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KPD Headlines, August 2009 |
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Summary of By: With the
heightened attention on national healthcare and all of the press that it is
generating it is time to step back and take a look at what has been going on
in Recent Health Care Reform
Legislation House Bill 2009 - This comprehensive
health care reform bill creates an Oregon Health Authority (OHA) which is
responsible for consolidating the duties of various government agencies as
well as organizing state health policy and health services. The OHA is responsible for implementing
health reform policies and programs to make health care accessible and
affordable for all Oregonians.
The bill also establishes a nine member Health Care Policy Board
appointed by the Governor. The
board will serve as the policy making and oversight body for the OHA. The board has been charged with a
number of duties which include: develop a premium assistance program to
provide universal health care coverage for all Oregonians, establish
statewide quality and cost containment standards, develop a plan for an
Oregon Health Insurance Exchange and create a baseline benefit plan offered
through the exchange. In
addition, there are several new requirements for insurers dealing with the
rate filing process and new data reporting requirements. The bill
that will have the most immediate impact on employers is House Bill 2116
which will add a one percent tax to health insurance premium effective
October 1, 2009. House Bill 2116
– Provider Tax The tax
is intended to address health care access for the uninsured. The bill creates a tax on medical
insurance premiums for four years as partial funding for increased access to
health care. It will extend
coverage to 80,000 uninsured The one
percent premium tax will be included in medical plan rates beginning October
1, 2009. Most carriers will be
adding this 1% charge to the rates that they quote for new groups and
renewals written for October 1st or later effective dates. Groups with coverage in place will see
a charge on their October invoices which will continue until their
renewal. A hospital tax is also
included in the bill. The
hospital tax will be offset by an increase in hospital Medicaid payments from
the federal government. A couple
of other key pieces of legislation that were passed during the recent session
include; Senate Bill 679
–Healthy Lifestyle Dividends Authorizes
insurers to pay cash rewards to members who enroll in approved programs to
promote healthy behaviors. Senate Bill 892
– Community Based Health Care Initiative Improves
access to health care for those without insurance by establishing a limited
number of community based health care programs that are exempt from the
Insurance Code. This bill will
help set up infrastructure that will put the State in a position to receive
proposed federal funding. The
bill declares an emergency and became effective June 23, 2009. Mandated Benefit Changes In
addition to the widespread health care reform called for in HB 2116 and HB
2009 the state legislators passed the following mandated benefit changes. This legislation applies to policies
or plans issued or renewed after January 1, 2010. For groups with existing coverage the
changes will be effective at the plan renewal. House Bill 2506 -
Professional Counselors and Marriage and Family Therapists Requires
group health benefit plans providing coverage for services performed by
clinical social workers or nurse practitioners to also cover services
provided by professional counselors or marriage and family therapists when
the counselor or therapist is acting within their lawful scope of practice. House Bill 2589
– Child Hearing Aids Requires
health benefit plans to provide coverage for one hearing aid per hearing
impaired ear for children under 18 years of age or dependent student
children. Hearing aids must be
necessary for the treatment of hearing loss. The bill allows insurers to limit the
benefits to $4,000 every 48 months. House Bill 2794
– HPV Vaccine All
health plans regulated by the state are required to cover the human papilloma
virus vaccine (HPV) vaccine for female beneficiaries who are at least 11
years of age, but no older than 26 years. Many insurance carriers already
cover this vaccine. Senate Bill 9
– Inborn Metabolic Errors This
bill extends the current legislation to cover the treatment of inborn errors
of metabolism in certain situations to health services and contractors and
multiple employer welfare agreements.
Currently the bill is applicable to individual and group health
insurance providers. Senate Bill 24
– Telemedicine Benefits This
bill requires health benefit plans to cover medically necessary telemedicine
(via video conference), provided that the health service would be covered
when provided in person. Senate Bill 316
– Clinical Trials Requires
health plans to cover the routine costs of care for patients who are enrolled
in a qualified clinical trial.
The bill defines a qualifying clinical trial and notes that insurers
providing the required coverage are not, based on that coverage, liable for
any adverse effects of the trial.
Senate Bill 381
– Traumatic Brain Injury Requires
health plans to provide coverage of medically necessary therapy and services
for the treatment of traumatic brain injuries. Senate Bill 734
– Tobacco Use Cessation Programs Requires
health plans to cover quit-smoking and other tobacco use cessation
programs. The health plan must
provide payment or reimbursement of at least $500 for tobacco cessation
programs for plan enrollees 15 years or older. A law
passed by the Oregon Legislature in 2007 (House Bill 2213) required insurance
companies to provide their members with out of pocket cost estimates for
common medical procedures through an interactive web site and toll free
number no later than July 1, 2009.
This deadline has now been reached and many Oregonians can now visit
their health insurance company web site to find out in advance what they will
need to pay for their next office visit, diagnostic test or other common
procedure. Insurers must provide
estimates for the five most common procedures in each of these categories:
office visits, radiology, lab, uncomplicated birth, immunizations,
orthopedics, and digestive system endoscopy. In
addition to new tools available on health insurance company websites the
Department of Consumer Business Services works with the Office for Oregon
Health Policy (OHPR) to provide the following tools to improve health care
cost transparency. ·
OHPR hospital cost comparison http://www.oregon.gov/OHPPR/RSCH/comparehospitalcosts.shtml ·
OHPR hospital quality reports http://www.oregon.gov/OHPPR/HQ/ Additional
information on recent insurance laws and regulations is available on the
Oregon Insurance Division website http://www.cbs.state.or.us/external/ins/orleg.html |
