SENATE SPECIAL COMMITTEE ON THE OREGON HEALTH PLAN

 

June 11, 2003                                                                                                         Hearing Room C

4:00 P.M.                                                                                                                      Tapes 33 - 34

 

MEMBERS PRESENT:         Sen. Peter Courtney, Co-Chair

Sen. Jackie Winters, Co-Chair

Sen. Kate Brown

Sen. Margaret Carter

Sen. Bill Fisher

Sen. Lenn Hannon

Sen. John Minnis

Sen. Bill Morrisette

 

STAFF PRESENT:                 Marjorie Taylor, Committee Administrator

Megan Jensen, Committee Assistant

 

MEASURE/ISSUES HEARD: HB 3624 A - Work Session

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 33, A

005

Co-Chair Winters

Calls the meeting to order at 4:15 p.m., opens a work session on HB 3624 A, and announces that it is the intent to have Holly Robinson, Legislative Counsel, review the amendments, and the committee will vote on the amendments conceptually so Robinson can put the amendments in the legal form for final consideration by the committee Friday morning.

HB 3624 A – WORK SESSION

018

Marjorie Taylor

Administrator.  Advises members they have the same explanatory materials provided to the committee yesterday (SEE EXHIBITS OF COMMITTEE MINUTES DATED JUNE 10, 2003), and that the committee has received today the HB 3624-A26 (EXHIBIT A), HB 3624-A27 (EXHIBIT B), and the HB 3624-A28 (EXHIBIT C) amendments.

028

Holly Robinson

Legislative Counsel.  Provides an overview of the HB3624-A26 amendments (EXHIBIT A).

044

Robinson

Explains the HB 3624-A27 amendments(EXHIBIT B).

049

Robinson

Explains the HB 3624-A28 amendments (EXHIBIT C).

060

Robinson

States there was a question yesterday about the “any willing provider” provisions and the Medicaid law and whether it applied.  A Kentucky statute applied on its face to the Medicaid programs and the statute was upheld.  States that she does not think it is a problem. 

066

Co-Chair Winters

Comments there was some confusion on the HB 3624-A17 amendments that were reviewed yesterday surrounding mental health.  States that Robinson has suggested a statement made on record would probably satisfy that issue.  The statement is, “It is not the intent of the legislature to transfer mental health services currently delivered through mental health organizations to any other prepaid managed health care service organization.”  Recalls testimony by Gina Firman and their concerns.

068

Sen. Minnis

Comments that he disagrees.  Believes that the amendment should be very clear in what it is saying.  On its surface, it says “all” these programs have to be served. 

080

Robinson

Comments she does not believe the Chair is recommending that the language be adopted.  Thinks the intent of the amendment was to maintain the status quo. 

078

Sen. Minnis

Comments the committee should scratch the amendment and make the statement.

 

Co-Chair Winters

Thanks Sen. Minnis.

088

Co-Chair Winters

Asks if the amendments deal with the emergency ambulance.

 

Robinson

Responds that provision is not included in this bill.

 

 

NOTE:  Proposed amendments HB 3624-A6, HB 3624-A10, HB 3624-A11, HB 3624-A12, HB 3624-A13, HB 3624-A14, HB 3624-A15, HB 3624-A17, HB 3624-A18, HB 3624-A19, HB 3624-A20, HB 3624-A21, HB 3624-A22, HB 3624-A23, and HB 3624-A25 were previously discussed (SEE EXHIBIT C OF COMMITTEE MINUTES DATED JUNE 10, 2003).

095

Robinson

Discusses the HB 3624-A12 amendments modifying definitions.  Explains that the HB 3624-A10 and-HB 3624-A21 amendments propose the same change, that is, to modify the definition of fully capitated health plan (FCHP)and the definition of physician care organization (PCO).  States that the concept is that reasonable access is one that is required by federal Medicaid law.

135

Sen. Morrisette

Comments that A and B hospitals are exempted in the HB 3624-A10 amendments and again in the HB 3624-A15 amendments.  Asks why A and B hospitals are exempted.

133

Robinson

Notes that the committee is only considering the definition section of the HB 3624-A10 and HB 3624-A21 amendments.

144

Taylor

Advises members that the HB 3624-A12, HB 3624-A10, and the HB 3624-A21 amendments modify Section 2 of HB 3624 A.

