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

ORS 442.310. Findings and policy. (1) The Legislative Assembly finds that the achievement of reasonable access to quality health care at a reasonable cost is a priority of the State of Oregon. (2) Problems preventing the priority in subsection (1) of this section from being attained include: (a) The inability of many citizens to pay for necessary health care, being covered neither by private insurance nor by publicly funded programs such as Medicare and Medicaid; (b) Rising costs of medical care which exceed substantially the general rate of inflation; (c) Insufficient price competition in the delivery of health care services that would provide a greater cost consciousness among providers, payers and consumers; (d) Inadequate incentives for the use of less costly and more appropriate alternative levels of health care; (e) Insufficient or inappropriate use of existing capacity, duplicated services and failure to use less costly alternatives in meeting significant health needs; and (f) Insufficient primary and emergency medical care services in medically underserved areas of the state. (3) As a result of rising health care costs and the concern expressed by health care providers, health care users, third-party payers and the general public, there is an urgent need to abate these rising costs so as to place the cost of health care within reach of all Oregonians without affecting the quality of care. (4) To foster the cooperation of the separate industry forces, there is a need to compile and disseminate accurate and current data, including but not limited to price and utilization data, to meet the needs of the people of Oregon and improve the appropriate usage of health care services. (5) It is the purpose of this chapter to establish area-wide and state planning for health services, staff and facilities in light of the findings of subsection (1) of this section and in furtherance of health planning policies of this state. (6) It is further declared that hospital costs should be contained through improved competition between hospitals and improved competition between insurers and through financial incentives on behalf of providers, insurers and consumers to contain costs. As a safety net, it is the intent of the Legislative Assembly to monitor hospital performance. [Formerly 442.025]
ORS Chapter 442 — Health Planning

ORS 442.325. Certificate of need for health care facility of health maintenance organization; exempt activities; policy relating to health maintenance organizations. (1) A certificate of need shall be required for the development or establishment of a health care facility of any new health maintenance organization. (2) Any activity of a health maintenance organization which does not involve the direct delivery of health services, as distinguished from arrangements for indirect delivery of health services through contracts with providers, shall be exempt from certificate of need review. (3) Nothing in ORS 244.050, 431.250, 441.015 to 441.119, 441.993, 442.015 to
ORS Chapter 442 — Health Planning

ORS 442.344. Exemptions from requirements. In furtherance of the purpose and intent of the Legislative Assembly as expressed in ORS 442.310 to achieve reasonable access to quality health care at a reasonable cost, the requirements of ORS
ORS Chapter 442 — Health Planning

ORS 442.347. Rural hospital required to report certain actions. A rural hospital exempted from the certificate of need requirement by ORS 442.315 (8) shall report any action taken by the hospital that would have required a certificate of need if the exemption did not exist. [1993 c.722 4] Note:
ORS Chapter 442 — Health Planning

ORS 442.350. [Formerly 441.140; repealed by 1989 c.1034 11]
ORS Chapter 442 — Health Planning

ORS 442.355. c.581 2; 2007 c.71 128; 2009 c.595 750; 2015 c.318 6; 2018 c.50 7; 2019 c.537 1; renumbered 442.370 in 2019]
ORS Chapter 442 — Health Planning

ORS 442.360. [1977 c.751 9; 1979 c.697 7; 1981 c.693 25; 1985 c.747 37; repealed by 1989 c.1034 11] REPORTING OF PROPOSED CAPITAL PROJECTS
ORS Chapter 442 — Health Planning

ORS 442.361. Definitions for ORS 442.361, 442.362 and 442.991. As used in this section and ORS 442.362 and 442.991: (1)(a) Capital project means: (A) The construction, development, purchase, renovation or any construction expenditure by or on behalf of a reporting entity, for which the cost: (i) For type A hospitals, exceeds five percent of gross revenue. (ii) For type B hospitals, exceeds five percent of gross revenue. (iii) For DRG hospitals, exceeds 1.75 percent of gross revenue. (iv) For ambulatory surgical centers, exceeds $2 million. (B) The purchase or lease of, or other comparable arrangement for, a single piece of diagnostic or therapeutic equipment for which the cost or, in the case of a donation, the value exceeds $1 million. The acquisition of two or more pieces of diagnostic or therapeutic equipment that are necessarily interdependent in the performance of ordinary functions shall be combined in calculating the cost or value of the transaction. (b) Capital project does not include a project financed entirely through charitable fundraising. (2) DRG hospital means a hospital that is not a type A or type B hospital and that receives Medicare reimbursement based upon diagnostic related groups. (3) Gross revenue has the meaning given that term in ORS 442.015. (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 DRG hospital. (d) An ambulatory surgical center as defined in ORS 442.015. [2009 c.595 1197; 2023 c.9 39] Note:
ORS Chapter 442 — Health Planning

