03/24/2017 Legislative Update March 27
“I equate marijuana and tobacco on the same level: I hate both of them!”Senator Laurie Monnes Anderson, Chair of the Senate Health Care Committee, goes public with her position after the hearing on licensure of retail tobacco shops.
2016 Session Preview
Oregon legislators convened at the State Capitol for Legislative Days January 13-15. The committee hearings and discussions were focused on preparing for the 35-day short “turbo-charged” session which starts February 1. Here’s a short primer:
The Rules of Session
The short session is designed to rebalance the budget and address emerging or housekeeping issues. The universe of bills is limited: legislators are allotted two bills each to introduce for the session. Committees each get three bills.
The Key Players
Gov. Kate Brown, a Democrat, will be in the spotlight as she orchestrates agreements on the minimum wage increase and clean energy. She is up for election in 2016 to fill the remaining two years in John Kitzhaber’s term.
House Speaker Tina Kotek and Sen. President Peter Courtney will ultimately shepherd the passage of key legislative initiatives through their chambers. The House and Senate have Democratic majorities.
Sen. Michael Dembrow, Chair of the Senate Workforce Committee, will continue to lead discussions on an increase to the minimum wage.
Health Care leadership: Rep. Mitch Greenlick, Sen. Laurie Monnes Anderson and Sen. Alan Bates will play key roles in reforming the Coordinated Care model in advance of the 2018 contract negotiations.
As a practical matter, the deadline to pass first chamber bills from committee is Thursday, February 11. So, if the bill doesn’t advance within the first days of session, it’s generally dead.
The Marquee Issues
Minimum Wage Increase
Gov. Kate Brown announced a plan to gradually increase the minimum wage from $9.25 to a high of $15.52 in 2022, for the Portland Metro area. For the rest of the state, the proposal would increase wages to $10.25 in 2017 to $13.50 in 2022.
Clean Electricity & Coal Transition Plan
Oregon environmental advocates and two of Oregon’s biggest electric utilities, PGE and Pacific Power recently announced an agreement to transition Oregon away from coal power by 2030 and to double renewable energy use by 2040. The proposal applies only to PGE and Pacific Power, who together serve about 70 percent of Oregon’s electricity needs. Customers of those utilities will continue to be protected by the state’s incremental 4 percent cost cap.
If this package passes in the 2016 session of the Oregon Legislature, it will eliminate the ballot measure proposed by the Renew Oregon coalition to address state greenhouse gas reduction.
Gov. Brown has said that a comprehensive transportation package is off the table until the longer 2017 session.
The Supreme Court ruling on PERS (provisions of the 2013 Grand Bargain to reduce PERS liabilities by cutting cost-of-living increases for retirees) doesn’t impact the 2015-17 budget but will create a hole of as much as $300 million for the 2017-19 and 2019-21 budgets.
The Big Issues for Physicians:
Increase liability limits for wrongful death actions
Trial lawyers are again promoting a bill to triple the $500,000 liability limit on noneconomic damages recoverable in wrongful death actions to $1.5 million. The bill also includes a yearly increase or decrease based on the cost-of-living for the previous calendar year in the Portland and Salem areas. A coalition of health care associations and the insurance industry successfully blocked a complete repeal of the statutory cap for wrongful death actions last session. However, some legislators support raising the statutory cap.
Repeal sunset on requirement that insurer reimburse licensed nurse practitioners and physician assistants (HB 2902)
The Oregon Nurses Association is seeking a repeal of the 2018 sunset for pay parity for primary care providers. The Oregon Medical Association supported HB 2902 in 2013, which established a temporary payment policy intended to immediately alleviate reimbursement cuts to nurse practitioners while an interim, 13-member Task Force was charged with developing a long term, viable payment reform solution. The OMA opposes the repeal because discussions on alternative payment mechanisms are still under way.
Last session the Legislature passed SB 231, which charges the Oregon Health Authority to work on alternative payment methodologies and multi-payer strategies.
Rep. Knute Buehler’s Bill
Part One: Linkage between the Prescription Drug Monitoring Program (PDMP) and the Emergency Department Information Exchange (EDIE) concept would enable the state to link the PDMP to EDIE to allow providers to maximize use of both systems. Secure “push” notifications from the PDMP would feed into EDIE to provide efficiencies in treating patients.
Part Two: Allow pharmacists to dispense naloxone.
Elections! The gubernatorial election. The Secretary of State race (the “Lt. Governor” position!) between Labor Commissioner Brad Avakian, State Senator Richard Devlin and State Representative Val Hoyle. Control of House and Senate.
If agreements can’t be reached on minimum wage and clean energy, ballot measure initiatives are in the works. Advocates who want to prohibit government from imposing immunizations requirements are working on a ballot measure. A Better Oregon is circulating a petition for a 2016 ballot measure to increase the corporate minimum tax for businesses whose Oregon sales exceed $25 million each year. Their target is out-of-state corporations. However, it may affect some healthcare providers, such as cancer clinics with high treatment costs.
The Wild Card(s)
While the universe of bills is limited, the universe of amendments is not. If a bill is in play, your amendments must align with the relating clause. You also need to have a legislator sponsor your idea. Unlike Congress, amendments must take place in committee, not on the floor of the House or Senate chamber.
Legislative Concept Preview
Committees also received a preview of upcoming legislative concepts for the 2016 session. Each member may submit two drafting requests and each committee has three drafting requests that can be submitted to legislative counsel.The deadline is January 19. Links to bills will be available January 27. Concepts that don’t achieve consensus may be postponed until 2017.