156

Robinson

Advises that the questions are on the changes to the definitions of FCHP and PCO.

158

Sen. Carter

Asks if the language in the HB 3624-A12 amendments that changes the definition of FCHP includes beneficiaries.

153

Robinson

Explains the process staff has established to have the committee consider the specific proposed changes in the various amendments. 

192

Taylor

Clarifies that the HB 3624-A10 and HB 3624-A21 amendments make the same changes in Section 2, and that the committee does not need to adopt both amendments.

195

Sen. Morrisette

Asks what the language in line 2 on page 2 in the HB 3624-A10 amendments means.

201

Robinson

Clarifies that only amendments to the definitions are being discussed at this time.

208

Co-Chair Courtney

Moves conceptually the amendments as represented to Section 2 of HB 3624 A by the  HB 3624-A12, HB 3624-A10, and HB 3624-A21 amendments. 

223

Sen. Minnis

Asks for clarification of the motion.

210

Robinson

Explains that the effect of the motion is to request a set of amendments that will contain changes to the definition of FCHP and PCO that will include language that they are organizations that provide an adequate network of providers to ensure that services are reasonably accessible to enrollees, which is the federal access standards.

252

Consensus

Committee agrees to approve conceptually the HB 3624-A10, HB 3624-A12, and HB 3624-A21 amendments, amending Section 2 of HB 3624 A.

238

Robinson

Provides explanation of HB 3624-A12 amendments to Section 3 of HB 3624 A.  Suggests that the committee separate the amendments contained within the HB 3624-A12 amendments.

 

Sen. Carter

Moves that the provision in the HB 3624-A12 amendments relating to Native Americans be approved.

 

Consensus

Committee agrees to conceptual approval of the provision relating to Native Americans.

272

Robinson

Explains that the second request was to exempt persons with chronic or serious health conditions that have special health needs (HB 3624-A21 amendments)—to include them on the list of individuals who would be exempted by the department by rules; it creates a new category.

290

Rep. Westlund

Asks what the amendment would do that is not already covered in the bill.

292

Robinson

Explains there currently is a group of individuals receiving services who have serious and chronic health conditions and special health needs whose comfort level was much greater if they were specifically included in the bill.  The department does have the ability to exempt them by rule.  As a group that is now on the fee-for-service system were uncomfortable that they were not specifically listed and did not want to rely on the department to exempt them out.

301

Rep. Bates

Asks if it pertains only to Section 3 of HB 3624 A.

 

Robinson

Responds affirmatively.  Explains this would be the sixth category that the department may exempt by rule from the mandatory enrollment requirement. 

309

Co-Chair Winters

Comments that testimony came from the special needs populations.

315

Consensus

Committee agrees to conceptual approval of the provision on allowing the department to exempt by rule the new category of people.

319

Co-Chair Winters

Recesses the meeting for a short period then reconvenes the meeting.

333

Robinson

Explains the HB 3624-A23 amendment to Section 3 of HB 3624 A.  States she considers this a clarification of what is currently in HB 3624 A, not new policy.

334

Consensus

Committee agrees to conceptually approve the HB 3624-A23 amendment to Section 3 of HB 3624 A.

335

Robinson

Explains that the HB 3624-A5 amendments would add another category of persons who would be exempted from the mandatory enrollment by rule by the department.  The group resides in long-term care facilities, residential facilities, or licensed foster homes.

342

Co-Chair Courtney

Comments that the issue was discussed yesterday and he thought it would be separated out.  Asks about the problems with this previously.

325

Robinson

Explains that the provision has been deleted from the HB 3624-A5 amendments and is now in the HB 3624-A27 amendment.

356

Robinson

Advises the committee can consider the remainder of the HB 3624-A25 amendments, independent of this provision. 

339

Co-Chair Winters

Asks for guidance on the difference between the HB 3624-A25 and HB 3624-A27 amendments.

340

Robinson

Explains she thinks the concern is about the department’s authority to make certain exceptions, and whether this body wants to make its own exceptions.  Believes the question is whether the committee wants to expand the list.

383

Sen. Hannon

Asks if the HB 3624-A27 amendment grow the list of exemptions.

386

Robinson

Responds affirmatively.

 

Co-Chair Winters

Asks if the HB 3624-A25 amendments incorporate the HB 3624-A27 amendment.

