Although Oregon lawmakers will only have 35 days to complete their work during the 2024 legislative session, there will be plenty of healthcare bills up for debate in that time.
Sen. Deb Patterson (D-Salem) and Rep. Rob Nosse (D-Portland) discussed their health priorities for the session with State of Reform. Patterson is chair of the Senate Interim Committee on Health Care, while Nosse chairs the House Interim Committee on Behavioral Health and Health Care. Oregon’s short session—its 2023 session lasted longer than five months—will begin on Feb. 5th.
The Senate Interim Committee on Health Care plans to consider several legislative concepts, including LC 85, Patterson said. The act would forbid the Health Evidence Review Commission from using quality of life as a measure for a service that may be covered by the state Medicaid program. The initiative has been considered in previous sessions, but did not move forward due to disagreement from various stakeholders.
“LC 85 brings back the concept of not using quality of life when deciding when someone is eligible for a medical treatment,” Patterson said. “We agreed not to move that forward if stakeholders would talk to each other. Their conversations got them to a place where there’s almost total agreement. So we’re bringing that forward again.”
The committee is also expected to consider LC 86, which would allow a pharmacist to test for and treat a virus, and require the Oregon Health Authority (OHA)’s medical assistance program to reimburse a pharmacist for those services. The initiative would begin on Oct. 1st and sunset on June 30th, 2026.
“The bill would expand the scope of what pharmacists can test for and treat. We had a meeting with the Oregon Medical Association, pharmacies, and the chief pharmacist at (Oregon Health and Science University). For this short session, the only thing they could agree on was to extend the ability of pharmacists to treat for COVID. So this would take it through the 2025 session to see if we can expand that scope going forward.”
— Patterson
The committee will also work on LC 87, which would require OHA to take steps to address challenges faced by hospitals in discharging patients with complex needs to post-acute care settings. There is currently a lack of placement options for patients with complex needs, as well as a lack of available public guardians for patients who are incapacitated.
“We’re going to ask for funding for four additional public guardians and a public director to help with that,” Patterson said. “Estimates say they need 12 public guardians to fully meet the need, but we don’t think we can get there so we’re asking for four.”
Patterson will be looking for support for an initiative that would provide Medicaid coverage for comprehensive cognitive assessment and care planning for people under age 65 who show signs of early onset dementia. These services are currently covered under Medicare, but not Medicaid, which covers only a short assessment for dementia.
Patterson will also advocate for a project that would establish a cross-sector social resource center in Salem. The project would be a collaboration between the YMCA and many community partners, and would serve high-need and at-risk families and individuals with a range of coordinated support services. It would be located across from a transit station in Salem, where homeless individuals often congregate.
“It’s in an area of high need, a couple blocks away from a women’s crisis center,” Patterson said. “We think that’s a great place for a pilot project. It would have affordable housing with wraparound services.”
House health priorities
The House Interim Committee on Behavioral Health and Health Care is expected to work on Nosse’s LC 115, which would require OHA to study how much money local mental health programs need to comply with state laws. A task force would study any burdens state laws pose to providers who offer care for mental health problems or substance use.
“It’s asking OHA to hire a smart person to do an evaluation of what it takes to run a proper community health program, and tell us what an ideal amount of funding [to run one] is. I’m pretty sure it’s going to be sobering. Where we rank on mental health outcomes as a state is really bad. But understanding where we’re at and where we need to go will be helpful in the long run.”
— Nosse
Another legislative concept expected to be considered by the committee would address copay accumulator programs, which are policies within private health insurance plans that prohibit enrollees from using co-pay assistance provided by a pharmaceutical manufacturer to meet their annual deductible. The initiative would require private insurance plans to count coupons for drugs that do not have a generic alternative towards the plan’s out-of-pocket maximum.
“If you’re paying $2,000 out of pocket, and the drug manufacturer gives you a coupon for $1,000, you can apply that toward your deductible,” Nosse said
Other bills the committee is expected to consider include:
- LC 98, which would require health professional regulatory boards to issue a temporary authorization to practice a health profession to eligible applicants within 10 days of receiving an application for licensure.
- LC 246 and 247, which would provide more financial transparency and worker protections in hospitals, and provide enhanced penalties for hospital workplace violence violations, respectively.
- LC 17, which would impose several new laws relating to pharmacy benefit managers (PBMs), including requiring them to be licensed in the state; changing the way drug stores can appeal the amounts PBMs pay them for the drugs they sell; and changing the way PBMs can audit drug stores.
- Rep. Maxine Dexter (D-Portland) plans to support a replacement for Senate Bill 549, which failed to pass in last year’s session. She and Oregon K-12 education leaders are advocating for an initiative that would provide additional resources for students through school-based health centers.
Re: LC85
I believe in practicing a great deal of patience with the recovering patient (I am a Physiatrist/Neurologist, Board Certified in Brain Injury Medicine). That means (for the severely brain injured, whether traumatic, anoxic or otherwise), continuing life supporting measures for sometimes 6 to 12 weeks, before a decision can be made whether a patient will regain any quality of life. That sometimes put me in direct opposition to some of the reasoning of acute care and even some palliative care physicians who felt it was time to withdraw care due to their perception of quality of life and their employers need to control expenses in view of limited resources.
My interpretation of “quality of life” may be something basic like, being able to recognize people, or to be able to swallow solids, but not liquids. The next doctor might think it has more to do with playing soccer with their kids. If we decide to use “quality of life” to determine if payment will be provided for a service, then we will need to be very careful to decide who decides what constitutes “quality of life”. I would really hate to defer that decision to anyone but the doctor and their patient, or the responsible medical power of attorney if the patient is unable to make decisions.
I have had the unfortunate experience to see the doctor withdraw care in a patient who was only temporarily (a matter of days) unable to speak for himself. The separated spouse directed the temporary feeding / hydration to stop, while the parents pleaded to give him a few more days. My protest and request for an Ethics committee involvement was closed by the Trauma surgeon who advised me he was chair of the committee. There is a lot of cost pressure by the hospitals who employ physicians, to encourage them to be aware of the cost of continuing care in a slow to recover patient.
These types of situations should not be further complicated and tainted by a system of order sets that stipulates what quality of life is necessary to continue to pay for one type of care or another. This is a medical decision that must be made by the patient in consultation with their doctor and not just one, but at least a medical ethics team, when there is uncertainty.
But, unless the health care system is equipped with Long Term Acute Care Hospital access, Medicare and Medicaid are not paying for continued care in the Acute Care hospital, and the Skilled Nursing Facilities are not always willing or equipped to provide the necessary care for these patients.
The Health Evidence Review Committee must not be the last resort when defining “quality of life” or to be an administrative tool to cut health care costs. This may be a convenient way to control costs, at the expense of the right thing to do.
Respectfully yours,
Bruce Stelmack, DO, MSc