justicedao/ipfs_state_laws huggingface dataset:
ORS Chapter 442 — Health Planning

ORS 442.612. Definitions. As used in ORS 442.612 to 442.630: (1) Adjust means to reduce a patients cost by a specified percentage. (2) Community benefit has the meaning given that term in ORS 442.601. (3) Gross charges means a hospitals full, established price for medical care that the hospital consistently and uniformly charges patients before applying any contractual allowance, discounts or deductions. (4)(a) Hospital has the meaning given that term in ORS 442.015, excluding any campus of the Oregon State Hospital, a hospital operated by the United States Department of Veterans Affairs Veterans Health Administration or any other hospital operated by the federal government. (b) Hospital includes only hospitals located in this state. (5) Hospital-affiliated clinic or affiliated clinic means a facility located in this state that provides outpatient health services and that is operated under the common control or ownership of a hospital. (6) Household means: (a)(A) A single individual; or (B) Spouses, domestic partners, or a parent and child under 18 years of age, living together; and (b) Other individuals for whom a single individual, spouse, domestic partner or parent is financially responsible. (7) Medically necessary means: (a) Necessary to prevent, diagnose or treat an illness, injury, condition or disease, or the symptoms of an illness, injury, condition or disease; and (b) Meeting accepted standards of medicine. (8) Nonprofit means: (a) Organized not for profit, pursuant to ORS chapter 65 or any predecessor of ORS chapter 65; or (b) Organized and operated as described under section 501(c) of the Internal Revenue Code as defined in ORS 305.842. (9) Patients cost means the portion of charges billed to a patient for care received at a hospital or a hospital-affiliated clinic that are not reimbursed by insurance or a publicly funded health care program, taking into account the requirements of section 501(r)(5) of the Internal Revenue Code that: (a) Prohibit a nonprofit hospital from billing gross charges; and (b) Limit amounts charged for emergency or other medically necessary care, to a patient who qualifies under the nonprofit hospitals financial assistance policy, to no more than amounts generally billed to a patient who has insurance that reimburses all or a portion of the cost of the care. (10) Social determinants of health means the social, economic and environmental conditions in which people are born, grow, work, live and age, shaped by the distribution of money, power and resources at local, national and global levels, institutional bias, discrimination, racism and other factors. [2019 c.497 1; 2021 c.96 3] Note: See second note under 442.610.
ORS Chapter 442 — Health Planning

ORS 442.614. (c) Whether the hospital is a nonprofit entity and whether the hospitals nonprofit status applies to the hospitals affiliated clinics; (d) During the reporting period: (A) How many applications for financial assistance the hospital received and of the applications received, the number of applications that were approved; (B) Of the patients who received financial assistance, the number of patients who received financial assistance without completing the hospitals financial assistance application process; and (C) Reported by payer type, the number of patients who received financial assistance and the number of patients who were denied financial assistance; (e) During the reporting period, the number of accounts that were: (A) Referred to a debt collector or collection agency during the reporting period; and (B) Transferred for extraordinary collection actions during the reporting period, listed by type of action; and (f) The average, median and total amount of debt, owed to the hospital by patients, that was placed in collections during the reporting period. (3) The authority shall prescribe the form and manner for reporting the information described in subsection (2) of this section. (4) A hospital that fails to file a timely report, as prescribed by the authority, may be subject to a civil penalty not to exceed $500 per day. Civil penalties shall be imposed as provided in ORS 183.745. Note: Section 6 (3), chapter 263, Oregon Laws 2023, provides: Sec. 6. (3) The Oregon Health Authority shall take any action before the operative dates specified in this section that is necessary to carry out section 1 of this 2023 Act [442.615] and the amendments to ORS 442.610, 442.618 and 646A.677 by sections 2 to 4 of this 2023 Act on and after the operative dates specified in this section. [2023 c.263 6(3)] Note: See second note under 442.610. (Community Benefit Spending)
ORS Chapter 442 — Health Planning

ORS 442.618. (1) As used in this section: (a) Extraordinary collection action means actions referenced in section 501(r)(6) of the Internal Revenue Code or implementing regulations. (b) Health care facility has the meaning given that term in ORS 442.015, excluding long term care facilities. (c) Payer type means one or more of the following persons legally responsible for all or part of the cost of hospital services: (A) A commercial insurer; (B) Medicare; (C) The state medical assistance program; (D) A patient who is uninsured or otherwise personally responsible for the cost of hospital services; or (E) Another payer type prescribed by the Oregon Health Authority by rule. (2) A hospital shall report annually to the authority the following information regarding all health care facilities and affiliated clinics that are owned in part or in full by the hospital or operating under the same brand as the hospital: (a) The address of each health care facility and affiliated clinic; (b) Whether the hospitals financial assistance policy, developed under ORS
ORS Chapter 442 — Health Planning