390

Robinson

Responds that it has what the proponents of the HB 3624-A25 amendments wanted left in.  Adds that the HB 3624-A26 and HB 3624-A28 amendments contain what is left of the HB 3624-A25 amendments.

395

Co-Chair Winters

Ask if the HB 3624-A27 amendment could contain the amendment in the HB 3614-A25 amendments; the committee probably would not need to have a consensus on the HB 3624-A25 amendments.   

400

Robinson

Responds that if the committee wants to deal with Section 3 of HB 3624 A, they should decide on the HB 3624-A25 amendment provision.

404

Sen. Fisher

Comments that the programs are under a different waiver and not subject to this, and that they need to be in there as an exception.  The HB 3624-A27 amendments deals with that issue along.  Suggests the committee have a consensus on removing the HB 3624-A25 and put the HB 3614-A27 amendment in its place.  Explains that it would allow the HB 3624-A25 amendments to be thrown out.

422

Consensus

Committee agrees to replace the HB 3624-A25 amendments with the HB 3624-A27 amendments.

423

Robinson

Explains that Section 4 of HB 3624 A is a continuation of the discussion regarding use of the managed care system versus fee-for-service payment system.  The issue is whether to require prepaid managed care organizations to provide enrollees with information about available contract providers within 30 days of the enrollee’s assignment (HB 3624-A12 amendments).

443

Rep. Westlund

Comments he does not see a problem with the provision. 

449

Rep. Bates

Asks that someone from a FCHP clinic explain the difficulty of physicians in certain instances.

458

Co-Chair Winters

Explains that the committee discussed the issue yesterday.  They can send notification within 30 days to the individuals.  The committee did not want the individuals not notified and not know they had the opportunity to get a doctor. 

460

Jeff Heatherington

Representing fully capitated health plans.  Clarifies that this clarifies that they will provide information about contacting an available provider.  States that they already have this in their contract and rule; they are already required to do it.

461

Consensus

Committee agrees to conceptually accept the provision to require prepaid managed care organizations to provide enrollees with information about available contract providers within 30 days of the enrollee’s assignment (HB 3624-A12 amendments).

TAPE 34, A

023

Robinson

Asks for confirmation that the HB 3624-A17 amendments have been withdrawn.

025

Consensus

Committee agrees that the HB 3624-A17 amendments have been withdrawn.

027

Robinson

Reviews the HB 3624-A21 amendments to Section 4.

031

Rep. Westlund

Asks for further explanation of the HB 3624-A21 amendments.

032

Robinson

Further explains the HB 3624-A21 amendments.

037

Rep. Westlund

Asks if the HB 3624-A21 amendments has not applied to public health care before.

039

Robinson

Responds they have not, but the requirement is comparable to what is in the federal Medicaid provisions.

046

Consensus

Committee agrees to conceptually accept the HB 3624-A21 amendments.

048

Robinson

Reviews the HB 3624-A23 amendments to Section 4 of HB 3624 A.

052

Consensus

Committee agrees to conceptually accept the HB 3624-A23 amendments.

053

Robinson

Reviews the HB 3624-A25 amendments to Section 4 of HB 3624 A. Explains that an additional amendment is contained in the HB 3624-A28 amendments to limit the any willing provider provision to pharmacy providers only.  Advises that the provision has been significantly narrowed by the HB 3428-A28 amendments.

056

Sen. Minnis

Comments that everyone is in agreement with the HB 3624-A28 amendment and suggests the committee approve it.

066

Consensus

Committee agrees to conceptually accept the portion of the HB 3428-A28 amendments addressing any willing provider in lieu of the HB 3624-A25 amendments.

070

Robinson

Explains the provisions of Section 5 of HB 3624 A and the HB 3624-A12 amendments that delete the requirement that the PCO not threaten the financial liability of the other FCHPs in the area.

083

Rep. Westlund

Comments that if this provision should become law, a PCO could establish itself anywhere, even if it threatened the financial viability of and existing fully capitated health plan.

090

Robinson

Explains there are three criteria in the bill that would be used to make the determination.  By removing this, it would be silent as opposed to a prohibition or some other legislative direction about the issue. 

