2016 End-of Session Report
Prepared for ORHA
March 2016


2016 ORHA Session Scorecard 

Key:  A = Good for ORHA; C = Mixed result for ORHA; F = Poor for ORHA


 Result Issue  Bill#   Details
 A  Loan Repayment Funded  SB 5701 $2 million included in the final budget bill for Medicaid
Primary Care Loan Repayment
 A  Rural Health Tax Credit Fix  SB 1507 A 2015 change to how distance is calculated for the tax credit
inadvertently resulted in 718 providers in non-rural communities
becoming eligible for the credit. Had legislators not fixed the
error, it would have cost the state $2.1 million.
 A  Rural Hospital Programs  SB 5701 Up to $10 million is now available for four projects designed
to strengthen rural hospitals.
 A  Wrongful Death Cap  HB 4136 The bill that would have tripled the cap on non-economic
damages did not pass this session.

KEY BILLS

$2M FOR LOAN REPAYMENT – SB 5701 PASSED
The final budget bill includes $2 million for the Medicaid Primary Care Loan
Repayment program. This will fund awards of up to $25,000 per year for five years for
qualified health care providers.
In 2013-15, this program provided 42 awards, about evenly split between rural and
urban underserved communities.

RURAL HEALTH TAX CREDIT FIX – SB 1507 PASSED
In the 2015 session, the legislature made a small change to the distance calculation
for eligibility. Previously, for a provider to be eligible, they had to be 10 miles “as the
crow flies” from a community of 40,000 or more. The 2015 bill changed that to 10
highway miles.
This small change inadvertently added 718 providers to the tax credit at a cost of
$2.1 million. This was not legislative intent.
Section 1 of SB 1507 simply deletes those three words “in highway miles” from the
statute.
The bill passed both chambers with overwhelming support.

$10M FOR RURAL HOSPITAL TRANSFORMATION – SB 5701 PASSED
The final budget bill includes up to $10 million for Rural Hospital Transformation. Four
items are included:
1. Post Acute Care ($4M to $7M) – working with Mayo Clinic to convert unused
critical access hospital beds into swing beds for recovery, allowing patients to be
transferred from DRG hospitals to a hospital closer to home.
2. GME Consortium ($1.5M) – support for the Graduate Medical Education
Consortium to facilitate development of residency programs in rural hospitals.
3. Virtual Clinics (up to $1.1M) – using telehealth to improve after-hours access to
primary care and urgent care services in rural communities.
4. Education on Population Health ($100,000) – webinars and training for rural
hospital administrators.
The $10 million comes from unspent revenues of the hospital tax in 2013-15. Precise
costs for these programs will depend on how many hospitals choose to participate.

TRIPLES WRONGFUL DEATH CAP – HB 4136 FAILED
The proposal would have increased the cap on awards in wrongful death cases from
$500,000 to $1.5 million and add an annual cost of living increase.
Trial lawyers say this bill is about reasonable compensation for the death of a loved
one. They said Oregon’s system, which has no cap on injury cases but a $500,000 cap
on wrongful deaths creates a perverse incentive for someone who is being sued to drag
out the lawsuit, hoping the injured person will die.
Opponents of the bill say caps are logical and provide predictability. They testified
that $250,000 was the cap put on deaths from 9/11.
There is also a correlation between caps and the cost of malpractice insurance.
Physicians in San Francisco, which has a $250,000 cap, pay 50% less than Portland
doctors with a $500,000 cap, who pay 50% less than Seattle doctors where there is no
cap.
Governor Brown was scheduled to testify in support of increasing the cap on
noneconomic damages in wrongful death cases from $500,000 to $1.5 million. But that
hearing was canceled and HB 4136 was not posted for a work session before the
deadline for bills to move out of committee. So the trial lawyers priority bill is dead for
this session.