ORS 442.624. Establishment of community benefit spending floor; rules. (1) Every two years, the Oregon Health Authority shall establish a community benefit spending floor as provided in this section based on objective data and criteria, including but not limited to the following: (a) Historical and current expenditures on community benefits by the hospital and the hospitals affiliated clinics. (b) Community needs identified in the community needs assessment conducted by the hospital in accordance with section 501(r)(3) of the Internal Revenue Code, and community health assessments and community health improvement plans of coordinated care organizations that serve the same geographic area served by the hospital and the hospitals affiliated clinics, in accordance with ORS 414.575 and 414.578. (c) The hospitals need to expand the health care workforce. (d) The overall financial position of the hospital and the hospitals affiliated clinics based on audited financial statements and other objective data. (e) The demographics of the population in the areas served by the hospital and the hospitals affiliated clinics. (f) The spending on the social determinants of health by the hospital or the hospitals affiliated clinics. (g) Taxes paid by the hospital and the hospitals payments, in lieu of taxes, paid to: (A) A local government; (B) The state; or (C) The United States government. (h) Criteria governing the manner in which the authority will consider input received from the general public under subsection (2)(c) of this section. (i) The hospitals obligations and commitments, as reported to the Internal Revenue Service, to: (A) Fund, support or provide health professions education; and (B) Fund health research. (j) For the Oregon Health and Science University hospital, its obligation to carry out the public purposes and missions specified in ORS 353.030. (2) In establishing the community benefit spending floors under subsection (1) of this section, the authority shall: (a) Consult with representatives of hospitals; (b) Provide an opportunity for hospitals and hospital-affiliated clinics to respond to any findings; (c) Solicit and consider comments from the general public; and (d) Consult with or solicit advice from one or more individuals with expertise in the economics of health care. (3) The authority shall adopt by rule alternative methodologies for hospitals and hospital-affiliated clinics to report data and to apply the community benefit spending floors, including but not limited to: (a) By each individual hospital and all of the hospitals nonprofit affiliated clinics; (b) By a hospital and a group of the hospitals nonprofit affiliated clinics; and (c) By all hospitals that are under common ownership and control and all of the hospitals nonprofit affiliated clinics. (4) Each hospital shall be provided the opportunity to select the applicable methodology from those adopted by the authority by rule under subsection (3) of this section. (5) The authority may adopt rules necessary to carry out the provisions of this section. [2019 c.497 6] Note: See second note under 442.610.
ORS Chapter 442 — Health Planning

ORS 442.625. [1999 c.1056 3; renumbered 442.870 in 2019] (Community Health Needs)
ORS Chapter 442 — Health Planning

ORS 442.630. Community health needs assessment and three-year strategy; public participation. A nonprofit hospital shall post to the hospitals website the following information regarding its community health needs assessment conducted in accordance with section 501(r)(3) of the Internal Revenue Code: (1) A description of the health care needs identified in the hospitals community health needs assessment; (2) The three-year strategy developed to address the health care needs of the community; (3) Annual progress on the implementation of the strategy; and (4) Opportunities for public participation in the assessment and development of the strategy. [2019 c.497 5] Note: See second note under 442.610. COOPERATIVE PROGRAM ON HEART AND KIDNEY TRANSPLANTS
ORS Chapter 442 — Health Planning

ORS 442.700. Definitions for ORS 442.700 to 442.760. As used in ORS 442.700 to 442.760: (1) Board of governors means the governors of a cooperative program as described in ORS 442.720. (2) Cooperative program means a program among two or more health care providers for the purpose of providing heart and kidney transplant services including, but not limited to, the sharing, allocation and referral of physicians, patients, personnel, instructional programs, support services, facilities, medical, diagnostic, laboratory or therapeutic services, equipment, devices or supplies, and other services traditionally offered by health care providers. (3) Health care provider means a hospital, physician or entity, a significant part of whose activities consist of providing hospital or physician services in this state. For purposes of the immunities provided by ORS 442.700 to 442.760 and 646.740, health care provider includes any officer, director, trustee, employee, or agent of, or any entity under common ownership and control with, a health care provider. (4) Hospital means a hospital, a long term care facility or an ambulatory surgical center, as those terms are defined in ORS 442.015, that is licensed under ORS 441.015 to 441.119 and 441.993. Hospital includes community health programs established under ORS 430.610 to 430.695. (5) Order means a decision issued by the Director of the Oregon Health Authority under ORS 442.710 either approving or denying an application for a cooperative program and includes modifications of an original order under ORS 442.730 (3)(b) and ORS 442.740 (1) and (4). (6) Party to a cooperative program agreement or party means an entity that enters into the principal agreement to establish a cooperative program and applies for approval under ORS 442.700 to 442.760 and 646.740 and any other entity that, with the approval of the director, becomes a member of a cooperative program. (7) Physician means a physician licensed under ORS chapter 677.
ORS Chapter 442 — Health Planning

