Hospital Reporting Program Statutes

The Hospital Reporting Program is guided by Oregon statutes and administrative rules that establish how hospitals report data related to community benefit data, hospital financial and utilization data, hospital discharge data, and capital projects reporting. This page provides direct access to the laws and administrative rules that govern the Hospital Reporting Program and outline reporting requirements for hospitals submitting data.

Hospital Community Benefit Reporting Statutes

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).

Definitions

The following definitions apply to OAR 409-023-0100 to 409-023-0115:
(1) “Affiliated clinic" or “hospital affiliated clinic" mean an outpatient clinic located in Oregon that is operating under the common control or ownership of a hospital.
(2) “Authority" means the Oregon Health Authority.
(3) “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, governmentally set fees, contractual allowances, or discounts for quick payment.
(4) “Community" means the geographic service area and patient population that the health care institution serves as defined by the hospital.
(5) “Community benefits" mean programs or activities that provide treatment or promote health and healing, address health disparities or address the social determinants of health in a response to identified community needs. They are not provided primarily for marketing purposes or to increase market share. Community benefit must generate a negative margin and meet at least one of the following criteria:
(a) Improve access to health services;
(b) Enhance population health or improve health disparities;
(c) Advance generalizable knowledge;
(d) Demonstrate charitable purpose; or
(e) Address social determinants of health.
(6) “Health System" means an organization that delivers health care services through hospitals, facilities, clinics, medical groups and other entities that are under common ownership or control.
(7) “Hospital" has the meaning provided in ORS 442.612.
(8) “Patient cost" has the meaning provided in ORS 442.612.
(9) “Prescreen" or “prescreening" means the process a hospital uses to proactively screen a patient for presumptive eligibility for financial assistance in accordance with ORS 442.615.
(10) “Presumptive eligibility" refers to a decision by the hospital that, based upon the hospital's prescreening, the patient qualifies for financial assistance.
(11) “Net cost" means the total expense incurred by the hospital minus any offsetting revenue such as grants, donations, or payments for service. Net costs may be provided using either a cost-to-charge ratio methodology or a cost accounting methodology.
(12) “Social Determinants of Health" has the meaning provided in ORS 442.612.
(13) “State medical assistance program" means a program for payment of health services provided to eligible Oregonians, including Medicaid and CHIP services under the OHP Medicaid Demonstration Project and Medicaid and CHIP services under the State Plan, or Healthier Oregon, or Bridge Program, or any other programs that may be prescribed by the Authority from time to time, in accordance with ORS 414.025(17).

Statutory/Other Authority: ORS 442.602, 442.615, 442.618 & 442.624
Statutes/Other Implemented: ORS 442.601, 442.602 & 442.612
History:
OHP 1-2024, amend filed 05/07/2024, effective 05/07/2024
OHP 5-2020, amend filed 12/21/2020, effective 12/21/2020
OHP 2-2008, f. & cert. ef. 7-1-08

