justicedao/ipfs_state_laws huggingface dataset:
945-030-0040 Assessment and Collection of Administrative Charge on Insurers (1) By the last Wednesday of each month, an insurer shall report to the Marketplace the insurer’s effectuated enrollment as of 11:59 PM on the 15th of the month and the anticipated effectuated enrollment for the following month. (2) The Marketplace shall assess an insurer an administrative charge on or before the 10th day of each month based on the number of reasonably anticipated effectuated members enrolled in Marketplace coverage in that month. (3) The Marketplace shall adjust the administrative charge when it reasonably believes an insurer has had changes or has made accurate corrections to enrollment for prior months, as follows: (a) For report months beginning July of a given year and ending June of the following year, the Marketplace shall adjust the administrative charge for coverage months beginning January of the given year through the report month. (b) The Marketplace shall not adjust the administrative charge for changes or corrections in enrollment for coverage months preceding the period described in paragraph (a) of this section. (4) The administrative charge is due in full to the Marketplace on the 10th day of the month following the assessment. (5) For any month in which the insurer does not make full payment within 5 days following the due date for the administrative charge, the Marketplace may impose a late payment charge of 1 percent of the amount due, to be paid on the next due date for the administrative charge. (6) If an insurer fails to pay the administrative charge or any late payment charge or both, the Director may: (a) Impose an annual 9% interest charge on the amount due; (b) Close that insurer’s Marketplace plans to new enrollment until all outstanding charges are paid; and/or (c) De-certify the insurer’s qualified health plans and/or stand-alone dental plans. (7) The insurer must maintain data that are sufficient: (a) To support the assessment reported to the director and any adjustments or corrections; and (b) For the Director to verify the amount reported, adjusted, or corrected. (8) Upon request and in the form, manner, and time prescribed by the Director, an insurer must provide to the Director the data described in paragraph 7 of this rule. (9) An insurer may contest the amount of the administrative charge assessed under this section through a contested case hearing under ORS 183.411 to 183.471. Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.105 History: OHIE 4-2015, f. & cert. ef. 11-6-15 OHIE 3-2015, f. & cert. ef. 10-15-15 Reverted to OHIE 5-2013, f. & cert. ef. 8-19-13 OHIE 1-2015(Temp), f. & cert. ef. 3-11-15 thru 9-4-15 OHIE 5-2013, f. & cert. ef. 8-19-13 OHIE 3-2013(Temp), f. & cert. ef. 5-28-13 thru 11-22-13 OHIE 1-2013, f. & cert. ef. 3-18-13
945-030-0045 Administrative Assessment on State Programs (1) The administrative assessment on state programs shall be established in an Intergovernmental Agreement between the Marketplace and the Oregon Health Authority. (2) The administrative assessment, expressed as a per member per month figure, shall be based on the number of individuals enrolled in state programs offered through the Marketplace. (3) The Intergovernmental Agreement shall specify the intervals and manner in which the administrative assessment is to be paid. (4) Marketplace staff will annually report to the Director on the assessment on state programs. Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.105 History: OHIE 4-2015, f. & cert. ef. 11-6-15 OHIE 3-2015, f. & cert. ef. 10-15-15 Reverted to OHIE 1-2014, f. & cert. ef. 1-16-14 OHIE 1-2015(Temp), f. & cert. ef. 3-11-15 thru 9-4-15 OHIE 1-2014, f. & cert. ef. 1-16-14
945-040-0020 Eligibility for Enrollment in a Qualified Health Plan in the Individual Market (1) To qualify for enrollment in a qualified health plan in the individual market, an applicant must: (a) Be a United States citizen or national, or a lawfully present non-citizen; (b) Be a resident of Oregon; and (c) Not be incarcerated. Incarceration pending the disposition of charges is not a disqualifying factor. (2) To qualify for enrollment in a qualified health plan that is a catastrophic plan, in addition to meeting the requirements of (1), an applicant must either: (a) Have not attained the age of 30 before the beginning of the plan year; or (b) Have a certification showing that he or she is exempt from the requirement to maintain minimum essential coverage for the plan year for which he or she is applying by reason of: (A) Lack of access to affordable coverage, in accordance with §5000A(e)(1) of the Internal Revenue Code; or (B) Hardship, in accordance with §5000A(e)(5) of the Internal Revenue Code. Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.500 History: OHIE 6-2013, f. & cert. ef. 9-30-13
