From the Care Act to the Able Act, A Rundown of the 2015 Health Bills that Passed

The Oregon Legislature passed five dozen new laws affecting healthcare policy that were covered in The Lund Report, making significant gains in public health, consumer protection, workers’ health benefits and mental health policy.

You win some, and you lose some, as the story goes, and Oregon’s 2015 legislative session was no different.

The Oregon Association of Hospitals and Health Systems walked away as one of the biggest winners, crushing a price transparency bill that would have exposed its members to competition, while the Legislature limited its efforts to increase transparency to a $250,000 tax-funded website that will publish historic statewide averages of hospital price information from the all-payer, all-claims database.

But the hospitals, in turn, lost a battle to the Oregon Nurses Association, and will no longer be able to turn a blind eye to their nurse staffing committees, whose recommendations will now have the force of law. The ONA couldn’t pass a bill to require nurses at blood drives -- after a big win in the House, the Red Cross lobbied to send that bill to a quiet defeat in the Senate. A bill to give nurse practitioners the privilege of performing vasectomies was similarly snipped.

The decision to cut the vasectomy bill was also a rare setback for Planned Parenthood, which had a highly productive session, winning passage of bills that increase patient privacy around health insurance information and make a woman’s access to birth control nearly unfettered.

Here’s a rundown of the many bills covered in The Lund Report in this year’s session, with a comprehensive compilation of the significant healthcare legislation that went the distance in the 2015 session. A separate article will look at the bills that fell short:

HB 2023 -- A Care Act for those with mental illness requires hospitals to work with patients and their supporters to craft a discharge plan once they leave the hospital. Advocates for the policy change testified that their loved ones had been cut to the wind, with little guidance on how to properly manage their outpatient care. The Oregon Association of Hospitals and Health Systems came on board to help them with the legislation. The bill was helped along and modeled after a separate AARP CARE Act -- HB 3378, which is tailored primarily to elderly patients.

HB 2028 -- Pharmacists will get enhanced professional powers with this bill, which allows them to prescribe smoking cessation products and medications needed for traveling to foreign countries. The policy builds on their ability to administer vaccines for adults and school-age children.

HB 2234 -- Health insurance companies and the Oregon Health Plan will now have to reimburse child abuse centers for the cost of their forensic assessments, which is seen as critical to allowing these successful safety net programs to continue.

HB 2828 -- The state will move forward with a comprehensive study of the best methods to finance a universal healthcare system for Oregon, which will include single payer and three other possibilities. It was a 12th-hour political victory for Sen. Michael Dembrow and other progressive Democrats, after Sen. Alan Bates withdrew his support at the 11th hour before bending to the wishes of his party.

HB 2300 -- Oregon’s version of the Libertarian “Right-to-Try” concept was heavily amended at the end of session after Sen. Steiner Hayward and Providence Health ethicists raised concerns about exploiting terminally ill patients. Patients who want to try unapproved medications must be told of other options, must be at least 18, and their physicians will have to file their rationale with the Oregon Health Authority, which will track the use of this law.

HB 2307 -- Oregon became just the third state to ban the practice of conversion therapy for minors, which promotes the discredited and harmful aim of turning gay or transgender teens into heterosexual or gender-conforming individuals. The bill, pushed by Rep. Rob Nosse and Basic Rights Oregon, attracted surprise conservative support from Senate Minority Leader Ted Ferrioli.

HB 2363 -- State law will now require that hospital physicians document any use of forced seclusion of mentally ill patients. The Oregon Health Authority already requires such documentation administratively, but advocates such as Disability Rights Oregon argued that the policy needed the force of law, similar to the law regarding the use of physical restraints.

HB 2368 -- Another Disability Rights Oregon bill, this one ensures that advance directives regarding mental health treatment take precedence over any other advance directive a person may have signed.

HB 2395 -- The hospital assessment tax, which the state uses to leverage federal tax dollars for the Medicaid program, was renewed for four years with resounding support from the hospitals themselves, who pay the tax but end up seeing a net profit on the back end when Oregon Health Plan patients receive care.

HB 2419 -- Hospitals will be required to hire qualified American Sign Language interpreters for deaf patients, just as they do for patients who speak a foreign language. Advocates have complained that some hospitals have cut corners and hired people who could not communicate with the hearing impaired.

