Bill Text: OR SB373 | 2013 | Regular Session | Engrossed

---

Bill Title: Relating to oral health care delivered by coordinated care organizations.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB373 Detail]

Download: Oregon-2013-SB373-Engrossed.html

---

     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 1589

                           A-Engrossed

                         Senate Bill 373
                 Ordered by the Senate April 24
           Including Senate Amendments dated April 24

Sponsored by Senator BATES (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure.

  Requires coordinated care organization { + , + }   { - to
provide oral health care through contracts with dental care
organizations unless no dental care organization provides
care - }  { +  by July 1, 2014, to contract with every dental
care organization providing dental care + } in geographic area
served by coordinated care organization { + , unless dental care
organization agrees not to contract with coordinated care
organization. Specifies that contract ends on earlier of July 1,
2017, or date dental care organization fails to meet coordinated
care organization's outcome, quality and performance
measures + }.
   { +  Authorizes dental care organizations to form limited
liability corporation or enter into another business arrangement
for purpose of contracting with coordinated care
organization. + }

                        A BILL FOR AN ACT
Relating to oral health care delivered by coordinated care
  organizations; amending ORS 414.625.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 414.625, as amended by section 20, chapter 8,
Oregon Laws 2012, is amended to read:
  414.625. (1) The Oregon Health Authority shall adopt by rule
the qualification criteria and requirements for a coordinated
care organization and shall integrate the criteria and
requirements into each contract with a coordinated care
organization.  Coordinated care organizations may be local,
community-based organizations or statewide organizations with
community-based participation in governance or any combination of
the two.  Coordinated care organizations may contract with
counties or with other public or private entities to provide
services to members.  The authority may not contract with only
one statewide organization. A coordinated care organization may
be a single corporate structure or a network of providers
organized through contractual relationships. The criteria adopted
by the authority under this section must include, but are not
limited to, the coordinated care organization's demonstrated
experience and capacity for:
  (a) Managing financial risk and establishing financial
reserves.
  (b) Meeting the following minimum financial requirements:
  (A) Maintaining restricted reserves of $250,000 plus an amount
equal to 50 percent of the coordinated care organization's total
actual or projected liabilities above $250,000.
  (B) Maintaining a net worth in an amount equal to at least five
percent of the average combined revenue in the prior two quarters
of the participating health care entities.
  (c) Operating within a fixed global budget.
  (d) Developing and implementing alternative payment
methodologies that are based on health care quality and improved
health outcomes.
  (e) Coordinating the delivery of physical health care, mental
health and chemical dependency services, oral health care and
covered long-term care services.
  (f) Engaging community members and health care providers in
improving the health of the community and addressing regional,
cultural, socioeconomic and racial disparities in health care
that exist among the coordinated care organization's members and
in the coordinated care organization's community.
  (2) In addition to the criteria specified in subsection (1) of
this section, the authority must adopt by rule requirements for
coordinated care organizations contracting with the authority so
that:
  (a) Each member of the coordinated care organization receives
integrated person centered care and services designed to provide
choice, independence and dignity.
  (b) Each member has a consistent and stable relationship with a
care team that is responsible for comprehensive care management
and service delivery.
  (c) The supportive and therapeutic needs of each member are
addressed in a holistic fashion, using patient centered primary
care homes or other models that support patient centered primary
care and individualized care plans to the extent feasible.
  (d) Members receive comprehensive transitional care, including
appropriate follow-up, when entering and leaving an acute care
facility or a long term care setting.
  (e) Members receive assistance in navigating the health care
delivery system and in accessing community and social support
services and statewide resources, including through the use of
certified health care interpreters, as defined in ORS 413.550,
community health workers and personal health navigators who meet
competency standards established by the authority under ORS
414.665 or who are certified by the Home Care Commission under
ORS 410.604.
  (f) Services and supports are geographically located as close
to where members reside as possible and are, if available,
offered in nontraditional settings that are accessible to
families, diverse communities and underserved populations.
  (g) Each coordinated care organization uses health information
technology to link services and care providers across the
continuum of care to the greatest extent practicable and if
financially viable.
  (h) Each coordinated care organization complies with the
safeguards for members described in ORS 414.635.
  (i) Each coordinated care organization convenes a community
advisory council that meets the criteria specified in section 13,
chapter 8, Oregon Laws 2012.
  (j) Each coordinated care organization prioritizes working with
members who have high health care needs, multiple chronic
conditions, mental illness or chemical dependency and involves
those members in accessing and managing appropriate preventive,
health, remedial and supportive care and services to reduce the
use of avoidable emergency room visits and hospital admissions.

