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.
In the 2018 legislative term, Oregon enacted the “Prescription Drug Price Transparency Act” (HB4005), which is fairly similar to what has become law in a few other states. When the price of a medicine rises more than 10 percent, a drug maker must report the reasons to the Oregon Department of Consumer and Business Services, including information about cost of production, marketing and research. Manufacturers face civil penalties of up to $10,000 per day for failing to comply. In addition to mandating new disclosures by drugmakers and insurers, the new law creates a task force that will develop a strategy for greater transparency across the entire supply chain of pharmaceutical products.
Oregon’s most recent legislative term ran from 2/5/2018 – 3/21/2018.
Recent Legislative Developments
|2018||HB4005||RELATING TO THE PRICE OF PRESCRIPTION DRUGS: Requires prescription drug manufacturer to report annually information to Department of Consumer and Business Services regarding prices of prescription drugs and costs associated with developing and marketing prescription drugs.||Passed – Signed by Governor 3/13/18.|
|HB4084||Requires hospitals no later than January 1, 2019 to have a charity care policy written in plain language and provided upon admission and with every billing or notice of amount owed to hospital by patient.||Failed.|
|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.||Failed.|
|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.||Failed.|
|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.
|2018||HB4136||Requires the Oregon Health Authority to collaborate with coordinated care organizations to develop a plan for full implementation of alternative payment methodologies and to develop metrics for investments in social determinants of health. It also requires the Authority to develop a plan to reimburse costs of at least 85% of services using alternative plan payment methodologies.||Failed.|
|HB4156||Prohibits carriers offering health benefit plans from makings specified changes to prescription drug coverage during plan year.||Failed.|
|HB4151||RELATING TO THE BULK PURCHASING OF PRESCRIPTION DRUGS: Requires the Administrator of Oregon Prescription Drug Program to establish an advisory committee to study and make recommendations regarding changes to program. Requires state agencies that purchase prescription drugs and Public Employees’ Benefit Board, Oregon Educators Benefit Board, Public Employees Retirement System and Oregon Health and Science University to purchase prescription drugs through Oregon Prescription Drug Program. Authorizes exemptions.] Requires administrator to submit final report to interim committee of House of Representatives related to health within 18 months. Permits coordinated care organizations to participate in program.||Failed.|
|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.||Failed.|
|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.||Failed.|
|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.||Failed.|
|2018||HB4105||Establishes penalty to be imposed by Department of Consumer and Business Services on employers that offer health insurance coverage to employees but have employees working at least 30 hours per week who receive health coverage through a medical assistance program.||Failed.|
|HB4136||Requires authority to collaborate with coordinated care organizations to develop a plan for full implementation of alternative payment methodologies and to develop metrics for investments in social determinants of health. Requires authority to develop plans to reimbursement cost of at least 85% of services using alternative payment methodologies. Requires authority to establish structure for collaboration between coordinated care organizations and community mental health programs in each geographical region to improve coordination of behavioral health services. Repeals sunset on Oregon Central Health Council. Requires expenditure of portion of coordinated care organization’s annual net income or reserves on services designed to address health disparities ad social determinants of health. Modifies composition of coordinated care organization governing body.||Failed.|
|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||Failed.|
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.
- 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. § 442.120 authorizes the Office for Oregon Health Policy and Research to request that each general hospital file an ambulatory surgery and inpatient discharge abstract record covering all patients discharged during the preceding calendar year.
- 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.
- R.S. § 442.468 directs the Office for Oregon Health Policy and Research to create a health care workforce database to provide information to state agencies and the Legislature about Oregon’s healthcare workforce.
- 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.
- 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.