945-040-0030 Eligibility for the Small Business Health Options Program (SHOP) (1) To qualify for the Marketplace’s Small Business Health Options Program (SHOP), a small employer must: (a) Meet the definition of small employer in ORS 743.730; (b) At a minimum, offer coverage in a qualified health plan to all full-time employees; and (c) Have a principal business address in Oregon, or offer coverage to all eligible employees whose primary worksite is located in Oregon. (2) A small employer that meets the minimum participation and contribution requirements for medical plans may apply for SHOP coverage throughout the year. A small employer that does not meet these requirements may apply for SHOP coverage between November 15 and December 15. The minimum participation and contribution requirements for dental plans apply throughout the year for a small employer offering dental plans through SHOP. (3) Once enrolled, an employer remains eligible for SHOP regardless of the number of additional employees it hires. (4) An employee is eligible to enroll in a qualified health plan through SHOP if the employee receives an offer of coverage from a qualified employer. Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.500 History: OHIE 4-2015, f. & cert. ef. 11-6-15 OHIE 3-2015, f. & cert. ef. 10-15-15 OHIE 6-2013, f. & cert. ef. 9-30-13
945-040-0050 Eligibility Standards for Special Populations (1) Advance Payments of the Premium Tax Credit for Lawfully Present Noncitizens Ineligible for Medicaid. The Marketplace must determine a tax filer eligible for advance payments of the premium tax credit if he or she: (a) Meets the requirements of 945-040-0040, except 945-040-0040(1)(a) and (b); and (b) One or more applicants for whom the tax filer attests that he or she expects to claim a personal exemption deduction on his or her tax return for the benefit year, including the tax filer and his or her spouse, is a noncitizen who is lawfully present and ineligible for Medicaid by reason of immigration status in accordance with section 36B(c)(1)(B) of the Internal Revenue Code. (2) Cost Sharing Reductions for American Indians/Alaska Natives. To qualify for cost sharing reductions, the applicant must: (a) Be a member of a federally recognized tribe; (b) Be eligible for and enroll in a qualified health plan; (c) Be eligible for advance payments of the premium tax credit; and (d) Have income that does not exceed 300 percent of the federal poverty level. (3) An applicant qualified under section (2) of this rule is not required to enroll in a silver-level qualified health plan to receive cost sharing reductions. (4) For an enrollee qualified under section (2) of this rule, carriers are required to eliminate any cost sharing under any plan chosen by the qualified applicant. (5) A member of a federally recognized tribe who is enrolled in a qualified health plan is eligible for no cost sharing for services provided directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or through referral under contract services. Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.500 History: OHIE 4-2015, f. & cert. ef. 11-6-15 OHIE 3-2015, f. & cert. ef. 10-15-15 OHIE 6-2013, f. & cert. ef. 9-30-13
945-040-0160 Appeal to the United States Department of Health and Human Services If an appellant disagrees with the appeal decision of the Exchange, he or she may make an appeal request to HHS within 30 days of the date of the notice of appeal decision through any of the methods described in OAR 945-040-0100(5). Statutory/Other Authority: ORS 741.002 Statutes/Other Implemented: ORS 741.500 History: OHIE 6-2013, f. & cert. ef. 9-30-13
950-020-0000 Purpose (1) These rules establish uniform standards for Regional Health Equity Coalitions (RHECs) and support alignment to the RHEC model. The Oregon Health Authority (OHA) is a funding partner for Regional Health Equity Coalitions. (2) The RHECs act as a link between diverse communities and OHA to better ensure community needs are identified and met so that health inequities, institutional racism, and discrimination can be addressed. The RHECs foster equity and mitigate harm in policy development and implementation by providing recommendations and guidance to OHA on policy concept. Statutory/Other Authority: ORS 413.042 & SB 70 (2021) Statutes/Other Implemented: SB 70 (2021) History: OHA 4-2023, renumbered from 943-021-0001, filed 05/04/2023, effective 05/04/2023 OHA 2-2022, adopt filed 05/25/2022, effective 05/25/2022
