reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 70 - HEALTH CARE MARKET OVERSIGHT PROGRAM › Section 409-070-0070 - Confidentiality

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An applicant
			 for review of a material change transaction may designate portions of a notice
			 and any documents thereafter submitted by the applicant in support of the
			 notice as confidential. The applicant shall file two versions of the notice.
			 One shall be marked as "CONFIDENTIAL" and shall contain the full unredacted
			 version of the notice or supporting materials and shall be maintained as such
			 by the Authority and the Department. The second shall be marked as "PUBLIC" and
			 shall contain a redacted version of the notice or supporting materials (from
			 which the confidential portions have been removed or obscured) and shall be
			 made available to the public by the Authority. An applicant claiming
			 confidentiality in respect of portions of a notice, or any documents thereafter
			 submitted by the applicant in support of the notice, shall include a redaction
			 log that provides a reasonably detailed statement of the grounds on which
			 confidentiality is claimed, citing the applicable statutory basis for
			 confidentiality of each portion.
(2) Confidential materials filed by an
			 applicant in connection with a transaction that is subject to review by each of
			 the Authority and the Department shall be maintained as confidential materials
			 in accordance with paragraph (1) of this rule, ORS 415.501(13)(c) and ORS
			 705.137.
Statutory/Other Authority: ORS 415.501
Statutes/Other Implemented: ORS 415.500 to
				  415.900
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 70 - HEALTH CARE MARKET OVERSIGHT PROGRAM › Section 409-070-0075 - Contested Case Hearings

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The Authority shall hold a contested case hearing upon a written request for a
			 hearing within the time specified in paragraph (3) of this rule by a person
			 aggrieved by any act, threatened act or failure of the Authority to act under
			 ORS 415.501 or OAR 409-070-0000  to OAR 409-070-0085.
(2) Contested case hearings shall be
			 conducted pursuant to ORS
			 183.411 through ORS
			 183.497 and the Attorney General's Uniform and Model Rules of Procedure for the Office
			 of Administrative Hearings, OAR 137-003-0501  through OAR 137-003-0700, and the
			 provisions of this rule.
(3) A
			 party to a material change transaction that wishes to contest a final order
			 issued by the Authority that fully resolves the notice of material change
			 transaction must request a hearing within 15 calendar days from the date of
			 service of the final order and a notice of right to a hearing.
(4) An applicant for emergency exemption
			 under OAR 409-070-0022  that wishes to contest a determination issued by the
			 Authority must request a hearing within 15 calendar days from the date of
			 service of the determination and a notice of right to a hearing.
(5) The Authority's determination:
(a) Not to approve a transaction at the
			 conclusion of the preliminary review period pursuant to OAR 409-070-0055;
			 and
(b) That a transaction is a
			 covered transaction following application under OAR 409-070-0042  shall, in each
			 case, be interlocutory and shall not be reviewable prior to the issuance of the
			 final order that fully resolves the notice of material change
			 transaction.
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 70 - HEALTH CARE MARKET OVERSIGHT PROGRAM › Section 409-070-0080 - Compliance with Conditions; Information Requests

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Following approval of a material change
			 transaction, the Authority may verify compliance with any conditions that the
			 Authority included in its approval of the transaction and issue such additional
			 orders, following notice and opportunity for hearing, as may be necessary to
			 enforce compliance with the terms and conditions of the approval of the
			 transaction; provided however, that the Authority may not impose new conditions
			 that are unrelated to, or not reasonably required to enforce compliance with,
			 those conditions, if any, that were included in the Authority's approval of the
			 transaction. Such verification of compliance shall occur, at minimum, at the
			 intervals required by ORS
			 415.501(19).
(2) The Authority may require that the
			 parties provide such information, reports, analyses and documentation as the
			 Authority may require in order to monitor and assess the impacts and effects of
			 the material change transaction as required in ORS
			 415.501(19),
			 including specifically, but without limitation, the effects and status of the
			 material change transaction under OAR 409-070-0062(1)  and OAR
			 409-070-0060(5).
(3) No person
			 shall file or cause to be filed with the Authority or the Department any
			 notice, article, certificate, report, statement, application or any other
			 information required or permitted to be so filed and known to such person to be
			 false or misleading in any material respect.
Statutory/Other Authority: ORS
				  415.501
Statutes/Other Implemented: ORS
				  413.037,
				  415.013,
				  415.103 & 415.500 to
				  415.900
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 70 - HEALTH CARE MARKET OVERSIGHT PROGRAM › Section 409-070-0085 - Effective Date; Implementation

