justicedao/ipfs_state_laws huggingface dataset:
409-021-0130 Requests to Obtain Copies of Public Use Health Data Files (1) Any requestor who wishes to obtain copies of public use health data files maintained by the Office shall provide all of the following: (a) Form D-1 (Research Data Request). (b) Form D-2 (Data Order Form). (c) Form D-3 (Data Use Agreement). (d) Full payment of fees. (2) All requests for public use health data files require the written approval of the Research and Data Manager. (3) Upon approval and receipt of full payment of fees, one copy of the requested public use health data file will be provided to the requestor. (4) The Office shall respond to public use health data file requests within a reasonable period of time, except that the Office's response may be delayed so that critical operations and activities are not unduly disrupted. The Office shall notify the requestor in writing if an extensive delay is anticipated. (5) This rule shall not apply to health data that the Office routinely makes available for direct download from the Office's web site. (6) The public use files may not be used to identify any individual, including but not limited to patients, physicians, and other health care providers. The requestor may not use outside information to attempt to ascertain the identity of particular individuals who are the subject of public use files. [ED. NOTE: Forms referred are available from the agency.] Statutory/Other Authority: ORS 192.440 & 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440, 192.496, 192.501 & 442.420(3)(d) History: OHP 1-2013, f. 1-24-13, cert. ef. 2-1-13 Renumbered from 409-021-0015, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07 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
409-021-0140 Requests and Requirements to Obtain Restricted Health Data Sets (1) The Office may authorize the disclosure of health data in accordance with an approved data use agreement entered into by both the Office and a researcher, pursuant to which the Office may disclose a restricted health data set to a researcher for research, public health, or health care operations. The intent of this rule is to generally apply the legal standard established in the HIPAA Privacy Rule applicable to limited data sets, 45 CFR 164.514(e). (2) Any requestor who wishes to obtain restricted health data sets from the Office shall provide all of the following: (a) Form D-1 (Research Data Request) (b) Form D-2 (Data Order Form) (c) Form D-3 (Data Use Agreement) (d) Full payment of fees. (3) All requests for restricted health data sets require the written approval of the Research and Data Manager. (4) Upon approval and receipt of full payment of fees, the Office is authorized to provide one copy of the requested restricted health data set to the requestor. (5) The Office shall respond to restricted health data set requests within a reasonable period of time, except that the Office’s response may be delayed so that critical operations and activities are not unduly disrupted. The Office shall notify the requestor in writing if an extensive delay is anticipated. [ED. NOTE: Forms referred are available from the agency.] 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 409-021-0030, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07 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
409-021-0150 Denial of Requests to Inspect or Obtain Copies of Health Data The Office shall deny requests to inspect health data, receive copies of public use health data sets, and receive copies of restricted health data sets in order to prevent uses that are not consistent with current agreements, policies, rules, regulations, or statutes. (1) The Office shall deny requests to examine health data or receive copies of health data for reasons that include, but are not limited to: (a) Fulfilling the request violates one or more of the Office’s current data use agreements with one or more other persons. (b) Fulfilling the request requires unreasonable interference with the Office’s regular discharge of duties. (c) Fulfilling the request requires disclosures that violate HIPAA privacy rules (45CFR parts 160 and 164). (d) Fulfilling the request requires disclosures that are an unreasonable invasion of privacy. If a request is denied for this reason, the burden is on the requestor to provide the Office clear and convincing evidence that fulfilling the data request is not an unreasonable invasion of privacy and that the public interest requires disclosing the requested data. (2) Nothing in these rules authorizes the Office to disclose health data in a form