Community Benefit Reporting

(1) Hospital reporting required pursuant to this rule must be consistent with generally accepted accounting principles (GAAP).
(2) The hospital must submit a completed Community Benefit Report form CBR-1 to the Authority within 240 days from the close of the hospital's fiscal year. The report will be deemed submitted as of the date the report is postmarked or electronically delivered to the Authority, whichever is first.
(3) Form CBR-1 must be completed in accordance with instructions published by the Authority in the Community Benefit Reporting Guidelines (CBR-2). The Authority has 30 days to review and request clarification or corrections to form CBR-1.
(4) No later than October 31 of each year, the Authority shall send out a summary file for hospitals to review and validate. Hospitals shall have 14 days to review the summary file and submit corrections.
(5) Hospitals that are part of a multi-hospital system may submit reports for all system hospitals in one submission, but each hospital must be separately reported and clearly identified in any submission. Nothing in this rule removes the requirement that hospitals report their individual community benefit activities.
(6) If the ownership or control of the hospital changes during the reporting year, each hospital owner or controller must submit a community benefit report for the hospital for the portion of the year it owned or controlled the hospital.
(7) The Authority shall inform each hospital subject to reporting of any changes to the Community Benefit Report (CBR-1) or Community Benefit Reporting Guidelines (CBR-2) for the subsequent year by July 1. Community Benefit Reporting Guidelines shall be posted on the Authority's website.
(a) Hospitals may report a community benefit activity in only one of the following categories as defined by the authority's Community Benefit Reporting Guidelines (CBR-2):
(A) Charity care;
(B) Losses related to Medicaid and State Children's Health Insurance Program;
(C) Losses related to other publicly funded health care programs, excluding Medicare;
(D) Community health improvement services;
(E) Health professionals' education;
(F) Subsidized health services;
(G) Research;
(H) Financial and in-kind contributions to the community;
(I) Community building activities; or
(J) Community benefit operations.
(b) Community benefit activities must be reported as net costs.
(c) Only activities that occur during the fiscal year of the report and are under the control or management of the hospital can be reported, except in the case of a large one-time expenditure.
(d) Large one-time expenditures for qualifying community benefit activity that is under the control or management of the hospital may be allocated across multiple fiscal years, provided that:
(A) The expenditure is a single-transaction contribution;
(B) The expenditure exceeds the lesser of $1 million or 0.5% of annual net patient revenue;
(C) The expenditure is made in the community benefit categories of cash and in-kind contributions, community health improvement activities, or community building activities, as defined in the Community Benefit Reporting Guidelines (CBR-2);
(D) Net costs are not allocated across more than five fiscal years; and
(E) The hospital provides the Authority with a description of the investment and a plan for allocation.
(8) In addition to the reporting requirements of sections (6) and (7), a nonprofit hospital shall submit the most recent version of its Community Health Needs Assessment and its Community Health Improvement Strategy as specified in ORS 442.630.
(9) Beginning with a hospital's fiscal year 2022 community benefit reports, the hospital shall report additional information, as prescribed in the Community Benefit Reporting Guidelines (CBR-2), relating to:
(a) The community need or health improvement strategy the community benefit activity addresses;
(b) Entities to which the hospital gave funds, grants, or in-kind contributions; and
(c) Activities that address the social determinants of health.
(10) Beginning with a hospital's fiscal year 2022, a hospital that works with a CCO or public health agency to address community need(s) shall identify:
(a) The community partner(s), and
(b) The community health needs assessment or community health improvement plan that identifies the community need(s) on either form CBR-1 or in supplemental documentation.
(11) Any information provided to the Authority pursuant to this reporting will be publicly available and may be included in the annual report produced by the Authority.
(12) The Authority shall annually report on community benefit activity to the Oregon Health Policy Board and produce a public report detailing community benefit activities performed by individual hospitals.
(13) A hospital that fails to report as required in these rules may be subject to a civil penalty not to exceed $500 per day.

Statutory/Other Authority: ORS 442.602
Statutes/Other Implemented: ORS 442.630
History:
OHP 5-2020, amend filed 12/21/2020, effective 12/21/2020

OHP 2-2008, f. & cert. ef. 7-1-08

Community Benefit Minimum Spending Floor

(1) The community benefit minimum spending floor program is effective January 1, 2021.
(2) The Authority shall calculate community benefit minimum spending floors for each hospital and its affiliated clinics in Oregon based on the fiscal year of the hospital, with each floor effective over the next two consecutive fiscal years. The Authority shall recalculate the spending floor every two years.
(3) The Authority will collect the data and criteria enumerated in ORS 442.624 on form CBR-3, if it is not already provided by hospitals on forms CBR-1 or FR-3, and from the general public for consideration in establishing hospital minimum community benefit floors. The Authority will post the spending floors for comment from the hospitals and general public as required under OAR 409-023-0110 (9).
(4) Community benefit minimum spending floors shall apply to all community benefit net costs reported to the Authority on Community Benefit Reporting Form (CBR-1).
(5) Each hospital may select among the following methodologies, as applicable to the hospital's organizational structure, for the purpose of applying a minimum community benefit floor:
(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;
(c) By all hospitals that are under common ownership and control and all of the hospitals' nonprofit affiliated clinics; or
(d) By any other grouping of hospitals and their hospital affiliated clinics that is approved by the Authority.
(6) The Authority will utilize the methodology selected by the hospital from among those listed in OAR 409-023-0110 (5) to assign each hospital's community benefit minimum spending floor, subject to the following requirements:
(a) Hospitals shall include audited financial statements and other objective data describing the overall financial positions of the hospitals and their affiliated clinics as grouped in the selected methodology on form CBR-3, if such information is not already incorporated into the audited financial reporting of the hospitals.
(b) Hospitals shall report the community benefit net costs that occur in their affiliated clinic(s) as grouped in the selected methodology on CBR-1.
(c) Hospitals choosing methodologies with multiple groupings shall report objective financial data and community benefit net costs for each facility such that the group totals, taken together, sum to be equal to the cumulative financials and net community benefit costs of all hospitals and affiliated clinics referenced in the chosen methodology.
(d) Each hospital shall inform the Authority of its elected organization groupings on form CBR-3 and provide all information requested on CBR-3 no later than 90 days prior to the start of their fiscal year.
(e) The elected organization grouping shall be maintained for the two-year duration of the community benefit minimum spending floor assignment, unless a facility within the organizational grouping closes or undergoes a change in ownership or control.
(7) The Authority shall publish the formula used to calculate hospitals' community benefit minimum spending floors by January 1 of every odd numbered year.
(8) The Authority shall provide a proposed community benefit spending floor applicable to a hospital and its elected organization grouping no later than 60 days prior to the start of the hospital's fiscal year.
(9) The proposed community benefit spending floor shall be posted to the Authority's website, and a public comment period of 30 days shall begin the day of posting. All subsequent changes or amendments to the spending floor shall also be posted to the website for comment.
(10) The hospital and its affiliates shall have 30 days from receipt of the proposed spending floor to comment or provide additional information which may be used to modify the proposed community benefit spending floor.
(11) The Authority shall notify each hospital of the final community benefit spending floor no later than the first business day of the initial fiscal year of the two-year period for which the spending floors are effective.
(12) A hospital may ask for a review of its minimum spending floor if the hospital experiences a change in circumstance outside its control that will result in serious financial harm to the hospital if the community benefit minimum spending floor remains unchanged.
(13) The authority may amend the formula, if necessary, based on review of community benefit reports and feedback from stakeholders and the general public.

