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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
House Bill 2215
Introduced and printed pursuant to House Rule 12.00. Presession filed (at the request of House Interim Committee
on Behavioral Health and Health Care for Representative Rob Nosse)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure as introduced.The statement includes a measure digest written in compliance with applicable readability
standards.
Digest: The Act changes the process for adopting global budgets for CCOs. (Flesch Readability
Score: 64.9).
Establishes a process for determining global budgets for coordinated care organizations that is
similar to the rate review process for insurers.
Takes effect on the 91st day following adjournment sine die.
A BILL FOR AN ACT
Relating to global budgets for coordinated care organizations; creating new provisions; amending
ORS 414.065; and prescribing an effective date.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Sections 2 and 3 of this 2025 Act are added to and made a part of ORS
chapter414.
SECTION 2. (1) When determining a global budget for a coordinated care organization,
the Director of the Oregon Health Authority shall publish a proposed global budget reflecting
the amounts that the coordinated care organization may be paid for the delivery of, man-
agement of, access to and quality of the health care delivered to members of the coordinated
care organization. A proposed global budget must include sufficient actuarial or other ana-
lyses, calculations or evaluations relied on by the Oregon Health Authority to provide a
reasonable opportunity for interested persons to be apprised of the authority’s rationale for
the proposed global budget. The director shall open a 30-day public comment period on the
proposed global budget. The director shall post all of the comments received to the
authority’s website without delay.
(2) After the close of the public comment period described in subsection (1) of this sec-
tion, the director shall issue a preliminary decision to approve, disapprove or modify the
proposed global budget. The director shall notify the coordinated care organization of, and
make available to the public, the preliminary decision, including:
(a) An explanation of the findings and rationale that are the basis for the preliminary
decision;and
(b) Any actuarial or other analyses, calculations or evaluations relied on by the director
in arriving at the preliminary decision.
(3) The director shall provide the coordinated care organization, or any person adversely
affected or aggrieved by the preliminary decision, the opportunity to meet with the authority
to discuss and respond to the preliminary decision. The meeting shall:
(a) Include an authority employee who reviewed the global budget; and
NOTE:Matter in boldfaced type in an amended section is new; matter [italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
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(b) Comply with the requirements of ORS 192.610 to 192.705.
(4)(a) The director shall issue a proposed order, no later than 30 days after the director
issues a preliminary decision under subsection (2) of this section, to approve, disapprove or
modify the proposed global budget based on the information submitted during the public
commentperiod.
(b) The authority shall mail the proposed order to the coordinated care organization and
post the proposed order to the authority’s website.
(c) The proposed order must include:
(A) An explanation of the findings and rationale that are the basis for the proposed order,
including any actuarial or other analyses, calculations or evaluations relied on by the direc-
tor in the director’s findings or rationale; and
(B) Notice of the right of the coordinated care organization or any person adversely af-
fected or aggrieved by the proposed order to request a review by the director, in accordance
with subsection (6) of this section, no later than 10 days after the date that the proposed
order was issued.
(5) If the coordinated care organization or a person adversely affected or aggrieved by
the proposed order does not timely request a review of the proposed order by the director,
the director shall issue a final order as described in subsection (6)(d) of this section.
(6) If the coordinated care organization or a person adversely affected or aggrieved by
the proposed order timely requests a review by the director of the proposed order:
(a) The requester may not supply new facts or data, but may provide a brief, memoran-
dum or analysis based on the evidence contained in the proposed global budget or received
and considered by the authority during the public comment period;
(b) The director may not delegate the decision-making authority for the request for re-
view to any other individual;
(c) The director shall issue a final order to approve, disapprove or modify the proposed
global budget no later than 30 days after the request for review is received by the director;
and
(d) The final order shall include:
(A) An explanation of the findings and rationale that are the basis for the final order;
and
(B) Notice of the right to a contested case hearing in accordance with ORS chapter 183.
(7)(a) If, following the issuance of a final order under subsection (6)(c) of this section but
before the effective date of the global budget approved by the final order, an event occurs
that materially affects the director’s decision to approve the global budget, the director may
open a new public comment period for a period of time that the director determines is nec-
essary to receive comments concerning the event. Based upon the event and the public
comments received, the director shall affirm the final order by providing a written explana-
tion of the basis for affirming the final order or issue a new proposed order, as described in
subsection (4) of this section.
