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OHPR Statutes

Administrator, Administration

ORS 442.011 to 442.025 
  
      442.011 Office for Oregon Health Policy and Research created; appointment of administrator. There is created in the Oregon Health Authority the Office for Oregon Health Policy and Research. The Administrator of the Office for Oregon Health Policy and Research shall be appointed by the Director of the Oregon Health Authority. The administrator shall be an individual with demonstrated proficiency in planning and managing programs with complex public policy and fiscal aspects such as those involved in the medical assistance program. [1993 c.725 §33; 1997 c.683 §16; 2001 c.69 §1; 2003 c.784 §5; 2007 c.697 §§14,15; 2009 c.595 §§747,748; 2011 c.720 §197]  
  
      442.015 Definitions. As used in ORS chapter 441 and this chapter, unless the context requires otherwise:
      (1) “Acquire” or “acquisition” means obtaining equipment, supplies, components or facilities by any means, including purchase, capital or operating lease, rental or donation, for the purpose of using such equipment, supplies, components or facilities to provide health services in Oregon. When equipment or other materials are obtained outside of this state, acquisition is considered to occur when the equipment or other materials begin to be used in Oregon for the provision of health services or when such services are offered for use in Oregon.
      (2) “Affected persons” has the same meaning as given to “party” in ORS 183.310.
      (3)(a) “Ambulatory surgical center” means a facility or portion of a facility that operates exclusively for the purpose of providing surgical services to patients who do not require hospitalization and for whom the expected duration of services does not exceed 24 hours following admission.
      (b) “Ambulatory surgical center” does not mean:
      (A) Individual or group practice offices of private physicians or dentists that do not contain a distinct area used for outpatient surgical treatment on a regular and organized basis, or that only provide surgery routinely provided in a physician’s or dentist’s office using local anesthesia or conscious sedation; or
      (B) A portion of a licensed hospital designated for outpatient surgical treatment.
      (4) “Delegated credentialing agreement” means a written agreement between an originating-site hospital and a distant-site hospital that provides that the medical staff of the originating-site hospital will rely upon the credentialing and privileging decisions of the distant-site hospital in making recommendations to the governing body of the originating-site hospital as to whether to credential a telemedicine provider, practicing at the distant-site hospital either as an employee or under contract, to provide telemedicine services to patients in the originating-site hospital.
      (5) “Develop” means to undertake those activities that on their completion will result in the offer of a new institutional health service or the incurring of a financial obligation, as defined under applicable state law, in relation to the offering of such a health service.
      (6) “Distant-site hospital” means the hospital where a telemedicine provider, at the time the telemedicine provider is providing telemedicine services, is practicing as an employee or under contract.
      (7) “Essential long term care facility” means an individual long term care facility that serves predominantly rural and frontier communities, as designated by the Office of Rural Health, and meets other criteria established by the Department of Human Services by rule.
      (8) “Expenditure” or “capital expenditure” means the actual expenditure, an obligation to an expenditure, lease or similar arrangement in lieu of an expenditure, and the reasonable value of a donation or grant in lieu of an expenditure but not including any interest thereon.
      (9) “Freestanding birthing center” means a facility licensed for the primary purpose of performing low risk deliveries.
      (10) “Governmental unit” means the state, or any county, municipality or other political subdivision, or any related department, division, board or other agency.
      (11) “Gross revenue” means the sum of daily hospital service charges, ambulatory service charges, ancillary service charges and other operating revenue. “Gross revenue” does not include contributions, donations, legacies or bequests made to a hospital without restriction by the donors.
      (12)(a) “Health care facility” means:
      (A) A hospital;
      (B) A long term care facility;
      (C) An ambulatory surgical center;
      (D) A freestanding birthing center; or
      (E) An outpatient renal dialysis center.
      (b) “Health care facility” does not mean:
      (A) A residential facility licensed by the Department of Human Services or the Oregon Health Authority under ORS 443.415;
      (B) An establishment furnishing primarily domiciliary care as described in ORS 443.205;
      (C) A residential facility licensed or approved under the rules of the Department of Corrections;
      (D) Facilities established by ORS 430.335 for treatment of substance abuse disorders; or
      (E) Community mental health programs or community developmental disabilities programs established under ORS 430.620.
      (13) “Health maintenance organization” or “HMO” means a public organization or a private organization organized under the laws of any state that:
      (a) Is a qualified HMO under section 1310 (d) of the U.S. Public Health Services Act; or
      (b)(A) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services:
      (i) Usual physician services;
      (ii) Hospitalization;
      (iii) Laboratory;
      (iv) X-ray;
      (v) Emergency and preventive services; and
      (vi) Out-of-area coverage;
      (B) Is compensated, except for copayments, for the provision of the basic health care services listed in subparagraph (A) of this paragraph to enrolled participants on a predetermined periodic rate basis; and
      (C) Provides physicians’ services primarily directly through physicians who are either employees or partners of such organization, or through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis.
      (14) “Health services” means clinically related diagnostic, treatment or rehabilitative services, and includes alcohol, drug or controlled substance abuse and mental health services that may be provided either directly or indirectly on an inpatient or ambulatory patient basis.
      (15) “Hospital” means:
      (a) A facility with an organized medical staff and a permanent building that is capable of providing 24-hour inpatient care to two or more individuals who have an illness or injury and that provides at least the following health services:
      (A) Medical;
      (B) Nursing;
      (C) Laboratory;
      (D) Pharmacy; and
      (E) Dietary; or
      (b) A special inpatient care facility as that term is defined by the authority by rule.
      (16) “Institutional health services” means health services provided in or through health care facilities and includes the entities in or through which such services are provided.
      (17) “Intermediate care facility” means a facility that provides, on a regular basis, health-related care and services to individuals who do not require the degree of care and treatment that a hospital or skilled nursing facility is designed to provide, but who because of their mental or physical condition require care and services above the level of room and board that can be made available to them only through institutional facilities.
      (18)(a) “Long term care facility” means a permanent facility with inpatient beds, providing:
      (A) Medical services, including nursing services but excluding surgical procedures except as may be permitted by the rules of the Director of Human Services; and
      (B) Treatment for two or more unrelated patients.
      (b) “Long term care facility” includes skilled nursing facilities and intermediate care facilities but does not include facilities licensed and operated pursuant to ORS 443.400 to 443.455.
      (19) “New hospital” means:
      (a) A facility that did not offer hospital services on a regular basis within its service area within the prior 12-month period and is initiating or proposing to initiate such services; or
      (b) Any replacement of an existing hospital that involves a substantial increase or change in the services offered.
      (20) “New skilled nursing or intermediate care service or facility” means a service or facility that did not offer long term care services on a regular basis by or through the facility within the prior 12-month period and is initiating or proposing to initiate such services. “New skilled nursing or intermediate care service or facility” also includes the rebuilding of a long term care facility, the relocation of buildings that are a part of a long term care facility, the relocation of long term care beds from one facility to another or an increase in the number of beds of more than 10 or 10 percent of the bed capacity, whichever is the lesser, within a two-year period in a facility that applied for a certificate of need between August 1, 2011, and December 1, 2012, or submitted a letter of intent under ORS 442.315 (7) between January 15, 2013, and January 31, 2013.
      (21) “Offer” means that the health care facility holds itself out as capable of providing, or as having the means for the provision of, specified health services.
      (22) “Originating-site hospital” means a hospital in which a patient is located while receiving telemedicine services.
      (23) “Outpatient renal dialysis facility” means a facility that provides renal dialysis services directly to outpatients.
      (24) “Person” means an individual, a trust or estate, a partnership, a corporation (including associations, joint stock companies and insurance companies), a state, or a political subdivision or instrumentality, including a municipal corporation, of a state.
      (25) “Skilled nursing facility” means a facility or a distinct part of a facility, that is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or an institution that provides rehabilitation services for the rehabilitation of individuals who are injured or sick or who have disabilities.
      (26) “Telemedicine” means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications. [1977 c.751 §1; 1979 c.697 §2; 1979 c.744 §31; 1981 c.693 §1; 1983 c.482 §1; 1985 c.747 §16; 1987 c.320 §233; 1987 c.660 §4; 1987 c.753 §2; 1989 c.708 §5; 1989 c.1034 §5; 1991 c.470 §9; 2001 c.100 §1; 2001 c.104 §181a; 2001 c.900 §179; 2003 c.75 §91; 2003 c.784 §11; 2005 c.22 §300; 2007 c.70 §242; 2009 c.595 §749; 2009 c.792 §63; 2013 c.414 §3; 2013 c.608 §16]
 
