November 2021 Legislative Update

“The mental pandemic will be long after the COVID pandemic is over.”
Diane Solomon, PMHNP, testifying about the provider wellness crisis.

November legislative day agendas were stacked with informational hearings held over from September. Legislative days were canceled that month due to the Special Session on redistricting and another COVID outbreak in the State Capitol Building. Here are the highlights this week:

• Legislators convene for virtual hearings about the workforce crisis, provider wellness and the fragility of the state’s behavioral health system during the COVID-19 pandemic.
• Gov. Brown indicates she may call an additional legislative session to address tenant eviction crisis.
• Tensions are high as legislators position themselves for the 2022 election, including a vacancy for the House speaker’s gavel.
• The Revenue Forecast is up another $725 million. Taxpayers due a $1.9 billion kicker this year and possibly one for $558 million in 2024.
• What’s next: The 2021 35-day session starts Feb 1. Committee meetings to prepare for the session will convene Jan. 11-13. The universe of bills will be small; each legislator is limited to two bill drafts. Bills will be introduced on medical liability during the COVID pandemic, provider wellness, workforce policies and other health care issues.

Health Care Workers in Crisis

Pandemic fatigue was the thread running through all of the health care presentations. Providers are traumatized and burned out after toiling through wave after wave of COVID infections. The OMA lobbyist testified that where there was once nightly applause for frontline workers, physicians are having tires slashed, spit on, and harassed when asking patients about their COVID vaccination status. Solutions to the crisis included: task force to address the nursing shortage, tax credits, compacts with other states, hazard pay, loan assistance or tuition forgiveness, reduce documentation burden, expand telehealth, break support for nurses (not “buddy breaks,” which double workload on stressed providers) modify CNA training requirements, wrap-around support for child care, mental health, housing and expansion of the Oregon Wellness Program, which provides free and confidential mental health support for physicians, advanced practice providers, physician assistants and dentists.

The Oregon State Hospital (OSH) Staffing Solutions workgroup recommends a change in PERS benefits for all OSH employees. OSH would need support from other agencies to consider the impacts this recommendation. They are also seeking a change to a 36-hour nurse schedule as equivalent to full time to help recruit and retain nurses (RN/LPN) at OSH. NAMI is seeking wage increases for community treatment providers, expanded community capacity and funding for low-barrier support warm lines.

The Spotlight Issue: 2022 Elections

Campaigns already are underway for the 2022 elections and candidates are jockeying for position. Speaker of the House Tina Kotek, D-NE Portland, and State Sen. Betsy Johnson, D-Scappoose, will run for governor when Gov. Kate Brown’s term expires. Rep. Kotek’s announcement set off a mad scramble to replace her with several legislators, including Rep. Rob Nosse, D-SE Portland, and Rep. Paul Evans, D-Monmouth, said to be considering a run. Rep. Janelle Bynum, D-Happy Valley, who already has announced her bid, said that support for the position was promised to her after she stepped aside from a contest for the job in 2021. Kotek and House Majority Leader Barbara Smith Warner clarified that they offered support for leadership roles but not necessarily as Speaker. (See the OPB article at the end of this newsletter for more detail.)

Sen. Johnson lost her gavel as Ways and Means Co-Chair when she announced she would run as an independent. Sen. Elizabeth Steiner Hayward, D-Beaverton, and Rep. Dan Rayfield, D-Eugene, will remain as co-chairs.

Rep. Andrea Salinas, D-Lake Oswego, has announced she will run for the new Congressional District Six. Rep. Lisa Reynolds, D-Portland, has announced she will move to Washington County to avoid a run-off between her and fellow physician Rep. Maxine Dexter, D-Portland. Sen. Chuck Thomsen, R-Hood River, has announced he doesn’t plan to seek re-election after 12 years but will support Rep. Daniel Bonham, R-the Dalles. Immunizations advocates are losing the sole Republican champion for removing non-medical exemptions for school vaccine requirements.

Other retirements: Sen. Chuck Riley, D-Hillsboro, Sen. Ginny Burdick, D-Portland, Sen. Michael Dembrow, D-Portland, Rep. Brian Clem, D-Salem, Rep. Brad Witt, D-Scappose.

Rep. Bill Post, R-Keizer, also has left office effective Nov. 30. He already has moved to Nevada. Rep. Mark Meek, D- Gladstone will run for the seat occupied by Sen. Bill Kennemer, R-Happy Valley. Rep. Suzanne Weber, R-Tillamook, will run for Sen. Betsy Johnson’s seat.

December Revenue Forecast: $1.9 billion kicker to taxpayers

“The revenue boom continues unabated,”
state economist Mark McMullen

Revenues are up over a billion dollars since the Legislature adjourned in June after making historic investments to address equity, housing and behavioral health. Gov. Brown has asked legislators to make investments to address workforce shortages and ongoing health disparities.

