reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 407 - DEPARTMENT OF HUMAN SERVICES › Division 120 - PROVIDER RULES › Section 407-120-0380 - Fraud and Abuse

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers
			 shall promptly refer all suspected fraud and abuse, including fraud or abuse by
			 its employees or in Department administration, to the MFCU, or to the
			 Department's audit unit.
(2)
			 Providers must permit the MFCU and the Department to inspect, copy, evaluate,
			 or audit books, records, documents, files, accounts, and facilities, without
			 charge, as required to investigate allegations or incidents of fraud or
			 abuse.
(3) Providers aware of
			 suspected fraud or abuse by a client must report the incident to the
			 Department's fraud unit.
(4) The
			 Department may share information for health oversight purposes with the MFCU
			 and other federal or state health oversight authorities.
(5) The Department may take actions necessary
			 to investigate and respond to substantiated allegations of fraud and abuse
			 including but not limited to suspending or terminating the provider from
			 participation in the Department's programs, withholding payments or seeking
			 recovery of payments made to the provider, or imposing other sanctions provided
			 under state law or regulations. Such actions by the Department may be reported
			 to CMS or other federal or state entities as appropriate.
Stat. Auth.: ORS
				  409.050,
				  411.060
Stats. Implemented: ORS
				  414.115,
				  414.125,
				  414.135,
				  414.145
Oregon Administrative Rules › Chapter 407 - DEPARTMENT OF HUMAN SERVICES › Division 120 - PROVIDER RULES › Section 407-120-0400 - MMIS Replacement Communication Plan

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The purpose of this rule is to describe
			 the Department's plan for communicating instructions and guidance related to
			 the Department's implementation of the replacement MMIS that began on December
			 9, 2008. System issues are anticipated to be identified for a period of time
			 during and after implementation. This rule is adopted to be effective
			 retroactively to December 9, 2008 for the purpose of providing continuity of
			 all MMIS communication efforts throughout the transition implementation process
			 and regular operations following the transition. By adopting this communication
			 plan in rule, the Department seeks to assure that eligible Department clients
			 receive all necessary and appropriate services, and that Department providers
			 and PHPs are correctly reimbursed for covered services provided to eligible
			 clients.
(2) To the extent
			 necessary to accomplish the purposes of this rule, the Department shall provide
			 guidance and instructions related to MMIS for providers and PHPs using its web
			 site and MMIS provider announcements.
(a) In
			 cases of limitations or system errors in the replacement MMIS, the Department
			 shall provide update information and important action required in concert with,
			 or in place of, normal established procedures.
(b) In other cases, the Department shall
			 provide instructions and guidance about the use of revised or improved
			 functionality that is available through the replacement MMIS, such as the use
			 of the web portal.
Oregon Administrative Rules › Chapter 407 - DEPARTMENT OF HUMAN SERVICES › Division 120 - PROVIDER RULES › Section 407-120-1505 - Provider and Contractor Audits, Appeals, and Post Payment Recoveries

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers or
			 entities under contract with the Department of Human Services (Department) or
			 the Oregon Health Authority (Authority) (hereafter referred to as "provider")
			 receiving payments from the Department or Authority are subject to audit or
			 other post payment review procedures (hereafter referred to as "audit") for all
			 payments applicable to items or services furnished or supplied by the provider
			 to or on behalf of Department or Authority clients.
(a) Audit rules and procedures ensure proper
			 payments were made based on requirements applicable to covered services, ensure
			 program integrity of the Department or Authority programs and services as
			 outlined in OAR 407-120-0310, and establish authority for the Office of
			 Payment, Accuracy and Recovery (OPAR), Provider Audit Unit (PAU) to recover
			 overpayments and discover possible instances of fraud, waste, and
			 abuse.
(b) The Department and
			 Authority share duties and functions related to audits and have the authority
			 to determine which of the two agencies is authorized to fulfill a particular
			 function. References in this rule to one agency should be construed to include,
			 as the context requires, either or both agencies.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 1 - PROCEDURAL RULES › Section 409-001-0000

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  183.341 &
				  413.042
Stats. Implemented: ORS
				  183.341,
				  409.560,
				  409.570,
				  409.745,
				  413.042,
				  413.225,
				  442.120,
				  442.205,
				  442.362,
				  442.420,
				  442.425,
				  442.445,
				  442.463,
				  442.466,
				  442.807, notes following ORS
				  442.851,
				  442.991 &
				  735.723
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 1 - PROCEDURAL RULES › Section 409-001-0005 - Model Rules of Procedure