Current through Register Vol. 63, No. 7, July 1, 2024
The effective date of these rules is January 1, 2023. These
				rules shall apply to notices of material change transactions received on or
				after January 1, 2023.
Statutory/Other Authority: ORS
				  415.501
Statutes/Other Implemented: ORS
				  415.500 to
				  415.900
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 90 - OFFICE OF HEALTH POLICY ADMINISTRATION (Repealed) › Section 409-090-0020

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  192.410 -
				  192.505 &
				  442.420(3)(d)
Stats. Implemented: ORS
				  192.410 -
				  192.505
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 90 - OFFICE OF HEALTH POLICY ADMINISTRATION (Repealed) › Section 409-090-0030

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  192.440 &
				  442.420(3)(d)
Stats. Implemented: ORS
				  192.440
Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 110 - HEALTH SYSTEMS PLANNING › Section 409-110-0030 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Publications referenced are available from the
				  agency.
Stat. Auth: ORS
				  413.225
Stats. Implemented: ORS
				  413.225
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 1 - PROCEDURAL RULES › Section 410-001-0000 - Model Rules of Procedure

Current through Register Vol. 63, No. 7, July 1, 2024
The Oregon Health Authority (Authority), Health Systems
				Division (Division), chapter 410, shall adhere to Authority rules in chapter
				943 regarding Model Rules of Procedure, Notices of Rulemaking, Adoption of
				Temporary Rules, and Delegation of Rulemaking Authority.
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: ORS
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 1 - PROCEDURAL RULES › Section 410-001-0005 - Notice of Proposed Rulemaking and Adoption of Temporary Rules

Current through Register Vol. 63, No. 7, July 1, 2024
Oregon Health Authority (Authority), Division of Medical
				Assistance Programs, chapter 410, will comply with Authority rules in chapter
				943 for Notices of Rulemaking and adoption of Temporary
				rules.
Stat. Auth.: ORS
				  183.335,
				  183.341 &
				  413.042
Stats. Implemented: ORS
				  183.325,
				  183.330,
				  183.335,
				  183.341,
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 1 - PROCEDURAL RULES › Section 410-001-0020 - Delegation of Rulemaking Authority

Current through Register Vol. 63, No. 7, July 1, 2024
Oregon Health Authority (Authority), Division of Medical
				Assistance Programs, chapter 410, will comply with Authority rules in chapter
				943 for Delegation of Rulemaking Authority.
Stat. Auth.: ORS
				  183.335,
				  183.341 &
				  413.042
Stats. Implemented: ORS
				  183.325,
				  183.330,
				  183.335,
				  183.341,
				  413.042 &
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0710 - General Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 purpose of these rules is to implement the assessment imposed on hospitals in
			 Oregon.
(2) The Authority shall
			 administer, enforce, and collect the hospital assessment. The Authority may
			 assign employees, auditors, and other agents as designated by the Director to
			 assist in the administration, enforcement, and collection of the assessments.
(3) The Authority may adopt forms
			 and reporting requirements, and change the forms and reporting requirements, as
			 necessary, to administer, enforce, and collect the assessments.
(4) The Authority may not use moneys from the
			 Hospital Quality Assurance Fund to supplant, directly or indirectly, other
			 moneys made available to fund services described in Section 9, Chapter 736,
			 Oregon Laws 2003 as amended by Section 2, Chapter 757, Oregon Laws
			 2005.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0720 - Disclosure of Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Except as otherwise provided by law, the Authority may not publicly divulge or
			 disclose the amount of income, expense, or other particulars set forth or
			 disclosed in any report or return required in the administration of the
			 assessments. Particulars include but are not limited to social security
			 numbers, employer numbers, or other hospital identification numbers, and any
			 business records required to be submitted to or inspected by the Authority or
			 its designee to allow it to determine the amounts of any assessments,
			 delinquencies, deficiencies, penalties, or interest payable or paid, or
			 otherwise administer, enforce, or collect a health care assessment to the
			 extent that such information shall be exempt from disclosure under ORS
			 192.501(5) or
			 other basis for exemption under Oregon's public records law.
(2) The Authority may:
(a) Furnish any hospital, or its authorized
			 representative, upon request of the hospital or representative, with a copy of
			 the hospital's report filed with the Authority for any quarter, or with a copy
			 of any report filed by the hospital in connection with the report, or with a
			 copy of any other information the Authority considers necessary;
(b) Publish information or statistics so
			 classified as to prevent the identification of income or any particulars
			 contained in any report or return;
(c) Disclose and give access to an officer or
			 employee of the Authority or its designee, or to the authorized representatives
			 of the U.S. Department of Health and Human Services, Centers for Medicare and
			 Medicaid Services, the Controller General of the United States, the Oregon
			 Secretary of State, the Oregon Department of Justice, the Oregon Department of
			 Justice Medicaid Fraud Control Unit, and other employees of the state or
			 federal government to the extent the Authority deems disclosure or access
			 necessary or appropriate for the performance of official duties in the
			 Authority's administration, enforcement, or collection of the
			 assessments.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0730 - Entities Subject to the Hospital Assessment

