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442.601 Definitions. As used in this section and ORS 442.602:
(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, addresses health disparities or addresses the social determinants of health in response to an identified community need. “Community benefit" includes:
(a) Charity care; (b) Losses related to Medicaid, State Children's Health Insurance Program or other publicly funded health care program shortfalls other than Medicare; (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.
(3) “Social determinants of health" has the meaning given that term in ORS 442.612. [Formerly 442.200]
442.602 Community benefit reporting; rules.
(1) The Oregon Health Authority 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 authority of the community benefits provided by the hospital, on a form prescribed by the authority.
(3) The authority 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 authority may adopt all rules necessary to carry out the provisions of this section. [Formerly 442.205]
(Financial Assistance Policies)
442.610 Notice of financial assistance policies.
(1) As used in this section:
(a) “Financial assistance policy" means a policy that meets the requirements of section 501(r) of the Internal Revenue Code and implementing regulations. (b) “Hospital" has the meaning given that term in ORS 442.015.
(2) A hospital shall have a written financial assistance policy that complies with the plain language standards for consumer contracts under ORS 180.545 (1).
(3) A hospital shall:
(a) Provide a paper copy of the financial assistance policy to a patient upon request; (b) Include on each billing statement notice of:
(A) The availability of financial assistance; (B) The contact information for the office or department of the hospital that can provide information about obtaining financial assistance; and (C) The direct Internet address for the financial assistance policy; and
(c) Maintain public displays in locations in the hospital that are accessible to the public that notify and inform patients about the financial assistance policy. Locations that are accessible to the public include but are not limited to the emergency department, if any, and the areas where patient admissions are processed.
(4) The Oregon Health Authority shall make available to hospitals and the general public a uniform application for financial assistance, created by a trade association representing hospitals, that may be used in any hospital in this state to request financial assistance. [2018 c.50 §9; 2018 c.50 §10]
Note: 442.610 to 442.630 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.
442.612 Definitions. As used in ORS 442.612 to 442.630 and 646A.677:
(1) “Adjust" means to reduce a patient's cost by a specified percentage.
(2) “Community benefit" has the meaning given that term in ORS 442.601.
(3) “Gross charges" means a hospital's full, established price for medical care that the hospital consistently and uniformly charges patients before applying any contractual allowance, discounts or deductions.
(4)(a) “Hospital" has the meaning given that term in ORS 442.015, excluding any campus of the Oregon State Hospital, a hospital operated by the United States Department of Veterans Affairs Veterans Health Administration or any other hospital operated by the federal government. (b) “Hospital" includes only hospitals located in this state.
(5) “Hospital-affiliated clinic" or “affiliated clinic" means a facility located in this state that provides outpatient health services and that is operated under the common control or ownership of a hospital.
(6) “Household" means:
(a)(A) A single individual; or (B) Spouses, domestic partners, or a parent and child under 18 years of age, living together; and (b) Other individuals for whom a single individual, spouse, domestic partner or parent is financially responsible.
(7) “Medically necessary" means:
(a) Necessary to prevent, diagnose or treat an illness, injury, condition or disease, or the symptoms of an illness, injury, condition or disease; and (b) Meeting accepted standards of medicine.
(8) “Nonprofit" means:
(a) Organized not for profit, pursuant to ORS chapter 65 or any predecessor of ORS chapter 65; or (b) Organized and operated as described under section 501(c) of the Internal Revenue Code as defined in ORS 305.842.
(9) “Patient's cost" means the portion of charges billed to a patient for care received at a hospital or a hospital-affiliated clinic that are not reimbursed by insurance or a publicly funded health care program, taking into account the requirements of section 501(r)(5) of the Internal Revenue Code that:
(a) Prohibit a nonprofit hospital from billing gross charges; and (b) Limit amounts charged for emergency or other medically necessary care, to a patient who qualifies under the nonprofit hospital's financial assistance policy, to no more than amounts generally billed to a patient who has insurance that reimburses all or a portion of the cost of the care.
(10) “Social determinants of health" means the social, economic and environmental conditions in which people are born, grow, work, live and age, shaped by the distribution of money, power and resources at local, national and global levels, institutional bias, discrimination, racism and other factors. [2019 c.497 §1]
Note: See note under 442.610.
442.614 Requirements for financial assistance policies. A nonprofit hospital's written financial assistance policy described in ORS 442.610 must:
(1) Provide for adjusting a patient's costs as follows:
(a) For a patient whose household income is not more than 200 percent of the federal poverty guidelines, by 100 percent; and (b) For a patient whose household income is more than 200 percent of the federal poverty guidelines and not more than 400 percent of the federal poverty guidelines, the hospital shall adopt a policy establishing an adjustment based on a sliding scale;
(2) Apply to all of the hospital's nonprofit affiliated clinics;
(3) Be translated into each language spoken by the lesser of 1,000 people or five percent of the population that resides in the nonprofit hospital's service area;
(4) Ensure that interpreter services are available to translate the policy into languages other than those described in subsection (3) of this section; and
(5) Apply to all medically necessary services or supplies. [2019 c.497 §2]
Note: The amendments to 442.614 by section 3, chapter 497, Oregon Laws 2019, become operative January 1, 2021. See section 14, chapter 497, Oregon Laws 2019. The text that is operative on and after January 1, 2021, is set forth for the user's convenience.
