SB 3 (ch 788) Oregon Healthy Kids Program
SB 3 establishes the Oregon Healthy Kids Program to provide affordable and accessible health care to children. The program is composed of:
- Medical assistance administered by the Department of Human Services, provided to children under state programs funded under the federal Social Security Act; under the Children’s Health Insurance Program, also funded under the federal Social Security Act; and under state programs funded by the legislature;
- A private health option administered by the Office of Private Health Partnerships;
- A statewide Healthy Kids Advice Line; and
- A statewide Healthy Kids Healthcare Access Line used in conjunction with statewide enrollment and retention efforts.
SB 3 also requires the Office of Private Health Partnerships to expand private coverage for children, and provides for grant and subsidy programs.
SB 3 takes effect only if Senate Joint Resolution 4 is approved by Oregon voters.
SB 8 (ch 566) Mandated coverage for oral anticancer medication
SB 8 requires health benefit plans that provide coverage for cancer chemotherapy treatment to provide coverage of orally administered anticancer medications. This mandated benefit is exempted from automatic repeal under ORS 743.700.
SB 59 (ch 313) Mandated coverage for acupuncture services by acupuncturist
SB 59 requires individual and group health insurance policies to cover acupuncture services performed by a licensed acupuncturist when the policy provides coverage for acupuncture services performed by a physician. The bill re-enacts this mandated benefit, which was repealed in 2001, and also exempts the benefit from automatic repeal under ORS 743.700.
SB 153 (ch 484) Limitation on insurer denial of state Medicaid claims
SB 153 prohibits a health insurer or other managed care entity from denying a claim submitted by the state Medicaid agency or a prepaid managed care health services organization based on the date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis of the claim, if:
- The agency or organization submits the claim within a three-year period beginning on the date in which the health care item or service was furnished, and
- Any action by the agency or organization to enforce its rights with respect to the claim is begun within six years of the agency’s submission of the claim.
The prohibition applies to an employee benefit plan, self-insured plan, managed care organization or group health plan, a third-party administrator, fiscal intermediary or pharmacy benefit manager of the plan or organization, or other party that is by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service.
SB 153 also requires a health insurer or other managed care entity to provide specified information to the state Medicaid agency or prepaid managed care health services organization, upon request by the agency or organization.
The need for this conforming legislation arose from amendments to the Social Security Act in the federal Debt Reduction Act at 42 USC 1396a(a)(25).
Effective date: June 20, 2007.
SB 191 enables Oregonians to benefit from recent federal legislation (the Long-Term Care Insurance Partnership Act) by permitting those who purchase partnership long-term care insurance policies to access Medicaid services, once policy benefits are exhausted, and protect assets up to the amount of policy benefits received. The bill incorporates consumer protections and insurance policy provisions required under the federal legislation and establishes specific training requirements for insurance producers selling long-term care insurance. The bill also enables this state’s Medicaid program to participate in the Long-Term Care Insurance Partnership Act and allows for protection of estate assets.
SB 191 took effect June 24, 2007, in order to allow rulemaking. The substantive provisions of the bill become operative Jan. 1, 2008.
SB 244 authorizes a health insurer to retain genetic information of an individual without authorization from the individual or a personal representative of the individual if the retention is for treatment, payment, or health care operations. The bill also authorizes a health insurer to disclose to another covered entity the genetic information of an individual without authorization if disclosure is made for health care operations activities and the other entity has a relationship with the individual.
Effective: July 17, 2007.
SB 257 (ch 393) Variable annuities, increased protections
SB 257 makes variable annuities, which are currently regulated as insurance, also subject to state securities regulation. The effect is to create broader enforcement authority and to improve supervision of brokers who sell annuities. State securities regulation requirements include registration of variable annuity products for sale, ensuring that insurance producers have the proper securities licensing to sell the product, and compliance with sales regulations.
SB 257 applies to variable annuities offered for sale on or after Jan. 1, 2008.
SB 491 (ch 504) Mandated coverage for bilateral cochlear implants
SB 491 requires a health insurance policy that covers a cochlear implant to provide coverage for bilateral cochlear implants. A cochlear implant is an electronic device surgically implanted to address deafness. To prevent unfair claims processing by insurers, the bill also specifies a minimum standard for a reasonable investigation of a claim for cochlear implants. This bill does not require cochlear implants themselves, but requires only that if they are covered, bilateral implants must be covered as well. This bill also exempts this mandated benefit from automatic repeal under ORS 743.700.
SB 586 (ch 242) Individual policies: selection of coverage
SB 586 makes permanent a temporary provision, enacted in 2003, that authorizes an insurer to specify which of its individual health benefit plans will be offered to an applicant. Applicants whose choice of plans is limited by a carrier have the option of obtaining coverage through the Oregon Medical Insurance Pool. Before the temporary provision, a carrier either had to deny coverage to an applicant or allow the applicant to select coverage from any of the plans offered by the carrier.
SB 676 (ch 346) Mandated coverage for services by physician assistants
SB 676 expands the existing law mandating health insurance coverage of services by a physician assistant to require payment whenever the claim is submitted directly by the physician assistant instead of the supervising physician. Before this change, payment has been required only when the medical services are provided by a physician assistant in a location, normally a rural area, in which a supervising physician does not regularly practice.
SB 989 (ch 826) Exemption of public bodies from Insurance Code when providing health coverage to employees
SB 989 expands the number of public bodies that are exempt from regulation under the Insurance Code when they self-insure their health insurance coverage. First, the bill will allow the exemption of school and community college districts whose covered employees and dependents and retired employees and dependents number at least 500. Before this change, the exemption applied if the number of covered employees and retired employees of a school or community college district, not including dependents, was 1,000 or more. Second, other public bodies that jointly or individually self-insure their health insurance coverage will be able to include dependents along with employees and retired employees in order to meet the minimum number of participants required for the exemption.
Effective: July 17, 2007.