Health care bills in Oregon’s 2016 session

Several bills in House first reading could impact state’s coordinated care organizations (CCOs).

HB 4107, sponsored by Rep. John Davis (D-26) and Rep. Jodi Hack (R-19), would limit the Oregon Health Authority (OHA) from retroactively changing terms of its contracts with state CCOs, barring certain specified conditions. The language of the bill specifies that OHA may only make these types of amendments if:

• The amendment does not result in a claim by the authority for the recovery of amounts paid by the authority to the coordinated care organization prior to the effective date of the amendment; or
• The Centers for Medicare and Medicaid Services assesses an overpayment and makes a written demand for repayment.

The effective date of this measure, if passed, would be the 91st day after adjournment of the 2016 regular session.

HB 4100, sponsored by Rep. Mitch Greenlick (D-33) and Sen. Elizabeth Steiner Hayward (D-17), make statutory changes to requirements for CCOs effective in 2018 and 2023.

• By 2018, all CCOs contracting with OHA must present a plan showing that they meet 2023 requirements.
• 2023 requirements include CCO demonstration of at least 80 percent of provider payments using alternative payment methodologies, the establishment of a local governing body, and creation of a Community Escrow Fund in the State Treasury to hold CCO restricted reserves. By this date, the Oregon Health Policy Board will also be required to adopt additional minimum requirements that CCOs must meet to continue contracts.

HB 4141, sponsored by Rep. Cedric Hayden (R-7), under declaration of emergency would allow the OHA to change the geographic areas served by CCOs. The conditions allowing such change by the agency are as follows:

• The coordinated care organization already serving the geographic area withdraws from all or a portion of the geographic area; and
• Other coordinated care organizations operating in the same geographic area do not have adequate capacity to enroll the members affected by the coordinated care organization’s withdrawal from all or part of the geographic area.

Other notable bills include:

HB 4017– declared under emergency, authorizes the OHA and the Department of Consumer and Business Services (DCBS) to create the blueprint for the state’s Basic Health Program, also authorizes the department to apply for state innovation waiver for this program.

HB 4059– authorizes the OHA to create the Pregnant Women’s Assistance Fund, a grant program which will help fund organizations that provide services encouraging and assisting pregnant women in carrying to term.

HB 4124– declared under emergency, would require the OHA to disclose prescription drug monitoring information under certain conditions and would permit certain employees of social service agencies to administer naloxone, a drug used for treatment of opioid overdose.

HB 4104 – excludes certain types of health insurance offering “limited benefit coverage” from statutory requirements for insurance carriers.

HB 4029-proposes changes to funding mechanism of public employees’ health care benefits to avoid excise tax under ACA; prohibits PEBB and OEBB from self-insuring, requires local governments and school districts to participate in “modified health care benefit plan.”