2019 Oregon Revised Statutes
Volume : 12 - Public Health
Chapter 442 - Health Planning
Section 442.386 - Health Care Cost Growth Benchmark program established.

(a) Support accountability for the total cost of health care across all providers and payers, both public and private;

(b) Build on the state’s existing efforts around health care payment reform and containment of health care costs; and

(c) Ensure the long-term affordability and financial sustainability of the health care system in this state.

(2) The Health Care Cost Growth Benchmark program is established. The program shall be administered by the Oregon Health Authority in collaboration with the Department of Consumer and Business Services, subject to the oversight of the Oregon Health Policy Board. The program shall establish a health care cost growth benchmark for increases in total health expenditures and shall review and modify the benchmark on a periodic basis.

(3) The health care cost growth benchmark must:

(a) Promote a predictable and sustainable rate of growth for total health expenditures as measured by an economic indicator adopted by the board, such as the rate of increase in this state’s economy or of the personal income of residents of this state;

(b) Apply to all providers and payers in the health care system in this state;

(c) Use established economic indicators; and

(d) Be measurable on a per capita basis, statewide basis and health care entity basis.

(4) The program shall establish a methodology for calculating health care cost growth:

(a) Statewide;

(b) For each provider and payer, taking into account the health status of the patients of the provider or the beneficiary of the payer; and

(c) Per capita.

(5) The program shall establish requirements for providers and payers to report data and other information necessary to calculate health care cost growth under subsection (4) of this section.

(6) Annually, the program shall:

(a) Hold public hearings on the growth in total health expenditures in relation to the health care cost growth in the previous calendar year;

(b) Publish a report on health care costs and spending trends that includes:

(A) Factors impacting costs and spending; and

(B) Recommendations for strategies to improve the efficiency of the health care system; and

(c) For providers and payers for which health care cost growth in the previous calendar year exceeded the health care cost growth benchmark:

(A) Analyze the cause for exceeding the health care cost growth benchmark; and

(B) If appropriate, require the provider or payer to undertake a performance improvement action plan. [2019 c.560 §2]

Note: See note under 442.385.

Note: Sections 3 to 6, chapter 560, Oregon Laws 2019, provide:

Sec. 3. (1) The Health Care Cost Growth Benchmark Implementation Committee is established under the direction of the Oregon Health Policy Board.

(2) The membership of the committee consists of the following:

(a) The Director of the Oregon Health Authority or the director’s designee;

(b) The Director of the Department of Consumer and Business Services or the director’s designee;

(c) An expert in health care financing and administration appointed by the Director of the Oregon Health Authority;

(d) An expert in health economics appointed by the Director of the Oregon Health Authority;

(e) At least one insurance broker appointed by the Director of the Department of Consumer and Business Services; and

(f) No more than 13 members appointed by the Governor to represent:

(A) The Health Insurance Exchange Advisory Committee created under ORS 741.004;

(B) The division of the Oregon Department of Administrative Services that serves as the department’s office of economic analysis;

(C) The Oregon Health Leadership Council;

(D) Health care systems or urban hospitals;

(E) Rural hospitals;

(F) Consumers;

(G) Members of the business community that purchase health insurance for their employees;

(H) Licensed and certified health care professionals; and

(I) The insurance industry.

(3) The committee shall design an implementation plan, in accordance with section 4 of this 2019 Act, for the Health Care Cost Growth Benchmark program established in section 2 of this 2019 Act [442.386].

(4) A majority of the members of the committee constitutes a quorum for the transaction of business.

(5) Official action by the committee requires the approval of a majority of the members of the committee.

(6) The Governor shall select one member to serve as chairperson.

(7) If there is a vacancy for any cause, the appointing authority shall make an appointment to become immediately effective.

(8) The committee shall meet at times and places specified by the call of the chairperson or of a majority of the members of the committee.

(9) The committee may adopt rules necessary for the operation of the committee.

(10) The Oregon Health Authority shall provide staff support to the committee.

(11)(a) Members of the committee, other than members representing consumers, are not entitled to compensation or reimbursement for expenses and serve as volunteers on the committee.

(b) Members representing consumers are not entitled to compensation but may be reimbursed from funds available to the authority for actual and necessary travel and other expenses incurred by the members in the performance of official duties in the manner and amount provided in ORS 292.495.

(12) All agencies of state government, as defined in ORS 174.111, are directed to assist the committee in the performance of the duties of the committee and, to the extent permitted by laws relating to confidentiality, to furnish information and advice that the members of the committee consider necessary to perform their duties. [2019 c.560 §3]

Sec. 4. (1) As used in this section:

(a) "Health care" has the meaning given that term in section 1 of this 2019 Act [442.385].

(b) "Health care cost growth" has the meaning given that term in section 1 of this 2019 Act.