that allows easy and precise identification of individual patients or individual licensed health care professionals. Statutory/Other Authority: ORS 192.440 & 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440 & 442.420(3)(d) History: OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-022-0010 Definitions The following definitions apply to OAR 409-022-0010 to 409-022-0070: (1) “Ambulatory Surgical Center” has the same meaning given that term in ORS 442.015. (2) "Ambulatory surgical discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a surgical or diagnostic procedure treatment in a hospital outpatient setting or an ambulatory surgical center setting into a data record. (3) “Authority” means the Oregon Health Authority. (4) "Emergency department discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for treatment in a hospital emergency department for patients that were not subsequently admitted to the same hospital as an inpatient. (5) “Health Care Facility” has the same meaning given that term in ORS 442.015. (6) "Hospital” has the same meaning given that term in ORS 442.015. (7) “Hospital inpatient” means acute care provided at a hospital in which the patient was formally admitted under a doctor’s order. (8) “Hospital outpatient” means acute care provided at a hospital in which the patient is not formally admitted to the hospital under a doctor’s order. (9) “Inpatient discharge data” means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a surgical or diagnostic procedure treatment in a hospital inpatient setting. Statutory/Other Authority: ORS 442.120 Statutes/Other Implemented: ORS 442.120 History: OHP 1-2020, amend filed 01/10/2020, effective 01/10/2020 OHP 14-2018, amend filed 11/20/2018, effective 12/01/2018 OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15 OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07
409-022-0015 Health Care Facility Annual Reports (1) The Authority may require an annual report from each licensed health care facility on utilization of the facility. (2) For hospitals, the Authority adopts the American Hospital Association annual survey, as administered by the Oregon Association of Hospitals and Health Systems, as the annual report on utilization of the facility. (3) For all other health care facilities, the Authority shall notify the health care facility of the requirement no later than December 31 of the year to be reported.¶ (4) A health care facility must submit the annual report on a form, prescribed by the Authority, no later than April 30 of the subsequent year. (5) The Authority shall acknowledge acceptance of the annual report or inform the licensed health care facility in writing of any corrections required within 30 days of the submission of an annual report by a health care facility. Statutory/Other Authority: ORS 442.420, 442.463 Statutes/Other Implemented: ORS 442.463 History: OHP 1-2020, amend filed 01/10/2020, effective 01/10/2020 OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018
409-022-0020 Hospital Reporting Requirements (1) All hospitals must submit the following, in a form and manner prescribed by the Authority: (a) Inpatient hospital discharge data; and (b) Emergency department discharge data, and (c) Ambulatory surgical discharge data in the hospital outpatient setting. (2) Inpatient hospital discharge data submitted must include the following data elements if the data elements are available: (a) Patient name; (b) Patient date of birth; (c) Patient race; (d) Patient ethnicity; (e) Patient sex; (f) Patient residential address; (g) Hospital identifier; (h) Admission date and hour; (i) Discharge date and hour; (j) Admitting diagnosis or chief complaint; (k) Principle diagnosis; (L) Secondary diagnoses; (m) Principle procedure performed; (n) Secondary procedures performed; (o) Dates of procedures performed; (p) External cause of injury codes; (q) Patient disposition or discharge status; (r) Admission source or point of origin; (3) Emergency department discharge data must include the following data elements if the data elements are available: (a) Patient name; (b) Patient date of birth; (c) Patient race; (d) Patient ethnicity; (e) Patient sex; (f) Patient residential address; (g) Hospital identifier; (h) Admission date and hour; (i) Discharge date and hour; (j) Principle diagnosis; (k) Secondary diagnoses; (L) Procedures performed; (m) Dates of procedures performed; (n) External cause of injury codes; (o) Patient disposition or discharge status; (p) Admission source or point of origin; (q) Admission type; (r) Total billed charges; (s) Revenue codes; and (t) Units of