ORS 413.022: Metrics and scoring subcommittee; identification of health outcome and quality measures and benchmarks.

(1) As used in this section: (a) “Downstream health outcome and quality measures” means: (A) The sets of core quality measures for the Medicaid program that are published by the Centers for Medicare and Medicaid Services in accordance with 42 U.S.C. 1320b-9a and 1320b-9b; and (B) If the sets of core quality measures for adults published by the Centers for Medicare and Medicaid Services do not include quality measures for oral health care for adults, quality measures of oral health care for adults adopted by the metrics and scoring subcommittee. (b) “Upstream health outcome and quality measures” means quality measures that focus on the social determinants of health. (2) There is created in the Health Plan Quality Metrics Committee a nine-member metrics and scoring subcommittee appointed by the Director of the Oregon Health Authority. The members of the subcommittee serve two-year terms and must include: (a) Three members at large; (b) Three individuals with expertise in health outcomes measures; and (c) Three representatives of coordinated care organizations. (3) The subcommittee shall use a public process in accordance with ORS 192.610 to 192.705 that includes an opportunity for public comment to select the downstream health outcome and quality measures and a minimum of four upstream health outcome and quality measures applicable to services provided by coordinated care organizations. (4) The Oregon Health Authority shall incorporate these measures into coordinated care organization contracts to hold the organizations accountable for performance and customer satisfaction requirements. The authority shall notify each coordinated care organization of any changes in the measures at least three months before the beginning of the contract period during which the new measures will be in place. (5) The subcommittee shall update the health outcome and quality measures annually, if necessary, to conform to the latest sets of core quality measures published by the Centers for Medicare and Medicaid Services. (6) All health outcome and quality measures must be consistent with the: (a) Terms and conditions of the demonstration project approved for this state by the Centers for Medicare and Medicaid Services under 42 U.S.C. 1315; and (b) Written quality strategies approved by the Centers for Medicare and Medicaid Services under 42 C.F.R. 438.340 and 457.1240. (7) The authority and the Oregon Health Policy Board shall evaluate on a regular and ongoing basis the outcome and quality measures selected by the subcommittee under this section for members in each coordinated care organization and for members statewide. (8) Members of the subcommittee who are not members of the Oregon Health Policy Board may receive compensation and the reimbursement of actual and necessary travel and other expenses incurred by them in the performance of their official duties in accordance with criteria adopted by the authority by rule and shall be reimbursed from funds available to the authority in the manner and amount provided in ORS 292.495. [Formerly 414.638] Sec. 15. (1) Notwithstanding ORS 414.638 (3) [renumbered 413.022 (3)], the downstream health outcome and quality measures for reporting year 2024 shall be selected by the metrics and scoring subcommittee from the Health Plan Quality Metrics Committee’s Aligned Measure Menu Set adopted by the Health Plan Quality Metrics Committee as of the effective date of this 2023 Act [July 31, 2023]. (2) Notwithstanding ORS 414.638 (3) [renumbered 413.022 (3)], until September 30, 2027, the metrics and scoring subcommittee may prioritize the following upstream health outcome and quality measures, at a minimum: (a) Health assessments for children in the custody of the Department of Human Services. (b) Addressing the social and emotional health of young children to ensure the children are prepared for kindergarten. (c) Meaningful language access to culturally responsive health care services. (d) Screening for social needs and referrals to address the social determinants of health. [2023 c.584 §15] Sec. 25. Section 15 of this 2023 Act is repealed on January 2, 2028. [2023 c.584 §25]