SB1529 2022 Session _ Insurance Coverage

House Republicans block OHA from receiving executive office powers; instead, guarantee insurance coverage for essential health care visits.

[Amendment B added Governor’s approval to declare an emergency, but isn’t that what we have now that has turned out so poorly?]
This bill allows the Oregon Health Authority’s Public Health Director to declare a health care emergency and to deploy the State Emergency Registry of Volunteers upon approval of the Governor, and provide workers’ compensation coverage for volunteers. Applies existing reimbursement cost-sharing to all contracts between pharmacies and pharmacy benefit managers, and increases access to primary care.

Limited Government
The State Emergency Registry of Volunteers in Oregon (SERV-OR) is a database of health care professionals, including physicians, nurses, pharmacists, Emergency Medical Technicians (EMTs), behavioral health providers, respiratory therapists and others who serve in response to emergencies. Providers who are licensed in another state may practice in Oregon upon declaration of an emergency. SB 1529A allows Assistant Director of the Oregon Health Authority to declare a health care emergency with Governor approval that impacts the economy of the state to make an impactful declaration for the entire state, and to deploy SERV-OR volunteers. Prohibits health benefit plans from excluding coverage for behavior or physical health services based on same day coverage, or impose a copay, or requiring prior authorization provided at specialty facility.

Free Markets
Pharmacy benefit managers (PBMs) are intermediaries between health insurers, pharmacies, wholesalers, and manufacturers. Most health insurers contract with PBMs to provide third-party administrative services for the insurer’s pharmacy benefit. House Bill 2185 (2019) imposed a number of requirements on PBMs operating in the state, including prohibiting the requirement that prescriptions be filled via mail order pharmacy and limiting the retroactive denial or reduction of claims. SB 1529A applies the pharmacy benefit manager requirements established in HB 2185 (2019) to all contracts entered into, renewed, or extended on or after January 1, 2021, and contracts automatically renewed on or after January 1, 2023.

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