      Note: The amendments to 442.015 by section 22, chapter 608, Oregon Laws 2013, become operative June 30, 2020. See section 26, chapter 608, Oregon Laws 2013. The text that is operative on and after June 30, 2020, is set forth for the user’s convenience.
      442.015. As used in ORS chapter 441 and this chapter, unless the context requires otherwise:
      (1) “Acquire” or “acquisition” means obtaining equipment, supplies, components or facilities by any means, including purchase, capital or operating lease, rental or donation, for the purpose of using such equipment, supplies, components or facilities to provide health services in Oregon. When equipment or other materials are obtained outside of this state, acquisition is considered to occur when the equipment or other materials begin to be used in Oregon for the provision of health services or when such services are offered for use in Oregon.
      (2) “Affected persons” has the same meaning as given to “party” in ORS 183.310.
      (3)(a) “Ambulatory surgical center” means a facility or portion of a facility that operates exclusively for the purpose of providing surgical services to patients who do not require hospitalization and for whom the expected duration of services does not exceed 24 hours following admission.
      (b) “Ambulatory surgical center” does not mean:
      (A) Individual or group practice offices of private physicians or dentists that do not contain a distinct area used for outpatient surgical treatment on a regular and organized basis, or that only provide surgery routinely provided in a physician’s or dentist’s office using local anesthesia or conscious sedation; or
      (B) A portion of a licensed hospital designated for outpatient surgical treatment.
      (4) “Delegated credentialing agreement” means a written agreement between an originating-site hospital and a distant-site hospital that provides that the medical staff of the originating-site hospital will rely upon the credentialing and privileging decisions of the distant-site hospital in making recommendations to the governing body of the originating-site hospital as to whether to credential a telemedicine provider, practicing at the distant-site hospital either as an employee or under contract, to provide telemedicine services to patients in the originating-site hospital.
      (5) “Develop” means to undertake those activities that on their completion will result in the offer of a new institutional health service or the incurring of a financial obligation, as defined under applicable state law, in relation to the offering of such a health service.
      (6) “Distant-site hospital” means the hospital where a telemedicine provider, at the time the telemedicine provider is providing telemedicine services, is practicing as an employee or under contract.
      (7) “Expenditure” or “capital expenditure” means the actual expenditure, an obligation to an expenditure, lease or similar arrangement in lieu of an expenditure, and the reasonable value of a donation or grant in lieu of an expenditure but not including any interest thereon.
      (8) “Freestanding birthing center” means a facility licensed for the primary purpose of performing low risk deliveries.
      (9) “Governmental unit” means the state, or any county, municipality or other political subdivision, or any related department, division, board or other agency.
      (10) “Gross revenue” means the sum of daily hospital service charges, ambulatory service charges, ancillary service charges and other operating revenue. “Gross revenue” does not include contributions, donations, legacies or bequests made to a hospital without restriction by the donors.
      (11)(a) “Health care facility” means:
      (A) A hospital;
      (B) A long term care facility;
      (C) An ambulatory surgical center;
      (D) A freestanding birthing center; or
      (E) An outpatient renal dialysis center.
      (b) “Health care facility” does not mean:
      (A) A residential facility licensed by the Department of Human Services or the Oregon Health Authority under ORS 443.415;
      (B) An establishment furnishing primarily domiciliary care as described in ORS 443.205;
      (C) A residential facility licensed or approved under the rules of the Department of Corrections;
      (D) Facilities established by ORS 430.335 for treatment of substance abuse disorders; or
      (E) Community mental health programs or community developmental disabilities programs established under ORS 430.620.
      (12) “Health maintenance organization” or “HMO” means a public organization or a private organization organized under the laws of any state that:
      (a) Is a qualified HMO under section 1310 (d) of the U.S. Public Health Services Act; or
      (b)(A) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services:
      (i) Usual physician services;
      (ii) Hospitalization;
      (iii) Laboratory;
      (iv) X-ray;
      (v) Emergency and preventive services; and
      (vi) Out-of-area coverage;
      (B) Is compensated, except for copayments, for the provision of the basic health care services listed in subparagraph (A) of this paragraph to enrolled participants on a predetermined periodic rate basis; and
      (C) Provides physicians’ services primarily directly through physicians who are either employees or partners of such organization, or through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis.
      (13) “Health services” means clinically related diagnostic, treatment or rehabilitative services, and includes alcohol, drug or controlled substance abuse and mental health services that may be provided either directly or indirectly on an inpatient or ambulatory patient basis.
      (14) “Hospital” means:
      (a) A facility with an organized medical staff and a permanent building that is capable of providing 24-hour inpatient care to two or more individuals who have an illness or injury and that provides at least the following health services:
      (A) Medical;
      (B) Nursing;
      (C) Laboratory;
      (D) Pharmacy; and
      (E) Dietary; or
      (b) A special inpatient care facility as that term is defined by the authority by rule.
      (15) “Institutional health services” means health services provided in or through health care facilities and includes the entities in or through which such services are provided.
      (16) “Intermediate care facility” means a facility that provides, on a regular basis, health-related care and services to individuals who do not require the degree of care and treatment that a hospital or skilled nursing facility is designed to provide, but who because of their mental or physical condition require care and services above the level of room and board that can be made available to them only through institutional facilities.
      (17)(a) “Long term care facility” means a permanent facility with inpatient beds, providing:
      (A) Medical services, including nursing services but excluding surgical procedures except as may be permitted by the rules of the Director of Human Services; and
      (B) Treatment for two or more unrelated patients.
      (b) “Long term care facility” includes skilled nursing facilities and intermediate care facilities but does not include facilities licensed and operated pursuant to ORS 443.400 to 443.455.
      (18) “New hospital” means:
      (a) A facility that did not offer hospital services on a regular basis within its service area within the prior 12-month period and is initiating or proposing to initiate such services; or
      (b) Any replacement of an existing hospital that involves a substantial increase or change in the services offered.
      (19) “New skilled nursing or intermediate care service or facility” means a service or facility that did not offer long term care services on a regular basis by or through the facility within the prior 12-month period and is initiating or proposing to initiate such services. “New skilled nursing or intermediate care service or facility” also includes the rebuilding of a long term care facility, the relocation of buildings that are a part of a long term care facility, the relocation of long term care beds from one facility to another or an increase in the number of beds of more than 10 or 10 percent of the bed capacity, whichever is the lesser, within a two-year period.
      (20) “Offer” means that the health care facility holds itself out as capable of providing, or as having the means for the provision of, specified health services.
      (21) “Originating-site hospital” means a hospital in which a patient is located while receiving telemedicine services.
      (22) “Outpatient renal dialysis facility” means a facility that provides renal dialysis services directly to outpatients.
      (23) “Person” means an individual, a trust or estate, a partnership, a corporation (including associations, joint stock companies and insurance companies), a state, or a political subdivision or instrumentality, including a municipal corporation, of a state.
      (24) “Skilled nursing facility” means a facility or a distinct part of a facility, that is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or an institution that provides rehabilitation services for the rehabilitation of individuals who are injured or sick or who have disabilities.
      (25) “Telemedicine” means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.
  
      442.020 [Amended by 1955 c.533 §4; 1973 c.754 §2; repealed by 1977 c.717 §23]
 
      442.025 Findings and policy. (1) The Legislative Assembly finds that the achievement of reasonable access to quality health care at a reasonable cost is a priority of the State of Oregon.
      (2) Problems preventing the priority in subsection (1) of this section from being attained include:
      (a) The inability of many citizens to pay for necessary health care, being covered neither by private insurance nor by publicly funded programs such as Medicare and Medicaid;
      (b) Rising costs of medical care which exceed substantially the general rate of inflation;
      (c) Insufficient price competition in the delivery of health care services that would provide a greater cost consciousness among providers, payers and consumers;
      (d) Inadequate incentives for the use of less costly and more appropriate alternative levels of health care;
      (e) Insufficient or inappropriate use of existing capacity, duplicated services and failure to use less costly alternatives in meeting significant health needs; and
      (f) Insufficient primary and emergency medical care services in medically underserved areas of the state.
      (3) As a result of rising health care costs and the concern expressed by health care providers, health care users, third-party payers and the general public, there is an urgent need to abate these rising costs so as to place the cost of health care within reach of all Oregonians without affecting the quality of care.
      (4) To foster the cooperation of the separate industry forces, there is a need to compile and disseminate accurate and current data, including but not limited to price and utilization data, to meet the needs of the people of Oregon and improve the appropriate usage of health care services.
      (5) It is the purpose of this chapter to establish area-wide and state planning for health services, staff and facilities in light of the findings of subsection (1) of this section and in furtherance of health planning policies of this state.
      (6) It is further declared that hospital costs should be contained through improved competition between hospitals and improved competition between insurers and through financial incentives on behalf of providers, insurers and consumers to contain costs. As a safety net, it is the intent of the Legislative Assembly to monitor hospital performance. [1977 c.751 §2; 1981 c.693 §2; 1983 c.482 §2; 1985 c.747 §1; 1987 c.660 §3]

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Ambulatory Surgery Reporting

ORS 442.120
 
      442.120 Ambulatory surgery and inpatient discharge abstract records; alternative data; rules; fees. In order to provide data essential for health planning programs:
      (1) The Office for Oregon Health Policy and Research may request, by July 1 of each year, each general hospital to file with the office ambulatory surgery and inpatient discharge abstract records covering all patients discharged during the preceding calendar year. The ambulatory surgery and inpatient discharge abstract record for each patient must include the following information, and may include other information deemed necessary by the office for developing or evaluating statewide health policy:
      (a) Date of birth;
      (b) Sex;
      (c) Zip code;
      (d) Inpatient admission date or outpatient service date;
      (e) Inpatient discharge date;
      (f) Type of discharge;
      (g) Diagnostic related group or diagnosis;
      (h) Type of procedure performed;
      (i) Expected source of payment, if available;
      (j) Hospital identification number; and
      (k) Total hospital charges.
      (2) By July 1 of each year, the office may request from ambulatory surgical centers licensed under ORS 441.015 ambulatory surgery discharge abstract records covering all patients admitted during the preceding year. Ambulatory surgery discharge abstract records must include information similar to that requested from general hospitals under subsection (1) of this section.
      (3) In lieu of abstracting and compiling the records itself, the office may solicit the voluntary submission of such data from Oregon hospitals or other sources to enable it to carry out its responsibilities under this section. If such data are not available to the office on an annual and timely basis, the office may establish by rule a fee to be charged to each hospital.
      (4) Subject to prior approval of the Oregon Health Policy Board and a report to the Emergency Board, if the Legislative Assembly is not in session, prior to adopting the fee, and within the budget authorized by the Legislative Assembly as the budget may be modified by the Emergency Board, the fee established under subsection (3) of this section may not exceed the cost of abstracting and compiling the records.
      (5) The office may specify by rule the form in which the records are to be submitted. If the form adopted by rule requires conversion from the form regularly used by a hospital, reasonable costs of such conversion shall be paid by the office.
      (6) Abstract records must include a patient identifier that allows for the statistical matching of records over time to permit public studies of issues related to clinical practices, health service utilization and health outcomes. Provision of such a patient identifier must not allow for identification of the individual patient.
      (7) In addition to the records required in subsection (1) of this section, the office may obtain abstract records for each patient that identify specific services, classified by International Classification of Disease Code, for special studies on the incidence of specific health problems or diagnostic practices. However, nothing in this subsection shall authorize the publication of specific data in a form that allows identification of individual patients or licensed health care professionals.
      (8) The office may provide by rule for the submission of records for enrollees in a health maintenance organization from a hospital associated with such an organization in a form the office determines appropriate to the office’s needs for such data and the organization’s record keeping and reporting systems for charges and services. [Formerly 442.355; 1991 c.703 §7; 1993 c.754 §7; 1995 c.727 §23; 1997 c.683 §19; 1999 c.581 §2; 2007 c.71 §128; 2009 c.595 §750]
 

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Advisory Committee on Physician Credentialing Information (ACPCI)

ORS 441.221 to 441.223 
      441.221 Advisory Committee on Physician Credentialing Information; membership; terms. (1) The Advisory Committee on Physician Credentialing Information is established within the Office for Oregon Health Policy and Research. The committee consists of nine members appointed by the Administrator of the Office for Oregon Health Policy and Research as follows:
      (a) Three members who are physicians licensed by the Oregon Medical Board or representatives of physician organizations doing business within the State of Oregon;
      (b) Three representatives of hospitals licensed by the Oregon Health Authority; and
      (c) Three representatives of health care service contractors that have been issued a certificate of authority to transact health insurance in this state by the Department of Consumer and Business Services.
      (2) All members appointed pursuant to subsection (1) of this section shall be knowledgeable about national standards relating to physician credentialing.
      (3) The term of appointment for each member of the committee is three years. If, during a member’s term of appointment, the member no longer qualifies to serve as designated by the criteria of subsection (1) of this section, the member must resign. If there is a vacancy for any cause, the administrator shall make an appointment to become immediately effective for the unexpired term.
      (4) Members of the committee are not entitled to compensation or reimbursement of expenses. [Formerly 442.800]
      Note: 441.221 to 441.223 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 441 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.

      441.222 Committee recommendations. (1) The Advisory Committee on Physician Credentialing Information shall develop and submit recommendations to the Administrator of the Office for Oregon Health Policy and Research for the collection of uniform information necessary for hospitals and health plans to credential physicians seeking membership on a hospital medical staff or designation as a participating provider for a health plan. The recommendations must specify:
      (a) The content and format of a credentialing application form; and
      (b) The content and format of a recredentialing application form.
      (2) The committee shall meet at least once every calendar year to review the uniform credentialing information and to assure the administrator that the information complies with credentialing standards developed by national accreditation organizations and applicable regulations of the federal government.
      (3) The Office for Oregon Health Policy and Research shall provide the support staff necessary for the committee to accomplish its duties. [Formerly 442.805]
      Note: See note under 441.221.
 
