Signed by Governor Kate Brown

Vote Smart's Synopsis:

Vote to pass a bill that authorizes the continuation of funding the Oregon Reinsurance Program.

Highlights:

• Defines “attachment point” as the threshold dollar amount, adopted by the Department of Consumer and Business Services by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are eligible for reinsurance payments (Sec. 1).

• Defines “reinsurance cap” as the threshold dollar amount, adopted by the department by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are no longer eligible for state reinsurance payments (Sec. 1).

• Defines “coinsurance rate” as the rate, adopted by the department by rule, at which the department will reimburse a reinsurance eligible health benefit plan for claims costs incurred for an insured individual’s covered benefits in a benefit year after the attachment point and before the reinsurance cap (Sec. 1).

• Authorizes the Department of Consumer and Business Services, after determining the attachment point, reinsurance cap, or coinsurance rate, and if it’s necessary to provide the full amount of funding budgeted for the Oregon Reinsurance Program when received claims are less than the amount of claims that were projected, to be able to (Sec. 1):

• Alter the attachment point or reinsurance cap during that benefit year; or

• Increase the coinsurance rate during the benefit year.

• Requires insurers to pay, no later than 45 days after the end of a calendar quarter, an assessment at a rate of two percent of the gross amount of premiums earned by the insurer during that calendar quarter that came from health plans delivered or issued for delivery in Oregon (Sec. 6).

• Establishes that an insurer who does not file a verified form, or pay an assessment required under section 5, chapter 538, in a timely manner will have a penalty that is the greater of (Sec. 7):

• An amount determined under ORS 731.988; or

• Five percent of the assessment due for the calendar quarter.

• Amends section 8, chapter 538, Oregon Laws 2017, to apply to premiums earned by an insurer for the period beginning January 1, 2020, and ending December 31, 2026 (Sec. 8).

• Requires managed care organizations to pay, no later than 45 days after the end of a calendar quarter, an assessment at a rate of two percent of the gross amount of premium equivalents received during that calendar quarter (Sec. 9).

• Amends section 12, chapter 538, Oregon Laws 2017, to apply to any payments made to a managed care organization by the Oregon Health Authority for the period beginning January 1, 2020, and ending December 31, 2026 (Sec. 9).

• Specifies that the assessment paid in accordance with section 3, chapter 538, Oregon Laws 2017, will be excluded in determining the 3.4 percent annual increase in per-member expenditures for health services (Sec. 11).

• Establishes that sections 1 to 9, chapter 736, Oregon Laws 2003, apply to net revenues earned by hospitals during a period starting July 1, 2019, and ending earlier than September 30, 2025, or the date on which the assessment does not qualify for federal financial participation under Title XIX or XXI of the Social Security Act (Sec. 13).

• Establishes that Sections 1 to 9, chapter 736, Oregon Laws 2003, are repealed on January 2, 2031 (Sec. 14).

• Specifies that nothing in the repeal of sections 1 to 9, chapter 736, Oregon Laws 2003, and section 1, chapter 608, Oregon Laws 2013, by section 12, chapter 736, Oregon Laws 2003, affects the imposition and collection of a hospital assessment under sections 1 to 9, chapter 736, Oregon Laws 2003, for a calendar quarter beginning before September 30, 2025 (Sec. 15).

• Establishes that all financial amounts in the Hospital Quality Assurance Fund on December 31, 2031, will be transferred to the General Fund (Sec. 16).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that authorizes the continuation of funding the Oregon Reinsurance Program.

Highlights:

• Defines “attachment point” as the threshold dollar amount, adopted by the Department of Consumer and Business Services by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are eligible for reinsurance payments (Sec. 1).

• Defines “reinsurance cap” as the threshold dollar amount, adopted by the department by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are no longer eligible for state reinsurance payments (Sec. 1).

• Defines “coinsurance rate” as the rate, adopted by the department by rule, at which the department will reimburse a reinsurance eligible health benefit plan for claims costs incurred for an insured individual’s covered benefits in a benefit year after the attachment point and before the reinsurance cap (Sec. 1).

• Authorizes the Department of Consumer and Business Services, after determining the attachment point, reinsurance cap, or coinsurance rate, and if it’s necessary to provide the full amount of funding budgeted for the Oregon Reinsurance Program when received claims are less than the amount of claims that were projected, to be able to (Sec. 1):

• Alter the attachment point or reinsurance cap during that benefit year; or

• Increase the coinsurance rate during the benefit year.

• Requires insurers to pay, no later than 45 days after the end of a calendar quarter, an assessment at a rate of two percent of the gross amount of premiums earned by the insurer during that calendar quarter that came from health plans delivered or issued for delivery in Oregon (Sec. 6).

• Establishes that an insurer who does not file a verified form, or pay an assessment required under section 5, chapter 538, in a timely manner will have a penalty that is the greater of (Sec. 7):

• An amount determined under ORS 731.988; or

• Five percent of the assessment due for the calendar quarter.

• Amends section 8, chapter 538, Oregon Laws 2017, to apply to premiums earned by an insurer for the period beginning January 1, 2020, and ending December 31, 2026 (Sec. 8).

• Requires managed care organizations to pay, no later than 45 days after the end of a calendar quarter, an assessment at a rate of two percent of the gross amount of premium equivalents received during that calendar quarter (Sec. 9).

• Amends section 12, chapter 538, Oregon Laws 2017, to apply to any payments made to a managed care organization by the Oregon Health Authority for the period beginning January 1, 2020, and ending December 31, 2026 (Sec. 9).

• Specifies that the assessment paid in accordance with section 3, chapter 538, Oregon Laws 2017, will be excluded in determining the 3.4 percent annual increase in per-member expenditures for health services (Sec. 11).

• Establishes that sections 1 to 9, chapter 736, Oregon Laws 2003, apply to net revenues earned by hospitals during a period starting July 1, 2019, and ending earlier than September 30, 2025, or the date on which the assessment does not qualify for federal financial participation under Title XIX or XXI of the Social Security Act (Sec. 13).

• Establishes that Sections 1 to 9, chapter 736, Oregon Laws 2003, are repealed on January 2, 2031 (Sec. 14).

• Specifies that nothing in the repeal of sections 1 to 9, chapter 736, Oregon Laws 2003, and section 1, chapter 608, Oregon Laws 2013, by section 12, chapter 736, Oregon Laws 2003, affects the imposition and collection of a hospital assessment under sections 1 to 9, chapter 736, Oregon Laws 2003, for a calendar quarter beginning before September 30, 2025 (Sec. 15).

• Establishes that all financial amounts in the Hospital Quality Assurance Fund on December 31, 2031, will be transferred to the General Fund (Sec. 16).

Full Bill Text