“Things are awesome but there may be a recession coming.”
Rep. Rob Nosse confirms his understanding of the state’s budget situation.

The Spotlight Issue this Week: Governor’s Recommended Budget (GRB) is released The governor’s health care budget prioritizes children’s health, health transformation (CCO 2.0) and closes the Medicaid funding gap of $830 billion Governor Kate Brown met with stakeholders in advance of interim Legislative Days to review her health care priorities and budget. The big change was a six-year plan to address Medicaid funding for the Oregon Health Plan in lieu of the perpetual two-year fix to address shortfalls. This will be done through a combination of hospital assessments, assessments on big companies that do not offer health insurance to employees and an increase in the tobacco tax by $2 per pack of cigarettes. Her goal is ambitious — she wants to pass this package no later than February.

Other priorities: universal home visiting services, suicide prevention and establishment of an Office of Children’s Health. The behavioral health system budget includes investments to create behavioral health homes, expand community services for the aid and assist population (mentally ill misdemeanor defendants) and expand in-home behavioral health services for youth.

INSIDER INFORMATION: The GRB is the first step in the budget process. The three co-chairs of Ways and Means will develop and introduce their proposed budget by March. Budget negotiations usually continue until the last day of session. The final budget is known as the Legislatively Adopted Budget. It includes the Christmas Tree bill — allocations for special projects.

Leadership Updates

Two senators share a gavel for Ways and Means co-chair; new leadership for House and Senate Republicans

Sen. Elizabeth Steiner Hayward and Sen. Betsy Johnson will share the Senate co-chair gavel for the Joint Ways and Means Committee. Rep. Dan Rayfield will be the House co-chair, taking over for Rep. Nancy Nathanson. Rep. Nathanson will be chair of the House Revenue Committee. All tax increase measures must originate in the House.

Senate President Peter Courtney, Senate Majority Leader Ginny Burdick, Speaker Tina Kotek and House Majority Leader Jennifer Williamson retain their posts. Sen. Herman Baertschiger was elected Senate Republican Leader, replacing Senate Minority Leader Jackie Winters. Rep. Carl Wilson will replace outgoing House Minority Leader Mike McLane. Committee assignments may be released as early as next week.

Revenue forecast: Sunny with a chance of tornados

The December Revenue forecast is up more than $75 million in general fund since the last forecast in August, but the state economists predict a slowdown on the horizon, perhaps as soon as 2020. The current forecast will translate into additional dollars for the kicker, which is expected to refund $724 million to Oregon taxpayers next year.

Lawmakers will still need to figure out how to address funding shortfalls of approximately $1 billion for the 2019-21 biennium, including an $830 million gap in Medicaid funding. There’s also an unfunded PERS liability of $26 billion. Speaker Kotek has developed a proposal to divert this year’s kicker into paying down a portion of the liability. In order to do so, she would need 40 votes, which requires two votes from the other side of the aisle.

SOS Audit on Opioids

Secretary of State Dennis Richardson released an audit report on the Prescription Drug Monitoring Program (PDMP) and constraints on the state’s ability to address the opioid crisis. Key findings: limitations on use by law enforcement, prescriber use of PDMP is voluntary and lack of certain information on Schedule V drugs, veterinary prescriptions, non-retail pharmacies, method of payment and diagnosis codes. Statutory changes are needed to implement those changes, many of which will be controversial. https://sos.oregon.gov/audits/Documents/2018-40.pdf

House and Senate Health Care Committee hearings OHA and DCBS Updates

The Senate and House Health Care Committees met separately but each held a hearing with OHA, DCBS and the governor’s office. Several dozen committee bills were introduced, stay tuned! In brief:

  • Governor’s Opioid Epidemic Task Force Legislative Proposals LC 633 The chief policy initiative is to declare addiction as a chronic illness and medical condition. This comports with science and best practices. The proposal also will launch a “Project Nurture” pilot program specific to pregnant women suffering with substance use disorder. This is based on the successful Health Share model. Provisions include: accreditation for treatment providers. OHA will convene the group to develop the accreditation standards. Also, Prior Authorization for public payers to expedite treatment, technical changes to the PDMP and for the needle exchange programs, an affirmative defense for possession of a controlled substance.

Oregon Prescription Drug Monitoring Program Update (EDIE and PDMP)

The Emergency Department Information Exchange and the Prescription Drug Monitoring Program are Health Information Technology systems to support work around reducing opioid prescribing.

