“What are we gonna do without Doc Bates?”
Senate President Peter Courtney laments the loss of Sen. Alan “Doc” Bates at his memorial service, which was held at the State Capitol. Sen. Bates died August 5.

Interim Legislative Days September 21-23

Legislative days convened on a somber note with a service to honor the memory of Sen. Alan Bates on Tuesday. The senator’s daughter and Gov. Kate Brown, Senate President Peter Courtney and House Speaker Tina Kotek, along with bipartisan leadership from both chambers, spoke at the service. Doc Bates was remembered as a champion of health reform transformation, a principled leader who took hard votes, and often, as the acting de facto “physician” to the Legislature. He will be greatly missed. 

The spotlight issue: Deadlines for 2017 Legislative Concepts

Monday, September 26, is the deadline for members and committees to request Legislative Concept drafts for pre-session filing by December 21. Legislators may still request unlimited drafts before session convenes February 1, but drafting will not be guaranteed. Already, lawmakers are announcing specific agendas; Speaker Kotek has announced her intention to put forward legislation on a state-wide cap on rent hikes and an end to “no-cause” evictions. Sen. Courtney told legislators to be prepared to vote on a comprehensive transportation package, Sen. Tim Knopp, R-Bend, and Sen. Betsy Johnson, D-Scappose, are looking at PERS reform. Governor Kate Brown, Sen. Majority Leader Ginny Burdick, D-Portland, and House Majority Leader Jennifer Williamson, D-Portland, intend to resume their work on gun violence prevention. On the health front, Rep. Mitch Greenlick, D-Portland, will take up CCO reform.

Here are some possible health-related concepts and workgroup efforts under way:

Payment Reform

  • Fair Payment/Balance Billing: the Department of Consumer and Business Services, the regulating body for the insurance industry, has convened a work group of providers, insurers and consumers to work on legislation to take patients out of the middle of billing disputes for out-of-network providers, such as anesthesiologists, radiologists, pathologists, surgeons, surgical assistants and other providers brought in to participate in a patient’s care. Dr. John Moorhead represented OR-ACEP and OMA at the meeting. He advocated for a transparent process that allows providers to negotiate for fair payment based on a model such the Fair Health Database (www.fairhealth.org) used by New York and Connecticut. Providers and insurers want to see an independent dispute resolution process. The group will continue to work during the interim on solutions to address billing and payment in a manner that meets the needs of health care providers and insurance carriers, as well as to reduce the financial burdens on patients.
  • Sen. Elizabeth Steiner Hayward, a family physician, is working with stakeholders to develop a concept on payment reform that will strengthen investment in Oregon’s primary care delivery system. The senator was the chief sponsor of SB 231, the payment reform bill which passed in 2015. It required state agencies to submit a report to the legislature on primary care spending and it required OHA to convene a primary care payment reform collaborative to advise and assist the authority in developing the Primary Care Transformation Initiative. Her bill will take additional steps, based on recommendations from the SB 231 Collaborative, to support robust investment in the primary care system.

Mental Health

  • Recommendations from OHA’s Behavioral Health Collaborative, to be released in December 2016.
  • Rep. Alissa Keny-Guyer’s Mental Health workgroup to implement 2015 legislation regarding hospital discharge policies and continuity of care, is considering options to expand these discharge policies to hospital emergency departments. OR-ACEP has voiced concerns about any type of legislation to put hospital discharge processes into statute.

Opioids  

  • Rep. Greenlick is exploring a concept to limit the amount of opioids patients can receive in their first prescription to 7-days. The OHA has already developed an opioid guidelines task force (Dr. Mike Henstrom serves on this task force) and is developing hospital metrics based on guidelines from the Oregon Chapter of the American College of Emergency Physicians in regard to the use of opioids in an emergency department setting. Again, OMA and other provider organizations generally oppose any efforts to legislate medical practice.

Coordinated Care Organizations

  • Rep. Mitch Greenlick, the chair of the House Health Care Committee, will reintroduce legislation to modify the requirements for CCOs in 2018 and 2023 in order to expand community involvement and transparency. At his request, the Oregon Health Policy Board is holding listening sessions around the state on the future of coordinated care.

Public Health

  • Gun Violence Prevention: Gun Violence Restraining Orders a mechanism to temporarily suspend firearms access on a case-by-case basis when people are deemed to be a danger to themselves or others, Firearm Transfer Criminal Background Checks, Prohibit transfer of firearm by dealer or private party for 10 business days (or more) if Department of State Police is unable to determine whether the recipient is qualified to receive a firearm. Restricting childhood access to firearms/safe storage: creates a new crime in Oregon called “endangering a minor by allowing access to a firearm.”
  • Tobacco 21: Sen. Steiner Hayward is re-introducing her legislative concept to increase the minimum age to purchase tobacco to 21. OR-ACEP supported this legislation in 2016.
  • Marijuana/Child Health and Safety: The Association of Oregon Counties (AOC) has convened a workgroup on marijuana and youth. The purpose is to strategize in advance of the 2017 session when they expect to have legislation that would roll back OHA rules on dosage limits, packaging, introduce cannabis cafes and amendments to the Indoor Clean Air Act to allow marijuana exemptions and topical (marijuana lotion, etc.) OR-ACEP is participating on the workgroup.
  • Distracted Driving: The Oregon Department of Transportation has convened a workgroup to review and clarify the state’s distracted driving law. OR-ACEP is participating on the workgroup.

The State Budget

The state economist released his quarterly budget forecast for September and revenues are down $2.2 million from the last forecast in June. State agencies are developing their budgets for the 2017-19 biennium to submit to the Governor for consideration. For the first time, they are being asked to submit two budgets; their usual proposed budget and one that contemplates the passage of Measure 97. If voters approve Measure 97, a 2.5 percent increase to the minimum corporate tax, it’s expected to generate $6 billion dollars during the biennium. The Governor will release her recommended budget in December. 