      441.223 Implementation of committee recommendations; rules. (1) Within 30 days of receiving the recommendations of the Advisory Committee on Physician Credentialing Information, the Administrator of the Office for Oregon Health Policy and Research shall forward the recommendations to the Director of the Oregon Health Authority. The administrator shall request that the Oregon Health Authority adopt rules to carry out the efficient implementation and enforcement of the recommendations of the committee.
      (2) The Oregon Health Authority shall:
      (a) Adopt administrative rules in a timely manner, as required by the Administrative Procedures Act, for the purpose of effectuating the provisions of ORS 441.221 to 441.223; and
      (b) Consult with each other and with the administrator to ensure that the rules adopted by the Oregon Health Authority are identical and are consistent with the recommendations developed pursuant to ORS 441.222 for affected hospitals and health care service contractors.
      (3) The uniform credentialing information required pursuant to the administrative rules of the Oregon Health Authority represent the minimum uniform credentialing information required by the affected hospitals and health care service contractors. Except as provided in subsection (4) of this section, a hospital or health care service contractor may request additional credentialing information from a licensed physician for the purpose of completing physician credentialing procedures used by the affected hospital or health care service contractor.
      (4) In credentialing a telemedicine provider, a hospital is subject to the requirements prescribed by rule by the authority under ORS 441.056. [Formerly 442.807]
      Note: See note under 441.221.
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Capitol Project Reporting

ORS 442.361 to 442.362, 442.991
 
       442.361 Definitions for ORS 442.361, 442.362 and 442.991. As used in this section and ORS 442.362 and 442.991:
      (1)(a) “Capital project” means:
      (A) The construction, development, purchase, renovation or any construction expenditure by or on behalf of a reporting entity, for which the cost:
      (i) For type A hospitals, exceeds five percent of gross revenue.
      (ii) For type B hospitals, exceeds five percent of gross revenue.
      (iii) For DRG hospitals, exceeds 1.75 percent of gross revenue.
      (iv) For ambulatory surgery centers, exceeds $2 million.
      (B) The purchase or lease of, or other comparable arrangement for, a single piece of diagnostic or therapeutic equipment for which the cost or, in the case of a donation, the value exceeds $1 million. The acquisition of two or more pieces of diagnostic or therapeutic equipment that are necessarily interdependent in the performance of ordinary functions shall be combined in calculating the cost or value of the transaction.
      (b) “Capital project” does not include a project financed entirely through charitable fundraising.
      (2) “DRG hospital” means a hospital that is not a type A or type B hospital and that receives Medicare reimbursement based upon diagnostic related groups.
      (3) “Gross revenue” has the meaning given that term in ORS 442.015.
      (4) “Reporting entity” includes the following if licensed pursuant to ORS 441.015:
      (a) A type A hospital as described in ORS 442.470.
      (b) A type B hospital as described in ORS 442.470.
      (c) A DRG hospital.
      (d) An ambulatory surgical center as defined in ORS 442.015. [2009 c.595 §1197]
 
      Note: 442.361 and 442.362 were added to and made a part of ORS chapter 442 by legislative action but were not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
 
      442.362 Reporting of proposed capital projects by hospitals and ambulatory surgical centers. The Office for Oregon Health Policy and Research may adopt rules requiring reporting entities within the state to publicly report proposed capital projects. Rules adopted under this section must:
      (1) Require a reporting entity to establish on the homepage of its website a prominently labeled link to information about proposed or pending capital projects. The information posted must include but is not limited to a report of the community benefit for the project, its estimated cost and a means for interested persons to submit comments. When a reporting entity posts the information required under this subsection, the reporting entity must notify the Office for Oregon Health Policy and Research of the posting in the manner prescribed by the office.
      (2) If a reporting entity does not have a website, require the reporting entity to publish notice of the proposed capital project in a major newspaper or online equivalent serving the region in which the proposed capital project will be located. The notice must include but is not limited to a report of the community benefit for the project, its estimated cost and a means for interested persons to submit comments. When a reporting entity publishes the information required under this subsection, the reporting entity must notify the Office for Oregon Health Policy and Research of the publication in the manner prescribed by the office.
      (3) Establish a publicly available resource for information collected under this section. [2009 c.595 §1198]
 
      Note: See note under 442.361.
 
      442.991 Civil penalties for failure to report proposed capital projects. (1) Any reporting entity that fails to report as required by rules of the Office for Oregon Health Policy and Research adopted pursuant to ORS 442.362 may be subject to a civil penalty.
      (2) The Administrator of the Office for Oregon Health Policy and Research shall adopt a schedule of penalties, not to exceed $500 per day of violation, that are based on the severity of the violation.
      (3) Civil penalties imposed under this section shall be imposed as provided in ORS 183.745.
      (4) Civil penalties imposed under this section may be remitted or mitigated upon such terms and conditions as the administrator considers proper and consistent with the public health and safety.
      (5) Civil penalties incurred under any law of this state are not allowable as costs for the purpose of rate determination or for reimbursement by a third-party payer. [2009 c.595 §1199]
 

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Community-based Health Care Initiatives

ORS 735.721 to 735.727 
  
      735.721 Definitions for ORS 735.721 to 735.727. As used in ORS 735.721 to 735.727:
      (1) “Community” means the area of geographically contiguous political subdivisions as determined by the Office for Oregon Health Policy and Research in collaboration with the board of directors of a community-based health care initiative.
      (2) “Qualified employee” means an individual who:
      (a) Is employed by a qualified employer;
      (b) Resides or works within a community;
      (c) Does not have health insurance; and
      (d) Does not qualify for publicly funded health care.
      (3) “Qualified employer” means an employer that:
      (a) Employs 1 to 50 full-time equivalent employees;
      (b) Pays a median wage to its employees that is equal to or below an amount that is 300 percent of the federal poverty guidelines;
      (c) For two months prior to enrollment in a community-based health care improvement program, or for the duration of the employer’s operation if the employer has been in operation less than two months, has not provided to employees employer-based health insurance coverage for which the employer contributes at least 50 percent of the cost of premiums;
      (d) Offers community-based health care services through a community-based health care improvement program to all qualified employees and their dependents regardless of health status;
      (e) Agrees to participate in a community-based health care improvement program for at least 12 months; and
      (f) Agrees to provide information that is deemed necessary by the community-based health care initiative to determine eligibility, assess dues and pay claims. [2009 c.470 §1; 2013 c.69 §1]
 
      Note: 735.721 to 735.727 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 735 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
      735.722 [Formerly 653.805; 2003 c.128 §1; 2003 c.683 §4; 2003 c.784 §12; 2005 c.238 §6; 2005 c.262 §6; 2005 c.727 §6; 2005 c.744 §24a; 2009 c.595 §1125; renumbered 414.842 in 2009]
 
      735.723 Requirements for approval; rules. (1) The Administrator of the Office for Oregon Health Policy and Research shall adopt rules for the approval of one community-based health care initiative per community that meets the requirements under subsection (2) of this section and of a community-based health care improvement program that meets the requirements under subsection (3) of this section. The office may not approve community-based health care initiatives for more than three communities during the period beginning with June 23, 2009, and ending June 30, 2013.
      (2) An approved community-based health care initiative shall:
      (a) Be a nonprofit corporation governed by a board of directors that includes, but is not limited to, representatives of participating health care providers and qualified employers. At least 80 percent of the board members must be residents of the community.
      (b) Contract with health care providers that offer health care services in the community to provide services to enrollees in the program.
      (c) Recruit qualified employers to enroll in the program.
      (d) Establish an operational structure for:
      (A) Assisting employees of qualified employers or their dependents to enroll in state medical assistance programs if appropriate;
      (B) Enrolling qualified employees and their dependents in the community-based health care improvement program;
      (C) Billing and collecting dues from qualified employers and qualified employees; and
      (D) Reimbursing participating health care providers for services to enrollees.
      (e) Establish a set of health care services that are covered in the community-based health care improvement program, cost-sharing requirements and incentives to encourage the utilization of primary care, wellness and chronic disease management services.
      (f) Maintain a liquid reserve account in an amount sufficient to pay all claims that have been incurred but not yet charged for a period of at least two months.
      (g) Provide to each qualified employee enrolled in the program a clear and concise written statement that describes the community-based health care improvement program and that includes:
      (A) The health care services that are covered;
      (B) Any exclusions or limitations on coverage of health care services, including any requirements for prior authorization;
      (C) Copayments, coinsurance, deductibles and any other cost-sharing requirements;
      (D) A list of participating health care providers;
      (E) The complaint process described in subsection (3)(b) of this section; and
      (F) The conditions under which the program or coverage through the program may be terminated.
      (h) Comply with the requirements of ORS 735.725 and 735.727.
      (3) An approved community-based health care improvement program shall:
      (a) Reimburse the cost of the set of health care services established by the initiative and provided in the community to qualified employers, qualified employees and their dependents.
      (b) Include an enrollee complaint process that ensures the resolution of complaints within 45 days.
      (4) An individual who is a qualified employee and whose employment with a qualified employer terminates may elect to continue enrollment of the individual and the individual’s dependents in an approved community-based health care improvement program for no more than 18 months by paying the required dues. The dues may not be greater than the amount that would be charged if the individual remained a qualified employee. An approved community-based health care initiative must notify an employee of the opportunity to continue coverage upon the individual’s termination of coverage under the qualified employer’s program. [2009 c.470 §2; 2013 c.69 §2]
 
      Note: See note under 735.721.
      735.725 Enrollment requirements. (1) A community-based health care initiative may limit enrollment in a community-based health care improvement program. If enrollment is limited, the initiative must establish a waiting list.
      (2) Except as provided in this section, an initiative may not restrict or deny enrollment in the program except for nonpayment of dues, fraud or misrepresentation.
      (3) As a condition for enrolling a qualified employer and maintaining the employer’s enrollment in the program, an initiative may require a minimum percentage of participation by qualified employees of an employer. [2009 c.470 §3]
 
      Note: See note under 735.721.
 
      735.727 Annual report to Legislative Assembly. A community-based health care initiative approved by the Administrator of the Office for Oregon Health Policy and Research must report to the Legislative Assembly no later than October 1 of each year. The report must contain at a minimum the following information:
      (1) The financial status of the community-based health care improvement program, including the dues, the costs per enrollee per month, the total amount of claims paid, the total amount of dues collected and the administrative expenses;
      (2) A description of the set of health care services covered by the program and an analysis of service utilization;
      (3) The number of qualified employers, qualified employees and dependents enrolled;
      (4) The number and scope of practice of participating health care providers;
      (5) Recommendations for improving the program and establishing programs in other geographical regions of the state; and
      (6) Any other information requested by the administrator or the Legislative Assembly. [2009 c.470 §4]
 
      Note: See note under 735.721.
 

