HPA Statute Details

ORS 413.006 Establishment of Oregon Health Policy Board (1) There is established the Oregon Health Policy Board, consisting of nine members appointed by the Governor.

     (2) The term of office of each member is four years, but a member serves at the pleasure of the Governor. Before the expiration of the term of a member, the Governor shall appoint a successor whose term begins on January 1 next following. A member is eligible for reappointment. If there is a vacancy for any cause, the Governor shall make an appointment to become immediately effective for the unexpired term.

     (3) The appointment of the board is subject to confirmation by the Senate in the manner prescribed in ORS 171.562 (Procedures for confirmation) and 171.565 (Vote required for confirmation).

     (4) Members of the board are entitled to reimbursement of per diem and travel expenses for their attendance at board meetings and subcommittee meetings as provided in ORS 292.495 (Compensation and expenses of members of state boards and commissions). [2009 c.595 §1]

 

ORS 413.007 Composition of board (1) The Oregon Health Policy Board consists of individuals who:

     (a) Are United States citizens and residents of this state;

     (b) Have demonstrated leadership skills in their professional and civic lives;

     (c) To the greatest extent practicable, represent the various geographic, ethnic, gender, racial and economic diversity of this state; and

     (d) Collectively offer expertise, knowledge and experience in consumer advocacy, management of a company that offers health insurance to its employees, public health, finance, organized labor, health care and the operation of a small business.

     (2) No more than four members of the board may be individuals:

     (a) Whose household incomes, during the individuals’ tenure on the board or during the 12-month period prior to the individuals’ appointment to the board, come from health care or from a health care related field; or

     (b) Who receive health care benefits from a publicly funded state health benefit plan.

     (3) No more than four members of the board may be, during the individuals’ tenure on the board or during the 12-month period prior to the individuals’ appointment to the board, employed in a health care or health care related field.

     (4) At least one member of the board shall have an active license to provide health care in Oregon and shall be appointed to serve in addition to the members offering the expertise, knowledge and experience described in subsection (1)(d) of this section. [2009 c.595 §4]

 

ORS 413.008 Chairperson (1) The Governor shall select from the membership of the Oregon Health Policy Board the chairperson and vice chairperson.

     (2) A majority of the members of the board constitutes a quorum for the transaction of business.

     (3) The board shall meet at least once every month and shall meet at least once every two years in each congressional district in this state, at a place, day and hour determined by the board. The board may also meet at other times and places specified by the call of the chairperson or a majority of the members of the board, or as specified in bylaws adopted by the board. [2009 c.595 §5]

 

ORS 413.011 Duties of board (1) The duties of the Oregon Health Policy Board are to:

     (a) Be the policy-making and oversight body for the Oregon Health Authority established in ORS 413.032 (Establishment of Oregon Health Authority) and all of the authority’s departmental divisions.

     (b) Develop and submit a plan to the Legislative Assembly by December 31, 2010, to provide and fund access to affordable, quality health care for all Oregonians by 2015.

     (c) Develop a program to provide health insurance premium assistance to all low and moderate income individuals who are legal residents of Oregon.

     (d) Publish health outcome and quality measure data collected by the Oregon Health Authority at aggregate levels that do not disclose information otherwise protected by law. The information published must report, for each coordinated care organization and each health benefit plan sold through the health insurance exchange or offered by the Oregon Educators Benefit Board or the Public Employees’ Benefit Board:

     (A) Quality measures;

     (B) Costs;

     (C) Health outcomes; and

     (D) Other information that is necessary for members of the public to evaluate the value of health services delivered by each coordinated care organization and by each health benefit plan.

     (e) Establish evidence-based clinical standards and practice guidelines that may be used by providers.

     (f) Approve and monitor community-centered health initiatives described in ORS 413.032 (Establishment of Oregon Health Authority) (1)(h) that are consistent with public health goals, strategies, programs and performance standards adopted by the Oregon Health Policy Board to improve the health of all Oregonians, and shall regularly report to the Legislative Assembly on the accomplishments and needed changes to the initiatives.

     (g) Establish cost containment mechanisms to reduce health care costs.

     (h) Ensure that Oregon’s health care workforce is sufficient in numbers and training to meet the demand that will be created by the expansion in health coverage, health care system transformations, an increasingly diverse population and an aging workforce.

     (i) Work with the Oregon congressional delegation to advance the adoption of changes in federal law or policy to promote Oregon’s comprehensive health reform plan.

     (j) Establish a health benefit package in accordance with ORS 741.340 (Health benefit plans offered through exchange) to be used as the baseline for all health benefit plans offered through the health insurance exchange.

     (k) Investigate and report annually to the Legislative Assembly on the feasibility and advisability of future changes to the health insurance market in Oregon, including but not limited to the following:

     (A) A requirement for every resident to have health insurance coverage.

     (B) A payroll tax as a means to encourage employers to continue providing health insurance to their employees.

