1. health and fitness

LEGISLATIVE UPDATE
Prepared for OAFP
April 5, 2015
SB 757 – Health Workforce Data Collection & Analysis
This bill would allocate funding ($450,000) to the Oregon Healthcare Workforce
Institute and the Oregon Center for Nursing to collect and analyze data on the health
care incentive programs. Proponents say that the only way for the legislature to make
informed decisions about how to adjust or continue implementation of these programs is
with sufficient data.
There is widespread support from the health care community, including the Oregon
Medical Association, Oregon Academy of Family Physicians, Oregon Rural Health
Association, Oregon Nurses Association, and the Oregon Association of Hospitals and
Health Systems.
Sen. Jeff Kruse (R-Roseburg) voiced his support as well. The committee passed the
bill with a referral to Ways and Means.
HB 3245 – Rural Health Tax Credit Underserved Expansion
This bill, introduced by Rep. Nancy Nathanson (D-Eugene), would add medically
underserved areas to the eligibility requirements for the Rural Health Tax Credit.
Scott Ekblad, Director of the Office of Rural Health, testified that the interim
workgroup on incentive programs had many ideas on how to adjust the Rural Health
Tax Credit, but that the consensus was they did not have enough data to make
informed decisions on how to do so. He estimates that this change would increase the
number of eligible recipients for the tax credit from 2,192 to 7,281.
Doug Barber, representing the Rural Health Association, testified that the goal of
administrative simplification is laudable. The problem is that it expands the tax credit
significantly, which is expensive.
HB 3396 – Combines Loan Repayment and Loan Forgiveness
Rep. Nancy Nathanson (D-Eugene) says Oregon allocates almost $30 million to
attracting and retaining health care providers in underserved communities. HB 3396
takes three of these incentive programs (loan forgiveness, loan repayment and Scholars
for a Healthy Oregon Initiative) that are closely related and puts them together in a
“Health Care Provider Incentive Fund. The bill would also create an advisory committee
to decide how the funding is spent.”
Nathanson told the House Health Committee, “We spend a lot of money, but we don’t
know which of these programs is moving the dial. It is unclear how effective these are
compared to each other or even on their own.” She also noted that because each
program is individually funded, there is no flexibility in addressing the needs of students.
For these reasons, she wants to pool the funding and administration of these programs.
Scott Ekblad, Director of the Office Of Rural Health, testified that OHSU’s Scholars
for a Healthy Oregon is an admissions program and does not really fit with the other
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two. He suggests that it be removed from the bill. He also noted that there is currently
no funding for loan repayment in the Governor and Co-Chairs’ budgets.
HB 3300 – OHP Linked to OEBB/PEBB
There is a large inconsistency between reimbursement rates paid by government
contracts. And while Public Employees' Benefit Board (PEBB) and Oregon Educators
Benefit Board (OEBB) pay at commercial rates, Medicaid reimburses only about 70
cents on the dollar.
This bill would prevent providers from “cherry picking” by requiring primary care
physicians to accept a certain percentage of Medicaid patients if they want to contract
with OEBB and PEBB to provide medical care. Rep. John Lively (D-Springfield)
introduced the bill in order to combat a lack of access to health care providers in Lane
County.
Debbie Farr, representing Trillium, said, “We want to make sure that we have true
access for Oregon Health Plan members.”
Alan Yordy, the President and Chief Mission Officer for PeaceHealth, testified in
support of the bill. “We have experienced in health care the idea of cost shifting for
many years. And while under community benefit we have seen charity care and bad
debt declining, we have seen the decline of Medicare and Medicaid payments as well…
HB 3300 is not a requirement that providers take charity or Medicaid. It’s not a stick. It’s
a carrot, saying that if you want one part of the government’s business, you have to do
this other part as well.”
Rep. Cedric Hayden (R-Cottage Grove) seemed to think the opposite. He said that
he hopes people will keep their minds open to other ways of tackling the same issue.
Rep. Knute Buehler (R-Bend) said repeatedly that we should be addressing the root
of the problem, which is Medicaid underpayment.
HB 2300 – “Right To Try”
Rep. Knute Buehler (R-Bend) led a workgroup on this bill since it was last heard. The
House Health Committee added amendments that:
 Limit the law to persons 15 years of age or older
 Define “terminal” as having 12 months to live
 Require the drugs must have passed Phase 1 FDA testing
 Includes mandatory insurance notification
 Waives liability of insurers and providers
The committee passed the bill unanimously. It now goes to the floor for debate.
SB 661 – Abuse Deterrent Opiod Rx Mandate
This bill would require insurers to reimburse “abuse deterrent opioid analgesic drug
products” at no additional cost from other opioid analgesic drugs. These drugs are
crush-resistant and/or become inactive when diverted into a different form.
Dr. David Russo, a pain management specialist, said, “More Oregonians die from
abuse of prescription drugs than heroin or cocaine combined.” He thinks these drugs
could help deter the abuse of prescription opiates.
Dr. Matthew Mcgaughey, a physical therapist, said, “Abuse deterrent medications
make it more difficult for patients to abuse or misuse them. Hydrocodone is the number
one prescribed medicine in the United States, and the number one most diverted.”