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Community Benefit Reporting

ORS 442.200 to 442.205
 
      442.200 Definitions for ORS 442.205. As used in this section and ORS 442.205:
      (1) “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, contractual allowances or discounts for quick payment.
      (2) “Community benefit” means a program or activity that provides treatment or promotes health and healing in response to an identified community need. “Community benefit” includes:
      (a) Charity care;
      (b) Losses related to Medicaid, Medicare, State Children’s Health Insurance Program or other publicly funded health care program shortfalls;
      (c) Community health improvement services;
      (d) Research;
      (e) Financial and in-kind contributions to the community; and
      (f) Community building activities affecting health in the community. [2007 c.384 §2]
 
      Note: 442.200 and 442.205 were added to and made a part of ORS chapter 442 by legislative action but were not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
 
442.205 Community benefit reporting; rules. (1) The Administrator of the Office for Oregon Health Policy and Research shall by rule adopt a cost-based community benefit reporting system for hospitals operating in Oregon that is consistent with established national standards for hospital reporting of community benefits.
      (2) Within 90 days of filing a Medicare cost report, a hospital must submit a community benefit report to the Office for Oregon Health Policy and Research of the community benefits provided by the hospital, on a form prescribed by the administrator.
      (3) The administrator shall produce an annual report of the information provided under subsections (1) and (2) of this section. The report shall be submitted to the Governor, the President of the Senate and the Speaker of the House of Representatives. The report shall be presented to the Legislative Assembly during each odd-numbered year regular session and shall be made available to the public.
      (4) The administrator may adopt all rules necessary to carry out the provisions of this section. [2007 c.384 §3; 2011 c.545 §56]
 
      Note: See note under 442.200.
 
 

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Credentialing - Electronic Information

ELECTRONIC CREDENTIALING INFORMATION
 
(Provisions relating to the submission, access and use of electronic credentialing information)
 
      Note: Sections 1 to 11, chapter 603, Oregon Laws 2013, provide:
      Sec. 1. Sections 2 to 7 of this 2013 Act are added to and made a part of ORS chapter 442. [2013 c.603 §1]
      Sec. 2. As used in sections 2 to 7 of this 2013 Act:
      (1) “Credentialing information” means information necessary to credential or recredential a health care practitioner.
      (2) “Credentialing organization” means a hospital or other health care facility, physician organization or other health care provider organization, coordinated care organization, business organization, insurer or other organization that credentials health care practitioners.
      (3) “Health care practitioner” means an individual authorized to practice a profession related to the provision of health care services in this state for which the individual must be credentialed.
      (4) “Health care regulatory board” means a board or other agency that authorizes individuals to practice a profession related to the provision of health care services for which the individual must be credentialed. [2013 c.603 §2]
      Sec. 3. (1)(a) The Oregon Health Authority, in consultation with the advisory work group convened under section 7 of this 2013 Act, shall establish a program for the purpose of providing to a credentialing organization access to information that is necessary to credential or recredential a health care practitioner.
      (b) To fulfill the requirements of this subsection, the authority shall establish and operate an electronic system through which credentialing information may be submitted to an electronic database and accessed. The system must operate and be accessible by credentialing organizations, health care practitioners and health care regulatory boards 24 hours a day, seven days a week. The authority may contract with a private entity to ensure the effective establishment and operation of the system.
      (c) To the greatest extent practicable, the electronic system shall use the most accessible and current technology available.
      (2) In consultation with the advisory work group convened under section 7 of this 2013 Act, the authority shall adopt rules for the operation of the electronic system, including:
      (a) Identification of the type of information that is necessary to credential or recredential each type of health care practitioner;
      (b) Processes by which a health care practitioner or health care regulatory board submits credentialing information to the authority or an entity that has entered into a contract with the authority under subsection (1)(b) of this section;
      (c) Processes, as required by recognized state and national credentialing standards, by which credentialing information submitted under section 4 of this 2013 Act is verified;
      (d) Processes by which a credentialing organization, health care practitioner or health care regulatory board may electronically access the database;
      (e) Processes by which a health care practitioner may attest that the credentialing information in the electronic database is current;
      (f) The purposes for which credentialing information accessed by a credentialing organization or health care regulatory board may be used; and
      (g) The imposition of fees, not to exceed the cost of administering sections 2 to 7 of this 2013 Act, on health care practitioners who submit credentialing information to the database and credentialing organizations that access the database.
      (3) All information, except for general information used for directories, as defined by the authority by rule, that is received, kept and maintained in the database under this section is exempt from public disclosure under ORS 192.410 to 192.505. [2013 c.603 §3]
      Sec. 4. (1)(a) As a condition of being authorized to practice a profession in this state, a health care practitioner or designee must submit to the Oregon Health Authority, an entity that has entered into a contract with the authority under section 3 (1)(b) of this 2013 Act or a health care regulatory board the credentialing information identified by the authority under section 3 (2)(a) of this 2013 Act.
      (b) A health care practitioner that, in good faith, submits credentialing information under this subsection is immune from civil liability that might otherwise be incurred or imposed with respect to the submission of that credentialing information.
      (2) The authority may require a health care regulatory board, after consulting with the health care regulatory board, to provide or supplement the credentialing information identified by the authority under section 3 (2)(a) of this 2013 Act.
      (3)(a) A credentialing organization shall obtain from the authority, or an entity that has entered into a contract with the authority under section 3 (1)(b) of this 2013 Act, the credentialing information of the health care practitioner that is kept and maintained in the electronic database described in section 3 of this 2013 Act. A credentialing organization may not request credentialing information from a health care practitioner if the credentialing information is available through the database. However, nothing in sections 2 to 7 of this 2013 Act shall prevent a credentialing organization from requesting additional credentialing information from a health care practitioner for the purpose of completing credentialing procedures for the health care practitioner used by the credentialing organization.
      (b) A credentialing organization that, in good faith, uses credentialing information provided under this subsection for the purposes established by the authority under section 3 (2)(e) of this 2013 Act is immune from civil liability that might otherwise be incurred or imposed with respect to the use of that credentialing information. [2013 c.603 §4]
      Sec. 5. A prepaid group practice health plan that serves at least 200,000 members in this state and that has been issued a certificate of authority by the Department of Consumer and Business Services may petition the Director of the Oregon Health Authority to be exempt from the requirements of sections 2 to 7 of this 2013 Act. The director may award the petition if the director determines that subjecting the health plan to sections 2 to 7 of this 2013 Act is not cost-effective. If a petition is awarded under this section, the exemption also applies to any health care facilities and health care provider groups associated with the health plan. [2013 c.603 §5]
      Sec. 6. The Director of the Oregon Health Authority shall adopt rules necessary for the administration of sections 2 to 7 of this 2013 Act. [2013 c.603 §6]
      Sec. 7. At least once per year, the Oregon Health Authority shall convene an advisory group consisting of individuals who represent credentialing organizations, health care practitioners and health care regulatory boards to review and advise the authority on the implementation of sections 2 to 7 of this 2013 Act and on the standard credentialing application used in this state. [2013 c.603 §7]
      Sec. 8. (1) To establish the electronic system described in section 3 of this 2013 Act, the Oregon Health Authority shall issue a request for information to seek input from potential contractors on capabilities and cost structures associated with the scope of work required to establish and maintain the electronic system. The authority shall use the results of the request for information to create a formal request for proposals. No later than 150 business days after the close of the request for information, the authority shall issue a formal request for proposals to establish and maintain the electronic system.
      (2) The authority may enter into a contract under section 3 (1)(b) of this 2013 Act with a private entity only if the private entity:
      (a) Can demonstrate appropriate technical, analytical and clinical knowledge and experience to carry out the duties prescribed by section 3 of this 2013 Act; or
      (b) Has a contract, or will enter into a contract, with another entity that meets the criteria described in this subsection. [2013 c.603 §8]
      Sec. 9. The Oregon Health Authority shall report on the implementation of the electronic system described in section 3 (1) of this 2013 Act and on the development of rules to be adopted under section 3 (2) of this 2013 Act to:
      (1) The interim committees of the Legislative Assembly related to health no later than October 1, 2014; and
      (2) The Legislative Assembly in the manner required by ORS 192.245:
      (a) On or before February 1, 2014; and
      (b) On or before February 1, 2015. [2013 c.603 §9]
      Sec. 10. Sections 8 and 9 of this 2013 Act are repealed on the date of the convening of the 2016 regular session of the Legislative Assembly as specified in ORS 171.010 [February 1, 2016]. [2013 c.603 §10]
      Sec. 11. (1) Sections 2 to 5 of this 2013 Act become operative on January 1, 2016.
      (2) The Oregon Health Authority may take any action necessary before the operative date specified in subsection (1) of this section to enable the authority to exercise, on and after the operative date specified in subsection (1) of this section, all the duties, functions and powers conferred on the authority by sections 2 to 5 of this 2013 Act. [2013 c.603 §11]
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Credentialing - Telemedicine Providers

      441.056 Credentialing telemedicine providers. (1) The Oregon Health Authority shall prescribe by rule the information and documents that a governing body of an originating-site hospital may request for credentialing a telemedicine provider located at a distant-site hospital.
      (2) The rules adopted by the authority under subsection (1) of this section must:
      (a) Prescribe a standard list of information and documents that shall be provided by a distant-site hospital;
      (b) Prescribe a list of information and documents that may be requested by an originating-site hospital in addition to the standard list of information and documents;
      (c) Prescribe a list of information and documents that may not be requested by an originating-site hospital; and
      (d) Be consistent with all applicable legal and accreditation requirements of an originating-site hospital and the health plans with which the originating-site hospital contracts.
      (3) Except as provided in subsection (4) of this section, an originating-site hospital in this state must comply with the rules adopted under this section if the telemedicine provider is located at a distant-site hospital that is located in this state. This section does not prevent hospitals located outside of this state from using or require such hospitals to use the prescribed list of information and documents in credentialing a telemedicine provider.
      (4) An originating-site hospital is not limited to the information and documents prescribed by the authority if the originating-site hospital has a delegated credentialing agreement with the distant-site hospital where the telemedicine provider is located and the governing body of the originating-site hospital accepts the recommendation of the medical staff to credential the telemedicine provider.
      (5) In the adoption of the rules described in subsections (1) and (2) of this section, the authority shall consult with representatives of distant-site hospitals and originating-site hospitals in this state. Once adopted, the authority may not amend the rules to alter the prescribed lists without first consulting representatives of distant-site hospitals and originating-site hospitals in this state.
      (6) This section does not affect the responsibilities of a governing body under ORS 441.055 and does not require a governing body of a hospital to grant privileges to a telemedicine provider. [2013 c.414 §2]
 
      Note: 441.056 was added to and made a part of ORS chapter 441 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
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Health Care Cost Review

ORS 442.400 to 442.463
 
     442.400 “Health care facility” defined. As used in ORS 442.400 to 442.463, unless the context requires otherwise, “health care facility” or “facility” means such facility as defined by ORS 442.015, exclusive of a long term care facility, and includes all publicly and privately owned and operated health care facilities, but does not include facilities described in ORS 441.065. [Formerly 441.415; 1979 c.697 §8; 1981 c.693 §15]
 
      442.405 Legislative findings and policy. The Legislative Assembly finds that rising costs and charges of health care facilities are a matter of vital concern to the people of this state. The Legislative Assembly finds and declares that it is the policy of this state:
      (1) To require health care facilities to file for public disclosure reports that will enable both private and public purchasers of services from such facilities to make informed decisions in purchasing such services; and
      (2) To encourage development of programs of research and innovation in the methods of delivery of institutional health care services of high quality with costs and charges reasonably related to the nature and quality of the services rendered. [Formerly 441.420; 1999 c.581 §3]
 
      442.410 [1977 c.751 §45; 1981 c.693 §16; 1983 c.482 §13; 1985 c.747 §38; 1995 c.727 §24; 1997 c.683 §20; repealed by 1999 c.581 §11]
 
      442.415 [1977 c.751 §46; 1983 c.482 §14; 1995 c.727 §25; 1997 c.683 §21; repealed by 1999 c.581 §11]
 