Current through Register Vol. 63, No. 7, July 1, 2024
The Oregon Health Authority, Health Policy and Analytics
				Division adopts the Attorney General's Uniform and Model Rules of Procedure
				applicable to rulemaking, effective July 2016.
The full text of the Attorney General's Model Rules of
				  Procedure is available from the Office of the Attorney General or the Oregon
				  Health Authority.
Statutory/Other Authority: ORS
				  183.341 & 413.042
Statutes/Other Implemented: ORS
				  183.341 &
				  413.042
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-015-0005  through
				409-015-0040:
(1) "Authority" means
			 the Oregon Health Authority.
(2)
			 "Charity care" means the uncollectible value, at the hospital's full
			 established rates, of services provided to financially indigent patients. The
			 uncollectible portion may vary from a very small percentage of the regular
			 charges for some patients, up to 100 percent for other patients.
(3) "Health care facility" means a hospital,
			 including any special inpatient care facility, and an ambulatory surgical
			 facility. The following facilities are not covered:
(a) Institutions providing only domiciliary
			 care;
(b) Infirmaries of state
			 institutions, colleges and universities;
(c) Federal facilities; and
(d) Long-term care facilities, or
			 hospital-based long-term care service.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0010 - Report Forms

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All
			 health care facilities shall file the required reports and data on forms
			 provided or approved by the Authority.
(2) The Authority adopts and incorporates by
			 reference the Patient Revenue and Unreimbursed Care form, Form FR-3.
(3) The Authority shall not accept obsolete
			 forms.
Forms referenced are available from the
				  agency.
Stat. Auth.: ORS
				  442.405,
				  442.420 &
				  442.425
Stats. Implemented: ORS
				  442.425
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0012 - Filing Date

Current through Register Vol. 63, No. 7, July 1, 2024
The date of filing for the Databank Monthly Data
				electronically, is the date of receipt by the Oregon Association of Hospitals
				and Health Systems. The date of filing for the Patient Revenue and Unreimbursed
				Care (Form FR-3) is the postmark date.
Forms referenced are available from the
				  agency.
Stat. Auth.: ORS
				  442.405(1),
				  442.420(3)(d)
				  & 442.425
Stats. Implemented: ORS
				  442.425
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0015 - Reports Required