Current through Register Vol. 63, No. 7, July 1, 2024
Each hospital in Oregon is subject to the hospital assessment
				except:
(1) Hospitals operated by the
			 United States Department of Veterans Affairs;
(2) Pediatric specialty hospitals providing
			 care to children at no charge;
(3)
			 Public hospitals other than hospitals created by health districts.
Statutory/Other Authority: 413.042, 410.070 &
				  411.060
Statutes/Other Implemented: 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0740 - The Hospital Assessment: Calculation, Report, Due Date

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The amount of
			 the assessment equals the assessment rate multiplied by the hospital's net
			 revenue, consistent with OAR
			 410-050-0750,
			 410-050-0860,
			 and
			 410-050-0861. The
			 assessment shall be imposed on net revenues earned by the hospital on or after
			 January 1, 2004, based on calendar quarters. The first calendar quarter begins
			 on January 1; the second calendar quarter begins on April 1; the third calendar
			 quarter begins on July 1; and the fourth calendar quarter begins on October
			 1.
(2) The assessment rate shall be
			 determined in accordance with OAR
			 410-050-0860  and
			 410-050-0861.
(3) The hospital shall file the quarterly
			 report on a form approved by the Authority on or before the 45th day following
			 the end of the calendar quarter for which an assessment is due. The quarterly
			 payment is due and shall be paid at the same time required for filing the
			 quarterly report. The hospital shall provide all information required on the
			 quarterly report when due. Failure to file or pay when due shall be a
			 delinquency.
(4) The fiscal year
			 reconciliation report, including the financial statement and reconciliation
			 statement, is due and shall be submitted to the Authority no later than the
			 final day of the sixth calendar month after the hospital's declared fiscal year
			 end. The fiscal year reconciliation assessment payment is due and shall be paid
			 at the same time required for filing the fiscal year reconciliation report. The
			 hospital shall provide all information required on the fiscal year
			 reconciliation report when due. Failure to file or pay when due shall be a
			 delinquency.
(5) Any report,
			 statement, or other document required to be filed under any provision of these
			 rules must be certified by the hospital's chief financial officer or designee.
			 The certification shall attest, based on best knowledge, information, and
			 belief, to the accuracy, completeness, and truthfulness of the
			 document.
(6) Payments may be made
			 electronically or by paper check. If the hospital pays electronically, the
			 accompanying report may either be faxed to the Authority at the fax number
			 provided on the report form or mailed to the address provided on the report
			 form. If the hospital pays by paper check, the accompanying report shall be
			 mailed with the check to the address provided on the report form.
(7) The Authority may charge the hospital a
			 fee of $100 if, for any reason, the check, draft, order, or electronic funds
			 transfer request is dishonored. This charge is in addition to any penalty for
			 nonpayment of the assessment that may also be due.
Statutory/Other Authority: 413.042, 410.070 &
				  411.060
Statutes/Other Implemented: 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0760 - Filing an Amended Report

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 hospital that submits a fiscal year reconciliation report without an audited
			 financial statement shall submit an amended fiscal year reconciliation report,
			 an audited financial statement, and such additional fiscal year reconciliation
			 payment (if owed) for assessments and deficiencies. The information shall be
			 submitted within 180 days after the fiscal year reconciliation report due date.
(2) Claim for Refund:
(a) If the amount of the assessment in the
			 amended fiscal year reconciliation report is less than the amount paid by the
			 hospital, the Authority may refund the overpayment. A refund may not exceed the
			 assessment amount actually paid by the hospital;
(b) The hospital shall provide all
			 information required on the report. No refunds shall be made prior to the
			 Authority receiving the hospital's audited financial statement for the declared
			 fiscal year. The Authority may audit the hospital, request additional
			 information, or request an informal conference prior to granting a refund or as
			 part of its review;
(c) If there
			 is an amount due from the hospital to the Authority for any past due
			 assessments or penalties, any refund otherwise allowable shall first be applied
			 to the unpaid assessments and penalties, and the hospital notified;
(d) A hospital may not deduct from current,
			 prospective, or future assessment payments an amount to which it claims to be
			 entitled as a refund for a prior period. The claim for refund shall be made to
			 the Authority. .
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0770 - Determining the Date Filed

