Tuesday, March 4, 2008

What Is The OHP?

Beginning in 1987, a group of Oregonians, appointed by Gov. Neil Goldschmidt, including health care providers and consumers, business, labor, insurers and lawmakers, agreed on a common objective — keep Oregonians healthy. They developed a political strategy to attain their objective, answering three main questions about Oregon's health plan: who is covered, what is covered, how is it financed and delivered. They agreed that:
• All citizens should have universal access to a basic level of care• Society is responsible for financing care for poor people• There must be a process to define a “basic” level of care• The process must be based on criteria that are publicly debated, reflect a consensus of social values, and consider the good of society as a whole• The health care delivery system must encourage use of services and procedures which are effective and appropriate, and discourage over-treatment• Health care is one important factor affecting health; funding for health care must be balanced with other programs which also affect health• Funding must be explicit and economically sustainable• There must be clear accountability for allocating resources and for the human consequences of funding decisionsThe result of this debate: From 1989-1993, the Oregon Legislature passed a series of laws known collectively as the Oregon Health Plan.Senate Bill 27 (1989) extended Medicaid coverage to Oregonians with income below the federal poverty level and established a set of benefits based on a prioritized list of health services. This expansion required waivers of federal law from the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid Services (CMS).SB27 also created the Oregon Health Services Commission to rank medical services from most to least important to the entire population. The Legislature defines the OHP Standard and OHP Plus benefit packages from this list. The prioritized list is maintained by the Health Services Commission.The Health Services Commission, following many hours of public hearings around the state, established a prioritized list of more than 700 physical health, dental, chemical dependency and mental health services. The Legislature sets the funding level to cover a certain number of services on the list, but cannot rearrange the list.

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