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Each health care facility shall file with the Authority financial statements,
			 with attached certification of audit, not later than 120 days following the
			 close of each fiscal year. If the financial statements of the facility are a
			 part of the combining of a for-profit or not-for-profit corporation, the
			 combining financial statements and attached certification of audit shall be
			 filed.
(2) Each health care
			 facility shall file an accurately completed Databank Monthly Data
			 electronically with the Oregon Association of Hospitals and Health Systems
			 (OAHHS) for receipt by OAHHS on or before the 23rd day of each month. This form
			 will transmit data for the preceding month. The Authority may, at its
			 discretion, exempt a special inpatient care facility, ambulatory surgical
			 facility or other health care facility from the requirements of this section.
			 The Authority may, by oral or written notification, require a health care
			 facility to use an express mail service to submit the Databank Monthly Data
			 Input Form to OAHHS.
(3) The
			 Authority may annually require that each health care facility provide a
			 breakdown of its unreimbursed care into bad debts, charity care, Medicare
			 deductions, Medicaid deductions and other contractual deductions, using Form
			 FR-3.
(4) Each health care
			 facility may be required to annually submit to the Authority a breakdown of its
			 gross patient service revenue into inpatient revenue and outpatient revenue,
			 and other applicable categories specified by Form FR-3.
(5) Documents filed with the Authority under
			 these rules are to be addressed to the Oregon Health Authority, Health Systems
			 Research & Data, 500 Summer St. NE E-64, Salem, Oregon 97301-1079.
Forms referenced are available from the
				  agency.
Stat. Auth.: ORS
				  442.405,
				  442.420 &
				  442.425
Stats. Implemented: ORS
				  442.425
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0030 - Modification of Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority, upon request of a health
			 care facility and for good cause, may relieve or modify the reporting
			 requirements provided for in these rules when the reporting requirement is
			 proven to the satisfaction of the Authority to impose an undue hardship.
(2) Unless otherwise specified by
			 the Authority, any relief or modification granted under section (1) of this
			 rule is restricted to the specific instance or occasion for which relief was
			 sought, and may not be construed to relieve any other reporting requirements of
			 the health care facility.
Stat. Auth.: ORS
				  442.405,
				  442.420 &
				  442.425
Stats. Implemented: ORS
				  442.425
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0035 - Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Pursuant to ORS 442.445, the Authority adopts
			 the following schedule of civil penalties:
(a) $250.00 per day for the first five days
			 of failure to file in accord with ORS
			 442.425; and
(b) $500.00 per day from the sixth day until
			 filing in accordance with ORS
			 442.425 is satisfactorily
			 accomplished.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 15 - HEALTH CARE FACILITY FINANCIAL REPORTING › Section 409-015-0040 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  442.405(2),
				  442.420(3)(d)&
				  442.425
Stats. Implemented: ORS
				  442.425
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 17 - DENTAL SERVICES: UNDERSERVED POPULATIONS › Section 409-017-0121 - Dental Therapy Definition of Underserved Populations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The purpose of this rule is to define the
			 term "underserved population" per ORS 679.624 for the Board of Dentistry Dental
			 Therapy rules.
(2) The term
			 "Underserved Population" refers to populations experiencing a shortage of
			 dental health services due to systemic inequities causing an inability to pay,
			 lack of access to culturally responsive, linguistically appropriate, and
			 comprehensive care, or other inequities for reasons of race, ethnicity,
			 national origin, language, disability, age, gender, gender identity, sexual
			 orientation, socioeconomic class, religion, intersections among these
			 communities or identities, or other socially determined circumstances. These
			 populations include, but are not limited to:
(a) Latino/a/x populations;
(b) Black or African American
			 populations;
(c) American
			 Indian/Alaska Native populations;
(d) Asian populations;
(e) Middle Eastern and North African
			 populations;
(f) Native Hawaiian
			 and Pacific Islander populations;
(g) Slavic and Eastern European
			 populations;
(h) Immigrants and
			 Refugees;
(i) Individuals with
			 limited English proficiency (LEP);
(j) Persons with disabilities;
(k) LGBTQ+ populations;
(l) Pregnant women, new mothers, and women
			 with children;
(m) Individuals
			 transitioning out of incarceration;
(n) Members of religious
			 minorities;
(o) People experiencing
			 unstable housing/houselessness/homelessness;
(p) Migrant and seasonal farmworkers, and
			 related family members;
(q) Young
			 adults and postsecondary graduating students who do not have coverage options
			 through a parent's plan, a student plan, or an employer plan;
(r) Government program-eligible consumers,
			 regardless of whether they are actually enrolled in the program, including
			 those eligible for OHP, Healthier Together Oregon/Cover All Oregonians, DHS
			 foster children;
(s) Uninsured or
			 under-insured individuals, including those receiving coverage though
			 community-based programs or funds;
(t) Other populations not listed above
			 experiencing inequities.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0005 - Introduction

Current through Register Vol. 63, No. 7, July 1, 2024
This division defines the access to the health data collected
				from various sources and stored at the Office for Oregon Health Policy and
				Research.
Stat. Auth.: ORS
				  442.420(3)(d)
Stats. Implemented: ORS
				  192.410 -
				  192.440 &
				  442.420(3)(d)
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in this division:
(1) "Computer" means a desktop personal
			 computer physically located in the Office.
(2) "Data use agreement" means the terms,
			 conditions, restrictions, and other rules governing the use of health data as
			 specified in Form D-1 (Research Data Request) and in Form D-3 (OHPR Data Use
			 Agreement).
(3) "Electronic media"
			 means the consumer media commonly used to store and transport up to 4.7 GB of
			 data. This includes, but is not limited to, floppy diskettes, CDs, DVDs, and
			 other forms of removable storage media.
(4) "Format" means the way health data
			 appears in a display, on electronic media, on printed copy, or in output or
			 data files produced by the Office's computer software.
(5) "Health data" means an electronic or
			 printed copy of a document, book, paper, file, or other materials, regardless
			 of mode received, that is filed or maintained in pursuit of law or in
			 connection with the transaction of public business. Health data reported to the
			 Office from hospitals and other health care facilities may include information
			 that is protected health information when it is maintained at the hospital or
			 health care facility. The Office obtains such information because it is
			 required by law, and because the Office acts in the capacity of a health
			 oversight agency. The Office is not a covered entity or a business associate of
			 a covered entity. Health data may include, but is not limited to:
(a) The socioeconomic and demographic
			 characteristics of a population;
(b) The incidence of specific diseases or
			 injuries;
(c) The severity of the
			 diseases and injuries;
(d) The
			 supply of health care services;
(e)
			 Characteristics of the health care providers;
(f) The utilization of health care services;
			 or
(g) Determining the need for
			 health care services.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0115 - Calculation of Fees

