care organization's network and that providers participating in a
coordinated care organization:
(A) Work together to develop best practices for care and
service delivery to reduce waste and improve the health and
well-being of members.
(B) Are educated about the integrated approach and how to
access and communicate within the integrated system about a
patient's treatment plan and health history.
(C) Emphasize prevention, healthy lifestyle choices,
evidence-based practices, shared decision-making and
communication.
(D) Are permitted to participate in the networks of multiple
coordinated care organizations.
(E) Include providers of specialty care.
(F) Are selected by coordinated care organizations using
universal application and credentialing procedures, objective
quality information and are removed if the providers fail to meet
objective quality standards.
(G) Work together to develop best practices for culturally
appropriate care and service delivery to reduce waste, reduce
health disparities and improve the health and well-being of
members.
(L) Each coordinated care organization reports on outcome and
quality measures adopted under ORS 414.638 and participates in
the health care data reporting system established in ORS 442.464
and 442.466.
(m) Each coordinated care organization uses best practices in
the management of finances, contracts, claims processing, payment
functions and provider networks.
(n) Each coordinated care organization participates in the
learning collaborative described in ORS 442.210 (3).
(o) Each coordinated care organization has a { - governance
structure - } { + governing body + } that includes:
(A) Persons that share in the financial risk of the
organization who must constitute a majority of the
{ - governance structure - } { + governing body + };
(B) The major components of the health care delivery system;
(C) At least two health care providers in active practice,
including:
(i) A physician licensed under ORS chapter 677 or a nurse
practitioner certified under ORS 678.375, whose area of practice
is primary care; and
(ii) A mental health or chemical dependency treatment provider;
(D) At least two members from the community at large, to ensure
that the organization's decision-making is consistent with the
values of the members and the community; and
(E) At least one member of the community advisory council.
{ + (p) Each coordinated care organization's governing body
establishes standards for publicizing the activities of the
coordinated care organization and the organization's community
Enrolled Senate Bill 725 (SB 725-B) Page 3
advisory councils, as necessary, to keep the community
informed. + }
(3) The authority shall consider the participation of area
agencies and other nonprofit agencies in the configuration of
coordinated care organizations.
(4) In selecting one or more coordinated care organizations to
serve a geographic area, the authority shall:
(a) For members and potential members, optimize access to care
and choice of providers;
(b) For providers, optimize choice in contracting with
coordinated care organizations; and
(c) Allow more than one coordinated care organization to serve
the geographic area if necessary to optimize access and choice
under this subsection.
(5) On or before July 1, 2014, each coordinated care
organization must have a formal contractual relationship with any
dental care organization that serves members of the coordinated
care organization in the area where they reside.
SECTION 4. Section 13, chapter 8, Oregon Laws 2012, is amended
to read:
{ + Sec. 13. + } (1) A coordinated care organization must
have a community advisory council to ensure that the health care
needs of the consumers and the community are being addressed. The
council must:
(a) Include representatives of the community and of each county
government served by the coordinated care organization, but
consumer representatives must constitute a majority of the
membership; { + and + }
{ - (b) Meet no less frequently than once every three months;
and - }
{ - (c) - } { + (b) + } Have its membership selected by a
committee composed of equal numbers of county representatives
from each county served by the coordinated care organization and
members of the governing body of the coordinated care
organization.
(2) The duties of the council include, but are not limited to:
(a) Identifying and advocating for preventive care practices to
be utilized by the coordinated care organization;
(b) Overseeing a community health assessment and adopting a
community health improvement plan to serve as a strategic
population health and health care system service plan for the
community served by the coordinated care organization; and
(c) Annually publishing a report on the progress of the
community health improvement plan.
(3) The community health improvement plan adopted by the
council should describe the scope of the activities, services and
responsibilities that the coordinated care organization will
consider upon implementation of the plan. The activities,
services and responsibilities defined in the plan may include,
but are not limited to:
(a) Analysis and development of public and private resources,
capacities and metrics based on ongoing community 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.
