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