100

Rep. Westlund

Explains that one of the issues while crafting the bill was the introduction of PCOs, and that he does not think it creates a fair competitive environment if an FCHP has to assume hospital risks operating in a given area and all of a sudden someone sets up a PCO next door that does not have to assume the very significant hospital risk.

104

Sen. Minnis

Comments he agrees with Rep. Westlund; this was part of their negotiations in the House and absent some compelling testimony, the committee should retain that portion of the bill.

123

Rep. Bates

Comments that we trying to control the health care costs in the OHP another issue involved and when an organization does not assume a full risk, we lose a significant tool in trying to hold the costs down.

139

Sen. Minnis

Notes that the HB 3624-A12 amendment deletes the provision from the bill.

152

No Consensus

Committee agrees to not accept the HB 3624-A12 amendments.

153

Robinson

Explains the HB 3624-A18 amendments to Section 5 of HB 3624 A.

150

Consensus

Committee agrees to conceptually accept the HB 3624-A18 amendments.

163

Robinson

Explains that Section 6 directs the department to contract with Kaiser Permanente to provide certain health services, and that the provision in the HB 3624-A25 amendments clarify that the department cannot have a sole contract in a designated area; the department would have to contract with other entities as well as Kaiser.  States that she considers it a clarification of the underlying policy.

168

Sen. Fisher

Asks if the HB 3624-A28 amendments are being substituted for the HB 3624-A25 amendments.

177

Robinson

Explains that this is a specific part of the HB 3624-A25 amendments.

179

Sen. Fisher

Asks if approval would say the committee wants to keep the provision in the HB 3624-A25 amendments.

179

Robinson

Responds affirmatively.

180

Consensus

Committee agrees to conceptually accept the provision in the HB 3624-A25 amendments that clarifies that the department cannot have a sole contract with Kaiser Permanente in a designated area.

181

Robinson

Explains that the HB 3624-A12 amendments would establish a new Section 6a that establishes a methodology for setting capitation rates for PCOs.  HB 3624 A does not address the issue.

186

Consensus

Committee agrees to conceptually accept the portion of the HB 3624-A12 amendments adding a new Section 6a to HB 3624 A.

188

Robinson

Explains that Section 10 of HB 3624 A talks about contracting with FCHPS to provide administrative services for fee-for-service clients if it is cost neutral to the department.  It would include, for an ASO type contract, management services for all prescription drugs except for psychiatric drugs.  This reflects a policy choice that appears later on in terms of the carve out for psychiatric drugs, antipsychotic drugs, and antidepressants.  Explains the HB 3624-A11 amendments.

209

Sen. Fisher

Asks why different definitions were used here than those used for the other exemptions on the resident and nursing facilities. 

213

Robinson

Explains that she made a mistake and will make sure the language is similar.

222

Consensus

Committee agrees to conceptually accept the HB 3624-A11 amendments.

223

Robinson

Explains the HB 3624-A13 amendments contain new language that would subject the ASO contracts, if they are providing pharmaceutical coverage services, to have to comply with the requirements of SB 819 (2001 Session).

232

Consensus

Committee agrees to conceptually accept the HB 3624-A13 amendments.

234

Robinson

Explains the HB 3624-A14 amendments to Section 10 of HB 3624 A.

246

Rep. Westlund

Comments that he had thought the HB 3624-A14 amendments were in conflict with the HB 3624-A13 amendments but no longer sees a conflict because the HB 3624-A13 amendments functionally deal with the fee-for-service population only, and that the HB 3624-A14 amendments deal with the FCHP populations.

266

Sen. Brown

Asks if the House committee included antidepressants under managed care for cost savings.

272

Rep. Westlund

Responds affirmatively and states it was also the fact that a very high percentage, 60-80 percent, of the lower level antidepressants are dispensed by primary care physicians in FCHPs.  They do not want to interfere with medications taken by the chronic and severely mentally ill.

296

Sen. Brown

Asks if Reps. Bates and Westlund oppose the amendment.

277

Reps. Bates and Westlund

Respond affirmatively. 

300

Sen. Carter

Asks why we would want to exclude doctors from prescribing low level antidepressants.

 

Rep. Bates

Comments on different prescriptions being dispensed to depressed and psychotic persons.

 

Sen. Carter

Asks if Rep. Bates and Westlund want to exempt them so this can continue, or whether they want to exempt them so it will not continue.

