summary
Introduced
01/13/2025
01/13/2025
In Committee
05/27/2025
05/27/2025
Crossed Over
05/08/2025
05/08/2025
Passed
Dead
Introduced Session
2025 Legislative Measures
Bill Summary
The statement includes a measure digest written in compliance with applicable readability standards. Digest: Tells some insurers to report more data to DCBS and makes rules about prior authorization for some procedures. Tells some insurers to use a program by a set date. (Flesch Readability Score: 60.8). Digest: This Act tells insurers, PEBB, OEBB and CCOs to exempt some health care providers from prior authorization in some situations and makes rules about how to do so. Adds reporting rules for these insurers to DCBS and OHA. (Flesch Readability Score: 60.6). Creates a process that exempts certain health care providers from prior authorization requirements under certain circumstances. Requires additional reporting about prior authorization to the De- partment of Consumer and Business Services from insurers offering a health benefit plan and tells the department to make certain this data publicly available. Applies these requirements to commercial health insurance, the Public Employees’ Benefit Board, the Oregon Educators Benefit Board and coordinated care organizations. Takes effect on the 91st day following adjournment sine die. Creates restrictions for prior authorization requirements during certain surgical proce- dures for insurers offering a health benefit plan. Requires certain insurers offering a health benefit plan to implement a prior authori- zation programming interface by January 1, 2027.
AI Summary
This bill aims to improve prior authorization processes for health insurance in Oregon by introducing several key provisions. Specifically, it requires insurers offering health benefit plans to refrain from requiring prior authorization for additional or related medical procedures discovered during an already approved surgical procedure, provided the new procedure is medically necessary and a covered benefit. The bill mandates that insurers implement a prior authorization application programming interface (API) by January 1, 2027, which will enable healthcare providers to electronically determine prior authorization requirements, submit requests, and receive responses through a secure system. Additionally, the bill expands reporting requirements for insurers, requiring them to provide detailed data to the Department of Consumer and Business Services about prior authorization requests, including approval rates, denial rates, appeal outcomes, and average processing times for both standard and expedited requests. The department will be required to publicly publish this data in a format that does not identify specific insurers. These changes apply to commercial health insurance, the Public Employees' Benefit Board, the Oregon Educators Benefit Board, and coordinated care organizations, with the goal of making the prior authorization process more transparent, efficient, and patient-centered.
Committee Categories
Health and Social Services
Sponsors (6)
Rob Nosse (D)*,
Deb Patterson (D)*,
Willy Chotzen (D),
Hai Pham (D),
Lisa Reynolds (D),
Jules Walters (D),
Last Action
Carried over to 06-09 by unanimous consent. (on 06/05/2025)
Official Document
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bill summary
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