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Questions and Answers on Rural Subsidy for 2011
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Article Content
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| August 2010 |
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Q
| What is the rural subsidy in PEBB?
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A
| PEBB’s rural subsidy, currently in place in 20 counties, pays providers as if they were in network without requiring them to contract with the plan. The subsidy also allows members in these counties to pay the lower, in-network share of the costs when they see providers who are not in the network.
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Q
| Why is the Board discontinuing the rural subsidy in Deschutes County?
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A
| Deschutes County comprises the Bend Metropolitan Statistical Area with a coordinated medical system of hospitals and clinics and a relatively robust level of providers for the population. The Board determined that the county profile does not fit with the rural county designation.
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| Why is the Board discontinuing the rural subsidy in Jackson County?
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A
| Jackson County comprises the Medford Metropolitan Statistical Area with a coordinated medical system of hospitals and clinics and a relatively robust level of providers for the population. The Board determined that the county profile does not fit with the rural county designation.
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Q
| How does the rural subsidy affect the supply of primary or specialty providers in rural areas?
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A
| There is no evidence that PEBB’s rural subsidy affects the number or geographic location of health care providers in any county.
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| How does the rural subsidy affect PEBB costs?
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A
| In 2009, the rural subsidy had the effect of increasing medical premiums for the statewide plan by $5 million.
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| How does the rural subsidy affect health care quality?
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| Contracts to participate in the plan’s network include requirements related to reporting on and improving quality of care provided to PEBB members. The rural subsidy removes the incentive for providers in these counties to contract to be in the network and comply with quality requirements.
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| Do members have the lower out-of-pocket costs only when they access care in their designated rural county?
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A
| No; the rural subsidy follows these members no matter where they access care. A member from a rural county who accesses care in Portland or anywhere in the state or country has the lower, in-network cost whether they use in-network or out-of-network providers.
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| Will the Board make additional changes to the rural subsidy?
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A
| The Board is continuing discussions on the rural subsidy – the concept, its application and its effect on the PEBB program of health benefits.
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