317

Rep. Bates

Explains that they want to have an opportunity to manage the use of antidepressants for the population other than antipsychotics.

324

Angela Kimball

National Alliance for the Mentally Ill of Oregon.  States they are concerned that without the carve out in the HB 3624-A14 amendments those who are consistently mentally ill may have restricted access to the full array of psychiatric medications, including the antidepressants.  Believes there are other cost containment measures that can be done without putting those medications under the management of the FCHPs. 

 

Anne Tweedt

Bristol-Myers Squibb. States that they share the concerns stated by Kimball, and that there will be a presentation before Ways and Means on the broader drug utilization review for the mental health drugs.  They want to put it in statue rather than rely on the administrative carve out as it is now.

369

Sen. Brown

Asks how they would manage the depression component under managed care and the psychotic component under fee-for-service, and what would be the practical implications.  States she is not clear what the access barriers would be.

375

Kimball

Replies that their concern is for those who have serious mental illnesses.  If  antidepressants are part of that and are managed by the health care plans, they could be subject to a formulary or prior authorization methods that may make it very difficult for them to easily get the exact antidepressant that might best compliment the array of medications they are taking.  Any access barriers seem to present huge implications in terms of quality of care.

385

Rep. Westlund

Agrees they need access and should not be restricted from whatever mix of drugs they need. The issue is trying to get not to the population that Kimball is addressing.  Most of that population does not go to a primary care physician for their psychiatric care.  States they have the exceptions process in the FCHPs and cannot imagine a physician not writing a given prescription for whatever drug the individual needs.

435

Sen. Minnis

States that some patients are denied access because the physician will not go the extra hoops of getting the clearance to get a drug other than one on the formulary list.  Believes the physician ought to make the decision, and that is the policy in SB 819 (2001 Session).

462

Sen. Brown

States that she doesn’t disagree but is not sure that is any different under managed care or fee-for-service. 

465

Sen. Minnis

Responds that the materials on Pharmaceutical Benefit Management companies (PBMs) and formularies show there are certain strategies about relationships with drug companies.

TAPE 33, B

026

Co-Chair Winters

Comments that we are back to SB 819 because we are dealing with the population that cannot always get to the doctor for their medications.  

033

Sen. Minnis

States that these populations are very difficult populations, and if it is difficult to access the medications, they will not get it.  States there is no doubt this will save money and the trade off is bad health care for mental health patients.

045

Robinson

Explains the HB 3624-A19 amendments to Section 10 of HB 3624 A.

057

Consensus

Committee agrees to conceptual approval of the HB 3624-A19 amendments to Section 10 of HB 3624.

059

Robinson

Explains the HB 3624-A22 amendments to Section 10 of HB 3624 A.

064

Co-Chair Winters

Advises, and is supported by the committee, that the provision on public contracting in the HB 3624-A22 amendments was removed yesterday. 

068

Robinson

Explains that a new section on standardized forms and training would be created by the HB 3624-A22 amendments. 

071

Sen. Brown

Asks if the new section would have a fiscal impact.

072

Robinson

Responds there probably is a fiscal impact.

074

Sen. Minnis

Comments the committee had discussion about the department doing this without the amendments; they could if they should choose to. 

077

Robinson

Clarifies that the issue for consideration is whether to include the provision on training that is in the HB 3624-A22 amendments.

090

Consensus

Committee agrees to conceptually accept the provision on standardized forms and training in the HB 3624-A22 amendments.

092

Robinson

Explains the HB 3624-A25 amendments to Section 10 of HB 3624 A. 

098

Consensus

Committee agrees to accept the provision in the HB 3624-A25 amendments to Section 10 of HB 3624 A.

099

Robinson

Explains the provisions of Section 11 of HB 3624 A and the HB 3624-A14 and HB 3624-A19 amendments.  Discusses options for Section 11.

124

Sen. Minnis

Suggests deleting the entire Section 11, and flagging the HB 3624-A14 amendments for further discussion if that is necessary.

 

Sen. Fisher

Questions how much will happen if it is not codified.

127

Co-Chair Winters

Advises that the committee can flag the section and come back later. 

131

Sen. Minnis

Suggests deleting Section 11 for now.

140

Sen. Brown

Request that amendments that are problematic be drafted separately and that the committee be given 24 hours to review them.

