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<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">Date: November 2, 2020</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">TO: Interested Parties</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">FROM: April Kelly, OEBB Rules Coordinator</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">RE: Notice of Proposed Rulemaking for OARs 111-080-0065 & -0070, OEBB Hospital Payment Proposed Rule Amendments</span><span lang="EN"><br>
</span><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">___________________________________________________________________________</span><span lang="EN"><o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">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.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">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.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">You are being invited to review these proposed rules and to comment on them.<strong><span style="font-family:"Arial",sans-serif"> If you
wish to present oral testimony, a public hearing will be held via conference call on November 19, 2020 at 11:00 am.
</span></strong>To provide oral testimony at the hearing, <strong><span style="font-family:"Arial",sans-serif">please dial 1-888-398-2342 access code: 537268#.</span></strong> <strong><span style="font-family:"Arial",sans-serif">You may also file written comments
before 5pm on November 30, 2020</span></strong> by submitting them to the OEBB Rules Coordinator at the following address:</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">OHA, OEBB</span><span lang="EN"><br>
</span><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">April Kelly, Administrative Rules Coordinator</span><span lang="EN"><br>
</span><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">500 Summer Street NE, E-88</span><span lang="EN"><br>
</span><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">Salem, Oregon 97301</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">Written comments may be e-mailed to:
<a href="mailto:April.R.Kelly@state.or.us" target="_blank">April.R.Kelly@state.or.us</a> or you may FAX comments to (503) 378-5832.</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">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.</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">For more details, please see the attached Notice of Proposed Rulemaking which includes the full text of these proposed rules.
</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">If you have any questions or would prefer a hardcopy be sent, please contact me at
<a href="mailto:April.R.Kelly@state.or.us" target="_blank">April.R.Kelly@state.or.us</a> or (503) 378-6588.</span><span lang="EN"><o:p></o:p></span></p>
<p><span lang="EN" style="font-size:12.0pt;font-family:"Arial",sans-serif">Thank you,</span><span lang="EN"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family:"Arial",sans-serif">April Kelly<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Program Benefits and Services Coordinator<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Oregon Educators Benefit Board / Public Employees’ Benefit Board<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Oregon Health Authority – Health Policy and Analytics<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Phone: 503-378-6588<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Email: <a href="April.R.Kelly@state.or.us">
April.R.Kelly@state.or.us</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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