OHA 2017-2019 Agency Request Budget

The Oregon Health Authority has released her agency budget request for 2017-2019 and the agency is seeking an additional $1 billion from the state general fund to cover costs that have resulted from Medicaid expansion. To put this into context, the general fund budget is $18.334 billion down slightly from the June forecast of $18.336 billion. 

The agency also asked for approximately $30 million to increase investment in public health modernization. This will help the public health system respond to emerging threats such as the Zika virus, meningitis outbreaks on college campuses, earthquake preparedness and environmental threats. Funding also is included for Oregon Health Plan coverage of all kids regardless of their citizenship status, and investments for the Oregon Common Credentialing Program. See the policy option packages here: https://www.oregon.gov/oha/Documents/OHA-2017-2019-ARB-Policy-Option-Packages.pdf

House and Senate Health Care Committee hearings

Health Transformation

OHA Behavioral Health Collaborative Update

A panel led by Lynne Saxton, Director of the Oregon Health Authority, provided an update on the Behavioral Health Collaborative. The 50-member collaborative was established in July to fast-track development of a plan to improve the state’s mental health system in time for consideration by the 2017 Legislature. 

The effort also will align with OHA’s agreement with the US Department of Justice on a three-year plan to improve mental health care access and improve outcomes for adults with serious and persistent mental illness. Data from a behavioral health mapping tool and information from state-wide behavioral health town halls, also will inform the discussions. 

Director Saxton said the collaborative’s efforts will link to the federal 1115 demonstration waiver for CCOs and health transformation and also the SB 231, the Multi-Payer Primarcy Care Payment Reform collaborative. The SB 231 collaborative is focusing on alternative payment models to incentivize efficient care delivery, reward quality and invest in the primary care delivery system. Recommendations will be made to the Oregon Health Policy Board. This effort is considered a foundational piece of health care transformation.

The Behavioral Health Collaborative also will look at behavioral health workforce issues and rely on the recommendations from the Oregon Health Policy’s Board’s committee on the Health Care Workforce.

Finally, the work will look at outcomes from a client focus. 

See the US DOJ/Oregon Performance Plan here: http://www.oregon.gov/oha/bhp/Pages/Oregon-Performance-Plan.aspx

Comprehensive Primary Care Plus Initiative

CPC + is a five-year model beginning in 2017 that is the largest primary care model implementation in US history. It involves 14 states and regions, up to 5,000 practices, 20,000 physicians and up to 25 million patients. In Oregon, 13 or the 16 CCOs are participating. This federal program will advance care delivery and payment to achieve delivery system reform and allow primary care practices to provide more comprehensive, team-based care for patients, particularly those with complex needs. Practices use these care coordination payments to hire nurses, mental health professionals, diabetes educators and other team members to improve care for their patients. Legislators expressed concern that some practices, such as pediatrics, were excluded from this innovative Medicare program. 

Coordinated Care Organizations

OHA Health System Transformation Quarterly Report

OHA provided the first Oregon Health System Transformation Quarterly Legislative Report. The model is to move as many people as possible from Fee-For-Service (FFS) model to a CCO. Over 400,000 new patients have been enrolled in Medicaid statewide, and approximately 95 percent of Oregonians have health insurance. The costs have been kept within a 3.4 percent average growth rate. Health System Transformation 2.0 (HST 2.0) will include: 

  • Focusing on accelerating quality and integration for our behavioral health system;
  • Integrating population health through public health modernization;
  • Continuing to move to value-based payments for incentivizing health outcomes;
  • Maintaining a financially sustainable model 

CCO Oregon Update

CCO Oregon, a non-profit member association for Coordinated Care organizations presented on their activities. One area of focus was the The CCO Oregon behavioral health workgroup, IBHAO, was formed in June 2014 by Primary Care Behavioral Health Integration experts from around the state. Their focus is  promote the practice of primary care behavioral health and to integrate many of the recommendations into their primary care practices, standardizing workflows, and creating best practices that can be replicated across the state. Legislators zeroed in on barriers to integration of behavioral health into primary care. Those include: financing, access, workforce. 

Public Health

Women’s Health 

The Women’s Foundation of Oregon presented its first report on women’s health since 1990. The report noted eight issues that can’t wait, including systemic racism regarding women and girls of color in Oregon, mental health challenges including the highest incidence of depression in the country and higher rates of childhood trauma than the national average. The report noted that nearly half of Oregon’s women and girls have experienced a childhood traumatic event, such as abuse or neglect. 

The report stated that the U.S. has among the highest infant mortality and low birth weight outcomes in the industrialized world. Oregon’s rates are higher than many states but women and babies of color in Oregon experience extreme disparities in birth outcomes, especially for African American and Native American infants. 

Childhood Obesity

Public health officials from the University of Ilinois and Oregon State University reported on the rising childhood obesity problem. Nationally, the prevalence of obesity ages 6-11 is 17.5 percent rising to over 20 percent for adolescents ages 12-19. They reviewed possible policy interventions including sugar-sweetened beverage taxes, changes to the Supplemental Nutrition Assistance Program and weighed the policy implications. Overall, they recommended increased changes to children’s diet and increased physical activity as key components to address rising childhood obesity rates. 

Link to the House and Senate committee materials here: 

House: https://olis.leg.state.or.us/liz/2015I1/Committees/HHC/2016-09-22-08-00/MeetingMaterials

Senate: https://olis.leg.state.or.us/liz/2015I1/Committees/SHC/2016-09-21-08-00/MeetingMaterials

For more information about the legislative process, please contact Katy King.

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