      442.420 Application for financial assistance; financial analysis and investigation authority; rules. (1) The Office for Oregon Health Policy and Research may apply for, receive and accept grants, gifts, payments and other funds and advances, appropriations, properties and services from the United States, the State of Oregon or any governmental body, agency or agencies or from any other public or private corporation or person, and enter into agreements with respect thereto, including the undertaking of studies, plans, demonstrations or projects.
      (2) The Administrator of the Office for Oregon Health Policy and Research shall conduct or cause to have conducted such analyses and studies relating to costs of health care facilities as considered desirable, including but not limited to methods of reducing such costs, utilization review of services of health care facilities, peer review, quality control, financial status of any facility subject to ORS 442.400 to 442.463 and sources of public and private financing of financial requirements of such facilities.
      (3) The administrator may also:
      (a) Hold public hearings, conduct investigations and require the filing of information relating to any matter affecting the costs of and charges for services in all health care facilities;
      (b) Subpoena witnesses, papers, records and documents the administrator considers material or relevant in connection with functions of the office subject to the provisions of ORS chapter 183;
      (c) Exercise, subject to the limitations and restrictions imposed by ORS 442.400 to 442.463, all other powers which are reasonably necessary or essential to carry out the express objectives and purposes of ORS 442.400 to 442.463; and
      (d) Adopt rules in accordance with ORS chapter 183 necessary in the administrator’s judgment for carrying out the functions of the office. [Formerly 441.435; 1981 c.693 §17; 1983 c.482 §15; 1985 c.747 §39; 1995 c.727 §26; 1997 c.683 §22; 1999 c.581 §4]
 
      442.425 Authority over reporting systems of facilities. (1) The Administrator of the Office for Oregon Health Policy and Research by rule may specify one or more uniform systems of financial reporting necessary to meet the requirements of ORS 442.400 to 442.463. Such systems shall include such cost allocation methods as may be prescribed and such records and reports of revenues, expenses, other income and other outlays, assets and liabilities, and units of service as may be prescribed. Each facility under the administrator’s jurisdiction shall adopt such systems for its fiscal period starting on or after the effective date of such system and shall make the required reports on such forms as may be required by the administrator. The administrator may extend the period by which compliance is required upon timely application and for good cause. Filings of such records and reports shall be made at such times as may be reasonably required by the administrator.
      (2) Existing systems of reporting used by health care facilities shall be given due consideration by the administrator in carrying out the duty of specifying the systems of reporting required by ORS 442.400 to 442.463. The administrator insofar as reasonably possible shall adopt reporting systems and requirements that will not unreasonably increase the administrative costs of the facility.
      (3) The administrator may allow and provide for modifications in the reporting systems in order to correctly reflect differences in the scope or type of services and financial structure between the various categories, sizes or types of health care facilities and in a manner consistent with the purposes of ORS 442.400 to 442.463.
      (4) The administrator may establish specific annual reporting provisions for facilities that receive a preponderance of their revenue from associated comprehensive group-practice prepayment health care service plans. Notwithstanding any other provisions of ORS 442.400 to 442.463, such facilities shall be authorized to utilize established accounting systems and to report costs and revenues in a manner consistent with the operating principles of such plans and with generally accepted accounting principles. When such facilities are operated as units of a coordinated group of health facilities under common ownership, the facilities shall be authorized to report as a group rather than as individual institutions, and as a group shall submit a consolidated balance sheet, income and expense statement and statement of source and application of funds for such group of health facilities. [Formerly 441.440; 1981 c.693 §18; 1995 c.727 §27; 1997 c.683 §23; 1999 c.581 §5; 2009 c.792 §40]
 
      442.430 Investigations; confidentiality of data.  (1) Whenever a further investigation is considered necessary or desirable by the Office for Oregon Health Policy and Research to verify the accuracy of the information in the reports made by health care facilities, the office may make any necessary further examination of the facility’s records and accounts. Such further examinations include, but are not limited to, requiring a full or partial audit of all such records and accounts.
      (2) In carrying out the duties prescribed by ORS 442.400 to 442.463, the office may utilize its own staff or may contract with any appropriate, independent, qualified third party. No such contractor shall release or publish or otherwise use any information made available to it under its contractual responsibility unless such permission is specifically granted by the office. [Formerly 441.445; 1995 c.727 §28; 1997 c.683 §24; 2009 c.792 §41]
 
      442.435 [Formerly 441.460; 1983 c.482 §16; 1987 c.660 §27; 1995 c.727 §29; 1997 c.683 §25; repealed by 1999 c.581 §11]
 
      442.440 [Formerly 441.465; 1983 c.482 §17; 1983 c.740 §161; repealed by 1987 c.660 §40]
 
      442.442 [1979 c.697 §10; repealed by 1981 c.693 §31] 
  
      442.445 Civil penalty for failure to perform. (1) Any health care facility that fails to perform as required in ORS 442.205 and 442.400 to 442.463 or section 3, chapter 838, Oregon Laws 2007, and rules of the Oregon Health Authority may be subject to a civil penalty.
      (2) The Oregon Health Authority shall adopt a schedule of penalties not to exceed $500 per day of violation, determined by the severity of the violation.
      (3) Civil penalties under this section shall be imposed as provided in ORS 183.745.
      (4) Civil penalties imposed under this section may be remitted or mitigated upon such terms and conditions as the authority considers proper and consistent with the public health and safety.
      (5) Civil penalties incurred under any law of this state are not allowable as costs for the purpose of rate determination or for reimbursement by a third-party payer. [Formerly 441.480; 1981 c.693 §19; 1983 c.482 §18; 1983 c.696 §21; 1991 c.734 §24; 1993 c.18 §110; 1995 c.727 §30; 1997 c.683 §26; 1999 c.581 §6; 2007 c.384 §4; 2007 c.838 §7; 2013 c.61 §2b]
 
      Note: The amendments to 442.445 by section 8, chapter 838, Oregon Laws 2007, become operative January 2, 2018. See section 9, chapter 838, Oregon Laws 2007. The text that is operative on and after January 2, 2018, including amendments by section 2c, chapter 61, Oregon Laws 2013, is set forth for the user’s convenience.
      442.445. (1) Any health care facility that fails to perform as required in ORS 442.205 and 442.400 to 442.463 and rules of the Oregon Health Authority may be subject to a civil penalty.
      (2) The Oregon Health Authority shall adopt a schedule of penalties not to exceed $500 per day of violation, determined by the severity of the violation.
      (3) Civil penalties under this section shall be imposed as provided in ORS 183.745.
      (4) Civil penalties imposed under this section may be remitted or mitigated upon such terms and conditions as the authority considers proper and consistent with the public health and safety.
      (5) Civil penalties incurred under any law of this state are not allowable as costs for the purpose of rate determination or for reimbursement by a third-party payer.
  
      442.450 Exemption from cost review regulations. The following are not subject to ORS 442.400 to 442.463:
      (1) Physicians in private practice, solo or in a group or partnership, who are not employed by, or hold ownership or part ownership in, a health care facility; or
      (2) Health care facilities described in ORS 441.065. [1977 c.751 §55]
 
      442.460 Information about utilization and cost of health care services. In order to obtain regional or statewide data about the utilization and cost of health care services, the Office for Oregon Health Policy and Research may accept information relating to the utilization and cost of health care services identified by the Administrator of the Office for Oregon Health Policy and Research from physicians, insurers or other third-party payers or employers or other purchasers of health care. [1985 c.747 §15; 1995 c.727 §31; 1997 c.683 §27; 1999 c.581 §7]
 
      442.463 Annual utilization report; contents; approval; rules. (1) Each licensed health facility shall file with the Office for Oregon Health Policy and Research an annual report containing such information related to the facility’s utilization as may be required by the Administrator of the Office for Oregon Health Policy and Research, in such form as the administrator prescribes by rule.
      (2) The annual report shall contain such information as may be required by rule of the administrator and must be approved by the administrator. [1985 c.747 §§18,19; 1995 c.727 §32; 1997 c.683 §28; 1999 c.581 §8]
     
Cited from:  http://www.oregonlegislature.gov/bills_laws/lawsstatutes/2013ors442.html
 

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Health Care Data Reporting

ORS 442.464, 442.466, 442.993
 
     442.464 Definitions for ORS 442.464 and 442.466. As used in this section and ORS 442.466, “reporting entity” means:
      (1) An insurer as defined in ORS 731.106 or fraternal benefit society as described in ORS 748.106 required to have a certificate of authority to transact health insurance business in this state.
      (2) A health care service contractor as defined in ORS 750.005 that issues medical insurance in this state.
      (3) A third party administrator required to obtain a license under ORS 744.702.
      (4) A pharmacy benefit manager or fiscal intermediary, or other person that is by statute, contract or agreement legally responsible for payment of a claim for a health care item or service.
      (5) A coordinated care organization as defined in ORS 414.025.
      (6) An insurer providing coverage funded under Part A, Part B or Part D of Title XVIII of the Social Security Act, subject to approval by the United States Department of Health and Human Services. [2009 c.595 §1200; 2011 c.602 §54]
 
      Note: 442.464 to 442.468 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 442 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
          442.466 Health care data reporting by health insurers. (1) The Administrator of the Office for Oregon Health Policy and Research shall establish and maintain a program that requires reporting entities to report health care data for the following purposes:
      (a) Determining the maximum capacity and distribution of existing resources allocated to health care.
      (b) Identifying the demands for health care.
      (c) Allowing health care policymakers to make informed choices.
      (d) Evaluating the effectiveness of intervention programs in improving health outcomes.
      (e) Comparing the costs and effectiveness of various treatment settings and approaches.
      (f) Providing information to consumers and purchasers of health care.
      (g) Improving the quality and affordability of health care and health care coverage.
      (h) Assisting the administrator in furthering the health policies expressed by the Legislative Assembly in ORS 442.025.
      (i) Evaluating health disparities, including but not limited to disparities related to race and ethnicity.
      (2) The Administrator of the Office for Oregon Health Policy and Research shall prescribe by rule standards that are consistent with standards adopted by the Accredited Standards Committee X12 of the American National Standards Institute, the Centers for Medicare and Medicaid Services and the National Council for Prescription Drug Programs that:
      (a) Establish the time, place, form and manner of reporting data under this section, including but not limited to:
      (A) Requiring the use of unique patient and provider identifiers;
      (B) Specifying a uniform coding system that reflects all health care utilization and costs for health care services provided to Oregon residents in other states; and
      (C) Establishing enrollment thresholds below which reporting will not be required.
      (b) Establish the types of data to be reported under this section, including but not limited to:
      (A) Health care claims and enrollment data used by reporting entities and paid health care claims data;
      (B) Reports, schedules, statistics or other data relating to health care costs, prices, quality, utilization or resources determined by the administrator to be necessary to carry out the purposes of this section; and
      (C) Data related to race, ethnicity and primary language collected in a manner consistent with established national standards.
      (3) Any third party administrator that is not required to obtain a license under ORS 744.702 and that is legally responsible for payment of a claim for a health care item or service provided to an Oregon resident may report to the Administrator of the Office for Oregon Health Policy and Research the health care data described in subsection (2) of this section.
      (4) The Administrator of the Office for Oregon Health Policy and Research shall adopt rules establishing requirements for reporting entities to train providers on protocols for collecting race, ethnicity and primary language data in a culturally competent manner.
      (5) The Administrator of the Office for Oregon Health Policy and Research shall use data collected under this section to provide information to consumers of health care to empower the consumers to make economically sound and medically appropriate decisions. The information must include, but not be limited to, the prices and quality of health care services.
      (6) The Administrator of the Office for Oregon Health Policy and Research may contract with a third party to collect and process the health care data reported under this section. The contract must prohibit the collection of Social Security numbers and must prohibit the disclosure or use of the data for any purpose other than those specifically authorized by the contract. The contract must require the third party to transmit all data collected and processed under the contract to the Office for Oregon Health Policy and Research.
      (7) The Administrator of the Office for Oregon Health Policy and Research shall facilitate a collaboration between the Department of Human Services, the Oregon Health Authority, the Department of Consumer and Business Services and interested stakeholders to develop a comprehensive health care information system using the data reported under this section and collected by the office under ORS 442.120 and 442.400 to 442.463. The administrator, in consultation with interested stakeholders, shall:
      (a) Formulate the data sets that will be included in the system;
      (b) Establish the criteria and procedures for the development of limited use data sets;
      (c) Establish the criteria and procedures to ensure that limited use data sets are accessible and compliant with federal and state privacy laws; and
      (d) Establish a time frame for the creation of the comprehensive health care information system.
      (8) Information disclosed through the comprehensive health care information system described in subsection (7) of this section:
      (a) Shall be available, when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal laws, as a resource to insurers, employers, providers, purchasers of health care and state agencies to allow for continuous review of health care utilization, expenditures and performance in this state;
      (b) Shall be available to Oregon programs for quality in health care for use in improving health care in Oregon, subject to rules prescribed by the Administrator of the Office for Oregon Health Policy and Research conforming to state and federal privacy laws or limiting access to limited use data sets;
      (c) Shall be presented to allow for comparisons of geographic, demographic and economic factors and institutional size; and
      (d) May not disclose trade secrets of reporting entities.
      (9) The collection, storage and release of health care data and other information under this section is subject to the requirements of the federal Health Insurance Portability and Accountability Act. [2009 c.595 §1201]
 
