ORS 414.578: Community health improvement plan to address health of children and youth.

(1) A community health improvement plan adopted by a coordinated care organization and its community advisory council in accordance with ORS 414.577 shall include a component for addressing the health of children and youth in the areas served by the coordinated care organization including, to the extent practicable, a strategy and a plan for: (a) Working with programs developed by the Early Learning Council, Early Learning Hubs, the Youth Development Council and the school health providers in the region; and (b) Coordinating the effective and efficient delivery of health care to children and adolescents in the community. (2) A community health improvement plan must be based on research, including research into adverse childhood experiences, and must identify funding sources and additional funding necessary to address the health needs of children and adolescents in the community and to meet the goals of the plan. The plan must also: (a) Evaluate the adequacy of the existing school-based health resources including school-based health centers and school nurses to meet the specific pediatric and adolescent health care needs in the community; (b) Make recommendations to improve the school-based health center and school nurse system, including the addition or improvement of electronic medical records and billing systems; (c) Take into consideration whether integration of school-based health centers with the larger health system or system of community clinics would further advance the goals of the plan; (d) Improve the integration of all services provided to meet the needs of children, adolescents and families; (e) Focus on primary care, behavioral health and oral health; and (f) Address promotion of health and prevention and early intervention in the treatment of children and adolescents. (3) A coordinated care organization shall involve in the development of its community health improvement plan, school-based health centers, school nurses, school mental health providers and individuals representing: (a) Programs developed by the Early Learning Council and Early Learning Hubs; (b) Programs developed by the Youth Development Council in the region; (c) The Healthy Start Family Support Services program in the region; (d) The Cover All People program and other medical assistance programs; (e) Relief nurseries in the region; (f) Community health centers; (g) Oral health care providers; (h) Community mental health providers; (i) Administrators of county health department programs that offer preventive health services to children; (j) Hospitals in the region; and (k) Other appropriate child and adolescent health program administrators. (4) The Oregon Health Authority may provide incentive grants to coordinated care organizations for the purpose of contracting with individuals or organizations to help coordinate integration strategies identified in the community health improvement plan adopted by the community advisory council. The authority may also provide funds to coordinated care organizations to improve systems of services that will promote the implementation of the plan. (5) Each coordinated care organization shall report to the authority, in the form and manner prescribed by the authority, on the progress of the integration strategies and implementation of the plan for working with the programs developed by the Early Learning Council, Early Learning Hubs, the Youth Development Council and school health care providers in the region, as part of the development and implementation of the community health improvement plan. The authority shall monitor statewide progress and the progress of each coordinated care organization related to working with communities and community programs toward improving equitable access to care and the quality of care for children and youth in the areas served by coordinated care organizations. No later than December 31 of each even-numbered year, the authority shall submit a report to the Legislative Assembly that describes the authority’s findings under this subsection. [Formerly 414.629; 2021 c.554 §5; 2025 c.176 §1] Sec. 1. Section 2 of this 2021 Act is added to and made a part of ORS chapter 414. [2021 c.467 §1] Sec. 2. (1) As used in this section, “health equity” has the meaning prescribed by the Oregon Health Policy Board and adopted by the Oregon Health Authority by rule. (2) The authority shall seek approval from the Centers for Medicare and Medicaid Services to: (a) Require a coordinated care organization to spend up to three percent of its global budget on investments: (A)(i) In programs or services that improve health equity by addressing the preventable differences in the burden of disease, injury or violence or in opportunities to achieve optimal health that are experienced by socially disadvantaged populations; (ii) In community-based programs addressing the social determinants of health; (iii) In efforts to diversify care locations; or (iv) In programs or services that improve the overall health of the community; or (B) That enhance payments to: (i) Providers who address the need for culturally and linguistically appropriate services in their communities; (ii) Providers who can demonstrate that increased funding will improve health services provided to the community as a whole; or (iii) Support staff based in the community that aid all underserved populations, including but not limited to peer-to-peer support staff with cultural backgrounds, health system navigators in nonmedical settings and public guardians. (b) Require a coordinated care organization to spend at least 30 percent of the funds described in paragraph (a) of this subsection on programs or efforts to achieve health equity for racial, cultural or traditionally underserved populations in the communities served by the coordinated care organization. (c) Require a coordinated care organization to spend at least 20 percent of the funds described in paragraph (a) of this subsection on efforts to: (A) Improve the behavioral health of members; (B) Improve the behavioral health care delivery system in the community served by the coordinated care organization; (C) Create a culturally and linguistically competent health care workforce; or (D) Improve the behavioral health of the community as a whole. (3) Expenditures