Bill Text: OR SB729 | 2013 | Regular Session | Introduced
Bill Title: Relating to Oregon Health Insurance Exchange.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB729 Detail]
Download: Oregon-2013-SB729-Introduced.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 3500
Senate Bill 729
Sponsored by Senator BATES
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Allows coordinated care organizations to participate in Oregon
Health Insurance Exchange.
A BILL FOR AN ACT
Relating to Oregon Health Insurance Exchange; amending ORS
741.310.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 741.310, as amended by section 10, chapter 38,
Oregon Laws 2012, and section 96, chapter 107, Oregon Laws 2012,
is amended to read:
741.310. (1) The following individuals and groups may purchase
qualified health plans through the health insurance exchange:
(a) Beginning January 1, 2014:
(A) Individuals and families; and
(B) Employers with no more than 50 employees.
(b) Beginning October 1, 2015, districts and eligible employees
of districts that are subject to ORS 243.886, unless their
participation is precluded by federal law.
(c) Beginning January 1, 2016, employers with 51 to 100
employees.
(2)(a) Only individuals who purchase health plans through the
exchange may be eligible to receive premium tax credits under
section 36B of the Internal Revenue Code and reduced cost-sharing
under 42 U.S.C. 18071.
(b) Only employers that purchase health plans through the
exchange may be eligible to receive small employer health
insurance credits under section 45R of the Internal Revenue Code.
(3) { - Only - } { + (a) + } An insurer that has a
certificate of authority to transact insurance in this state and
that meets applicable federal requirements for participating in
the exchange may offer a qualified health plan through the
exchange.
{ + (b) A coordinated care organization that meets the
criteria in ORS 414.625 (1) may offer through the exchange no
more than one qualified health plan that:
(A) Meets the requirements of ORS 414.625 (2); and
(B) Provides the level of coverage required by ORS 414.707. + }
{ + (c) + } { - Any - } { + All + } qualified health
{ - plan - } { + plans + } must be certified under subsection
(4) of this section. { - Prepaid managed care health services
organizations that do not have a certificate of authority to
transact insurance may serve only medical assistance recipients
through the exchange and may not offer qualified health
plans. - }
(4)(a) The Oregon Health Insurance Exchange Corporation shall
adopt by rule uniform requirements, standards and criteria for
the certification of qualified health plans, including
requirements that a qualified health plan provide, at a minimum,
essential health benefits and have acceptable consumer and
provider satisfaction ratings.
(b) The corporation may limit the number of qualified health
plans that may be offered through the exchange as long as the
same limit applies to all insurers.
(c) The corporation shall consult with stakeholders, including
but not limited to representatives of school administrators,
school board members and school employees, regarding the plans
that may be offered through the exchange to districts and
eligible employees of districts under subsection (1)(b) of this
section.
(5) Notwithstanding subsection (4) of this section, the
corporation shall certify as qualified a dental only health plan
as permitted by federal law.
(6) The corporation shall establish one streamlined and
seamless application and enrollment process for both the exchange
and the state medical assistance program.
(7) The corporation, in collaboration with the appropriate
state authorities, may establish risk mediation programs within
the exchange.
(8) The corporation shall establish by rule a process for
certifying insurance producers to facilitate the transaction of
insurance through the exchange, in accordance with federal
standards and policies.
(9) The corporation shall ensure, as required by federal laws,
that an insurer charges the same premiums for plans sold through
the exchange as for identical plans sold outside of the exchange.
(10) The corporation is authorized to enter into contracts for
the performance of duties, functions or operations of the
exchange, including but not limited to contracting with:
(a) All insurers that meet the requirements of subsections (3)
and (4) of this section, to offer qualified health plans through
the exchange; and
(b) Navigators certified by the corporation under ORS 741.002.
(11) The corporation is authorized to apply for and accept
federal grants, other federal funds and grants from
nongovernmental organizations for purposes of developing,
implementing and administering the exchange. Moneys received
under this subsection shall be deposited in an account
established under ORS 741.101.
SECTION 2. ORS 741.310, as amended by section 12, chapter 415,
Oregon Laws 2011, section 11, chapter 38, Oregon Laws 2012, and
section 97, chapter 107, Oregon Laws 2012, is amended to read:
741.310. (1) The following individuals and groups may purchase
qualified health plans through the health insurance exchange:
(a) Individuals and families;
(b) Employers with no more than 100 employees; and
(c) Districts and eligible employees of districts that are
subject to ORS 243.886, unless their participation is precluded
by federal law.
(2)(a) Only individuals who purchase health plans through the
exchange may be eligible to receive premium tax credits under
section 36B of the Internal Revenue Code and reduced cost-sharing
under 42 U.S.C. 18071.
(b) Only employers that purchase health plans through the
exchange may be eligible to receive small employer health
insurance credits under section 45R of the Internal Revenue Code.
(3) { - Only - } { + (a) + } An insurer that has a
certificate of authority to transact insurance in this state and
that meets applicable federal requirements for participating in
the exchange may offer a qualified health plan through the
exchange.
{ + (b) A coordinated care organization that meets the
criteria in ORS 414.025 (1) may offer through the exchanges no
more than one qualified health plan that:
(A) Meets the requirements of ORS 414.625 (2); and
(B) Provides the level of coverage required by ORS 414.707.
(c) + } { - Any - } { + All + } qualified health
{ - plan - } { + plans + } must be certified under subsection
(4) of this section. { - Prepaid managed care health services
organizations that do not have a certificate of authority to
transact insurance may serve only medical assistance recipients
through the exchange and may not offer qualified health
plans. - }
(4)(a) The Oregon Health Insurance Exchange Corporation shall
adopt by rule uniform requirements, standards and criteria for
the certification of qualified health plans, including
requirements that a qualified health plan provide, at a minimum,
essential health benefits and have acceptable consumer and
provider satisfaction ratings.
(b) The corporation may limit the number of qualified health
plans that may be offered through the exchange as long as the
same limit applies to all insurers.
(c) The corporation shall consult with stakeholders, including
but not limited to representatives of school administrators,
school board members and school employees, regarding the plans
that may be offered through the exchange to districts and
eligible employees of districts under subsection (1)(c) of this
section.
(5) Notwithstanding subsection (4) of this section, the
corporation shall certify as qualified a dental only health plan
as permitted by federal law.
(6) The corporation shall establish one streamlined and
seamless application and enrollment process for both the exchange
and the state medical assistance program.
(7) The corporation, in collaboration with the appropriate
state authorities, may establish risk mediation programs within
the exchange.
(8) The corporation shall establish by rule a process for
certifying insurance producers to facilitate the transaction of
insurance through the exchange, in accordance with federal
standards and policies.
(9) The corporation shall ensure, as required by federal laws,
that an insurer charges the same premiums for plans sold through
the exchange as for identical plans sold outside of the exchange.
(10) The corporation is authorized to enter into contracts for
the performance of duties, functions or operations of the
exchange, including but not limited to contracting with:
(a) Insurers that meet the requirements of subsections (3) and
(4) of this section, to offer qualified health plans through the
exchange; and
(b) Navigators certified by the corporation under ORS 741.002.
(11) The corporation is authorized to apply for and accept
federal grants, other federal funds and grants from
nongovernmental organizations for purposes of developing,
implementing and administering the exchange. Moneys received
under this subsection shall be deposited in an account
established under ORS 741.101.
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