      Note: See note under 442.464.
 
      442.993 Civil penalties for failure to report health care data of health insurers. (1) Any reporting entity that fails to report as required in ORS 442.466 or rules of the Office for Oregon Health Policy and Research adopted pursuant to ORS 442.466 may be subject to a civil penalty.
      (2) The Administrator of the Office for Oregon Health Policy and Research shall adopt a schedule of penalties not to exceed $500 per day of violation, determined by the severity of the violation.
      (3) Civil penalties under this section shall be imposed as provided in ORS 183.745.
      (4) Civil penalties imposed under this section may be remitted or mitigated upon such terms and conditions as the administrator considers proper and consistent with the public health and safety.
      (5) Civil penalties incurred under any law of this state are not allowable as costs for the purpose of rate determination or for reimbursement by a third-party payer. [2009 c.595 §1202]
 
      Note: 442.993 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 442 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.

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Health Care Workforce Database

ORS 442.468, 676.410 
  
   442.468 Health care workforce data reporting. (1) Using data collected from all health care professional licensing boards, including but not limited to boards that license or certify chemical dependency and mental health treatment providers and other sources, the Office for Oregon Health Policy and Research shall create and maintain a healthcare workforce database that will provide information upon request to state agencies and to the Legislative Assembly about Oregon’s healthcare workforce, including:
      (a) Demographics, including race and ethnicity.
      (b) Practice status.
      (c) Education and training background.
      (d) Population growth.
      (e) Economic indicators.
      (f) Incentives to attract qualified individuals, especially those from underrepresented minority groups, to healthcare education.
      (2) The Administrator for the Office for Oregon Health Policy and Research may contract with a private or public entity to establish and maintain the database and to analyze the data. The office is not subject to the requirements of ORS chapters 279A, 279B and 279C with respect to the contract. [2009 c.595 §1174; 2011 c.602 §30]
 
      Note: See note under 442.464.
 
  676.410 Information required for issuance or renewal of certain licenses; confidentiality; fees. (1) As used in this section, “healthcare workforce regulatory board” means the:
      (a) Occupational Therapy Licensing Board;
      (b) Oregon Medical Board;
      (c) Oregon State Board of Nursing;
      (d) Oregon Board of Dentistry;
      (e) Physical Therapist Licensing Board;
      (f) State Board of Pharmacy; and
      (g) Board of Examiners of Licensed Dietitians.
      (2)(a) An applicant for a license from a healthcare workforce regulatory board or renewal of a license by a healthcare workforce regulatory board shall provide the information prescribed by the Office for Oregon Health Policy and Research pursuant to subsection (3) of this section.
      (b) Except as provided in subsection (4) of this section, a healthcare workforce regulatory board may not approve a subsequent application for a license or renewal of a license until the applicant provides the information.
      (3) The Administrator for the Office for Oregon Health Policy and Research shall collaborate with the healthcare workforce regulatory boards to adopt rules for the manner, form and content for reporting, and the information that must be provided to a healthcare workforce regulatory board under subsection (2) of this section, which may include:
      (a) Demographics, including race and ethnicity.
      (b) Education information.
      (c) License information.
      (d) Employment information.
      (e) Primary and secondary practice information.
      (f) Anticipated changes in the practice.
      (g) Languages spoken.
      (4)(a) A healthcare workforce regulatory board shall report healthcare workforce information collected under subsection (2) of this section to the Office for Oregon Health Policy and Research.
      (b) A healthcare workforce regulatory board shall keep confidential and not release personally identifiable data collected under this section for a person licensed, registered or certified by a board. This paragraph does not apply to the release of information to a law enforcement agency for investigative purposes or to the release to the Office for Oregon Health Policy and Research for state health planning purposes.
      (5) The requirements of subsection (2) of this section apply to an applicant for issuance or renewal of a license who is or who is applying to become:
      (a) An occupational therapist or certified occupational therapy assistant as defined in ORS 675.210;
      (b) A physician as defined in ORS 677.010;
      (c) A physician assistant as defined in ORS 677.495;
      (d) A nurse or nursing assistant licensed or certified under ORS 678.010 to 678.410;
      (e) A dentist or dental hygienist as defined in ORS 679.010;
      (f) A physical therapist or physical therapist assistant as defined in ORS 688.010;
      (g) A pharmacist or pharmacy technician as defined in ORS 689.005; or
      (h) A licensed dietitian, as defined in ORS 691.405.
      (6) A healthcare workforce regulatory board may adopt rules as necessary to perform the board’s duties under this section.
      (7) In addition to licensing fees that may be imposed by a healthcare workforce regulatory board, the Oregon Health Policy Board shall establish fees to be paid by applicants for issuance or renewal of licenses reasonably calculated to reimburse the actual cost of obtaining or reporting information as required by subsection (2) of this section. [2009 c.595 §1175] 
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Health Evidence Review Commission (HERC)

ORS 414.688 to 414.704
     
      414.688 Commission established; membership. (1) As used in this section:
      (a) “Practice of pharmacy” has the meaning given that term in ORS 689.005.
      (b) “Retail drug outlet” has the meaning given that term in ORS 689.005.
      (2) The Health Evidence Review Commission is established in the Oregon Health Authority, consisting of 13 members appointed by the Governor in consultation with professional and other interested organizations, and confirmed by the Senate, as follows:
      (a) Five members must be physicians licensed to practice medicine in this state who have clinical expertise in the areas of family medicine, internal medicine, obstetrics, perinatal health, pediatrics, disabilities, geriatrics or general surgery. One of the physicians must be a doctor of osteopathy, and one must be a hospital representative or a physician whose practice is significantly hospital-based.
      (b) One member must be a dentist licensed under ORS chapter 679 who has clinical expertise in general, pediatric or public health dentistry.
      (c) One member must be a public health nurse.
      (d) One member must be a behavioral health representative who may be a social services worker, alcohol and drug treatment provider, psychologist or psychiatrist.
      (e) Two members must be consumers of health care who are patient advocates or represent the areas of indigent services, labor, business, education or corrections.
      (f) One member must be a complementary or alternative medicine provider who is a chiropractic physician licensed under ORS chapter 684, a naturopathic physician licensed under ORS chapter 685 or an acupuncturist licensed under ORS chapter 677.
      (g) One member must be an insurance industry representative who may be a medical director or other administrator.
      (h) One member must be a pharmacy representative who engages in the practice of pharmacy at a retail drug outlet.
      (3) No more than six members of the commission may be physicians either in active practice or retired from practice.
      (4) Members of the commission serve for a term of four years at the pleasure of the Governor. A member is eligible for reappointment.
      (5) Members are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for in ORS 292.495. Claims for expenses shall be paid out of funds available to the Oregon Health Authority for purposes of the commission. [2011 c.720 §22]
 
      Note: 414.688 to 414.750 and 414.631 and 414.651 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
      414.689 Members; meetings. (1) The Health Evidence Review Commission shall select one of its members as chairperson and another as vice chairperson, for terms and with duties and powers the commission determines necessary for the performance of the functions of the offices.
      (2) A majority of the members of the commission constitutes a quorum for the transaction of business.
      (3) The commission shall meet at least four times per year at a place, day and hour determined by the chairperson. The commission also shall meet at other times and places specified by the call of the chairperson or of a majority of the members of the commission.
      (4) The commission may use advisory committees or subcommittees whose members are appointed by the chairperson of the commission subject to approval by a majority of the members of the commission. The advisory committees or subcommittees may contain experts appointed by the chairperson and a majority of the members of the commission. The conditions of service of the experts will be determined by the chairperson and a majority of the members of the commission.
      (5) The Office for Oregon Health Policy and Research shall provide staff and support services to the commission. [2011 c.720 §23]
 
      Note: See note under 414.688. 
      414.690 Prioritized list of health services. (1) The Health Evidence Review Commission shall regularly solicit testimony and information from stakeholders representing consumers, advocates, providers, carriers and employers in conducting the work of the commission.
      (2) The commission shall actively solicit public involvement through a public meeting process to guide health resource allocation decisions.
      (3) The commission shall develop and maintain a list of health services ranked by priority, from the most important to the least important, representing the comparative benefits of each service to the population to be served. The list must be submitted by the commission pursuant to subsection (5) of this section and is not subject to alteration by any other state agency.
      (4) In order to encourage effective and efficient medical evaluation and treatment, the commission:
      (a) May include clinical practice guidelines in its prioritized list of services. The commission shall actively solicit testimony and information from the medical community and the public to build a consensus on clinical practice guidelines developed by the commission.
      (b) May include statements of intent in its prioritized list of services. Statements of intent should give direction on coverage decisions where medical codes and clinical practice guidelines cannot convey the intent of the commission.
      (c) Shall consider both the clinical effectiveness and cost-effectiveness of health services, including drug therapies, in determining their relative importance using peer-reviewed medical literature as defined in ORS 743A.060.
      (5) The commission shall report the prioritized list of services to the Oregon Health Authority for budget determinations by July 1 of each even-numbered year.
      (6) The commission shall make its report during each regular session of the Legislative Assembly and shall submit a copy of its report to the Governor, the Speaker of the House of Representatives and the President of the Senate.
      (7) The commission may alter the list during the interim only as follows:
      (a) To make technical changes to correct errors and omissions;
      (b) To accommodate changes due to advancements in medical technology or new data regarding health outcomes;
      (c) To accommodate changes to clinical practice guidelines; and
      (d) To add statements of intent that clarify the prioritized list.
      (8) If a service is deleted or added during an interim and no new funding is required, the commission shall report to the Speaker of the House of Representatives and the President of the Senate. However, if a service to be added requires increased funding to avoid discontinuing another service, the commission shall report to the Emergency Board to request the funding.
      (9) The prioritized list of services remains in effect for a two-year period beginning no earlier than October 1 of each odd-numbered year. [2011 c.720 §24]
 
