justicedao/ipfs_state_laws huggingface dataset:
407-120-0150 Testing — EDI Transactions (1) When a trading partner or authorized EDI submitter registers an EDI transaction with the Department, the Department may require testing before authorizing the transaction. Testing may include third party and business-to-business testing. An EDI submitter must be able to demonstrate its capacity to send and receive each transaction type for which it has registered. The Department will reject any EDI transaction if an EDI submitter either refuses or fails to comply with the Department testing requirements. (2) The Department may require EDI submitters to complete compliance testing at an EDI submitter's expense for each transaction type if either the Department or an EDI submitter has experienced a change to hardware or software applications by entering into business-to-business testing. (3) When third party or business-to-business testing is completed to the Department's satisfaction, the Department will notify an EDI submitter that it will register and accept the transactions in the production environment. This notification authorizes an EDI submitter to submit the registered EDI transactions to the Department for processing and response, as applicable. If there are any changes in the trading partner or EDI submitter authorization, profile data or EDI registration information on file with the Department, updated information must be submitted to the Department as required in OAR 407-120-0190. (4) Testing will be conducted using secure electronic media communications methods. (5) An EDI submitter may be required to re-test with the Department if the Department format changes or if the EDI submitter format changes. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DHSD 13-2011, f. & cert. ef. 12-27-11 DHSD 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11 Renumbered from 410-001-0150, DHSD 1-2008, f. & cert. ef. 2-1-08 DMAP 30-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08 OMAP 55-2003, f. & cert. ef. 8-22-03 OMAP 25-2003(Temp), f. & cert. ef. 3-21-03 thru 9-8-03
407-120-0165 Pharmacy Point of Sale Access Pharmacy providers who electronically bill pharmaceutical claims must participate in and submit claims using the POS system, except as provided in OAR 410-121-0150. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: DHSD 1-2008, f. & cert. ef. 2-1-08 DHSD 13-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08
407-120-0180 Record Retention and Audit (1) Records Retention. A provider, web portal submitter, trading partner, and EDI submitter shall maintain, for a period of no less than seven years from the date of service, complete, accurate, and unaltered copies of all source documents associated with all data transmissions. (2) EDI Trade Data Log. An EDI submitter must establish and maintain a trade data log that must record all data transmissions taking place between an EDI submitter and the Department during the term of a TPA. A trading partner and EDI submitter must take necessary and reasonable steps to ensure that the trade data log constitutes a current, truthful, accurate, complete, and unaltered record of all data transmissions between the parties and must be retained by each party for no less than 24 months following the date of the data transmission. The trade data log may be maintained on electronic media or other suitable means provided that, if necessary, the information may be timely retrieved and presented in readable form. (3) Right to Audit. A provider must allow and require any web portal submitter to allow, and a trading partner must allow and require an EDI submitter or other agent to allow access to the Department, the Oregon Secretary of State, the Oregon Department of Justice Medicaid Fraud Unit, or its designees, and DHHS or its designees to audit relevant business records, source documents, data, data transmissions, trade data logs, or information systems of a provider and its web portal submitter, and a trading partner, and its agents, as necessary, to ensure compliance with these rules. A provider must allow and require its web portal submitter to allow, and a trading partner must allow and require an EDI submitter or other agent to allow the Department, or its designee, access to ensure that adequate security precautions have been made and are implemented to prevent unauthorized disclosure of any data, data transmissions, or other information. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: Renumbered from 410-001-0180, DHSD 1-2008, f. & cert. ef. 2-1-08 DMAP 30-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08 OMAP 55-2003, f. & cert. ef. 8-22-03 OMAP 25-2003(Temp), f. & cert. ef. 3-21-03 thru 9-8-03
