* [[Health for Oregonians]], an initiative by several people affiliated with AboutUs.org to work toward a healthy Oregon.
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Senate Bill 329
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* [http://www.hopeforahealthyoregon.com/home.php Hope for a Healthy Oregon] web site, apparently maintained by the legislators who passed SB 329 (?)
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Printed pursuant to Senate Interim Rule 213.28 by order of the President of the Senate in conformance with presession filing rules, indicating neither advocacy nor opposition on the part of the President (at the request of [http://arcweb.sos.state.or.us/legislative/legislativeminutes/2007/senate/Health%20Care%20Reform/SHCR0129.htm Senate Interim Commission on Health Care Access and Affordability])
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CHAPTER ................
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== AN ACT ==
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Relating to the Oregon Health Fund program; creating new provisions; amending [http://www.leg.state.or.us/ors/414.html ORS 414.221, 414.312, 414.314, 414.316, 414.318, 414.320] and [http://www.leg.state.or.us/ors/442.html 442.011] and sections 2 and 3, chapter 314, Oregon Laws 2005; appropriating money; limiting expenditures; and declaring an emergency.
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Whereas improving and protecting the health of Oregonians must be a primary issue and an important goal of the state; and
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Whereas the objective of Oregon's health care system is health, not just the financing and delivery of health care services; and
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Whereas health is more than just the absence of physical and mental disease, it is the product of a number of factors, only one of which is access to the medical system; and
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Whereas persons with disabilities and other ongoing conditions can live long and healthy lives; and
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Whereas Oregonians cannot achieve the objective of health unless all individuals have timely access to a defined set of essential health services; and
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Whereas Oregonians cannot achieve the objective of health unless the state invests not only in health care, but also in education, economic opportunity, housing, sustainable environmental stewardship, full participation and other areas that are important contributing factors to health; and
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Whereas the escalating cost of health care is compromising the ability to invest in those other areas that contribute to the health of the population; and
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Whereas Oregon cannot achieve its objective of health unless Oregonians control costs in the health care system; and
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Whereas Oregon cannot control costs unless Oregonians:
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# Develop effective strategies through education of individuals and health care providers, development of policies and practices as well as financial incentives and disincentives to empower individuals to assume more personal responsibility for their own health status through the choices they make;
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# Reevaluate the structure of Oregon's financing and eligibility system in light of the realities and circumstances of the 21st century and of what Oregonians want the system to achieve from the standpoint of a healthy population; and
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# Rethink how Oregonians define a 'benefit' and restructure the misaligned financial incentives and inefficient system through which health care is currently delivered; and
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Whereas public resources are finite, and therefore the public resources available for health care are also finite; and
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Whereas finite resources require that explicit priorities be set through an open process with public input on what should and should not be financed with public resources; and
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Whereas those priorities must be based on publicly debated criteria that reflect a consensus of social values and that consider the good of individuals across their lifespans; and
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Whereas those with more disposable private income will always be able to purchase more health care than those who depend solely on public resources; and
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Whereas society is responsible for ensuring equitable financing for the defined set of essential health services for those Oregonians who cannot afford that care; and
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Whereas health care policies should emphasize public health and encourage the use of quality services and evidence-based treatment that is appropriate and safe and that discourages unnecessary treatment; and
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Whereas health care providers and informed patients must be the primary decision makers in the health care system; and
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Whereas access, cost, transparency and quality are intertwined and must be simultaneously addressed for health care reform to be sustainable; and
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Whereas health is the shared responsibility of individual consumers, government, employers, providers and health plans; and
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Whereas individual consumers, government, employers, providers and health plans must be part of the solution and share in the responsibility for both the financing and delivery of health care; and
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Whereas the current health care system is unsustainable in large part because of outdated federal policies that reflect the realities of the last century instead of the realities of today and that are based on assumptions that are no longer valid; and
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Whereas the ability of states to maintain the public's health is increasingly constrained by those federal policies, which were built around 'categories' rather than a commitment to ensure all citizens have timely access to essential health services; and
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Whereas the economic and demographic environment in which state and federal policies were created has changed dramatically over the past 50 years, while the programs continue to reflect a set of circumstances that existed in the mid-20th century; and
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Whereas any strategies for financing, mandating or developing new programs to expand access must address what will be covered with public resources and how those services will be delivered; otherwise, those strategies will do little to stem escalating medical costs, make health care more affordable or create a sustainable system; and
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Whereas incremental changes will not solve Oregon's health care crisis and comprehensive reform is required; now, therefore,
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Be It Enacted by the People of the State of Oregon:
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== SECTION 1 (name of Act) ==
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{ +
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Sections 2 to 13 of this 2007 Act shall be known and may be cited as the Healthy Oregon Act.
