Legislative Update 2009

HR 1424 affects all large-group plans (including self-funded groups) issued or renewed beginning Nov. 1, 2009.

Summary of legislation: Member contribution, including copays, coinsurance, deductible and limitations on coverage, must be on par with coverage for other medical services.

Oregon implementation: For large groups, as they are issued or renewed on Nov 1, 2009 and after, a prior exclusion for more than one long-term mental health residential program per calendar year will be amended to limit mental health residential programs to 60 days per calendar year. In addition, chemical dependency residential programs will be limited to 60 days per calendar year. These changes will apply to small groups as they are issued or renewed Jan . 1, 2010, and after.

Washington implementation: Washington group mental health and chemical dependency benefits are affected by changes in both federal and Washington state requirements. For large-group plans, as they are issued or renewed on Nov. 1, 2009, and after, mental health residential coverage will be limited to 60 days per calendar year. Chemical dependency residential coverage will also be limited to 60 days per calendar year. For small-group plans, as they are issued or renewed Jan. 1, 2010, and after, mental health residential coverage will be limited to 60 days per calendar year. Chemical dependency residential services will be limited to $15,000 every two years.

HR 2851 affects all small- and large-group plans (including self-funded groups) issued or renewed beginning Nov. 1, 2009.

Summary of legislation: Dependent children who are full-time students may retain coverage while on medical leave for up to 12 months (or until the child reaches the limiting age).

S 2499 enacts new reporting requirements that affect all small- and large-group plans (including self-funded groups), effective immediately.

Summary of legislation: Insurers and health plan administrators must provide quarterly enrollment reporting to CMS, including employer tax identification numbers, employer group size (by CMS counting rules) and social security numbers for employees and dependents.

Implementation: Collection and reporting of data is ongoing. Read further information on Medicare secondary payer reporting guidelines.

HR 1 generally applies to self-funded and insured groups, but does not affect members on Oregon or Washington portability plans.

Summary of legislation: Eligible individuals pay only 35 percent of their COBRA or Oregon continuation premiums, and the remaining 65 percent is reimbursed to the employer or to Providence Health Plan through a tax credit. For COBRA coverage, employers continue to pay 100 percent of all COBRA premiums to the insurer. The first premium period affected began on March 1, 2009.

Implementation: Administration of the premium subsidy is ongoing. Read further information on COBRA and state continuation benefits.

A 1 percent tax on health insurance premiums was passed by the Oregon Legislature as part of Oregon House Bill 2116 and was signed into law by Gov. Ted Kulongoski. Together with federal matching funds and a revised tax on hospitals, the premium tax helps fund health care access for about 80,000 of Oregon’s uninsured children and an additional 35,000 low-income adults. HB 2116 (PDF)

What changes for Oregon groups: In response to the new law and in accordance with Oregon Insurance Division guidelines, rates for fully insured groups in Oregon will be adjusted to reflect the new 1 percent tax beginning with the October premium. Billing for the October premium occurs in early September.

Coverage is guaranteed for a large class of genetic diseases that especially affect children and that cause metabolic disorders resulting in a wide range of symptoms. SB 009 (PDF)

What changes for Oregon groups: No change. SB 009 removed the sunset restriction on an earlier bill covering inborn errors of metabolism. The new law is consistent with how the benefit is currently administered in Providence Health Plan group contracts.

Health insurance plans must provide coverage for medically necessary, evidence-based telemedical health service if that same service is covered by the plan when provided in person.
SB 024 (PDF)

What changes for Oregon groups: Clinical services provided to a member by a health care professional through a two-way video communication will be added as a benefit to Providence Health Plan 2010 contracts. The member contribution, including application of deductible, copayment and coinsurance, will be the same as for a comparable health service provided in person.

Health insurance carriers must provide coverage for medically necessary conventional care for members undergoing treatment as part of a qualifying clinical trial. SB 316 (PDF)

What changes for Oregon groups: Coverage for routine care for members participating in qualifying clinical trials is included in Providence Health Plan benefits. Coverage does not include the cost of the drug, treatment or services being investigated; nor does it cover preventing or treating complications that result from the trial.

Coverage must include medically necessary therapy and services for the treatment of traumatic brain injury. SB 381 (PDF)

What changes for Oregon groups: No change. Coverage for traumatic brain injury already is included in Providence Health Plan group contracts.

Health insurance carriers must provide at least $500 in coverage for tobacco use cessation programs for members 15 years old and older. SB 734 (PDF)

What changes for Oregon groups: Coverage for tobacco use cessation programs that are recommended by a physician and include both educational and medical components will be expanded on Providence Health Plan 2010 contracts.

Eligible individuals pay only 35 percent of their Oregon continuation premiums, and the remaining 65 percent is reimbursed to the employer or to Providence Health Plan through a tax credit. HB 2433 (PDF)

What changes for Oregon groups: No change. Administration of the premium subsidy is ongoing. For Oregon continuation coverage, former employees will send an Oregon continuation election form and a subsidy request form to their former employer. Employers should review these forms, complete the employer section and send Providence Health Plan signed copies. Premium bills are adjusted accordingly. Employers are responsible for collecting premiums for continuation members and for paying continuation premiums to Providence Health Plan as billed.

The first premium period affected began on March 1, 2009. Read further information on COBRA and state continuation benefits.

Marriage and family counselors practicing within the scope of their license must be compensated as qualified practitioners when providing covered services. HB 2506 (PDF)

What changes for Oregon groups: Marriage and family counseling services are excluded from coverage on most Providence Health Plan contracts. However, marriage and family counselors can be reimbursed for other covered services when they are practicing within the scope of their licenses.

Health insurance carriers are required to provide coverage for hearing aids for enrollees under 18 years of age. HB 2589 (PDF)

What changes for Oregon groups: Coverage for hearing aids (one per ear) for enrollees under age 18 will be added as a benefit to Providence Health Plan 2010 contracts. The member contribution will be at the same level as other durable medical equipment. Some limits apply. All members have access to hearing aid discounts through Providence Health Plan’s partnership with TruHearing.

The Washington legislative session included signing SB 5725 (PDF) on organ transplant limits into law.

What changes for Washington groups: The organ transplant lifetime benefit limit on Washington commercial small and large group plans issued or renewed on or after Jan. 1, 2010, will be raised to $350,000.