407-120-0190 Material Changes (1) Changes in Any Material Information – EDT Process. A trading partner must submit an updated TPA, application for authorization, or EDI registration form to the Department within ten business days of any material change in information. A material change includes but is not limited to mailing or email address change, contract number or contract status (termination, expiration, extension), identification of authorized individuals of a trading partner or EDI submitter, the addition or deletion of authorized transactions, or any other change that may affect the accuracy of or authority for an EDI transaction. The Department may act on data transmissions submitted by a trading partner and its EDI submitter based on information on file in the application for authorization and EDI registration forms until an updated form has been received and approved by the Department. A trading partner’s signature or the signature of an authorized EDI submitter is required to ensure that an updated TPA, authorization, or EDI registration form is valid and authorized. (2) Changes in Any Material Information – Web Portal Access. Providers must submit an updated web portal registration form to the Department within ten business days of any material changes in information. A material change includes but is not limited to mailing or email address change, contract number or contract status (termination, suspension, expiration), identification of web portal submitter contact information, or any other change that may affect the accuracy of or authority for a DDE transaction. The Department is authorized to act on data transmissions submitted by a provider and its web portal submitter based on information on file in the web portal registration form until an updated form has been received and approved by the Department. A provider’s signature or the signature of an authorized business representative is required to ensure that an updated web portal registration form is valid and authorized. (3) Failure to submit a timely updated form may impact the ability of a data transaction to be processed without errors. Failure to submit a signed, updated form may result in the rejection of a data transmission. Statutory/Other Authority: ORS 409.050 & 414.065 Statutes/Other Implemented: ORS 414.065 History: Renumbered from 410-001-0190, DHSD 1-2008, f. & cert. ef. 2-1-08 DMAP 30-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08 OMAP 55-2003, f. & cert. ef. 8-22-03 OMAP 25-2003(Temp), f. & cert. ef. 3-21-03 thru 9-8-03
407-120-0380 Fraud and Abuse (1) Providers shall promptly refer all suspected fraud and abuse, including fraud or abuse by its employees or in Department administration, to the MFCU, or to the Department's audit unit. (2) Providers must permit the MFCU and the Department to inspect, copy, evaluate, or audit books, records, documents, files, accounts, and facilities, without charge, as required to investigate allegations or incidents of fraud or abuse. (3) Providers aware of suspected fraud or abuse by a client must report the incident to the Department's fraud unit. (4) The Department may share information for health oversight purposes with the MFCU and other federal or state health oversight authorities. (5) The Department may take actions necessary to investigate and respond to substantiated allegations of fraud and abuse including but not limited to suspending or terminating the provider from participation in the Department's programs, withholding payments or seeking recovery of payments made to the provider, or imposing other sanctions provided under state law or regulations. Such actions by the Department may be reported to CMS or other federal or state entities as appropriate. Statutory/Other Authority: ORS 409.050 & 411.060 Statutes/Other Implemented: ORS 414.115, 414.125, 414.135 & 414.145 History: DHSD 11-2008, f. 12-26-08, cert. ef. 12-27-08 DHSD 6-2008(Temp), f. & cert. ef. 7-1-08 thru 12-27-08 DHSD 15-2007, f. 12-31-07, cert. ef. 1-1-08
409-001-0005 Model Rules of Procedure The Oregon Health Authority, Health Policy and Analytics Division adopts the Attorney General’s Uniform and Model Rules of Procedure applicable to rulemaking, effective July 2016. [ED. NOTE: The full text of the Attorney General’s Model Rules of Procedure is available from the Office of the Attorney General or the Oregon Health Authority.] Statutory/Other Authority: ORS 183.341 & 413.042 Statutes/Other Implemented: ORS 183.341 & 413.042 History: OHP 25-2019, minor correction filed 12/27/2019, effective 12/27/2019 OHP 4-2018, amend filed 06/11/2018, effective 06/11/2018 OHP 1-2002, f. & cert. ef. 1-2-02 OHP 1-1998, f. & cert. ef. 5-6-98 OHP 1-1997, f. & cert. ef. 8-25-97 HP 1-1996, f. & cert. ef. 1-2-96 HP 1-1994, f. & cert. ef. 4-22-94 HP 1-1992, f. & cert. ef. 6-8-92 HP 6-1990, f. & cert. ef. 6-13-90 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 1-1987, f. & ef. 2-3-87 SHPD 12-1985, f. & ef. 11-15-85 SHPD 40-1983, f. & ef. 11-21-83 SHPD 8-1981, f. & ef. 11-18-81 SHPD 1-1980, f. & ef. 2-19-80 SHPD 2, f. & ef. 11-2-77 SHPD 1(Temp), f. & ef. 8-19-77