  (k) Members have a choice of providers within the coordinated
care organization's network and that providers participating in a
coordinated care organization:
  (A) Work together to develop best practices for care and
service delivery to reduce waste and improve the health and
well-being of members.
  (B) Are educated about the integrated approach and how to
access and communicate within the integrated system about a
patient's treatment plan and health history.
  (C) Emphasize prevention, healthy lifestyle choices,
evidence-based practices, shared decision-making and
communication.
  (D) Are permitted to participate in the networks of multiple
coordinated care organizations.
  (E) Include providers of specialty care.
  (F) Are selected by coordinated care organizations using
universal application and credentialing procedures, objective
quality information and are removed if the providers fail to meet
objective quality standards.
  (G) Work together to develop best practices for culturally
appropriate care and service delivery to reduce waste, reduce
health disparities and improve the health and well-being of
members.
  (L) Each coordinated care organization reports on outcome and
quality measures adopted under ORS 414.638 and participates in
the health care data reporting system established in ORS 442.464
and 442.466.
  (m) Each coordinated care organization uses best practices in
the management of finances, contracts, claims processing, payment
functions and provider networks.
  (n) Each coordinated care organization participates in the
learning collaborative described in ORS 442.210 (3).
  (o) Each coordinated care organization has a governance
structure that includes:
  (A) Persons that share in the financial risk of the
organization who must constitute a majority of the governance
structure;
  (B) The major components of the health care delivery system;
  (C) At least two health care providers in active practice,
including:
  (i) A physician licensed under ORS chapter 677 or a nurse
practitioner certified under ORS 678.375, whose area of practice
is primary care; and
  (ii) A mental health or chemical dependency treatment provider;
  (D) At least two members from the community at large, to ensure
that the organization's decision-making is consistent with the
values of the members and the community; and
  (E) At least one member of the community advisory council.
  (3) The authority shall consider the participation of area
agencies and other nonprofit agencies in the configuration of
coordinated care organizations.
  (4) In selecting one or more coordinated care organizations to
serve a geographic area, the authority shall:
  (a) For members and potential members, optimize access to care
and choice of providers;
  (b) For providers, optimize choice in contracting with
coordinated care organizations; and
  (c) Allow more than one coordinated care organization to serve
the geographic area if necessary to optimize access and choice
under this subsection.
    { - (5) On or before July 1, 2014, each coordinated care
organization must have a formal contractual relationship with any
dental care organization that serves members of the coordinated
care organization in the area where they reside. - }
   { +  (5)(a) On or before July 1, 2014, each coordinated care
organization shall enter into a contract with each dental care
organization that provides dental care in the geographic area
served by a coordinated care organization unless the coordinated
care organization and a dental care organization mutually agree
not to enter into a contract.
  (b) A coordinated care organization may not contract with
dental care providers other than dental care organizations until
the coordinated care organization has contracted with, or
mutually agreed not to contract with, all of the dental care
organizations providing dental care in the geographic area served
by the coordinated care organization.
  (c) A contract entered into under paragraph (a) of this
subsection shall be for a term ending on the earlier of:
  (A) July 1, 2017; or
  (B) The date a coordinated care organization determines that a
dental care organization is not meeting the coordinated care
organization's outcome, quality and performance measures.
  (d) Two or more dental care organizations may jointly form a
limited liability corporation or enter into another business
arrangement for the purpose of contracting with a coordinated
care organization. + }
                         ----------