justicedao/ipfs_state_laws huggingface dataset:
410-125-0170 Death Occurring on Day of Admission A hospital receiving DRG reimbursements will receive the DRG reimbursement for the inpatient stay when death occurs on the day of admission as long as at least one hospital benefit day is available. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 53-1991, f. & cert. ef. 11-18-91, Renumbered from 410-125-0840 HR 32-1991(Temp), f. & cert. ef. 7-29-91 HR 28-1991(Temp), f. & cert. ef. 7-1-91 HR 3-1991, f. & cert. ef. 1-4-91 HR 36-1990(Temp), f. 10-29-90, cert. ef. 11-1-90 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0570 HR 18-1990(Temp), f. 6-29-90, cert. ef. 7-1-90 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0006, 461-015-0020 & 461-015-0124 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 45-1989, f. & cert. ef. 8-21-89 AFS 37-1989(Temp), f. 6-30-89, cert. ef. 7-1-89 AFS 36-1989(Temp), f. & cert. ef. 6-30-89 AFS 15-1989(Temp), f. 3-31-89, cert. ef. 4-1-89 AFS 7-1989(Temp), f. 2-17-89, cert. ef. 3-1-89 AFS 63-1988, f. 10-3-88, cert. ef. 12-1-88 AFS 47-1988(Temp), f. 7-13-88, cert. ef. 7-1-88 AFS 26-1988, f. 3-31-88, cert. ef. 4-1-88 AFS 12-1988, f. 2-10-88, cert. ef. 6-1-88 AFS 62-1987(Temp), f. 12-30-87, cert. ef. 1-1-88 AFS 46-1987, f. & cert. ef. 10-1-87 AFS 33-1987(Temp), f. & cert. ef. 7-22-87 AFS 61-1986, f. 8-12-86, cert. ef. 9-1-86 AFS 46-1986(Temp), f. 6-25-86, cert. ef. 7-1-86 AFS 52-1985, f. 9-3-85, cert. ef. 10-1-85 AFS 6-1985, f. 1-28-85, cert. ef. 2-1-85 AFS 45-1984, f. & cert. ef. 10-1-84 AFS 1-1984, f. & cert. ef. 1-9-84 AFS 37-1983(Temp), f. & cert. ef. 7-15-83 Renumbered from 461-015-0120(5) AFS 60-1982, f. & cert. ef. 7-1-82 AFS 18-1982(Temp), f. & cert. ef. 3-1-82 AFS 57-1980, f. 8-29-80, cert. ef. 9-1-80 AFS 14-1980, f. 3-27-80, cert. ef. 4-1-80
410-125-0175 Hospitals Providing Specialized Outpatient Services Some hospitals provide specific highly specialized outpatient services by arrangement with the Division. Reimbursement is made according to the terms of a written agreement or contract. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 53-1991, f. & cert. ef. 11-18-91 HR 28-1991(Temp), f. & cert. ef. 7-1-91
410-125-0180 Public Rates Rates billed to Division of Medical Assistance Programs cannot exceed the facility’s public billing rate. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 42-1991, f. & cert. ef. 10-1-91 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0240 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0015 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 46-1987, f. & ef. 10-1-87 AFS 1-1984, f. & ef. 1-9-84 AFS 37-1983(Temp), f. & ef. 7-15-83 AFS 51-1982, f. 5-28-82, ef. 6-30-82 AFS 30-1982, f. 4-26-82, ef. 5-1-82 AFS 14-1980, f. 3-27-80, ef. 4-1-80
410-125-0200 Time Limitation for Submission of Claims Division of Medical Assistance Programs (Division) will accept a claim up to 12 months after the date of service. The date of discharge is the date of service for an inpatient hospital claim. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 42-1991, f. & cert. ef. 10-1-91 HR 2-1991, f. & cert. ef. 1-4-91 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0250 AFS 72-1989, f. & cert. ef. 12-1-89 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89
410-125-0201 Independent ESRD Facilities (1) Independent End Stage Renal Dialysis (ESRD) Facilities: (a) ESRD facilities are reimbursed for Continuous Ambulatory Peritoneal Dialysis. (b) (CAPD), Continuous Cycling Peritoneal Dialysis (CCPD), and Hemodialysis: (A) Composite at 80% of the Medicare allowed amount, except for Epoetin. (B) Epoetin is reimbursed at 100% of the Medicare maximum allowed amount. (2) Other dialysis related charges which are allowed by Medicare, are reimbursed at 80% of the Medicare maximum allowed amount. Allowable clinical laboratory charges are reimbursed according to the Division’s fee schedule. Billed charges may not exceed the Medicare maximum allowable amount. (3) The Division follows Medicare's criteria for coverage of Epoetin, Intradialytic Parenteral Nutrition services, and the frequency schedule for laboratory tests for ESRD services. When laboratory tests are performed at a frequency greater than specified by Medicare, the additional tests must be billed separately, and are covered by the Division only if the tests are medically justified by accompanying documentation. A diagnosis of ESRD alone is not sufficient medical evidence to warrant coverage of the additional tests. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 73-2005, f. 12-29-05, cert. ef. 1-1-06 OMAP 34-1999, f. & cert. ef. 10-1-99 HR 53-1991, f. & cert. ef. 11-18-91, Renumbered from 410-125-0820 HR 28-1991(Temp), f. & cert. ef. 7-1-91 HR 2-1991, f. & cert. ef. 1-4-91 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0560 HR 9-1990(Temp), f. 3-30-90, cert. ef. 4-1-90 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0124 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 45-1989, f. & cert. ef. 8-21-89 AFS 37-1989(Temp), f. 6-30-89, cert. ef. 7-1-89 AFS 36-1989(Temp), f. & cert. ef. 6-30-89 AFS 15-1989(Temp), f. 3-31-89, cert. ef. 4-1-89 AFS 7-1989(Temp), f. 2-17-89, cert. ef. 3-1-89 AFS 63-1988, f. 10-3-88, cert. ef. 12-1-88 AFS 47-1988(Temp), f. 7-13-88, cert. ef. 7-1-88 AFS 26-1988, f. 3-31-88, cert. ef. 4-1-88 AFS 12-1988, f. 2-10-88, cert. ef. 6-1-88 AFS 62-1987(Temp), f. 12-30-87, cert. ef. 1-1-88 AFS 46-1987, f. & cert. ef. 10-1-87 AFS 33-1987(Temp), f. & cert. ef. 7-22-87 AFS 61-1986, f. 8-12-86, cert. ef. 9-1-86 AFS 46-1986(Temp), f. 6-25-86, cert. ef. 7-1-86 AFS 52-1985, f. 9-3-85, cert. ef. 10-1-85 AFS 6-1985, f. 1-28-85, cert. ef. 2-1-85 AFS 45-1984, f. & cert. ef. 10-1-84 AFS 1-1984, f. & cert. ef. 1-9-84 AFS 37-1983(Temp), f. & cert. ef. 7-15-83 Renumbered from 461-015-0120(5) AFS 60-1982, f. & cert. ef. 7-1-82 AFS 18-1982(Temp), f. & cert. ef. 3-1-82 AFS 57-1980, f. 8-29-80, cert. ef. 9-1-80 AFS 14-1980, f. 3-27-80, cert. ef. 4-1-80
410-125-0221 Payment in Full The payment made by Medicaid towards any inpatient or outpatient services, including cost outlier, disproportionate share, and capital payments, constitutes payment in full for the service. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 17-2006, f. 6-12-06, cert. ef. 7-1-06 HR 53-1991, f. & cert. ef. 11-18-91, Renumbered from 410-125-0840 HR 32-1991(Temp), f. & cert. ef. 7-29-91 HR 28-1991(Temp), f. & cert. ef. 7-1-91 HR 3-1991, f. & cert. ef. 1-4-91 HR 36-1990(Temp), f. 10-29-90, cert. ef. 11-1-90 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0570 HR 18-1990(Temp), f. 6-29-90, cert. ef. 7-1-90 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0006, 461-015-0020 & 461-015-0124 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 45-1989, f. & cert. ef. 8-21-89 AFS 37-1989(Temp), f. 6-30-89, cert. ef. 7-1-89 AFS 36-1989(Temp), f. & cert. ef. 6-30-89 AFS 15-1989(Temp), f. 3-31-89, cert. ef. 4-1-89 AFS 7-1989(Temp), f. 2-17-89, cert. ef. 3-1-89 AFS 63-1988, f. 10-3-88, cert. ef. 12-1-88 AFS 47-1988(Temp), f. 7-13-88, cert. ef. 7-1-88 AFS 26-1988, f. 3-31-88, cert. ef. 4-1-88 AFS 12-1988, f. 2-10-88, cert. ef. 6-1-88 AFS 62-1987(Temp), f. 12-30-87, cert. ef. 1-1-88 AFS 46-1987, f. & cert. ef. 10-1-87 AFS 33-1987(Temp), f. & cert. ef. 7-22-87 AFS 61-1986, f. 8-12-86, cert. ef. 9-1-86 AFS 46-1986(Temp), f. 6-25-86, cert. ef. 7-1-86 AFS 52-1985, f. 9-3-85, cert. ef. 10-1-85 AFS 6-1985, f. 1-28-85, cert. ef. 2-1-85 AFS 45-1984, f. & cert. ef. 10-1-84 AFS 1-1984, f. & cert. ef. 1-9-84 AFS 37-1983(Temp), f. & cert. ef. 7-15-83 Renumbered from 461-015-0120(5) AFS 60-1982, f. & cert. ef. 7-1-82 AFS 18-1982(Temp), f. & cert. ef. 3-1-82 AFS 57-1980, f. 8-29-80, cert. ef. 9-1-80 AFS 14-1980, f. 3-27-80, cert. ef. 4-1-80
410-125-0400 Discharge (1) A discharge from a hospital is the formal release of a patient to home, to another facility such as an intermediate care facility or nursing home, to a home health care agency, or to another provider of health care services. (2) For services beginning January 1, 1993, and later, the transfer of a patient from acute care to a distinct part physical rehabilitation unit (i.e., a unit exempt from the Medicare Prospective Payment System) within the same hospital will be considered a discharge. The admission to the rehabilitation unit is billed separately. All other transfers occurring within a hospital, including transfers to Medicare PPS-exempt psychiatric units, will not be considered discharges, and all charges for services must be submitted on a single UB-04 billing for the admission. (3) Transfer from a hospital occurs when an individual is formally released to another acute care hospital, to a long-term acute care hospital, to a skilled nursing facility, or an intermediate care