409-015-0005 Definitions The following definitions apply to OAR 409-015-0005 through 409-015-0040: (1) “Authority” means the Oregon Health Authority. (2) "Charity care" means the uncollectible value, at the hospital's full established rates, of services provided to financially indigent patients. The uncollectible portion may vary from a very small percentage of the regular charges for some patients, up to 100 percent for other patients. (3) "Health care facility" means a hospital, including any special inpatient care facility, and an ambulatory surgical facility. The following facilities are not covered: (a) Institutions providing only domiciliary care; (b) Infirmaries of state institutions, colleges and universities; (c) Federal facilities; and (d) Long-term care facilities, or hospital-based long-term care service. (4) "Medicare and Medicaid deductions" means the uncollectible differences between the hospital's full established charges for individual services and the rates paid by Medicare or Medicaid for composite services. (5) "Other contractual deductions" means the uncollectible differences between full established charges for individual services and the contractual rates paid by a third-party payer for composite services, usually on a per diem, per discharge or capitation basis. (6) "Provision for bad debts" means the estimated amount of accounts receivable expected to result in credit losses. (7) "Unreimbursed care" means the sum of the provision for bad debts plus charity service, Medicare deductions, Medicaid deductions and contractual deductions. Statutory/Other Authority: ORS 442.400 & 442.420 Statutes/Other Implemented: ORS 442.400 & 442.420 History: OHP 4-2016, f. & cert. ef. 3-28-16 OHP 1-2002, f. & cert. ef. 1-2-02 OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 OHP 1-1997, f. & cert. ef. 8-25-97 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1994, f. & cert. ef. 4-22-94 HP 2-1992, f. & cert. ef. 10-19-92 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 1-1987, f. & ef. 2-3-87 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82 SHPD 6-1981, f. & ef. 10-2-81 SHPD 1-1979, f. & ef. 6-1-79
409-015-0010 Report Forms (1) All health care facilities shall file the required reports and data on forms provided or approved by the Authority. (2) The Authority adopts and incorporates by reference the Patient Revenue and Unreimbursed Care form, Form FR-3. (3) The Authority shall not accept obsolete forms. [ED. NOTE: Forms referenced are available from the agency.] Statutory/Other Authority: ORS 442.405, 442.420 & 442.425 Statutes/Other Implemented: ORS 442.425 History: OHP 4-2016, f. & cert. ef. 3-28-16 OHP 3-2011, f. 2-8-11, cert. ef. 3-1-11 OHP 1-2002, f. & cert. ef. 1-2-02 OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 OHP 1-1997, f. & cert. ef. 8-25-97 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1994, f. & cert. ef. 4-22-94 HP 2-1992, f. & cert. ef. 10-19-92 HP 2-1990, f. & cert. ef. 2-12-90 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 12-1986, f. & ef. 7-7-86 SHPD 18-1984, f. & ef. 12-20-84 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82 SHPD 6-1981, f. & ef. 10-2-81 SHPD 1-1979, f. & ef. 6-1-79
409-015-0012 Filing Date The date of filing for the Databank Monthly Data electronically, is the date of receipt by the Oregon Association of Hospitals and Health Systems. The date of filing for the Patient Revenue and Unreimbursed Care (Form FR-3) is the postmark date. [ED. NOTE: Forms referenced are available from the agency.] Statutory/Other Authority: ORS 442.405, 442.420 & 442.425 Statutes/Other Implemented: ORS 442.425 History: OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10 OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1990, f. & cert. ef. 2-12-90 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 18-1984, f. & ef. 12-20-84 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82