     (L) Meet cost-containment goals by structuring reimbursement rates to reward comprehensive management of diseases, quality outcomes and the efficient use of resources by promoting cost-effective procedures, services and programs including, without limitation, preventive health, dental and primary care services, web-based office visits, telephone consultations and telemedicine consultations.

     (m) Oversee the expenditure of moneys from the Health Care Workforce Strategic Fund to support grants to primary care providers and rural health practitioners, to increase the number of primary care educators and to support efforts to create and develop career ladder opportunities.

     (n) Work with the Public Health Benefit Purchasers Committee, administrators of the medical assistance program and the Department of Corrections to identify uniform contracting standards for health benefit plans that achieve maximum quality and cost outcomes and align the contracting standards for all state programs to the greatest extent practicable.

     (o) Work with the Health Information Technology Oversight Council to foster health information technology systems and practices that promote the Oregon Integrated and Coordinated Health Care Delivery System established by ORS 414.570 (System established) and align health information technology systems and practices across this state.

     (2) The Oregon Health Policy Board is authorized to:

     (a) Subject to the approval of the Governor, organize and reorganize the authority as the board considers necessary to properly conduct the work of the authority.

     (b) Submit directly to the Legislative Counsel, no later than October 1 of each even-numbered year, requests for measures necessary to provide statutory authorization to carry out any of the board’s duties or to implement any of the board’s recommendations. The measures may be filed prior to the beginning of the legislative session in accordance with the rules of the House of Representatives and the Senate.

     (3) If the board or the authority is unable to perform, in whole or in part, any of the duties described in ORS 413.006 (Establishment of Oregon Health Policy Board) to 413.042 (Rules) and 741.340 (Health benefit plans offered through exchange) without federal approval, the authority is authorized to request, in accordance with ORS 413.072 (Public process required if waiver of federal requirement involves policy change), waivers or other approval necessary to perform those duties. The authority shall implement any portions of those duties not requiring legislative authority or federal approval, to the extent practicable.

     (4) The enumeration of duties, functions and powers in this section is not intended to be exclusive nor to limit the duties, functions and powers imposed on the board by ORS 413.006 (Establishment of Oregon Health Policy Board) to 413.042 (Rules) and 741.340 (Health benefit plans offered through exchange) and by other statutes.

     (5) The board shall consult with the Department of Consumer and Business Services in completing the tasks set forth in subsection (1)(j) and (k)(A) of this section. [2009 c.595 §9; 2011 c.9 §55; 2011 c.720 §125; 2012 c.38 §15; 2013 c.1 §55; 2013 c.681 §44; 2015 c.3 §42; 2015 c.243 §2; 2015 c.389 §6]

 

In accordance with applicable provisions of ORS chapter 183, the Oregon Health Policy Board may adopt rules necessary for the administration of the laws that the board is charged with administering. [2009 c.595 §6]

ORS 413.016 Authority of board to establish advisory and technical committees (1) The Oregon Health Policy Board may establish such advisory and technical committees as the board considers necessary to aid and advise the board in the performance of the board’s functions. These committees may be continuing or temporary committees. The board shall determine the representation, membership, terms and organization of the committees and shall appoint the members of the committees.

     (2) Members of the committees who are not members of the board are not entitled to compensation, but at the discretion of the board may be reimbursed from funds available to the board for actual and necessary travel and other expenses incurred by them in the performance of their official duties, in the manner and amount provided in ORS 292.495 (Compensation and expenses of members of state boards and commissions). [2009 c.595 §8]

 

ORS 413.017 Public Health Benefit Purchasers Committee, Health Care Workforce Committee and Health Plan Quality Metrics Committee (1) The Oregon Health Policy Board shall establish the committees described in subsections (2) to (4) of this section.

     (2)(a) The Public Health Benefit Purchasers Committee shall include individuals who purchase health care for the following:

     (A) The Public Employees’ Benefit Board.

     (B) The Oregon Educators Benefit Board.

     (C) Trustees of the Public Employees Retirement System.

     (D) A city government.

     (E) A county government.

     (F) A special district.

     (G) Any private nonprofit organization that receives the majority of its funding from the state and requests to participate on the committee.

     (b) The Public Health Benefit Purchasers Committee shall:

     (A) Identify and make specific recommendations to achieve uniformity across all public health benefit plan designs based on the best available clinical evidence, recognized best practices for health promotion and disease management, demonstrated cost-effectiveness and shared demographics among the enrollees within the pools covered by the benefit plans.

     (B) Develop an action plan for ongoing collaboration to implement the benefit design alignment described in subparagraph (A) of this paragraph and shall leverage purchasing to achieve benefit uniformity if practicable.

     (C) Continuously review and report to the Oregon Health Policy Board on the committee’s progress in aligning benefits while minimizing the cost shift to individual purchasers of insurance without shifting costs to the private sector or the health insurance exchange.

