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LEGISLATIVE UPDATE
Prepared for OAFP
March 26, 2017
SB 754 – Tobacco 21 passes Senate
Oregon could become the third state to raise the legal age to purchase tobacco to 21. Sen. Elizabeth Steiner Hayward (D-Portland) sponsored the bill. “This bill will decrease youth smoking rates, decrease tobacco-related diseases and health care costs, and it will improve public life,” she said. “This is good policy for Oregonians.”
Sen. Alan Olsen (R-Clackamas) described it as another example of the nanny state.
The bill passed the Senate 19-8. It now goes to the House for consideration.
HB 2387 – Rx Payment Reform
The House Health Committee met on Wednesday afternoon to solely discuss Rep. Rob Nosse’s (D-Portland) expansive prescription drug cost control bill.
Lorey Freeman, the drafter of the bill, explained the bill to the committee:
- Section 1 requires manufacturers to rebate “excessive costs” to carriers. The bill would establish what is excessive by averaging the 5 highest costs in other countries for the same drug. This section also requires manufacturers to give at least 60-day notice if the price of a drug will increase by more than 3.4%.
- Section 2 requires the carriers that receive the rebates to cap the copay for individuals.
- Section 3 requires manufacturers to report on drugs that have an introductory price of more than $10,000 or if a drug’s price has increased by more than 3.4% in 12 months. It also requires manufacturers to report on their patient assistance programs.
-Section 4 allows for DCBS to apply civil penalties to manufacturers who fail to comply with the reporting piece of this bill.
Republicans showed some concern about the bill, but felt a bit blindsided by the forum. They thought the meeting would allow for more public comment rather than discourse between committee members.
The committee took no action on the bill.
HB 3087 – Paid Family Leave
An overflow crowd was on hand to listen to Oregon first step toward creating a statewide system for paid family leave. “Every employer and employee would be covered, no matter how much they work,” the House Early Childhood Committee was told.
The program would be funded with a payroll tax: 0.5% by the employee, matched by the employer. That works out to $25 per month for an employee making $60,000.
Employees would be able to tap into the fund when they need it, for the birth of child, care for a spouse, or death of a parent. Paid leave would be limited to 12 weeks per year with an additional six weeks of benefits for parental leave.
Supporters of the plan say nationally, as of 2015, only 12% of Americans have access to paid family leave through their employer. Many women have to return to work within two weeks of having a baby, even though bonding with a newborn is important for the newborn and parents.
Employers are concerned about another cost on top of the paid sick leave and minimum wage increases that were recently added.
The bill would require a three-fifths majority in both the House and the Senate, so it will need at least a little Republican support if it’s to pass.
SB 237 – Plans with Co-Pay Only for Rx
A group of Oregonians who use high-cost prescription drugs want 25% of Oregon’s commercial insurance plans to be co-pays only — no co-insurance, no deductibles — for prescriptions.
Patrick Stode told the Senate Health Committee, “This would provide affordable options for those living with chronic disease.”
Elise Brown representing AHIP (America’s Health Insurance Plans) said, “This bill does nothing to solve the underlying problem and will only drive up premiums.” Tom Holt, Cambia, said bills like this, “Insulate Rx manufacturers from the one thing they fear most – consumer pressure.”
SB 831 – DOs and Podiatrists Supervise PAs
This would change the definition of “supervising physician” to allow osteopathic physicians and podiatrists to supervise physician assistants, as we as MDs. The DOs were described as “enthusiastically neutral” on the bill.
There is no opposition.
HB 3135 – Requires OHP payment for IUD after labor and delivery
The Oregon Health Plan would have to pay for long-acting, reversible contraceptive devices such as IUDs when a woman is still in the hospital after delivering a baby. Prof Maria Rodriguez, OHSU, told the House Health Committee, “The same service that would be offered during an outpatient visit should be offered during her hospital stay.” Supporters said these long-acting devices, which cost $00 to $800, are up to 20-times more effective than other birth control methods.
Rep. Knute Buehler (R-Bend) described this as an, “Important opportunity to help improve women’s health.”
HB 2527 – Expand Pharmacist Contraceptive Authority
Oregon was the first state to allow pharmacists to prescribe contraceptives. Oregon’s law and program have become a model for other states. Sen. Elizabeth Steiner Hayward (D-Portland) said she was recently at a pharmacy that had a big sign saying, “we can now prescribe your birth control.”
HB 2527 expands on that effort by adding hormonal contraceptives including vaginal rings and injectable Depo-Provera that pharmacists could prescribe and dispense.