OHA COVID-19 Update

OHA Director Pat Allen, Public Health Director Rachel Banks and Dr. Dean Sidelinger, the State Public Health Officer, testified on the status of OHA’s response to the COVID-19 pandemic. Here’s a report by the numbers:

• Total cases: 378,174. (4th lowest in the nation.)
• Deaths in Oregon: 4,803. (6th lowest in the nation.)
• Delta variant is approximately 3x more transmissible and may cause more severe disease.
• Pfizer vaccine is 93-100 percent effective in the US against severe disease. Approximately 78-87 percent for symptomatic disease. Expect similar results for Moderna.
• 78.1 percent of Oregonians have at least one dose of COVID vaccination.
• 72.3 percent have completed two does.
• 15.1 percent have a booster shot.
• Pediatric vaccines: 5.6 percent. Over 40,000 children have been vaccinated since FDA approval last week.
• Cost of a COVID vaccine: An investigation by the Kaiser Family Foundation determined that the cost of a test can range anywhere from $20 to $850, with $127 being the median cost.
• When will the pandemic end? Never. It will become endemic. OHA Director Pat Allen said given the rise in cases from last year, we will be wearing masks — at least indoors — until sometime next year.
• Challenges: OHA is working with DHS to get people out of hospitals and into care facilities. These are complex patients who need a lot of casework. Monitoring workforce capacity following the vaccination requirements, resource requests and shortages, funeral home activity and morgue storage capacity. Blood supply shortages, closure of Bi-Mart pharmacy creating critical shortages in region 9, Eastern Oregon. Employed 1,500 National Guard member in non-patient care roles. Submitting extension for FEMA vaccination teams.

K-12 School Update

ODE Director Colt Gill testified. The recent decline in Delta variant COVID-19 cases has leveled off and cases now appear to be increasing. This is how it will affect schools, teachers and students:

Legislators asked if COVID vaccines would be required to attend K-12. Director Gill noted that the OHA makes decisions via rule after consulting with the rule advisory process, which can be lengthy.

Bill Preview 2022

• COVID Medical liability, Rep. Maxine Dexter, D-Portland.
• Expand Oregon Wellness Program to include nurses and other providers. $740,000.
• Policies and funding to address the health workforce and nursing shortage crisis.
• Brain Injury Trust:  Connect brain injury survivors with support and services through the OHA. Senate Health Care Committee Bill

Transforming Care: Role of the Oregon Health Policy Board (OHPB)

The OHPB charge is policy oversight of the OHA. Their 2021 legislative direction is HB 2081, Cost Growth Target Accountability Mechanisms, HB 2362 Health Care Market Oversight, HB 2086/HB 2949 Behavioral Health Workforce and Infrastructure, SB 65 Transition of Health Insurance Marketplace. Overall priorities: health equity, OHA’s 1115 waiver renewal, implementing the cost-growth reduction program,

Update on the Coverage/Access Landscape

Jeremy Vandehey from OHA and Alex Cheng from DCBS, testified about health care access and coverage. Approximately 94 percent of Oregonians are insured but coverage has not been accessible to all. Communities of color are likely to be uninsured. Health care is unaffordable for Oregon families. Universal coverage is central to health equity. Oregon will fill in gaps through HB 3352, the Cover All People legislation passed last year with a $100 million dollar investment.

Proposed Medicaid strategies: Continuous OHP enrollment for kids 0-6. Two-year continuous OHP enrollment for people ages 6 and older even if their income changes, fast easy way to enroll in OHP at the same time as SNAP benefits.

House Behavioral Health Committee
Behavioral Health Package of Resources Update

OHA Director Steve Allen declared the behavioral health system is currently in crisis. There’s wear and tear on front-line health care workers. Higher demand for behavioral health resources at a time when the system is overloaded and losing personnel. Looking to remove some of the administrative reporting and contract requirements (that won’t compromise safety) for the emergency workforce response. OHA has paused or changed 42 reporting contracts. Incentives include retention and hiring bonuses on par with other health care providers — estimated $2,000 per person. 7,000 workers in the BH residential system. Includes BH nurses and other workers. Use of ARPA grants to provide innovative solutions such as child care, additional staff for supervision or relief shifts.

Behavioral Health investments

• Supporting Behavioral Health workforce: $60 million to remove financial barriers and strengthen the BH workforce pipeline with an emphasis on workforce diversity
• $20 million for a grant program to licensed behavioral health professionals to provide supervised clinical experience
• Supporting simple access to responsive and effective services”: $130 million ($65      million state general fund, $65 million federal) to increase residential treatment, services and housing
• $121 million ($24.5 million state general fund, $96.5 million federal) for certified community behavioral health clinics
• $21 million ($19.2 million state general fund, $2.3 million federal) for community services for “Aid & Assist”
• $302 million for addiction and recovery services called for in Ballot Measure 110, and it backfills the $70 million, which that measure redirected from other behavioral health services
• $6 million to fund peer respite centers in specified regions
• Require system alignment and shared meaningful outcomes: $50 million for transformation and system alignment in the behavioral health system
• $15 million for the crisis care system ($10 million for Mobile Crisis Funding and $5 million for call center resources)

Timeline

OHA is in the process of hiring staff and will do planning and rule making in 2022. Contracts will be awarded next summer with the awards beginning Dec. 9, 2022.

988 Crisis Line Workgroup Update

HB 2417 (2021)

Ways and Means Human Services Subcommittee

OHA sought approval of grants for the Health Insurance Marketplace ($800,000) Climate and Health Programs ($12 million) Mobile Crisis Services ($1 million) Provider relief funds (unspecified federal grant.) The Provider Relief Fund is a $186.5 billion federal program that provides financial relief to health care providers for expenses or lost revenues attributable to COVID-19; the program also supports COVID-19 testing and treatment for uninsured individuals.

OHA also submitted a report on increased federal awards totaling $642 million from March 2020 through early October 2021 to respond to the COVID-19 pandemic.