HB 2466 -- This bill was pushed by the Oregon Insurance Division as a means of further re-aligning Oregon’s insurance code with the federal government in the wake of the Affordable Care Act. But the policy drew fire from the health insurance co-ops because the Senate version, which was adopted, also extended old pre-Obamacare plans for the small group market, which they claim will drive up the cost of insurance for ACA-compliant plans, as well as favor the big insurers over their companies, which do not sell pre-ACA plans.

HB 2468 -- Another bill from the Oregon Insurance Division, this one authorizes the division to set parameters for network adequacy in the individual and small group health insurance markets. The bill had widespread support from a stakeholder group of insurers, healthcare advocates, and alternative health providers, who felt that insurance companies were excluding them from their networks.

HB 2522 -- The Oregon Health Insurance Marketplace, the newest division of the Department of Consumer & Business Services, will be required to hash out how the state can use Obamacare subsidies to provide cost-free insurance to low-income Pacific Islanders who have been barred from the Oregon Health Plan but cannot afford subsidized insurance either.

HB 2546 -- Oregon became the 43rd state to ban electronic cigarettes for minors. The devices were also included in the Indoor Clean Air Act. The law does not include the exemption that vape shops sought to allow consumers to test the items.

HB 2560 -- Oregon insurers will be required to cover the full cost of colonoscopies as a preventive service, even if the patient had already undergone a simpler, fecal immunochemical test. The bill, championed by Rep. Mitch Greenlick, will open the door for more people to get screened for colon cancer with the less invasive test, and then follow up with a colonoscopy if needed.

HB 2600 -- Small employers who fall under the Oregon Family Leave Act but not the Federal Medical Leave Act will have to continue to pay health insurance premiums for employees who take unpaid leave. The policy had already been in place under federal law for employers with 50 or more employees, but the Oregon law, which includes all employers with 25 employees, had not.

HB 2605 -- The Oregon Insurance Division will have to offer a preliminary rate decision, provide more detailed information and give health insurers a more reasonable appeal process when it reviews rates for individual and small group health insurance. The bill had been pushed by Oregon’s Health CO-OP after the company was upset over an unwanted rate hike in 2014.

HB 2638 -- The CCOs and the Oregon Health Authority will be able to leverage the state’s prescription drug management program to possibly save on drug costs for Medicaid members, but pressure from PhARMA killed a separate provision in the Senate that would have allowed the health authority to require prior approval of new blockbuster drugs for six months while the state’s Pharmacy & Therapeutics Committee deliberated the efficacy of the new drugs.

HB 2758 -- Patients will have the ability to redirect their explanation of benefit documents away from the policyholder under this bill, pushed by Planned Parenthood and domestic violence victim advocates. The patient privacy bill is geared toward young people who don’t want their parents to know their medical information as well as those who may be insured through an estranged or abusive spouse.

HB 2796 -- Music therapists will now be licensed in Oregon, raising their professional standards and easing their ability to be compensated by insurers and the state for their work.

HB 2876 -- Scrub techs, or surgical technologists, also won certification this session, helping to ensure that they’re qualified to do the job when they work in Oregon hospitals.

HB 2879 -- Pharmacists will be able to prescribe birth control from behind the counter, similar to Sudafed, after a woman completes a screening tool. The bill was pushed by Rep. Knute Buehler, a moderate freshman Republican considering a run for the governor’s office.

HB 2930 -- Hospitals who rely on certified nurse midwives will have to give them admitting privileges, something that will help not only midwives but obstetricians, whom midwives have leaned on to admit their patients to the hospital for child birth.

HB 2931 -- School districts will have to develop plans for testing their classrooms for radon -- a heavy, radioactive gas that lingers in high concentrations on the ground floors of buildings in random parts of Oregon. Radon is the leading cause of lung cancer for non-smokers.

HB 2934 -- The Oregon Health Authority will negotiate the details for a Basic Health Plan with the federal government and stakeholders. If approved by the Legislature, the plan would offer low or no-cost coverage to legal residents under 200 percent of poverty, and could act as an add-on to the work of the CCOs, although a straight expansion is probably not doable.

HB 2948 -- This bill clarifies the information that healthcare providers can share about mental health patients with their supporters, under federal privacy laws. The policy is designed to help physicians and nurses be more forthcoming without worrying about running afoul of HIPAA.

