Enrolled bill

SB 1504 makes technical changes to statutes adopted or amended during the 2011 Session in Senate Bill 89, including changes to Oregon's state continuation law and provisions to implement the federal Affordable Care Act (ACA).

Before passage of SB 89, state continuation rights applied to former spouses of employees of employers having 20 or more employees and to former spouses of members of groups of 20 or more certificate holders. SB 89 extended the continuation rights to former spouses of employees or members of employers or groups having 20 or more enrollees. This inadvertent change in terminology expanded the applicability of state continuation rights. SB 1504 changes the statutory provision to the way it existed before passage of SB 89.

SB 1504 also eliminates obsolete state continuation notice provisions and allows DCBS to develop state continuation notice requirements by rule.

Another change made by SB 89 required an insurer to provide special notice under some circumstances when cancelling coverage. The amendment included circumstances when coverage is cancelled for nonpayment of premium which was not intended. SB 1504 excludes cancellation for nonpayment of premium from the special notice requirements enacted in SB 89.

SB 1504 also clarifies that a complaint about a denial of a claim must be treated as reviewable unless the complainant specifically declines review. SB 1504 revises the language included in SB 89 relating to continued coverage pending the outcome of an internal appeal to be consistent with requirements of the ACA.

Before passage of SB 89, under a medical services contract to which an insurer is not a party, a patient had the right to appeal a denial based on the insurer's determination that the procedure is not medically necessary or is experimental. SB 89 inadvertently eliminated this right and SB 1504 restores the right.

Finally, SB 1504 applies retroactively to policies and certificates issued or renewed on or after June 23, 2011, the effective date of SB 89

• Effective Date: March 5, 2012
• Applicability: Policies and certificates issued or renewed on or after June 23, 2011

Enrolled bill

SB 1580 is the Governor's health care transformation bill. It provides legislative approval of the proposals submitted by the Oregon Health Authority (OHA) to implement the Oregon Integrated and Coordinated Care Delivery System (CCOs) created by House Bill 3650 during the 2011 legislative session. The new delivery system replaces the prior system of managed care organizations, mental health organizations and dental care organizations that provide services to Medicaid and Oregon Health Plan patients.

SB 1580 allows the Department of Consumer and Business Services (DCBS) to enter into information sharing agreements with the OHA governing the disclosure of information reported to DCBS by insurers.

SB 1580 prohibits entities from discriminating in participation or reimbursement of providers based on licensure, but allows quality measures and cost controls. It establishes an appeal process for aggrieved providers and requires the OHA to adopt rules regarding network adequacy, provider types and qualifications, provider discipline, and provider reimbursement rates.

SB 1580 also creates a work group on patient safety and defensive medicine to recommend legislation in 2013 to improve patient safety, reduce medical liability costs, and more effectively compensate those injured as a result of medical errors. The bill requires the OHA to adopt CCO criteria, including minimum financial requirements, reserve and risk management criteria and requirements for coordination of care, governance and community engagement. The bill creates a metrics and scoring committee appointed by the OHA to adopt quality and outcome measures.

SB 1580 also makes technical corrections.

• Effective Date: Date: March 2, 2012

Enrolled bill

House Bill 4046 exempts accident-only insurance policies and specified policies that pay benefits on an indemnity basis, from the assessment imposed in 2009 in House Bill 2116. That bill created an account funded by a one percent assessment on health insurance premiums, to be used by the Oregon Health Authority (OHA) for children's medical assistance programs. Some types of insurance policies were excluded from the assessment such as vision-only and dental-only policies, and Medicare advantage plans.

This bill removes the requirement that insurers pay a one percent assessment on premiums from accident only, specified disease, and hospital indemnity policies that pay benefits on an indemnity basis to Department of Consumer and Business Services to help fund the Healthy Kids program. Currently, the assessment will end on September 30, 2013. The exemption from the assessment allowed by HB 4046 is effective on September 29, 2013 so the exempted premiums will continue to pay the assessment but if the program and assessment is extended, these policies would not be subject to the assessment.

• Effective Date: September 29, 2013

Enrolled bill

HB 4128 requires health benefit plans to cover medically necessary dental or orthodontic services for treatment of craniofacial anomalies. Craniofacial anomalies are narrowly defined to mean "a physical disorder identifiable at birth that affects the bony structures of the face or head, including but not limited to cleft palate, cleft lip…." HB 4128 does not provide treatment for temporomandibular joint disorder or maxillofacial conditions that result in overbite, cross bite, malocclusion, or similar irregularities of the teeth.

HB 4128 is a new health insurance mandate. Due to the timing of passage of HB 4128, this mandate is not included as an "essential health benefit" in the benchmark plan Oregon submitted to meet the implementation requirements of the federal Affordable Care Act, so the costs attributable to this mandate in plans offered through the Oregon Health Insurance Exchange will be the responsibility of the State of Oregon.

• Effective Date: Jan.1, 2013
• Applicability: Policies and certificates issued or renewed on or after Jan. 1, 2013

Enrolled bill

HB 4164 approves the Oregon Health Insurance Exchange Corporation business plan as required by Senate Bill 99 (2011 Legislative Session). The bill also includes technical and conforming amendments. It clarifies the financial structure of the Exchange by removing role of State Treasury and allowing Exchange to operate as an independent entity, including establishing and depositing moneys into federally insured depositories.

HB 4164 also authorizes the board of directors or executive director of the Exchange to contract with carriers to develop innovative health benefit plans for employees of corporation if plans are approved the Department of Consumer and Business Services and exempts such plans from Insurance Code requirements for small employer health benefit plans.

Finally, the bill allows school districts and eligible employees of school districts (including community colleges) to obtain health insurance through the Exchange beginning in 2015 rather than obtaining the coverage from the Oregon Education Benefits Board.

• Effective Date: March 8, 2012