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For
			 the purposes of these rules, any reports, requests, appeals, payments, or other
			 response by the hospital shall be received by the Authority either:
(a) Before the close of business on the date
			 due; or
(b) If mailed, postmarked
			 before midnight of the due date.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0780 - Records Audit by the Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The hospital shall maintain financial
			 records necessary and adequate to determine the net revenue for any calendar
			 period for which an assessment may be due.
(2) The Authority or its designee may audit
			 the hospital's records at any time for a period of five years following the
			 date the assessment is due to verify or determine the hospital's net revenue.
(3) The Authority may issue a
			 notice of deficiency or issue a refund based upon its audit findings.
(4) Any audit, finding, or
			 position may be reopened if there is evidence of fraud, malfeasance,
			 concealment, misrepresentation of material fact, omission of income, or
			 collusion either by the hospital or by the hospital and a representative of the
			 Authority.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0790 - Determining Assessment for Hospital Failure to File

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The law places an affirmative duty on the
			 hospital to file a timely and correct report.
(2) In the case of a failure by the hospital
			 to file a report or to maintain necessary and adequate records, the Authority
			 shall determine the hospital's assessment liability according to the best of
			 its information and belief. Best of its information and belief means the
			 Authority shall use evidence available to the Authority at the time of the
			 determination on which a reasonable person would rely on in determining the
			 assessment. The Authority's determination of assessment liability shall be the
			 basis for the assessment due in any notice of proposed action.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0800 - Financial Penalty for Failure to File a Report or Failure to Pay Tax When Due

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A hospital that
			 fails to file a quarterly report or pay a quarterly assessment when due shall
			 be subject to a penalty of up to $500 per day of delinquency. The Authority, in
			 its sole discretion, shall determine the penalty for failure to pay the
			 assessment or file a report. In making this determination, the Authority shall
			 consider evidence such as prior late payments, prior penalties, and
			 circumstances related to delinquency. The penalty accrues from the date of
			 delinquency, notwithstanding the date of any notice under these rules.
(2) A hospital that fails to file
			 a fiscal year reconciliation report when due is subject to a penalty of up to
			 $500 per day of delinquency. The Authority, in its sole discretion, shall
			 determine the penalty for failure to pay the assessment or file a report. In
			 making this determination, the Authority shall consider evidence such as prior
			 late payments, prior penalties, and circumstances related to delinquency. The
			 penalty accrues from the date of delinquency, notwithstanding the date of any
			 notice under these rules.
(3) A
			 hospital that files a fiscal year reconciliation report, but fails to pay a
			 fiscal year reconciliation assessment when due is subject to a penalty of up to
			 $500 per day of delinquency up to a maximum of five percent of the amount due.
			 The Authority, in its sole discretion, shall determine the penalty for failure
			 to pay the reconciliation assessment payment or file a fiscal year
			 reconciliation report. In making this determination, the Authority shall
			 consider evidence such as prior late payments, prior penalties, and
			 circumstances related to delinquency. The penalty accrues from the date of
			 delinquency, notwithstanding the date of any notice under these rules.
(4) The total amount of penalty
			 imposed under this section for each reporting period may not exceed five
			 percent of the assessment for the reporting period for which penalty is being
			 imposed.
(5) The Authority shall
			 collect any penalties imposed under this section and deposit the funds in the
			 Authority's account established under ORS
			 413.101.
(6) Penalties paid under this section are in
			 addition to the hospital's assessment liability.
(7) If the Authority determines that a
			 hospital is subject to a penalty, the Authority shall issue a notice of
			 proposed action as described in OAR 410-050-0810.
(8) If a hospital requests a contested case
			 hearing pursuant to OAR 410-050-0830, the Director, at the Director's sole
			 discretion, may waive or reduce the amount of penalty assessed.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0810 - Notice of Proposed Action