950-030-0000 Purpose These rules establish uniform standards and practices for the collection of data on race, ethnicity, preferred spoken or signed and preferred written language, disability, sexual orientation and gender identity by the Oregon Health Authority (OHA) and others required by law or contract. Standardized data collection methodology will improve the ability of OHA, community partners, elected officials, and other decision makers to recognize, address, target and eliminate inequities experienced by distinct tribal, racial, cultural, and linguistic communities; people with disabilities; and LGBTQIA2S+ communities. These standards allow OHA to meet federal reporting expectations; compare Oregon's progress with national trends; improve quality service delivery; and ensure equitable allocation of resources. Statutory/Other Authority: ORS 413.161 & ORS 413.042 Statutes/Other Implemented: ORS 413.161 History: EID 2-2024, amend filed 07/02/2024, effective 07/02/2024 OHA 3-2023, renumbered from 943-070-0000, filed 05/04/2023, effective 05/04/2023 OHA 1-2021, amend filed 03/23/2021, effective 03/23/2021 OHA 2-2020, temporary amend filed 09/29/2020, effective 10/01/2020 through 03/29/2021 OHA 2-2014, f. & cert. ef. 3-10-14
950-030-0010 Definitions The following definitions apply to OAR 950, divisions 30 and 38: (1) “Caregiver” means a person, paid or unpaid, related or unrelated, who acts on behalf of or cares for the individual. (2) “Contractor” means a person or governmental entity who has a legal agreement with the Oregon Health Authority to provide goods or services. (3) "Demographic data" means collected information in accordance with these rules related to age, sex, gender, sexual orientation, race, ethnicity, preferred spoken, signed and written language, interpreter needs, English proficiency and disability. (4) "Ethnicity" means a demographic designation for a group of people sharing a culture that includes race, religion, language, and other cultural characteristics including ancestry or country of origin. (5) “Gender identity”: (a) Means a demographic designation that describes a person’s inner sense of being such as a girl, woman, female, boy, man, male, or something else, or having no gender. (b) Does not mean a biological, anthropological or genetic distinction. (6) “Gender modality” means how an individual’s gender identity stands in relation to their gender assigned at birth. F or example, a person whose gender modality is transgender is someone whose gender identity is different from what was assigned at birth . (7) “Individual” means the person who is the subject of the demographic data that is being collected. (8) “LGBTQIA2S+” means lesbian, gay, bisexual, transgender or gender expansive, queer or questioning/exploring, intersex, asexual, two-spirit, and other terms that may be used to describe a sexual or gender minority identity. (9) “Primary racial or ethnic identity” means the race or ethnicity with which an individual most identifies when opting to choose from multiple designations. (10) “Race”: (a) Means a demographic designation for a group of people who share a common heredity, and Includes shared ancestry, national origin and sociocultural characteristics. (b) Does not mean a biological, anthropological or genetic distinction. (11) “REALD” means race, ethnicity, language and disability. (12) “Requestor” means an individual or entity that is collecting REALD and SOGI information in accordance with these rules. (13) “Sexual orientation” means a demographic designation that describes how an individual characterizes their emotional and sexual attraction to others. (14) “SOGI” means sexual orientation, gender identity and gender modality. (15) “Subcontractor” means a person or governmental entity who has a legal agreement with a contractor as that is defined in this rule, to provide goods or services. Statutory/Other Authority: ORS 413.161 & ORS 413.042 Statutes/Other Implemented: ORS 413.161 History: EID 2-2024, amend filed 07/02/2024, effective 07/02/2024 OEI 18-2023, minor correction filed 05/12/2023, effective 05/12/2023 OHA 3-2023, renumbered from 943-070-0010, filed 05/04/2023, effective 05/04/2023 OHA 1-2021, amend filed 03/23/2021, effective 03/23/2021 OHA 2-2020, temporary amend filed 09/29/2020, effective 10/01/2020 through 03/29/2021 OHA 2-2014, f. & cert. ef. 3-10-14