Current through Register Vol. 63, No. 7, July 1, 2024
The Office shall charge fees necessary to fully recover the
				reasonable costs of responding to data requests and requests to examine health
				data maintained by the Office.
(1) The
			 costs that the Office shall recover include, but are not limited to:
(a) Cost of materials and copying as provided
			 in OAR 409-909-0020.
(b) Cost of
			 staff time necessary to respond to the request.
(c) Administrative costs necessary to process
			 the request.
(d) Any reasonable
			 additional costs the Office deems necessary to respond to the
			 request.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0120 - Inspection of Health Data

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 An inspection of the health data that are maintained at the Office shall be
			 only by appointment during the normal working days and business hours of the
			 Office.
(2) Requests to inspect
			 health data that are maintained by the Office may, at the Office's discretion,
			 require an approved data use agreement as provided in OAR
			 409-021-0130(1).
(3) The inspection
			 shall take place at the Office; on a case-by-case basis, other reasonable
			 locations may be designated at the sole discretion of the Administrator of the
			 Office.
(4) The inspection of the
			 requested data shall be in a format commonly employed by the Office for
			 maintaining the requested data.
(5)
			 Recovery of fees, if any, shall take place at the time of inspection.
Stat. Auth.: ORS
				  192.440 &
				  442.420(3)(d)
Stats. Implemented: ORS
				  192.410 -
				  192.440 &
				  442.420(3)(d)
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0130 - Requests to Obtain Copies of Public Use Health Data Files

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any requestor
			 who wishes to obtain copies of public use health data files maintained by the
			 Office shall provide all of the following:
(a)
			 Form D-1 (Research Data Request).
(b) Form D-2 (Data Order Form).
(c) Form D-3 (Data Use Agreement).
(d) Full payment of fees.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0140 - Requests and Requirements to Obtain Restricted Health Data Sets

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Office may
			 authorize the disclosure of health data in accordance with an approved data use
			 agreement entered into by both the Office and a researcher, pursuant to which
			 the Office may disclose a restricted health data set to a researcher for
			 research, public health, or health care operations. The intent of this rule is
			 to generally apply the legal standard established in the HIPAA Privacy Rule
			 applicable to limited data sets,
			 45
			 CFR 164.514(e).
(2) Any requestor who wishes to obtain
			 restricted health data sets from the Office shall provide all of the following:
(a) Form D-1 (Research Data
			 Request)
(b) Form D-2 (Data Order
			 Form)
(c) Form D-3 (Data Use
			 Agreement)
(d) Full payment of
			 fees.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 21 - ACCESS OF DATA AND FEES FOR DATA SEARCH › Section 409-021-0150 - Denial of Requests to Inspect or Obtain Copies of Health Data

Current through Register Vol. 63, No. 7, July 1, 2024
The Office shall deny requests to inspect health data, receive
				copies of public use health data sets, and receive copies of restricted health
				data sets in order to prevent uses that are not consistent with current
				agreements, policies, rules, regulations, or statutes.
(1) The Office shall deny requests to examine
			 health data or receive copies of health data for reasons that include, but are
			 not limited to:
(a) Fulfilling the request
			 violates one or more of the Office's current data use agreements with one or
			 more other persons.
(b) Fulfilling
			 the request requires unreasonable interference with the Office's regular
			 discharge of duties.
(c) Fulfilling
			 the request requires disclosures that violate HIPAA privacy rules (45CFR parts
			 160 and 164).
(d) Fulfilling the
			 request requires disclosures that are an unreasonable invasion of privacy. If a
			 request is denied for this reason, the burden is on the requestor to provide
			 the Office clear and convincing evidence that fulfilling the data request is
			 not an unreasonable invasion of privacy and that the public interest requires
			 disclosing the requested data.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0005

