ORS Chapter 413
Chapter 413 — HealthCare Access, Financing and Delivery
2009 EDITION
HEALTHCARE ACCESS, FINANCING AND DELIVERY
HUMANSERVICES; JUVENILE CODE; CORRECTIONS
OREGONHEALTH POLICY BOARD
413.006 Establishmentof Oregon Health Policy Board
413.007 Compositionof board
413.008 Chairperson;quorum; meetings
413.011 Dutiesof board
413.014 Rules
413.016 Authorityof board to establish advisory and technical committees
413.017 PublicHealth Benefit Purchasers Committee and Health Care Workforce Committee
413.018 HealthCare Workforce Strategic Fund
OREGONHEALTH AUTHORITY
413.031 OregonHealth Authority Fund
413.032 Establishmentof Oregon Health Authority
413.033 OregonHealth Authority director
413.034 OregonHealth Authority officers and employees
413.037 Administeringoaths; depositions; subpoenas
413.042 Rules
OREGONHEALTH INSURANCE EXCHANGE
Note OregonHealth Insurance Exchange--2009 c.595 §17
413.064 Healthbenefit plans offered through Oregon Health Insurance Exchange
413.075 Applicationof antitrust laws
HEALTHCARE DELIVERY SYSTEM CAPACITY
413.201 Targetedoutreach for Health Care for All Oregon Children program; grants to addresshealth care access barriers
413.225 Grantsto safety net providers; evaluation of implementation of Health Care for AllOregon Children program; rules
HEALTHCARE PRACTICES
413.250 StatewideHealth Improvement Program
413.260 Patientcentered primary care home health care delivery model
HEALTHINFORMATION TECHNOLOGY
413.300 Definitionsfor ORS 413.300 to 413.308
413.301 HealthInformation Technology Oversight Council
413.302 Councilmembership
413.303 Councilchairperson; quorum; meetings
413.306 Rules
413.308 Dutiesof council
(Temporaryprovisions relating to transfer of duties, functions and powers to OregonHealth Authority are compiled as notes following ORS 413.308)
413.005 [Formerly413.010; 1965 c.556 §21; 1973 c.651 §7; 2003 c.14 §184; repealed by 2005 c.381 §30]
OREGONHEALTH POLICY BOARD
413.006Establishment of Oregon Health Policy Board. (1) There is established theOregon Health Policy Board, consisting of nine members appointed by theGovernor.
(2)The term of office of each member is four years, but a member serves at thepleasure of the Governor. Before the expiration of the term of a member, theGovernor shall appoint a successor whose term begins on January 1 nextfollowing. A member is eligible for reappointment. If there is a vacancy forany cause, the Governor shall make an appointment to become immediatelyeffective for the unexpired term.
(3)The appointment of the board is subject to confirmation by the Senate in themanner prescribed in ORS 171.562 and 171.565.
(4)Members of the board are entitled to reimbursement of per diem and travelexpenses for their attendance at board meetings and subcommittee meetings asprovided in ORS 292.495. [2009 c.595 §1]
Note: Section 2,chapter 595, Oregon Laws 2009, provides:
Sec.2.Notwithstanding the term of office specified by section 1 of this 2009 Act[413.006], of the members first appointed to the Oregon Health Policy Board:
(1)Two shall serve for terms ending December 31, 2011.
(2)Two shall serve for terms ending December 31, 2012.
(3)Two shall serve for terms ending December 31, 2013.
(4)Three shall serve for terms ending December 31, 2014. [2009 c.595 §2]
413.007Composition of board.(1) The Oregon Health Policy Board consists of individuals who:
(a)Are United States citizens and residents of this state;
(b)Have demonstrated leadership skills in their professional and civic lives;
(c)To the greatest extent practicable, represent the various geographic, ethnic,gender, racial and economic diversity of this state; and
(d)Collectively offer expertise, knowledge and experience in consumer advocacy,management of a company that offers health insurance to its employees, publichealth, finance, organized labor, health care and the operation of a smallbusiness.
(2)No more than four members of the board may be individuals:
(a)Whose household incomes, during the individuals’ tenure on the board or duringthe 12-month period prior to the individuals’ appointment to the board, comefrom health care or from a health care related field; or
(b)Who receive health care benefits from a publicly funded state health benefitplan.
(3)No more than four members of the board may be, during the individuals’ tenureon the board or during the 12-month period prior to the individuals’appointment to the board, employed in a health care or health care relatedfield.
(4)At least one member of the board shall have an active license to provide healthcare in Oregon and shall be appointed to serve in addition to the membersoffering the expertise, knowledge and experience described in subsection (1)(d)of this section. [2009 c.595 §4]
413.008Chairperson; quorum; meetings. (1) The Governor shall select from themembership of the Oregon Health Policy Board the chairperson and vicechairperson.
(2)A majority of the members of the board constitutes a quorum for the transactionof business.
