Oregon Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Oregon Grantee: Oregon Department of Consumer and Business Services

Award Date: October 31, 2016

Total Award: $1,245,919

Baseline Award: $476,998

Selected Market Reforms Amount: $510,000

Workload Award Amount: $258,921

• Section 2707 - The Oregon Department of Consumer and Business Services will hire a medical professional with a background in pharmacology to assist in the review of health insurance issuers’ prescription drug formularies that are submitted along with their binders in their annual filings, to better protect consumers and to prevent discrimination in the pricing of prescription drugs.

• Section 2713 - The Oregon Department of Consumer and Business Services will build a field market conduct examination program for enhanced compliance to include a review of health insurance issuers' practices, including but not limited to the issuance of policies, the level of coverage provided under health insurance issuers' policy contracts, and the processing of claims for these benefits.

• Section 2726 - The Oregon Department of Consumer and Business Services will strengthen its field market conduct examination program to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). Market conduct examinations will include a review of benefits provided by health insurance issuers related to all areas of mental health and substance abuse treatment and an evaluation of compliance in the issuance of policies, the level of coverage provided under policy contracts, prior authorizations, communications to members of benefit determinations and the processing of claims for these benefits.