ORS 442.362. Reporting of proposed capital projects by hospitals and ambulatory surgical centers. The Oregon Health Authority may adopt rules requiring reporting entities within the state to publicly report proposed capital projects. Rules adopted under this section must: (1) Require a reporting entity to establish on the home page of its website a prominently labeled link to information about proposed or pending capital projects. The information posted must include but is not limited to a report of the community benefit for the project, its estimated cost and a means for interested persons to submit comments. When a reporting entity posts the information required under this subsection, the reporting entity must notify the authority of the posting in the manner prescribed by the authority. (2) If a reporting entity does not have a website, require the reporting entity to publish notice of the proposed capital project in a major newspaper or online equivalent serving the region in which the proposed capital project will be located. The notice must include but is not limited to a report of the community benefit for the project, its estimated cost and a means for interested persons to submit comments. When a reporting entity publishes the information required under this subsection, the reporting entity must notify the authority of the publication in the manner prescribed by the authority. (3) Establish a publicly available resource for information collected under this section. [2009 c.595 1198; 2015 c.318 30] Note: See note under
ORS Chapter 442 — Health Planning

ORS 442.370. Ambulatory surgery and inpatient discharge abstract records; rules; fees. (1) In order to provide data essential for health planning programs: (a) The Oregon Health Authority shall obtain directly from each hospital licensed to operate in this state, or from a third party working on behalf of or by contract with the hospital, the following information prescribed by the authority by rule: (A) Ambulatory surgery discharge abstract records; (B) Inpatient discharge abstract records; and (C) Emergency department discharge abstract records. (b) The authority shall obtain directly from each ambulatory surgical center licensed to operate in this state, or from a third party working on behalf of or by contract with the ambulatory surgical center, the following information prescribed by the authority by rule: (A) Ambulatory surgery discharge abstract records; and (B) Discharge abstract records of patients discharged from extended stay centers licensed under ORS 441.026 that are affiliated with the ambulatory surgical center. (2) The authority may establish by rule a fee to be charged to each ambulatory surgical center. (3) The fee established under subsection (2) of this section may not exceed the cost of abstracting and compiling the records. (4) The authority may specify by rule the form in which records are to be submitted. If the form adopted by rule requires conversion from the form regularly used by a hospital, ambulatory surgical center or extended stay center, reasonable costs of such conversion shall be paid by the authority. (5) The authority may provide by rule for the submission of ambulatory surgery, inpatient and emergency department discharge abstract records for enrollees in a health maintenance organization in a form the authority determines appropriate to the authoritys needs for the data and the organizations record keeping and reporting systems for charges and services. (6) The authority shall notify any entity submitting data under this section of any changes to the data sets that must be submitted, no later than July 1 of the calendar year preceding the effective date of the changes. (7) The authority may contract with a third party to receive and process the records submitted under this section. [Formerly 442.120] Note:
ORS Chapter 442 — Health Planning

ORS 442.372. Definitions for ORS 442.372 and 442.373. As used in this section and ORS 442.373, reporting entity means: (1) An insurer as defined in ORS 731.106 or fraternal benefit society as described in ORS 748.106 required to have a certificate of authority to transact health insurance business in this state. (2) A health care service contractor as defined in ORS 750.005 that issues medical insurance in this state. (3) A third party administrator required to obtain a license under ORS 744.702. (4) A pharmacy benefit manager or fiscal intermediary, or other person that is by statute, contract or agreement legally responsible for payment of a claim for a health care item or service. (5) A coordinated care organization as defined in ORS 414.025. (6) An insurer providing coverage funded under Part A, Part B or Part D of Title XVIII of the Social Security Act, subject to approval by the United States Department of Health and Human Services. [Formerly 442.464] Note:
ORS Chapter 442 — Health Planning

