Signed by Governor John Kitzhaber

Vote Smart's Synopsis:

Vote to pass a bill that establishes an implementation plan for coordinated care organizations.

Highlights:

• Authorizes the amendment of existing contracts between the Oregon Health Authority and prepaid managed care health services organizations that were in effect on July 1, 2011 to convert the prepaid managed care organizations into coordinated care organizations (Sec. 2).

• Specifies that coordinated care organizations may be local, community-based organizations, statewide organizations with community-based participation in governance, or any combination of the two (Sec. 20).

• Establishes goals for coordinated care organizations including, but not limited to, the following (Sec. 5):
• To encourage each member to be an “active partner” in directing the member’s health care;
• To educate each member about how to navigate the coordinated health care system;
• To provide access to advocates, including qualified peer wellness specialists, personal health navigators, and qualified community health workers;
• To provide assistance that is culturally and linguistically appropriate to the member’s need to access appropriate services; and
• To encourage members to use wellness and prevention resources and to make healthy lifestyle choices.

• Requires coordinated care organizations to utilize any appropriate services that will reduce the number of avoidable emergency room visits and hospital admissions (Sec. 20).

• Establishes requirements for coordinated care organizations including, but not limited to, the following (Sec. 20):
• Maintenance of cash reserves of $250,000 plus an amount equal to 50 percent of the organization’s total liabilities above $250,000;
• Operation within a fixed budget;
• Coordination of the delivery of physical, dental and mental health care, as well as chemical dependency services and long-term care services; and
• Engagement with community members and health care providers to address regional, cultural, socioeconomic and racial disparities in health care that exist among the coordinated care organization’s members and in the organization’s community.

• Requires coordinated care organizations to prioritize working with members who have the following conditions (Sec. 20):
• High health care needs;
• Multiple chronic conditions;
• Mental illness; and
• Chemical dependency.

• Authorizes coordinated care organizations to disclose protected health care information, with the exception of psychotherapy notes, without the authorization of the patient to other health care providers and public health entities for the purposes of treatment, operation, payment, and health oversight (Sec. 16).

• Authorizes a member who is dually eligible for Medicare and Medicaid to withdraw from any coordinated care organization that does not provide adequate care and enroll in another of his or her choice, or receive Medicare-covered services on a fee-for-service basis (Sec. 5).

• Requires the governing body of each coordinated care organization to consist of the following (Sec. 20):
• At least 2 health care providers in active practice, including a licensed physician or certified nurse whose specialty is primary care and a mental health or chemical dependency treatment provider;
• At least 2 members of the community; and
• At least 1 member of the community advisory council.

• Requires each coordinated care organization to establish a formal contractual relationship with any dental care organization that serves members of the coordinated care organization in the area where they reside by July 1, 2014 (Sec. 20).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that establishes an implementation plan for coordinated care organizations.

Highlights:

• Authorizes the amendment of existing contracts between the Oregon Health Authority and prepaid managed care health services organizations that were in effect on July 1, 2011 to convert the prepaid managed care organizations into coordinated care organizations (Sec. 2).

• Specifies that coordinated care organizations may be local, community-based organizations, statewide organizations with community-based participation in governance, or any combination of the two (Sec. 20).

• Establishes goals for coordinated care organizations including, but not limited to, the following (Sec. 5):
• To encourage each member to be an “active partner” in directing the member’s health care;
• To educate each member about how to navigate the coordinated health care system;
• To provide access to advocates, including qualified peer wellness specialists, personal health navigators, and qualified community health workers;
• To provide assistance that is culturally and linguistically appropriate to the member’s need to access appropriate services; and
• To encourage members to use wellness and prevention resources and to make healthy lifestyle choices.

• Requires coordinated care organizations to utilize any appropriate services that will reduce the number of avoidable emergency room visits and hospital admissions (Sec. 20).

• Establishes requirements for coordinated care organizations including, but not limited to, the following (Sec. 20):
• Maintenance of cash reserves of $250,000 plus an amount equal to 50 percent of the organization’s total liabilities above $250,000;
• Operation within a fixed budget;
• Coordination of the delivery of physical, dental and mental health care, as well as chemical dependency services and long-term care services; and
• Engagement with community members and health care providers to address regional, cultural, socioeconomic and racial disparities in health care that exist among the coordinated care organization’s members and in the organization’s community.

• Requires coordinated care organizations to prioritize working with members who have the following conditions (Sec. 20):
• High health care needs;
• Multiple chronic conditions;
• Mental illness; and
• Chemical dependency.

• Authorizes coordinated care organizations to disclose protected health care information, with the exception of psychotherapy notes, without the authorization of the patient to other health care providers and public health entities for the purposes of treatment, operation, payment, and health oversight (Sec. 16).

• Authorizes a member who is dually eligible for Medicare and Medicaid to withdraw from any coordinated care organization that does not provide adequate care and enroll in another of his or her choice, or receive Medicare-covered services on a fee-for-service basis (Sec. 5).

• Requires the governing body of each coordinated care organization to consist of the following (Sec. 20):
• At least 2 health care providers in active practice, including a licensed physician or certified nurse whose specialty is primary care and a mental health or chemical dependency treatment provider;
• At least 2 members of the community; and
• At least 1 member of the community advisory council.

• Requires each coordinated care organization to establish a formal contractual relationship with any dental care organization that serves members of the coordinated care organization in the area where they reside by July 1, 2014 (Sec. 20).

Full Bill Text