Hospital Reporting Program Statutes

Hospital Community Benefit Reporting Statutes

The Community Benefit Program is guided by Oregon statutes and administrative rules that establish how hospitals report on their community benefit impacts in their communities. This page provides direct access to the laws and administrative rules that govern the Community Benefit Program and outline reporting requirements for hospitals submitting data.

As used in this section and ORS 442.602 (community benefit reporting):

(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 Medicaid, State Children's Health Insurance Program or other publicly funded health care program shortfalls other than Medicare;

(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 (Definitions). [Formerly 442.200]

(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]

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 (Definitions).

(c) “Nonprofit" has the meaning given that term in ORS 442.612 (Definitions).

(2) A hospital shall have a written financial assistance policy that complies with the plain language standards for consumer contracts under ORS 180.545 (Plain language standards).

(3) A hospital shall:

(a) Provide a paper copy of the financial assistance policy and an application form to apply for financial assistance to a patient upon request;

(b) Include on each billing statement, on the hospital's website home page and on any website where the patient pays a bill or accesses information about the patient's account, a prominently displayed 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 Internet address for the financial assistance policy and the Internet address where an application for financial assistance may be accessed, completed and submitted online, including on a mobile device;

(c) Accept an application for financial assistance that is submitted:

(A) In an online application; or

(B) Sent by mail to or submitted in person at the hospital's address as shown on the application; and

(d) 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) Intentionally left blank —Ed.

(a) A nonprofit hospital's application for financial assistance, when completed by a resident of this state:

(A) May require the resident to provide only:

(i) The patient's household income, for purposes of ORS 442.614 (Requirements for financial assistance policies); and

(ii) Information about any third party that may be liable for the cost of the services, as permitted by ORS 646A.677 (Requirement to screen for financial assistance before transferring medical debt for collection).

(B) Must clearly mark as optional any other information, including information about the patient's assets.

(b) A nonprofit hospital may not use information other than information listed in paragraph (a) of this subsection to deny financial assistance to a resident of this state.

(c) This subsection does not prohibit:

(A) A hospital from requiring a patient to respond to requests from the patient's insurer as needed for the insurer to adjudicate the hospital's claim for reimbursement, as permitted by ORS 646A.677 (Requirement to screen for financial assistance before transferring medical debt for collection); or

(B) A nonprofit hospital from requiring a patient to provide information that the Centers for Medicare and Medicaid Services requires the hospital to collect for the purpose of cost reporting. [2018 c.50 §9; 2018 c.50 §10; 2023 c.263 §2]Note: The amendments to 442.610 (Notice of financial assistance policies) by section 2, chapter 263, Oregon Laws 2023, become operative July 1, 2024. See section 6, chapter 263, Oregon Laws 2023. The text that is operative until July 1, 2024, is set forth for the user's convenience. 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 (Definitions).

(2) A hospital shall have a written financial assistance policy that complies with the plain language standards for consumer contracts under ORS 180.545 (Plain language standards) (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.

Note: 442.610 (Notice of financial assistance policies) to 442.630 (Community health needs assessment and three-year strategy) 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.

As used in ORS 442.612 (Definitions) to 442.630 (Community health needs assessment and three-year strategy):

(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 (Definitions).

(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) Intentionally left blank —Ed.

(a) “Hospital" has the meaning given that term in ORS 442.015 (Definitions), 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) Intentionally left blank —Ed.

(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 (Application of Internal Revenue Code to certain property tax laws).

(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; 2021 c.96 §3]

Note: See second note under 442.610 (Notice of financial assistance policies).

(1) A nonprofit hospital's written financial assistance policy described in ORS 442.610 (Notice of financial assistance policies) must:

(a) 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;

(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;

(b) Apply to all of the hospital's nonprofit affiliated clinics;

(c) 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;

(d) Ensure that interpreter services are available to translate the policy into languages other than those described in paragraph (c) of this subsection; and

(e) Apply to all medically necessary services or supplies.

(2) Intentionally left blank —Ed.

