Healthcare (Insurance)

SB 1527 requires Oregon’s Public Employees’ Benefit Board and Oregon Educators Benefit Board to cover cervical cancer screenings and necessary follow-up tests (like colposcopy or biopsies) without cost-sharing for their members. The bill amends Oregon health insurance laws to mandate this coverage under specific benefit plans. It applies to health benefit plans issued, renewed, or extended on or after the bill’s effective date. The law ensures these screenings and follow-up care are fully covered at no cost to enrollees. This directly affects public employees and educators enrolled in these state benefit programs.

Modifies the requirements for screening a hospital patient for presumptive eligibility for financial assistance. [ Prohibits the Oregon Health Authority from requiring certain home health agencies to comply with Medicare conditions of participation. ] [ Modifies the requirements for how the Department of Human Services must publish Residential Care Quality Measurement Program data. ] Removes the requirement that an applicant for a residential care facility administrator license hold a bachelor's degree in a health or social service related field. Allows a person residing in a correctional facility to receive prerelease medical assistance benefits under certain circumstances. [ Prohibits the authority or a coordinated care organization from requiring prior authorization for medical assistance coverage for repairing complex rehabilitation technology if the repair costs $1,500 or less. ] Modifies the requirements for meetings held by the Health Evidence Review Commission. Modifies the composition of the Medicaid Advisory Committee. Modifies the eligibility requirements for parent providers who are paid to provide attendant care services to their children. {See A-Eng Bill for omitted text.} Allows a full-time dentistry student enrolled in an out-of-state dental education program to practice dentistry without a license if the student is supervised by a faculty member of a dental education program accredited by the Commission on Dental Accreditation of the American Dental Association. Requires casualty or health insurance policies to provide coverage for medically necessary anesthesia services, regardless of duration, for any covered procedures. Requires dental insurers to follow certain rules for payment and denial of claims. Requires the Legislative Policy and Research Director to develop and propose to the [ Legislative Policy and Research Committee ] committees with jurisdiction over health care an insurance coverage mandate impact statement policy. Directs the [ committee ] committees to perform due diligence in considering the proposal and authorizes the [ committee ] committees to modify the proposal if the [ committee ] committees so [ determines ] determine , and then to adopt the policy. Repeals requirement that enrollees in individual or group policies or certificates of health insurance [ or members of coordinated care organizations ] be assigned by their insurer [ or organization ] to primary care providers under certain circumstances. Specifies exemptions from the requirement that pharmacy services administrative organizations must register with the Department of Consumer and Business Services as third party administrators. {See A-Eng Bill for omitted text.} Modifies requirements for the Prescription Drug Affordability Board's annual affordability determination for insulin products. Allows licensees of the Occupational Therapy Licensing Board and the Oregon Board of Physical Therapy to provide psilocybin services as licensed psilocybin service facilitators while providing occupational therapy or physical therapy services. {See A-Eng Bill for omitted text.} Lowers the age at which a naturopathic physician may request a retired license status from 70 years of age to [60] 65 years of age. Includes nurse practitioners and physician associates in the definition of "attending physician" for purposes of the treatment of workers’ compensable injuries. Declares an emergency, effective on passage.

] Imposes requirements and restrictions on insurer and coordinated care organization audits of claims for reimbursement submitted by behavioral health treatment providers. Becomes operative on January 1, 2027. Adds information that certain carriers must annually report to the Department of Consumer and Business Services regarding compliance with behavioral health parity requirements. [ Takes effect on the 91st day following adjournment sine die. ].

Requires certain health insurers offering a health benefit plan in this state that provide utilization review or have utilization review provided on their behalf to notify a health care provider each time the insurer uses artificial intelligence or other automated technology to automatically downcode a claim for reimbursement submitted by the provider. Requires insurers to make an appeals process available to a provider who has had a claim automatically downcoded using artificial intelligence or other automated technology.