Coordinated Care Organizations
Greenlick proposal: “A blueprint for what a CCO should look like”
Rep. Mitch Greenlick, the chair of the House HealthCare Committee, wants an overhaul of the current system in advance of negotiations for the 2018-22 contracts. Provisions will require all CCOs to be community based nonprofit organizations by 2023 with a governing board comprised of half local community members, one quarter provider representatives and the other quarter risk bearing entity representatives. A community escrow account in the State Treasury would hold the CCO’s reserves. New minimum standards, established by the Oregon Health Policy Board would be enacted. Payment reform is included: by 2023, 80 percent of all payments to providers by CCOs must use alternative payment methodologies. This is moving away from the fee-for-service model. Finally, for the 2018 contracts, CCOs must explain what steps they have taken to improve healthcare delivery.
Bates proposal: “This is true transparency”
Sen. Alan Bates, Co-Chair of the Joint Ways and Means budget-writing committee on Human Services, has developed a “CCO Reconciliation Proposal” with five components. It would require OHA to issue a determination on 99 percent of all applications or renewals within 30 days of submission; requires quality incentive measures before the end of the first quarter of the measurement year; additional benefits for members must be added at the beginning of the contract year; OHA must open up the enrollment rule to strengthen foster care and “opt out” provisions; and OHA must create uniform reporting for all CCOs so rates and data can be compared equitably.
Hayden proposal: “Assurance for our healthcare providers”
Rep. Cedric Hayden, Vice Chair of the House Health Care Committee, is considering a proposal to assure certainty for CCOs throughout their contracts. His proposal would prevent the Oregon Health Authority from imposing new requirements on CCOs in the middle of their contracts unless there was a risk that Medicaid recipient might lose coverage otherwise. This bill is in response to the controversial rate-setting changes imposed by OHA on CCOs in August of last year.
Basic Health Program
The Affordable Care Act allows states to waive specific provisions in order to implement innovative state solutions to healthcare issues such as the Basic Health Plan. This concept, with amendments, would charge the Department of Business and Consumer Services with crafting a blueprint for a basic health plan, and subject to legislative approval, submitting an application to the federal government before 2017.
It also establishes a stakeholder group to advise and assist in identifying ACA provisions that, if waived, would improve the state’s health care system.
Licensing tobacco retailers
The Senate Health Care committee has a bill to license retail tobacco shops. Amendments still are under way but a provision to preempt local government from enacting their own requirements is controversial. Grocers who sell tobacco products want to have a uniform statewide policy. Public health advocates want to allow local jurisdictions to keep in place their own policies, which may be stricter than state law.
This concept would raise the minimum age for the sale of tobacco to age 21. Rep. Alissa Keny-Guyer is teaming up with Sen. Elizabeth Steiner Hayward to reduce youth access to tobacco.
The Housing Relief Act of 2016
Rep. Alissa Keny-Guyer, chair of the House Human Services and Housing Committee, is leading the way to provide renter relief from soaring rents and additional renter protections. Her proposal would extend notification for no-cause evictions after the first year of tenancy from 60 days to 90 days, notification for rent increases would go from 30 days to 90 days. The Act would include $8 million in one-time funds in an emergency housing account and $2 million for a shelter housing assistance program. A retaliation statute that would prohibit landlords from evicting people without cause after someone complained about mold, a broken dishwasher or some other issue, also is being considered. Another proposal would make it easier for cities to waive state building requirements and zoning laws for emergency housing.
Foster Care Protections
Sen. Sara Gelser is promoting a package of bills designed to protect and improve care for children in day care facilities and foster care. Gov. Kate Brown has ordered an investigation into the Department of Human Services child welfare system to address abuse in the system. Sen. Gelser’s proposals would make top managers subject to misdemeanor charges of official misconduct for failing to halt placements in abusive homes or facilities. Her proposal also calls for additional licensing investigators. The foster abuse system is in charge of approximately 8,000 children.
Legislative Days January 13-15
In addition to previewing legislative concepts, legislators also held informational hearings. Oregon Health Authority Director Lynne Saxton provided updates before the House Health Care Committee on the medicaid enrollment system and operational issues, efforts to revise and shorten the Oregon Health Plan application, the statewide listening tour on behavioral health, and final CCO contracts. All 16 CCOs have signed contracts for 2016. However the new contract has a provision which clarifies that if CMS fails to approve the proposed 2016 CCO Payment Rates prior to the effective date of the 2016 Amended and Restated CCO Contract, OHA would pay the Contractor at the proposed rates, subject to adjustment for any “overpayment” or “underpayment.” CCOs are expected to challenge this new “claw-back” provision. Last year Family Care was ordered to pay back $55 million and five other CCOs had to pay back nearly $50 million. A lawsuit filed by Family Care over the rates is still pending in Marion County Court.
House Health Care materials can be found here: https://olis.leg.state.or.us/liz/2015I1/Committees/HHC/2016-01-13-14-00/MeetingMaterials
State Epidemiologist Katrina Hedberg briefed the Senate Health Care Committee on opioids and the spectrum of interventions to decrease the amount of opioids prescribed. One of the interventions was to co-prescribe naloxone with opioids for at-risk patients and to explore options to allow naloxone prescription by pharmacists. In 2014, 154 Oregonians died as a result of prescription opioids.
Senate Health Care materials can be found here: https://olis.leg.state.or.us/liz/2015I1/Committees/SHC/2016-01-13-08-00/MeetingMaterials
For more information about the legislative process, please contact Katy King: KatyKing01@gmail.com
For more information about the legislative process, please contact Katy King.