442.614. A nonprofit hospital's written financial assistance policy described in ORS 442.610 must:
(a) For a patient whose household income is not more than 200 percent of the federal poverty guidelines, by 100 percent; (b) For a patient whose household income is more than 200 percent of the federal poverty guidelines and not more than 300 percent of the federal poverty guidelines, by a minimum of 75 percent; (c) For a patient whose household income is more than 300 percent of the federal poverty guidelines and not more than 350 percent of the federal poverty guidelines, by a minimum of 50 percent; and (d) For a patient whose household income is more than 350 percent of the federal poverty guidelines and not more than 400 percent of the federal poverty guidelines, by a minimum of 25 percent;
(5) Apply to all medically necessary services or supplies.
442.618 Annual reports related to financial assistance policies and nonprofit status; penalties.
(1) As used in this section, “health care facility" has the meaning given that term in ORS 442.015, excluding long term care facilities.
(2) A hospital shall report annually to the Oregon Health Authority the following information regarding all health care facilities and affiliated clinics that are owned in part or in full by the hospital or operating under the same brand as the hospital:
(a) The address of each health care facility and affiliated clinic; (b) Whether the hospital's financial assistance policy, developed under ORS 442.614, is posted in the health care facility and affiliated clinic and available to patients of the facility and affiliated clinic; and (c) Whether the hospital is a nonprofit entity and whether the hospital's nonprofit status applies to the hospital's affiliated clinics.
(3) The authority shall prescribe the form and manner for reporting the information described in subsection (2) of this section.
(4) A hospital that fails to file a timely report, as prescribed by the authority, may be subject to a civil penalty not to exceed $500 per day. Civil penalties shall be imposed as provided in ORS 183.745. [2019 c.497 §7]
(Community Benefit Spending)
442.624 Establishment of community benefit spending floor; rules.
(1) Every two years, the Oregon Health Authority shall establish a community benefit spending floor as provided in this section based on objective data and criteria, including but not limited to the following:
(a) Historical and current expenditures on community benefits by the hospital and the hospital's affiliated clinics. (b) Community needs identified in the community needs assessment conducted by the hospital in accordance with section 501(r)(3) of the Internal Revenue Code, and community health assessments and community health improvement plans of coordinated care organizations that serve the same geographic area served by the hospital and the hospital's affiliated clinics, in accordance with ORS 414.575 and 414.578. (c) The hospital's need to expand the health care workforce. (d) The overall financial position of the hospital and the hospital's affiliated clinics based on audited financial statements and other objective data. (e) The demographics of the population in the areas served by the hospital and the hospital's affiliated clinics. (f) The spending on the social determinants of health by the hospital or the hospital's affiliated clinics. (g) Taxes paid by the hospital and the hospital's payments, in lieu of taxes, paid to:
(A) A local government; (B) The state; or (C) The United States government.
(h) Criteria governing the manner in which the authority will consider input received from the general public under subsection (2)(c) of this section. (i) The hospital's obligations and commitments, as reported to the Internal Revenue Service, to:
(A) Fund, support or provide health professions education; and (B) Fund health research.
(j) For the Oregon Health and Science University hospital, its obligation to carry out the public purposes and missions specified in ORS 353.030.
(2) In establishing the community benefit spending floors under subsection (1) of this section, the authority shall:
(a) Consult with representatives of hospitals; (b) Provide an opportunity for hospitals and hospital-affiliated clinics to respond to any findings; (c) Solicit and consider comments from the general public; and (d) Consult with or solicit advice from one or more individuals with expertise in the economics of health care.
(3) The authority shall adopt by rule alternative methodologies for hospitals and hospital-affiliated clinics to report data and to apply the community benefit spending floors, including but not limited to:
(a) By each individual hospital and all of the hospital's nonprofit affiliated clinics; (b) By a hospital and a group of the hospital's nonprofit affiliated clinics; and (c) By all hospitals that are under common ownership and control and all of the hospitals' nonprofit affiliated clinics.
(4) Each hospital shall be provided the opportunity to select the applicable methodology from those adopted by the authority by rule under subsection (3) of this section.
(5) The authority may adopt rules necessary to carry out the provisions of this section. [2019 c.497 §6]
Note: 442.624 becomes operative January 1, 2021. See section 14, chapter 497, Oregon Laws 2019.
442.625 [1999 c.1056 §3; renumbered 442.870 in 2019]
(Community Health Needs)
442.630 Community health needs assessment and three-year strategy; public participation. A nonprofit hospital shall post to the hospital's website the following information regarding its community health needs assessment conducted in accordance with section 501(r)(3) of the Internal Revenue Code:
(1) A description of the health care needs identified in the hospital's community health needs assessment;
(2) The three-year strategy developed to address the health care needs of the community;
(3) Annual progress on the implementation of the strategy; and
(4) Opportunities for public participation in the assessment and development of the strategy. [2019 c.497 §5]
Note: See note under 442.610.
Note: Section 12, chapter 497, Oregon Laws 2019, provides:
Sec. 12. No later than December 31, 2022, the Oregon Health Authority shall report to the interim committees of the Legislative Assembly related to health on the implementation of sections 1 to 7 of this 2019 Act [442.612 to 442.630 and 646A.677] and the amendments to ORS 442.200 by section 10 of this 2019 Act. [2019 c.497 §12]
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