Oregon

SUMMARY

Oregon is a leader in promoting healthcare price transparency with a state-run APCD and comprehensive mandatory reporting statues for hospitals and other facilities. Oregon is experimenting with health delivery and payment reform, directing various state agencies to conduct studies on the feasibility of alternative health care delivery financing and coordinated care models that reward quality over volume of patients.

 

LEGISLATION/REGULATION

Legislative Calendar

Oregon’s regular legislative session has ended for 2017.

 

Recent Legislative Developments

Healthcare Transparency

2017

 

 

 

 

 

HB3083 AN ACT RELATING TO THE HEALTH INSURANCE EXCHANGE: would require the Department of Consumer Business Services to convene a task force consisting of seven members to study and no later than September 15, 2018, make recommendations to the director and to the interim committees of the Legislative Assembly related to health for improving and stabilizing the health insurance exchange, including but not limited to utilizing a technical platform other than healthcare.gov. Inactive –Died.
SB792 RELATING TO PRESCRIPTION DRUG PRICING: would require manufactures to clearly and conspicuously disclose in their advertisements for prescriptions drug the wholesale price for prescription paid by paid by pharmacies in the state. This bill would all the Attorney General to impose a civil penalty for the violation of this requirement. Inactive –Died.
SB793 AN ACT RELATING TO THE COST OF HEALTH CARE SERVICES: would have required certain licensed health care facilities to publish their contracted charges to insurers for the top 100 most common inpatient procedures and 100 most common outpatient procedures. The information would have been published on providers’ websites and directly in facilities, if requested by patient.

See The Source’s Blog post on SB900 and SB891.

Inactive –Died.

 

Healthcare Cost

2017 HB2492

 

RELATING TO HEALTH CARE:  would establish dispute resolution procedures for emergency service charges and for unexpected medical bills for out-of-network health care services. This bill would require insurers to make a process available for out-of-network referrals and prior authorizations. It would require insurers to reimburse the cost of out-of-network health care services in specified circumstances. It would also require provides to disclose to patients the health plans in which providers participate and require the Department of Consumer and Business Services to convene an out-of-network reimbursement rate task force. Inactive –Died.
HB2897 RELATING TO HEALTH INSURANCE: would prohibit insurers from restricting covered services to in-network providers, imposing higher deductibles, copayments, or out-of-pocket maximums for physician ordered prescription drugs, laboratory tests, or physician referrals requiring generic drugs, except for controlled substances, to be filled at in-network pharmacies. It would also require insurers to reimburse immunization at the same rate across all providers and to reimburse drugs within the same class in the same amount. Inactive –Died.
SB399 RELATING TO PRESCRIPTION DRUG COSTS: would prohibit small employers, group or individual health benefit plans from requiring enrollees in plan to incur more than $250 out of pocket costs for covered prescription drugs purchased during a single retail encounter. This bill would require the drug manufacturer to have a process for providing a rebate to the insurer of the difference between $250 and the copayment for prescription drug under express terms of the health benefit plan. Inactive –Died.

 

Healthcare Markets

2017 SB1046

 

AN ACT RELATING TO STATEWIDE INSURANCE COVERAGE: would establish the “Health care for All Oregon Board” which would develop, implement, and oversee the “Health Care for All Oregon Plan” to be administered by the Oregon Health Authority. This bills aims to provide comprehensive health care coverage to all individuals residing or working in Oregon.  This bill would repeal the health insurance exchange upon implementation of the Health Care for All Oregon Plan. This bill would also supplant coverage by private insurers for health services covered by the plan. It would establish an office Health Care for All Oregon Ombudsman in office of the Governor. Lastly, it would appropriate moneys from the General Fund to Health Care for All Oregon Board for purposes of the Health Care for All Oregon Plan Inactive –Died.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Healthcare Transparency

  • R.S. § 413.032 establishes the Oregon Health Authority, which is the state Medicaid agency for the administration of funds and also is charged with carrying out the policies adopted by the Oregon Health Policy Board. The Authority is to study and recommend standards to the Legislature for the review of administrative expenses of health insurers, approval of rates, and enforcement of rating rules; structure Medicaid reimbursement rates to reward comprehensive management, efficiency and quality outcomes; and to create an all-claims, all payer claims database to provide comparative cost and quality information to consumers.

