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 current regular legislatives session runs from 2/1/2017 – 7/10/2017.

 

Recent Legislative Developments

Healthcare Transparency

2015-2016

 

 

 

 

 

SB440  AN ACT RELATING TO MEASURING THE QUALITY OF HEALTH CARE: establishes the Oregon Health Plan Quality Metrics Committee and requires the Governor to appoint individuals to the Health Policy Board. Once appointed, the Health Policy Board will develop a strategic plan for the collection and analysis of health care data from the coordinated care organizations and plans offered to the Oregon Public Employees’ Benefit Board and the Oregon Educators Benefit Board. This data shall be published. Passed—on 6/15/15. Chapter 389 (2015 Laws). Effective 6/11/15.
SB900 AN ACT RELATING TO HEALTH CARE PRICE DATA—AN ALL PAYER ALL CLAIMS DATABASE: requires the Oregon Health Authority (“Authority”) to collect health care data from reporting entities (private and government insurance providers). The Authority is required to post to its website health care price information.

This data must include the median prices paid by the entities to the hospital and hospital outpatient clinics for—at a minimum—the 50 most common inpatient procedures and the 100 most common outpatient procedures. This published information must be easily accessible, displayed in a consumer-friendly format, and updated annually.

The Authority, in consultation with interested stakeholders, will: formulate the data sets that will be included in the system; will establish the criteria and procedures for the development and limited use of the data sets; will ensure that limited data use sets are accessible and compliant with federal and state privacy laws; and will establish a timeframe for the creation of a comprehensive health care information system.

Information disclosed through this system will: (i) be available to the public in a manner that ensures privacy and security of personal health information; (ii) will be presented in a way that allows comparisons of geographic, demographic, and economic factors and institutional size; and (iii) may not disclose trade secrets of reporting entities.

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

Passed—on 8/13/15. Chapter 845 (2015 Laws). Effective 8/12/15.
SB891 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.
HB3486

 

PHARMACEUTICAL PRICE CAP: would have required pharmaceutical manufacturers of prescription drugs with an annual wholesale cost of $10,000 or more—or per course of treatment—to file an annual report with the Oregon Health Authority. Passage of the bill would have required the report to include: (i) manufacturer and predecessor manufacturer research and development costs (ii) all subsidies, grants, and other forms of monetary support used by the manufacturer and any predecessor manufacturer in researching and developing the drug; (iii) clinical trials costs; (iv) manufacturing and distribution costs; (v) acquisition costs (e.g., patents, etc.); and (vi) marketing and advertising costs. Inactive –Died.

 

Healthcare Cost

2015-2016 SB665

 

HOSPITAL RATE COMMISSION: would have required the Oregon Health Authority (“Authority”) to create a Hospital Rate Commission that would have reviewed health care charges billed by certain hospitals and recommended to the Authority whether it should approve charges as reasonable or not. A fee would have been deemed unreasonable if it was “based on inefficient or inappropriate use of existing capacity, duplicated services and failure to use less costly alternatives in meeting the needs of patients.” On the other hand, charges equal to or less than Medicare payment rates would have been considered reasonable. Hospitals that charged unreasonable fees would have been assessed civil penalties. Inactive — Died.

 

Healthcare Markets

2015-2016 SB330

 

EXECUTIVE COMPENSATION LIMITS FOR NON-PROFIT HOSPITALS: would have required non-profit hospitals to adopt formulas that met specific criteria for compensation of hospital executives. The bill also would have required non-profit hospitals to solicit public comment on their formulas and would have required that the hospitals report to the Oregon Health Authority all compensation paid to executives, directors, trustees, and certain other employees. 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