     (c) The Oregon Health Policy Board shall work with the Public Health Benefit Purchasers Committee to identify uniform provisions for state and local public contracts for health benefit plans that achieve maximum quality and cost outcomes. The board shall collaborate with the committee to develop steps to implement joint contract provisions. The committee shall identify a schedule for the implementation of contract changes. The process for implementation of joint contract provisions must include a review process to protect against unintended cost shifts to enrollees or agencies.

     (3) (a) The Health Care Workforce Committee shall include individuals who have the collective expertise, knowledge and experience in a broad range of health professions, health care education and health care workforce development initiatives.

     (b) The Health Care Workforce Committee shall coordinate efforts to recruit and educate health care professionals and retain a quality workforce to meet the demand that will be created by the expansion in health care coverage, system transformations and an increasingly diverse population.

     (c) The Health Care Workforce Committee shall conduct an inventory of all grants and other state resources available for addressing the need to expand the health care workforce to meet the needs of Oregonians for health care.

     (4) (a) The Health Plan Quality Metrics Committee shall include the following members appointed by the Oregon Health Policy Board:

     (A) An individual representing the Oregon Health Authority;

     (B) An individual representing the Oregon Educators Benefit Board;

     (C) An individual representing the Public Employees’ Benefit Board;

     (D) An individual representing the Department of Consumer and Business Services;

     (E) Two health care providers;

     (F) One individual representing hospitals;

     (G) One individual representing insurers, large employers or multiple employer welfare arrangements;

     (H) Two individuals representing health care consumers;

     (I) Two individuals representing coordinated care organizations;

     (J) One individual with expertise in health care research;

     (K) One individual with expertise in health care quality measures; and

     (L) One individual with expertise in mental health and addiction services.

     (b) The committee shall work collaboratively with the Oregon Educators Benefit Board, the Public Employees’ Benefit Board, the authority and the department to adopt health outcome and quality measures that are focused on specific goals and provide value to the state, employers, insurers, health care providers and consumers. The committee shall be the single body to align health outcome and quality measures used in this state with the requirements of health care data reporting to ensure that the measures and requirements are coordinated, evidence-based and focused on a long term statewide vision.

     (c) The committee shall use a public process that includes an opportunity for public comment to identify health outcome and quality measures that may be applied to services provided by coordinated care organizations or paid for by health benefit plans sold through the health insurance exchange or offered by the Oregon Educators Benefit Board or the Public Employees’ Benefit Board. The authority, the department, the Oregon Educators Benefit Board and the Public Employees’ Benefit Board are not required to adopt all of the health outcome and quality measures identified by the committee but may not adopt any health outcome and quality measures that are different from the measures identified by the committee. The measures must take into account the recommendations of the metrics and scoring subcommittee created in ORS 414.638 (Metrics and scoring subcommittee) and the differences in the populations served by coordinated care organizations and by commercial insurers.

     (d) In identifying health outcome and quality measures, the committee shall prioritize measures that:

     (A) Utilize existing state and national health outcome and quality measures, including measures adopted by the Centers for Medicare and Medicaid Services, that have been adopted or endorsed by other state or national organizations and have a relevant state or national benchmark;

     (B) Given the context in which each measure is applied, are not prone to random variations based on the size of the denominator;

     (C) Utilize existing data systems, to the extent practicable, for reporting the measures to minimize redundant reporting and undue burden on the state, health benefit plans and health care providers;

     (D) Can be meaningfully adopted for a minimum of three years;

     (E) Use a common format in the collection of the data and facilitate the public reporting of the data; and

     (F) Can be reported in a timely manner and without significant delay so that the most current and actionable data is available.

     (e) The committee shall evaluate on a regular and ongoing basis the health outcome and quality measures adopted under this section.

     (f) The committee may convene subcommittees to focus on gaining expertise in particular areas such as data collection, health care research and mental health and substance use disorders in order to aid the committee in the development of health outcome and quality measures. A subcommittee may include stakeholders and staff from the authority, the Department of Human Services, the Department of Consumer and Business Services, the Early Learning Council or any other agency staff with the appropriate expertise in the issues addressed by the subcommittee.

     (g) This subsection does not prevent the authority, the Department of Consumer and Business Services, commercial insurers, the Public Employees’ Benefit Board or the Oregon Educators Benefit Board from establishing programs that provide financial incentives to providers for meeting specific health outcome and quality measures adopted by the committee.

     (5) Members of the committees described in subsections (2) to (4) of this section who are not members of the Oregon Health Policy Board are not entitled to compensation but shall be reimbursed from funds available to the board for actual and necessary travel and other expenses incurred by them by their attendance at committee meetings, in the manner and amount provided in ORS 292.495 (Compensation and expenses of members of state boards and commissions). [2009 c.595 §7; 2015 c.3 §43; 2015 c.389 §2; 2019 c.3 §1]