Statutory/Other Authority: ORS 442.602 & 442.624
Statutes/Other Implemented: ORS 442.601, ORS 442.602, 442.612, 442.624 & 442.630
History:
OHP 5-2020, adopt filed 12/21/2020, effective 12/21/2020

Annual reports of financial assistance policies and nonprofit status

(1) For purposes of this rule:
(a) “Health care facility" means:
(A) A hospital;
(B) An ambulatory surgical center;
(C) A freestanding birthing center;
(D) An outpatient renal dialysis facility; or
(E) An extended stay center.
(b) “Reportable affiliated clinic" means an outpatient clinic located in Oregon that:
(A) Is operating under the common control of a hospital; or
(B) Is owned in whole or part by the hospital; or
(C) Is operating under the same brand of the hospital.
(2) A hospital or health system designee must submit a health care facility and reportable affiliated clinic report using the Hospital Facility and Clinic Report form (form HFCR) to the Authority, annually, by June 30 of each calendar year. The report shall identify its health care facilities and reportable affiliated clinics on form HFCR and provide the following:
(a) The health care facility name and street address for the facility location;
(b) The reportable affiliated clinic name and street address for the clinic location;
(c) The non-profit status of each health care facility or reportable affiliated clinic; and
(d) An attestation, signed by an officer of the hospital, that the hospital's financial assistance policy as developed under ORS 442.614 has been posted in the health care facilities and reportable affiliated clinics, and has been made available to patients of the facility and reportable affiliated clinic.
(3) Effective for hospital fiscal years that begin on or after January 1, 2025, hospitals must submit the Hospital Financial Assistance Report form (form HFAR) no later than 150 days after the end of the hospital's fiscal year, for certain financial assistance data from the most recently completed fiscal year. Data on form HFAR must include:
(a) Total number of financial assistance applications received in the fiscal year, and of the received applications, the number approved and denied by the following payer types:
(A) Uninsured;
(B) Medicare and Medicare Advantage;
(C) State medical assistance programs including out-of-state Medicaid;
(D) Commercial or private health insurance; and
(E) All other payers.
(b) Total number of patients who received cost adjustments based on:
(A) Completing a hospital's financial assistance application; and
(B) Without completing a hospital's financial assistance application, but instead as a result of the hospital's presumptive eligibility process as specified in OAR 409-023-0120.
(c) Total number of patient accounts referred to a debt collector or collection agency;
(d) Total number of patient accounts in which extraordinary collection activities (ECA) occurred, listed by the following categories, as described in 26 C.F.R. 1.501(r)-6(b):
(A) Selling of an individual's debt to another party (except for those sales not considered an ECA as described in 26 C.F.R. 1.501(r)-6(b)(2));
(B) Reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus;
(C) Deferring or denying, or requiring a payment before providing, medically necessary care because of an individual's nonpayment of one or more bills for previously provided care covered under the hospital's financial assistance policy, as described in 26 C.F.R. 1.501(r)-6(b)(iii); and
(D) Taking actions that require a legal or judicial process including, but not limited to, liens, judgements, garnishments, foreclosures, or other action related to collection of a debt owed to the hospital as described in 26 CFR 1.501(r)-6(b)(iv)(A)-(G).
(e) The average and median per person debt, as well as the total amount of debt owed to the hospital by patients whose accounts were either placed in collections or referred to a collection agency during the reporting period.
(4) The Authority shall provide the necessary data reporting templates and make them available on its website no later than September 30th of each year for the upcoming fiscal year reporting.
(5) Data collected on form HFCR and form HFAR shall be made publicly available on the Hospital Reporting Program of the Authority's website. Prior to posting on its website, the Authority shall suppress information as necessary to protect patient confidentiality in accordance with applicable laws and regulations, as well as with the Authority's policies regarding small number reporting.
(6) A hospital that fails to report as required in OAR 409-023-0115 may be subject to a civil penalty not to exceed $500 per day.