HB 3041 -- A bill brought forward by OHSU students directs school districts to allow children to bring sunscreen to school, preventing school officials from taking the myopic view that sunburn-preventing cream is a medication needing a doctor’s note.

HB 3068 -- The Department of Environmental Quality has been asked to study and provide the Legislature with more innovative ways to encourage Oregon residents to move away from dirty wood stoves to heating devices that produce less air pollution, such as natural gas or wood pellets. Poor air quality in the Willamette Valley has put the state at risk of EPA sanctions if it does not clean up its act.

HB 3100 -- The Oregon Health Authority will be working closely with counties to determine how each local jurisdiction will ensure public health services for Oregon residents. The bill came about after numerous meetings since 2013 due to a public health funding crisis in southern Oregon.

HB 3139 -- Rep. Cedric Hayden got help in his effort to open up mobile dental charity clinics in rural Oregon communities. This bill requires municipalities to adopt ordinances that allow such clinics. Hayden has been unsuccessful in opening clinics in several Lane County communities.

HB 3301 -- Health insurers will have to provide a path for naturopathic doctors to be classified as primary care providers if they are engaged in primary care and not speciality care. The bill shows the Legislature’s support for the profession. Naturopaths are increasingly being used by clinics such as ZoomCare as mid-level providers on par with nurse practitioners and physician assistants.

HB 3343 -- Oregon health insurers will be required to pay for 12-month supplies of birth control for women and girls who have an established prescription, helping to reduce the risk of pregnancy by 30 percent.

HB 3347 -- Mentally ill people who are at risk of imminent harm because of their inability to take care of themselves will be able to be civilly committed to the state mental hospital, under this bill sponsored by Rep. Val Hoyle. The bill drew initial opposition from Disability Rights Oregon, but the amended version effectively clarifies existing law.

HB 3378 -- The CARE Act, pushed by AARP, will require hospitals to develop discharge plans to help lay caregivers assist elderly patients and others in need of extended care with their treatment when they return home. The plans will offer these informal caregivers instructions on how to help with basic needs of living as well as medication management and administration.

HB 3400 -- After months of debate, the Legislature finally agreed on how to implement the legalization of marijuana, allowing an easy means for Eastern Oregon counties to ban cannabis dispensaries locally for both medical and recreational reefer, but requiring a vote of the people for a ban in Western Oregon. Marijuana will be given a value-added retail tax of 17 percent at point of sale. A separate bill allowed medical dispensaries to sell pot to non-patients tax-free, starting Oct. 1.

SB 1 -- Cover Oregon, the embarrassingly inoperable health insurance exchange, formally ended as the Legislature moved the remaining responsibilities of the exchange to a new division created within the Department of Consumer & Business Services.

SB 7 -- The Oregon Health Authority will have to procure any information technology projects through the Department of Administrative Services, which has tech specialists. This bill was designed to prevent another Cover Oregon debacle, given the health authority’s involvement in the failed development of the insurance exchange website.

SB 93 -- People with chronic medications will be able to get 90-day supplies of their medicine, reducing the number of trips to the pharmacy as well as the chance that a patient will allow their prescription to run out, risking much greater health complications. The bill survived a last-minute attack from the health insurance industry that argued that it would spike costs to employee health plans.

SB 144 -- Health insurance companies will now have to pay for telemedical services provided to patients outside a healthcare facility -- such as a person’s home, workplace or some other remote location. An earlier bill was killed under opposition from the hospital and health insurance lobby, but this version came together with the joined support of ZoomCare and Providence Health & Services, both of which have been leaders in telemedicine, which promises to reduce healthcare costs while increasing access.

SB 228 -- Inspection fees for X-ray machines, tanning beds and other devices that emit radiation could rise as much as 50 percent, ensuring that the Oregon Health Authority’s Public Health Division can continue to ensure the machines are meeting quality control standards and that the tanning businesses are complying with a 2013 law prohibiting them from offering their service to minors.

SB 231 -- Health insurance companies will be required to report the amount of money they spend on primary care in this bill, which also tasks the Oregon Health Authority with convening a healthcare collaborative to concoct new primary care payment models. The bill creates a new anti-trust exemption, but concerns were allayed in the House as the exemption was narrowed to the public meetings and records of this collaborative.

SB 302 -- This bill fixes the state law to ensure that dentists are allowed to prescribe medications related to dentistry, after a legal opinion momentarily took away this right. A separate related bill, SB 301, clarifying the practices of dental hygienists, also passed.