ORS 442.705. Legislative findings; goals. (1) The Legislative Assembly finds that direct competition among health care providers in the field of heart and kidney transplant services may not result in the most cost efficient and least expensive transplant services for the citizens of this state and that it is in the public interest to allow cooperative programs among health care providers providing heart and kidney transplant services. (2) The Legislative Assembly declares that, to the extent provided in ORS 442.700 to 442.760, it is the policy and intent of this state to displace competition among health care providers providing heart and kidney transplant services by allowing health care providers to enter into cooperative programs governing the provision of heart and kidney transplant services in order to achieve in each instance the following goals: (a) Reduction of, or protection against, rising costs of heart and kidney transplant services; (b) Reduction of, or protection against, rising prices for heart and kidney transplant services; (c) Improvement or maintenance of the quality of heart and kidney transplant services provided in this state; (d) Reduction of, or protection against, duplication of resources including, without limitation, expensive medical specialists, medical equipment and sites of service; (e) Improvement or maintenance of efficiency in the delivery of heart and kidney transplant services; (f) Improvement or maintenance of public access to heart and kidney transplant services; (g) Increase in donations of organs for transplantation; and (h) Improvement in the continuity of patient care. (3) The Legislative Assembly further declares that the goals identified in subsection (2) of this section represent the policies of this state. (4) The Legislative Assembly further declares that once a cooperative program is approved under ORS 442.700 to 442.760, there is an interest in insuring stability in the provision of health care services by a cooperative program, to the extent stability is consistent with achieving the goals identified in subsection (2) of this section. (5) The Director of the Oregon Health Authority shall actively supervise the cooperative program in accordance with authority under ORS 442.700 to 442.760 and 646.740.
ORS Chapter 442 — Health Planning

ORS 442.715. Authorized practices under approved cooperative program. (1) To the extent permitted by an order issued under ORS 442.710, health care providers providing heart and kidney transplant services through a cooperative program approved under ORS 442.700 to 442.760 may engage in the following practices in order to achieve the goals described in ORS 442.705 (2): (a) Set prices for heart and kidney transplants and all services directly related to heart and kidney transplants; (b) Refuse to deal with competitors in the heart and kidney transplant market; (c) Allocate product, service, geographic and patient markets directly relating to heart and kidney transplants; (d) Acquire and maintain a monopoly in heart and kidney transplant services; and (e) Engage in other activities that might give rise to liability under ORS 646.705 to 646.836 or federal antitrust laws. (2) To the extent permitted by an order issued under ORS 442.710 and in addition to the provisions of subsection (1) of this section, physicians participating in a cooperative program may agree among themselves on referrals of nontransplant cardiac surgeries to the extent necessary to achieve redistribution of the cardiac surgery cases among participating surgeons. (3) The Legislative Assembly intends that all persons arranging or participating in a cooperative program approved and conducted in accordance with an order issued under ORS 442.710 and all persons participating in good faith negotiations conducted pursuant to ORS 442.750 shall: (a) Not be subject to the provisions of ORS 646.705 to 646.836 so long as the activities of the cooperative program are regulated, lawful and approved in accordance with ORS 442.700 to 442.760 and 646.740; and (b) Receive the full benefit of state action immunity under federal antitrust laws.
ORS Chapter 442 — Health Planning

ORS 442.720. Board of governors for cooperative program. (1) If the Director of the Oregon Health Authority issues an order approving an application for a cooperative program under ORS 442.710, the director shall establish a board of governors to govern the cooperative program. The board of governors shall not constitute, for any purpose, a governmental agency. (2) The board of governors shall consist of the president or other chief executive officer of each health care provider that is a party to the cooperative program agreement and the director or a designee of the director. The designee shall serve at the pleasure of the director. The designee shall not have any economic or other interest in any of the health care providers associated with the cooperative program. (3) In governing the cooperative program, the board of governors shall develop policy and approve budgets for the implementation of the cooperative program. (4) The director or designee of the director may reject any operating or capital budget of the cooperative program upon a finding by the director that the budget is not consistent with the goals listed in ORS 442.705 (2) that the cooperative program is expected to achieve.
ORS Chapter 442 — Health Planning

ORS 442.725. Annual report of board of governors. Not later than 60 days following each anniversary date of the approval of a cooperative program by the Director of the Oregon Health Authority, the board of governors of the cooperative program shall deliver an annual report to the director. The report shall specifically describe: (1) How heart and kidney transplant services and related services of the cooperative program are being provided in accordance with the order; (2) Which of the goals identified in the order are being achieved and to what extent; and (3) Any substantial changes in the cooperative program.
ORS Chapter 442 — Health Planning