149

Robinson

Responds that she would like to have the comprehensive amendment include the deletion, and then have the policy choices in separate amendments. 

170

Sen. Minnis

Notes the HB 3624-A11 and HB 3624-A12 amendments to Section 11 and states that he thought the committee had dealt with institutional pharmacies.

166

Sen. Brown

States she is not so concerned with the HB 3624-A11 and HB 3624-A12 amendments to Section 11, but is concerned about the HB 3624-A14 and HB 3624-A19 amendments in Section 11 and the carve out for antidepressants.  Believes the fiscal issues could be included in a separate amendment and would like clarification about people who are severely mentally ill and whether they are even covered under the managed care provision, and how many we re talking about.  If we are carving out the antidepressants because of the concern for people with severe mental illness, those might come under other exemptions.  If that is the case, the debate is moot. 

198

Sen. Fisher

Asks if there is consensus on the HB 3624-A11 and HB 3624-A12 amendments as it would be reworded according to the definition. 

204

Consensus

Committee agrees to approve conceptually the HB 3624-A11 and HB 3624-A12 amendments and the rewording according to the definition, and to delete the HB 3624-A14 and HB 3624-A19 amendments.

209

Robinson

Explains Section 12 of HB 3624 A and the HB 3614-A10 and HB 3624-A15 amendments.

232

Sen. Morrisette

Comments that exempting the A and B hospitals leads to confusion as to whether they are exempted from all sections of the bill.

 

Robinson

Advises that type A and B hospitals are only exempt from this section.

 

Sen. Hannon

Asks if there is a federal or state exemption already in place.

228

Robinson

Explains that there are statutes that talk about how the department has to pay a type A and B hospital; they get paid at cost.  Those statutes will not be changed. 

258

Sen. Hannon

Asks if the HB 3624-A10 amendments take out the prohibition on the hospitals.

240

Robinson

Responds she thinks it does.  The HB 3624-A10 and HB 3624-A12 amendments overlap and one decision is whether the committee wants the no-decline policy in or out.  The second decisions is whether the committee wants the non-arbitration piece that is in both, and the third decision is whether the committee wants reimbursement to be set at the lesser of bill charges or a blank of Medicare, or whether the committee wants the blank filled in.

274

Consensus

Committee agrees conceptually to leave a blank for the percentage of Medicare and to leave the prohibition as it is in HB 3624 A.

256

Robinson

Advises members that the remaining issue is non-binding arbitration..

259

Rep. Westlund

Comments that the House committee tried to figure out a way that the FCHPs and hospitals could enter into some type of arbitration/negotiations while setting the rate.  Currently, if they cannot come to terms, it  automatically falls to the fee-for-service level, which gives the FCHPs an advantage in the negotiations.  Explains this is trying to raise the rates for hospitals while at the same time requiring hospitals to take all members who are enrolled in FCHPs.  Believes it is fair to leave the rate blank in order to continue the discussion and it is equally fair that the hospitals have to take the patients, and it is fair for both parties that there be some type of arbitration process if negotiations between the FCHPs and hospitals break down.  Adds that he thinks it is fair to exempt the Type A and B hospitals.

308

Co-Chair Winters

Asks Rep. Westlund what his position is if the rates are not increased.

 

Rep. Westlund

Explains that is why he is suggesting that the rate be left blank.

316

Consensus

Committee agrees to conceptually accept the provision on non-binding arbitration in the HB 3624-A10 amendments.

302

Robinson

Clarifies that the consensus is that the current provision on declining a patient will stay in HB 3624 A, there will be a reimbursement scheme that the hospitals will have to take the lesser of billed charges or some blank percentage of Medicare, there will be a provision about non-binding arbitration, and A and B hospitals will be exempted from this section of HB 3624 A.

337

Sen. Carter

Comments that it would appear that while the committee is trying to craft a package today and bring partners on board, the committee should also build the kind of relationships that people would not mind being a partner to, and does not know if that has been done in terms of the hospitals and how they are reimbursed.

346

Robinson

Explains the HB 3624-A20 amendments creating new Section 12a and 12b on mail order pharmacies.

 

Consensus

Committee agrees conceptually to accept the HB 3624-A20 amendments.

368

Sen. Fisher

Comments there was a reference made yesterday to the HB 3624-A12 amendments and part of the amendment having been left out.