GROUND EMERGENCY MEDICAL TRANSPORT (GEMT) – HB 4030 PASSED
EMS providers say there is a significant gap between the cost of emergency
transport and reimbursement by Medicaid. Ways and Means approved the plan for the
Oregon Health Authority to amend Oregon’s Medicaid plan that would result in an
increase in Medicaid reimbursement for EMS services of as much as 40%.
Washington and California are already doing this. Oregon wants to expand on their
plans, which cover public EMS providers. HB 4030 will create a workgroup with the goal
of expanding this enhanced reimbursement to cover nonprofit and private EMS
providers as well. Eugene-Springfield Fire Department Chief Randall Groves said, “We
are going to do what we can to make this legislation equitable to all.”
The bill passed both chambers unanimously.

INSURANCE
NP AND PA PAY PARITY SUNSET REMOVAL – SB 1503 PASSED
Lobbyists for the Oregon Nurses’ Association and the Oregon Society of Physician’s
Assistants brought this bill forward to remove the sunset on the nurse practitioner pay
equity statute.
The Oregon Medical Association (OMA), the Osteopathic Physicians and Surgeons
of Oregon (OPSO) and America’s Health Insurance Plans (AHIP) initially opposed the
bill. They supported increasing reimbursement but doing it in a way that does not
standardize payment in the current payment model. As David Walls, OPSO, put it, “the
goal of HB 2902 (2013) was to increase primary care payment, not to standardize the
current payment model.”
However, an amendment added on the House side added data collection provisions
brought the OMA and AHIP to neutral. The bill now requires the Oregon Health Policy
Board to collect data from insurers regarding payment for nurse practitioners and
physicians’ assistants.

COFA PREMIUM ASSISTANCE PROGRAM – HB 4071 PASSED
This bill creates a program to provide financial assistance for health care premiums
and out-of-pocket costs for Pacific Islanders legally residing in Oregon under the
Compact of Free Association who have incomes under 138% of federal poverty.
Despite this population’s ability to work and pay taxes, federal law bars them from
Medicaid. They are, however, eligible for subsidized commercial insurance through the
Insurance Marketplace.
Berri Leslie, Administrator for the Marketplace, explained that under this plan, when a
low-income COFA member applies for insurance on the marketplace they would receive
a federal tax credit that would cover 90% of the cost. The state would cover the other
10% at a cost of $1.75 million per year.
The committee passed the bill unanimously with a referral to Ways and Means.

BASIC HEALTH BLUEPRINT – HB 4017 PASSED
DCBS will convene a new stakeholder group to develop the blueprint for a Basic
Health Plan to bring back to the 2017 legislative session. It could provide Oregonians
with incomes between 138% and 200% of federal poverty with a less expensive
alternative to subsidized commercial insurance. If approved by the state and CMS,
people eligible for the Basic Health Plan would lose the subsidized commercial
insurance they have now and would choose between two Basic Health Plans to be
offered through the Insurance Marketplace.
Providence testified that it is concerned about the potential impact of removing
50,000 lives from the individual market.
The 2016 session approved $415,000 to update the data and analysis for the Basic
Health Plan blueprint including adult dental.

CADILLAC TAX – HB 4029 FAILED
The Affordable Care Act contains a provision that will tax an employer who provides
health insurance benefits over a certain threshold. This provision was supposed to go
into effect in 2018 but was recently postponed until 2020.
Rep. Julie Parish (R-West Linn) introduced this bill to deal with the so-called Cadillac
Tax - the tax scheduled to begin in 2020 on health plans with rich benefits that exceed
limits set by the Affordable Care Act.
Her idea was to move public employees to the exchange, and allow them to use the
excess benefit dollars toward other benefits like retirement savings accounts. The
amendment to this bill would start a task force to deal with this issue.
Rep. Mitch Greenlick (D-Portland) suggested that he and Rep. Parish lead a
workgroup on this issue in the interim.
Later in the session, Kathy Loretz, Public Employees Benefit Board (PEBB) Director,
provided informational testimony on the status of PEBB benefits for the House Health
Committee this week. Currently, the PEBB spend for individuals is over the federal
threshold, but the spend for families is far below. She says “PEBB has long been
designed to be family friendly.” The premium ratio for a family covered through PEBB is
very low (1:1.37 in 2016). That is, it only costs 37% more for an employee to cover their
entire family.
In order for PEBB to meet the $10,200 premium threshold for an employee and
$27,500 for an employee and family, PEBB is decreasing their premium spend for
individuals and increasing the spend for families. Moving to these adjusted ratios
reduces PEBB’s exposure to the “Cadillac” tax. Overall, this is intended to be net-zero
across all pools.
Rep. Alyssa Keny-Guyer (D-Portland) says that going forward she wants to be very
careful about impacting families negatively. Rep. Mitch Greenlick (D-Portland) says that
at the end of the day, we want to have confidence that PEBB is well under the threshold
that triggers the tax.