409-015-0015 Reports Required (1) Each health care facility shall file with the Authority financial statements, with attached certification of audit, not later than 120 days following the close of each fiscal year. If the financial statements of the facility are a part of the combining of a for-profit or not-for-profit corporation, the combining financial statements and attached certification of audit shall be filed. (2) Each health care facility shall file an accurately completed Databank Monthly Data electronically with the Oregon Association of Hospitals and Health Systems (OAHHS) for receipt by OAHHS on or before the 23rd day of each month. This form will transmit data for the preceding month. The Authority may, at its discretion, exempt a special inpatient care facility, ambulatory surgical facility or other health care facility from the requirements of this section. The Authority may, by oral or written notification, require a health care facility to use an express mail service to submit the Databank Monthly Data Input Form to OAHHS. (3) The Authority may annually require that each health care facility provide a breakdown of its unreimbursed care into bad debts, charity care, Medicare deductions, Medicaid deductions and other contractual deductions, using Form FR-3. (4) Each health care facility may be required to annually submit to the Authority a breakdown of its gross patient service revenue into inpatient revenue and outpatient revenue, and other applicable categories specified by Form FR-3. (5) Documents filed with the Authority under these rules are to be addressed to the Oregon Health Authority, Health Systems Research & Data, 500 Summer St. NE E-64, Salem, Oregon 97301-1079. [ED. NOTE: Forms referenced are available from the agency.] Statutory/Other Authority: ORS 442.405, 442.420 & 442.425 Statutes/Other Implemented: ORS 442.425 History: OHP 4-2016, f. & cert. ef. 3-28-16 OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10 OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1990, f. & cert. ef. 2-12-90 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 12-1986, f. & ef. 7-7-86 SHPD 18-1984, f. & ef. 12-20-84 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82 SHPD 6-1981, f. & ef. 10-2-81 SHPD 1-1979, f. & ef. 6-1-79
409-015-0022 Instructions to Form RR-4 Text in ORMS History: OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 HP 2-1990, f. & cert. ef. 2-12-90 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 18-1984, f. & ef. 12-20-84 Reverted to OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 Sunset on 09-28-2017
409-015-0030 Modification of Reporting Requirements (1) The Authority, upon request of a health care facility and for good cause, may relieve or modify the reporting requirements provided for in these rules when the reporting requirement is proven to the satisfaction of the Authority to impose an undue hardship. (2) Unless otherwise specified by the Authority, any relief or modification granted under section (1) of this rule is restricted to the specific instance or occasion for which relief was sought, and may not be construed to relieve any other reporting requirements of the health care facility. Statutory/Other Authority: ORS 442.405, 442.420 & 442.425 Statutes/Other Implemented: ORS 442.425 History: OHP 4-2016, f. & cert. ef. 3-28-16 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82 SHPD 6-1981, f. & ef. 10-2-81 SHPD 1-1979, f. & ef. 6-1-79
409-015-0035 Civil Penalties (1) Pursuant to ORS 442.445, the Authority adopts the following schedule of civil penalties: (a) $250.00 per day for the first five days of failure to file in accord with ORS 442.425; and (b) $500.00 per day from the sixth day until filing in accordance with ORS 442.425 is satisfactorily accomplished. (2) Any amount of civil penalty imposed by the Authority may not be allowed as a reimbursable cost item and may not be recoverable from any category of payment source or patient. Statutory/Other Authority: ORS 442.405, 442.420 & 442.445 Statutes/Other Implemented: ORS 442.445(2) History: OHP 4-2016, f. & cert. ef. 3-28-16 OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99 HP 2-1991, f. & cert. ef. 11-8-91 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 21-1983, f. & ef. 6-28-83 SHPD 9-1982(Temp), f. & ef. 12-30-82 SHPD 6-1981, f. & ef. 10-2-81 SHPD 1-1979, f. & ef. 6-1-79