facility. When a physician sends a patient directly to another hospital for further inpatient care, the discharge should be billed as a transfer, regardless of the mode of transportation. (4) When the Division receives claims from two hospitals for the same patient, and the date of discharge from one hospital is the same as the date of admission to the other, the Division will assume that a transfer has occurred. The Division will change the discharge status code on the first claim to 02 (Transferred to Another Acute Care Facility), automatically generating an adjustment if the claim has already been adjudicated, unless discharge status on the claim is already 02 (Transfer) or 07 (Discharge AMA). If it is believed that the Division made an error in assigning Discharge Status code 02 to a claim, the hospital may submit an Adjustment Request along with supporting documentation from the medical record. (5) A transfer between units within a hospital is not a transfer for billing purposes, except in the case of transfers to distinct part physical rehabilitation units. Note that transfers in the other direction from rehabilitative care to acute care are not considered discharges from the rehabilitation unit unless the stay in the acute setting exceeds seven days. Stays of seven days or less in the acute care setting may not be billed separately. (6) Some transfers, including transfers to distinct part rehabilitation units, require prior authorization. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 31-2016, f. 6-29-16, cert. ef. 7-1-16 DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08 DMAP 19-2008, f. 6-13-08, cert. ef. 7-1-08 HR 36-1993, f. & cert. ef. 12-1-93 HR 39-1992, f. 12-31-92, cert. ef. 1-1-93 HR 42-1991, f. & cert. ef. 10-1-91 AFS 72-1989, f. & cert. ef. 12-1-89 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89
410-125-0401 Definitions: Emergent, Urgent, and Elective Admissions (1) EMERGENT ADMISSION — an admission which occurs after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in: (a) Placing their health or the health of an unborn child in serious jeopardy; (b) Serious impairment of bodily functions; or (c) Serious dysfunction of any bodily organ or part. "Immediate medical attention" is defined as medical attention which could not be delayed by 24 hours. (2) URGENT ADMISSION — an admission which occurs for evaluation or treatment of a medical disorder that could become an emergency if not diagnosed or treated in a timely manner; that delay is likely to result in prolonged temporary impairment; and that unwarranted prolongation of treatment increases the risk of treatment by the need for more complex or hazardous treatment or the risk of development of chronic illness or inordinate physical or psychological suffering by the patient. An urgent admission is defined as one which could not have been delayed for a period of 72 hours. (3) ELECTIVE ADMISSION — an admission which is or could have been scheduled in advance and for which a delay of 72 hours or more in the delivery of medical treatment or diagnosis would not have substantially affected the health of the patient. See Prior Authorization section of the Hospital Services rules for requirements. [Publications: Publications referenced are available from the agency.] Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 12-2001, f. 3-30-01, cert. ef. 4-1-01 OMAP 34-1999, f. & cert. ef. 10-1-99 HR 39-1992, f. 12-31-92, cert. ef. 1-1-93 HR 42-1991, f. & cert. ef. 10-1-91
410-125-0410 Readmission (1) A patient whose readmission for surgery or follow-up care is planned at the time of discharge must be placed on leave of absence status, and both admissions must be combined into a single billing. The Division of Medical Assistance Programs (Division) will make one payment for the combined service. Examples of planned readmissions include, but are not limited to, situations where surgery could not be scheduled immediately, a specific surgical team was not available, bilateral surgery was planned, or when further treatment is indicated following diagnostic tests but cannot begin immediately. (2) A patient whose discharge and readmission to the hospital is within thirty (30) days for the same or related diagnosis must be combined into a single billing. Division shall make one payment for the amount appropriate for the combined service. (3) This rule does not apply to: (a) Readmissions for an unrelated diagnosis; (b) Readmissions occurring more than 30 days after the date of discharge; (c) Readmissions for a diagnosis that may require episodic (a series) acute care hospitalizations to stabilize the medical condition such as, but not limited to: diabetes, asthma, or chronic obstructive pulmonary disease. See billing instructions in the Hospital Supplemental guide on the Division’s website for additional information. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 32-2012, f. 6-29-12, cert. ef. 7-1-12 DMAP 32-2010, f. 12-15-10, cert. ef. 1-1-11 OMAP 13-2005, f. 3-11-05, cert. ef. 4-1-05 OMAP 11-2004, f. 3-11-04, cert. ef. 4-1-04 HR 36-1993, f. & cert. ef. 12-1-93
410-125-0550 X-Ray or EKG Procedures Furnished in Emergency Room The Division pays for only one interpretation of an x-ray or EKG procedure furnished to an emergency room patient, and that is for the interpretation and report that directly contributed to the diagnosis and treatment of the patient. A second interpretation of an x-ray or EKG is considered to be for quality control purposes only, and is not reimbursable. Payment will be made for a second interpretation only under unusual circumstances, such as questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: : ORS 414.065 History: OMAP 28-2000, 9-29-00, cert. ef. 10-1-00
410-125-0600 Non-Contiguous Out-of-State Hospital Services (1) Non-contiguous out-of-state hospitals are those hospitals located more than 75 miles from the Oregon border. (2) The hospital must be enrolled as a provider with Oregon Medical Assistance Programs to receive payment. Contact the Division of Medical Assistance Programs (Division) for information on enrollment. (3) Billings are sent to the Division. (4) When the service provided is emergent or urgent, no prior authorization is required. The claim should be sent to the Division along with documentation supporting the emergent or urgent requirement for treatment. (5) In a non-emergency situation, prior authorization is required for all services. Contact: the Division. (6) Claims must be billed on the electronic 837I or on a paper CMS 1450 (UB-04), unless other arrangements are made for billing through the Division. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08 DMAP 19-2008, f. 6-13-08, cert. ef. 7-1-08 OMAP 17-2006, f. 6-12-06, cert. ef. 7-1-06 HR 36-1993, f. & cert. ef. 12-1-93 HR 42-1991, f. & cert. ef. 10-1-91 HR 2-1991, f. & cert. ef. 1-4-91 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0450 AFS 72-1989, f. & cert. ef. 12-1-89 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89
410-125-0620 Special Reports and Exams and Medical Records Refer to the Division’s Administrative Exams and Reports Billing rules (chapter 410 division 150) for information and instructions on billing for administrative exams and reports. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 70-2004, f. 9-15-04, cert. ef. 10-1-04 OMAP 28-2000, f. 9-29-00, cert. ef. 10-1-00 OMAP 34-1999, f. & cert. ef. 10-1-99 HR 3-1997, f. 1-31-97, cert. ef. 2-1-97 HR 36-1993, f. & cert. ef. 12-1-93 HR 39-1992, f. 12-31-92, cert. ef. 1-1-93 HR 42-1991, f. & cert. ef. 10-1-91 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0460 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0040 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 46-1987, f. & ef. 10-1-87 AFS 60-1982, f. & ef. 7-1-82 AFS 14-1980, f. 3-27-80, ef. 4-1-80
410-125-0641 Medicare (1) A Medicare/Medicaid claim can automatically be sent to the Division after adjudicated by Medicare. This saves the effort of a second submission, as well as ensuring a more accurate and speedier payment by the Division. Medicare will automatically transmit the correct Medicare payment, coinsurance, and deductible information to Division. (2) Hard copy billings sent to Medicare can also be automatically sent to the Division. Refer to the Hospital Services Supplemental Information for specific billing instructions. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 70-2004, f. 9-15-04, cert. ef. 10-1-04 OMAP 34-1999, f. & cert. ef. 10-1-99 HR 36-1993, f. & cert. ef. 12-1-93 HR 42-1991, f. & cert. ef. 10-1-91