{ + (4) The council shall meet at least once every three
months. The council shall post a report of its meetings and
Enrolled Senate Bill 725 (SB 725-B) Page 4
discussions to the website of the coordinated care organization
and other websites appropriate to keeping the community informed
of the council's activities. The council, the governing body of
the coordinated care organization or a designee of the council or
governing body has discretion as to whether public comments
received at meetings that are open to the public will be included
in the reports posted to the website and, if so, which comments
are appropriate for posting.
(5) If the regular council meetings are not open to the public
and do not provide an opportunity for members of the public to
provide written and oral comments, the council shall hold
semiannual meetings:
(a) That are open to the public and attended by the members of
the council;
(b) At which the council shall report on the activities of the
coordinated care organization and the council;
(c) At which the council shall provide written reports on the
activities of the coordinated care organization; and
(d) At which the council shall provide the opportunity for the
public to provide written or oral comments.
(6) The coordinated care organization shall post to the
organization's website contact information for, at a minimum, the
chairperson, a member of the community advisory council or a
designated staff member of the organization.
(7) Meetings of the council are not subject to ORS 192.610 to
192.710. + }
SECTION 5. Section 13, chapter 8, Oregon Laws 2012, as amended
by section 4 of this 2013 Act, is amended to read:
{ + Sec. 13. + } (1) A coordinated care organization must
have a community advisory council to ensure that the health care
needs of the consumers and the community are being addressed. The
council must:
(a) Include representatives of the community and of each county
government served by the coordinated care organization, but
consumer representatives must constitute a majority of the
membership; and
(b) Have its membership selected by a committee composed of
equal numbers of county representatives from each county served
by the coordinated care organization and members of the governing
body of the coordinated care organization.
(2) The duties of the council include, but are not limited to:
(a) Identifying and advocating for preventive care practices to
be utilized by the coordinated care organization;
(b) Overseeing a community health assessment and adopting a
community health improvement plan to serve as a strategic
population health and health care system service plan for the
community served by the coordinated care organization; and
(c) Annually publishing a report on the progress of the
community health improvement plan.
(3) The community health improvement plan adopted by the
council should describe the scope of the activities, services and
responsibilities that the coordinated care organization will
consider upon implementation of the plan. The activities,
services and responsibilities defined in the plan may include,
but are not limited to:
(a) Analysis and development of public and private resources,
capacities and metrics based on ongoing community health
assessment activities and population health priorities;
(b) Health policy;
(c) System design;
Enrolled Senate Bill 725 (SB 725-B) Page 5
(d) Outcome and quality improvement;
(e) Integration of service delivery; and
(f) Workforce development.
(4) The council shall meet at least once every three months.
The council shall post a report of its meetings and discussions
to the website of the coordinated care organization and other
websites appropriate to keeping the community informed of the
council's activities. The council, the governing body of the
coordinated care organization or a designee of the council or
governing body has discretion as to whether public comments
received at meetings that are open to the public will be included
in the reports posted to the website and, if so, which comments
are appropriate for posting.
(5) If the regular council meetings are not open to the public
and do not provide an opportunity for members of the public to
provide written and oral comments, the council shall hold
{ - semiannual - } { + quarterly + } meetings:
(a) That are open to the public and attended by the members of
the council;
(b) At which the council shall report on the activities of the
coordinated care organization and the council;
(c) At which the council shall provide written reports on the
activities of the coordinated care organization; and
(d) At which the council shall provide the opportunity for the
public to provide written or oral comments.
(6) The coordinated care organization shall post to the
organization's website contact information for, at a minimum, the
chairperson, a member of the community advisory council or a
designated staff member of the organization.
(7) Meetings of the council are not subject to ORS 192.610 to
192.710.
SECTION 6. { + The amendments to section 13, chapter 8, Oregon
Laws 2012, by section 5 of this 2013 Act become operative January
1, 2015. + }
SECTION 7. { + 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. + }
----------
Passed by Senate April 23, 2013
Repassed by Senate June 19, 2013
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House June 13, 2013
.............................................................
Tina Kotek, Speaker of House
Enrolled Senate Bill 725 (SB 725-B) Page 6
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 725 (SB 725-B) Page 7