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+ }
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== SECTION 2 (definitions) ==
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{ + As used in sections 2 to 13 of this 2007 Act, except as otherwise specifically provided or unless the context requires otherwise:
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# '''Accountable health plan''' means a prepaid managed care health services organization described in ORS 414.725 or an entity that contracts with the Oregon Health Fund Board to provide a health benefit plan, as defined in ORS [http://law.justia.com/oregon/codes/2005/vol16/743.html 743.730], through the Oregon Health Fund program.
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# '''Core health care safety net provider''' means a safety net provider that is especially adept at serving persons who experience significant barriers to accessing health care, including homelessness, language and cultural barriers, geographic isolation, mental illness, lack of health insurance and financial barriers, and that has a mission or mandate to deliver services to persons who experience barriers to accessing care and serves a substantial share of persons without health insurance and persons who are enrolled in Medicaid or Medicare, as well as other vulnerable or special populations.
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# '''Defined set of essential health services''' means the services:
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## Identified by the Health Services Commission using the methodology in ORS 414.720 or an alternative methodology developed pursuant to section 9 (3)(c) of this 2007 Act; and
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## Approved by the Oregon Health Fund Board.
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# '''Employer''' has the meaning given that term in ORS 657.025.
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# '''Oregon Health Card''' means the card issued by the Oregon Health Fund Board that verifies the eligibility of the holder to participate in the Oregon Health Fund program.
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# '''Oregon Health Fund''' means the fund established in section 8 of this 2007 Act.
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# '''Oregon Health Fund Board''' means the board established in section 5 of this 2007 Act.
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# '''Safety net provider''' means providers that deliver health services to persons experiencing cultural, linguistic, geographic, financial or other barriers to accessing appropriate, timely, affordable and continuous health care services. 'Safety net providers' includes health care safety net providers, core health care safety net providers, tribal and federal health care organizations and local nonprofit organizations, government agencies, hospitals and individual providers. + }
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== SECTION 3 (principles) ==
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{ +
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The Oregon Health Fund program shall be based on the following principles:
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# '''Expanding access.''' The state Medicaid program, the Oregon State Children's Health Insurance Program and the Family Health Insurance Assistance Program must be expanded to include the current uninsured population in Oregon to the greatest extent possible.
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# '''Equity.''' All individuals must be eligible for and have timely access to at least the same set of essential and effective health services.
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# '''Financing of the health care system must be equitable, broadly based and affordable.'''
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# '''Population benefit.''' The public must set priorities to optimize the health of Oregonians.
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# '''Responsibility for optimizing health must be shared''' by individuals, employers, health care systems and communities.
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# '''Education is a powerful tool for health promotion.''' The health care system, health plans, providers and government must promote and engage in education activities for individuals, communities and providers.
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# '''Effectiveness.''' The relationship between specific health interventions and their desired health outcomes must be backed by unbiased, objective medical evidence.
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# '''Efficiency.''' The administration and delivery of health services must use the fewest resources necessary to produce the most effective health outcome.
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# '''Explicit decision-making.''' Decision-making will be clearly defined and accessible to the public, including lines of accountability, opportunities for public engagement and how public input will be used in decision-making.
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# '''Transparency.''' The evidence used to support decisions must be clear, understandable and observable to the public.
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# '''Economic sustainability.''' Health service expenditures must be managed to ensure long-term sustainability, using efficient planning, budgeting and coordination of resources and reserves, based on public values and recognizing the impact that public and private health expenditures have on each other.
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# '''Aligned financial incentives.''' Financial incentives must be aligned to support and invest in activities that will achieve the goals of the Oregon Health Fund program.
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# '''Wellness.''' Health and wellness promotion efforts must be emphasized and strengthened.
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# '''Community-based.''' The delivery of care and distribution of resources must be organized to take place at the community level to meet the needs of the local population, unless outcomes or cost can be improved at regional or statewide levels.
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# '''Coordination.''' Collaboration, coordination and integration of care and resources must be emphasized throughout the health care system.
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# '''The health care safety net is a key delivery system element''' for the protection of the health of Oregonians and the delivery of community-based care.