410-125-0720 Adjustment Requests (1) Most overpayment and under-payments are resolved through the adjustment process. Only paid claims can be adjusted. If no payment was made, the claim must be submitted using a CMS 1450 (UB-04) for processing. All overpayments must be reported. Overpayments will be taken from future payments. (2) Much of the information required on the Adjustment Request Form is printed on the paper Remittance Advice or the electronic 835. Documentation may be submitted to support the request. Attach a copy of the claim and paper Remittance Advice or the electronic 835 to the Adjustment Request (Division 1036). Adjustment requests must be submitted in writing to the Division of Medical Assistance Programs (Division). (3) Complete adjustment instructions can be found in Hospital Services Supplemental Information. [Publications: Publications referenced are available from the agency.] Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08 DMAP 19-2008, f. 6-13-08, cert. ef. 7-1-08 OMAP 17-2006, f. 6-12-06, cert. ef. 7-1-06 OMAP 70-2004, f. 9-15-04, cert. ef. 10-1-04 HR 42-1991, f. & cert. ef. 10-1-91 HR 2-1991, f. & cert. ef 1-4-91 HR 31-1990(Temp), f. & cert. ef. 9-11-90 HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0510 AFS 72-1989, f. & cert. ef. 12-1-89 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89
410-125-1040 Accounting and Record Keeping (1) All records for a given fiscal period must be kept for three years after the Medicare audit for that period has been finalized. (2) Each hospital is required to make its financial records available for auditing within the state of Oregon at a location specified by the provider. (3) All hospital records are subject to inspection and review by Division personnel and Department personnel during the period the records are required to be held. (4) All expenses must be documented in detail as a part of the record. All capital expenditures requiring approval under the Certificate of Need process, and not having such approval, will be disallowed. (5) Hospitals without a Medicare agreement must use the Hospital Administrative Services (HAS) system of reporting. (6) Record keeping and reporting must be based on date of service, not date of payment. Billings for patients determined by the Division to be eligible for Title XIX or Program 5 must be included as accruals, even those billings not yet paid. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: HR 42-1991, f. & cert. ef. 10-1-91 HR 21-1990, f. & cert ef. 7-9-90, Renumbered from 461-015-0660 AFS 72-1989, f. & cert. ef. 12-1-89, Renumbered from 461-015-0121 AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89 AFS 60-1982, f. & cert. ef. 7-1-82; Renumbered from 461-015-0120(2) AFS 18-1982(Temp), f. & cert. ef. 3-1-82 AFS 57-1980, f. 8-29-80, cert. ef. 9-1-80 AFS 14-1980, f. 3-27-80, cert. ef. 4-1-80
410-125-1070 Type A and Type B Hospitals (1) Type A and Type B hospitals must submit the following information to the Division: (a) The aggregate percent increase in patient charges and the effective date of the increase within 30 days following the end of their fiscal year for increases in the preceding year. Aggregate percent increase in patient charges is defined as the percent increase in patient revenues due to charge increases; and (b) The amount of payment received by the hospital, from each Division-contracted managed care plan and third-party payers, for inpatient and outpatient hospital services provided to managed care members, within the hospital's fiscal year. (2) When a hospital is contracted with a Prepaid Health Plan (PHP), within thirty (30) days of the Division’s request the hospital will supply the Division the following information: (a) The name of the contracting PHP; and (b) The dates for which the contract will be effective; and (c) The contracted services and reimbursement rates. (3) The hospital and PHP must coordinate payment information to verify and return the PHP payment data file sent by the Division within ninety (90) days from date the data file is received by the hospital. (4) Failure to supply the requested information within timelines stated may result in a discretionary sanction or fine (see OAR 410-120-1440). No sanction or fine will be imposed if the Division determines, at its sole discretion, that the hospital was unable to coordinate payment information with the PHP through no fault of the hospital’s own. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08 OMAP 31-2005, f. 6-20-05, cert. ef. 7-1-05 OMAP 12-2001, f. 3-30-01, cert. ef. 4-1-01