Current through Register Vol. 63, No. 7, July 1, 2024
Forms referred are available from the
				  agency.
Stat. Auth.: ORS
				  442.420(3)(d),
				  ORS 442.445(2)
				  & ORS 442.463
Stats. Implemented: ORS
				  442.445 & ORS
				  442.463
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-022-0010  to
				409-022-0070:
(1) "Ambulatory Surgical
			 Center" has the same meaning given that term in ORS
			 442.015.
(2) "Ambulatory surgical discharge data"
			 means the consolidation of complete billing, medical, and personal information
			 describing a patient, the services received, and charges billed for a surgical
			 or diagnostic procedure treatment in a hospital outpatient setting or an
			 ambulatory surgical center setting into a data record.
(3) "Authority" means the Oregon Health
			 Authority.
(4) "Emergency
			 department discharge data" means the consolidation of complete billing,
			 medical, and personal information describing a patient, the services received,
			 and charges billed for treatment in a hospital emergency department for
			 patients that were not subsequently admitted to the same hospital as an
			 inpatient.
(5) "Health Care
			 Facility" has the same meaning given that term in ORS
			 442.015.
(6) "Hospital" has the same meaning given
			 that term in ORS
			 442.015.
(7) "Hospital inpatient" means acute care
			 provided at a hospital in which the patient was formally admitted under a
			 doctor's order.
(8) "Hospital
			 outpatient" means acute care provided at a hospital in which the patient is not
			 formally admitted to the hospital under a doctor's order.
(9) "Inpatient discharge data" means the
			 consolidation of complete billing, medical, and personal information describing
			 a patient, the services received, and charges billed for a surgical or
			 diagnostic procedure treatment in a hospital inpatient setting.
Statutory/Other Authority: ORS
				  442.120
Statutes/Other Implemented: ORS
				  442.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0015 - Health Care Facility Annual Reports

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may require an annual
			 report from each licensed health care facility on utilization of the facility.
(2) For hospitals, the Authority
			 adopts the American Hospital Association annual survey, as administered by the
			 Oregon Association of Hospitals and Health Systems, as the annual report on
			 utilization of the facility.
(3)
			 For all other health care facilities, the Authority shall notify the health
			 care facility of the requirement no later than December 31 of the year to be
			 reported.
(4) A health care
			 facility must submit the annual report on a form, prescribed by the Authority,
			 no later than April 30 of the subsequent year.
(5) The Authority shall acknowledge
			 acceptance of the annual report or inform the licensed health care facility in
			 writing of any corrections required within 30 days of the submission of an
			 annual report by a health care facility.
Statutory/Other Authority: ORS
				  442.420,
				  442.463
Statutes/Other Implemented: ORS
				  442.463
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0020 - Hospital Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All hospitals must submit the following,
			 in a form and manner prescribed by the Authority:
(a) Inpatient hospital discharge data;
			 and
(b) Emergency department
			 discharge data, and
(c) Ambulatory
			 surgical discharge data in the hospital outpatient setting.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0025 - Ambulatory Surgical Centers Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) On and after January 1, 2020, all
			 licensed Ambulatory Surgical Centers that bill any public or private insurance
			 on behalf of the patient must submit ambulatory surgical discharge data to the
			 Authority, in a form and manner prescribed by the Authority.
(2) Data submitted must include the following
			 data elements if the data elements are available:
(a) Patient name;
(b) Patient date of birth;
(c) Patient race;
(d) Patient ethnicity;
(e) Patient sex;
(f) Patient residential address;
(h) Facility name;
(i) Admission date;
(j) Discharge date;
(k) Principle diagnosis;
(l) Secondary diagnoses;
(m) Procedures performed;
(n) Dates of procedures performed;
(o) External cause of injury codes;
(p) Patient disposition or discharge
			 status;
(q) Admission source or
			 point of origin;
(r) Admission
			 type; and
(s) Total billed
			 charges;
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0030 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  420.120
Stats. Implemented: ORS
				  420.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0035 - Ambulatory Surgical Center Fees

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority shall assess a fee pursuant
			 to ORS
			 442.120 that shall not exceed the total cost of receiving, processing, analyzing and
			 maintaining ambulatory surgical discharge data.
(2) The fee shall not exceed $1.75 per
			 discharge.
(3) The fee shall be
			 calculated by totaling the costs of receiving, processing, analyzing and
			 maintaining the data in the previous two quarters and dividing the total by the
			 number of records received to derive a per record fee.
(4) The Authority shall invoice ambulatory
			 surgical centers every six months based on the calculated per record fee and
			 the number of records submitted. Fees assessed for January 1 through June 30
			 shall be invoiced no later than December 1 of the same year. Fees assessed for
			 July 1 through December 31 shall be invoiced no later than June 1 of the
			 subsequent year.
Statutory/Other Authority: ORS
				  442.120
Statutes/Other Implemented: ORS
				  442.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0040 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  420.120
Stats. Implemented: ORS
				  420.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0050 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  420.120
Stats. Implemented: ORS
				  420.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0060