service. (4) Ambulatory surgical discharge data submitted for hospital outpatient services must include the following data elements if the data elements are available: (a) Patient name; (b) Patient date of birth; (c) Patient race; (d) Patient ethnicity; (e) Patient sex; (f) Patient residential address; (g) Hospital identifier; (h) Admission date; (i) Discharge date; (j) Principle diagnosis; (k) Secondary diagnoses; (L) Procedures performed; (m) Dates of procedures performed; (n) External cause of injury codes; (o) Patient disposition or discharge status; (p) Admission source or point of origin; (q) Admission type; (r) Total billed charges; (s) Revenue codes; and (t) Units of service. Statutory/Other Authority: ORS 442.120 Statutes/Other Implemented: ORS 442.120 History: OHP 1-2020, amend filed 01/10/2020, effective 01/10/2020 OHP 14-2018, amend filed 11/20/2018, effective 12/01/2018 OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15 OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07
409-022-0025 Ambulatory Surgical Centers Requirements (1) On and after January 1, 2020, all licensed Ambulatory Surgical Centers that bill any public or private insurance on behalf of the patient must submit ambulatory surgical discharge data to the Authority, in a form and manner prescribed by the Authority. (2) Data submitted must include the following data elements if the data elements are available: (a) Patient name; (b) Patient date of birth; (c) Patient race; (d) Patient ethnicity; (e) Patient sex; (f) Patient residential address; (h) Facility name; (i) Admission date; (j) Discharge date; (k) Principle diagnosis; (L) Secondary diagnoses; (m) Procedures performed; (n) Dates of procedures performed; (o) External cause of injury codes; (p) Patient disposition or discharge status; (q) Admission source or point of origin; (r) Admission type; and (s) Total billed charges; (3) Mandatory reporters shall submit data following standard file layout and data values as prescribed by the Authority. Statutory/Other Authority: ORS 442.120 Statutes/Other Implemented: ORS 442.120 History: OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018
409-022-0035 Ambulatory Surgical Center Fees (1) The Authority shall assess a fee pursuant to ORS 442.120 that shall not exceed the total cost of receiving, processing, analyzing and maintaining ambulatory surgical discharge data. (2) The fee shall not exceed $1.75 per discharge. (3) The fee shall be calculated by totaling the costs of receiving, processing, analyzing and maintaining the data in the previous two quarters and dividing the total by the number of records received to derive a per record fee. (4) The Authority shall invoice ambulatory surgical centers every six months based on the calculated per record fee and the number of records submitted. Fees assessed for January 1 through June 30 shall be invoiced no later than December 1 of the same year. Fees assessed for July 1 through December 31 shall be invoiced no later than June 1 of the subsequent year. Statutory/Other Authority: ORS 442.120 Statutes/Other Implemented: ORS 442.120 History: OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018
409-022-0070 Health Care Facility Utilization and Discharge Data Use and Disclosure The Authority may use and disclose data submitted to it under these rules in accordance with ORS 442.120 and OAR 943.014. Statutory/Other Authority: ORS 442.120 Statutes/Other Implemented: ORS 442.120 History: OHP 14-2018, amend filed 11/20/2018, effective 12/01/2018 OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15 OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07
409-023-0100 Definitions The following definitions apply to OAR 409-023-0100 to 409-023-0115: (1) “Affiliated clinic” or “hospital affiliated clinic” mean an outpatient clinic located in Oregon that is operating under the common control or ownership of a hospital. (2) “Authority” means the Oregon Health Authority. (3) “Charity care” means free or discounted health services provided to persons who cannot afford to pay and from whom a hospital has no expectation of payment. Charity care does not include bad debt, governmentally set fees, contractual allowances, or discounts for quick payment. (4) “Community” means the geographic service area and patient population that the health care institution serves as defined by the hospital. (5) “Community benefits” mean programs or activities that provide treatment or promote health and healing, address health disparities or address the social determinants of health in a response to identified community needs. They are not provided primarily for