OR HB4039

Oregon Health Authority (OHA) must establish a transparent, data-driven process for developing capitation rates for coordinated care organizations (CCOs), including reconciling data with CCOs, publishing preliminary rates for review, and providing 90 days' notice of fee schedule changes.

OHA is prohibited from adopting any new rule, program, or contractual requirement costing $1 million or more per biennium unless required by state or federal law; this prohibition sunsets January 2, 2028.

Three-year moratorium imposed on the requirement for CCOs to spend a portion of annual net income or reserves on addressing health disparities and social determinants of health; the requirement resumes January 1, 2030.

OHA must prepare a medical assistance cost impact statement before adopting any permanent or temporary rule (except procedural rules) and must commission an independent review of the current rate development process with a report due to the Legislature by September 15, 2027.

CCOs receive extended notice periods: 30 days (increased from 14) to refuse contract renewal, and medical loss ratio requirements will be calculated as a three-year rolling average rather than annually.