SB 411 -- People injured in an auto accident will be able to combine the insurance policies of both cars involved in the wreck. Their medical care will also be paid first before their insurer is repaid by the liable party.

SB 454 -- All employers with 10 or more employees will have to allow their workers to earn a week of paid sick leave, as the Democrats used their enhanced majority to pass this top policy priority on a party-line vote. Oregon’s law mirrors a voter-approved initiative in Massachusetts, and will join the Commonwealth with the nation’s most progressive law.

SB 469 -- The recommendation of hospital nurse staffing committees will now have the force of law after the Oregon Nurses Association found bipartisan approval for their policy change. The nurses union successfully argued that the committees had not been taken seriously by some hospitals. The hospital association dropped its opposition after winning a minor compromise and passage of the bill became certain.

SB 478 -- After four years of trying, Rep. Keny-Guyer’s persistence paid off as the state finally passed her policy proposal requiring the manufacturers of children’s products to report their use of toxic chemicals and then begin a lengthy process of replacing those chemicals with safer alternatives. The bill passed on a party-line in the Senate but had broad bipartisan support in the House.

SB 492 -- Domestic violence victims will be able to use their paid sick time to take care of problems associated with their situation under this bill, which unlike the law requiring paid sick time, received bipartisan support.

SB 520 -- Sen. Jeff Kruse promoted this bill, which lowers the age of children who can receive vaccinations from pharmacists from 11 to 7. The policy will allow children who need to catch up on their vaccine requirements to visit the pharmacy instead of making a doctor’s appointment.

SB 705 -- Developers tearing down homes will have to have the houses and apartments checked for asbestos first, as the bill from Sen. Dembrow closed a loophole that already requires this for renovations.

SB 710 -- Healthcare providers and facilities will have to give patients one free copy of their medical records, which will help people who are fighting appeals of federal disability benefits. Some people had been shut out of benefits because they could not afford to pay for these records, the processing of which is often farmed out to for-profit side businesses.

SB 777 -- Sen. Sara Gelser and Rep. Cedric Hayden teamed up to pass the Able Act, which allows disabled persons and their families to set up 529 savings accounts, giving them the ability to save money without losing federal benefits or needing to hire expensive attorneys.

SB 833 -- The Oregon Health Authority will now have to give CCOs 60 days to review any changes in contracts. The bill became necessary after the health authority sent the CCOs their 2015 contracts on Xmas Eve last year and required them to sign the contracts in seven days, even as they left on holiday and the contracts were reportedly riddled with mistakes.

SB 839 -- People who have been using illegal drugs will not risk prosecution if they seek emergency medical help under this bill, which had near-universal support to help prevent drug-related deaths from untreated overdoses.

SB 840 -- Nurse practitioners will be able to put a three-day medical hold at local hospitals on people in mental crises, a privilege that had been limited to doctors, even if the patient had been treated by a nurse practitioner. The bill expanding their scope of practice was actually brought forward by the hospital association, not the Oregon Nurses Association.

SB 895 -- Schools will have to offer information about their vaccination rates on school report cards, giving parents with vulnerable children better information about which schools are most at risk of a disease outbreak because of widespread refusal of vaccines. The bill also tightens a loophole in 2013 legislation that will require all students, not just new students, to show informed consent before given a non-medical exemption.

SB 900 -- The hospital association pushed this legislation, calling on taxpayers to spend $250,000 so the state can set up a website to show historic average prices of procedures performed at their hospitals. Sen. Steiner Hayward opposed, arguing the bill wouldn’t do anything to help consumers. Sen. Shields went a step further, arguing that the bill was a plain attempt by the hospitals to aide in the defeat of SB 891, which would have made them show their prices and exposed them to unwanted competition.

SB 901 -- The hospital association and the ambulatory surgery centers worked together on legislation that requires health insurers to send payment for services directly to providers. Some insurance companies had attempted to coerce the providers into signing unfavorable contracts by sending the checks to patients, some of whom cashed the checks without paying the providers.

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Comments

Another important health bill introduced by the Oregon School Nurses Association that passed is SB 698.  This bill creates a position in the OHA for a State School Nurse Consultant to provide leadership and coordination.  In addition to convening a task force to examine school health services funding and determining how to move from education dollars funding school health and using health dollars to fund it instead.  

Steve Moore