Oregon lawmakers meeting in Salem for their five-week short session are taking up weighty issues including who can own doctors’ offices, how health care facilities are approved and improve coordination in the state’s emergency medical services system.
Lawmakers also will take up issues that include further addressing the state’s health care workforce shortages and making changes to its drug decriminalization law. Legislation seeks to address barriers keeping Oregonians from treatment in a state consistently ranked among the worst for mental health services.
“We all know that we need more access to treatment facilities, and a more streamlined and coordinated system of care in Oregon,” House Majority Leader Julie Fahey said during a press conference last week. “And for that to happen, we need more facilities and we need a bigger workforce.”
Lawmakers approved more than $1 billion for behavioral health in the 2021, which they followed up with hundreds of millions more in following sessions.
Last week a state-funded consultant reported that Oregon still doesn’t have enough treatment facilities to meet people’s needs. The report found it would cost more than $500 million over at least five years to establish 3,000 additional behavioral health beds.
Senate Majority Leader Kate Lieber said during a press availability that the Legislature will be making additional investments in behavioral health, and how much depends on the revenue forecast that comes out Wednesday.
She said that in previous sessions, lawmakers allocated money to expand behavioral health facilities and increase pay for workers. This session, she said, lawmakers will focus on what’s needed to attract people to the profession.
“Ultimately, we’re going to have to pay people more money to do this work,” she said. “There is a lot of high acuity out there. Our workers are on the frontlines of this crisis, and we’ve got to continue to make sure we are supporting them.”
Gov. Tina Kotek said during a media availability that after considerable spending on behavioral health authorized in previous legislative sessions, she is pressing state agencies to account for how the money is being spent.
“So if the legislature says, ‘We want to spend more money,’ I want to be able to say, ‘Here’s where you should spend it,’” she said.
House Minority Leader Jeff Helfrich said that Republicans plan to force some “difficult conversations” on new spending.
State Rep. Cyrus Javadi, a Tillamook Republican who sits on a key health care committee, told The Lund Report that it’s time to look at red tape that is preventing facilities from being built and workers from being licensed.
“It’s almost like you've got all this cash in your pocket, and you’re at the store, but the product you want to buy isn’t there,” he said.
House Speaker Dan Rayfield, D-Corvallis, said lawmakers would take “significant steps” on the state’s behavioral health and addiction crisis along with the housing and homeless, the session’s primary issues.
But lawmakers have a short timeline, Rayfield noted. The first legislative deadline comes in a week, when most bills need to be scheduled for a committee vote to keep moving.
The session’s other health care bills wade into disputes over the flow of money and medications in the drug supply chain. Others try to address increased violence against health care workers. What follows are some of the major bills.
Mental health and addiction
House Bill 4092 requires the Oregon Health Authority to study how much funding county mental health programs need to provide required services.
House Bill 4151 creates a task force to study ways to increase the diversity of behavioral health workers serving the state’s young people.
House Bill 4002 is the majority Democrats’ bill to modify Measure 110, the 2020 ballot measure that decriminalized drugs, including meth and heroin. Currently a placeholder, amendments to the bill are expected to include partial drug recriminalization and policy changes designed to make treatment more accessible.
House Bill 4036 is Republicans’ response to HB 4002. It reinstates a misdemeanor penalty for drug possession. It would also mandate prison sentences for drug dealers and require treatment as part of probation for some people convicted of possessing illicit substances.
House Bill 4062 is another, shorter Republican-sponsored bill that would restore misdemeanor penalties to possess or use controlled substances in public.
House Bill 4114 allows police to take a publicly intoxicated person to their home or a treatment center. It also allows treatment centers to hold someone who has been given an opioid reversal medication for 72 hours.
Health care workforce
House Bill 4071 seeks to make it easier for nurses and other medical workers with an out-of-state license and no red flags in their background to temporarily practice in Oregon while they apply for state licensing. State Rep. Ed Diehl, R-Scio, told The Lund Report he introduced the bill after hearing complaints about licensure delays.
House Bill 4011 allocates $5 million to the Oregon Center for Nursing to develop programs to recruit and retain nurse educators, which are in short supply. It also allocates $1 million to help the Mental Health and Addiction Certification Board of Oregon recruit and retain behavioral health workers.