ORS 442.730. Review and evaluation of report; modification or revocation of order of approval. (1) The Director of the Oregon Health Authority shall review and evaluate the annual report delivered under ORS 442.725. The director shall: (a) Determine the extent to which the cooperative program is achieving the goals identified in the order; (b) Review the activities being conducted to achieve the goals; and (c) Determine whether each of the activities is still necessary and appropriate to achieve the goals. (2) If the director determines that additional information is needed for the review described in subsection (1) of this section, the director may order the board of governors to provide the information within a specified time. (3) Within 60 days after receiving the annual report or any additional information ordered under subsection (2) of this section, the director shall: (a) Approve the report if the director determines that the cooperative program is operating in accordance with the order and that the goals identified in the order are being adequately achieved by the cooperative program; (b) Modify the order as appropriate to adjust to changes in the cooperative program approved by the director and approve the report as provided in paragraph (a) of this subsection; (c) Order the board of governors to make remedial changes in anticompetitive activities not in compliance with the order and request the board of governors to report on progress not later than a deadline specified by the director; (d) Revoke approval of the cooperative program; or (e) Take any of the actions set forth in ORS 442.740.
ORS Chapter 442 — Health Planning

ORS 442.735. Complaint procedure. (1) Any person may file a complaint with the Director of the Oregon Health Authority requesting that a specific decision or action of a cooperative program supervised by the director be reversed or modified, or that approval for all or part of the activities permitted by the order be suspended or terminated. The complaint shall allege the reasons for the requested action and shall include any evidence relating to the complaint. (2) The director on the directors own initiative may at any time request information from the board of governors concerning the activities of the cooperative program to determine whether the cooperative program is in compliance with the order.
ORS Chapter 442 — Health Planning

ORS 442.740. Powers of director over action under cooperative program. (1) During the review of the annual report described in ORS 442.730, after receiving a complaint under ORS 442.735, or on the directors own initiative, the Director of the Oregon Health Authority may take one or more of the following actions: (a) If the director determines that a particular decision or action is not in accordance with the order, or that the parties are engaging in anticompetitive activity not permitted by the order, the director may direct the board of governors to identify and implement corrective action to insure compliance with the order or may modify the order. (b) If the director determines that the cooperative program is engaging in unlawful activity not permitted by the order or is not complying with the directive given under paragraph (a) of this subsection, the director may serve on the cooperative program a proposed order directing the cooperative program to: (A) Conform with the directive under paragraph (a) of this subsection; or (B) Cease and desist from engaging in the activity. (2) The cooperative program shall have up to 30 days to comply with a proposed order under subsection (1)(b) of this section unless the board of governors demonstrates additional time is needed for compliance. (3) If the director determines that the participants in the cooperative program are in substantial noncompliance with the cease and desist directive, the director may seek an appropriate injunction in the circuit courts of Marion or Multnomah Counties. (4) If the director determines that a sufficient number of the goals set forth in ORS 442.705 (2) are not being achieved or that the cooperative program is engaging in activity not permitted by the order, the director may suspend or terminate approval for all or part of the activities approved and permitted by the order. (5) A proposed order to be entered under subsection (1)(b) or (4) of this section may be served upon the cooperative program without prior notice. The cooperative program may contest the proposed order by filing a written request for a contested case hearing with the director not later than 20 days following the date of the proposed order. The proposed order shall become final if no request for a hearing is received. Unless inconsistent with this subsection, the provisions of ORS chapter 183, as applicable, shall govern the hearing procedure and any judicial review. (6) The only effect of an order suspending or terminating approval under ORS 442.700 to 442.760 shall be to withdraw the immunities granted under ORS 442.715 (3) for anticompetitive activity permitted by the order and taken after the effective date of the order.
ORS Chapter 442 — Health Planning

ORS 442.745. Disclosure of confidential information not waiver of right to protect information. If parties to a cooperative program agreement provide the Director of the Oregon Health Authority with written or oral information that is confidential or otherwise protected from disclosure under Oregon law, the disclosures shall not be considered a waiver of any right to protect the information from disclosure in other proceedings.
ORS Chapter 442 — Health Planning

ORS 442.750. Status of actions under cooperative program; effect on other liability. (1) Notwithstanding the provisions of ORS 646.705 to 646.836: (a) A cooperative program for which approval has been granted under ORS 442.700 to
ORS Chapter 442 — Health Planning

ORS 442.755. Rules; costs; fees. (1) The Director of the Oregon Health Authority shall adopt rules as may be necessary to carry out the provisions of ORS 442.700 to 442.760. (2) The costs of program approval and supervision shall be paid by the parties to a cooperative program agreement and the director shall set fees for application, annual review and supervision as necessary to fund the directors supervision of the program.