(a) A nonprofit hospital's written financial assistance policy described in ORS 442.610 (Notice of financial assistance policies) may not require a patient to apply for medical assistance, as defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414), before the patient will be screened for or provided financial assistance.

(b) This subsection does not prohibit a hospital from providing information to patients about their eligibility for medical assistance or assisting patients in applying for medical assistance. [2019 c.497 §2; 2019 c.497 §3; 2021 c.96 §1]

Note: See second note under 442.610 (Notice of financial assistance policies).

(1) As used in this section:

(a) “Financial assistance" includes:

(A) Charity care, as defined in ORS 442.601 (Definitions); or

(B) An adjustment to a patient's costs for care under ORS 442.614 (Requirements for financial assistance policies) (1)(a).

(b) “Hospital" has the meaning given that term in ORS 442.612 (Definitions).

(2) Using the process prescribed by the Oregon Health Authority under subsection (3) of this section, a hospital licensed under ORS 441.025 (License issuance) shall screen a patient for presumptive eligibility for financial assistance if the patient:

(a) Is uninsured;

(b) Is enrolled in the state medical assistance program; or

(3) The authority shall adopt by rule the process for screening a patient for presumptive eligibility for financial assistance under subsection (2) of this section. The rules and process must:

(a) Prohibit a hospital from requiring a patient to provide documentation or other verification;

(b) Ensure that the process will not cause any negative impact on the patient's credit score;

(c) Require a hospital, before sending a bill to the patient, to conduct the screening and apply any financial assistance for which the patient qualifies to the bill; and

(d) Require the hospital to notify a patient if the patient has been screened and to explain to the patient, in language approved by the authority, how to apply for financial assistance if financial assistance was denied, or how to apply for additional financial assistance above what the patient received.

(4) A patient may apply for financial assistance:

(a) If the patient was screened for presumptive eligibility for financial assistance and was found not to be eligible or the patient disagrees with the amount of the financial assistance that was offered;

(b) If a patient was not screened for presumptive eligibility for financial assistance; or

(5) A hospital may require a patient who applies for financial assistance under subsection (4) of this section to provide documentation or verification of information reported as necessary for the hospital to determine the patient's eligibility for financial assistance.

(6) If a patient applies for financial assistance after having paid for the services and the patient is found to have been eligible for financial assistance when the services were provided:

(a) The hospital shall refund the amount of financial assistance for which the patient qualified;

(b) If the hospital previously determined, incorrectly, that the patient did not qualify for financial assistance for the services based on information provided by the patient at the time of the incorrect determination, the hospital shall also pay the patient interest on the amount of financial assistance at the rate set by the Federal Reserve and any other associated reasonable costs, such as legal expenses and fees, incurred by the patient in securing financial assistance; and

(c) If the hospital sold the debt to a collection agency or authorized a collection agency to collect debts on behalf of the hospital, the hospital shall notify the collection agency that the debt is invalid.

(7) If a patient applies for financial assistance and the hospital determines that the patient is eligible for financial assistance based on documentation provided by the patient, the patient's eligibility for financial assistance continues for nine months following the hospital's determination, and the patient may not be required to reapply for financial assistance for services provided during that nine-month period.

(8) Intentionally left blank —Ed.

(a) A hospital must have a written process that is in plain English, and in other languages as required by law, for a patient to appeal a hospital's denial of financial assistance, in whole or in part, and that allows the patient, or an individual acting on behalf of the patient, to correct any deficiencies in documentation or to request a review of the denial by the hospital's chief financial officer or the chief financial officer's designee. The authority shall prescribe by rule the requirements for the appeal process.

(b) If a hospital denies a patient's application for financial assistance, whether in whole or in part, the hospital must notify the patient of the denial and include in the notice an explanation of the hospital's appeal process.

(9) During the pendency of an appeal that is filed using a hospital's appeal process under subsection (8) of this section, if:

(a) The hospital has initiated collection activities, the hospital must suspend all collection activities; and

(b) The hospital sold the debt under appeal to a collection agency or has authorized a collection agency to collect debts on behalf of the hospital, the hospital must notify the collection agency to suspend collection activities. [2023 c.263 §1]

Note: 442.615 (Financial assistance) becomes operative July 1, 2024. See section 6, chapter 263, Oregon Laws 2023.