Tom Holt, Cambia, testified against the bill, saying this is an attempt by Pfizer to force
insurers to pay for their new, expensive drug. He said, “There is no strong peer-
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reviewed evidence that these drugs are any safer. According to the Prescription Drug
Monitoring Program, in one month there were 485 opioid prescriptions for every 1000
Oregonians.” He also noted that, “These abuse deterrent opioids cost between $300
and $500, three to five times as expensive as generic opioids.” And to mandate their
use is counterproductive to our efforts to lower the cost of health care.
Sen. Laurie Monnes-Anderson (D-Gresham) says she has no plans of working the
bill this session unless significant new evidence comes forward.
HB 2875 – Strengthen PBM law
Community pharmacists were back at the legislature saying the bill they passed in an
effort to control Pharmacy Benefit Manager (PBM) abuses needs more teeth.
One pharmacist said his chain of ten small pharmacies “had 15,357 claims
reimbursed (by the PBM) below his cost.”
Another pharmacist told of a drug that cost her $688 but the PBM would only pay
$442.
They said the PBM law needs clear enforcement and that changes need to be made
to the Maximum Allowable Cost (MAC) that controls how much they get paid.
SB 415 – Bans the sale of Flavored E-Cigarettes and Smokeless tobacco
There was no discussion as the Senate Health Committee passed the bill with a
referral to the Revenue Committee to discuss the potential impact on revenue for the
state.
SB 833 – CCO 30-day Contract Notice Change
This bill would require the Oregon Health Authority to give coordinated care
organizations (CCOs) at least 30 days' advance notice of proposed contract
amendments.
Bill Guest, Executive Director of Willamette Valley Community Health, testified that
they received their proposed contract from OHA on Christmas Eve. They had less than
seven days to review the complicated proposal and, he said, there was no one at OHA
to respond to questions and concerns — they were on vacation.
OHA did not oppose the bill which was passed by the Senate Health Committee.
SB 7 – OHA IT Procurement
This bill would require the Oregon Health Authority to go through the Department of
Administrative Services (DAS) to procure IT projects. Sen. Peter Courtney introduced
this bill as a direct result of the problems with Cover Oregon.
The Senate Health Committee passed the bill.
SB 916 – Lyme disease Treatment
Brought forward by a number of citizens afflicted with chronic symptoms from Lyme
Disease who claim they were inadequately treated, Senate Bill 916 would require the
Oregon Medical Board and State Board of Nursing to adopt rules regarding the
diagnosis and treatment of Lyme disease that are consistent with guidelines developed
by the International Lyme and Associated Diseases Society.
According to the Oregon Health Authority, “The guidelines developed by the
International Lyme and Associated Diseases Society are not endorsed by the CDC and
conflict with the evidence-based, scientifically supported guidelines developed by the
Infectious Diseases Society of America (IDSA). The IDSA guidelines currently represent
the best available synthesis of the medical literature on the diagnosis and treatment of
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Lyme disease. The IDSA, with input from CDC experts and other doctors, has
developed and published Lyme disease treatment guidelines.“
The Oregon Medical Association opposes the bill. They say using the Oregon
Medical Board to set standards of care is not an appropriate use of the board.
The Oregon Medical Board thinks that setting the standard for care in statute sets a
dangerous precedent for other diseases that have no universal standard of care. The
Oregon Nurses Association opposes the bill for the same reasons.
Sen. Laurie Monnes-Anderson (D-Portland) stated that we need to look at standards
of care in Washington and California but she is hesitant to put standards of care in
statute. She says they won’t move this bill but will look into the issue to better
understand the differences in treatment from state to state.
HB 3347 – Defining person with mental illness for civil commitments
Rep. Val Hoyle (D-Eugene) said this bill would allow someone to be civilly committed
when they are a danger to themselves and others and when they are unable to provide
for personal needs. She and others gave the example of a psychotic homeless woman
who was living in a urine and feces-covered tent, hoarding spoiled food with rats that
she called her friends.
Two people spoke in opposition. One said, “I don’t think this bill is going to solve the
problem. The mental health system, unfortunately, is not a good system.” The other,
Greg Eubank from Eugene, said the bill would result in trying to force people into
treatment that they don’t necessarily want.
HB 3132 – Bonding for behavioral health facilities
Tax-exempt conduit bonds are used to fund the construction of hospitals and longterm care facilities. This bill would add behavioral treatment facilities and battered
women’s shelters to that list.
Rep. Ken Helm (D-Beaverton) told the House Health Committee that 12,000 requests
for shelter from domestic violence went unmet last year. He said this bill would make it
more affordable to build needed facilities.
First Deadline This Friday
Committees have until Friday, April 10 to post work sessions for bills that are still in
their committee of origin. So there will be a mad scramble this week to keep bills alive.
Committees have until Tuesday, April 21 to complete those work sessions. Then the
focus will shift to bills that have already passed the other chamber.
Bills not scheduled by the 10th are considered dead. There are always exceptions but
that is the rule.
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