marketing purposes or to increase market share. Community benefit must generate a negative margin and meet at least one of the following criteria: (a) Improve access to health services; (b) Enhance population health or improve health disparities; (c) Advance generalizable knowledge; (d) Demonstrate charitable purpose; or (e) Address social determinants of health. (6) “Health System” means an organization that delivers health care services through hospitals, facilities, clinics, medical groups and other entities that are under common ownership or control. (7) “Hospital” has the meaning provided in ORS 442.612. (8) “Patient cost” has the meaning provided in ORS 442.612. (9) “Prescreen” or “prescreening” means the process a hospital uses to proactively screen a patient for presumptive eligibility for financial assistance in accordance with ORS 442.615. (10) “Presumptive eligibility” refers to a decision by the hospital that, based upon the hospital’s prescreening, the patient qualifies for financial assistance. (11) “Net cost” means the total expense incurred by the hospital minus any offsetting revenue such as grants, donations, or payments for service. Net costs may be provided using either a cost-to-charge ratio methodology or a cost accounting methodology. (12) “Social Determinants of Health” has the meaning provided in ORS 442.612. (13) “State medical assistance program” means a program for payment of health services provided to eligible Oregonians, including Medicaid and CHIP services under the OHP Medicaid Demonstration Project and Medicaid and CHIP services under the State Plan, or Healthier Oregon, or Bridge Program, or any other programs that may be prescribed by the Authority from time to time, in accordance with ORS 414.025(17). Statutory/Other Authority: ORS 442.602, 442.615, 442.618 & 442.624 Statutes/Other Implemented: ORS 442.601, 442.602 & 442.612 History: OHP 1-2024, amend filed 05/07/2024, effective 05/07/2024 OHP 5-2020, amend filed 12/21/2020, effective 12/21/2020 OHP 2-2008, f. & cert. ef. 7-1-08
409-024-0000 Definitions The following definitions apply to OAR 409-024-0000 to 409-024-0130: (1) “Authority” means the Oregon Health Authority. (2) “Capital project” has the meaning described in ORS 442.361. (3) “Community benefits” mean programs or activities that provide treatment or promote health and healing as a response to identified community needs and are not provided primarily for marketing purposes or to increase market share. (4) “Reporting entity” includes the following if licensed pursuant to ORS 441.015: (a) A type A hospital as described in ORS 442.470. (b) A type B hospital as described in ORS 442.470. (c) A diagnostic-related group (DRG) hospital as described in ORS 442.361. (d) An ambulatory surgical center as defined in ORS 442.015. (e) Any Type A, Type B, or DRG hospital as defined in (4)(a) through (c) above that is certified as a Critical Access Hospital by the Centers for Medicare and Medicaid Services. Statutory/Other Authority: ORS 442.362 Statutes/Other Implemented: ORS 442. 361 & 442.362 History: OHP 7-2015, f. & cert. ef. 9-24-15 OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10
409-024-0110 Capital Project Report (1) Each reporting entity must submit to the Authority a report of pending or proposed capital projects using a Capital Project Reporting Form CPR-1 as defined by the Authority. The report must be completed in accordance with instructions in the capital project reporting guidelines published on the Authority’s website. (2) The Capital Project Reporting Form CPR-1 shall include but is not limited to: (a) A summary of the information posted by the reporting entity under ORS 442.362. (b) The procedure that the reporting entity used to collect public comment. (c) A summary of expected community benefits for the project. (d) The estimated cost of the project. (3) Capital project reports must be submitted to the Authority no later than 30 days after financing for a project that has been approved for ambulatory surgical centers or within 30 days after the project has been approved by the hospital’s board of directors or other governing body for hospitals. The report shall be considered submitted on the date the report is postmarked or electronically delivered to the Authority, whichever is first. (4) The Authority shall maintain on its website a publicly available resource to enable interested parties to view capital project reports filed with the Authority. Statutory/Other Authority: ORS 442.362 Statutes/Other Implemented: ORS 442.361 & 442.362 History: OHP 7-2015, f. & cert. ef. 9-24-15 OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10
