2007 Legislative Updates
The 2007 Legislative Session adjourned recently ending one of the shortest sessions in history. As in all sessions, there are winners and losers. Here is a list of bills affecting rural health care and how they did this session.
SB 37 Rural Safety Net Bill
SB 37 would have funded the Emergency Medical Services Enhancement Account. In addition, it would have assisted isolated Rural Health Clinics in the forms of technical and financial support as well as provided seed money for Rural Health Viability Grants, which were authorized by the 2001 Legislature but never received the authorized appropriation.
A portion of SB 37 was included in the Healthy Kids Initiative, which passed as SB 3. That proposal will now go to voters in the 2007 November election. In addition to expanding coverage for children, passage would fund and direct the Office of Rural Health to award to rural health care providers grants that promote any of the following goals: (1) Replacement or renovation of aging rural hospitals. (2) Modernization of capital equipment. (3) Preservation of access to local health services in rural areas through short-term support of vulnerable rural health care providers. (4) Expansion of community health educational opportunities. (5) Providing incentives for the development of long-term, sustainable approaches to providing improved health care services and increased access to quality health care in rural areas. (6) Development of collaborative approaches that sustain access to quality rural health care. (7) Expanding or sustaining health care for financially and physically vulnerable rural populations. (8) Providing operational support for rural health centers that are not federally qualified health centers.
SB 162 Modifies EMS Trauma Systems Program
SB 162 was introduced to address recommendations contained in a recent National Highway Transportation Safety Administration (NHTSA) assessment of Oregon emergency medical services system. The bill would: better define the general duties of Emergency Medical Services/Trauma Systems Program (EMS/TS); increase the scope of authority of EMS/TS to include all level of EMS providers and types of response vehicles; provide for medical direction and oversight that supports local service providers; require the development of a comprehensive state EMS plan that focuses on systems of care for life-threatening illness and injury; create meaningful definitions where none existed before; create the State Critical Illness and Serious Injury Steering Committee and clarify roles of existing EMS/TS committees and subcommittees; mandate a comprehensive reporting and data management system that will be linked to quality improvement; allow for enhanced provider reimbursement subject to availability of funds; create a Board of Emergency Responders similar to other health professional boards; and allow the Governor to deploy EMS personnel and equipment during a declared emergency. SB 162 died in committee.
SB 183/HB 3630 Extends Professional Liability Insurance Subsidy
SB 183 continues the Medical Malpractice Reinsurance Program created with the passage of HB 3630 in 2003. Created as a temporary solution for high insurance premiums that were driving rural physicians from practice, the program was originally set to sunset December 31, 2007. The program is now extended to 2011 with changes.
SB 183 will continue to use SAIF funds to reduce the premiums for: doctors specializing in obstetrics and nurse practitioners certified for obstetric care at 80%; for doctors specializing in family or general practice who provide obstetrical services at 60 percent; and 40% for doctors and nurse practitioners engaging in one or more of the following practices: Family practice without obstetrics, General practice, Internal medicine, Geriatrics, Pulmonary medicine, Pediatrics, General surgery, Anesthesiology. Those who do not practice in one of the above areas are covered as follows: 35 percent for calendar year 2008, 25 percent for calendar year 2009, 15 percent for calendar year 2010, 15 percent for calendar year 2011. Funds are estimated to last until 2011. No funds are expected to remain after 2011.
In addition, providers must be willing to serve patients with Medicare and/or Medicaid coverage in at least the same percentage as the Medicare and Medicaid populations in the counties in which they practice.
The ORH will work with SAIF Corp to finalize rules. Program information will be posted on the ORH website in early fall.
SB 188 Oregon Rural Health Services Loan Repayment Program
The Oregon Rural Health Services loan repayment program was created in 1989 (ORS 442.550 – 442.570). It was funded at a level of $400,000 per biennium, and remains at that level today. The program benefits primary care physicians, nurse practitioners, physician assistants, pharmacists and, with the passage of SB 188, dentists.
Since 1994, the first year that loan repayment awards were made, 122 health care professionals have been awarded loan repayment through this program. 38% are physicians, 38% are nurse practitioners, 22% are physician assistants and 2% are pharmacists. Of the 122 awardees, 20% are currently receiving payment, 38% have fulfilled their obligation and completed the program, and 42% either declined or forfeited their award.
SB 188 made programmatic changes in the statute to enable communities to use this program as a direct recruitment incentive, facilitate a higher rate of compliance by loan repayment awardees, encourage donations to the program by rural communities (and enable OSAC to invest those contributions in those same communities) and add dentists to the list of eligible awardees. Additional funds were requested in the Governor’s budget (part of the Oregon Student Assistance Commission budget, HB 5044) but they were not approved by the legislature.
HB 2500/SB 459 Expands tax credit to Firefighters First Responders
Oregon’s current EMT Tax Credit Program, passed in the 2005 legislative session, grants up to $250 in a personal income tax credit for EMTs who volunteer their services to rural Oregon communities. However, the program unintentionally poses eligibility barriers for those who both work as a rural EMT and volunteer their time providing emergency medical services. HB 2500 and SB 459 were introduced to fix the problem. While there was support for the changes, they did not make it through the legislature and the bill died at the time of adjournment.
HB 2201/ SB 3 Creates Oregon Healthy Kids Program
The Governor’s signature health reform, the Healthy Kids Program, was designed to expand coverage for uninsured children. The bill was defeated in the House. Supporters were unable to get the necessary 2/3rd vote to increase the cigarette tax. To keep the plan alive, legislators have referred the measure, passed as SB 3, to the voters this November. In addition, the legislature added portions of SB 37, the Rural Safety Net Bill. If passed by voters, this measure would provide money to the Office of Rural Health to award grants that promote any of the following goals: replacement or renovation of aging rural hospitals; modernization of capital equipment; preservation of access to local health services in rural areas through short-term support of vulnerable rural health care providers; expansion of community health educational opportunities; providing incentives for the development of long-term, sustainable approaches to providing improved health care services and increased access to quality health care in rural areas; development of collaborative approaches that sustain access to quality rural health care; expanding or sustaining health care for financially and physically vulnerable rural populations; providing operational support for rural health centers that are not federally qualified health centers.
SB 329 The Healthy Oregon Act
SB 329 was developed by the interim Senate Commission on Health Care Access and Affordability, chaired by Sen. Ben Westlund and Sen. Alan Bates. It is the result of work from the Commission along with components of Governor John Kitzhaber’s Archimedes plan, Governor Kulongoski’s Oregon Health Policy Commission and the Oregon Business Council Proposal. In addition, there was input from citizens throughout the state.
SB 329 did pass with a number of changes. The bill creates the Oregon Health Fund Board, with a mandate to develop a plan for an affordable health system to be acted upon by the 2009 legislature.
The Health Fund Board would be charged with developing a plan to provide essential health services to all Oregonians. The board will consist of seven members appointed by the Governor and confirmed by the Senate. Board members will be aided by professional staff from the Oregon Health Policy Commission, the Office for Oregon Health Policy and Research, the Health Services Commission, and the Medicaid Advisory Committee.
The Oregon Health Fund Board will create subcommittees that examine financing, the delivery system, benefits, and eligibility and enrollment of health care policies. They will also establish a federal policy committee to study the impact of federal laws on health care goals and ask the Oregon congressional delegation to take action.