February 25, 2008

Speeding to the finish

Many scoffed when the Legislature set a target of Feb. 29 to adjourn the supplemental February 2008 session. But with little money to spend, dozens of bills that cost money, and no office space for legislators to hide from lobbyists, legislators wrapped up their work one week early.

Committees used the time between bills to hold informational hearings on issues that might come up in 2009. All bills with a fiscal impact were referred to the Ways and Means Committee. When the committee did not schedule hearings on some costly bills, tempers flared.

Three issues provided intrigue in the Capitol all month:

• The Legislature ultimately approved the bonds necessary for the University of Oregon's basketball arena to go forward;
• The Legislature passed a measure that will give voters a choice between Kevin Mannix's $200-$400 million lock-'em-up property crimes ballot measure (Initiative Petition 40) and a less-costly legislative alternative; and
• Neither Sen. Ben Westlund (D-Tumalo) nor Speaker Jeff Merkley (D-Portland) were able to round up the votes to pass a bill to crack down on the mortgage lending industry.

Budget picture comes together

Legislative budget leaders spent about $13 million in general fund dollars, and left a $30 million ending fund balance as a rainy day fund. The plan also allows the Department of Human Services to plow $23 million in "rebalance" savings back into DHS programs. Winners included:

• $12.2 million for adult foster care, relative foster care, assisted living centers and stabilizing Oregon Project Independence;
• $7.3 million for additional child welfare workers;
• $2.5 million for statewide grants and a recovery assessment of the Umatilla basin regional aquifer;
• Authorizing 39 additional state troopers and investing $485,000 this biennium to move to 24/7 State Police coverage
• Protecting affordable housing with an investment of $2 million ($1 million in general fund, $1 million from the agency)
• $6.6 million for the Oregon State Hospital;
• $3.9 million for Measure 49 implementation;
• $500,000 for two medical home pilot projects;
• $426,000 for Big Look Task Force Funding;
• $1.6 million for debt restructuring at the Oregon Museum of Science and Industry; and
• $500,000 to help local governments with disaster loans in situations like those recently experienced on the Oregon coast.

Many were disappointed that legislators could not find the money to expand health insurance coverage for 5,000 needy children by increasing the Oregon Health Plan enrollment period from six months to a year. That would have cost $4 million for the remainder of the 2007-09 budget, but the roll-up costs of $20 million in 2009-11 proved too much to overcome.

Expect the Emergency Board to convene in June to make further adjustments.

HB 3614 - Ways and Means drops OHP expansion; funds medical home pilots
The long-term costs of expanding enrollment in the Oregon Health Plan from 6 months to 12 months were too much for the Ways and Means Committee. In the face of the recent $183 million drop in the revenue forecast, Ways and Means is wary of spending millions now that becomes multi-millions in 2009-11. So they dropped plans to expand OHP coverage for children.

But the committee did agree to spend $500,000 in one-time funding for two medical home pilot projects. DHS will administer a grant program for two proposals designed to: improve preventive health services; increase access to appropriate, affordable and efficiently delivered primary care for families; provide new access to health care for children; and explore alternative models for reimbursement of health care services.

One of the grants shall be awarded for a project that predominantly serves a rural area as defined by the Office of Rural Health.

Though HB 3614 never passed, funding for the medical home grants was included in SB 1089.

SB 1089 - Funding to study of gaps in mental health system and medical home models
Community mental health advocates asked the legislature for a $150,000 study of the gaps in the current adult mental health system, and it was funded at the last possible minute. The budget bill (SB 5556) contains $150,000 for this purpose and the companion HB 3626 contains the language explaining the study. The study is due in October 2008.

The bill also includes funding for two medical home pilot projects (see story above).

SB 1075 - Sen. Gordly's mental health task force rides last days' roller coaster
Sen. Avel Gordly's last bill - a task force to develop a plan for a comprehensive, integrated system of mental health and addiction services for seniors, persons with disabilities and persons in underserved racial or ethnic communities - looked as though it would die in the Joint Ways and Means Committee.

So Sen. Gordly (I-Portland) made a motion on the Senate floor to withdraw the bill from committee, but that motion was defeated in a procedural vote, with the Republican senators supporting Senator Gordly's motion and the Democrats opposing it.

But all was not loss. Ways and Means took the essence of Sen. Gordly's bill - an assessment of the community mental health needs of particularly vulnerable populations in this state - and folded it into SB 1089 that will analyze gaps in the mental health system.

Health licensing boards
Rep. Mitch Greenlick (D-Portland) says he plans to introduce an omnibus health licensing board bill for the 2009 session, so he's holding a series of informational hearings in his House Health Committee.

The Governor's office reported that it works with 20 health-related boards, but the rules differ for each one:

• Some require Senate confirmation for Governor appointees.
• Terms of service vary from 3 to 4 years.
• Rules for removal of board members vary from no specified procedure, removal only for cause, to serving at the pleasure of the Governor.

Greenlick is considering standardizing rules for removal, increasing the number of public members serving on health licensing boards, and increased administrative oversight of boards by the executive branch.