 

Robinson

Advises that she has added the language. 

376

Robinson

Explains Section 13 of HB 3614 A and the HB 3614-A11 amendments to exempt institutional pharmacies.

386

Consensus

Committee agrees conceptually to accept the portion of the HB 3624-A11 amendments to Section 13 of HB 3624 A.

390

Robinson

Explains the HB 3624-A12 amendments to Section 13 of HB 3624 A.

393

Rep. Westlund

Asks what is different about the provision than what is in HB 3624 A.

 

Robinson

Explains that it was not included in all the sections and the decision was made to have that same requirement apply to all the contracts.

 

Sen. Morrisette

Comments on previous audit discussion and states that the committee said that an audit is possible under the existing rules.  Asks if the committee needs language for audits.

416

Robinson

Responds the answer is yes, and that there is also some discussion about doing a separate audit bill.

423

Robinson

Explains the HB 3624-A13 amendments to Section 13 of HB 3624 A.

440

Consensus

Committee agrees to conceptually accept the HB 3624-A13 amendments to Section 13 of HB 3624 A.

441

Robinson

Explains the HB 3624-A25 amendments to Section 13 of HB 3624 A establishing a pharmacy benefits administrator.

454

Consensus

Committee agrees  to conceptually accept the HB 3624-A25 amendments to Section 13 of HB 3624 A.

458

Rep. Westlund

Asks if there is anything in the Section 13 amendments that requires the FCHPs to utilize the services of the state PBM, now PBA.

468

Robinson

Responds negatively.

TAPE 34, B

020

Robinson

Explains Section 15 of HB 3624 and the HB 3624-A13 amendments that were requested by Sen. Minnis making it subject to the PDL.

024

Consensus

Committee agrees to conceptually accept the HB 3624-A13 amendments to Section 15 of HB 3624 A.

028

Robinson

Explains that the HB 3624-A12 amendments change the operative date from a date certain of October 1 to a date contingent on waiver approval.

031

Consensus

Committee agrees conceptually to accept the HB 3624-A12 amendments to Section 18 of HB 3624 A.

030

Robinson

Explains the new Section 20 in HB 3624 A that would be created by the HB 3624-A6 amendments.

040

Consensus

Committee agrees conceptually to accept the HB 3624-A6 amendment creating a new Section 20 in HB 3624 A.

039

Rep. Westlund

Asks if nurse practitioners get full cost reimbursement.

040

Robinson

Responds they do not.

042

Robinson

Explains that the HB 3624-A26 (EXHIBIT A) and HB 3624-A28 amendments (EXHIBIT C) are new and have pieces that have not been included.  Explains the HB 3624-A26 and HB 3624-A28 amendments and the differences.  Advises that the committee must decide if they want a long or short report. 

065

Sen. Hannon

Asks if it is important to have quarterly statements of outstanding provider claims as provided in the HB 3624-A26 amendments.

070

Robinson

Explains that she believes those who wanted the additional information would be satisfied with the more limited information that is on page 2 of the HB 3624-A28 amendments.

083

Tom Holt

Oregon State Pharmacists Association.  Explains that the reason for the difference between the two amendments was their misunderstanding of what Sen. Minnis requested yesterday.  Believes Sen. Minnis’ amendments are the HB 3624-A26 (EXHIBIT A).  Explains that the reason for the various reports was to be able to provide a regular statement of financial condition.  It would be a good way for the department to monitor the condition of the plans and providers and to be able to monitor the conditions of the plans.  Their intention in the HB 3624-A28 amendments was simply to try to comply with what Sen. Minnis seemed to be saying but they obviously misunderstood.  States that they recommend the HB 3624-A26 amendments.

103

Sen. Carter

Asks if the information being requested is from the planned membership piece—those who are partners with the OHP.

115

Holt

Responds that the FCHPs would be reporting this information.

118

Sen. Hannon

Asks if the fee-for-service providers would have to provide this information.

 

Holt

Replies the fee-for-service providers would not; the managed care plans such as pharmacies or physicians would have to provide the information.

140

Rep. Westlund

Asks that the representative for the FCHPs explain what they currently do, and states he believes it is similar to what is requested in the HB 3624-A26 amendments.