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+ }
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== SECTION 4 (goals) ==
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{ +
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The intent of the Healthy Oregon Act is to develop an Oregon Health Fund program comprehensive plan, based upon the principles set forth in section 3 of this 2007 Act, that meets the intended goals of the program to:
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# As a primary goal, cover the current uninsured population in Oregon through the expansion of the state Medicaid program, the Oregon State Children's Health Insurance Program and the Family Health Insurance Assistance Program;
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# Reform the health care delivery system to maximize federal and other public resources without compromising proven programs supported by federal law that ensure to vulnerable populations access to efficient and high quality care;
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# Ensure that all Oregonians have timely access to and participate in a health benefit plan that provides high quality, effective, safe, patient-centered, evidence-based and affordable health care delivered at the lowest cost;
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# Develop a method to finance the coverage of a defined set of essential health services for Oregonians that is not necessarily tied directly to employment;
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# Allow the potential for employees, employers, individuals and unions to participate in the program, or to purchase primary coverage or offer, purchase or bargain for coverage of benefits beyond the defined set of essential health services;
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# Allow for a system of public and private health care partnerships that integrate public involvement and oversight, consumer choice and competition within the health care market;
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# Use proven models of health care benefits, service delivery and payments that control costs and overutilization, with emphasis on preventive care and chronic disease management using evidence-based outcomes and a health benefit model that promotes a primary care medical home;
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# Provide services for dignified end-of-life care;
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# Restructure the health care system so that payments for services are fair and proportionate among various populations, health care programs and providers;
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# Fund a high quality and transparent health care delivery system that will be held to high standards of transparency and accountability and allows users and purchasers to know what they are receiving for their money;
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# Ensure that funding for health care is equitable and affordable for all Oregon residents, especially the uninsured; and
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# Ensure, to the greatest extent possible, that annual inflation in the cost of providing access to essential health care services does not exceed the increase in the cost of living for the previous calendar year, based on the Portland-Salem, OR-WA, Consumer Price Index for All Urban Consumers for All Items, as published by the Bureau of Labor Statistics of the United States Department of Labor.
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+ }
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== SECTION 5 (Health Fund Board membership) ==
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# There is established within the Department of Human Services the Oregon Health Fund Board that shall be responsible for developing the Oregon Health Fund program comprehensive plan. The board shall consist of seven members appointed by the Governor, subject to confirmation by the Senate pursuant to section 4, Article III of the Oregon Constitution. The members of the board shall be selected based upon their ability to represent the best interests of Oregon as a whole. Members of the board shall have expertise, knowledge and experience in the areas of consumer advocacy, management, finance, labor and health care, and to the extent possible shall represent the geographic and ethnic diversity of the state. A majority of the board members must consist of individuals who do not receive or have not received within the past two years more than 50 percent of the individual's income or the income of the individual's family from the health care industry or the health insurance industry.
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# Each board member shall serve for a term of four years. However, a board member shall serve until a successor has been appointed and qualified. A member is eligible for reappointment.
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# If there is a vacancy for any cause, the Governor shall make an appointment to become effective immediately for the balance of the unexpired term.
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# The board shall select one of its members as chairperson and another as vice chairperson, for such terms and with duties and powers necessary for the performance of the functions of such offices as the board determines.
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# A majority of the members of the board constitutes a quorum for the transaction of business.
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# Official action by the board requires the approval of a majority of the members of the board.
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# A member of the board is not entitled to compensation for services as a member, but is entitled to expenses as provided in ORS 292.495 (2).
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+ }
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== SECTION 6 (executive director of OHFB) ==
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# Within 30 days after the effective date of this 2007 Act, the Governor shall appoint an executive director of the Oregon Health Fund Board who will be responsible for establishing the administrative framework for the board.
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# The executive director appointed under this section may employ and shall fix the duties and amounts of compensation of persons necessary to carry out the provisions of sections 2 to 13 of this 2007 Act. Those persons shall serve at the pleasure of the executive director.
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# The executive director shall serve at the pleasure of the Governor.
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+ }
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== SECTION 7 (relevance of ORS chapter 279) ==
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Except as otherwise provided by law, and except for ORS 279A.250 to 279A.290, the provisions of ORS chapters 279A, 279B and 279C do not apply to the Oregon Health Fund Board.
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+ }
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== SECTION 8 (Oregon Health Fund) ==
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{ +
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# The Oregon Health Fund is established separate and distinct from the General Fund. Interest earned from the investment of moneys in the Oregon Health Fund shall be credited to the fund. The Oregon Health Fund may include:
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## Employer and employee health care contributions.
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## Individual health care premium contributions.