Note: 442.615 (Financial assistance) 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.

Note: Section 5, chapter 263, Oregon Laws 2023, provides:

Sec. 5. A hospital is not required to have in place an appeals process described in section 1 (8) of this 2023 Act [442.615 (Financial assistance) (8)] before January 1, 2025. [2023 c.263 §5]

1) As used in this section, “health care facility" has the meaning given that term in ORS 442.015 (Definitions), 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 (Requirements for financial assistance policies), 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 (Civil penalty procedures). [2019 c.497 §7]Note: The amendments to 442.618 (Annual reports related to financial assistance policies and nonprofit status) by section 3, chapter 263, Oregon Laws 2023, become operative January 1, 2025. See section 6, chapter 263, Oregon Laws 2023. The text that is operative on and after January 1, 2025, is set forth for the user's convenience.

442.618 (Annual reports related to financial assistance policies and nonprofit status). (1) As used in this section:

(a) “Extraordinary collection action" means actions referenced in section 501(r)(6) of the Internal Revenue Code or implementing regulations.

(b) “Health care facility" has the meaning given that term in ORS 442.015 (Definitions), excluding long term care facilities.

(c) “Payer type" means one or more of the following persons legally responsible for all or part of the cost of hospital services:

(A) A commercial insurer;

(B) Medicare;

(C) The state medical assistance program;

(D) A patient who is uninsured or otherwise personally responsible for the cost of hospital services; or

(E) Another payer type prescribed by the Oregon Health Authority by rule.

(2) A hospital shall report annually to the 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 (Requirements for financial assistance policies), complies with ORS 442.610 (Notice of financial assistance policies) (3);

(c) Whether the hospital is a nonprofit entity and whether the hospital's nonprofit status applies to the hospital's affiliated clinics;

(d) During the reporting period:

(A) How many applications for financial assistance the hospital received and of the applications received, the number of applications that were approved;

(B) Of the patients who received financial assistance, the number of patients who received financial assistance without completing the hospital's financial assistance application process; and

(C) Reported by payer type, the number of patients who received financial assistance and the number of patients who were denied financial assistance;

(e) During the reporting period, the number of accounts that were:

(A) Referred to a debt collector or collection agency during the reporting period; and

(B) Transferred for extraordinary collection actions during the reporting period, listed by type of action; and

(f) The average, median and total amount of debt, owed to the hospital by patients, that was placed in collections during the reporting period.

(3) The authority shall prescribe the form and manner for reporting the information described in subsection (2) of this section.

Note: Section 6 (3), chapter 263, Oregon Laws 2023, provides:

Sec. 6. (3) The Oregon Health Authority shall take any action before the operative dates specified in this section that is necessary to carry out section 1 of this 2023 Act [442.615 (Financial assistance)] and the amendments to ORS 442.610 (Notice of financial assistance policies), 442.618 (Annual reports related to financial assistance policies and nonprofit status) and 646A.677 (Requirement to screen for financial assistance before transferring medical debt for collection) by sections 2 to 4 of this 2023 Act on and after the operative dates specified in this section. [2023 c.263 §6(3)]

Note: See second note under 442.610 (Notice of financial assistance policies).

(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 (Community advisory councils) and 414.578 (Community health improvement plan).

(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

(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 (Public policy of university).

(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;

(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

(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: See second note under 442.610 (Notice of financial assistance policies).

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 second note under 442.610 (Notice of financial assistance policies).

Hospital Reporting Program Statutes

Hospital Community Benefit Reporting Statutes

Oregon Revised Statutes (ORS) 442.601

Oregon Revised Statutes (ORS) 442.602

Oregon Revised Statutes (ORS) 442.610

Oregon Revised Statutes (ORS) 442.612

Oregon Revised Statutes (ORS) 442.614

Oregon Revised Statutes (ORS) 442.615

Oregon Revised Statutes (ORS) 442.618

Oregon Revised Statutes (ORS) 442.624

Oregon Revised Statutes (ORS) 442.630