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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
Senate Bill 609
Sponsored by Senator CAMPOS; Senators PATTERSON, REYNOLDS, Representative BOWMAN (Presession filed.)
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 tells OHA and CCOs to set minimum rates for reimbursing certain health care
providers. (Flesch Readability Score: 63.6).
Establishes minimum amounts of reimbursement for primary care, optometry, dental care and
behavioral health services provided to recipients of medical assistance.
A BILL FOR AN ACT
Relating to equitable access to health care services.
Whereas it is the intent of the Legislative Assembly to achieve the goals of universal and eq-
uitable access to an appropriate level of high quality health care for all Oregonians; and
Whereas the Legislative Assembly finds that current reimbursement rates in the state medical
assistance program significantly reduce access to primary physical and behavioral health services
for the most vulnerable Oregonians, which perpetuates health inequity; and
Whereas the Legislative Assembly finds that the lack of access to primary care, optometry,
dental care and behavioral health services limits continuity of care and delays timely treatment,
leading to inferior health outcomes and increasing health care costs paid by the people in this state;
and
Whereas the Legislative Assembly finds that approximately 33 percent of Oregonians access
care through the state medical assistance program, which covers nearly half of all births in this
state;and
Whereas the Legislative Assembly finds that a robust primary care system for all Oregonians
will increase equity, quality, reliability, availability and continuity of care, leading to improved
health outcomes and lower costs; now, therefore,
Be It Enacted by the People of the State of Oregon:
SECTION 1. Section 2 of this 2025 Act is added to and made a part of ORS chapter 414.
SECTION 2.(1) As used in this section:
(a) “Behavioral health provider” means a provider, other than a primary care provider,
who is licensed under ORS chapter 675 to provide behavioral health services.
(b) “Behavioral health services” means mental health or substance use disorder treat-
ment and services that are provided in a setting other than a hospital, emergency depart-
ment or urgent care center.
(c) “Conversion factor” means the dollar amount assigned to one unit of the resource-
based relative value.
(d) “Dental care provider” means a provider:
(A) Who is a:
(i) Dentist or dental hygienist licensed by the Oregon Board of Dentistry under ORS
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.
LC 2191 SB609
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chapter 679 or 680; or
(ii) Team of dentists or a dental clinic; and
(B) Who provides dental care services.
(e) “Dental care services” means the following services that are provided in a setting
other than a hospital, emergency department or urgent care center:
(A) Comprehensive primary dental care; or
(B) Basic diagnostic and preventative dental services.
(f) “Optometrist” means a provider licensed under ORS chapter 683 to provide optometry
services.
(g) “Optometry services” means preventative or routine eye examination services that
are provided in a setting other than a hospital, emergency department or urgent care center.
(h) “Primary care provider” means a provider:
(A) Who is a:
(i) Physician licensed by the Oregon Medical Board under ORS chapter 677; or
(ii) Nurse practitioner licensed by the Oregon State Board of Nursing under ORS 678.375
to 678.390; and
(B) Whose clinical practice is:
(i) Family medicine;
(ii) General internal medicine;
(iii) Pediatrics;
(iv) Prenatal and postnatal obstetrics; or
(v) General psychiatry.
(i) “Primary care services” means services provided by a primary care provider in a
setting other than a hospital, emergency department or urgent care center.
(j) “Resource-based relative value” means the weight assigned to a Current Procedural
Terminology code by the Centers for Medicare and Medicaid Services under 42 C.F.R. 414.22
or a weight assigned to a dental service using a methodology similar to the methodology used
by the Centers for Medicare and Medicaid Services under 42 C.F.R. 414.22.
(2)(a) Beginning January 1, 2026, the Oregon Health Authority shall establish the mini-
mum reimbursement amounts paid to a primary care provider, optometrist, dental care
provider or behavioral health provider as follows:
(A) For primary care services and optometry services, a conversion factor of $85 multi-
plied by the resource-based relative value unit assigned to the applicable code for the service
that is published in the most recent Medicare Physician Payment Schedule final rule.
(B) For dental care services, the greater of:
(i) A conversion factor of $85 multiplied by the resource-based relative value unit as-
signed to the applicable code for the service that is published in the most recent Medicare
Physician Payment Schedule final rule, if applicable, or published by the relevant professional
association of dental providers; or
(ii) 100 percent of the average health insurer reimbursement rate for the service.
(C) For behavioral health services, the greater of:
(i) A conversion factor of $85 multiplied by the resource-based relative value unit as-
signed to the applicable code for the service that is published in the most recent Medicare
Physician Payment Schedule final rule; or
(ii) 150 percent of the average health insurer reimbursement rate for the service.
[2] SB609
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(b) For each subsequent calendar year after 2026, the authority shall increase the mini-
mum reimbursement amounts under this subsection by 3.4 percent.
(3) A coordinated care organization shall reimburse contracted primary care providers,
optometrists, dental care providers and behavioral health providers the amounts specified in
subsection (2) of this section excluding any bonus or quality incentive payments received by
the provider. A coordinated care organization may use alternate payment methodologies if
the payments are no less than the amounts specified in subsection (2) of this section.
(4) A coordinated care organization shall expend the portion of any global budget that is
allocated for primary care services, optometry services, dental care services and behavioral
health services solely on the provision of primary care services, optometry services, dental
care services and behavioral health services.
(5) The authority may not request an increase in General Fund appropriations or in ex-
penditure limitations to carry out the provisions of this section but must carry out the
provisions of this section within the authority’s legislatively approved budget.
SECTION 3. (1) The Oregon Health Authority shall monitor and review changes in the
reimbursement amounts paid in accordance with section 2 of this 2025 Act over a four-year
period and prepare a report on whether the reimbursement amounts paid for services de-
scribed in section 2 of this 2025 Act:
(a) Reduced wait times and increased access and provider choice for medical assistance
recipients;
(b) Increased employment of traditional health workers;
(c) Improved health outcomes and equity among medical assistance recipients; and
(d) Reduced costs in the medical assistance program due to lower utilization of services
in higher cost categories of services such as hospital or specialty care services.
(2) The authority shall submit the report prepared in accordance with subsection (1) of
this section to the interim committees of the Legislative Assembly related to health no later
than December 31, 2031.
SECTION 4. No later than 60 days after the effective date of this 2025 Act, the Oregon
Health Authority shall seek approval from the Centers for Medicare and Medicaid Services
to secure federal financial participation in the reimbursement amounts paid to providers
under section 2 of this 2025 Act.
SECTION 5. Sections 2 and 3 of this 2025 Act become operative upon the receipt of ap-
proval from the Centers for Medicare and Medicaid Services under section 4 of this 2025 Act.
[3]