145

Jan Buffin

Manager, Marion-Polk Community Health Plan in Marion and Polk counties.  Explains they have historically provided solvency reports on a quarterly basis.  Those solvency reports are turned into OMAP and are public information.  As a plan, they go in quarterly and access everybody’s solvency reports and prepare quarterlies which they share amongst the plans.  Any person or agency is capable of doing that also.  Feels the solvency reports, if they are prepared properly, provide information as to whether the plan is solvent or not.

167

Rep. Westlund

Asks if the information is required or if it is something they just do.

 

Buffin

Responds they are required by contract to report to OMAP.

168

Rep. Westlund

Asks if Buffin has looked at the HB 3624-A26 amendments.

 

Buffin

Responds that she has not looked at the HB 3624-A26 amendments specifically today. 

 

Co-Chair Winters

Questions whether the provision needs to be in the bill if the agency is already requiring it. 

176

Sen. Carter

Asks Holt why he thinks this language is necessary, and if there is something outstanding that partners have missed because she can understand being a pharmacists when a partner in the plan does not pay the pharmacy on time or correctly.  Asks if that is what he is saying by the proposed language.

183

Holt

Responds affirmatively.  Adds that the element that should not be overlooked is the reporting of aggregate rebate dollars from the manufacturers.  That provision is in both the HB 3614-A26 and HB 3624-A28 amendments.

189

Co-Chair Winters

Comments she does not think it has any negative factor and would just as soon leave it in and deal with it.

200

Robinson

Advises that she has left a provision off the list.  Explains that a group has requested language relating to the ASO contracts discussed in Section 10.  Notes the additional amendment language in lines 15-23 of the HB 3624-A28 amendments to Section 10(3) of HB 3624 A.

226

Sen. Carter

Comments she does not have a problem with the amendment because she thinks the committee passed some language previously in terms of timely payments to outstanding debtors or partnerships.

230

Consensus

Committee agrees conceptually to the HB 3624-A28 amendments.

231

Co-Chair Winters

Suggests that the committee include the HB 3624-A14 and HB 3624-A19 amendments instead of having them separate. 

243

Consensus

Committee agrees conceptually to accept the HB 3614-A14 and HB 3624-A19 amendments.

243

Sen. Brown

Comments that in Section 3, she is extremely concerned the HB 3624-A21 amendments exempting people with serious or chronic health condition is extremely broad and would include most everybody in the system. 

251

Co-Chair Winters

Suggests that the committee may want to be more specific in the amendment.

251

Sen. Carter

Comments that she has the same concern as Sen. Brown.

253

Sen. Morrisette

Comments that the HB 3624-A27 amendments replace the HB 3624-A25 amendments.  Asks if people who are disabled and live in their own homes would be included.

268

Co-Chair Winters

Responds that the reason institutionalized people are excluded is because the arrangement with them is different.

263

Sen. Fisher

Comments that those who live in their own homes are not included in the waiver.

266

Sen. Minnis

Asks if mandating hospitals to treat patients undermines the need to have a contract or to get the parties together and agree to a contract.

276

Co-Chair Winters

Responds that she believes Sen. Carter was raising the same issue, and advises that the committee will revisit it because there was not a consensus on that language.

286

Robinson

Asks for permission to include pieces in future amendments that may have been missed and further clarification if necessary. 

290

Co-Chair Winters

Acknowledges Robinson’s requests and gives permission for drafting.  Asks that the amendments be available by tomorrow.

298

Rep. Westlund

Asks if the HB 3624-A18 amendments to Section 5 of HB 3624 A, which allow DHS the flexibility in using the criteria in determining a contract with a PCO, would allow the department to not consider the three mandatory criteria.

 

Robinson

Explains that the department would have to consider them as opposed to absolutely following them; that gives the department flexibility.

315

Sen. Minnis

Asks if the committee can force a binding arbitration mechanism for FCHPs and hospitals.

 

Robinson

Responds affirmatively.  They could be required to arbitrate and accept the terms.

325

Co-Chair Winters

Closes the work session on HB 3624 A and adjourns the meeting at 5:55 p.m.

 

EXHIBIT SUMMARY

 

A - HB 3624, HB 3624-A26 amendments, Sen. Minnis, 1 p

B – HB 3624, HB 3624-A27 amendments, staff, 1 p

C – HB 3624, HB 3624-A28 amendments, Ton Holt, 2 pp