Bill > HB2029

This bill establishes comprehensive regulations for how insurers and the Oregon Health Authority can conduct audits of behavioral health treatment claims, with the goal of creating more transparent and fair auditing processes. The bill defines key terms like "audit" and "behavioral health treatment" and sets specific rules for insurers and coordinated care organizations (CCOs) when reviewing claims. Insurers and CCOs must provide clear, plain-language documentation of claim requirements, notify providers of changes at least 30 days in advance, and follow strict guidelines during audits. These guidelines include time limitations on when audits can be conducted (no more than 12 months after a claim for insurers, and no more than five years for CCOs), requiring audits to be reviewed by behavioral health professionals, and prohibiting audits that are structured to financially incentivize finding errors. The bill also mandates that insurers and CCOs cannot recoup payments for minor clerical errors, must provide providers opportunities to correct mistakes, and cannot hold patients financially responsible for services that were deemed medically necessary at the time of delivery. Additionally, the Oregon Health Authority is required to collaborate with healthcare providers, CCOs, and community groups to develop recommendations for improving audit processes, with a report due by July 1, 2026. The provisions of the bill will become operative on January 1, 2027, giving organizations time to prepare for the new requirements.

Budget and Finance, Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB2029