Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 23 - COMMUNITY BENEFIT REPORTING › Section 409-023-0125 - Requirements for a Process for Patient Appeals of Financial Assistance Determinations

Current through Register Vol. 63, No. 7, July 1, 2024
(1)  Requirements for patient appeals of financial assistance
				determination are effective January 1, 2025.
(2)  Hospitals must document their financial assistance appeals
				process in their financial assistance policy.
(3)  A patient may only appeal determinations based on
				applications for financial assistance.
(4)  If a hospital denies an application for financial
				assistance, finds the application to be incomplete or missing documentation, or
				provides a patient cost adjustment for less than 100% of the patient costs, the
				hospital must, within ten (10) business days, notify the patient of their
				ability to take corrective action or appeal the determination. The notification
				must meet the following criteria:
(a)  The notification must be written in plain language and
				either the preferred language of the patient or otherwise in alignment with the
				translation standards specified in ORS 442.614.
(b)  The notification may be delivered by mail, email, in
				person, or through an online portal, if the patient is a registered user of the
				hospital's portal. The notification must be delivered separately and in
				addition to any financial assistance statements included on billing
				statements.
(c)  The notification must clearly specify whether the
				application was incomplete or if the patient was denied due to not meeting
				eligibility criteria.
(A)  If the application is found to be incomplete, missing
				documentation, or containing errors, the notification must designate the
				application as incomplete and requiring further action by the patient. The
				notice must further clearly describe the deficiencies and the actions the
				patient can take to complete the application by correcting the deficiencies.
(B)  If the application was denied based on a failure to meet
				eligibility criteria, the notification must specify the relevant eligibility
				criteria and provide contact information so that the patient can request
				further information about the relevant eligibility criteria and the information
				that was used by the hospital to reach its determination.
(d)  The notification must include a clear description of how
				the patient may submit corrections or additional documentation and how the
				patient may request an appeal. At a minimum, a patient must be able to submit
				corrections or additional documentations and request an appeal electronically,
				by either email or through a secure online portal, by mail, and by in-person
				delivery.
(e)  The notification must inform the patient that if the
				patient chooses to appeal, the patient may request review by the hospital's
				Chief Financial Officer or a designee of the hospital's Chief Financial Officer
				who has been delegated decision-making authority over the appeal.
(f)  The notification must inform the patient that the patient
				may also submit an appeal through a written statement or other supporting
				documentation.
(g)  The notification must provide contact information to an
				appropriate hospital representative who may answer questions about the appeals
				process or the patient's financial assistance application.