Senate Bill 1594 requires mental health and substance use facilities to have a worker safety plan in place, and creates penalties for those that don’t. State Sen. Chris Gorsek, D-Gresham, said he sponsored the bill in response to the death of Haley Rogers, who was stabbed to death while working overnight at a group home. The bill also creates a new training program for behavioral health workers.
House Bill 4088 requires hospitals to post signs notifying employees about their rights if they’re assaulted. It also makes it a felony to knowingly assault a hospital worker. State Rep. Travis Nelson, D-Portland, said he’s working on an amendment to account for people who commit assaults while experiencing a mental health disorder.
Health care access
House Bill 4136 would allocate $5 million to Lane County Public Health to set up a basic life support unit and other services. The bill is in response to the closure of PeaceHealth University District hospital, which has meant people needing emergency care have had to travel to PeaceHealth Sacred Heart RiverBend in Springfield.
House Bill 4070 would increase state grants for school-based health centers, clinics that offer medical services to students. Proponents say the centers are more important than ever as more youth report struggling with mental health issues.
House Bill 4139 removes the requirement of state approval for new hospitals providing inpatient psychiatric services, inpatient rehabilitation services or substance use treatment as well as new long term care facilities. The state’s “certificate of need” process seeks to make sure limited health care investments serve community needs. Backers of the bill argue the system obstructs needed treatment.
Senate Bill 1565 requires the state to pay parents to care for their disabled children if other caregivers aren’t available.
Senate Bill 1578 directs the Oregon Health Authority to set up an online system to help providers schedule health care interpreters.
Senate Bill 1507 orders the health authority to help hospitals with their ongoing problem of patients they can’t discharge because they need care at a skilled nursing or other facility. The bill cites a lack of public guardians — court-appointed positions who protect someone who has been deemed incapacitated.
Senate Bill 1508 restricts a state panel overseeing Medicaid services from using a standard for determining what treatments are covered. The bill targets use of a measure called quality-adjusted life year (QALY), which measures a treatments’ effectiveness by how much it improves patients’ lives. Supporters say the practice helps combat excessive pricing and promote effective spending, but critics, including the pharmaceutical industry, conservatives and advocates for people with disabilities, say the approach discriminates against older patients and those with disabilities.
Pharmacy and drugs
House Bill 4149 requires state licensing of pharmacy benefit managers, companies that administer health insurers’ pharmaceutical benefits that are often accused of driving local pharmacies out of business.
House Bill 4010 prohibits drug manufacturers from, among other things, limiting where safety net clinics can send patients for prescriptions.
House Bill 4012 bans an insurer from requiring patients to obtain drugs from a specific pharmacy.
House Bill 4113 would prohibit insurers from disallowing pharmaceutical industry copay programs from being counted toward deductibles and out-of-pocket maximums. Patient groups say the insurer practice blocks patients from needed medications, while others say it helps keep drug prices down and combats pharmaceutical industry efforts to promote costly patented drugs over other effective medications that are less profitable.
Senate Bill 1506 requires the health authority to pay pharmacists for testing and treating for COVID-19.
House Bill 4077 sets up a task force to help schools bill Medicaid for services that allow students to attend class.
Other changes
House Bill 4081 seeks to modernize emergency medical services by standardizing data collection and setting up an advisory board.
House Bill 4130 is intended to prevent private equity or other large corporations from increasing their influence in Oregon’s health care system. The bill closes what its backers call legal “loopholes” that allow corporations to sidestep Oregon’s requirement that doctors own medical practices.
House Bill 4089 requires hospitals to report additional financial data, including cash on hand and investments. It also requires hospitals to pay at least minimum wage for workers who are required to be on call.
House Bill 4091 creates a committee representing various health care interests to examine the costs and effects of proposed legislation containing new mandates that particular services be covered.
House Bill 4150 allows doctors to be notified if a patient overdoses on an opioid or other drug.
House Bill 4105 allocates money to the Nurse-Family Partnership, a program that pairs pregnant parents who have a substance use disorder with nurses who will stay with the affected families until they are two years old.
