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LEGISLATIVE UPDATE
Prepared for OAFP
February 14, 2016
SB 1507 – Rural Health Tax Credit Fix
Section 1 of SB 1507 is a technical fix to the Rural Health Tax Credit. 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.
SB 1507 simply deletes those three words “in highway miles” from the statute.
The bill is scheduled for a work session this week.
HB 4100 – CCO Contracting
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 re-doing the CCO contracts,” he says.
John Eames, HealthShare of Oregon, says he believes this is the critical time to have this conversation.
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.”
SB 1531 – CCOs
Sen. Laurie Monnes Anderson (D-Gresham) says that there are three consensus parts to Sen. Alan Bates’ (D-Medford) bill. The committee did not have time to review the newest amendment to the bill before the deadline and did not move the bill forward. Sen. Bates will likely add the consensus pieces to a bill already in Ways and Means.
HB 4107 – Retroactive Changes to CCO Contracts
Rep. John Davis (R-Wilsonville) says the retroactivity of contracts has caused significant consternation in the CCO community. This bill would require 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 CMS requires it.
Courtney Davis, COHO, testified that this is particularly important as we move away from fee-for-service payments and into a global budget that is focused on quality rather than quantity.
The committee passed the bill. It now goes to the House floor.
HB 4141 – CCO Geographic Boundaries
Rep. Cedric Hayden (R-Cottage Grove) introduced this bill to address concern about the Oregon Health Authority’s ability to change contracts with CCOs. He 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 prohibits the OHA from changing the geographic boundaries (and thus the lives covered) of a CCO area while under contract.
The committee passed the bill.
MODA Update
According to Laura Cali, Oregon Insurance Commissioner, and Pat Allen, Director, Department of Consumer and Business Services (DCBS), MODA has worked out an agreement with DCBSto raise $179 million in capital that will allow them to resume selling individual insurance. Those dollars will cover their existing policies as well as a buffer in the event of other occurrences.
This capital will come from selling assets as well, says Allen. “This is not just accounting maneuvers and kicking the can down the road… More than managing costs, we’re talking about the adequacy of their premiums to support the cost of their claims… They, as you know, have received large rate increases.”
HB 4017 – Basic Health Plan Blueprint
This bill requires the Department of Consumer and Business Services (DCBS) to submit a Basic Health plan blueprint to the legislature in 2017. Under the Affordable Care Act (ACA), a state is allowed to use most of the funds that would normally go to commercial subsidies for a Basic Health plan. Basic Health covers everybody from 138% to 200% of the federal poverty line.
The committee amended the bill to include a technical fix that gives DCBS more freedom in their blueprint design, and removed language that instructs the blueprint to exclude adult dental.
Rep. Cedric Hayden (R-Cottage Grove) voted against the bill. He says, “This step is too much too quickly… We are struggling, particularly in the rural parts of the state, to meet the need that is already there.”
Rep. Knute Buehler thinks that we are addressing the wrong problem. He thinks we should make sure we can afford the Oregon Health Plan we currently have in place before we look at a Basic Health plan.
Responding to stakeholder concerns, Rep. Mitch Greenlick (D-Portland) made it clear that legislative counsel says the bill does not give DCBS authority to submit 1332 waivers without legislative approval.
The committee passed the bill on a partisan vote—Democrats in support, Republicans against. It now goes to Ways and Means.
HB 4136 – Wrongful Death Cap Passes House
The first big floor fight of the session erupted over efforts by Trial Lawyers and Democrats to increase the cap for noneconomic damages in Wrongful Death cases from $500,000 to $1.5 million.
Rep. Paul Holvey (D-Eugene) said, “It should not be predetermined and does not seem just. It should be left to the jury.”
House Republican Leader Rep. Mike McLane (R-Powell Butte) objected saying, “This will, without a doubt, raise the cost of rural health care. The cost of health care is higher when the caps go up.”
The brouhaha erupted when Rep. Bill Post (R-Keizer) displayed an oversized check made out to the Trial Lawyers. Democrats objected saying it impugned the motives of other members and Post was forced to take it down. That set off Rep. McLane. Republicans tried to amend the bill so any jury award above $500,000 would go entirely to the injured party. Democrats rejected that amendment. So Republicans said each $1.5 million award meant a check for an additional $350,000 for trial lawyers.
When debate concluded the bill passed 33 – 26 with three Democrats voting no and one Republican voting yes. The bill now goes to the Senate for consideration.
SB 1559 – Tobacco and E-Cigarette Sales Licensure
Anyone who sells tobacco in Oregon would be required to get a license from the Department of Revenue beginning January 1, 2017 if this bill is passed.
Sen. Laurie Monnes Anderson (D-Gresham) says, “One of the best parts about the base bill is that we will have an opportunity for education with the small convenience stores. I am confident that sales to minors will go down with the help of this bill.”
The bill passed on a party-line vote. It now heads to Ways and Means.
SB 1504 – Physical Therapy Compact
Passage of this bill would require Oregon to adopt the Physical Therapist Interstate Licensure Compact, allowing physical therapists and physical therapist assistants to practice in other compact member states without being re-licensed.
The bill passed unanimously with last minute technical amendments. It now goes to the floor for debate.
HB 1568 – Anti-Discrimination in Health Care
“This bill would codify anti-discriminatory language in the Affordable Care Act (ACA),” says Jim Gardner, PhRMA. 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 that 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 are adamantly opposed to the bill. Tom Holt, Cambia, used the hepatitis C medicine, Sovaldi, as an example. He said that if Cambia was not able to distinguish between a patient that is showing signs and symptoms and clearly needs treatment, and every patient that has tested positive, they estimate that 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.
HB 4124 – Pharmacist Naloxone Prescriptions and Administration
This bill would allow ER doctors to access the Oregon Prescription Drug Monitoring Program (PDMP) through their electronic medical records. 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) is appreciative of the broad support for the bill, though he says, “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.”
The committee passed the bill. It now goes to Ways and Means.
HB 4105 – Biosimilar Notification
Rep. Rob Nosse (D-Portland) has brought back the bill that requires a notice to be sent within five business days to the patient when a “biosimilar” is dispensed. Patient advocacy groups and the OMA support the bill arguing that it is in a patient’s best interest to know what they are taking.
The committee added an amendment that sunsets the bill in 2022 and passed the bill. It moved through the House with 55 votes. It will be heard in Senate Health this week.
SB 1505 – Pharmacy Benefit Managers (PBMs)
This bill removes the $50 cap on pharmacy benefit manager registration and renewal fees in order to allow Department of Consumer and Business Services (DCBS) to set fees that reasonably cover the costs of law enforcement of PBMs.
HB 4042 – General Assistance Pilot Project
This pilot project would provide funds for a General Assistance program. The program would contact people that qualify such as those who are homeless and those who are disabled. These populations would be offered housing assistance and personal incidental funds, as well as assistance to apply for, and secure federal Social Security Administration disability benefits. The caseload would be capped at a maximum monthly average of 200 cases.
The committee passed the bill. It now goes to Ways and Means.
Revenue Forecast Stays Flat
Economists told Legislators this week, “The economy continues to grow at a healthy pace” but capital gains and tax revenues are down, so the revenue forecast is flat. It’s actually up $1.8 million this biennium and final accounting from the 2013-15 biennium added $52 million to the beginning balance. So Ways and Means has a little more to work with. But, economists say, there are storm clouds on the horizon.
The forecast for 2017-19 dropped $165 million. And Ways and Means says they are already looking at a $1 billion hole, the result of huge PERS deficits and reduced federal funding for the Medicaid expansion, among other reasons.
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