950-030-0060 Sexual Orientation and Gender Identity (SOGI) Demographic Data Collection Standards (1) A requestor must ask the questions in this rule using the following age-based guidelines: (a) For individuals under age 5, a requestor must ask the question in section (4) of this rule. (b) For individuals ages 5 to 11, a requestor must ask the questions in section (4) and (9) of this rule. (c) For individuals ages 12 and 13, a requestor must ask either the questions in sections (2) through (6) or the questions in sections (4) and (9) of this rule, and should use professional judgment to determine which of these two sets of questions to ask. (d) For individuals ages 14 and older, a requestor must ask the questions in sections (2) through (6) of this rule. (2) A requestor must ask an open-ended question regarding gender identity: "Describe your gender in any way you prefer:" (3) A requestor must ask the following questions regarding gender identity and gender modality: (a) “What is your gender?” Response options: (A) Girl or woman. (B) Boy or man. (C) Nonbinary. (D) Agender/No gender. (E) Bigender. (F) Demiboy. (G) Demigirl. (H) Genderfluid. (I) Genderqueer. (J) Questioning/Exploring. (K) Not listed, my gender is: (with open text box). (L) I have a gender identity not listed here that is specific to my ethnicity: (with open text box). (b) “Are you transgender?” Response options: (A) Yes. (B) No. (C) Questioning/Exploring. (4) A requestor must ask the following questions regarding sex: “What is your sex?” Response options: (a) Female. (b) Male. (c) Intersex. (d) Not listed, my sex is: (with open text box). (5) A requestor must ask an open-ended question regarding sexual orientation: "Describe your sexual orientation or sexual identity in any way you prefer:” (with open text box) (6) A requestor must ask the following question regarding sexual orientation: “What is your sexual orientation? (a) Same-gender loving. (b) Lesbian. (c) Gay. (d) Bisexual. (e) Pansexual. (f) Straight or heterosexual. (g) Asexual Spectrum. (h) Queer. (i) Questioning/Exploring. (j) Not listed, my sexual orientation is: (with open text box). (7) For individuals who selected the race and ethnicity category of “American Indian” or “Alaska Native” specified in OAR 950-030-0030(2)(a) or (2)(b), the requestor must display the additional response option of “Two Spirit” for the questions in sections (3)(a) and (6) of this rule. (8) For questions specified in sections (3)(a), (6) and (9) of this rule, a requestor must instruct individuals, either in writing or verbally, that more than one response may be chosen. (9) A requestor must ask the following question: “Are you currently:” Response options: (a) A boy. (b) A girl. (c) Both a boy and a girl. (d) Neither a boy nor a girl. (e) Something else. Specify: (with open text box). (f) It changes over time. Statutory/Other Authority: ORS 413.161 & ORS 413.042 Statutes/Other Implemented: ORS 413.161 History: EID 2-2024, adopt filed 07/02/2024, effective 07/02/2024
950-030-0200 Reporting Progress on Implementation (1) All programs of the Oregon Health Authority (OHA) that collect demographic data must report to the OHA Equity and Inclusion Division in February of each even numbered year. Reports shall include information about each program’s: (a) Progress in implementing these standards. (b) Challenges to full implementation of these standards. (c) Plan for addressing challenges, including identifying responsible staff and timeline. (2) The OHA Equity and Inclusion Division shall use data provided by the programs to create a report for the legislature as required by ORS 413.162. Statutory/Other Authority: ORS 413.042 & ORS 413.161 Statutes/Other Implemented: ORS 413.161 History: EID 2-2024, amend filed 07/02/2024, effective 07/02/2024 OHA 3-2023, renumbered from 943-070-0060, filed 05/04/2023, effective 05/04/2023 OHA 2-2014, f. & cert. ef. 3-10-14
950-033-0000 REALD & SOGI Grant Program (1) Establishes the REALD & SOGI Grant Program Rules. The Program offers grants supporting safe data collection by community health organizations and community-based groups with demonstrated experience serving tribal communities, communities of color, LGBTQ+ people, people with disabilities, people who speak primary languages other than English and other underserved populations. (2)(a) Purpose and Scope (b) ORS 413.166 requires the Oregon Health Authority (OHA) to develop and administer a grant program to provide funding for the purpose of supporting safe REALD & SOGI data collection by community health organizations and community-based groups with demonstrated experience serving tribal communities, communities of color, LGBTQIA2S+ people, people with disabilities, people who speak primary languages other than English and other underserved populations. These rules implement that grant program, referred to as the REALD & SOGI grant program. Statutory/Other Authority: ORS 413.446 Statutes/Other Implemented: ORS 413.446 History: EID 3-2024, adopt filed 10/01/2024, effective 10/01/2024