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  442.120
Stats. Implemented: ORS
				  442.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0070 - Health Care Facility Utilization and Discharge Data Use and Disclosure

Current through Register Vol. 63, No. 7, July 1, 2024
The Authority may use and disclose data submitted to it under
				these rules in accordance with ORS
				442.120 and OAR 943.014.
Statutory/Other Authority: ORS
				  442.120
Statutes/Other Implemented: ORS
				  442.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 22 - HEALTH CARE FACILITY UTILIZATION AND DISCHARGE DATA SUBMISSION REQUIREMENTS › Section 409-022-0080 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  420.120
Stats. Implemented: ORS
				  420.120
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0100 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-023-0100  to
				409-023-0115:
(1)  "Affiliated clinic" or "hospital affiliated clinic" mean
				an outpatient clinic located in Oregon that is operating under the common
				control or ownership of a hospital.
(2)  "Authority" means the Oregon Health Authority.
(3)  "Charity care" means free or discounted health services
				provided to persons who cannot afford to pay and from whom a hospital has no
				expectation of payment. Charity care does not include bad debt, governmentally
				set fees, contractual allowances, or discounts for quick payment.
(4)  "Community" means the geographic service area and patient
				population that the health care institution serves as defined by the
				hospital.
(5)  "Community benefits" mean programs or activities that
				provide treatment or promote health and healing, address health disparities or
				address the social determinants of health in a response to identified community
				needs. They are not provided primarily for marketing purposes or to increase
				market share. Community benefit must generate a negative margin and meet at
				least one of the following criteria:
(a)  Improve access to health services;
(b)  Enhance population health or improve health
				disparities;
(c)  Advance generalizable knowledge;
(d)  Demonstrate charitable purpose; or
(e)  Address social determinants of health.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0105 - Community Benefit Reporting

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Hospital reporting required pursuant to
			 this rule must be consistent with generally accepted accounting principles
			 (GAAP).
(2) The hospital must
			 submit a completed Community Benefit Report form CBR-1 to the Authority within
			 240 days from the close of the hospital's fiscal year. The report will be
			 deemed submitted as of the date the report is postmarked or electronically
			 delivered to the Authority, whichever is first.
(3) Form CBR-1 must be completed in
			 accordance with instructions published by the Authority in the Community
			 Benefit Reporting Guidelines (CBR-2). The Authority has 30 days to review and
			 request clarification or corrections to form CBR-1.
(4) No later than October 31 of each year,
			 the Authority shall send out a summary file for hospitals to review and
			 validate. Hospitals shall have 14 days to review the summary file and submit
			 corrections.
(5) Hospitals that are
			 part of a multi-hospital system may submit reports for all system hospitals in
			 one submission, but each hospital must be separately reported and clearly
			 identified in any submission. Nothing in this rule removes the requirement that
			 hospitals report their individual community benefit activities.
(6) If the ownership or control of the
			 hospital changes during the reporting year, each hospital owner or controller
			 must submit a community benefit report for the hospital for the portion of the
			 year it owned or controlled the hospital.
(7) The Authority shall inform each hospital
			 subject to reporting of any changes to the Community Benefit Report (CBR-1) or
			 Community Benefit Reporting Guidelines (CBR-2) for the subsequent year by July
			 1. Community Benefit Reporting Guidelines shall be posted on the Authority's
			 website.
(a) Hospitals may report a community
			 benefit activity in only one of the following categories as defined by the
			 authority's Community Benefit Reporting Guidelines (CBR-2):
(A) Charity care;
(B) Losses related to Medicaid and State
			 Children's Health Insurance Program;
(C) Losses related to other publicly funded
			 health care programs, excluding Medicare;
(D) Community health improvement
			 services;
(E) Health professionals'
			 education;
(F) Subsidized health
			 services;
(G) Research;
(H) Financial and in-kind contributions to
			 the community;
(I) Community
			 building activities; or
(J)
			 Community benefit operations.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0110 - Community Benefit Minimum Spending Floor