Statutory/Other Authority: ORS 442.618
Statutes/Other Implemented: ORS 442.618
History:
OHP 1-2024, amend filed 05/07/2024, effective 05/07/2024
OHP 5-2020, adopt filed 12/21/2020, effective 12/21/2020

Requirements for prescreening patients for presumptive eligibility for financial assistance

(1) Prescreening and presumptive eligibility rules are effective July 1, 2024.
(2) Hospitals must document their prescreening process in their financial assistance policy. Process documentation must disclose the software products and all other third-party services used to evaluate patient household income for prescreening.
(3) The prescreening process and presumptive eligibility determination is not considered an application for financial assistance and does not disqualify a patient from seeking financial assistance.
(4) The prescreening process must use the financial assistance eligibility standards published in the hospital's financial assistance policy and in accordance with the minimum standards specified in ORS 442.614. Any adjustment to patient cost due to the prescreening process must meet the minimum standards specified in ORS 442.614.
(5) Hospitals must complete prescreening for financial assistance and make any resulting adjustments to patient cost prior to sending the patient a billing statement.
(6) Prior to taking any other prescreening actions, the hospital must determine if during the previous nine (9) month period, the patient has applied for financial assistance and the hospital has determined that the patient is eligible for financial assistance based on documentation provided by the patient. If yes, the patient must receive a patient cost adjustment in accordance with ORS 442.614, prior to receiving a billing statement.
(7) Hospitals must prescreen for presumptive eligibility for financial assistance whenever the patient meets any of the following criteria:
(a) Is uninsured; or
(b) Is enrolled in a state medical assistance program; or
(c) Will owe the hospital more than $1,500 for a single hospital encounter after all adjustments from insurance or third-party payers, if applicable, have been made.
(8) Hospitals may prescreen patients who do not meet any of the criteria in (7) above at the hospital's discretion or as established in the hospital's financial assistance policy.
(9) A hospital must not require a patient to present documentation or other verification related to any eligibility criteria as a condition of prescreening or a requirement for adjustment to the patient costs as a result of prescreening. A hospital may accept voluntary submission of information or documentation that would assist the hospital in the prescreening process as long as the hospital does not compel the patient to provide the information.
(10) Hospitals may use existing patient data in the prescreening process, including but not limited to:
(a) Existing patient records;
(b) Information routinely collected during patient registration or admission;
(c) Information voluntarily supplied by the patient;
(d) Previous financial assistance adjustments; and
(e) Existing eligibility for assistance programs. Examples include, but are not limited to: Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Women, Infants and Children (WIC), free lunch or breakfast programs, low-income home energy assistance programs, or any other programs which are means tested and would reasonably reflect the approximate patient household income.
(f) If a hospital's initial prescreening method fails to return information about the patient, the hospital must make a good faith effort to determine the patient's presumptive eligibility status based on other information available to the hospital.
(11) A hospital may use third-party income verification software tools or services or contract with a third party to conduct the prescreening if:
(a) The process does not cause any negative impact on the patient's credit score;
(b) Evaluations must be based on eligibility criteria established in the hospital's written financial assistance policy. Evaluations by non-profit hospitals must be based on household income only, and cannot consider household assets or any assessment, evaluation or score that predicts the patient's propensity or ability to pay; and
(c) If a third-party service or software tool fails to return information about the patient, or specifies the patient's income is unknown, the hospital make a good faith effort to determine the patient's presumptive eligibility status based on information available to the hospital.
(12) Hospitals must document methods utilized under (10) and (11) they took to prescreen the patient.
(13) A hospital must notify the patient in writing of the results of the prescreening process, regardless of outcome. The notification must meet the following standards:
(a) Be written in plain language and either the preferred language of the patient or otherwise in alignment with the translation standards specified in ORS 442.614;
(b) Delivered by a minimum of one of the following means:
(A) Letter;
(B) Email, if agreed to by the patient as an acceptable form of communication;
(C) Message or notification on an online patient portal if the patient is a registered user of the patient portal;
(D) A prominently displayed notice on the billing statement;
(E) An insert accompanying a billing statement; or
(F) In-person acknowledgement signed by the patient.
(c) Clearly state the outcome of the prescreening using plain language for each of the following outcomes:
(A) Presumptively eligible for full financial assistance;
(B) Presumptively eligible for partial financial assistance;
(C) Not presumptively eligible for financial assistance; or
(D) Unable to determine presumptive eligibility status.
(d) If the prescreening process determines that the patient is not presumptively eligible, or their eligibility cannot be determined, or the patient cost adjustment was less than 100% of the patient cost amount, the hospital must further state the following information:
(A) That the patient may still apply for financial assistance, or additional financial assistance, by using the standard hospital financial assistance application;
(B) How a patient may request and receive a physical application or access an online application;
(C) How a patient may request assistance in completing the financial assistance application; and
(D) That the patient is eligible to apply for financial assistance for at least 240 days following the first billing statement for the services provided or at least 12 months after the patient pays for the services provided, or for any additional time period beyond these minimums as specified in the hospital's financial assistance policies.