950-033-0010 Definitions The following definitions apply to OAR 950-033-0000 to 950-033-0045, unless otherwise noted: (1) “Awardee” means an applicant that is selected for a grant award through the REALD & SOGI grant program. (2) “Grant agreement” means a legal document agreed to and signed by awardee and the Oregon Health Authority (OHA) that describes the terms and conditions for receipt of the grant award. (3) “Grant applicant” or “applicant” means an eligible entity that submits an application for a grant award from the REALD & SOGI Grant Program. (4) “Community health organization” includes but is not limited to community focused or supported health organizations such as FQHCs, community health clinics, and healthcare focused community-based groups and organizations (CBOs), and tribal health clinics. (5) “Community-based group” or “Community Based Organization” (CBO) means a group or organization that is community driven, that support and are aimed at improving specific communities’ social and physical health, well-being, success and overall quality of life, and that often are representative of communities that have been marginalized, oppressed, underserved, stigmatized and discriminated against. (6) “Culturally responsive” means showing full respect for and the relevance of the beliefs, practices, culture and linguistic needs of diverse people and communities being served; having the capacity to respond to the unique issues and characteristics of diverse communities, taking into account language, cultural approaches, strengths, perspectives, experiences, values and norms; and being welcoming, accessible, appropriate and effective for all eligible intended recipients. (7) “Trauma-informed” or “trauma awareness” means considering and evaluating the role that trauma plays in the lives of people seeking assistance and providing assistance in a manner that is responsive to the vulnerabilities of trauma survivors and avoids inadvertent re-traumatization. Statutory/Other Authority: ORS 413.116 Statutes/Other Implemented: ORS 413.116 History: EID 3-2024, adopt filed 10/01/2024, effective 10/01/2024
950-033-0020 Grant Announcement The Oregon Health Authority must announce availability of funding from the REALD & SOGI Grant Program and the announcement must include: (1) Available funding; (2) Eligible entities and services; (3) Term of the grant; (4) Template grant agreement; (5) Template budget; (6) Application criteria; and (7) Evaluation and review process. Statutory/Other Authority: ORS 413.116 Statutes/Other Implemented: ORS 413.166 History: EID 3-2024, adopt filed 10/01/2024, effective 10/01/2024
950-033-0025 Eligible Entities and Eligible Services Community health organizations and community-based groups in Oregon are eligible to apply for the REALD & SOGI grant. In accordance with ORS 413.166. The Oregon Health Authority, Equity and Inclusion Division encourages grant applications that describe activities that provide culturally responsive, trauma-informed trainings on the collection of the demographic data described in ORS 413.164(2). Statutory/Other Authority: ORS 413.446 Statutes/Other Implemented: ORS 413.446 History: EID 3-2024, adopt filed 10/01/2024, effective 10/01/2024
950-033-0030 Application Criteria An application for REALD & SOGI grant funding must contain all information required by OHA in the grant solicitation, including but not limited to: (1) A detailed scope of work that provides a description of the services to be offered or training to be received, in order to provide culturally responsive, trauma-informed trainings on the collection of the data described in ORS 413.164(2) The description must include a plan for how the applicant would use funding, indicating what, if any, services would be subcontracted; (2) Documentation of the applicant’s experience offering the proposed support and/or trainings; (3) Documentation of the applicant’s experience with providing training on any or all of the following topics, as these terms are described in OAR 944, division 010: (a) Trauma-informed services; (b) Culturally and linguistically specific services; (c) Culturally and linguistically responsive services; (d) Services to individuals with intellectual and developmental disabilities; (e) Services to individuals with physical disabilities; (f) Gender affirming and responsive care; (g) LGBTQIA2S+ affirming and inclusive services; (h) Youth friendly and inclusive services. (4) If the applicant is a past recipient of REALD & SOGI funding, the applicant must provide a detailed description of the services provided under the previous award and how the usage of an additional award would be substantially different; (5) A detailed project description that includes timelines for deliverables if funded with REALD & SOGI funds, the estimated number of individuals to be served over the term of the grant for each service type, and the intended impact of the project; (6) A detailed operating budget for the project using the provided template and including a budget narrative. Statutory/Other Authority: ORS 413.166 Statutes/Other Implemented: ORS 413.166 History: EID 3-2024, adopt filed 10/01/2024, effective 10/01/2024