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Prior
			 to issuing a notice of proposed action, the Authority shall notify the hospital
			 of the potential deficiency or failure to report that could give rise to the
			 imposition of a penalty. The Authority shall issue a notification letter within
			 30 calendar days of the report or payment due date. The hospital shall have 30
			 calendar days from the date of the notice to respond. The Authority may
			 consider the response and any amended final report under OAR 410-050-0760  in
			 its notice of proposed action. In all cases that the Authority has determined
			 that a hospital has an assessment deficiency or failure to report, the
			 Authority shall issue a notice of proposed action. The Authority may not issue
			 a notice of proposed action if the issue is resolved satisfactorily within 59
			 days from the date of mailing the notification letter.
(2) The Authority shall issue a notice of
			 proposed action within 60 calendar days from the date of mailing the
			 notification letter.
(3) Contents
			 of the notice of proposed action shall include:
(a) The applicable reporting period;
(b) The basis for determining the
			 corrected amount of assessment;
(c) The corrected assessment due as
			 determined by the Authority;
(d)
			 The amount of assessment paid by the hospital;
(e) The resulting deficiency, which is the
			 difference between the amount received by the Authority and the corrected
			 amount due as determined by the Authority;
(f) Statutory basis for the penalty;
(g) Amount of penalty per day of
			 delinquency;
(h) Date upon which
			 the penalty began to accrue;
(i)
			 Date the penalty stopped accruing or circumstances under which the penalty
			 shall stop accruing;
(j) The total
			 penalty accrued up to the date of the notice;
(k) Instructions for responding to the
			 notice; and
(l) A statement of the
			 hospital's right to a hearing.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0820 - Required Notice

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority
			 shall send any required notice to the address and contact person identified by
			 the hospital on its most recently filed report.
(2) Any notice required to be sent to the
			 Authority shall be sent to the point of contact identified on the communication
			 from the Authority to the hospital.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0830 - Hearing Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any hospital
			 that receives a notice of proposed action may request a contested case hearing
			 under ORS 183.
(2) The hospital
			 may request a hearing by submitting a written request within 20 days of the
			 date of the notice of proposed action.
(3) Prior to the hearing, the hospital shall
			 meet with the Authority for an informal conference:
(a) The informal conference may be used to
			 negotiate a written settlement agreement.
(b) If the settlement agreement includes a
			 reduction or waiver of penalties, the agreement shall be approved and signed by
			 the Director.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0840 - Final Order of Payment

Current through Register Vol. 63, No. 7, July 1, 2024
A final order of payment is a final Authority action, expressed
				in writing, based on a notice of proposed action where a payment amount is due
				to the Authority. The Authority shall issue a final order of payment for
				deficiencies or penalties when:
(1)
			 The hospital did not make a timely request for a hearing;
(2) Any part of the deficiency and penalty
			 was upheld after a hearing; or
(3)
			 Upon the agreement of the hospital and the Authority.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0850 - Remedies Available after Final Order of Payment

