Oregon Legislative News

The Oregon State Legislature convened for the 2009 session on January 12 and adjourned on June 29, 2009. Bills are effective on January 1, 2010 unless otherwise stated.

Legislation Awaiting the Governor’s Signature

HB 2116 - Health Care Assessments

Implements a 1% premium tax on health insurers that will sunset in four years and will serve as dedicated funding to expand Medicaid, SCHIP, and premium assistance programs for young adults. The tax will apply to health insurance, defined as “insurance of humans against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness or childbirth, or against expense incurred in prevention of sickness, in dental care or optometrical service, and every insurance appertaining thereto, including insurance against the risk of economic loss assumed under a less than fully insured employee health benefit plan. ‘Health insurance’ does not include workers’ compensation coverages.” Excluded from the premium tax are disability income insurance, long-term care, vision-only, and dental-only plans. The bill also includes a hospital “net revenue” assessment to replace existing hospital assessments set to expire later this year. Finally, the bill establishes the “Health Care for Oregon Children” program which includes an expansion of the SCHIP program and a premium assistance program under the Office of Private Health Partnerships. The premium assistance program includes:

• Full premium assistance for children in families under 200% of the federal provider level (FPL) and have access to employer sponsored coverage;
• Sliding scale assistance for children in families between 200 and 300% of FPL;
• Access to the program without subsidies for children in families above 300% FPL.
  

HB 2194 - Oregon Medical Insurance Pool Assessments and Eligibility

Modifies the definition of ‘medical insurance’ for the purposes of OMIP to mean “insurance of humans against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness or childbirth, or against expense incurred in prevention of sickness, in dental care or optometrical service, and every insurance appertaining thereto, including insurance against the risk of economic loss assumed under a less than fully insured employee health benefit plan.” The bill also specifies the types of insureds excluded from the calculation of OMIP assessments and modifies requirements for portability health plans under the pool by removing the requirement that a recipient reside in Oregon for 180 days.

HB 3496 - Severe Intestinal Malabsorption

Eliminates the six-year sunset of Oregon’s existing mandate requiring coverage for elemental enteral formulas for the treatment of severe intestinal malabsorption.

SB 456 - Integrated Health Home Program

Establishes a patient centered primary care program charged with developing core attributes and uniform quality measures. The bill also authorizes participation in the program by Oregon’s medical assistance programs and proposed establishing a statewide health improvement program to reduce chronic disease.

SB 507 - Provider Contracting

Requires health insurers to approve or reject an application to become a preferred provider within 90 days of receipt of the application and requires the insurer to pay all claims for covered medical services that are provided by a provider during the credentialing period. The legislation permits an insurer to pay the claims during or after the credentialing period, and permits payment at the rate paid to nonparticipating providers. The bill notes that the new law does not require payment for services provided during the credentialing period if the provider was previously rejected or terminated as a participating provider, provided that the rejection or termination was due to failure to provide services within recognized standards of the provider’s profession and the provider was given the opportunity to contest the rejection or termination of participation as a preferred provider.

SB 508 - Provider Contracting/Provider Refunds

Specifies that, except in cases of fraud or abuse of billing, health insurers may not request a refund from a health care provider of a payment previously made unless the insurer requests the refund in writing within 24 months after payment (30 months if related to coordination of benefits) was made and includes in the request the reason that the insurer believes the provider owes a refund. Legislation also prohibits providers from requesting additional payment from an insurer unless the request is made in writing within 24 months after the date the claim was denied or payment intended to satisfy the claim was made by the insurer (except in the case of fraud).

Legislation Signed by the Governor

HB 2009 - Health Reform

Comprehensive health care reform legislation, the provisions of which include:

• Establishes the Oregon Health Policy Board (Board) to serve as the policy-making and oversight body for the Oregon Health Authority;
• Charges the Board with a number of duties, including development of a premium assistance program and plan to provide universal coverage, establishing quality and cost-containment standards, and developing a plan for the Oregon Health Insurance Exchange (Exchange);
• Establishes the Oregon Health Authority (Authority), with responsibility over the Exchange, including the responsibility of developing a base-line package of benefits to serve as the basis for plans offered within the exchange;
• Charges the Authority with developing uniform contracting standards and establishing an all-claims, all-payer database;
• Establishes the Oregon Health Insurance Exchange and provides standards for plans to be offered within the exchange;
• Permits the plan of operation for the Exchange to take into consideration and make recommendations regarding an individual mandate and determination of whether the Exchange should serve as the exclusive mechanism for the purchase of individual and small employer coverage;
• Establishes a new framework for rate filings, including a mandatory 30 day public comment period, a required filing of administrative costs on a per-member, per-month basis, and lists factors to be considered when approving or rejecting a rate filing;
• Establishes work groups or standards for the following: medical homes, a newly created Health Information Technology Oversight Council, comparative effectiveness, uniform eligibility and claims standards, and data reporting. 

