Oregon committee hears heated debate over bill to curb insurer audits of behavioral-health providers

The House Committee on Behavioral Health heard more than two hours of testimony Feb. 5 on House Bill 4,028, a measure that would limit how insurers and coordinated care organizations audit behavioral-health providers and add new reporting and transparency requirements.

Representative Rob Noss, chief sponsor, told the committee the bill is meant to ‘‘right-size’’ the audit process for small practitioner providers and make audits more transparent and fair. Noss summarized the bill's three parts: restrictions on commercial insurer audits (sections 1–3), separate rules for coordinated care organizations and Medicaid (sections 4–6), and a new reporting provision (section 7). He said the bill would require audits to be written in plain language, list documents required for claims, and ‘‘identify which requirements may result in recoupment for failure to comply.’’

Supporters, including small-practice clinicians and provider groups, urged passage. JL Wilson of the Oregon Independent Mental Health Professionals summarized sections 1–6 and listed specific protections: a 12-month limit on insurer clawbacks in the commercial market (with…