Current through Register Vol. 63, No. 7, July 1, 2024
Any amounts due and owing under the final order of payment and
				any interest thereon may be recovered by Oregon as a debt to the state, using
				any available legal and equitable remedies. These remedies include, but are not
				limited to:
(1) Collection activities
			 including, but not limited to, deducting the amount of the final deficiency or
			 penalty from any sum then or later owed to the hospital by the Authority; and
(2) Every payment obligation owed
			 by the hospital to the Authority under a final order of payment shall bear
			 interest at the statutory rate of interest in ORS
			 82.010 accruing from the date of
			 the final order of payment and continuing until the payment obligation,
			 including interest, has been discharged.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2015 HB
				  2395
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0860 - Director Determines Assessment Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Director shall determine the
			 assessment rate.
(2) The rate of
			 assessment shall be imposed on the net revenue of each hospital subject to the
			 assessment. The Director shall consult with representatives of hospitals before
			 setting the rate.
(3) The Director
			 may reduce the rate of assessment to the maximum rate allowed under federal law
			 if the reduction is required to comply with federal law. If the rate is reduced
			 pursuant to this section, the Director shall notify the hospitals as to the
			 effective date of the rate reduction.
(4) The Director may impose a lower rate of
			 assessment on Type A hospitals and Type B hospitals to take into account the
			 hospital's financial position.
(5)
			 A hospital is not guaranteed that any additional moneys paid to the hospital in
			 the form of payments for services will equal or exceed the amount of the
			 assessment paid by the hospital.
Statutory/Other Authority: 413.042
Statutes/Other Implemented: 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0861 - Assessment Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The assessment
			 rate for the period beginning January 1, 2005, and ending June 30, 2006, is .68
			 percent.
(2) The assessment rate
			 for the period beginning July 1, 2006, and ending December 31, 2007, is .82
			 percent.
(3) The assessment rate
			 for the period beginning January 1, 2008, and ending June 30, 2009, is .63
			 percent.
(4) The assessment rate
			 for the period of January 1, 2008 through June 30, 2009 does not apply to the
			 period beginning July 1, 2009.
(5)
			 The assessment rate for the period beginning July 1, 2009, and ending September
			 30, 2009, is .15 percent.
(6) The
			 assessment rate for the period beginning October 1, 2009, and ending June 30,
			 2010, is 2.8 percent.
(7) The
			 assessment rate for the period beginning July 1, 2010, and ending June 30,
			 2011, is 2.32 percent.
(8) The
			 assessment rate for the period beginning July 1, 2011, and ending September 30,
			 2011, is 5.25 percent.
(9) The
			 assessment rate for the period beginning October 1, 2011, and ending December
			 31, 2011, is 5.08 percent.
(10) The
			 assessment rate for the period beginning January 1, 2012, and ending March 31,
			 2013, is 4.32 percent.
(11) The
			 assessment rate for the period beginning April 1, 2013, and ending September
			 30, 2014, is 5.30 percent.
(12) The
			 assessment rate for the period beginning October 1, 2014, and ending March 31,
			 2016, is 5.80 percent.
(13) The
			 assessment rate for the period beginning April 1, 2016, and ending June 30,
			 2017, is 5.30 percent.
(14) The
			 assessment rate for the period beginning July 1, 2017, and ending October 4,
			 2017, is 6.00 percent.
(15) The
			 assessment rate for the period beginning October 5, 2017, and ending December
			 31, 2017, is 5.30 percent.
(16) The
			 assessment rate for the period beginning January 1, 2018, is 6.0
			 percent.
(17) For Type A/B
			 hospitals, the assessment rate for the period beginning January 1, 2018, and
			 ending June 30, 2018, is 4.00 percent.
(18) For Type A/B hospitals, the assessment
			 rate for the period beginning July 1, 2018, and ending June 30, 2019, is 4.75
			 percent.
(19) For Type A/B
			 hospitals, the assessment rate for the period beginning July 1, 2019, and
			 ending November 30, 2019 is 4.20 percent.
(20) For Type A/B hospitals, the assessment
			 rate for the period beginning December 1, 2019, and ending December 31, 2019 is
			 2.69 percent.
(21) For Type A/B
			 hospitals, the assessment rate for the period beginning January 1, 2020, and
			 ending September 30, 2020 is 5.5 percent.
(22) For Type A/B hospitals, the assessment
			 rate for the period beginning October 1, 2020, is 6.00 percent.
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 50 - TAX RULES › Section 410-050-0870 - Sunset Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 hospital assessment applies to net revenue received by hospitals on or after
			 January 1, 2004, and before October 1, 2019.
(2) The Type A and B hospital assessment
			 applies to net revenue received by hospitals on or after January 1, 2018, and
			 before October 1, 2021.
Statutory/Other Authority: 413.042
Statutes/Other Implemented: 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 110 - SAFETY NET CAPACITY GRANT PROGRAM › Section 410-110-0025 - Scope