      Note: Section 6, chapter 771, Oregon Laws 2013, provides:
      Sec. 6. Not later than August 30, 2013, the Health Evidence Review Commission shall begin the process of evaluating applied behavior analysis, as defined in section 2 of this 2013 Act, as a treatment for autism spectrum disorder, as defined in section 2 of this 2013 Act, for the purpose of updating the list of health services recommended under ORS 414.690. Any adjustments to the list of health services that result from the evaluation process must be implemented not later than:
      (1) October 1, 2014, if the adjustments do not require the development of new medical coding; and
      (2) April 1, 2015, if the adjustments require the development or adoption of new medical coding. [2013 c.771 §6]
 
      414.695 Medical technology assessment. (1) As used in this section and ORS 414.698:
      (a) “Medical technology” means medical equipment and devices, medical or surgical procedures and techniques used by health care providers in delivering medical care to individuals, and the organizational or supportive systems within which medical care is delivered.
      (b) “Medical technology assessment” means evaluation of the use, clinical effectiveness and cost of a technology in comparison with its alternatives.
      (2) The Health Evidence Review Commission shall develop a medical technology assessment process. The Oregon Health Authority shall direct the commission with regard to medical technologies to be assessed and the timing of the assessments.
      (3) The commission shall appoint and work with an advisory committee whose members have the appropriate expertise to conduct a medical technology assessment.
      (4) The commission shall present its preliminary findings at a public hearing and shall solicit testimony and information from health care consumers. The commission shall give strong consideration to the recommendations of the advisory committee and public testimony in developing its assessment.
      (5) To ensure that confidentiality is maintained, identification of a patient or a person licensed to provide health services may not be included with the data submitted under this section, and the commission shall release such data only in aggregate statistical form. All findings and conclusions, interviews, reports, studies, communications and statements procured by or furnished to the commission in connection with obtaining the data necessary to perform its functions is confidential pursuant to ORS 192.501 to 192.505. [2011 c.720 §25]
 
      Note: 414.695 to 414.701 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
      414.698 Comparative effectiveness of medical technologies. (1) The Health Evidence Review Commission shall conduct comparative effectiveness research of medical technologies selected in accordance with ORS 414.695. The commission may conduct the research by comprehensive review of the comparative effectiveness research undertaken by recognized state, national or international entities. The commission may consider evidence relating to prescription drugs that is relevant to a medical technology assessment but may not conduct a drug class evidence review or medical technology assessment solely of a prescription drug. The commission shall disseminate the research findings to health care consumers, providers and third-party payers and to other interested stakeholders.
      (2) The commission shall develop or identify and shall disseminate evidence-based health care guidelines for use by providers, consumers and purchasers of health care in Oregon.
      (3) The Oregon Health Authority shall vigorously pursue health care purchasing strategies that adopt the research findings described in subsection (1) of this section and the evidence-based health care guidelines described in subsection (2) of this section. [2011 c.720 §26]
 
      Note: See note under 414.695.
 
      414.701 Commission may not rely solely on comparative effectiveness research. The Health Evidence Review Commission, in ranking health services or developing guidelines under ORS 414.690 or in assessing medical technologies under ORS 414.698, and the Pharmacy and Therapeutics Committee, in considering a recommendation for a drug to be included on any preferred drug list or on the Practitioner-Managed Prescription Drug Plan, may not rely solely on the results of comparative effectiveness research. [2011 c.720 §26a]
 
      Note: See note under 414.695.
 
      414.704 Advisory committee. The Health Evidence Review Commission shall consult with an advisory committee in determining priorities for mental health care and chemical dependency. The advisory committee shall include mental health and chemical dependency professionals who provide inpatient and outpatient mental health and chemical dependency care. [Formerly 414.730]
 
      Note: See note under 414.688. 
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Medicaid Advisory Committee (MAC)

ORS 414.211 to 414.227
 
      414.211 Medicaid Advisory Committee.
      (1) There is established a Medicaid Advisory Committee consisting of not more than 15 members appointed by the Governor.
      (2) The committee shall be composed of:
      (a) A physician licensed under ORS chapter 677;
      (b) Two members of health care consumer groups that include Medicaid recipients;
      (c) Two Medicaid recipients, one of whom shall be a person with a disability;
      (d) The Director of the Oregon Health Authority or designee;
      (e) The Director of Human Services or designee;
      (f) Health care providers;
      (g) Persons associated with health care organizations, including but not limited to coordinated care organizations under contract to the Medicaid program; and
      (h) Members of the general public.
      (3) In making appointments, the Governor shall consult with appropriate professional and other interested organizations. All members appointed to the committee shall be familiar with the medical needs of low income persons.
      (4) The term of office for each member shall be two years, but each member shall serve at the pleasure of the Governor.
      (5) Members of the committee shall receive no compensation for their services but, subject to any applicable state law, shall be allowed actual and necessary travel expenses incurred in the performance of their duties from the Oregon Health Authority Fund. [1995 c.727 §43; 2007 c.70 §192; 2009 c.595 §287; 2011 c.602 §37; 2011 c.720 §132]
 
      Note: 414.211 and 414.221 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
      414.215 [1967 c.502 §19; 1991 c.66 §21; repealed by 1995 c.727 §48]
 
      414.220 [1957 c.692 §2; repealed by 1963 c.631 §2]
 
      414.221 Duties of committee. The Medicaid Advisory Committee shall advise the Director of the Oregon Health Authority and the Director of Human Services on:
      (1) Medical care, including mental health and alcohol and drug treatment and remedial care to be provided under ORS chapter 414; and
      (2) The operation and administration of programs provided under ORS chapter 414. [1995 c.727 §44; 2003 c.784 §7; 2007 c.697 §16; 2009 c.595 §288; 2011 c.720 §133]
 
      Note: See note under 414.211.
 
      414.225 Oregon Health Authority to consult with committee. The Oregon Health Authority shall consult with the Medicaid Advisory Committee concerning the determinations required under ORS 414.065. [1967 c.502 §20; 1991 c.66 §22; 1995 c.727 §46; 2003 c.784 §8; 2009 c.595 §289]
 
      414.227 Application of public meetings law to advisory committees. (1) ORS 192.610 to 192.690 apply to any meeting of an advisory committee with the authority to make decisions for, conduct policy research for or make recommendations to the Oregon Health Authority, the Oregon Health Policy Board or the Department of Human Services on administration or policy related to the medical assistance program operated under this chapter.
      (2) Subsection (1) of this section applies only to advisory committee meetings attended by two or more advisory committee members who are not employed by a public body. [2001 c.353 §2; 2009 c.595 §290; 2011 c.720 §134]
 

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Pain Management Commission (PMC)

ORS 413.570 to 413.599
 
      413.570 Pain Management Commission; duties; staffing. (1) The Pain Management Commission is established within the Oregon Health Authority. The commission shall:
      (a) Develop pain management recommendations;
      (b) Develop ways to improve pain management services through research, policy analysis and model projects; and
      (c) Represent the concerns of patients in Oregon on issues of pain management to the Governor and the Legislative Assembly.
      (2) The pain management coordinator of the authority shall serve as staff to the commission. [Formerly 409.500]
 
      Note: 413.570 to 413.599 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 413 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
 
      413.572 Additional duties of commission. (1) The Pain Management Commission shall:
      (a) Develop a pain management education program curriculum and update it biennially.
      (b) Provide health professional regulatory boards and other health boards, committees or task forces with the curriculum.
      (c) Work with health professional regulatory boards and other health boards, committees or task forces to develop approved pain management education programs as required.
      (d) Review the pain management curricula of educational institutions in this state that provide post-secondary education or training for persons required by ORS 413.590 to complete a pain management education program. The commission shall make recommendations about legislation needed to ensure that adequate information about pain management is included in the curricula reviewed and shall report its findings to the Legislative Assembly in the manner required by ORS 192.245 by January 1 of each odd-numbered year.
      (2) As used in this section, “educational institution” has the meaning given that term in ORS 348.105. [Formerly 409.510]
 
      Note: See note under 413.570.
 
      413.574 Membership of commission. (1) The Pain Management Commission shall consist of 19 members as follows:
      (a) Seventeen members shall be appointed by the Director of the Oregon Health Authority. Prior to making appointments, the director shall request and consider recommendations from individuals and public and private agencies and organizations with experience or a demonstrated interest in pain management issues, including but not limited to:
      (A) Physicians licensed under ORS chapter 677 or organizations representing physicians;
      (B) Nurses licensed under ORS chapter 678 or organizations representing nurses;
      (C) Psychologists licensed under ORS 675.010 to 675.150 or organizations representing psychologists;
      (D) Physician assistants licensed under ORS chapter 677 or organizations representing physician assistants;
      (E) Chiropractic physicians licensed under ORS chapter 684 or organizations representing chiropractic physicians;
      (F) Naturopaths licensed under ORS chapter 685 or organizations representing naturopaths;
      (G) Clinical social workers licensed under ORS 675.530 or organizations representing clinical social workers;
      (H) Acupuncturists licensed under ORS 677.759;
      (I) Pharmacists licensed under ORS chapter 689;
      (J) Palliative care professionals or organizations representing palliative care professionals;
      (K) Mental health professionals or organizations representing mental health professionals;
      (L) Health care consumers or organizations representing health care consumers;
      (M) Hospitals and health plans or organizations representing hospitals and health plans;
      (N) Patients or advocacy groups representing patients;
      (O) Dentists licensed under ORS chapter 679;
      (P) Occupational therapists licensed under ORS 675.210 to 675.340;
      (Q) Physical therapists licensed under ORS 688.010 to 688.201; and
      (R) Members of the public.
      (b) Two members shall be members of a legislative committee with jurisdiction over human services issues, one appointed by the President of the Senate and one appointed by the Speaker of the House of Representatives. Both members shall be nonvoting, ex officio members of the commission.
      (2) The term of office of each member is four years, but a member serves at the pleasure of the appointing authority. Before the expiration of the term of a member, the appointing authority shall appoint a successor whose term begins on July 1 next following. A member is eligible for reappointment. If there is a vacancy for any cause, the appointing authority shall make an appointment to become immediately effective for the unexpired term.
      (3) Members of the commission are not entitled to compensation or reimbursement for expenses and serve as volunteers on the commission. [Formerly 409.520]
 
      Note: See note under 413.570.
 
      413.576 Selection of chairperson and vice chairperson; requirements for commission meetings. (1) The Director of the Oregon Health Authority shall select one member of the Pain Management Commission as chairperson and another as vice chairperson, for such terms and with duties and powers necessary for the performance of the functions of such offices as the director determines.
      (2) A majority of the voting members of the commission constitutes a quorum for the transaction of business.
      (3) The commission shall meet at least once every six months at a place, day and hour determined by the director. The commission also shall meet at other times and places specified by the call of the chairperson or of a majority of the members of the commission. [Formerly 409.530]
 
      Note: See note under 413.570.
 