CCOS
CCO CONTRACTING – HB 4100 FAILED
Rep. Mitch Greenlick (D-Portland) proposed this bill in order to discuss how the state
ought to contract with CCOs in 2018. “This bill formulates eight new procedures for redoing
the CCO contracts,” he says.
Martin Taylor, CareOregon, agrees. He testified that this bill sits in contrast to two
other bills in the legislature right now. “One that requires CCOs to sign Evergreen
contracts that say if they meet minimum standards, they won’t lose their contract. On
the other extreme, if we do nothing, we have a process that opens it up completely
every five years to whoever offers the best value... What I like about this bill is that it
cuts a middle path. It says, we are going to raise the bar every five years and if you rise
to that bar we will continue working with you.”
Rep. Knute Buehler (R-Bend) asked the two, “What are the three major problems that
we need to solve in the CCO version 1.0?”
Taylor said most important are alternative payment methodologies that share risk
between the provider and the payer. He believes it is when the risk is shared that you
have the greatest opportunity to bend the cost curve. He also noted “I don’t understand
why CCOS are for profit entities. These are tax dollars. People are not giving us those
dollars so that we can make a lot of money, they are giving us those dollars with the
intention of helping people get out of poverty.”
Rep. Greenlick responded, “When we wrote the original bill we went about it very
pragmatically because we need $981 million from the federal government to balance
the budget. So we let every flower grow to see what happens. Some of those
blossomed into beautiful rose gardens. Others became these kind of weedy patches.”
Rep. Greenlick realized they had more time to deal with this than he initially thought
and thus did not push his bill forward this session. He will certainly be working on this in
the interim however and will likely have a bill in 2017 to deal with the issue.

CCO CONTRACTING AND TRANSPARENCY – SB 1531 FAILED
In the aftermath of retroactive changes to coordinated care organization (CCO)
contracts, Sen. Alan Bates’ (D-Medford) proposed legislation to modify requirements for
these contracts. The bill would have limited the Oregon Health Authority’s ability to
change contracts and budgets mid-contract, and included a number of provisions to
increase transparency in the contracting process.
Sen. Bates brought together all the CCOs in an attempt to draft legislation that
everyone could agree on. However, there was still discussion among stakeholders late
in the game and the bill ultimately died.

RETROACTIVE CHANGES TO CCO CONTRACTS – HB 4107 PASSED
Rep. John Davis (R-Wilsonville) testified that the retroactivity of contracts has caused
significant consternation in the CCO community. This bill requires the Oregon Health
Authority (OHA) to provide 60-day notice for contract changes and would allow “claw
backs” due to overpayment to be applied retroactively only if the Center for Medicaid
and Medicare Services (CMS) “requires it as a condition of approval.”

CCO GEOGRAPHIC BOUNDARIES – HB 4141 PASSED
Rep. Cedric Hayden (R-Cottage Grove) introduced this bill to address concern about
the Oregon Health Authority’s (OHA) ability to change contracts with CCOs. The bill
prohibits the OHA from changing the geographic boundaries (and by extension the lives
covered) of a CCO area while under contract.
Rep. Hayden believes Coordinated Care Organizations (CCOS) need stability in their
contracts in order to invest properly in their patients and networks. “We are not
suggesting that the OHA shouldn’t have the authority to go in and make sure CCOs are
[delivering adequate services], we are simply asking for some sideboards so that they
have some stability.”
The bill passed both chambers unanimously.