Current through Register Vol. 63, No. 7, July 1, 2024
These rules establish criteria for awarding grants under the
				Safety Net Capacity Grant Program, which was established to ensure that safety
				net providers have capacity to serve vulnerable and underserved children in
				Oregon.
Stat. Auth: ORS
				  413.225
Stats. Implemented: ORS
				  413.225,
				  2015 c.
				  837,
				  §
											34&
				  414.231
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 110 - SAFETY NET CAPACITY GRANT PROGRAM › Section 410-110-0030 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-110-0025  to
				409-110-0045:
(1) "Authority" means
			 the Oregon Health Authority.
(2)
			 "Community-sponsored Clinic" means a non-profit, community-based clinic that
			 does not receive state or federal funding and is sponsored by the local
			 community in the form of grants and donations, including in-kind donations of
			 goods and services.
(3) "Culturally
			 and Linguistically Appropriate Services" means health care services that are
			 respectful of and responsive to cultural and linguistic needs. Please refer to
			 the "National Standards on Culturally and Linguistically Appropriate Services"
			 (CLAS), United States Department of Health and Human Services, Office of
			 Minority Health.
(4) "Primary
			 Healthcare Service" means physical, oral, mental, behavioral, and vision health
			 services that are delivered in a manner that reflects the state's emphasis on
			 patient-centered care.
(5)
			 "Program" means the Safety Net Capacity Grant Program.
(6) "Safety Net Provider" means a public or
			 non-profit federally qualified health center, school-based health center,
			 tribal health clinic, rural health clinic, or community-sponsored clinic that
			 provides primary care and preventive physical, oral, mental, behavioral and
			 vision health services to low-income patients without charge or using a sliding
			 scale.
(8) "Target Population"
			 refers to children who are not eligible for the Oregon Healthy Kids Program for
			 reasons other than income.
Publications referenced are available from the
				  agency
Stat. Auth: ORS
				  413.225
Stats. Implemented: ORS
				  413.225,
				  2015 c.
				  837,
				  §
											34&
				  414.231
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 110 - SAFETY NET CAPACITY GRANT PROGRAM › Section 410-110-0035 - Program Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Program is intended to ensure that the target population has access to primary
			 physical, oral, mental, behavioral, and vision health services.
(2) The Authority shall award grants to
			 safety net providers through the Program.
(3) Services covered through the Program are
			 limited to primary and preventive physical, oral, mental, behavioral, and
			 vision health services.
(4)
			 Children in the target population through the age of 18 are eligible to receive
			 services through the program.
(5)
			 The grant amount awarded shall take into consideration the distribution and
			 concentration of the target population in the proposed service area.
(6) The Program is competitive and proposals
			 that include collaboration with community partners may be given preference.
(7) The Authority shall administer
			 the Program including soliciting, reviewing, evaluating, and selecting
			 successful grant proposals. The Authority shall also provide project
			 monitoring, technical assistance and submit periodic status reports to
			 interested parties.
(8) Grant
			 funding shall be awarded for the remainder of the 2015-2017 biennium, with the
			 possibility of extensions.
(10) The
			 Authority shall distribute safety net grant funds to successful applicants on
			 an incremental basis.
Stat. Auth.: ORS
				  413.225
Stats. Implemented: ORS
				  413.225,
				  2015 c.
				  837,
				  §
											34
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 110 - SAFETY NET CAPACITY GRANT PROGRAM › Section 410-110-0040 - Grant Award Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Authority shall advertise grant proposals through publication on its website
			 and through communication to eligible entities.
(2) All proposals must be submitted in a form
			 specified by the Program and by the date specified in the solicitation
			 document.
(3) The Authority shall
			 document receipt of all proposals.
(4) To qualify for a grant through the
			 Program, applicants must be able to credibly estimate the number of new and
			 existing children in the target population they will serve, as well as the
			 number of estimated visits for the target population.
(5) The Authority shall evaluate all
			 proposals based upon but not limited to the following evaluation elements:
(a) Demonstrated capacity to provide primary
			 health care services.
(b)
			 Demonstrated capacity or description of a credible plan to serve the target
			 population.
(c) Demonstrated
			 capacity or description of a credible plan to assure that services are
			 culturally and linguistically competent.
(d) Demonstrated capacity or description of a
			 credible plan to identify, contact, and provide primary care services to the
			 target population.
(e) Demonstrated
			 readiness to be operational within 60 days of grant award.
(f) Maintenance of operating hours and
			 locations to ensure accessibility.
(g) Demonstrated ability to partner with
			 community-based and other community organizations and to leverage funds, where
			 possible.
(h) Submission of a
			 proposed work plan, including timeline, discrete programs and products,
			 evaluation outcomes, and budget.
(i) Demonstrated capacity or description of a
			 credible plan for implementing data systems that can report on delivery of
			 services and health outcomes, preferably through the utilization of electronic
			 health records that are Certification Commission for Health Information
			 Technology certified.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 110 - SAFETY NET CAPACITY GRANT PROGRAM › Section 410-110-0045 - Monitoring and Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A grantee shall:
(a) Submit grant reports to the Authority on
			 a periodic basis. Grant reports will indicate progress to achieve grant
			 benchmarks and goals and report on the expenditure of grant dollars. Failure to
			 comply with reporting requirements may result in grant suspension or
			 termination; and
(b) Report
			 specific data or information, to be determined by the Authority.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0000 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
The Purpose of this Chapter 410, Division 115, is to establish
				uniform standards for the Authority's administration of Oregon Health Plan
				(OHP) Bridge (as defined in OAR 410-115-0005  below). The rules set forth below
				in this Chapter 410, Division 115 apply exclusively to the administration and
				provision of OHP Bridge. Any rule set forth in this Chapter 410, Division 115
				that contradicts or conflicts with any rules of general applicability found in
				other Divisions included in OAR Chapter 410 are superseded by the rules and
				provisions in this OAR Chapter 410, Division 115.
Statutory/Other Authority: ORS
				  414.241 & 413.042
Statutes/Other Implemented: ORS
				  414.241,
				  413.042,
				  414.025, 414.65 &
				  414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0005 - Acronyms and Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The acronyms
			 and definitions within this rule specifically pertain to OHP Bridge. This rule
			 does not include an exhaustive list of acronyms and definitions that apply to
			 OHP Bridge. Other acronyms and definitions that may apply to OHP Bridge are
			 found in OAR 410-141-3500, OAR 410-120-0000, and OAR 410-200-0015.
(2) "Basic Health Program" means a joint
			 federal and state funded program for medical assistance established under
			 section 1331 of the federal Patient Protection and Affordable Care Act of 2010
			 and Title 42, Chapter IV, Subchapter 1 of the Code of Federal Regulations,
			 which the state has elected to adopt and implement as OHP Bridge.
(3) "Oregon Health Plan (OHP) Bridge" means
			 the health insurance programs established by the state under Oregon House Bill
			 4035 (2022 Regular Session) and in accordance with ORS
			 414.241 which is available to
			 individuals who meet certain age, financial, and other eligibility requirements
			 OAR Chapter 410, Division 200. OHP Bridge provides the same health insurance
			 benefits (covered services) to all eligible individuals but due to federal law,
			 OHP Bridge is delivered through two different medical assistance programs which
			 are listed below in this rule:
(a) "OHP
			 Bridge - Basic Medicaid" means the Medicaid eligibility category created by the
			 state to provide OHP Bridge covered services to OHP Bridge - Basic Medicaid
			 members described in OAR 410-200-0437.
(b) "OHP Bridge - Basic Health Program" means
			 the Basic Health Program established by the state as a medical assistance
			 program administered by the Authority, which provides OHP Bridge covered
			 services to OHP Bridge - Basic Health Program members described in OAR
			 410-200-0438.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0010 - Application

