Permanent rule hearing notice filing date: 2/12/2021
Rule Hearing Date: 3/24/2022
Permanent rule filing date: 8/17/2021
Amends: OAR 945-030-0030
Need for the rule and description: The proposed amendment to OAR 945-030-0030 establishes the assessment fees for qualified health plans and stand-alone dental plans for calendar year 2023. ORS 741.105 requires the Oregon Health Authority (OHA) to establish assessment fees for qualified health plans and stand-alone dental plans sold through the health insurance marketplace.
The Oregon Health Insurance Marketplace (Marketplace) office of the Health Policy and Analytics (HPA) division of OHA administers Oregon's health insurance exchange and partners with the federal platform (HealthCare.gov) for enrollment and eligibility determination. The assessment funds Marketplace administrative and operational expenses, as well as grants to navigators, in-person assisters, and application counselors certified under ORS 741.002. The assessment is calculated for each insurer per member-per-month (PMPM) based on the number of individuals who have effectuated enrollment in health insurance policies through the federal platform. These rates are reviewed annually, adjusted based on budget and enrollment projections, and submitted to the OHA director for approval. Proposed changes are subject to rulemaking as amendments to OAR 945-030-0030.
The proposed amendment maintains the current assessment rate of $5.50 PMPM for qualified health plans and $0.36 PMPM for stand-alone dental plans for calendar year 2023.