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## Federal funds from Title XIX or XXI of the Social Security Act, and state matching funds, that are made available to the fund, excluding Title XIX funds for long term care supports, services and administration, and reimbursements for graduate medical education costs pursuant to 42 U.S.C. 1395ww(h) and disproportionate share adjustments made pursuant to 42 U.S.C.
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1396a(a)(13)(A)(iv).
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## Contributions from the United States Government and its agencies for which the state is eligible provided for purposes that are consistent with the goals of the Oregon Health Fund program.
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## Moneys appropriated to the Oregon Health Fund Board by the Legislative Assembly for carrying out the provisions of the Healthy Oregon Act.
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## Interest earnings from the investment of moneys in the fund.
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## Gifts, grants or contributions from any source, whether public or private, for the purpose of carrying out the provisions of the Healthy Oregon Act.
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## All moneys in the Oregon Health Fund are continuously appropriated to the Oregon Health Fund Board to carry out the provisions of the Healthy Oregon Act.
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## The Oregon Health Fund shall be segregated into subaccounts as required by federal law.
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+ }
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== SECTION 9 ==
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{ + (1)(a) The Oregon Health Fund Board shall
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establish a committee to examine the impact of federal law
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requirements on reducing the number of Oregonians without health
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insurance, improving Oregonians' access to health care and
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achieving the goals of the Healthy Oregon Act, focusing
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particularly on barriers to reducing the number of uninsured
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Oregonians, including but not limited to:
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(A) Medicaid requirements such as eligibility categories and
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household income limits;
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(B) Federal tax code policies regarding the impact on accessing
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health insurance or self-insurance and the affect on the
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portability of health insurance;
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(C) Emergency Medical Treatment and Active Labor Act
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regulations that make the delivery of health care more costly and
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less efficient; and
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(D) Medicare policies that result in Oregon's health care
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providers receiving significantly less than the national average
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Medicare reimbursement rate. The committee shall survey providers
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and determine how this and other Medicare policies and procedures
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affect costs, quality and access. The committee shall assess how
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an increase in Medicare reimbursement rates to Oregon providers
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would benefit Oregon in health care costs, quality and access to
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services, including improved access for persons with disabilities
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and improved access to long term care.
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(b) With the approval of the Oregon Health Fund Board, the
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committee shall report its findings to the Oregon congressional
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delegation no later than July 31, 2008.
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(c) The committee shall request that the Oregon congressional
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delegation:
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(A) Participate in at least one hearing in each congressional
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district in this state on the impacts of federal policies on
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health care services; and
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(B) Request congressional hearings in Washington, D.C.
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(2) The Oregon Health Fund Board shall develop a comprehensive
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plan to achieve the Oregon Health Fund program goals listed in
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section 4 of this 2007 Act. The board shall establish
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subcommittees, organized to maximize efficiency and effectiveness
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and assisted, in the manner the board deems appropriate, by the
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Oregon Health Policy Commission, the Office for Oregon Health
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Policy and Research, the Health Services Commission and the
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Medicaid Advisory Committee, to develop proposals for the Oregon
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Health Fund program comprehensive plan. The proposals may
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address, but are not limited to, the following:
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(a) Financing the Oregon Health Fund program, including but not
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limited to proposals for:
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(A) A model for rate setting that ensures providers will
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receive fair and adequate compensation for health care services.
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(B) Collecting employer and employee contributions and
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individual health care premium contributions, and redirecting
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them to the Oregon Health Fund.
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(C) Implementing a health insurance exchange to serve as a
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central forum for uninsured individuals and businesses to
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purchase affordable health insurance.
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(D) Taking best advantage of health savings accounts and
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similar vehicles for making health insurance more accessible to
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uninsured individuals.
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(E) Addressing the issue of medical liability and medical
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errors including, but not limited to, consideration of a
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patients' compensation fund.
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(F) Requesting federal waivers under Titles XIX and XXI of the
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Social Security Act, or other federal matching funds that may be
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made available to implement the comprehensive plan and increase
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access to health care.
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(G) Evaluating statutory and regulatory barriers to the
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provision of cost-effective services, including limitations on
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access to information that would enable providers to fairly
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evaluate contract reimbursement, the regulatory effectiveness of
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the certificate of need process, consideration of a statewide
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uniform credentialing process and the costs and benefits of
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improving the transparency of costs of hospital services and
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health benefit plans.
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(b) Delivering health services in the Oregon Health Fund
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program, including but not limited to proposals for:
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(A) An efficient and effective delivery system model that
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ensures the continued viability of existing prepaid managed care
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health services organizations, as described in ORS 414.725, to
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serve Medicaid populations.