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The community benefit minimum spending
			 floor program is effective January 1, 2021.
(2) The Authority shall calculate community
			 benefit minimum spending floors for each hospital and its affiliated clinics in
			 Oregon based on the fiscal year of the hospital, with each floor effective over
			 the next two consecutive fiscal years. The Authority shall recalculate the
			 spending floor every two years.
(3)
			 The Authority will collect the data and criteria enumerated in ORS
			 442.624 on form CBR-3, if it is not already provided by hospitals on forms CBR-1 or
			 FR-3, and from the general public for consideration in establishing hospital
			 minimum community benefit floors. The Authority will post the spending floors
			 for comment from the hospitals and general public as required under OAR
			 409-023-0110 (9).
(4) Community
			 benefit minimum spending floors shall apply to all community benefit net costs
			 reported to the Authority on Community Benefit Reporting Form
			 (CBR-1).
(5) Each hospital may
			 select among the following methodologies, as applicable to the hospital's
			 organizational structure, for the purpose of applying a minimum community
			 benefit floor:
(a) By each individual
			 hospital and all of the hospital's nonprofit affiliated clinics;
(b) By a hospital and a group of the
			 hospital's nonprofit affiliated clinics;
(c) By all hospitals that are under common
			 ownership and control and all of the hospitals' nonprofit affiliated clinics;
			 or
(d) By any other grouping of
			 hospitals and their hospital affiliated clinics that is approved by the
			 Authority.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0115 - Annual reports of financial assistance policies and nonprofit status

Current through Register Vol. 63, No. 7, July 1, 2024
(1)  For purposes of this rule:
(a)  "Health care facility" means:
(A)  A hospital;
(B)  An ambulatory surgical center;
(C)  A freestanding birthing center;
(D)  An outpatient renal dialysis facility; or
(E)  An extended stay center.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0120 - Requirements for prescreening patients for presumptive eligibility for financial assistance

Current through Register Vol. 63, No. 7, July 1, 2024
(1)  Prescreening and presumptive eligibility rules are
				effective July 1, 2024.
(2)  Hospitals must document their prescreening process in
				their financial assistance policy. Process documentation must disclose the
				software products and all other third-party services used to evaluate patient
				household income for prescreening.
(3)  The prescreening process and presumptive eligibility
				determination is not considered an application for financial assistance and
				does not disqualify a patient from seeking financial assistance.
(4)  The prescreening process must use the financial assistance
				eligibility standards published in the hospital's financial assistance policy
				and in accordance with the minimum standards specified in ORS 442.614. Any
				adjustment to patient cost due to the prescreening process must meet the
				minimum standards specified in ORS 442.614.
(5)  Hospitals must complete prescreening for financial
				assistance and make any resulting adjustments to patient cost prior to sending
				the patient a billing statement.
(6)  Prior to taking any other prescreening actions, the
				hospital must determine if during the previous nine (9) month period, the
				patient has applied for financial assistance and the hospital has determined
				that the patient is eligible for financial assistance based on documentation
				provided by the patient. If yes, the patient must receive a patient cost
				adjustment in accordance with ORS 442.614, prior to receiving a billing
				statement.
(7)  Hospitals must prescreen for presumptive eligibility for
				financial assistance whenever the patient meets any of the following
				criteria:
(a)  Is uninsured; or
(b)  Is enrolled in a state medical assistance program;
				or
(c)  Will owe the hospital $500 or more after all adjustments
				from insurance or third-party payers, if applicable, have been made.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 24 - CAPITOL PROJECT REPORTING PROGRAM › Section 409-024-0000 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR
				409-024-0000  to
				409-024-0130:
(1) "Authority" means the Oregon
			 Health Authority.
(2) "Capital
			 project" has the meaning described in ORS
			 442.361.
(3) "Community benefits" mean programs or
			 activities that provide treatment or promote health and healing as a response
			 to identified community needs and are not provided primarily for marketing
			 purposes or to increase market share.
(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 diagnostic-related group (DRG) hospital
			 as described in ORS 442.361.
(d) An ambulatory surgical center as defined
			 in ORS 442.015.
(e) Any Type A, Type B, or DRG hospital as
			 defined in (4)(a) through (c) above that is certified as a Critical Access
			 Hospital by the Centers for Medicare and Medicaid Services.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 24 - CAPITOL PROJECT REPORTING PROGRAM › Section 409-024-0110 - Capital Project Report

