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LEGISLATIVE UPDATE
Prepared for OAFP
May 21, 2017
Policy Committees Preparing to Close
House and Senate policy committees have two weeks to wrap up their business for this session. June 2 is the final day for them to hold work sessions. Bills that don’t pass need to be sent to the Rules Committee or Ways and Means to stay alive after that.
Revenue Forecast Up; Kicker likely to kick
State economists expect the personal income tax kicker to kick, sending $409 million back to taxpayers next year. The median taxpayer is expected to receive about $80, while the average household will receive about $200. There are still a few weeks left in the biennium, so it’s possible tax receipts will slow and the kicker won’t kick.
The corporate kick will also kick. That $76 million goes to the K-12 Education Fund.
Even with the kickers, revenues for 2017-19 are expected to be up by $187 million from the last forecast, giving legislators $21.2 billion to work with. That’s up from $20.05 billion in 2015-17. But Democratic leaders say it is still $1.4 billion short of what they need to fund the continuing service level budget.
SB 934 – Primary Care Payment Reform
“We know that when we invest up front for prevention and chronic disease management that we save dollars in specialist visits and hospitalizations,” Sen. Elizabeth Steiner Hayward (D-Portland) told the House Health Committee.
Jessica Adamson on behalf of Providence testified in support of the bill noting that they have more than 50 PCPCHs of their own. They have issues with measuring primary care as a percent of “premium,” however, due to premiums being higher in certain parts of the state. They believe that this methodology will disincentivize carriers from participation in the individual market. She is working with the bills’ sponsor on an amendment.
The committee was open to amendments. The bill is scheduled for a work session on Monday.
HB 3418 – PEBB/OEBB pay hospitals 200% Medicare
House Speaker Rep. Tina Kotek (D-Portland) told the House Rules Committee that Oregon hospital costs are 17% higher than neighboring states so they need to find a way to rein in those expenses.
Her proposal would cap inpatient hospital expenses at 200% of Medicare and outpatient hospital expenses at 185% of Medicare for the state’s 276,000 employees and dependents covered through PEBB and OEBB. “Costs are going up as utilization is going down and we are way above the Medicare reimbursement,” she said.
She said this would save $30 million a year in PEBB’s self-insured plans, reduce OEBB premiums by 10% and save OEBB $47.5M per year on plans offered by Moda alone. “This will be a component of an PEBB/OEBB cost containment bill that is in the works.”
Speaking for the Hospital Association, Marty Cahill, CEO of Samaritan Lebanon Community Hospital said, “Using Medicare to set hospital rates for the PEBB and OEBB population is inappropriate and short-sighted.”
Doug Barber, representing the Oregon Association of Health Underwriters, said this would be a cost-shift onto commercial insurance ratepayers.
The committee approved the bill on a party-line vote, sending it to Ways and Means.
HB 2339 – Surprise Billing not resolved yet
The Senate Health Committee is struggling to decide how to resolve the on-going battle over how to pay out-of-network providers in an in-network setting to prevent surprise billing to the policyholder.
“The place we’ve gotten down to is we are haggling over price,” DCBS Director Pat Allen said.
OMA and other specialists proposed a complicated three-tiered methodology where insurers would just pay any bill up to $1,200; use usual and customary or some other negotiated amount on larger charges; ending up in dispute resolution.
Committee chair Sen. Laurie Monnes Anderson (D-Gresham) said, “I want to get away from the provider – insurer arbitration. That is why it is hard for me to swallow your amendment.”
The committee spent 20 minutes floating ideas about payment methodology. They liked the idea of using Oregon’s All Payer All Claims (APAC) database but Pat Allen said APAC wasn’t ready for that yet, “although I think we will be.”
The committee asked Allen to come back with a new proposal next week.
HB 2103 – NP vasectomies
Family physician Pete Reagan, MD told the Senate Health Committee, he performed 1,500 vasectomies during his career. He said a male nurse practitioner in his office really wanted to perform vasectomies but was prohibited by law. “A conscientious nurse practitioner could learn to do this procedure as well as I could,” he said.
Two urologists testified that nurse practitioners do not have the surgical training necessary to perform vasectomies safely. But their arguments were not well received.
“The only way I could conceivably support passage of this bill would be if the Oregon legislators were consigned to having their vasectomies performed by sub-optimally trained providers such as nurse practitioners,” Greg McCoy, a Portland neurologist said. “If this were the case it would be a short-lived law I can assure you.”
Brian O’Halloran, a urologist from Bend, added, “Allowing someone with the same formal surgical training as a gas station attendant to perform surgery on someone’s testicles is not putting patient safety first.”
Sen. Elizabeth Steiner Hayward responded, “I can’t tell you how insulted I am by comments that both of you made.”
The bill is scheduled for a work session next week.
SB 485 - Physician Ownership
The bill that will allow for-profit corporations to operate rural health clinics was a point of contention this week in the House Health Committee.
Cedric Hayden (D-Cottage Grove) says, “I’d like to applaud Orchid Health and what they do. They have done a lot for rural Oregon. But I am concerned that this alters the physician ownership statute.” He said he could get behind a non-profit corporation owning a clinic, but not for-profits.
This got other committee members, including Democrats to reassess their support of the bill as written. In a bizarre last minute discussion, the committee passed the bill on a party line vote, but multiple Democrats said they would prefer to not pass it.
It now goes to the floor for debate.
SB 235 – Enclosed Spaces clarification and Tobacco Retail Licensure
Oregon is just one of nine states in the country that does not require a license to sell tobacco. SB 235 started as a tobacco retail licensure bill but the Senate ultimately chose to remove that provision. The bill currently fixes an error with the definition of “enclosed spaces” in the Clean Indoor Air Act.
Public health advocates including the Multnomah County Public Health Department and the Oregon Nurses Association would like to add back language that would instate a statewide tobacco retail licensure program. Local jurisdictions, in the amendment, would still be allowed to pass city ordinances that imposed even stricter regulations on tobacco retailers, but would have to do some work to align them with the statewide program.
Shawn Miller, NW Grocery Association, says they are neutral on the enclosed spaces but opposed to the amendment. They are not opposed to a statewide license, Miller says, they simply do not support the amendment because it would allow for local jurisdictions to enact additional requirements for licensure such as a barrier from schools. Representatives of the vaping industry and corner stores were likewise opposed to the amendment but open to licensure in a different form.
HB 2398 – OHP Balance Billing
John Mullen, Oregon Law Center, says there are cases when an Oregon Health Plan (OHP) member, despite having coverage, is billed by a provider. Some providers have sent these debts to collections, which can make it difficult for a patient to do things like get an apartment.
This bill would require providers to verify OHP status before billing and require them to wait 90 days to send a bill to collections. It also directs the Oregon Health Authority to convene a stakeholder group to discuss these changes and report to the legislature.
Courtni Dresser, Oregon Medical Association (OMA), says this will require some additional administration on the part of providers.
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