Overview
Oregon is one of several states seeking to rein in healthcare costs by establishing cost growth targets. The state committee charged with designing such a program provided its recommendations to lawmakers, and they have since updated the law to implement the program. Oregon is also 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.
Oregon is also a leader in promoting healthcare price transparency with a state-run APCD and comprehensive mandatory reporting statues for hospitals and other facilities. The state offers its residents strong surprise billing protections, requiring insurers to provide enrollees reasonable cost estimates for most non-emergency care provided both in-network and out-of-network and capping patient costs for out-of-network emergency services at in-network rates. Oregon also requires telehealth coverage for video visits, with fuller coverage required for some diabetes care.
Additionally, to address the rising cost of prescription drugs, under Oregon’s “Prescription Drug Price Transparency Act,” 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 failure to comply. In addition to mandating new disclosures by drugmakers and insurers, the law creates a task force that will develop a strategy for greater transparency across the entire supply chain of pharmaceutical products.
With respect to competition, the state has long required prior notice of nonprofit healthcare transactions and additionally provides statutory authority for attorney general review and approval of such transactions based on a broad set of criteria that include public interest and antitrust review.
For 2024, Oregon passed legislation regulating Pharmacy Benefits Managers and legislation addressing recipients of medical assistance. The state also considered bills to deal with 340B drugs, financial transparency of hospitals, control of medical professional corporations, and certificate of need, all of which ultimately died.
See below for an overview of existing Oregon state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/17/2023 - 6/26/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 2009 – Oregon
Introduced: 2019 Status: Inactive / Dead
Allows individuals who do not qualify for medical assistance or premium tax credits under Affordable Care Act to enroll in coordinated care organizations by paying premiums that cover actuarial value of health services. Requires Oregon …
HB 2010 – Oregon
Introduced: 2021 Status: Enacted
Directs Oregon Health Authority, in collaboration with Department of Consumer and Business Services, to create implementation plan for public health plan to be made available to individuals and families in individual health insurance market and …
HB 2010 – Oregon
Introduced: 2019 Status: Enacted
Extends Oregon Reinsurance Program and authorizes Department of Consumer and Business Services to request extension of waiver for state innovation. Authorizes department to change attachment point or coinsurance rate for program under specified conditions. Extends …
HB 2012 – Oregon
Introduced: 2019 Status: Inactive / Dead
Allows individuals who do not qualify for medical assistance or premium tax credits under Affordable Care Act to enroll in coordinated care organizations by paying premiums that cover actuarial value of health services. Requires Oregon …
HB 2042 – Oregon
Introduced: 2021 Status: Inactive / Dead
Prohibits surprise billing for emergency services provided at out-of-network facility. Prohibits surprise billing for emergency services provided at out-of-network facility. Prohibits out-of-network health care provider or health care facility from billing or attempting to collect …
Or. Rev. Stat. § 413.071. Federal law to govern administration of federally granted funds; waiver: Oregon Health Authority – Oregon
Introduced: Status: Enacted
Notwithstanding any other provision of law, federal laws shall govern the administration of federally granted funds. The Director of the Oregon Health Authority may request a waiver of any federal law in order to fully …
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Or. Rev. Stat. § 413.072. Applications for waiver of federal statutory or regulatory requirements; procedure for submission: Oregon Health Authority – Oregon
Introduced: Status: Enacted
The Oregon Health Authority may submit applications for waiver of federal statutory or regulatory requirements to the federal government or any agency of the federal government.
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Or. Rev. Stat. § 414.025. Definitions: Medical Assistance – General Provisions – Oregon
Introduced: Status: Enacted
Definition section for the Medical Assistance chapter.
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Or. Rev. Stat. § 414.065. Determination of health care and services covered; quality measures; reimbursement; cost sharing; payments by Oregon Health Authority as payment in full; rules: Medical Assistance – Oregon
Introduced: Status: Enacted
The Oregon Health Authority shall determine Standards, including outcome and quality measures, to be observed in the provision of health care and services, reasonable fees, charges, daily rates and global payments for meeting the costs …
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Or. Rev. Stat. § 414.066. Billing patient for services covered by medical assistance prohibited: Medical Assistance – Oregon
Introduced: Status: Enacted
“A health care provider may not bill or solicit payment from a medical assistance applicant or recipient for services, except for copayments or other charges authorized by the Oregon Health Authority by rule.” See definition …
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Oregon Association of Hospitals and Health Systems v. State of Oregon and Oregon Health Authority – Oregon
District Court: Oregon U.S. District Court, Portland Division Status: Pending
Oregon Association of Hospitals and Health Systems, the trade group for hospitals in Oregon, filed a suit in district court on October 3, 2022 against …
PhRMA v. Stolfi – Oregon
District Court: District Court of Oregon Status: Decided
PhRMA is challenging Oregon’s drug price transparency laws HB 4005, 2018 (Disclosure Law) and HB 2658, 2019 (Advance Notification Law) alleging that the laws are …
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Oregon operates on a biennial budget cycle. 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 submits a proposed budget in December and is expected to sign the budget at the end of June.
ANTITRUST ENFORCEMENT
- Oregon was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES
- Oregon State Legislature
- Oregon Office of the Attorney General
- Oregon Insurance Division
- Oregon Health Authority