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Each reporting entity must submit to the Authority a report of pending or
			 proposed capital projects using a Capital Project Reporting Form CPR-1 as
			 defined by the Authority. The report must be completed in accordance with
			 instructions in the capital project reporting guidelines published on the
			 Authority's website.
(2) The
			 Capital Project Reporting Form CPR-1 shall include but is not limited to:
(a) A summary of the information posted by
			 the reporting entity under ORS
			 442.362.
(b) The procedure that the reporting entity
			 used to collect public comment.
(c) A summary of expected community benefits
			 for the project.
(d) The estimated
			 cost of the project.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 24 - CAPITOL PROJECT REPORTING PROGRAM › Section 409-024-0120 - Public Comments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each
			 reporting entity must make available a means for interested persons to submit
			 public comments on the capital project either on their website or by posting
			 public notice in a major newspaper for a period of no less than seven days.
			 Comments must be collected for a period of no less than 30 days and made
			 available for public review.
(2)
			 The hospital or ambulatory care center shall then notify the Authority after
			 the 30 day public comment if the hospital or ambulatory care center chooses to
			 complete the project as is or if the project has changed and an expected
			 completion date. The Authority shall post this update on its website for 30
			 days.
Stat. Auth.: ORS
				  442.362
Stats. Implemented: ORS
				  442.361 &
				  442.362
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 24 - CAPITOL PROJECT REPORTING PROGRAM › Section 409-024-0130 - Civil Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If
			 the Authority learns that any reporting entity has failed to file a capital
			 project report, the Authority shall contact the reporting entity by certified
			 mail requesting the unfiled report. If the reporting entity fails to reply
			 within 30 calendar days or continues to be non-compliant with the reporting
			 requirements, the Authority shall assess a civil penalty pursuant to the
			 following schedule:
(a) $250 per day for the
			 first five days of failure to file in accordance with ORS
			 442.991; and
(b) $500 per day from the sixth day until
			 filing in accordance with ORS
			 442.991 is completed.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 25 - ALL PAYER ALL CLAIMS DATA REPORTING PROGRAM › Section 409-025-0110 - General Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Determination of "mandatory reporter":
(a) For carriers and licensed third-party
			 administrators, the Authority shall identify mandatory reporters using
			 information collected by DCBS including, but not limited to, data from the
			 Health Insurance Member Enrollment Report.
(A) The Authority shall aggregate the most
			 recent four quarters of data.
(B)
			 The Authority shall calculate the mean total lives for each carrier and
			 licensed third-party administrator. Mean total lives shall be calculated by
			 using the total covered lives in the following lines of business for each
			 carrier and licensed third-party administrator:
(i) Large group;
(ii) Small group;
(iii) Individual market;
(iv) Medicare Advantage; and
(v) Self-insured.
(C) All carriers and licensed third-party
			 administrators with calculated mean total lives of 5,000 or higher shall be
			 mandatory reporters.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 25 - ALL PAYER ALL CLAIMS DATA REPORTING PROGRAM › Section 409-025-0120 - Data File Layout, Format, and Coding Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All mandatory reporters shall submit
			 claims-based data for all claims where the subscriber's residence is in Oregon
			 or the subscriber is enrolled in a plan for which the State of Oregon is the
			 payer.
(2) Claims-based data files
			 shall include:
(a) Enrollment;
(b) Medical claims;
(c) Pharmacy claims;
(d) Dental claims;
(e) Provider;
(f) Subscriber-billed premiums; and
(g) Control totals files.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 25 - ALL PAYER ALL CLAIMS DATA REPORTING PROGRAM › Section 409-025-0125 - Payment Arrangement Reporting: File Layout, Format, and Coding Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 All mandatory reporters other than PBMs shall report payment arrangements for
			 all contracts sitused in Oregon. For contracts issued at the group level, the
			 contract is considered sitused where the contract is sold. For contracts that
			 are issued at the individual level, the contract is considered sitused where
			 the individual resides.
(2) All
			 data files shall include:
(a) Payment
			 arrangement file described in Appendix 1; and
(b) Payment arrangement control file
			 described in Appendix 2.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 25 - ALL PAYER ALL CLAIMS DATA REPORTING PROGRAM › Section 409-025-0130 - Data Submission Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Mandatory reporters shall submit data
			 files as specified in the Data Submission Schedule. Voluntary reporters may
			 consult with the Authority to submit healthcare claims data files on an
			 alternative schedule.
(2) Mandatory
			 and voluntary reporters shall submit data files directly to the data vendor
			 unless otherwise specified by the Authority. Each mandatory reporter is
			 required to maintain an active user in the data vendor's reporting portal to
			 receive communications on deadlines and submit files and resolve validation
			 issues in a timely manner.
(3)
			 Mandatory and voluntary reporters shall transmit data files using one of the
			 following approved processes:
(a) Secure file
			 transfer protocol (SFTP) including separate strong encryption of data files
			 prior to SFTP transmission; or
(b)
			 Any process incorporating strong encryption that is approved in writing by both
			 the Authority and the data vendor.