ORS § 413.022

Current through 2024 Regular Session legislation effective June 6, 2024

Section 413.022 - Metrics and scoring subcommittee; identification of health outcome and quality measures and benchmarks

(1) As used in this section:

(a) "Downstream health outcome and quality measures" means:

(A) The sets of core quality measures for the Medicaid program that are published by the Centers for Medicare and Medicaid Services in accordance with 42 U.S.C. 1320b-9a and 1320b-9b; and

(B) If the sets of core quality measures for adults published by the Centers for Medicare and Medicaid Services do not include quality measures for oral health care for adults, quality measures of oral health care for adults adopted by the metrics and scoring subcommittee.

(b) "Upstream health outcome and quality measures" means quality measures that focus on the social determinants of health.

(2) There is created in the Health Plan Quality Metrics Committee a nine-member metrics and scoring subcommittee appointed by the Director of the Oregon Health Authority. The members of the subcommittee serve two-year terms and must include:

(a) Three members at large;

(b) Three individuals with expertise in health outcomes measures; and

(c) Three representatives of coordinated care organizations.

(3) The subcommittee shall use a public process in accordance with ORS 192.610 to 192.705 that includes an opportunity for public comment to select the downstream health outcome and quality measures and a minimum of four upstream health outcome and quality measures applicable to services provided by coordinated care organizations.

(4) The Oregon Health Authority shall incorporate these measures into coordinated care organization contracts to hold the organizations accountable for performance and customer satisfaction requirements. The authority shall notify each coordinated care organization of any changes in the measures at least three months before the beginning of the contract period during which the new measures will be in place.

(5) The subcommittee shall update the health outcome and quality measures annually, if necessary, to conform to the latest sets of core quality measures published by the Centers for Medicare and Medicaid Services.

(6) All health outcome and quality measures must be consistent with the:

(a) Terms and conditions of the demonstration project approved for this state by the Centers for Medicare and Medicaid Services under 42 U.S.C. 1315; and

(b) Written quality strategies approved by the Centers for Medicare and Medicaid Services under 42 C.F.R. 438.340 and 457.1240.

(7) The authority and the Oregon Health Policy Board shall evaluate on a regular and ongoing basis the outcome and quality measures selected by the subcommittee under this section for members in each coordinated care organization and for members statewide.

(8) Members of the subcommittee who are not members of the Oregon Health Policy Board may receive compensation and the reimbursement of actual and necessary travel and other expenses incurred by them in the performance of their official duties in accordance with criteria adopted by the authority by rule and shall be reimbursed from funds available to the authority in the manner and amount provided in ORS 292.495.

ORS 413.022

Formerly 414.638

413.022 was added to and made a part of ORS chapter 413 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.

Sections 15 and 25, chapter 584, Oregon Laws 2023, provide:

Sec. 15. (1) Notwithstanding ORS 414.638 (3) [renumbered 413.022 (3)], the downstream health outcome and quality measures for reporting year 2024 shall be selected by the metrics and scoring subcommittee from the Health Plan Quality Metrics Committee's Aligned Measure Menu Set adopted by the Health Plan Quality Metrics Committee as of the effective date of this 2023 Act [July 31, 2023].

(2) Notwithstanding ORS 414.638 (3) [renumbered 413.022 (3)], until September 30, 2027, the metrics and scoring subcommittee may prioritize the following upstream health outcome and quality measures, at a minimum:

(a) Health assessments for children in the custody of the Department of Human Services.

(b) Addressing the social and emotional health of young children to ensure the children are prepared for kindergarten.

(d) Screening for social needs and referrals to address the social determinants of health. [2023 c. 584, § 15]

Sec. 25. Section 15 of this 2023 Act is repealed on January 2, 2028. [2023 c. 584, § 25]

Sections 18 and 19, chapter 584, Oregon Laws 2023, provide:

Sec. 18. (1) The Oregon Health Authority shall study the coordinated care organization quality incentive program administered by the authority and the structure of the metrics and scoring subcommittee, created in ORS 414.638 [renumbered 413.022], to develop recommendations for programmatic changes and changes to the subcommittee structure so that the design of the coordinated care organization quality incentive program is primarily focused on addressing health inequities, including the structural drivers of health inequities.

(2) In conducting the study, the authority shall work with individuals whose health is most affected by the medical assistance program and individuals from communities most harmed by health inequities. The authority shall also engage with metrics experts, health care providers, coordinated care organizations and other health system representatives.

(3) Not later than September 15, 2024, the authority shall report to the interim committees of the Legislative Assembly related to health, in the manner provided in ORS 192.245, the findings and recommendations from the study and may include recommendations for legislation. [2023 c. 584, § 18]

Sec. 19. Section 18 of this 2023 Act is repealed on January 2, 2025. [2023 c. 584, § 19]