 

 

  • R.S. § 442.400 through .463, the chapter entitled “Cost Reporting by Health Care Facilities,” furthers the legislature’s articulated purpose of enabling private and public purchasers of healthcare service to make informed decisions and to encourage programs that link charges to the nature and quality of services rendered by empowering the Office of Oregon Health Policy and Research to apply for funds to undertake certain studies, plans, and demonstration projects.
    • The Office is directed to conduct studies relating to costs of healthcare facilities including methods of reducing costs, utilization review, peer review, quality control, and financial status (the Office has authority to prescribe regulations for mandatory uniform financial reporting). Licensed health facilities are obligated to file utilization information with the Office in an annual report as required by rule.

 

  • R.S. § 442.466 empowers the Office for Oregon Health Policy and Research to require certain reporting entities to report health care data for the purpose of populating the state’s all-payer claims database. An all-payer claims database (APCD) is a database for aggregating health care claims data from payers, providers, and other reporting entities in order to compare costs among physicians and health care systems, promote cost containment and facilitate quality improvement.

 

 

Healthcare Markets

  • R.S. § 414.620 through .628, the chapter entitled “Coordinated Care Organizations,” creates the Oregon Integrated and Coordinated Health Care Delivery System, which is a system of state policies and actions to “make coordinated care organizations accountable for care management and provision of integrated and coordinated health care […] managed within fixed global budgets, by providing care so that efficiency and quality improvements reduce medical cost inflation […].” The Oregon Health Authority is charged with adopting rules for the qualification criteria and requirements for a coordinated care organization.
    • Under the statute, 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,” which includes the adoption of a community health improvement plan. A coordinated care organization may also request, and the Health Authority shall designate, an Authority employee to serve as a day-to-day point for contact for the exchange of information between the agency and the organization, called an “Innovator Agent.”

 

  • R.S. § 646.735 affords state action immunity from federal antitrust laws for certain coordinated care organizations designed to “identify appropriate service delivery systems and reimbursement methods to align incentives in support of integrated and coordinated health care delivery.”

 

  • R.S. § 742.018 prohibits any policy of insurance from containing a provision that the policy be construed according to the laws of any other state or country.

 

  • R.S. 442.315 prohibits hospitals, skilled nursing or intermediate care facilities, and long term care facilities from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Oregon Health Authority through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

  • R.S. § 414.646, effective July 1, 2017, a coordinated care organization may not discriminate against a provider with respect to participation in the organization on the basis of their scope of practice. The Oregon Health Authority is directed to adopt a process for resolving claims of discrimination based on scope of practice, and shall consider the organizations network adequacy, provider types and qualifications, provider disciplines, and provider reimbursement rates in resolving a claim of discrimination.

 

  • R.S. § 414.645 requires that a coordinated care organization must maintain a network of providers sufficient in numbers and areas of practice and geographically distributed to ensure that health services are reasonably accessible to enrollees.

 

2017 – 2019 BUDGET

The biennium budget begins on July 1 of an odd-numbered year and ends on June 30 of the next odd-numbered year. The Governor is expected to sign the 2017-2019 Budget at the end of June 2017. To view the Governor’s most recent proposal on Oregon’s health spending, click here.

 

LITIGATION/ENFORCEMENT

  • Dischinger Orthodontics v. Regence BlueCross BlueShield, Or. Cir. Ct., No. 14-cv-7130, filed 6/18/14: plaintiffs, seeking class-action certification, alleged that Regence BlueCross BlueShield of Oregon had amassed profits of over $150 million, alleging that the excess of profits was in violation of the entity’s non-profit status and therefore violated the plaintiff’s insurance contract (incorporating the provisions of the articles of incorporation and bylaws).The case was dismissed for lack of standing with prejudice.

 

  • Oregon was one of 16 states to file an amicus brief in the Ninth Circuit appeal of  Luke’s Health Care Sys. v. FTC.

 

KEY RESOURCES

Oregon State Legislature

Oregon Office of the Attorney General

Oregon Insurance Division

Oregon Health Authority