ORS 442.385. Definitions for ORS 442.385 and 442.386. As used in this section and ORS 442.386: (1) Frontline worker means any worker whose total annual compensation is less than $200,000, adjusted annually to reflect any percentage changes in the Consumer Price Index for All Urban Consumers, West Region (All Items), as published by the Bureau of Labor Statistics of the United States Department of Labor, excluding executive managers and salaried managers. (2) Health care means items, services and supplies intended to improve or maintain human function or treat or ameliorate pain, disease, condition or injury, including but not limited to the following types of services: (a) Medical; (b) Behavioral; (c) Substance use disorder; (d) Mental health; (e) Surgical; (f) Optometric; (g) Dental; (h) Podiatric; (i) Chiropractic; (j) Psychiatric; (k) Pharmaceutical; (L) Therapeutic; (m) Preventive; (n) Rehabilitative; (o) Supportive; or (p) Geriatric. (3) Health care cost growth means the annual percentage change in total health expenditures in this state. (4) Health care entity means a payer or a provider. (5) Health insurance has the meaning given that term in ORS 731.162. (6) Net cost of private health insurance means the difference between health insurance premiums received by a payer and the claims for the cost of health care paid by the payer under a policy or certificate of health insurance. (7) Payer means: (a) An insurer offering a policy or certificate of health insurance or a health benefit plan as defined in ORS 743B.005; (b) A publicly funded health care program, including but not limited to Medicaid, Medicare and the State Childrens Health Insurance Program; (c) A third party administrator; and (d) Any other public or private entity, other than an individual, that pays or reimburses the cost for the provision of health care. (8) Provider means an individual, organization or business entity that provides health care. (9) Total compensation means wages, benefits, salaries, bonuses and incentive payments provided to a frontline worker by a provider. (10)(a) Total health expenditures means all health care expenditures on behalf of residents of this state by public and private sources, including: (A) All payments on providers claims for reimbursement of the cost of health care provided; (B) All payments to providers other than payments described in subparagraph (A) of this paragraph; (C) All cost-sharing paid by residents of this state, including but not limited to copayments, deductibles and coinsurance; and (D) The net cost of private health insurance. (b) Total health expenditures may include expenditures for care provided to out-of-state residents by in-state providers to the extent practicable. [2019 c.560 1; 2021 c.51 1; 2023 c.393 1] Note:
ORS Chapter 442 — Health Planning

ORS 442.394. Acceptance by facilities as payment in full. (1) A hospital or ambulatory surgical center shall bill and accept as payment in full an amount determined in accordance with ORS 243.256 and 243.879, if applicable, or the payment methodology prescribed by the Oregon Health Authority under ORS 442.392. (2) This section does not apply to type A or type B hospitals, as described in ORS
ORS Chapter 442 — Health Planning

ORS 442.396. Attestation of compliance by insurers; rules. An insurer, as defined in ORS 731.106, that contracts with the Oregon Health Authority, including with the Public Employees Benefit Board and the Oregon Educators Benefit Board, to provide health insurance coverage for state employees, educators or medical assistance recipients must annually attest, on a form and in a manner prescribed by the authority, to its compliance with ORS 243.256, 243.879,
ORS Chapter 442 — Health Planning

ORS 442.400. Health care facility defined. As used in ORS 442.400 to 442.463, unless the context requires otherwise, health care facility or facility means such facility as defined by ORS 442.015, exclusive of a long term care facility, and includes all publicly and privately owned and operated health care facilities, but does not include facilities described in ORS 441.065.
ORS Chapter 442 — Health Planning

ORS 442.405. Legislative findings and policy. The Legislative Assembly finds that rising costs and charges of health care facilities are a matter of vital concern to the people of this state. The Legislative Assembly finds and declares that it is the policy of this state: (1) To require health care facilities to file for public disclosure reports that will enable both private and public purchasers of services from such facilities to make informed decisions in purchasing such services; and (2) To encourage development of programs of research and innovation in the methods of delivery of institutional health care services of high quality with costs and charges reasonably related to the nature and quality of the services rendered.
ORS Chapter 442 — Health Planning

ORS 442.420. Application for financial assistance; financial analysis and investigation authority; rules. (1) The Oregon Health Authority may apply for, receive and accept grants, gifts, payments and other funds and advances, appropriations, properties and services from the United States, the State of Oregon or any governmental body, agency or agencies or from any other public or private corporation or person, and enter into agreements with respect thereto, including the undertaking of studies, plans, demonstrations or projects. (2) The authority shall conduct or cause to have conducted such analyses and studies relating to costs of health care facilities as considered desirable, including but not limited to methods of reducing such costs, utilization review of services of health care facilities, peer review, quality control, financial status of any facility subject to ORS 442.400 to 442.463 and sources of public and private financing of financial requirements of such facilities. (3) The authority may also: (a) Hold public hearings, conduct investigations and require the filing of information relating to any matter affecting the costs of and charges for services in all health care facilities; (b) Subpoena witnesses, papers, records and documents the authority considers material or relevant in connection with functions of the authority subject to the provisions of ORS chapter 183; (c) Exercise, subject to the limitations and restrictions imposed by ORS 442.400 to
ORS Chapter 442 — Health Planning

ORS 442.425. Financial reporting systems. (1) The Oregon Health Authority by rule may specify one or more uniform systems of financial reporting necessary to meet the requirements of ORS 442.400 to 442.463. Such systems shall include such cost allocation methods as may be prescribed and such records and reports of revenues, expenses, other income and other outlays, assets and liabilities, and units of service as may be prescribed. Each facility under the authoritys jurisdiction shall adopt such systems for its fiscal period starting on or after the effective date of such system and shall make the required reports on such forms as may be required by the authority. The authority may extend the period by which compliance is required upon timely application and for good cause. Filings of such records and reports shall be made at such times as may be reasonably required by the authority. (2) Existing systems of reporting used by health care facilities shall be given due consideration by the authority in carrying out the duty of specifying the systems of reporting required by ORS 442.400 to 442.463. The authority insofar as reasonably possible shall adopt reporting systems and requirements that will not unreasonably increase the administrative costs of the facility. (3) The authority may allow and provide for modifications in the reporting systems in order to correctly reflect differences in the scope or type of services and financial structure between the various categories, sizes or types of health care facilities and in a manner consistent with the purposes of ORS 442.400 to
ORS Chapter 442 — Health Planning