Statutory/Other Authority: ORS 442.615
Statutes/Other Implemented: ORS 442.614 & 442.615
History:
OHP 3-2026, amend filed 06/29/2026, effective 07/01/2026
OHP 1-2024, adopt filed 05/07/2024, effective 05/07/2024

Requirements for a Process for Patient Appeals of Financial Assistance Determinations

(1) Requirements for patient appeals of financial assistance determination are effective January 1, 2025.
(2) Hospitals must document their financial assistance appeals process in their financial assistance policy.
(3) A patient may only appeal determinations based on applications for financial assistance.
(4) If a hospital denies an application for financial assistance, finds the application to be incomplete or missing documentation, or provides a patient cost adjustment for less than 100% of the patient costs, the hospital must, within ten (10) business days, notify the patient of their ability to take corrective action or appeal the determination. The notification must meet the following criteria:
(a) The notification must be written in plain language and either the preferred language of the patient or otherwise in alignment with the translation standards specified in ORS 442.614.
(b) The notification may be delivered by mail, email, in person, or through an online portal, if the patient is a registered user of the hospital's portal. The notification must be delivered separately and in addition to any financial assistance statements included on billing statements.
(c) The notification must clearly specify whether the application was incomplete or if the patient was denied due to not meeting eligibility criteria.
(A) If the application is found to be incomplete, missing documentation, or containing errors, the notification must designate the application as incomplete and requiring further action by the patient. The notice must further clearly describe the deficiencies and the actions the patient can take to complete the application by correcting the deficiencies.
(B) If the application was denied based on a failure to meet eligibility criteria, the notification must specify the relevant eligibility criteria and provide contact information so that the patient can request further information about the relevant eligibility criteria and the information that was used by the hospital to reach its determination.
(d) The notification must include a clear description of how the patient may submit corrections or additional documentation and how the patient may request an appeal. At a minimum, a patient must be able to submit corrections or additional documentations and request an appeal electronically, by either email or through a secure online portal, by mail, and by in-person delivery.
(e) The notification must inform the patient that if the patient chooses to appeal, the patient may request review by the hospital's Chief Financial Officer or a designee of the hospital's Chief Financial Officer who has been delegated decision-making authority over the appeal.
(f) The notification must inform the patient that the patient may also submit an appeal through a written statement or other supporting documentation.
(g) The notification must provide contact information to an appropriate hospital representative who may answer questions about the appeals process or the patient's financial assistance application.
(5) A hospital must allow a patient the remaining duration of the 240-day application period after the date of the first post-discharge billing statement for the care provided, as specified in 26 CFR 1.501(r)-1(b)(3), or 45 days from the date the patient was notified of the financial assistance determination to correct deficiencies in the application or request an appeal, whichever is greater. A hospital may conduct standard billing practices during the application period if there is not a pending appeal. However, this does not remove the hospital's obligation to reimburse a patient if found to be eligible for financial assistance, in accordance with ORS 442.615.
(6) During the pendency of an appeal a hospital must:
(a) Suspend all collection activities if the hospital has initiated collection activities; and
(b) If the hospital has 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; and
(c) Provide the patient with a written statement, delivered in accordance with OAR 409-023-0125(4)(b), and any request by the patient to use a specific, permitted, different delivery method, that contains:
(A) Confirmation of receipt of the patient's appeal request;
(B) Notice that:
(i) The hospital has suspended all collection activities that it has initiated; and
(ii) If the hospital has sold debt to a collection agency or authorized a collection agency to collect debts on behalf of the hospital, that the hospital has notified the collection agency to suspend collection activities.
(C) Information on any actions the patient may take if a patient has requested a review by the hospital's Chief Financial Officer or a designee.
(7) If it is determined by the hospital officer with the authority to determine the appeal that the patient must provide additional information, the patient must be allowed an additional 45 days, minimum, to provide the requested information. This additional time period runs from the date the hospital officer with the authority to determine the appeal informs the patient that they must supply additional information.
(8) A hospital may allow for multiple meetings to make a decision about the appeal.
(9) A hospital must allow for a third party acting with consent and on behalf of the patient to take action on a patient's application and/or represent the patient on appeal. A hospital may require documentation of consent to representation from the patient.
(10) A hospital must issue a written determination on the appeal within 30 days of either the date of the final appeals meeting or the date of receipt of corrections related to application deficiencies, whichever is later. The hospital must communicate its determination in accordance with plain language and preferred language requirements established in OAR 409-023-0125(4)(a) and it must be delivered in accordance with OAR 409-023-0125(4)(b), and any request by the patient to use a specific, permitted, delivery method.
(a) If the final determination results in a denial of financial assistance, the hospital must also notify the patient of the date on which suspended collection activities, if any, will resume.
(b) A hospital may not resume suspended collection activities until a patient is notified of the final determination.
(11) A patient who has taken corrective action on an application that was determined to have deficiencies may request an appeal if the application is subsequently denied based on a failure to meet the hospital's eligibility criteria.