Public members from the Dental Board, Pharmacy Board and Board of Medicine testified that public members play an important role on health licensing boards. But they all argued that it would be "disastrous" to have public members make up a majority of the boards.

Patrick Braatz, executive director of the Board of Dentistry, said he managed the health licensing boards in Wisconsin when they went through a similar change, adding public members. He said it resulted in bigger tables and longer meetings, but no difference in discipline for the professions.

Committee hearing on public reporting of malpractice claims
SB 337, signed into law in 2007, allows the Oregon Medical Board to reveal more information about medical malpractice claims that result in an admission of liability, a judicial determination, or a money settlement.

The House Health Care Committee learned late last week that the Oregon Medical Board is interpreting the law to mean that only "claims" need be reported publicly and to be a claim, there must have been a court complaint. Members of the committee think this interpretation is narrower than what they intended. Look for legislation in 2009 to fix the problem.

OHSU plans medical school expansion through regional partners
OHSU is looking to Oregon's System of Higher Education and regional medical providers to increase the number of physicians it can train in its medical school.

UO, OSU and PSU are working with OHSU to develop an Honors Plus program that would allow talented undergraduates to combine their senior year of college with their first year of medical school. Each college campus hopes to begin with 12 students in the program and build up to 45 or 50.

PeaceHealth in Eugene is already providing opportunities for third and fourth year medical rotations. Dr. Ron Stock testified before the Senate Subcommittee on Health Care Reform that PeaceHealth physicians are excited about sharing their knowledge with medical students. So far, 117 doctors in more than a dozen specialties have served as faculty in the program.

OHSU also plans to work with PeaceHealth and other medical systems to expand medical school residency programs.

After hearing the presentations, committee chair Sen. Frank Morse (R-Corvallis) said, "We have to find a way to make this happen."

OHSU is working on a proposal for the 2009 session.

Psychiatrists plan rural partnerships with family physicians
Access to mental health services in rural areas is a hot topic with legislators. Lobbyists for the Oregon Psychiatric Association last week said their organization is planning to launch a program linking psychiatrists with rural family physicians to better serve the mental health needs of patients in rural areas.

FHIAP funding shortfall
Last October, the federal government told Oregon that it could no longer use SCHIP dollars for adults. Instead, Oregon would have to use Medicaid matching funds at a match rate of 61.32 versus the 72.96 match rate for SCHIP. This creates a $5.6 million shortfall for FHIAP (Family Health Insurance Assistance Program) in the current 2007-09 biennium.

The Governor's office did not want to ask for $5 million to make up the difference. Instead, they propose shifting 3,900 from FHIAP to OHP Standard. This will result in fewer slots available for the OHP Standard lottery planned for March. As of last week, more than 66,000 low-income Oregonians had registered for the 10,000 available slots.

Sen. Alan Bates (D-Medford) proposed shifting provider taxes to keep people in FHIAP but the managed care plans and hospitals objected. So the state will ask CMS for a waiver to move FHIAP enrollees with incomes less than 85 percent of the federal poverty level to OHP Standard.

Expanding dependent coverage for young adults
Twenty-somethings in Oregon have the highest rates of uninsurance.

• 41 percent of 20-24 year olds do not have health insurance
• 36 percent of 25-29 year olds lack insurance.

Many of them had health insurance, but lost it when they aged off their parent's plan. Two Willamette University Law School students proposed helping young adults keep their health insurance by expanding dependent coverage.

Rep. Ben Cannon (D-Portland) plans to introduce legislation in the 2009 session, so legislators held an informational hearing on the topic in the House Health Committee.

A growing number of states have passed expanded dependent coverage statutes. New Jersey is the most aggressive, allowing parents to keep dependent children on their plan until age 30.

Insurance carriers said most young adults who want insurance purchase individual plans that are often less expensive than dependent coverage in the small group market. They also expressed concern that less healthy young adults would gravitate to the small group market, while the healthier population would purchase the less expensive individual plans.

Rep. Cannon says every family will make decisions based on what works best for them. He says expanding dependent coverage will simply provide one more option.

Use of psychotropic drugs by foster children
A new draft report by DHS shows that children in the foster care system are prescribed psychotropic drugs at five or six times the rate as other children in the Oregon Health Plan. Members of the House Human Services Committee were shocked to learn that 9 percent of the foster children are on atypical antipsychotics, "which are not approved by FDA for use in children," according to Walter Shaffer, MD, who chairs the DHS Medication Management Workgroup.

Child Welfare told the committee it has only one nurse to review medications for the 2,000 children in foster care. DHS promised that steps will be take to improve oversight, monitoring and access to mental health services.

Rep. Sara Gelser (D-Corvallis) expressed concern that foster children were being medicated when what they need is mental health services. Gelser said reimbursement is a significant problem in the children's mental health system. "The Children's Farm Home in Corvallis had to shut down outpatient services because the state reimbursement is inadequate.

OAFP bill tracking Website: http://www.capitolonramp.com/lts/guests/1437310/

Legislative audio and video: http://www.leg.state.or.us/listn/

For more information contact Doug Barber at dbarber@ulum.com or 541-434-7023.