MENTAL HEALTH
MENTAL HEALTH & FIREARMS – SB 1551 FAILED
Sen. Floyd Prozanski introduced this bill to stop people who are a threat to
themselves or others from being able to buy firearms. It would have allowed a
physician, mental health professional, health care provider, educator or family member
to record a temporary hold preventing a person from purchasing a gun.
Prozanski withdrew the bill saying the short session did not allow time for thoughtful
consideration of this concept. He said he plans to work on it during the interim and
possibly bring it back in 2017.

STUDENT SAFETY TIP LINE – HB 4075 PASSED
Ways and Means appropriated $1 million for Oregon State Police to create and
operate a statewide tip line so students and the public can report threats to student
safety. OSP will work with behavioral health providers for appropriate response when
reports come in. Threats can include harassment, intimidation, bullying, cyberbullying
and threats of violence or self-harm.

RX
PHARMACIST NALOXONE RX AND PDMP FOR EDS – HB 4124 PASSED
This bill has two components related to opiods and opiod abuse:
1. PDMP for EDs – It allow Emergency Departments (ED) to connect their
Emergency Department Information Exchange with the Prescription Drug
Management Program (PDMP). This will make it easier for EDs to quickly see
whether a patient has recently filled an opiod prescription.
2. Naloxone Rx – The bill also increases access to Naloxone, a prescription drug that
can save the life of a person overdosing from opioids. A pharmacist would be
allowed to prescribe and dispense this drug to someone who has undergone
training. The bill was amended to allow naloxone to be administered wherever a
person may overdose.
Rep. Knute Buehler (R-Bend) was appreciative of the broad support for the bill,
though he said, “I am disappointed to see the fiscal focusing only on the cost and not on
the savings. Every overdose patient admitted to the ICU costs around $90,000.”

PBM FEES – SB 1505 FAILED
There have been 26,000 complaints about 22 Pharmacy Benefit Managers (PBMs)
reported to the Department of Consumer and Business Services (DCBS). This bill would
have authorized the DCBS to adopt by rule fees that are reasonably calculated to pay
costs associated with administering laws regulating pharmacy benefit managers. PBMs
currently only pay $50 to register with the state.
Proponents ultimately ran out of time this session, as they were still in discussion with
stakeholders when committees shut down.

BIOSIMILAR REPORTING – HB 4105 PASSED
Rep. Rob Nosse (D-Portland) brought back the bill that requires the pharmacist to
send a notice within five business days to the patient when a “biosimilar” is dispensed.
Patient advocacy groups and the Oregon Medical Association (OMA) supported the bill
arguing that it is in a patient’s best interest to know what they are taking.
Insurers say this is a burdensome requirement that targets a class of drugs that can
save people a lot of money. Tom Holt, Cambia Health, testified against the bill saying,
“It does not make sense to us to cast a cloud over this new class of drugs. Though we
don’t have exact savings, people in the industry expect this class of drugs to save
around 25%.”
Biosimilars have been widely used in Europe for years. The FDA is reportedly close
to approving the first biosimilars for us in the US.

CHARITABLE PRESCRIPTION DRUG PROGRAM – SB 1514 PASSED
Oregon’s Charitable Prescription Drug Program has been in effect since 2010 and
allows pharmacies that are registered with the Board of Pharmacy as a “charitable
pharmacy” to dispense donated prescription drugs to patients who are uninsured, don’t
have adequate prescription coverage or are enrolled in a public assistance program.
SB 1514 allows charitable pharmacies to accept donations not just from individuals
but also from other charitable prescription drug programs. All the requirements currently
in statute would apply to these donations as well.
There was no opposition to this bill in committee and it passed both chambers
unanimously.

OTHER ISSUES OF INTEREST
TOBACCO RETAILER LICENSES – SB 1559 FAILED
This bill requires tobacco retailers to obtain a license from the state. This license
includes a fee that will offset the cost of administering the licenses. The bill also allows
local jurisdictions to adopt rules regarding distances from schools but exempts existing
convenience stores from such a requirement.
The bill came under fire from the American Heart Association and the American
Cancer Society for pre-empting local anti-smoking regulations.
But the bill died at the end of the legislative session when it got caught up in a
brokered deal in the Senate. Republicans agreed to suspend the requirement that every
bill be read in its entirety before debate begins if three bills, including SB 1559, were
killed.