described in subsection (2) of this section are in addition to the expenditures required by ORS 414.572 (1)(b)(C) and must: (a) Be part of a plan developed in collaboration with or directed by members of organizations or organizations that serve local priority populations that are underserved in communities served by the coordinated care organization, including but not limited to regional health equity coalitions, and be approved by the coordinated care organization’s community advisory council; (b) Demonstrate, through practice-based or community-based evidence, improved health outcomes for individual members of the coordinated care organization or the overall community served by the coordinated care organization; (c) Be expended from a coordinated care organization’s global budget with the least amount of state funding; and (d) Be counted as medical expenses by the authority in a coordinated care organization’s base medical budget when calculating the coordinated care organization’s global budget and flexible spending requirements for a given year. (4) Expenditures by a coordinated care organization in working with one or more of the nine federally recognized tribes in this state or urban Indian health programs to achieve health equity may qualify as expenditures under subsection (2) of this section. (5) The authority shall: (a) Make publicly available the outcomes described in subsection (3)(b) of this section; and (b) Report expenditures under subsection (2) of this section to the Centers for Medicare and Medicaid Services. (6) Upon receipt of approval from the Centers for Medicare and Medicaid Services to carry out the provisions of this section, the authority shall adopt rules in accordance with the terms of the approval. [2021 c.467 §2] Sec. 2. (1) As used in this section, “health equity” has the meaning prescribed by the Oregon Health Policy Board and adopted by the Oregon Health Authority by rule. (2) The authority shall: (a) Require a coordinated care organization to spend no less than three percent of its global budget on investments: (A)(i) In programs or services that improve health equity by addressing the preventable differences in the burden of disease, injury or violence or in opportunities to achieve optimal health that are experienced by socially disadvantaged populations; (ii) In community-based programs addressing the social determinants of health; (iii) In efforts to diversify care locations; or (iv) In programs or services that improve the overall health of the community; or (B) That enhance payments to: (i) Providers who address the need for culturally and linguistically appropriate services in their communities; (ii) Providers who can demonstrate that increased funding will improve health services provided to the community as a whole; or (iii) Support staff based in the community that aid all underserved populations, including but not limited to peer-to-peer support staff with cultural backgrounds, health system navigators in nonmedical settings and public guardians. (b) Require a coordinated care organization to spend at least 30 percent of the funds described in paragraph (a) of this subsection on programs or efforts to achieve health equity for racial, cultural or traditionally underserved populations in the communities served by the coordinated care organization. (c) Require a coordinated care organization to spend at least 20 percent of the funds described in paragraph (a) of this subsection on efforts to: (A) Improve the behavioral health of members; (B) Improve the behavioral health care delivery system in the community served by the coordinated care organization; (C) Create a culturally and linguistically competent health care workforce; or (D) Improve the behavioral health of the community as a whole. (3) Expenditures described in subsection (2) of this section are in addition to the expenditures required by ORS 414.572 (1)(b)(C) and must: (a) Be part of a plan developed in collaboration with or directed by members of organizations or organizations that serve local priority populations that are underserved in communities served by the coordinated care organization, including but not limited to regional health equity coalitions, and be approved by the coordinated care organization’s community advisory council; (b) Demonstrate, through practice-based or community-based evidence, improved health outcomes for individual members of the coordinated care organization or the overall community served by the coordinated care organization; (c) Be expended from a coordinated care organization’s global budget with the least amount of state funding; and (d) Be counted as medical expenses by the authority in a coordinated care organization’s base medical budget when calculating the coordinated care organization’s global budget and flexible spending requirements for a given year. (4) Expenditures by a coordinated care organization in working with one or more of the nine federally recognized tribes in this state or urban Indian health programs to achieve health equity may qualify as expenditures under subsection (2) of this section. (5) The authority shall: (a) Make publicly available the outcomes described in subsection (3)(b) of this section; and (b) Report expenditures under subsection (2) of this section to the Centers for Medicare and Medicaid Services. (6) The authority shall convene an oversight committee in consultation with the office within the authority that is charged with ensuring equity and inclusion. The oversight committee shall be composed of members who represent the regional and demographic diversity of this state based on statistical evidence compiled by the authority about medical assistance recipients and at least one representative from the nine federally recognized tribes in this state or urban Indian health programs. The oversight committee shall: (a) Evaluate the impact of expenditures described in subsection (2) of this section on promoting health equity and improving the social determinants of health in the communities served by each coordinated care organization; (b) Recommend best practices and criteria for investments described in subsection (2) of this section; and (c) Resolve any disputes between the authority and a coordinated care organization over what qualifies as an expenditure under subsection (2) of this section.