Statutory/Other Authority: ORS 442.615
Statutes/Other Implemented: ORS 442.614 & 442.615
History:
OHP 1-2024, adopt filed 05/07/2024, effective 05/07/2024

Hospital Financial & Utilization Reporting Statutes

“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]

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]

Application for financial assistance; financial analysis and investigation authority; rules.

(1) The Oregon Health Authority 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 authority 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 authority 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 authority considers material or relevant in connection with functions of the authority 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 for carrying out the functions of the authority. [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; 2015 c.318 §31]

Financial reporting systems.

(1) The Oregon Health Authority 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 authority’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 authority. The authority 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 authority.

(2) Existing systems of reporting used by health care facilities shall be given due consideration by the authority in carrying out the duty of specifying the systems of reporting required by ORS 442.400 to 442.463. The authority insofar as reasonably possible shall adopt reporting systems and requirements that will not unreasonably increase the administrative costs of the facility.

(3) The authority 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 authority 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; 2015 c.318 §32]

Investigations; confidentiality of data.

(1) Whenever a further investigation is considered necessary or desirable by the Oregon Health Authority to verify the accuracy of the information in the reports made by health care facilities, the authority 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 authority 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 authority. [Formerly 441.445; 1995 c.727 §28; 1997 c.683 §24; 2009 c.792 §41; 2015 c.318 §33]

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]

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 Oregon Health Authority may accept information relating to the utilization and cost of health care services identified by the authority 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; 2015 c.318 §34]

Annual utilization report; contents; approval; rules.

(1) Each licensed health facility shall file with the Oregon Health Authority an annual report containing such information related to the facility’s utilization as may be required by the authority, in such form as the authority prescribes by rule.

(2) The annual report shall contain such information as may be required by rule of the authority and must be approved by the authority. [1985 c.747 §§18,19; 1995 c.727 §32; 1997 c.683 §28; 1999 c.581 §8; 2015 c.318 §35]

Definitions

The following definitions apply to OAR 409-015-0005 through 409-015-0040:

(1) “Authority" means the Oregon Health Authority.

(2) "Charity care" means the uncollectible value, at the hospital's full established rates, of services provided to financially indigent patients. The uncollectible portion may vary from a very small percentage of the regular charges for some patients, up to 100 percent for other patients.

(3) "Health care facility" means a hospital, including any special inpatient care facility, and an ambulatory surgical facility. The following facilities are not covered:

(a) Institutions providing only domiciliary care;

(b) Infirmaries of state institutions, colleges and universities;

(d) Long-term care facilities, or hospital-based long-term care service.

(4) "Medicare and Medicaid deductions" means the uncollectible differences between the hospital's full established charges for individual services and the rates paid by Medicare or Medicaid for composite services.

(5) "Other contractual deductions" means the uncollectible differences between full established charges for individual services and the contractual rates paid by a third-party payer for composite services, usually on a per diem, per discharge or capitation basis.

(6) "Provision for bad debts" means the estimated amount of accounts receivable expected to result in credit losses.

(7) "Unreimbursed care" means the sum of the provision for bad debts plus charity service, Medicare deductions, Medicaid deductions and contractual deductions.

Statutory/Other Authority: ORS 442.400 & 442.420
Statutes/Other Implemented: ORS 442.400 & 442.420
History:
OHP 4-2016, f. & cert. ef. 3-28-16
OHP 1-2002, f. & cert. ef. 1-2-02
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
OHP 1-1997, f. & cert. ef. 8-25-97
HP 1-1996, f. & cert. ef. 1-2-96
HP 2-1994, f. & cert. ef. 4-22-94
HP 2-1992, f. & cert. ef. 10-19-92
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 1-1987, f. & ef. 2-3-87
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82
SHPD 6-1981, f. & ef. 10-2-81
SHPD 1-1979, f. & ef. 6-1-79

Report Forms

(1) All health care facilities shall file the required reports and data on forms provided or approved by the Authority.