  • EDIE: To date: 2/3rds of hospitals have EDIE alerts integrated into electronic health records. The other 20 are in progress.
  • PDMP: 94 percent of top prescribers are registered. For all prescribers it’s 83 percent. PDMP queries are skyrocketing — over 135 percent increase since streamlining system.

Governor’s Children’s Cabinet

The governor convened a Children’s Cabinet earlier this year with state agencies, legislators and a few non-profit associations. The vision: All Oregon children living in poverty have pathways to rise to the middle class and achieve their full potential

  • Prioritizing ending children’s homelessness — major issues of workgroup.
  • Integrating substance abuse disorder treatment and behavioral health programs for families
  • Increasing access to quality, affordable child care
  • Ensuring all children have health care coverage
  • Providing preschool for children in poverty so they start kindergarten ready to learn
  • Ensuring every child has quality education by lowering class sizes for K-3 and expanding the school year
  • Helping parents obtain living wage jobs
  • Finalizing a comprehensive Child Welfare system based on positive human development and safely reducing the need for foster care

CCO 2.0

OHA is shifting from the policy mode to the state procurement mode for the next phase of CCOs. One change: CCO applicants will establish service areas based on county boundaries (right now there aren’t defined areas). The advantage: it aligns with behavioral health and public health infrastructure and prevents redlining districts to exclude high numbers of sick people. Exceptions will be made if applicants can achieve transformation goals. The plan doesn’t impose limits on the location of the CCO’s provider network. The request for proposals will be released January 2019. Contracts will be awarded in June 2019.

Behavioral Health

  • Aid and Assist Workgroup: The Aid and Assist patients are criminal defendants whose fitness to proceed is in question. They are there to increase competency so they can stand trial. The courts may order such defendants to be committed to the state hospital for services and supervision necessary to restore the defendant’s fitness to proceed. A workgroup has been convened to look at investments for this population. Proposals would: increase community capacity to divert individuals from admissions and move those ready for discharge. Funding would be targeted to six counties (Douglas, Marion, Klamath, Multnomah, Washington and Lane.) Funds can be used for dedicated district attorney, housing, transportation, medication, forensic evaluations, training. Final recommendations will be released in January/February 2019.
  • Behavioral Health Justice Reinvestment Initiative: A workgroup has been convened to develop a statewide policy framework to improve outcomes for people in the criminal justice system with behavioral health conditions.
  • Unity Center: In compliance as of 10/31.

Primary Care Payment Reform Collaborative

A multi-stakeholder advisory body was established by the Oregon Legislature in 2015 (SB 231) tasked with helping OHA develop and implement a Primary Care Transformation Initiative. The charge was to develop and share best practices in technical assistance and methods of reimbursement that facilitate health care innovation and invest in primary care. Oregon was the first state to develop this model. Delaware recently passed legislation based on Oregon’s law. The collaborative is working on payment models to expand value-based care and behavioral and physical health integration. A report will be released in early January.

Public Health Immunizations

Overview of vaccine reportable diseases

  • Exciting news! Diptheria has been eliminated. Measles doesn’t exist unless it’s imported. Rubella has been eradicated. Tetanus is low-level. Hep A is on the decline. On the verge of global eradication of polio.
  • Challenge: pertussis, mumps and chronic infections.
  • Vaccination rates for 2-year-olds. The number has steadily risen from 2014-17 to 68 percent. This can be attributed to CCO metrics.
  • Vaccination rates by schools: Median percentage is 94 percent. However, nine percent of schools have rates below 80 percent. Junction City is the lowest with just 49 kids and 20 percent up-to-date.
  • Non-medical exemptions are on the rise from 1 percent of kids in 2000 to 7.5 percent.
  • Herd immunity is 93 percent for measles.
  • HPV: There are 12,000 cases of cervical cancer and 4,000 deaths. Only 60 percent of teenagers are up-to-date

Tobacco 21

Key finding: 11th-grade cigarette smoking is decreasing. However, the rise in e-cigarettes is a concern. 2011-17 11.5 percent to 7.7 percent cigarettes, e-cigarettes 1.8 percent to 12.7 percent.

School Based Mental Health Services Expansion Proposal

  • Counties with no existing services ($2 million)
  • Counties with clear unmet need, even with existing services ($2 million), as demonstrated by Oregon Healthy Teens, Office of Rural Health and other data
  • Address shortfall from 2017 SBHC Mental Health Expansion Capacity grant requests ($1.1 million)
  • Develop services in pre-K and elementary school settings, targeting trauma and developing resilience in students who’ve experienced ACEs at earlier ages ($1 million)

DCBS Open Enrollment Status Report

For more information or questions, contact: KatyKing01@gmail.com

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