HB 2433 - State Mini-COBRA Subsidies and Notice Requirements

Extends the period of eligibility for state continuation coverage from six to nine months and allows the Director of the Department of Consumer and Business Services to adopt rules as necessary to allow Oregonians to take full advantage of the benefits provided by the federal law. The bill also includes the following provisions, which have been enacted by emergency rule:

• Extends the period of continuation coverage for assistance eligible individuals (AEIs) to provide coverage periods of no less than 9 months;
• Allows an independent election of coverage for all qualified beneficiaries;
• Creates a second election opportunity for state continuation coverage for AEIs who experienced a qualifying event on or after 9/1/08 and before the effective date of HB 2433 and either did not elect or whose continuation coverage ended for any reason (e.g., lapse due to nonpayment, expiration of 6-month coverage period);
• Specifies that enrollees who take advantage of the second election opportunity are provided a period of continuous coverage for purposes of calculating creditable coverage. 

HB 2506 - Provider Mandates - Behavioral Health

Requires group health benefit plans providing coverage for services performed by clinical social workers or nurse practitioners to also cover services provided by professional counselors or marriage and family therapists when the counselor or therapist is acting within their lawful scope of practice.

HB 2755 - Reinsurance Pool for Individual and Small Group

Requires the Department of Consumer and Business Services to collaborate with the Office for Oregon Health Policy and Research to conduct a study of options for utilizing reinsurance and other risk spreading mechanisms for the individual and small employer markets. Among the considerations to be included are the feasibility of a single state reinsurance plan, whether to include other health insurance markets, and alternatives being used in other states or considered by the federal government. The Department of Consumer and Business Services is required to report on the status of the study no later than October 1, 2010, and submit the required report no later than December 1, 2010.

Tort Reform

• H.B. 2585 permits class actions for recovery of statutory minimum penalties for violations of the Unlawful Trade Practices Act, the federal Truth in Lending Act, and similar statutes.
• H.B. 3111 prohibits the awarding of attorney fees and court costs to prevailing defendants in civil actions unless the court finds that a private party plaintiff had no objectively reasonable basis for bringing an action or asserting the grounds for an appeal.
• S.B. 745 permits the recovery of attorney’s fees even though the prevailing party prevails by a claim or defense asserting that the contract is unenforceable, or a claim asserting that the prevailing party was not a party to the contract.

HB 3418 - Medical Homes

Requires the Department of Human Services to report (no later than June 30, 2010) on the feasibility of implementing a system for reimbursement of health care delivered through primary care homes in the Medicaid program.  

SB 679 - Rebating and Permissible Benefits

Permits insurers offering health benefit plans to pay cash dividends to enrollees in the plan who participate in approved programs that promote health behaviors, and notes that the dividends are not considered premium variations.

Mandated Benefits:

• HB 2589 - Child Hearing Aids requires health benefit plans to provide coverage for one hearing aid per hearing impaired ear for children under 18 years of age or over 18 years of age, if the dependent is enrolled in an accredited educational institution. The bill requires coverage for hearing aids that are necessary for the treatment of hearing loss and have been prescribed, fitted, and dispensed by a licensed audiologist with the approval of a licensed physician.
• HB 2794 - HPV Vaccine requires health benefit plans, health care services contractors, and multiple employer welfare agreements to provide coverage for the human papillomavirus vaccine for female enrollees who are at least 11 years of age but no older than 26 years of age.
• SB 9 - Inborn Metabolic Errors extends the state’s existing mandate for coverage of treatment of inborn errors of metabolism that involve amino acid, carbohydrate and fat metabolism (currently applicable to individual and group health insurance policies) to health services contractors and multiple employer welfare agreements.
• SB 24 - Telemedicine requires health benefit plans, health services contractors, and multiple employer welfare agreements to provide coverage for medically necessary telemedicine, provided that the health service would be covered when provided in-person.
• SB 316 - Clinical Trials requires health benefit plans, health care services contractors, and multiple employer welfare agreements to provide coverage for the routine costs of care for patients enrolled in qualifying clinical trials, including medically necessary conventional care and items or services covered by the plan if typically provided outside of a clinical trial. The bill defines a qualifying clinical trial and notes that insurers providing the required coverage are not, based on that coverage, liable for any adverse effects of the clinical trial.
• SB 381 - Traumatic Brain Injury requires health benefit plans, health care services contractors, and multiple employer welfare agreements to provide coverage of medically necessary therapy and services for the treatment of traumatic brain injuries.
• SB 734 - Tobacco Cessation Programs requires health benefit plans, health care services contractors, and multiple employer welfare agreements to provide payment, coverage or reimbursement of at least $500 for tobacco cessation programs for plan enrollees 15 years of age or older.

You'll find more information on recent insurance laws and regulations on the Oregon Insurance Division Web site.