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Laws and Rules Governing the Health Policy and Analytics Division

The laws governing the activities and scope of the Health Policy and Analytics Division (HPA) are defined in the Oregon Revised Statutes (ORS). The Oregon Administrative Rules (OAR) determine how those laws will be implemented. Learn more from the State Legislative website and the Secretary of State website.

Current Rulemakings

Proposed Permanent Rulemakings

The Oregon Health Authority has filed notice of proposed rulemaking with the Secretary of State's office for the ​Health Care Provider Incentive Program. Please see the notice for further details.

409-036 Notice of Proposed Rulemaking

Public comment may be provided through August 22nd at 5 pm, please see notice for contact details.

Public Rules Hearing
August 16, 2022 2:00-3:00 pm

Accommodation requests related to a disability or requests for interpreter services should be made by August 11 to Pete Edlund at pete.edlund@dhsoha.state.or.us or (503) 931-8873 (voice/text). All relay calls are accepted. Every effort will be made to provide services to requests received after August 11, however submitting your request as early as possible is greatly appreciated.

ZoomGov meeting link

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Meeting ID: 160 911 0341
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PLEASE NOTE (8/12/22):
Numbering errors were discovered in the proposed claims file and PAF layouts. Corrected versions are linked below, and the permanent rule will have these corrections:

The Oregon Health Authority has filed two notices of proposed rulemaking with the Secretary of State’s office for the All Payer All Claims program (the two separate notices are due to different effective dates). Please see the notices for further details:

Public comment may be provided through July 21 at 5 pm; please see notices for contact details.

A joint public rules hearing is also being held for both notices:

Public Rules Hearing
July 19, 2022 2:05-2:55 pm


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Meeting ID: 160 055 2107 
Passcode: 851732 

Find your local number: https://www.zoomgov.com/u/acVqchFALc 
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​409-017-0120 Dental Services: Underserved Populations definition

HPA has filed notice of proposed rulemaking with the Secretary of State to define underserved populations for dental services in administrative rule.

Notice of Proposed Rulemaking​

Hearing scheduled for:
Wednesday, June 15, 1:00 pm - 2:00 pm
Remote Meeting Only
ZoomGov Meeting Link

Meeting ID: 160 176 2772
Passcode: 618216
Dial by your location
        +1 669 254 5252 US (San Jose)
        +1 646 828 7666 US (New York)

Last day to submit written comments: 6/21/22 5:00 pm

Written comments should be emailed to peter.m.edlund@dhsoha.state.or.us​

Adopted Rules

HPA Rules by CHAPTER NUMBER

Chapter 409 - Health Policy and Analytics
Chapter 431 - Oregon Prescription Drug Program (OPDP)
Chapter 945 - Oregon Health Insurance Marketplace

HPA Rules by SUBJECT CATEGORIES

HPA rules basically fall into three categories: 1) Commissions; 2) Data Reporting, and 3) Programs. The links below provide additional information not found on the Secretary of State's website, including:

  • Rule (current and upcoming)
  • Attachments, tables, forms (if applicable)
  • Applicable statutes (ORS) that govern the rule
  • Program website

Commissions

Rule: ​OAR 409-060
Applicable statutes
Commission website

OAR 409-060 includes the following rules:

  • 409-060-0100 Scope
  • 409-060-0110 Definitions
  • 409-060-0120 HERC Process for Evidence-based Reports
  • 409-060-0130 Medical Technology Assessments
  • 409-060-0140 Evidence-based Guidelines
  • 409-060-0150 Coverage Guidelines

Rule: OAR 409-050
Applicable Statutes
Commission Website

OAR 409-050 includes the following rules:

  • 409-050-0100 Purpose
  • 409-050-0110 Definitions
  • 409-050-0120 Commission Positions
  • 409-050-0130 Pain Management Education Program Requirements

Data Reporting Rules

Rule: OAR 409-021
Applicable Statutes

OAR 409-021 includes the following rules:

  • 409-021-0005 Introduction
  • 409-021-0010 Definitions
  • 409-021-0115 Calculations of Fees
  • 409-021-0120 Inspection of Health Data
  • 409-021-0130 Requests to Obtain Copies of Public Use Health Data Files
  • 409-021-0140 Requests & Requirements to Obtain Restricted Health Data Sets
  • 409-021-0150 Denial of Requests to Inspect or Obtain Copies of Health Data

Rule: ​OAR 409-024
Applicable Statutes
Program Website

 OAR 409-024 includes the following rules:

  • 409-024-0000 Definitions
  • 409-024-0110 Capital Project Report
  • 409-024-0120 Public Comments
  • 409-024-0130 Civil Penalties

​Rule: OAR 409-023
Applicable Statutes
Program website

OAR 409-023 consists of the following rules:

  • 409-023-0100 Definitions
  • 409-023-0105 Community Benefit Reporting
  • 409-023-0110 Community Benefit Minimum Spending Floor
  • 409-023-0115 Annual reports of financial assistance policies and nonprofit status​

​Rule: OAR 409-026
Applicable Statute
Program Website

OAR 409-026 includes the following rules:

  • 409-026-0100 Definitions
  • 409-026-0110 Data Elements
  • 409-026-0120 Reporting Schedule and Format
  • 409-026-0130 Fees
  • 409-026-0140 Data Access

Rule: OAR 409-015
Applicable Statutes
Program website

OAR 409-015 includes the following rules:

  • ​409-015-0005 Definitions
  • 409-015-0010 Report Forms
  • 409-015-0012 Filing Date
  • 409-015-0015 Reports Required
  • 409-015-0030 Modification of Reporting Requirements
  • 409-015-0035 Civil Penalties

​Rule: OAR 409-022
Applicable Statutes: ORS 442.370​

OAR 409-022 includes the following rules:

  • 409-022-0010 Definitions
  • 409-022-0015 Health Care Facility Annual Reports
  • 409-022-0020 Hospital Reporting Requirements
  • 409-022-0025 Ambulatory Surgical Centers Requirements
  • 409-022-0035 Ambulatory Surgical Center Fees
  • 409-022-0060 Access to Health Data
  • 409-022-0070 Health Care Facility Utilization and Discharge Data Use and Disclosure

Rule: ​OAR 409-028
Annual Supplemental Provider Level APM Summary Report Form
Website:  https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/All-Payer-All-Claims.aspx

OAR 409-028 includes the following rules:includes the following rules:

  • 409-028-0000 Purpose and Scope
  • 409-028-0010 Definitions
  • 409-028-0020 Coordinated Care Organization (CCO) Reporting Requirements

Programs

Rule: OAR 409-045
Application Forms: Credentialing / Recredentialing
Applicable Statutes
Program Website

OAR 409-045 includes the following rules:

  • 409-045-0025 Definitions
  • 409-045-0030 Oregon Common Credentialing Program
  • 409-045-0035 Oregon Practitioner Credentialing Application
  • 409-045-0040 Credentialing Information Verifications
  • 409-045-0045 Health Care Regulatory Board Participation
  • 409-045-0050 Credentialing Organization Participation
  • 409-045-0055 Health Care Practitioner Participation
  • 409-045-0060 Use of Health Care Practitioner Information
  • 409-045-0065 Common Credentialing Advisory Group
  • 409-045-0070 Imposition of Fees
  • 409-045-0075 Complaints
  • 409-045-0115 Telemedicine Providers General Applicability Credentialing Requirements
  • 409-045-0120 Telemedicine Providers Standard List of Credentialing Documents
  • 409-045-0125 Telemedicine Providers Distant-Site Hospital Agreements
  • 409-045-0130 Telemedicine Providers Hold Harmless Clause
  • 409-045-0135 Telemedicine Providers Information Sharing or Use of Data

​OAR 409-036 includes the following rules:

  • 409-036-0000 Purpose and Scope
  • 409-036-0010 Definitions
  • 409-036-0020 Types of Incentives Offered under the Program
  • 409-036-0030 Eligibility Criteria specific to Loan Repayment Subsidies
  • 409-036-0040 Eligibility Criteria specific to Scholarships for Students in Health Professional Training Programs at Other Institutions of Higher Learning
  • 409-036-0050 Eligibility Criteria and Program Requirements specific to Medical Malpractice Insurance Program Subsidies
  • 409-036-0060 Participation and Application Requirements
  • 409-036-0070 Application and Review Process
  • 409-036-0080 Maximum Award Amounts
  • 409-036-0090 Transfer of Provider Service Obligation to Another Site
  •  409-036-0100 Suspension of Waiver of Provider Service Obligation
  • 409-036-0110 Monitoring and Follow-up Requirements
  • 409-036-0120 Failure to Comply; Penalties & Appeals
  • 409-036-0130 Contributions to the Health Care Provider Incentive Fund
  • 409-036-0140 Program Integrity
  • 409-036-0150 Data Sharing

Program Website
Statute

​Rule: OAR 409-030 (rev. 11-15-19)
Attachment: Table 1
Statute
Program Website

OAR 409-030 includes the following rules:

  • 409-030-0100 Purpose
  • 409-030-0110 Definitions
  • 409-030-0120 General Applicability
  • 409-030-0130 Health Professional Disciplines
  • 409-030-0140 Clinical Settings
  • 409-030-0150 Exceptions
  • 409-030-0160 Regular Review of Clinical Standards
  • 409-030-0170 Administrative Requirements for Clinical Placement
  • 409-030-0180 Immunization Standards
  • 409-030-0190 Screening Standards
  • 409-030-0200 Tuberculosis Screening
  • 409-030-0210 Drug Testing for Substance Abuse and Misuse
  • 409-030-0220 State and Nationwide Criminal Background Checks
  • 409-030-0230 Training Standards
  • 409-030-0240 Insurance and Liability Coverage
  • 409-030-0250 Information Sharing or Use of Data

​Rule: ORS 431-121
Applicable Statutes
Program website

OAR 431-121 contains the following rules:

  • 431-121-2000 Definitions
  • 431-121-2005 General Administration
  • 431-121-2010 Pharmacy Providers
  • 431-121-2020 Program Price
  • 431-121-2030 Preferred Drug List
  • 431-121-2050 Enrollment
  • 431-121-2065 Contracted Services

​Rule: OAR 409-055
Attachment: Tables 1-4
Applicable Statutes
Program Website

OAR 409-055 contains the following rules:

  • 409-055-0000 Purpose & Scope
  • 409-055-0010 Definitions
  • 409-055-0020 Program Administration
  • 409-055-0030 Practice Application & Recognition Process
  • 409-055-0040 Recognition Criteria
  • 409-055-0045 5 STAR Designation
  • 409-055-0050 Data Reporting Requirements for Recognized PCPCHs
  • 409-055-0060 Verification
  • 409-055-0070 Compliance
  • 409-055-0080 Insurance Carrier, Managed Care Plan & Public Stakeholder Communication
  • 409-055-0090 Reimbursement Objectives

​Rule: 409-035
Applicable Statutes
Program Website

OAR 409-035 contains the following rules:

  • 409-035-0000 Purpose
  • 409-035-0010 Definitions
  • 409-035-0020 Health Care Facility Participation Requirements
  • 409-035-0030 Physician Participation Requirements
  • 409-035-0040 Application Review Process
  • 409-035-0050 Monitoring and Follow-up Requirements
  • 409-035-0060 Transfer of J-1 Waiver Physician Obligation

​Rule: OAR 409-001
Applicable Statute: ORS 183.341 and 413.042

ORS 409-001 contains the following rule:

  • 409-001-0005 Model Rules of Procedure


Resources

State Laws (ORS)
Secretary of State rules (OAR)
OHA Rulemaking

Contact Info

Pete Edlund
Rules Coordinator
OHA-Health Policy & Analytics
421 SW Oak Street, Ste. 850
Portland, OR 97204
Cell: 503-931-8873

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