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority shall conduct the
			 application process for OHP Bridge in accordance with the provisions outlined
			 in OAR 410-200-0110.
(2) Consistent
			 with 42 C.F.R.
			 435.905(b), the Authority
			 must provide assistance to all individuals who apply or want to apply for OHP
			 Bridge (applicants), including without limitation, those applicants who may be
			 of Limited English Proficiency, as well as individuals living with
			 disabilities.
(3) Applicants to OHP
			 Bridge may utilize authorized representatives in accordance with OAR
			 410-200-0111.
(4) Applicants to OHP
			 Bridge have the right to receive application and health care system navigation
			 assistance from assisters, navigators, and other individuals certified by the
			 Authority to provide application assistance, in accordance with OAR
			 410-120-0045.
Statutory/Other Authority: ORS
				  411.400,
				  411.402,
				  411.404,
				  413.042,
				  414.241,
				  414.534 & 414.706
Statutes/Other Implemented: ORS
				  411.400,
				  411.402,
				  411.404,
				  413.042,
				  414.241,
				  414.534,
				  414.706,
				  411.406,
				  411.439,
				  413.038,
				  414.025 &
				  414.536
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0015 - Eligibility and Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility
			 requirements for OHP Bridge - Basic Medicaid and OHP Bridge - Basic Health
			 Program are described in OAR 410-200-0437  and in OAR 410-200-0438.
(2) Effective start dates for OHP Bridge -
			 Basic Medicaid and OHP Bridge - Basic Health Program coverage are established
			 in OAR 410-200-0115.
(3) In the
			 event OHP Bridge coverage is incorrectly terminated or denied due to agency
			 error, coverage shall commence or be reinstated as follows:
(a) If incorrectly denied due to agency
			 error, the individual's enrollment in OHP Bridge and their benefit coverage
			 shall begin on the first day of the month in which benefits may have been
			 effective had the Authority not erred in its initial determination;
			 or
(b) If incorrectly terminated
			 due to agency error, the individual's OHP Bridge coverage shall be reinstated
			 with no gap in coverage.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0020 - Continuity of Health Care

Current through Register Vol. 63, No. 7, July 1, 2024
The agency shall coordinate eligibility and enrollment between
				the Oregon Health Authority (Authority), the Department of Human Services
				(Department), and the Federally Facilitated Marketplace as set forth in OAR
				410-200-0110  - Coordinated Eligibility and Enrollment Process with the
				Department of Human Services and the Federally Facilitated Marketplace.
Statutory/Other Authority: ORS
				  413.042,
				  414.241 &  42 CFR 600
Statutes/Other Implemented: ORS
				  413.042 &
				  414.241
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 115 - OHP Bridge › Section 410-115-0025 - Grievances and Appeals: Managed Care Entities Obligations; OHP Bridge Program Member Rights

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In administering OHP Bridge, Managed Care
			 Entities must comply with the grievance, appeal, and contested case
			 administrative rules set forth in OARs 410-141-3875  through
			 410-141-3915.
(2) OHP Bridge
			 members have the right to file a grievance, appeal an adverse benefit
			 determination, and request a contested case hearing as described in OARs
			 410-141-3875  through OAR 410-141-3915.
Statutory/Other Authority: ORS
				  413.042,
				  414.065,
				  414.241 &
				  42 CFR
				  600.335
Statutes/Other Implemented: ORS
				  413.042,
				  414.065,
				  414.241,
				  414.727 &  42 CFR 600