Healthcare

Removes provisions relating to the use of the prioritized list of health services in the state medical assistance program. Requires the Oregon Health Authority to establish a definition of medical necessity and medical necessity criteria. Requires the Health Evidence Review Commission to develop and maintain clinical coverage policies that are consistent with the authority's definition of medical necessity and with federal laws governing mandatory and optional medical assistance services. Declares an emergency, effective on passage.

Requires for the certification of a managed care provider plan that the plan not discriminate against any willing provider within the geographical service area of the managed care organization. Includes nurse practitioners, physician associates, chiropractic physicians and naturopathic physicians in the definition of "attending physician" for purposes of the treatment of workers' compensable injuries.

] Requires the Oregon Health Authority and coordinated care organizations to ensure that access to behavioral health treatment in the medical assistance program is comparable to access to medical and surgical treatment and that limitations are applied to behavioral health treatment no more stringently than to medical and surgical treatment. Prohibits the authority or a contracted external quality review organization, under certain circumstances, from making a negative finding about or imposing a penalty on a coordinated care organization based on documents or templates created by the authority for use by a coordinated care organization. Modifies certain statutes to clarify roles and responsibilities for the delivery of behavioral health services and to update terminology. Modifies the types of providers that may be reimbursed in the state medical assistance program for the cost of health services delivered using telemedicine. Becomes operative on January 1, 2027. Takes effect on the 91st day following adjournment sine die.

Prohibits the Oregon Health Authority from taking enforcement actions against providers or payers under the Health Care Cost Growth Target program before January 1, 2036. Sunsets January 2, 2036. Takes effect on the 91st day following adjournment sine die.

Declares this state's policy to protect engagement in certain activities relating to reproductive health care and gender-affirming treatment. Prohibits cooperation with law enforcement agencies of the federal government or other states in actions involving legally-protected reproductive or gender-affirming health care activities. Modifies provisions regarding interstate actions involving legally-protected reproductive or gender-affirming health care activities. Makes specified records and information confidential. Provides protection from disciplinary action for direct entry midwives who provide reproductive health care and gender-affirming treatment under specified circumstances. Declares an emergency, effective on passage.

Modifies the requirements for screening a hospital patient for presumptive eligibility for financial assistance. [ Prohibits the Oregon Health Authority from requiring certain home health agencies to comply with Medicare conditions of participation. ] [ Modifies the requirements for how the Department of Human Services must publish Residential Care Quality Measurement Program data. ] Removes the requirement that an applicant for a residential care facility administrator license hold a bachelor's degree in a health or social service related field. Allows a person residing in a correctional facility to receive prerelease medical assistance benefits under certain circumstances. [ Prohibits the authority or a coordinated care organization from requiring prior authorization for medical assistance coverage for repairing complex rehabilitation technology if the repair costs $1,500 or less. ] Modifies the requirements for meetings held by the Health Evidence Review Commission. Modifies the composition of the Medicaid Advisory Committee. Modifies the eligibility requirements for parent providers who are paid to provide attendant care services to their children. {See A-Eng Bill for omitted text.} Allows a full-time dentistry student enrolled in an out-of-state dental education program to practice dentistry without a license if the student is supervised by a faculty member of a dental education program accredited by the Commission on Dental Accreditation of the American Dental Association. Requires casualty or health insurance policies to provide coverage for medically necessary anesthesia services, regardless of duration, for any covered procedures. Requires dental insurers to follow certain rules for payment and denial of claims. Requires the Legislative Policy and Research Director to develop and propose to the [ Legislative Policy and Research Committee ] committees with jurisdiction over health care an insurance coverage mandate impact statement policy. Directs the [ committee ] committees to perform due diligence in considering the proposal and authorizes the [ committee ] committees to modify the proposal if the [ committee ] committees so [ determines ] determine , and then to adopt the policy. Repeals requirement that enrollees in individual or group policies or certificates of health insurance [ or members of coordinated care organizations ] be assigned by their insurer [ or organization ] to primary care providers under certain circumstances. Specifies exemptions from the requirement that pharmacy services administrative organizations must register with the Department of Consumer and Business Services as third party administrators. {See A-Eng Bill for omitted text.} Modifies requirements for the Prescription Drug Affordability Board's annual affordability determination for insulin products. Allows licensees of the Occupational Therapy Licensing Board and the Oregon Board of Physical Therapy to provide psilocybin services as licensed psilocybin service facilitators while providing occupational therapy or physical therapy services. {See A-Eng Bill for omitted text.} Lowers the age at which a naturopathic physician may request a retired license status from 70 years of age to [60] 65 years of age. Includes nurse practitioners and physician associates in the definition of "attending physician" for purposes of the treatment of workers’ compensable injuries. Declares an emergency, effective on passage.

] Imposes requirements and restrictions on insurer and coordinated care organization audits of claims for reimbursement submitted by behavioral health treatment providers. Becomes operative on January 1, 2027. Adds information that certain carriers must annually report to the Department of Consumer and Business Services regarding compliance with behavioral health parity requirements. [ Takes effect on the 91st day following adjournment sine die. ].

Adds new requirements for obtaining an initial license to operate and maintain a hospice program. [ Requires a hospice program to apply for a new initial license after a change in ownership. ] Prohibits individuals who have been excluded from participation in Medicare or Medicaid or have been found liable for fraud or abuse from holding an ownership interest in a hospice program. Requires the Oregon Health Authority to complete rulemaking within 24 months. Subject to exceptions, prohibits the authority from issuing new hospice licenses until rulemaking is complete. Declares an emergency, effective on passage.

Modifies the requirements for Medicaid supplemental reimbursements paid to emergency medical services providers. Declares an emergency, effective on passage.

Authorizes the Director of the Employment Department to adopt rules establishing an accounting system for handling moneys in the Paid Family and Medical Leave Insurance Fund. Takes effect on the 91st day following adjournment sine die.