PRIORITIZATION OF HEALTH SERVICES A Report to the Governor and the 74th Oregon Legislative Assembly Oregon Health Services Commission Office for Oregon Health Policy and Research Department of Administrative Services 2007 TABLE OF CONTENTS List of Figures . iii Health Services Commission and Staff . .v Acknowledgments . .vii Executive Summary . ix CHAPTER ONE: A HISTORY OF HEALTH SERVICES PRIORITIZATION UNDER THE OREGON HEALTH PLAN Enabling Legislatiion . 3 Early Prioritization Efforts . 3 Gaining Waiver Approval . 5 Impact . 6 CHAPTER TWO: PRIORITIZATION OF HEALTH SERVICES FOR 2008-09 Charge to the Health Services Commission . .. 25 Biennial Review of the Prioritized List . 26 A New Prioritization Methodology . 26 Public Input . 36 Next Steps . 36 Interim Modifications to the Prioritized List . 37 Technical Changes . 38 Advancements in Medical Technology . .42 CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES Practice Guidelines . 47 Age-Related Macular Degeneration (AMD) . 47 Chronic Anal Fissure . 48 Comfort Care . 48 Complicated Hernias . 49 Diagnostic Services Not Appearing on the Prioritized List . 49 Non-Prenatal Genetic Testing . 49 Tuberculosis Blood Test . 51 Early Childhood Mental Health . 52 Adjustment Reactions In Early Childhood . 52 Attention Deficit and Hyperactivity Disorders in Early Childhood . 53 Disruptive Behavior Disorders In Early Childhood . 54 Mental Health Problems In Early Childhood Related To Neglect Or Abuse . 54 Mood Disorders in Early Childhood . 55 Erythropoietin . 55 Mastocytosis . 56 Obesity . 56 Bariatric Surgery . 56 Non-Surgical Management of Obesity . 58 PET Scans . 58 Prenatal Screening for Down Syndrome . 59 Prophylactic Breast Removal . 59 Psoriasis . 59 Reabilitative Therapies . 60 i TABLE OF CONTENTS (Cont’d) CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES (CONT’D) Practice Guidelines (Cont’d) Sinus Surgery . 61 Subtalar Arthroereisis . 61 Ventricular assist devices . 61 Coding Specifications . 62 Adjustment Reactions In Early Childhood . 62 Bariatric Surgery . 62 Statements of Intent . 62 Viral Self-limiting Encephalitis, Myelitis and Encephalomyelitis . 63 Medical Codes Not Appearing on the Prioritized List . 63 CHAPTER FOUR: SUBCOMMITTEES, TASK FORCES AND WORKGROUPS Health Outcomes Subcommittee . 67 Mental Health Care and Chemical Dependency Subcommittee . 67 HSC Actuarial Advisory Committee . 67 HSC Genetics Advisory Committee . 68 Line Zero Task Force . 68 Prioritization Principles Workgroup . 69 2006 Biennial Review Workgroup . 69 CHAPTER FIVE: RECOMMENDATIONS . .73 APPENDIX A: COMMISSION AND SUBCOMMITTE MEMBERSHIP Health Services Commission . .. A-3 Commission Staff . A-8 Mental Health Care and Chemical Dependency Subcommittee . A-9 APPENDIX B: BIENNIAL REVIEW CHANGES APPENDIX C: PRIORITIZED HEALTH SERVICES Frequently Asked Questions: A User’s Guide to the Prioritized List . C-5 2008-09 Prioritized List of Health Services . C-13 Statements of Intent . C-93 Practice Guidelines Guideline Notes for Diagnostic Services Not Appearing on the 2008-09 Prioritized List of Health Services . C-97 Guideline Notes for Health Services Appearing on the 2008-09 Prioritized List of Health Services . C-101 Prevention Tables . C-117 APPENDIX D: INDEXES TO THE 2008-09 PRIORITIZED LIST OF HEALTH SERVICES Condition Index . D-5 Treatment Index . D-61 ii LIST OF FIGURES Figure 1.1 Cost/Utility Formula Used In First Prioritization Attempt . 4 Figure 1.2 Chronology of Oregon’s Health Care Reform Initiatives . 9 Figure 2.1 Rank Order Of Health Care Categories . ..