Oregon Revised Statutes Chapter 442 § 442.396 — Attestation of compliance by insurers; rules

Attestation of compliance by insurers; rules. An insurer, as defined in ORS 731.106, that contracts with the Oregon Health Authority, including with the Public Employees’ Benefit Board and the Oregon Educators Benefit Board, to provide health insurance coverage for state employees, educators or medical assistance recipients must annually attest, on a form and in a manner prescribed by the authority, to its compliance with ORS 243.256, 243.879, 442.392 and 442.394. A contract with an insurer subject to the requirements of this section may not be renewed without the attestation required by this section. [2011 c.418 §9] Note: See note under 442.392. (Temporary provisions relating to primary care payment reform collaborative) Note: Sections 2 to 5, chapter 575, Oregon Laws 2015, provide: Sec. 2. (1) As used in this section: (a) “Carrier” means an insurer that offers a health benefit plan, as defined in ORS 743B.005. (b) “Coordinated care organization” has the meaning given that term in ORS 414.025. (c) “Primary care” means family medicine, general internal medicine, naturopathic medicine, obstetrics and gynecology, pediatrics or general psychiatry. (d) “Primary care provider” includes: (A) A physician, naturopath, nurse practitioner, physician associate or other health professional licensed or certified in this state, whose clinical practice is in the area of primary care. (B) A health care team or clinic that has been certified by the Oregon Health Authority as a patient centered primary care home. (2)(a) The Oregon Health Authority shall convene a primary care payment reform collaborative to advise and assist in the implementation of a Primary Care Transformation Initiative to: (A) Use value-based payment methods that are not paid on a per claim basis to: (i) Increase the investment in primary care; (ii) Align primary care reimbursement by all purchasers of care; and (iii) Continue to improve reimbursement methods, including by investing in the social determinants of health; (B) Increase investment in primary care without increasing costs to consumers or increasing the total cost of health care; (C) Provide technical assistance to clinics and payers in implementing the initiative; (D) Aggregate the data from and align the metrics used in the initiative with the work of the Health Plan Quality Metrics Committee established in ORS 413.017; (E) Facilitate the integration of primary care behavioral and physical health care; and (F) Ensure that the goals of the initiative are met by December 31, 2027. (b) The collaborative is a governing body, as defined in ORS 192.610. (3) The authority shall invite representatives from all of the following to participate in the primary care payment reform collaborative: (a) Primary care providers; (b) Health care consumers; (c) Experts in primary care contracting and reimbursement; (d) Independent practice associations; (e) Behavioral health treatment providers; (f) Third party administrators; (g) Employers that offer self-insured health benefit plans; (h) The Department of Consumer and Business Services; (i) Carriers; (j) A statewide organization for mental health professionals who provide primary care; (k) A statewide organization representing federally qualified health centers; (L) A statewide organization representing hospitals and health systems; (m) A statewide professional association for family physicians; (n) A statewide professional association for physicians; (o) A statewide professional association for nurses; and (p) The Centers for Medicare and Medicaid Services. (4) The primary care payment reform collaborative shall annually report to the Oregon Health Policy Board and to the Legislative Assembly on the achievement of the primary care spending targets in ORS 414.572 and 743.010 and the implementation of the Primary Care Transformation Initiative. (5) A coordinated care organization shall report to the authority, no later than October 1 of each year, the proportion of the organization’s total medical costs that are allocated to primary care. (6) The authority, in collaboration with the Department of Consumer and Business Services, shall adopt rules prescribing the primary care services for which costs must be reported under subsection (5) of this section. [2015 c.575 §2; 2017 c.384 §1; 2017 c.489 §13; 2024 c.73 §171] Sec. 3. No later than February 1 of each year, the Oregon Health Authority and the Department of Consumer and Business Services shall report to the Legislative Assembly, in the manner provided in ORS 192.245: (1) The percentage of the medical expenses of carriers, coordinated care organizations, the Public Employees’ Benefit Board and the Oregon Educators Benefit Board that is allocated to primary care; and (2) How carriers, coordinated care organizations, the Public Employees’ Benefit Board and the Oregon Educators Benefit Board pay for primary care. [2015 c.575 §3; 2016 c.26 §7]