409-024-0120 Public Comments (1) Each reporting entity must make available a means for interested persons to submit public comments on the capital project either on their website or by posting public notice in a major newspaper for a period of no less than seven days. Comments must be collected for a period of no less than 30 days and made available for public review. (2) The hospital or ambulatory care center shall then notify the Authority after the 30 day public comment if the hospital or ambulatory care center chooses to complete the project as is or if the project has changed and an expected completion date. The Authority shall post this update on its website for 30 days. Statutory/Other Authority: ORS 442.362 Statutes/Other Implemented: ORS 442.361 & 442.362 History: OHP 7-2015, f. & cert. ef. 9-24-15 OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10
409-024-0130 Civil Penalties (1) If the Authority learns that any reporting entity has failed to file a capital project report, the Authority shall contact the reporting entity by certified mail requesting the unfiled report. If the reporting entity fails to reply within 30 calendar days or continues to be non-compliant with the reporting requirements, the Authority shall assess a civil penalty pursuant to the following schedule: (a) $250 per day for the first five days of failure to file in accordance with ORS 442.991; and (b) $500 per day from the sixth day until filing in accordance with ORS 442.991 is completed. (2) Any amount of civil penalty assessed 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 442.362 Statutes/Other Implemented: ORS 442.361, 442.362 & 442.991 History: OHP 7-2015, f. & cert. ef. 9-24-15 OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10
409-025-0130 Data Submission Requirements (1) Mandatory reporters shall submit data files as specified in the Data Submission Schedule. Voluntary reporters may consult with the Authority to submit healthcare claims data files on an alternative schedule. (2) Mandatory and voluntary reporters shall submit data files directly to the data vendor unless otherwise specified by the Authority. Each mandatory reporter is required to maintain an active user in the data vendor’s reporting portal to receive communications on deadlines and submit files and resolve validation issues in a timely manner. (3) Mandatory and voluntary reporters shall transmit data files using one of the following approved processes: (a) Secure file transfer protocol (SFTP) including separate strong encryption of data files prior to SFTP transmission; or (b) Any process incorporating strong encryption that is approved in writing by both the Authority and the data vendor. Statutory/Other Authority: ORS 442.466 Statutes/Other Implemented: ORS 442.464 & 442.466 History: OHP 8-2022, amend filed 12/01/2022, effective 12/01/2022 OHP 2-2019, amend filed 05/30/2019, effective 01/01/2020 OHP 7-2018, amend filed 06/29/2018, effective 01/01/2019 OHP 2-2017, f. 6-23-17, cert. ef. 1-1-18 OHP 13-2016, f. & cert. ef. 9-13-16 OHP 10-2016, f. 6-22-16, cert. ef. 1-1-17 OHP 1-2016, f. & cert. ef. 1-5-16 OHP 4-2012, f. 5-23-12, cert. ef. 6-1-12 OHP 1-2010, f. 2-26-10, cert. ef. 3-1-10
409-025-0170 Public Disclosure The Authority and applicable contractors, shall perform data analyses and publish data and reports that serve the public’s interest. This may include, but is not limited to: (1) Comparing healthcare cost and quality; (2) Assessing health care utilization; (3) Assessing the capacity and distribution of healthcare resources; (4) Assessing health care purchasing decisions; (5) Assessing the effectiveness of public health programs; or (6) Assessing disparities in health care delivery and outcomes. Statutory/Other Authority: ORS 442.466 Statutes/Other Implemented: ORS 442.464 & 442.466 History: OHP 8-2022, amend filed 12/01/2022, effective 12/01/2022 OHP 1-2016, f. & cert. ef. 1-5-16 OHP 1-2010, f. 2-26-10, cert. ef. 3-1-10
409-025-0180 APAC Technical Advisory Group The Oregon Health Authority shall convene a technical advisory group to advise the Authority on submission specifications including but not limited to file layouts, the Data Submission Schedule, and any additional data submission requirements. The advisory group shall include but is not limited to representatives from: (1) Mandatory reporters; (2) Providers; (3) Researchers, and; (4) Other stakeholders and interested parties. Statutory/Other Authority: ORS 413.042 & 442.466 Statutes/Other Implemented: ORS 442.464 & 442.466 History: OHP 1-2019, adopt filed 05/30/2019, effective 07/01/2019