[MyOEBB] OEBB - Notice of Proposed Rulemaking - Hospital Payment Rule Amendments

[MyOEBB system updates]

Date:             November 2, 2020

TO:                Interested Parties

FROM:           April Kelly, OEBB Rules Coordinator

RE:                Notice of Proposed Rulemaking for OARs 111-080-0065 & -0070, OEBB Hospital Payment Proposed Rule Amendments
___________________________________________________________________________
The Oregon Health Authority, Oregon Educators Benefit Board (OEBB), is proposing to permanently amend OARs 111-080-0065 & 111-080-0070, OEBB's Hospital Payment Rules. Senate Bill 1067 (2017 Regular Session) established a cap on OEBB health benefit plan claims payments for inpatient and outpatient hospital services, with payment for in-network hospital services limited to 200% of the amount Medicare would pay for the services and payments to out-of-network hospitals limited to 185% of the amount Medicare would pay for the services. The legislation included provisions specifying that certain hospitals are not subject to these payment caps as well as language requiring that a health plan carrier or third-party administrator that does not reimburse claims on a fee-for service basis take into account the limits established in SB 1067 when determining payments for hospital services. SB 1067 states that such non-fee-for-services, i.e. alternative payment methods, include, but are not limited to, value based payments, capitation payments, and bundled payments.

The proposed amendments to OEBB's established hospital payment rules are necessary to clarify aspects of the hospital reimbursement limit and provide for consistent implementation across OEBB's insurance carriers.

You are being invited to review these proposed rules and to comment on them. If you wish to present oral testimony, a public hearing will be held via conference call on November 19, 2020 at 11:00 am. To provide oral testimony at the hearing, please dial 1-888-398-2342 access code: 537268#. You may also file written comments before 5pm on November 30, 2020 by submitting them to the OEBB Rules Coordinator at the following address:

OHA, OEBB
April Kelly, Administrative Rules Coordinator
500 Summer Street NE, E-88
Salem, Oregon 97301

Written comments may be e-mailed to: April.R.Kelly at state.or.us<mailto:April.R.Kelly at state.or.us> or you may FAX comments to (503) 378-5832.

Final rules will be filed after consideration of all comments and after Board approval. Any comments received after November 30 will not be reviewed or considered by OEBB unless OEBB decides to extend the public comment period to everyone.

For more details, please see the attached Notice of Proposed Rulemaking which includes the full text of these proposed rules.

If you have any questions or would prefer a hardcopy be sent, please contact me at April.R.Kelly at state.or.us<mailto:April.R.Kelly at state.or.us> or (503) 378-6588.

Thank you,
April Kelly
Program Benefits and Services Coordinator
Oregon Educators Benefit Board / Public Employees' Benefit Board
Oregon Health Authority - Health Policy and Analytics
Phone: 503-378-6588
Email: April.R.Kelly at state.or.us


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