409-017-0121 Dental Therapy Definition of Underserved Populations (1) The purpose of this rule is to define the term “underserved population” per ORS 679.624 for the Board of Dentistry Dental Therapy rules. (2) The term “Underserved Population” refers to populations experiencing a shortage of dental health services due to systemic inequities causing an inability to pay, lack of access to culturally responsive, linguistically appropriate, and comprehensive care, or other inequities for reasons of race, ethnicity, national origin, language, disability, age, gender, gender identity, sexual orientation, socioeconomic class, religion, intersections among these communities or identities, or other socially determined circumstances. These populations include, but are not limited to: (a) Latino/a/x populations; (b) Black or African American populations; (c) American Indian/Alaska Native populations; (d) Asian populations; (e) Middle Eastern and North African populations; (f) Native Hawaiian and Pacific Islander populations; (g) Slavic and Eastern European populations; (h) Immigrants and Refugees; (i) Individuals with limited English proficiency (LEP); (j) Persons with disabilities; (k) LGBTQ+ populations; (L) Pregnant women, new mothers, and women with children; (m) Individuals transitioning out of incarceration; (n) Members of religious minorities; (o) People experiencing unstable housing/houselessness/homelessness; (p) Migrant and seasonal farmworkers, and related family members; (q) Young adults and postsecondary graduating students who do not have coverage options through a parent's plan, a student plan, or an employer plan; (r) Government program-eligible consumers, regardless of whether they are actually enrolled in the program, including those eligible for OHP, Healthier Together Oregon/Cover All Oregonians, DHS foster children; (s) Uninsured or under-insured individuals, including those receiving coverage though community-based programs or funds; (t) Other populations not listed above experiencing inequities. Statutory/Other Authority: ORS 679.624 Statutes/Other Implemented: ORS 679.624 History: OHP 6-2022, adopt filed 08/30/2022, effective 08/30/2022
409-021-0005 Introduction This division defines the access to the health data collected from various sources and stored at the Office for Oregon Health Policy and Research. Statutory/Other Authority: ORS 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440 & 442.420(3)(d) History: OHP 1-2002, f. & cert. ef. 1-2-02 OHP 1-1997, f. & cert. ef. 8-25-97 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1994, f. & cert. ef. 4-22-94 HP 2-1992, f. & cert. ef. 10-19-92 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 5-1986, f. & ef. 1-24-86
409-021-0115 Calculation of Fees The Office shall charge fees necessary to fully recover the reasonable costs of responding to data requests and requests to examine health data maintained by the Office. (1) The costs that the Office shall recover include, but are not limited to: (a) Cost of materials and copying as provided in OAR 409-909-0020. (b) Cost of staff time necessary to respond to the request. (c) Administrative costs necessary to process the request. (d) Any reasonable additional costs the Office deems necessary to respond to the request. (2) Upon receipt of a completed form D-1, the Office shall provide a written estimate of fees within a reasonable period of time, unless the complete fees for the data request are the published fees for obtaining copies of public use health data files. (3) The Office reserves the right to discount or waive fees for State agencies or at the discretion of the Administrator of the Office. (4) The Office may develop contractual agreements for routinely providing data to a person at a discounted fee, upon approval of the Administrator of the Office. Statutory/Other Authority: ORS 192.440 & 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440 & 442.420(3)(d) History: Renumbered from 409-021-0025, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 5-1986, f. & ef. 1-24-86
409-021-0120 Inspection of Health Data (1) An inspection of the health data that are maintained at the Office shall be only by appointment during the normal working days and business hours of the Office. (2) Requests to inspect health data that are maintained by the Office may, at the Office’s discretion, require an approved data use agreement as provided in OAR 409-021-0130(1). (3) The inspection shall take place at the Office; on a case-by-case basis, other reasonable locations may be designated at the sole discretion of the Administrator of the Office. (4) The inspection of the requested data shall be in a format commonly employed by the Office for maintaining the requested data. (5) Recovery of fees, if any, shall take place at the time of inspection. Statutory/Other Authority: ORS 192.440 & 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440 & 442.420(3)(d) History: Renumbered from 409-021-0020, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07 HP 1-1996, f. & cert. ef. 1-2-96 HP 2-1988, f. & cert. ef. 3-25-88 SHPD 5-1986, f. & ef. 1-24-86