      413.580 Pain Management Fund. There is established the Pain Management Fund in the Oregon Health Authority Fund established under ORS 413.101. All moneys credited to the Pain Management Fund are continuously appropriated for the purposes of ORS 413.570 to 413.599 to be expended by the Pain Management Commission established under ORS 413.570. [Formerly 409.540]
 
      Note: See note under 413.570.
 
      413.582 Acceptance of contributions. The Pain Management Commission may accept contributions of funds and assistance from the United States Government or its agencies or from any other source, public or private, and agree to conditions thereon not inconsistent with the purposes of the commission. All such funds shall be deposited in the Pain Management Fund established in ORS 413.580 to aid in financing the duties, functions and powers of the commission. [Formerly 409.550]
 
      Note: See note under 413.570.
 
      413.590 Pain management education required of certain licensed health care professionals; duties of Oregon Medical Board; rules. (1) A physician assistant licensed under ORS chapter 677, a nurse licensed under ORS chapter 678, a psychologist licensed under ORS 675.010 to 675.150, a chiropractic physician licensed under ORS chapter 684, a naturopath licensed under ORS chapter 685, an acupuncturist licensed under ORS 677.759, a pharmacist licensed under ORS chapter 689, a dentist licensed under ORS chapter 679, an occupational therapist licensed under ORS 675.210 to 675.340 and a physical therapist licensed under ORS 688.010 to 688.201 must complete one pain management education program described under ORS 413.572.
      (2) The Oregon Medical Board, in consultation with the Pain Management Commission, shall identify by rule physicians licensed under ORS chapter 677 who, on an ongoing basis, treat patients in chronic or terminal pain and who must complete one pain management education program established under ORS 413.572. The board may identify by rule circumstances under which the requirement under this section may be waived. [Formerly 409.560]
 
      Note: See note under 413.570.
 
      413.592 Completion of pain management education program. A person required to complete one pain management education program established under ORS 413.572 shall complete the program:
      (1) Within 24 months of January 2, 2006;
      (2) Within 24 months of the first renewal of the person’s license after January 2, 2006; or
      (3) For a physician assistant for whom an application under ORS 677.510 has been approved before January 2, 2006, within 24 months after January 2, 2006. [Formerly 409.565]
 
      Note: See note under 413.570.
 
      413.599 Rules. In accordance with applicable provisions of ORS chapter 183, the Pain Management Commission may adopt rules necessary to implement ORS 413.570 to 413.599. [Formerly 409.570]
 
      Note: See note under 413.570.

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Patient Centered Primary Care Home Program

ORS 442.210, 414.655
  
      442.210 Patient centered primary care home program. (1) There is established in the Office for Oregon Health Policy and Research the patient centered primary care home program. Through this program, the office shall:
      (a) Define core attributes of the patient centered primary care home to promote a reasonable level of consistency of services provided by patient centered primary care homes in this state. In defining core attributes related to ensuring that care is coordinated, the office shall focus on determining whether these patient centered primary care homes offer comprehensive primary care, including prevention and disease management services;
      (b) Establish a simple and uniform process to identify patient centered primary care homes that meet the core attributes defined by the office under paragraph (a) of this subsection;
      (c) Develop uniform quality measures that build from nationally accepted measures and allow for standard measurement of patient centered primary care home performance;
      (d) Develop uniform quality measures for acute care hospital and ambulatory services that align with the patient centered primary care home quality measures developed under paragraph (c) of this subsection; and
      (e) Develop policies that encourage the retention of, and the growth in the numbers of, primary care providers.
      (2)(a) The Director of the Oregon Health Authority shall appoint an advisory committee to advise the office in carrying out subsection (1) of this section.
      (b) The director shall appoint to the advisory committee 15 individuals who represent a diverse constituency and are knowledgeable about patient centered primary care home delivery systems and health care quality.
      (c) Members of the advisory committee are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for in ORS 292.495. Claims for expenses shall be paid out of funds appropriated to the office for the purposes of the advisory committee.
      (d) The advisory committee shall use public input to guide policy development.
      (3) The office will also establish, as part of the patient centered primary care home program, a learning collaborative in which state agencies, private health insurance carriers, third party administrators and patient centered primary care homes can:
      (a) Share information about quality improvement;
      (b) Share best practices that increase access to culturally competent and linguistically appropriate care;
      (c) Share best practices that increase the adoption and use of the latest techniques in effective and cost-effective patient centered care;
      (d) Coordinate efforts to develop and test methods to align financial incentives to support patient centered primary care homes;
      (e) Share best practices for maximizing the utilization of patient centered primary care homes by individuals enrolled in medical assistance programs, including culturally specific and targeted outreach and direct assistance with applications to adults and children of racial, ethnic and language minority communities and other underserved populations;
      (f) Coordinate efforts to conduct research on patient centered primary care homes and evaluate strategies to implement the patient centered primary care home to improve health status and quality and reduce overall health care costs; and
      (g) Share best practices for maximizing integration to ensure that patients have access to comprehensive primary care, including preventative and disease management services.
      (4) The Legislative Assembly declares that collaboration among public payers, private health carriers, third party purchasers and providers to identify appropriate reimbursement methods to align incentives in support of patient centered primary care homes is in the best interest of the public. The Legislative Assembly therefore declares its intent to exempt from state antitrust laws, and to provide immunity from federal antitrust laws, the collaborative and associated payment reforms designed and implemented under subsection (3) of this section that might otherwise be constrained by such laws. The Legislative Assembly does not authorize any person or entity to engage in activities or to conspire to engage in activities that would constitute per se violations of state or federal antitrust laws including, but not limited to, agreements among competing health care providers or health carriers as to the prices of specific levels of reimbursement for health care services.
      (5) The office may contract with a public or private entity to facilitate the work of the learning collaborative described in subsection (3) of this section and may apply for, receive and accept grants, gifts, payments and other funds and advances, appropriations, properties and services from the United States, the State of Oregon or any governmental body or agency or from any other public or private corporation or person for the purpose of establishing and maintaining the collaborative. [2009 c.595 §1163] 
  
      Note: 442.210 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 442 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation. 

 

       414.655 Patient centered primary care homes in coordinated care organizations. (1) The Oregon Health Authority shall establish standards for the utilization of patient centered primary care homes in coordinated care organizations.
      (2) Each coordinated care organization shall implement, to the maximum extent feasible, patient centered primary care homes, including developing capacity for services in settings that are accessible to families, diverse communities and underserved populations. The organization shall require its other health and services providers to communicate and coordinate care with the patient centered primary care home in a timely manner using electronic health information technology.
      (3) Standards established by the authority for the utilization of patient centered primary care homes by coordinated care organizations may require the use of federally qualified health centers, rural health clinics, school-based health clinics and other safety net providers that qualify as patient centered primary care homes to ensure the continued critical role of those providers in meeting the needs of underserved populations.
      (4) Each coordinated care organization shall report to the authority on uniform quality measures prescribed by the authority by rule for patient centered primary care homes.

 

      (5) Patient centered primary care homes must participate in the learning collaborative described in ORS 442.210 (3). [2011 c.602 §6] 
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Physician Visa Waiver Program

ORS 413.248
 
     413.248 Physician Visa Waiver Program; rules; fees. 
      (1) The Physician Visa Waiver Program is established in the Oregon Health Authority. The purpose of the program is to make recommendations to the United States Department of State for a waiver of the foreign country residency requirement on behalf of foreign physicians holding visas who seek employment in federally designated shortage areas.
      (2) A foreign physician who has completed a residency in the United States may apply to the authority for a recommendation for a waiver of the foreign country residency requirement in order to obtain employment in a federally designated shortage area in the state. Applications shall be on the forms of and contain the information requested by the authority. Each application shall be accompanied by the application fee.
      (3) The authority reserves the right to recommend or decline to recommend any request for a waiver.
      (4) The authority shall adopt rules necessary to implement and administer the program, including but not limited to adopting an application fee not to exceed the cost of administering the program. [Formerly 409.745]
 
      Note: See note under 413.246.

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Primary Care Provider Loan Repayment

 
413.233, 413.127
 
      413.233 Primary care provider loan repayment program; rules. (1) There is created in the Oregon Health Authority the primary care provider loan repayment program for the purpose of assisting primary care providers who have committed to serving medical assistance recipients in rural or medically underserved areas of the state.
      (2) The authority shall prescribe by rule:
      (a) Participant eligibility criteria, including the types of primary care providers who may participate in the program;
      (b) The terms and conditions of participation in the program, including the duration of the term for which a participant makes a commitment under subsection (1) of this section;
      (c) The types of loans for which payments may be provided;
      (d) The priority for distribution of funds available under ORS 413.127 if the funds are insufficient to provide assistance to all of the applicants who are eligible to participate in the program; and
      (e) The financial penalties imposed on a participant who fails to complete the term of the commitment.
      (3) The authority may enter into contracts with one or more public or private entities to administer the program or parts of the program. [2013 c.177 §1]
 
      Note: See note under 413.231.
 
      413.127 Primary Care Provider Loan Repayment Fund. (1) There is established the Primary Care Provider Loan Repayment Fund in the State Treasury, separate and distinct from the General Fund. Interest earned by the Primary Care Provider Loan Repayment Fund is credited to the fund. The Primary Care Provider Loan Repayment Fund consists of moneys appropriated from the General Fund, federal moneys received for the purpose of operating the primary care provider loan repayment program and financial penalties recovered by the Oregon Health Authority from primary care providers who fail to meet their service obligations. Moneys in the Primary Care Provider Loan Repayment Fund are continuously appropriated to the authority to be used to implement and operate the primary care provider loan repayment program.
      (2) The authority may accept gifts, grants, bequests, endowments and donations from public or private sources for deposit into the Primary Care Provider Loan Repayment Fund. [2013 c.177 §2]
 
      Note: See note under 413.105
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Student Clinical Training Requirements

413.435
 
      413.435 Administrative requirements for students in clinical training. (1) The Oregon Health Authority, in collaboration with the State Workforce Investment Board, shall convene a work group to develop standards for administrative requirements for student placement in clinical training settings in Oregon. The work group may include representatives of:
      (a) State education agencies;
      (b) A public educational institution offering health care professional training;
      (c) Independent or proprietary educational institutions offering health care professional training;
      (d) An employer of health care professionals; and
      (e) The Health Care Workforce Committee established under ORS 413.017.
      (2)(a) The work group shall develop standards for:
      (A) Drug screening;
      (B) Immunizations;
      (C) Criminal records checks;
      (D) Health Insurance Portability and Accountability Act orientation; and
      (E) Other standards as the work group deems necessary.
      (b) The standards must apply to students of nursing and allied health professions. The standards may apply to students of other health professions.
      (c) The standards must pertain to clinical training in settings including but not limited to hospitals and ambulatory surgical centers, as those terms are defined in ORS 442.015.
      (3) The work group shall make recommendations on the standards developed under this section and the initial and ongoing implementation of the standards to the Oregon Health Policy Board established in ORS 413.006.
      (4) The authority may establish by rule standards for student placement in clinical training settings that incorporate the standards developed under this section and approved by the Oregon Health Policy Board. [2011 c.136 §1]
 
      Note: See note under 413.430.
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