Rep. Sheri Malstrom (D-Beaverton) said, “This is a wonderful concept.”
SB 963 – DO Manipulation Mandate
Osteopaths say some insurers deny payment for diagnosis and Osteopathic Manipulative Treatment when they are in the same office visit. “They arbitrarily decide not to pay both codes when they occur on the same day,” David Walls, Osteopathic Physicians of Oregon, told the Senate Health Committee.
Tom Holt, Cambia, said, “This is where we do see abusive billing. We pay for diagnosis and we pay for treatment but not two payments for one visit.”
Sen. Elizabeth Steiner Hayward (D-Portland), who is also a family physician, pushed back saying, “Osteopathic manipulation is as much a procedure as draining an abscess.” She said she could not understand the insurers’ denying these charges. “It’s like saying we will pay for an annual exam but not a pap smear on the same day.”
The committee chair said they plan a work session on the bill next week.
SB 423 – PA Prescribing
This would allow physician assistants to dispense controlled substances in schedules III and IV of the federal Controlled Substances Act.
Sen. Elizabeth Steiner Hayward (D-Portland) says she recognizes that PAs were excluded from the requirement to report to the PDMP when prescribing narcotics. She thinks this was an omission when that legislation was drafted and wants to make sure that anybody prescribing reports to the PDMP.
The committee passed the bill.
SB 783 – User Friendly Coverage Info and Prior Authorizations
Proponents say that patients are often covered for a procedure for a limited amount of visits. After that, the insurer refuses to cover the procedure and the patient is left with the bill. The purpose of this is to provide more transparency and accountability.
The bill requires insurers to provide enrollees and health care providers with information on covered benefits in a format that is user-friendly.
Elise Brown, America’s Health Insurance Plans (AHIP), says they have questions about what is meant by “user friendly.”
The committee asked for clarification from DCBS.
HB 2408 – School Based Health Centers and Mental Health
Rep. John Lively (D-Springfield) introduced a bill that would appropriate $1 million to plan, establish and operate new school-based health centers, $3 million to increase student access to school-based mental health providers and to fund a pilot program that uses trauma-informed approaches.
Some are concerned about dollars going to the school districts to operate medical clinics, rather than be integrated with the rest of the health care system.
Rep. Cedric Hayden (R-Cottage Grove) said, “Within the current waiver, we have a certain amount of dollars set aside for community benefit.” His concern is that we will create siloes by operating medical clinics under the Department of Education.
Rep. Lively responded that in the urban centers, we have those opportunities to work collaboratively, but in rural areas, they are more much more limited.
HB 2981 – OHP Application Timeliness
There have been enrollment and re-enrollment issues with the Oregon Health Plan. A representative from Family Care says 49% of their members lose their coverage within the first year. Additionally, it takes 40 days on average for an application to be processed. They say that they cannot help their members because they cannot see inside the system to see if they are covered.
Rep. Mitch Greenlick (D-Portland) says, “I can tell you my colleagues and I are absolutely committed to solve this problem.”
Rep. Rob Nosse (D-Portland) says that it is completely ludicrous that somebody would be on hold for 7 hours.
Rep. Greenlick replied sarcastically, well that’s just the total, it’s probably just 4 hours and 3 hours so it’s not that bad.
3276 – Coverage for Disease Outbreak and Epidemic Control
Rep. Nancy Nathanson (D-Eugene) told the committee the University of Oregon experienced a meningococcal outbreak in 2015. At the U of O, over 30,000 vaccines were administered, many of which were not covered by insurance. This cost the University $533,000. One of the reasons insurers would not pay for the vaccines was their requirement that the vaccines be administered by a person’s primary care physician or by an in-network provider. The problem, in Nathanson’s eyes is that in the event of an outbreak, quick action is critical, and it is unreasonable to expect students to travel many hundreds of miles or across state lines to get the vaccine.
This bill would require insurers to cover prophylactic measures if the state’s Public Health Director determines there exists a disease outbreak, epidemic or other public health crisis.
HB 2540 – Bachelors Nursing Degrees at Community Colleges
Oregon’s eleven community college nursing programs would be able to expand their offerings to include a Bachelor of Nursing degree. Rep. Jodi Hack (R-Salem) said it would, “make it more affordable to get a nursing degree.”
Charlie Tveit, Lakeview Hospital CEO, said, “We need help. The best way for nurses to get training is through our local Klamath Community College.”
Karen Brady from Legacy Health said, “If community colleges offered a RN-BSN program, we would have a better chance of recruiting locally-prepared nurses.”
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