(b) In the consideration of public comments or the event described in paragraph (a) of
this subsection or in issuing any new proposed order, the director may consider supplemental
facts or data reasonably related to the event described in paragraph (a) of this subsection.
(8) Subsections (2) to (7) of this section do not require the director or the authority to
perform any actuarial or other analyses, calculations or evaluations.
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SECTION 3. No later than December 31 of each year, the Oregon Health Authority shall
report to the Health Care Cost Growth Target program established in ORS 442.386 and to the
interim committees of the Legislative Assembly related to health, in the manner provided in
ORS 192.245, the following information about global budgets for coordinated care organiza-
tions developed by the authority under section 2 of this 2025 Act:
(1) Proposed global budgets, including any actuarial or other analyses, calculations or
evaluations that the authority relied on in developing the proposed global budgets;
(2) A summary of the public comments on the proposed global budgets and a summary
of any reviews requested by a coordinated care organization or a person adversely affected
or aggrieved by a proposed order under section 2 of this 2025 Act; and
(3) Final orders adopting global budgets.
SECTION 4. ORS 414.065, as amended by section 1, chapter 18, Oregon Laws 2024, is amended
to read:
414.065. (1)(a) Consistent with ORS 414.690, 414.710, 414.712 and 414.766 and section 2 of this
2025 Act and other statutes governing the provision of and payments for health services in medical
assistance, the Oregon Health Authority shall determine, subject to such revisions as it may make
from time to time and to legislative funding:
(A) The types and extent of health services to be provided to each eligible group of recipients
of medical assistance.
(B) Standards, including outcome and quality measures, to be observed in the provision of health
services.
(C) The number of days of health services toward the cost of which medical assistance funds
will be expended in the care of any person.
(D) Reasonable fees, charges, daily rates and global payments for meeting the costs of providing
health services to an applicant or recipient.
(E) Reasonable fees for professional medical and dental services which may be based on usual
and customary fees in the locality for similar services.
(F) The amount and application of any copayment or other similar cost-sharing payment that the
authority may require a recipient to pay toward the cost of health services.
(b) The authority shall adopt rules establishing timelines for payment of health services under
paragraph (a) of this subsection.
(2) In making the determinations under subsection (1) of this section and in the imposition of
any utilization controls on access to health services, the authority may not consider a quality of life
in general measure, either directly or by considering a source that relies on a quality of life in
generalmeasure.
(3) The types and extent of health services and the amounts to be paid in meeting the costs
thereof, as determined and fixed by the authority and within the limits of funds available therefor,
shall be the total available for medical assistance, and payments for such medical assistance shall
be the total amounts from medical assistance funds available to providers of health services in
meeting the costs thereof.
(4) Except for payments under a cost-sharing plan, payments made by the authority for medical
assistance shall constitute payment in full for all health services for which such payments of medical
assistance were made.
(5) Notwithstanding subsection (1) of this section, the Department of Human Services shall be
responsible for determining the payment for Medicaid-funded long term care services and for con-
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tracting with the providers of long term care services.
(6) In determining a global budget for a coordinated care organization pursuant to section 2
of this 2025 Act:
(a) The allocation of the payment, the risk and any cost savings shall be determined by the
governing body of the organization;
(b) The authority shall consider the community health assessment conducted by the organization
in accordance with ORS 414.577 and reviewed annually, and the organization’s health care costs;
and
(c) The authority shall take into account the organization’s provision of innovative, nontradi-
tional health services.
(7) Under the supervision of the Governor, the authority may work with the Centers for Medi-
care and Medicaid Services to develop, in addition to global budgets, payment streams:
(a) To support improved delivery of health care to recipients of medical assistance; and
(b) That are funded by coordinated care organizations, counties or other entities other than the
state whose contributions qualify for federal matching funds under Title XIX or XXI of the Social
Security Act.
SECTION 5. Sections 2 and 3 of this 2025 Act apply to global budget determinations for
coordinated care organizations initiated on or after the operative date specified in section 6
of this 2025 Act.
SECTION 6.(1) Sections 2 and 3 of this 2025 Act become operative on January 1, 2026.
(2) The Oregon Health Authority may take any action before the operative date specified
in subsection (1) of this section that is necessary to enable the authority to exercise, on and
after the operative date specified in subsection (1) of this section, all of the duties, functions
an powers conferred on the authority by sections 2 and 3 of this 2025 Act.
SECTION 7.This 2025 Act takes effect on the 91st day after the date on which the 2025
regular session of the Eighty-third Legislative Assembly adjourns sine die.
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