VAPING SYSTEMS TAX – HB 4062 FAILED
This bill would have enacted a 50% sales tax on all vape, or e-cigarette, products.
The Oregon Medical Association and the Oregon Nurses Association support the bill,
saying the price increase would put these products out of reach for younger users who
are very price responsive.
Vape-shop owners and e-cigarette liquid producers testified that this would raise the
tax on vape systems above that of tobacco products. They say a tax this high would put
them out of business and send people back to cigarettes.
Though this particular bill did not have the support to make it out of committee, there
is certainly support to tax these products. We expect to see this back in 2017.

IMPAIRED HEALTH PROFESSIONALS – HB 4016 PASSED
Oregon’s Health Professionals’ Services Program (HPSP) is a monitoring program
run by the Oregon Health Authority (OHA) for health professional licensees with
substance use or mental health disorders. Currently, the Board of Dentistry, the Board
of Nursing, the Board of Pharmacy, and the Medical Board participate in HPSP.
This bill permits any medical board in Oregon to contract directly for these services
instead of going through OHA. Proponents say this will save $150,000 per year on
administrative costs while maintaining the intent of the HPSP.
The bill passed both chambers unanimously.

ADVANCE DIRECTIVE – SB 1552 FAILED
Oregon’s Advance Directive form, developed in 1993, was the first in the nation.
But it is long and complicated.
An interim work group that included hospitals, attorneys and health plans proposed
SB 1552 that would have simplified burdensome witnessing requirements.
The bill also created a new temporary advance directive form that includes a
checklist expressing the individual’s desires regarding end of life care including
situations of close to death, advanced progressive illness, and extraordinary suffering. It
also allows the individual to attach additional information.
Finally, the bill created a new Advance Directive Rules Adoption Committee. The 13-
member committee would include, among others, a hospital representative, a clinical
ethicist, a primary care provider, and two providers with expertise in palliative or hospice
care. That committee would develop a new, permanent Advance Directive by rule.
Despite broad support, the bill was ultimately held up in end-of-session partisan
politics and failed to move out of Ways and Means before the committee closed.

PHYSICAL THERAPY LICENSURE COMPACT – SB 1504 PASSED
The Oregon Physical Therapy Association introduced this bill to add Oregon to the
physical therapy licensure compact. This will allow physical therapists to practice in any
other state that is part of the compact without re-licensure.
Rep. Knute Buehler (R-Bend) was excited about the bill. He said, “I am very
supportive of this concept and I intend to bring a similar bill forward next session for
physicians.”
The bill passed both chambers with overwhelming support.

ANTI-DISCRIMINATION IN HEALTH CARE – SB 1568 FAILED
Pharma introcued this bill saying it “would codify anti-discriminatory language in the
Affordable Care Act (ACA).” The effect would be to prohibit the denial of health care
services based on age, expected length of life, present or predicted disability, degree of
medical dependency, or quality of life.
Lynne Saxton, Director of the Oregon Health Authority, says this bill in fact goes
beyond the ACA requirements and would “potentially impact the state’s ability to
manage costs and quality based on considering effectiveness and appropriateness of
treatment.”
Insurers adamantly opposed to the bill. Tom Holt, Cambia, used the hepatitis C drug,
Sovaldi, as an example. He said if Cambia was not able to distinguish between a patient
who is showing signs and symptoms and clearly needs treatment, and every patient
who has tested positive, they estimate it could cost Cambia $68 million annually. The
cost of just Sovaldi and one other high cost drug could raise annual premiums for a
household by upwards of $800.
The bill will not move forward this session.

GENERAL ASSISTANCE PILOT PROJECT – HB 4042 PASSED
DHS now has $1.7 million to launch a General Assistance Pilot Project targeting
people eligible for the Oregon Health Plan who are homeless. The program would
provide clients up to $545 per month for housing, up to $90 per month for utilities, and
$60 per month for personal incidental funds. They would also be offered assistance to
apply for, and secure federal Social Security Administration disability benefits.
The program begins July 1, 2016 and will be capped at 200 individuals.


ORHA 2016,

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