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Oregon update.

On 30 June the Oregon legislature affirmed its commitment to provide health care for all Oregonians by adopting a standard benefit package for health services that includes 587 lines of the prioritized health service Est developed by the Health Services Commission.

In 1989 the legislature began the process by creating the Health Services Commission, whose mandate was to create a ranked list of health services ordered from the most important to the least important, based on the comparative benefit of each health service to the population to be served. After eighteen months of deliberation, the commission presented a prioritized list of health services to the legislature on 1 May 1991.

After public hearings on what level of benefits should be funded, the legislature drew a line at 587, which represents about 90 percent of the cost of the 709 ranked services. This benefit package now forms the keystone of the Oregon Health Plan. The package will be offered to Medicaid recipients upon receipt of federal waivers, and will form the minimum benefit package to be offered to all employees as of July 1995.

This constitutes a good, comprehensive benefit package which covers the vast majority of those services needed by persons seeking care," State Senate President John Kitzhaber stated. Services provided under the standard benefit package encompass preventive care for children and adults, including dental care, treatment for accidents and injuries, immunizations, prenatal care, and treatment for life-threatening conditions. Organ transplants such as heart transplants for cardiomyopathy, liver transplants for biliary atresia, and bone marrow transplants for acute non-lymphocytic leukemias are examples of covered services.

Significant additional state funding-approximately $30 million in state general funds, to be matched with some $60 million in federal funds-was added to the Medicaid program to ensure that the 120,000 Oregonians with family incomes below the federal poverty level iU be covered. The additional funding was required to assure that effective medical services will be available to all Oregonians.

Oregon continued its reform of the health care financing system by passing additional small market insurance reforms. Guaranteed insurance to small groups, rate bands, and voluntary reinsurance to small insurers represent some of the reforms mandated by the legislature.

In 1993 the Health Services Commission also will include mental health and chemical dependency services in the prioritized list, as well as extend services to the aged, blind, and disabled, and foster children in the Oregon Health Plan.

With the standard benefit package defined, Oregon is now applying for waivers of certain federal Medicaid regulations. Should the waivers be granted, the Oregon Health Plan is scheduled to be implemented July 1992. Paige R. Sipes-Metzer is Executive director, Oregon Health Services Commission, Salem, Ore.

"The legislature has in fact provided adequate funding to achieve real health care reform, certainly when you measure adequacy in terms of continuing the momentum for universal coverage. They voted to fund 98 percent of 'essential' services and 82 percent of 'very important' services, along with some services valuable to certain individuals." The additional state funding for Medicaid answers a concern that otherwise has considerable force-that the plan would 'sock it to poor women and children.' It doesn't." Michael Garland Oregon Health Decisions Diagnosis: Pneumococcal

pneumonia Treatment: Medical therapy Line: 1 Category.- 1 (Essential) Diagnosis: Pregnancy Treatment: Obstetrical care Line: 22 Category. 2 (Essential) Diagnosis: Imminent death Treatment: Comfort care Line: 188 Category: 7 (Essential) Diagnosis: Cataract Treatment: Extraction of

cataract Line: 374 Category. 11 (Very important) Diagnosis: Paraplegia ... Treatment: Medical therapy

and rehabilitation Line: 420 Category. 13 (Very important) Diagnosis: Fracture of facial bones... Treatment: surgery Line: 587 Category: 10 (Very important)
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Title Annotation:Oregon has recently passed legislation providing a standard benefit package for health services
Author:Sipes-Metzler, Paige R.
Publication:The Hastings Center Report
Date:Sep 1, 1991
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