(3)The board shall meet at least once every month and shall meet at least onceevery two years in each congressional district in this state, at a place, dayand hour determined by the board. The board may also meet at other times andplaces specified by the call of the chairperson or a majority of the members ofthe board, or as specified in bylaws adopted by the board. [2009 c.595 §5]
413.009 [Formerly413.020; 1965 c.556 §22; 1967 c.204 §2; 1969 c.468 §4; 1973 c.651 §8; repealedby 2005 c.381 §30]
413.010 [Amended by1961 c.620 §9; renumbered 413.005]
413.011Duties of board.(1) The duties of the Oregon Health Policy Board are to:
(a)Be the policy-making and oversight body for the Oregon Health Authorityestablished in ORS 413.032 and all of the authority’s departmental divisions,including the Oregon Health Insurance Exchange described in section 17, chapter595, Oregon Laws 2009.
(b)Develop and submit a plan to the Legislative Assembly by December 31, 2010, toprovide and fund access to affordable, quality health care for all Oregoniansby 2015.
(c)Develop a program to provide health insurance premium assistance to all low andmoderate income individuals who are legal residents of Oregon.
(d)Establish and continuously refine uniform, statewide health care qualitystandards for use by all purchasers of health care, third-party payers andhealth care providers as quality performance benchmarks.
(e)Establish evidence-based clinical standards and practice guidelines that may beused by providers.
(f)Approve and monitor community-centered health initiatives described in ORS413.032 (1)(g) that are consistent with public health goals, strategies,programs and performance standards adopted by the Oregon Health Policy Board toimprove the health of all Oregonians, and shall regularly report to theLegislative Assembly on the accomplishments and needed changes to theinitiatives.
(g)Establish cost containment mechanisms to reduce health care costs.
(h)Ensure that Oregon’s health care workforce is sufficient in numbers andtraining to meet the demand that will be created by the expansion in healthcoverage, health care system transformations, an increasingly diversepopulation and an aging workforce.
(i)Work with the Oregon congressional delegation to advance the adoption ofchanges in federal law or policy to promote Oregon’s comprehensive healthreform plan.
(j)Establish a health benefit package in accordance with ORS 413.064 to be used asthe baseline for all health benefit plans offered through the Oregon HealthInsurance Exchange.
(k)Develop and submit a plan to the Legislative Assembly by December 31, 2010,with recommended policies and procedures for the Oregon Health InsuranceExchange developed in accordance with section 17, chapter 595, Oregon Laws2009.
(L)Develop and submit a plan to the Legislative Assembly by December 31, 2010,with recommendations for the development of a publicly owned health benefitplan that operates in the exchange under the same rules and regulations as allhealth insurance plans offered through the exchange, including fully allocatedfixed and variable operating and capital costs.
(m)By December 31, 2010, investigate and report to the Legislative Assembly, andannually thereafter, on the feasibility and advisability of future changes tothe health insurance market in Oregon, including but not limited to thefollowing:
(A)A requirement for every resident to have health insurance coverage.
(B)A payroll tax as a means to encourage employers to continue providing healthinsurance to their employees.
(C)Expansion of the exchange to include a program of premium assistance and toadvance reforms of the insurance market.
(D)The implementation of a system of interoperable electronic health recordsutilized by all health care providers in this state.
(n)Meet cost-containment goals by structuring reimbursement rates to rewardcomprehensive management of diseases, quality outcomes and the efficient use ofresources by promoting cost-effective procedures, services and programsincluding, without limitation, preventive health, dental and primary careservices, web-based office visits, telephone consultations and telemedicineconsultations.
(o)Oversee the expenditure of moneys from the Health Care Workforce Strategic Fundto support grants to primary care providers and rural health practitioners, toincrease the number of primary care educators and to support efforts to createand develop career ladder opportunities.
(p)Work with the Public Health Benefit Purchasers Committee, administrators of themedical assistance program and the Department of Corrections to identifyuniform contracting standards for health benefit plans that achieve maximumquality and cost outcomes and align the contracting standards for all stateprograms to the greatest extent practicable.
(2)The Oregon Health Policy Board is authorized to:
(a)Subject to the approval of the Governor, organize and reorganize the authorityas the board considers necessary to properly conduct the work of the authority.
(b)Submit directly to the Legislative Counsel, no later than October 1 of eacheven-numbered year, requests for measures necessary to provide statutoryauthorization to carry out any of the board’s duties or to implement any of theboard’s recommendations. The measures may be filed prior to the beginning ofthe legislative session in accordance with the rules of the House ofRepresentatives and the Senate.
(3)If the board or the authority is unable to perform, in whole or in part, any ofthe duties described in ORS 413.006 to 413.064 without federal approval, theboard is authorized to request waivers or other approval necessary to performthose duties. The board shall implement any portions of those duties notrequiring legislative authority or federal approval, to the extent practicable.
(4)The enumeration of duties, functions and powers in this section is not intendedto be exclusive nor to limit the duties, functions and powers imposed on theboard by ORS 413.006 to 413.064 and by other statutes.
