Legislation Signed into Law
|Primary Focus||Updates the requirements for mental health parity coverage for commercial health insurance and Medicaid|
|Title/Description||Promotes the treatment of MH/SUD pursuant to the Federal Parity Law and generally accepted standards of care pursuant to defined parameters.|
HB 3046 amends existing state law by requiring substantive improvements on how insurers and coordinated care organizations cover MH/SUD services. The new statutory provisions will implement the basic requirements embedded in the Federal Parity Law for the covered entities to assess and report how the “processes, strategies, evidentiary standards and other factors used to apply nonquantitative treatment limitations (NQTLs) for MH/SUD treatment are comparable to and applied no more stringently that similar factors for medical/surgical treatment.
The new law requires detailed annual reporting addressing requirements, including how insurers reimburse for MH/SUD services. The new amendments also add more detail identifying what the relevant behavioral health clinical specialties are which are protected under the new requirements. In addition, insurers and coordinated care organizations need to follow generally accepted standards of care (in large part based on the Wit vs. United case) which addresses proper levels of care and the need to treat co-occurring behavioral health conditions among other coverage principles.
In addition, the state law identifies a process of how generally accepted standards of care will be followed during any “medical necessity, utilization, or other clinical review is conducted for the diagnosis, prevention or treatment of behavioral health conditions or relating to service intensity, levels of care placement, continued stay or discharge….” The state also will ensure that insurer networks are providing sufficient access to a range of MN/SUD professionals, which includes factoring the patient’s age, language, culture and complex behavior health conditions.
Most of the amendments go into effect January 1, 2025, but the requirements for utilization management (i.e. OR HB 3046, Section 8) will go into effect January 1, 2023.
Enacted through OR HB 3046; signed by the Governor on July 27, 2021. Elements of the law are based on The Kennedy Forum’s Six Step Compliance Guide and two model laws to promote parity and the generally accepted standards of care. Click here for those resources.
|Primary Focus||Mandated Benefit: SUD|
|Title/Description||Treatment of chemical dependency, including alcoholism, and mental or nervous conditions; rules|
|Citation||ORS § 743A.168|
A group health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide coverage for expenses arising from the diagnosis of and treatment for chemical dependency, including alcoholism, and for mental or nervous conditions at the same level as, and subject to limitations no more restrictive than, those imposed on coverage or reimbursement of expenses arising from treatment for other medical conditions.
Formerly 743.556. Amended by Ore. HB 3091.
|Primary Focus||Access to services/Eligibility|
|Title/Description||Provider networks; rules|
|Citation||ORS § 743B.505|
An insurer offering a health benefit plan in this state that provides coverage to individuals or to small employers, as defined under the law, through a specified network of health care providers shall:
Amended by Ore. HB 2341.
|Status||Signed into Law 8/2017|
This bill changed the section of state insurance law so that the Department of Consumer and Business Services must do the following:
The bill authorized a maximum of $600,000 to fund the examinations and report above.
|Sponsor||Office of the Governor|
|Status||Signed into Law 5/2015|
This bill changed the section of state insurance law so that insurance plans had to meet health care provider network standards. Among other things, the bill requires that a plan’s provider network have a sufficient number, geographic distribution, and type of providers to ensure access to covered services. The bill specifically mentions that mental health and substance use treatment must be accessible.
|Sponsor||Rep. Conger, Sen. Devlin, Rep. McLane, Rep. Parrish, Sen. Hass, and Sen. Johnson|
|Status||Signed into Law 8/2013|
|Summary||This bill changed the section of the state insurance law about autism coverage to what it is currently, particularly the requirements about applied behavior analysis. Scroll to the bottom of the page to read the summary of this section of the law.|
|Sponsor||Rep. Barnhart and Rep. Greenlick|
|Status||Signed into Law 6/2013|
|Summary||This bill changed the parity section of the state insurance law so that insurance plans are no longer exempt from covering court-ordered services that are the result of a conviction for driving while intoxicated.|
|Primary Focus||Parity: General|
|Title/Description||Services provided by psychologist|
|Citation||ORS § 743A.048|
Whenever any provision of any individual or group health insurance policy or contract provides for payment or reimbursement for any service which is within the lawful scope of a licensed psychologist:
|Sponsor||Requested by the Oregon Health Authority|
|Status||Signed into Law 6/2011|
|Summary||This bill changed state law so that court-ordered services that are the result of a conviction for driving while intoxicated can be covered by Medicaid, if the services are medically necessary.|
|Status||Signed into Law 6/2009|
|Summary||This bill changed state law so that if a plan provides coverage for services offered by a clinical social worker, the plan must also cover services provided by a professional counselor or marriage and family therapist.|