(2) The Authority adopts and incorporates by reference the Patient Revenue and Unreimbursed Care form, Form FR-3.

(3) The Authority shall not accept obsolete forms.

[ED. NOTE: Forms referenced are available from the agency.]

Statutory/Other Authority: ORS 442.405, 442.420 & 442.425
Statutes/Other Implemented: ORS 442.425
History:
OHP 4-2016, f. & cert. ef. 3-28-16
OHP 3-2011, f. 2-8-11, cert. ef. 3-1-11
OHP 1-2002, f. & cert. ef. 1-2-02
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
OHP 1-1997, f. & cert. ef. 8-25-97
HP 1-1996, f. & cert. ef. 1-2-96
HP 2-1994, f. & cert. ef. 4-22-94
HP 2-1992, f. & cert. ef. 10-19-92
HP 2-1990, f. & cert. ef. 2-12-90
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 12-1986, f. & ef. 7-7-86
SHPD 18-1984, f. & ef. 12-20-84
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82
SHPD 6-1981, f. & ef. 10-2-81
SHPD 1-1979, f. & ef. 6-1-79

Filing Date

The date of filing for the Databank Monthly Data electronically, is the date of receipt by the Oregon Association of Hospitals and Health Systems. The date of filing for the Patient Revenue and Unreimbursed Care (Form FR-3) is the postmark date.

[ED. NOTE: Forms referenced are available from the agency.]

Statutory/Other Authority: ORS 442.405, 442.420 & 442.425
Statutes/Other Implemented: ORS 442.425
History:
OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
HP 1-1996, f. & cert. ef. 1-2-96
HP 2-1990, f. & cert. ef. 2-12-90
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 18-1984, f. & ef. 12-20-84
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82

Reports Required

(1) Each health care facility shall file with the Authority financial statements, with attached certification of audit, not later than 120 days following the close of each fiscal year. If the financial statements of the facility are a part of the combining of a for-profit or not-for-profit corporation, the combining financial statements and attached certification of audit shall be filed.

(2) Each health care facility shall file an accurately completed Databank Monthly Data electronically with the Oregon Association of Hospitals and Health Systems (OAHHS) for receipt by OAHHS on or before the 23rd day of each month. This form will transmit data for the preceding month. The Authority may, at its discretion, exempt a special inpatient care facility, ambulatory surgical facility or other health care facility from the requirements of this section. The Authority may, by oral or written notification, require a health care facility to use an express mail service to submit the Databank Monthly Data Input Form to OAHHS.

(3) The Authority may annually require that each health care facility provide a breakdown of its unreimbursed care into bad debts, charity care, Medicare deductions, Medicaid deductions and other contractual deductions, using Form FR-3.

(4) Each health care facility may be required to annually submit to the Authority a breakdown of its gross patient service revenue into inpatient revenue and outpatient revenue, and other applicable categories specified by Form FR-3.

(5) Documents filed with the Authority under these rules are to be addressed to the Oregon Health Authority, Health Systems Research & Data, 500 Summer St. NE E-64, Salem, Oregon 97301-1079.

[ED. NOTE: Forms referenced are available from the agency.]

Statutory/Other Authority: ORS 442.405, 442.420 & 442.425
Statutes/Other Implemented: ORS 442.425
History:
OHP 4-2016, f. & cert. ef. 3-28-16
OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
HP 1-1996, f. & cert. ef. 1-2-96
HP 2-1990, f. & cert. ef. 2-12-90
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 12-1986, f. & ef. 7-7-86
SHPD 18-1984, f. & ef. 12-20-84
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82
SHPD 6-1981, f. & ef. 10-2-81
SHPD 1-1979, f. & ef. 6-1-79

Instructions to Form RR-4

Text in ORMS

History:
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
HP 2-1990, f. & cert. ef. 2-12-90
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 18-1984, f. & ef. 12-20-84
Reverted to OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
Sunset on 09-28-2017

Modification of Reporting Requirements

(1) The Authority, upon request of a health care facility and for good cause, may relieve or modify the reporting requirements provided for in these rules when the reporting requirement is proven to the satisfaction of the Authority to impose an undue hardship.

(2) Unless otherwise specified by the Authority, any relief or modification granted under section (1) of this rule is restricted to the specific instance or occasion for which relief was sought, and may not be construed to relieve any other reporting requirements of the health care facility.

