409-070-0005 Definitions When used and not otherwise defined in OAR 409-070-0000 through OAR 409-070-0085, the following terms have the meaning given in this section: (1) "Administrative services" means support and administration services, outsourced and subcontracted services and other equivalent services and servicing arrangements relating to, supporting or facilitating the provision of patient care and services. (2) "Authority" means the Oregon Health Authority. (3) "AVP methodologies" means the advanced value-based payment models (3A and higher) described in the Oregon Value-Based Payment Compact (June 28, 2021). (4) “Business entity” has the meaning given in ORS 731.116. (5) "Carrier" means: (a) A carrier as defined in ORS 743B.005 (but excluding subsection (d) thereof); or (b) Any person that offers Medicare Advantage plans in this state. (6) "Charitable organization" has the meaning given in ORS 128.620. (7) "Comprehensive management services" means a person provides all or substantially all the personnel, or manages all or substantially all the operations, of a health care entity. (8) "Control" means the direct or indirect power to manage a legal entity or set the legal entity's policies, whether by owning voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position or corporate office. (9) "Coordinated care organization" has the meaning given in ORS 414.025. (10) "Corporate affiliation" means a health care entity controls, is controlled by, or is under common control with another legal entity. (11) "Covered transaction" means a transaction described in OAR 409-070-0010. (12) "Department" means the Department of Consumer and Business Services. (13) "Domestic health insurer" means an insurer as defined in ORS 731.106 or a health care service contractor as defined in ORS 750.005 that is formed under the laws of this state and has a certificate of authority from the Department to insure personal health risks, or pay for or provide health care services, whether in the form of indemnity insurance, managed care products or any other form or type of individual or group health insurance or health care service contract. (14) In accordance with ORS 415.500(2), "essential services" means: (a) Services that are funded on the prioritized list of health services described in ORS 414.690, as in effect at the time of notice submission; and (b) Services that are essential to achieve health equity. (15) In accordance with ORS 415.500(3), "health benefit plan" has the meaning given in ORS 743B.005. (16) In accordance with ORS 415.500(4)(a), "health care entity" includes all of the following: (a) An individual health professional licensed or certified in this state. (b) A hospital, as defined in ORS 442.015. (c) A hospital system. (d) A carrier that offers a health benefit plan or Medicare Advantage plan in this state. (e) A coordinated care organization or a prepaid managed care health services organization, as the term is defined in ORS 414.025. (f) Any other person or business entity that has as a primary function the provision of health care items or services, including physical, behavioral or dental health items or services. (g) Any other person or business entity that is a parent organization of, has control over, is controlled by, or is under common control with, an entity that has as a primary function the provision of health care items or services. (17) In accordance with ORS 415.500(4)(b), "health care entity" does not include: (a) Long term care facilities, as defined in ORS 442.015. (b) Facilities licensed and operated under ORS 443.400 through 443.455. (18) "Health equity" means a health system having and offering infrastructure, facilities, services, geographic coverage, affordability and all other relevant features, conditions and capabilities that will provide all people with the opportunity and reasonable expectation that they can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or their socially determined circumstances. (19) "Hospital" has the meaning given in ORS 442.015. (20) “Hospital system” means: (a) A parent corporation of one or more hospitals and any entity affiliated with the parent through ownership, governance, control, or membership; or (b) A hospital and any entity affiliated with the hospital through ownership, governance, control, or membership. (21) "Independent practice association" has the meaning given in ORS 743B.001. (22) "Material change transaction" means a covered transaction that is material under the materiality standards set forth in OAR 409-070-0015. (23) In accordance with ORS 415.500(8), "net patient revenue" means the total amount of income, after allowance for contractual amounts, charity care and bad debt, received for patient care and services, including: (a) Value-based payments, incentive payments, capitation payments, payments under any similar contractual arrangement for the prepayment or reimbursement of patient care and services; and (b) Any payment received by a hospital to reimburse a hospital assessment under ORS 414.855. (24) "Person" means an individual, corporation, association, partnership, limited liability company, limited liability partnership, political subdivision, joint stock company, trust or unincorporated organization, or an entity or combination of entities similar to the entities described in this paragraph. (25) "Program website" means the Authority's website for the Health Care Market Oversight Program, currently at https://www.oregon.gov/oha/HPA/HP/Pages/health-care-market-oversight.aspx. (26) "Provider" means a person licensed, certified or otherwise authorized or permitted by laws of Oregon to administer or provide medical or mental health services in the ordinary course of business or practice of a profession. (27) In accordance with ORS 415.500(9), "revenue" of a party to the transaction means: (a) Net patient revenue; or (b) The gross amount of premiums received by a health care entity that are derived from health benefit plans. (28) “Services that are essential to achieve health equity” means: (a) Any service directly related to the treatment of a chronic condition; (b) Pregnancy-related services; (c) Prevention services including non-clinical services; or (d) Health care system navigation and care coordination services. (29) "Term sheet" means a memorandum of understanding or letter of intent setting forth the negotiated terms and conditions of the proposed transaction in reasonable detail, signed by the parties to a proposed transaction, or any other equivalent document that sets forth an agreement in principle for a proposed transaction. (30) "These rules" means the rules set forth in OAR 409-070-0000 through OAR 406-070-0085. (31) "Voting security" means a security that entitles the owner or holder of the security to vote at a meeting of shareholders, a membership interest having voting rights in a limited liability company or nonprofit corporation, a partnership interest having voting rights in a limited or general partnership or any other type of instrument that confers on the holder of the instrument voting rights in the governance of a legal entity. A "voting security" also includes a security that is convertible into a voting security or that is evidence of a right to acquire a voting security. Statutory/Other Authority: ORS 415.501 Statutes/Other Implemented: ORS 415.500 - 415.900 History: OHP 6-2024, amend filed 12/13/2024, effective 12/16/2024 OHP 10-2022, amend filed 12/08/2022, effective 12/08/2022 OHP 1-2022, adopt filed 02/22/2022, effective 03/01/2022