(5)The board shall consult with the Department of Consumer and Business Servicesin completing the tasks set forth in subsection (1)(j), (k) and (m)(A) and (C)of this section. [2009 c.595 §9]
413.014Rules.In accordance with applicable provisions of ORS chapter 183, the Oregon HealthPolicy Board may adopt rules necessary for the administration of the laws thatthe board is charged with administering. [2009 c.595 §6]
413.015 [Formerly413.030; repealed by 1969 c.69 §8]
413.016Authority of board to establish advisory and technical committees. (1) The OregonHealth Policy Board may establish such advisory and technical committees as theboard considers necessary to aid and advise the board in the performance of theboard’s functions. These committees may be continuing or temporary committees.The board shall determine the representation, membership, terms andorganization of the committees and shall appoint the members of the committees.
(2)Members of the committees who are not members of the board are not entitled tocompensation, but at the discretion of the board may be reimbursed from fundsavailable to the board for actual and necessary travel and other expensesincurred by them in the performance of their official duties, in the manner andamount provided in ORS 292.495. [2009 c.595 §8]
413.017Public Health Benefit Purchasers Committee and Health Care Workforce Committee. (1) The OregonHealth Policy Board shall establish the committees described in subsections (2)and (3) of this section.
(2)(a)The Public Health Benefit Purchasers Committee shall include individuals whopurchase health care for the following:
(A)The Public Employees’ Benefit Board.
(B)The Oregon Educators Benefit Board.
(C)Trustees of the Public Employees Retirement System.
(D)A city government.
(E)A county government.
(F)A special district.
(G)Any private nonprofit organization that receives the majority of its fundingfrom the state and requests to participate on the committee.
(b)The Public Health Benefit Purchasers Committee shall:
(A)Identify and make specific recommendations to achieve uniformity across allpublic health benefit plan designs based on the best available clinicalevidence, recognized best practices for health promotion and diseasemanagement, demonstrated cost-effectiveness and shared demographics among theenrollees within the pools covered by the benefit plans.
(B)Develop an action plan for ongoing collaboration to implement the benefitdesign alignment described in subparagraph (A) of this paragraph and shallleverage purchasing to achieve benefit uniformity if practicable.
(C)Continuously review and report to the Oregon Health Policy Board on thecommittee’s progress in aligning benefits while minimizing the cost shift toindividual purchasers of insurance without shifting costs to the private sectoror the Oregon Health Insurance Exchange.
(c)The Oregon Health Policy Board shall work with the Public Health BenefitPurchasers Committee to identify uniform provisions for state and local publiccontracts for health benefit plans that achieve maximum quality and costoutcomes. The board shall collaborate with the committee to develop steps toimplement joint contract provisions. The committee shall identify a schedulefor the implementation of contract changes. The process for implementation ofjoint contract provisions must include a review process to protect againstunintended cost shifts to enrollees or agencies.
(d)Proposals and plans developed in accordance with this subsection shall becompleted by October 1, 2010, and shall be submitted to the Oregon HealthPolicy Board for its approval and possible referral to the Legislative Assemblyno later than December 31, 2010.
(3)(a)The Health Care Workforce Committee shall include individuals who have thecollective expertise, knowledge and experience in a broad range of healthprofessions, health care education and health care workforce developmentinitiatives.
(b)The Health Care Workforce Committee shall coordinate efforts to recruit andeducate health care professionals and retain a quality workforce to meet thedemand that will be created by the expansion in health care coverage, systemtransformations and an increasingly diverse population.
(c)The Health Care Workforce Committee shall conduct an inventory of all grantsand other state resources available for addressing the need to expand thehealth care workforce to meet the needs of Oregonians for health care.
(4)Members of the committees described in subsections (2) and (3) of this sectionwho are not members of the Oregon Health Policy Board are not entitled tocompensation but shall be reimbursed from funds available to the board foractual and necessary travel and other expenses incurred by them by theirattendance at committee meetings, in the manner and amount provided in ORS292.495. [2009 c.595 §7]
413.018Health Care Workforce Strategic Fund. There is established in the StateTreasury, separate and distinct from the General Fund, the Health CareWorkforce Strategic Fund. The fund shall consist of moneys obtained fromfederal and private sources as well as any moneys appropriated to the fund bythe Legislative Assembly. Moneys in the fund are continuously appropriated tothe Oregon Health Authority to meet the goals established by the Health CareWorkforce Committee established pursuant to ORS 413.017. [2009 c.595 §7a]
413.019 [Formerly413.040; 1967 c.116 §2; repealed by 2005 c.381 §30]
413.020 [Renumbered413.009]
413.025 [Formerly 413.150;1969 c.69 §6; repealed by 1981 c.784 §38]
413.029 [Formerly413.190; repealed by 2005 c.381 §30]
413.030 [Amended by1961 c.620 §10; renumbered 413.015]
OREGONHEALTH AUTHORITY
413.031Oregon Health Authority Fund. The Oregon Health Authority Fund isestablished in the State Treasury, separate and distinct from the General Fund.Interest earned by the Oregon Health Authority Fund shall be credited to thefund. Moneys in the fund are continuously appropriated to the Oregon HealthAuthority for carrying out the duties, functions and powers of the authorityunder ORS 413.032. [2009 c.595 §18]