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(B) The design and implementation of a program to create a
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public partnership with accountable health plans to provide,
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through the use of an Oregon Health Card, health insurance
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coverage of the defined set of essential health services that
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meets standards of affordability based upon a calculation of how
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much individuals and families, particularly the uninsured, can be
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expected to spend for health insurance and still afford to pay
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for housing, food and other necessities. The proposal must ensure
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that each accountable health plan:
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(i) Does not deny enrollment to qualified Oregonians eligible
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for Medicaid;
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(ii) Provides coverage of the entire defined set of essential
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health services;
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(iii) Will develop an information system to provide written
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information, and telephone and Internet access to information,
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necessary to connect enrollees with appropriate medical and
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dental services and health care advice;
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(iv) Offers a simple and timely complaint process;
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(v) Provides enrollees with information about the cost and
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quality of services offered by health plans and procedures
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offered by medical and dental providers;
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(vi) Provides advance disclosure of the estimated out-of-pocket
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costs of a service or procedure;
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(vii) Has contracts with a sufficient network of providers,
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including but not limited to hospitals and physicians, with the
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capacity to provide culturally appropriate, timely health
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services and that operate during hours that allow optimal access
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to health services;
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(viii) Ensures that all enrollees have a primary care medical
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home;
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(ix) Includes in its network safety net providers and local
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community collaboratives;
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(x) Regularly evaluates its services, surveys patients and
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conducts other assessments to ensure patient satisfaction;
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(xi) Has strategies to encourage enrollees to utilize
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preventive services and engage in healthy behaviors;
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(xii) Has simple and uniform procedures for enrollees to report
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claims and for accountable health plans to make payments to
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enrollees and providers;
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(xiii) Provides enrollment, encounter and outcome data for
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evaluation and monitoring purposes; and
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(xiv) Meets established standards for loss ratios, rating
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structures and profit or nonprofit status.
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(C) Using information technology that is cost-neutral or has a
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positive return on investment to deliver efficient, safe and
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quality health care and a voluntary program to provide every
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Oregonian with a personal electronic health record that is within
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the individual's control, use and access and that is portable.
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(D) Empowering individuals through education as well as
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financial incentives to assume more personal responsibility for
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their own health status through the choices they make.
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(E) Establishing and maintaining a registry of advance
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directives and Physician Orders for Life-Sustaining Treatment
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(POLST) forms and a process for assisting a person who chooses to
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execute an advance directive in accordance with ORS 127.531 or a
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POLST form.
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(F) Designing a system for regional health delivery.
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(G) Combining, reorganizing or eliminating state agencies
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involved in health planning and policy, health insurance and the
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delivery of health care services and integrating and streamlining
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their functions and programs to maximize their effectiveness and
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efficiency. The subcommittee may consider, but is not limited to
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considering, the following state agencies, functions or programs:
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(i) The Health Services Commission;
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(ii) The Oregon Health Policy Commission;
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(iii) The Health Resources Commission;
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(iv) The Medicaid Advisory Committee;
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(v) The Department of Human Services, including but not limited
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to the state Medicaid agency, the Office for Oregon Health Policy
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and Research, offices involved in health systems planning,
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offices involved in carrying out the duties of the department
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with respect to certificates of need under ORS 443.305 to 443.350
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and the functions of the department under ORS chapter 430;
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(vi) The Department of Consumer and Business Services;
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(vii) The Oregon Patient Safety Commission;
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(viii) The Office of Private Health Partnerships;
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(ix) The Public Employees' Benefit Board;
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(x) The State Accident Insurance Fund Corporation; and
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(xi) The Office of Rural Health.
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(c) Establishing the defined set of essential health services,
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including but not limited to proposals for a methodology,
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consistent with the principles in section 3 of this 2007 Act, for
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determining and continually updating the defined set of essential
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health services. The Oregon Health Fund Board may delegate this
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function to the Health Services Commission established under ORS
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414.715.
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(d) The eligibility requirements and enrollment procedures for
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the Oregon Health Fund program, including, but not limited to,
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proposals for:
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(A) Public subsidies of premiums or other costs under the
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program.
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(B) Streamlined enrollment procedures, including:
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(i) A standardized application process;
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(ii) Requirements to ensure that enrollees demonstrate Oregon
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residency;
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(iii) A process to enable a provider to enroll an individual in
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the Oregon Health Fund program at the time the individual
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presents for treatment to ensure coverage as of the date of the