Chapter 595 of the 2009 Oregon Laws established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research . Through this program, the Office shall:
This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality. The PCPCH program serves as the pathway for primary care practice participation in all patient-centered medical home related programs in Oregon including the Comprehensive Primary Care initiative, Coordinated Care Organizations, and 2703 Health Homes.
Chapter 602 of the 2011 Oregon Laws established the Oregon Integrated and Coordinated Health Care Delivery System. This law requires the Oregon Health Authority (OHA) to establish standards for using PCPCHs within Coordinated Care Organizations (CCO) and requires CCOs to implement PCPCHs to the extent possible. Standards may require the use of Federally Qualified Health Centers (FQHCs), rural health clinics, school-based health clinics and other safety net providers that qualify as PCPCHs.
The Oregon Health Authority and the Northwest Health Foundation, in partnership with the Oregon Health Care Quality Corporation, launched the Patient-Centered Primary Care Institute in September 2012 to support primary care practice transformation in Oregon. A broad array of resources are available to primary care practices through this program including behavioral health integration support, learning collaboratives and expert networks.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Oregon Comprehensive Primary Care Initiative | Multi-Payer | Statewide | CMS Comprehensive Primary Care Initiative | |
Oregon Comprehensive Primary Care Plus | Multi-Payer | Statewide | CMS Comprehensive Primary Care Plus (CPC+) |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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CMS State Innovation Model (SIM) Test Award - Oregon | Grant | Statewide | CMS State Innovation Model (SIM) | |
Oregon Coordinated Care Organizations (CCOs) | Medicaid | Statewide | Medicaid Section 1115 Waiver | |
Tri-State Child Health Improvement Consortium (T-CHIC) - Oregon | Grant | Alaska, Oregon, West Virginia | CHIPRA Quality Demonstration Grant |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Aetna Patient-Centered Medical Home Program - Oregon | Commercial | Statewide | Aetna Patient-Centered Medical Home Program |
Legislation | Status | Year |
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Chapter 602 of the 2011 Oregon Laws This law established the Oregon Integrated and Coordinated Health Care Delivery System. It requires the Oregon Health Authority (OHA) to establish standards for using PCPCHs within Coordinated Care Organizations (CCO) and requires CCOs to implement PCPCHs to the extent possible. |
Enacted | 2011 |
Chapter 595 of the 2009 Oregon Laws The legislation established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research. This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality. |
Enacted | 2009 |
Oregon Senate Bill 934 - Relating to payments for primary care; creating new provisions; and amending ORS Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. Requires Department of Consumer and Business Services to establish requirements for carrier to submit plan for increasing spending on primary care as percentage of total medical expenditures if carrier is spending less than 12 percent of total medical expenditures. Extends sunset on Primary Care Transformation Initiative.
PASSED - Effective date, January 1, 2018.
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Enacted | 2017 |
SB 765 A: Relating to Primary Care Modifies definitions of "primary care" and "total medical expenditures" for purpose of reports on spending for primary care by insurance carriers, Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations.
Requires all carriers, providing specified health insurance Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations to report on spending anticipated in upcoming year on primary care, and on use of alternative payment methodologies for reimbursing costs of primary care and on percentage of spending on primary care that uses alternative payment methodologies. Requires Department of Consumer and Business Services and Oregon Health Authority to prescribe by rule percentage of primary care expenditures that must be reimbursed using alternative payment methodologies.
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Pending | 2019 |
SB 765 Requires the state's Medicaid Coordinated Care Organizations (CCOs), state-run educators' and public employees' plans and state-regulated health insurance carriers to annually report the percentage of total medical expenditures planned to be spent on primary care, the percentage of spending on primary care that will be made using APMs, and the types of APMs used. Requires CCOs, no later than January 1, 2023 to spend at least 12 percent of total medical expenditures on primary care. Requires the Oregon Health Authority (OHA) to take into account anticipated primary care spending and use of alternative payment methodologies (APMs) when determining CCO global budgets. Requires CCOs, state educators' and public employees health plans, and insurance carriers, no later than January 1, 2023, to reimburse a certain percentage of all primary care costs through APMs. This percentage will be established by Oregon Health Authority and Department of Consumer and Business Services (DCBS). |
Was Not Enacted | 2019 |
SB 231 Requires most large health plans, Public Employees' Benefit Board and the Oregon Educators Benefit Board to report on the percentage of total medical expenditures devoted to primary care. |
Enacted | 2015 |
SB 934 Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. Requires Department of Consumer and Business Services to establish requirements for carrier to submit plan for increasing spending on primary care as percentage of total medical expenditures if carrier is spending less than 12 percent of total medical expenditures. Extends sunset on Primary Care Transformation Initiative. |
Enacted | 2017 |