Attestation of compliance by insurers
- • rules
An insurer, as defined in ORS 731.106 (“Insurer”), that contracts with the Oregon Health Authority, including with the Public Employees’ Benefit Board and the Oregon Educators Benefit Board, to provide health insurance coverage for state employees, educators or medical assistance recipients must annually attest, on a form and in a manner prescribed by the authority, to its compliance with ORS 243.256 (Reimbursement methodology for payment to hospitals), 243.879 (Reimbursement methodology for payment to hospitals), 442.392 (Uniform payment methodology for hospital and ambulatory surgical center services) and 442.394 (Acceptance by facilities as payment in full). A contract with an insurer subject to the requirements of this section may not be renewed without the attestation required by this section. [2011 c.418 §9]
Note: Sections 2 to 5, chapter 575, Oregon Laws 2015, provide:
Sec. 2. (1) As used in this section:
(a) “Carrier” means an insurer that offers a health benefit plan, as defined in ORS 743B.005 (Definitions).
(b) “Coordinated care organization” has the meaning given that term in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414).
(c) “Primary care” means family medicine, general internal medicine, naturopathic medicine, obstetrics and gynecology, pediatrics or general psychiatry.
(d) “Primary care provider” includes:
(A) A physician, naturopath, nurse practitioner, physician assistant or other health professional licensed or certified in this state, whose clinical practice is in the area of primary care.
(B) A health care team or clinic that has been certified by the Oregon Health Authority as a patient centered primary care home.
(2)(a) The Oregon Health Authority shall convene a primary care payment reform collaborative to advise and assist in the implementation of a Primary Care Transformation Initiative to:
(A) Use value-based payment methods that are not paid on a per claim basis to:
(i) Increase the investment in primary care;
(ii) Align primary care reimbursement by all purchasers of care; and
(iii) Continue to improve reimbursement methods, including by investing in the social determinants of health;
(B) Increase investment in primary care without increasing costs to consumers or increasing the total cost of health care;
(C) Provide technical assistance to clinics and payers in implementing the initiative;
(D) Aggregate the data from and align the metrics used in the initiative with the work of the Health Plan Quality Metrics Committee established in ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee and Health Plan Quality Metrics Committee);
(E) Facilitate the integration of primary care behavioral and physical health care; and
(F) Ensure that the goals of the initiative are met by December 31, 2027.
(b) The collaborative is a governing body, as defined in ORS 192.610 (Definitions for ORS 192.610 to 192.690).
(3) The authority shall invite representatives from all of the following to participate in the primary care payment reform collaborative:
(a) Primary care providers;
(b) Health care consumers;
(c) Experts in primary care contracting and reimbursement;
(d) Independent practice associations;
(e) Behavioral health treatment providers;
(f) Third party administrators;
(g) Employers that offer self-insured health benefit plans;
(h) The Department of Consumer and Business Services;
(j) A statewide organization for mental health professionals who provide primary care;
(k) A statewide organization representing federally qualified health centers;
(L) A statewide organization representing hospitals and health systems;
(m) A statewide professional association for family physicians;
(n) A statewide professional association for physicians;
(o) A statewide professional association for nurses; and
(p) The Centers for Medicare and Medicaid Services.
(4) The primary care payment reform collaborative shall annually report to the Oregon Health Policy Board and to the Legislative Assembly on the achievement of the primary care spending targets in ORS 414.625 (Coordinated care organizations) and 743.010 (Health insurance policy and health benefit plan forms) and the implementation of the Primary Care Transformation Initiative.
(5) A coordinated care organization shall report to the authority, no later than October 1 of each year, the proportion of the organization’s total medical costs that are allocated to primary care.
(6) The authority, in collaboration with the Department of Consumer and Business Services, shall adopt rules prescribing the primary care services for which costs must be reported under subsection (5) of this section. [2015 c.575 §2; 2017 c.384 §1; 2017 c.489 §13]
Sec. 3. No later than February 1 of each year, the Oregon Health Authority and the Department of Consumer and Business Services shall report to the Legislative Assembly, in the manner provided in ORS 192.245 (Form of report to legislature):
(1) The percentage of the medical expenses of carriers, coordinated care organizations, the Public Employees’ Benefit Board and the Oregon Educators Benefit Board that is allocated to primary care; and
(2) How carriers, coordinated care organizations, the Public Employees’ Benefit Board and the Oregon Educators Benefit Board pay for primary care. [2015 c.575 §3; 2016 c.26 §7]
Sec. 4. (1) The Legislative Assembly declares that collaboration among insurers, purchasers and providers of health care to coordinate service delivery systems and develop innovative reimbursement methods in support of integrated and coordinated health care delivery is in the best interest of the public. The Legislative Assembly therefore declares its intent to exempt from state antitrust laws, and to provide immunity from federal antitrust laws through the state action doctrine, the activities specified in section 2 (2) of this 2015 Act, of the participants in the primary care payment reform collaborative, that might otherwise be constrained by such laws.
(2) The Director of the Oregon Health Authority or the director’s designee shall engage in state supervision of the primary care payment reform collaborative to ensure that the activities and discussions of the participants in the collaborative are limited to the activities described in section 2 (2) of this 2015 Act.
(3) Groups that include, but are not limited to, health insurance companies, health care centers, hospitals, health service organizations, employers, health care providers, health care facilities, state and local governmental entities and consumers may meet to facilitate the development, implementation and operation of the Primary Care Transformation Initiative in accordance with section 2 of this 2015 Act.
(4) The Oregon Health Authority may conduct a survey of the entities and individuals specified in subsection (3) of this section to assist in the evaluation of the Primary Care Transformation Initiative.
(5) A survey or meeting under subsection (3) or (4) of this section is not a violation of state antitrust laws and shall be considered state action for purposes of federal antitrust laws through the state action doctrine. [2015 c.575 §4]
Sec. 5. (1) Sections 1 to 4, chapter 575, Oregon Laws 2015, are repealed on December 31, 2027.
(2) Section 3 of this 2017 Act is repealed on December 31, 2027. [2015 c.575 §5; 2016 c.26 §8; 2017 c.489 §19]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.