(c) "Health care cost growth benchmark" has the meaning given that term in section 1 of this 2019 Act.

(d) "Health care entity" has the meaning given that term in section 1 of this 2019 Act.

(e) "Health insurance" has the meaning given that term in ORS 731.162.

(f) "Payer" has the meaning given that term in section 1 of this 2019 Act.

(g) "Provider" has the meaning given that term in section 1 of this 2019 Act.

(h) "Total health expenditures" has the meaning given that term in section 1 of this 2019 Act.

(2) The Health Care Cost Growth Benchmark Implementation Committee, in designing the implementation plan for the Health Care Cost Growth Benchmark program, shall:

(a) Recommend the governance structure for the program.

(b) Recommend a methodology to establish the health care cost growth benchmark and the economic indicators to be used in establishing the benchmark.

(c) Establish the initial benchmark and specify the frequency and manner in which the benchmark should be reevaluated and updated.

(d) Identify the data that providers and payers shall report for the program to be able to:

(A) Measure the benchmark;

(B) Validate the benchmark; and

(C) Identify the health care cost growth of an institutional provider or provider group and of providers that are part of the institutional provider or provider group.

(e)(A) Determine the technical assistance and support necessary to support providers and payers working to remain at or below the health care cost growth benchmark; and

(B) Identify opportunities to leverage existing public and private financial resources, or alternative funding, to provide the technical assistance and support.

(f) Recommend approaches for measuring the quality of care that account for patient health status.

(g) Seek to align the approaches for measuring the quality of care under paragraph (f) of this subsection with the outcome and quality measures adopted by the Health Plan Quality Metrics Committee.

(h) Identify opportunities for lowering costs, improving the quality of care and improving the efficiency of the health care system by using innovative payment models for all payers, including payment models that do not use a per-claim basis for payments.

(i) Recommend a system for identifying:

(A) Unjustified variations in prices or in health care cost growth; and

(B) The factors that contribute to the unjustified variations.

(j) Identify providers and payers that are required to report.

(k) Recommend accountability and enforcement processes, which may be phased in over time, including:

(A) Measures to ensure compliance with reporting requirements;

(B) Procedures for imposing a performance improvement action plan or other escalating enforcement actions when a provider or payer fails to remain at or below the benchmark; and

(C) Measures to enforce compliance with the health care cost growth benchmark in programs administered by the Oregon Health Authority and the Department of Consumer and Business Services, including but not limited to:

(i) The medical assistance program;

(ii) Medical, dental, vision and other health care benefit plans offered by the Public Employees’ Benefit Board;

(iii) Medical, dental, vision and other health care benefit plans offered by the Oregon Educators Benefit Board;

(iv) Insurance offered through the health insurance exchange; and

(v) The review of health insurance premium rates by the department.

(L) Make recommendations regarding the reporting of data collected by the Health Care Cost Growth Benchmark program, including recommendations for:

(A) Publication of an annual health care cost trends report and analyses on the statewide health care cost growth benchmark, total health expenditures and spending by each type of health care entity;

(B) Elements to be included in the annual health care cost trends report, such as:

(i) Services provided, sorted by provider organization;

(ii) Services paid for, sorted by the type of payer;

(iii) Variations in cost trends, sorted by category of service; and

(iv) Affordability of health care, based on prices, insurance premiums and types of payment;

(C) Frequency and format of public hearings conducted in accordance with section 2 (6)(a) of this 2019 Act [442.386 (6)(a)];

(D) Publication of recommendations for policies and strategies for achieving the health care cost growth benchmark;

(E) Publication of performance improvement action plans and other enforcement actions; and

(F) Reporting to the Legislative Assembly.

(m) Establish an implementation timeline and the phases of implementation that may include the establishment of the initial health care cost growth benchmark under paragraph (c) of this subsection in 2021, with reporting, enforcement and penalties beginning in 2022. [2019 c.560 §4]

Sec. 5. (1) No later than September 15, 2020, the Health Care Cost Growth Benchmark Implementation Committee shall report to the Oregon Health Policy Board for approval, and to the interim committees of the Legislative Assembly related to health, the committee’s recommendations under section 4 of this 2019 Act. The report shall include a legislative concept for carrying out the provisions of section 4 (2)(k)(B) of this 2019 Act regarding the imposition of performance improvement action plans or other escalating enforcement actions when a provider or payer fails to remain at or below the health care cost growth benchmark.

(2) The Oregon Health Authority and the Department of Consumer and Business Services shall implement the recommendations of the committee, except for the provisions in the legislative concept described in subsection (1) of this section, upon approval by the board. [2019 c.560 §5]

Sec. 6. Sections 3, 4 and 5 of this 2019 Act are repealed on January 2, 2022. [2019 c.560 §6]