ORS 442.430. Investigations; confidentiality of data. (1) Whenever a further investigation is considered necessary or desirable by the Oregon Health Authority to verify the accuracy of the information in the reports made by health care facilities, the authority may make any necessary further examination of the facilitys records and accounts. Such further examinations include, but are not limited to, requiring a full or partial audit of all such records and accounts. (2) In carrying out the duties prescribed by ORS 442.400 to 442.463, the authority may utilize its own staff or may contract with any appropriate, independent, qualified third party. No such contractor shall release or publish or otherwise use any information made available to it under its contractual responsibility unless such permission is specifically granted by the authority.
ORS Chapter 442 — Health Planning

ORS 442.450. Exemption from cost review regulations. The following are not subject to ORS
ORS Chapter 442 — Health Planning

ORS 442.460. Information about utilization and cost of health care services. In order to obtain regional or statewide data about the utilization and cost of health care services, the Oregon Health Authority may accept information relating to the utilization and cost of health care services identified by the authority from physicians, insurers or other third-party payers or employers or other purchasers of health care.
ORS Chapter 442 — Health Planning

ORS 442.463. (4) The authority may establish specific annual reporting provisions for facilities that receive a preponderance of their revenue from associated comprehensive group-practice prepayment health care service plans. Notwithstanding any other provisions of ORS 442.400 to 442.463, such facilities shall be authorized to utilize established accounting systems and to report costs and revenues in a manner consistent with the operating principles of such plans and with generally accepted accounting principles. When such facilities are operated as units of a coordinated group of health facilities under common ownership, the facilities shall be authorized to report as a group rather than as individual institutions, and as a group shall submit a consolidated balance sheet, income and expense statement and statement of source and application of funds for such group of health facilities.
ORS Chapter 442 — Health Planning

ORS 442.466. Note: See note under
ORS Chapter 442 — Health Planning

ORS 442.469. [1985 c.747 24; 1987 c.660 11; 1989 c.1034 7; 1995 c.727 34; 1997 c.683 30; repealed by 1999 c.581 11] RURAL HEALTH
ORS Chapter 442 — Health Planning

ORS 442.470. Definitions for ORS 442.470 to 442.507. As used in ORS 442.470 to 442.507: (1) Acute inpatient care facility means a licensed hospital with an organized medical staff, with permanent facilities that include inpatient beds, and with comprehensive medical services, including physician services and continuous nursing services under the supervision of registered nurses, to provide diagnosis and medical or surgical treatment primarily for but not limited to acutely ill patients and accident victims. (2) Council means the Rural Health Coordinating Council. (3) Office means the Office of Rural Health. (4) Primary care physician means a doctor licensed under ORS chapter 677 whose specialty is family practice, general practice, internal medicine, pediatrics or obstetrics and gynecology. (5) Rural critical access hospital means a facility that meets the criteria set forth in 42 U.S.C. 1395i-4 (c)(2)(B) and that has been designated a critical access hospital by the Office of Rural Health. (6)(a) Rural hospital means a hospital characterized as one of the following: (A) A type A hospital, which is a small and remote hospital that has 50 or fewer beds and is more than 30 miles from another acute inpatient care facility; (B) A type B hospital, which is a small and rural hospital that has 50 or fewer beds and is 30 miles or less from another acute inpatient care facility; (C) A type C hospital, which is considered to be a rural hospital and has more than 50 beds, but is not a referral center; or (D) A rural critical access hospital. (b) Rural hospital does not include a hospital of any class that was designated by the federal government as a rural referral hospital before January 1, 1989.
ORS Chapter 442 — Health Planning

ORS 442.475. Office of Rural Health. There is created the Office of Rural Health in the Oregon Health and Science University.
ORS Chapter 442 — Health Planning

ORS 442.480. Rural Health Care Revolving Account. (1) There is established the Rural Health Care Revolving Account in the General Fund. (2) All moneys appropriated for the purposes of ORS 442.470 to 442.507 and all moneys paid to the Office of Rural Health by reason of loans, fees, gifts or grants for the purposes of ORS 442.470 to 442.507 shall be credited to the Rural Health Care Revolving Account. (3) All moneys contained in the Rural Health Care Revolving Account are continuously appropriated to the Oregon Department of Administrative Services for the Office of Rural Health and shall be used for the purposes of ORS