Statutory/Other Authority: ORS 442.405, 442.420 & 442.425
Statutes/Other Implemented: ORS 442.425
History:
OHP 4-2016, f. & cert. ef. 3-28-16
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82
SHPD 6-1981, f. & ef. 10-2-81
SHPD 1-1979, f. & ef. 6-1-79

Civil Penalties

(1) Pursuant to ORS 442.445, the Authority adopts the following schedule of civil penalties:

(a) $250.00 per day for the first five days of failure to file in accord with ORS 442.425; and

(b) $500.00 per day from the sixth day until filing in accordance with ORS 442.425 is satisfactorily accomplished.

(2) Any amount of civil penalty imposed by the Authority may not be allowed as a reimbursable cost item and may not be recoverable from any category of payment source or patient.

Statutory/Other Authority: ORS 442.405, 442.420 & 442.445
Statutes/Other Implemented: ORS 442.445(2)
History:
OHP 4-2016, f. & cert. ef. 3-28-16
OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99
HP 2-1991, f. & cert. ef. 11-8-91
HP 2-1988, f. & cert. ef. 3-25-88
SHPD 21-1983, f. & ef. 6-28-83
SHPD 9-1982(Temp), f. & ef. 12-30-82
SHPD 6-1981, f. & ef. 10-2-81
SHPD 1-1979, f. & ef. 6-1-79

Hospital Discharge Data Reporting Statutes

Ambulatory surgery and inpatient discharge abstract records; rules; fees.

(1) In order to provide data essential for health planning programs:

(a) The Oregon Health Authority shall obtain directly from each hospital licensed to operate in this state, or from a third party working on behalf of or by contract with the hospital, the following information prescribed by the authority by rule:

(A) Ambulatory surgery discharge abstract records;

(B) Inpatient discharge abstract records; and

(b) The authority shall obtain directly from each ambulatory surgical center licensed to operate in this state, or from a third party working on behalf of or by contract with the ambulatory surgical center, the following information prescribed by the authority by rule:

(A) Ambulatory surgery discharge abstract records; and

(B) Discharge abstract records of patients discharged from extended stay centers licensed under ORS 441.026 that are affiliated with the ambulatory surgical center.

(2) The authority may establish by rule a fee to be charged to each ambulatory surgical center.

(3) The fee established under subsection (2) of this section may not exceed the cost of abstracting and compiling the records.

(4) The authority may specify by rule the form in which records are to be submitted. If the form adopted by rule requires conversion from the form regularly used by a hospital, ambulatory surgical center or extended stay center, reasonable costs of such conversion shall be paid by the authority.

(5) The authority may provide by rule for the submission of ambulatory surgery, inpatient and emergency department discharge abstract records for enrollees in a health maintenance organization in a form the authority determines appropriate to the authority’s needs for the data and the organization’s record keeping and reporting systems for charges and services.

(6) The authority shall notify any entity submitting data under this section of any changes to the data sets that must be submitted, no later than July 1 of the calendar year preceding the effective date of the changes.

(7) The authority may contract with a third party to receive and process the records submitted under this section. [Formerly 442.120]

Note: 442.370 was added to and made a part of ORS chapter 442 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.

Definitions

The following definitions apply to OAR 409-022-0010 to 409-022-0070:
(1) “Ambulatory Surgical Center" has the same meaning given that term in ORS 442.015.
(2) "Ambulatory surgical discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a surgical or diagnostic procedure treatment in a hospital outpatient setting or an ambulatory surgical center setting into a data record.
(3) “Authority" means the Oregon Health Authority.
(4) "Emergency department discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for treatment in a hospital emergency department for patients that were not subsequently admitted to the same hospital as an inpatient.
(5) “Health Care Facility" has the same meaning given that term in ORS 442.015.
(6) "Hospital" has the same meaning given that term in ORS 442.015.
(7) “Hospital inpatient" means acute care provided at a hospital in which the patient was formally admitted under a doctor's order.
(8) “Hospital outpatient" means acute care provided at a hospital in which the patient is not formally admitted to the hospital under a doctor's order.
(9) “Inpatient discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a surgical or diagnostic procedure treatment in a hospital inpatient setting.

Statutory/Other Authority: ORS 442.120
Statutes/Other Implemented: ORS 442.120
History:
OHP 1-2020, amend filed 01/10/2020, effective 01/10/2020
OHP 14-2018, amend filed 11/20/2018, effective 12/01/2018
OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15
OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

Health Care Facility Annual Reports

(1) The Authority may require an annual report from each licensed health care facility on utilization of the facility.
(2) For hospitals, the Authority adopts the American Hospital Association annual survey, as administered by the Oregon Association of Hospitals and Health Systems, as the annual report on utilization of the facility.
(3) For all other health care facilities, the Authority shall notify the health care facility of the requirement no later than December 31 of the year to be reported.¶
(4) A health care facility must submit the annual report on a form, prescribed by the Authority, no later than April 30 of the subsequent year.
(5) The Authority shall acknowledge acceptance of the annual report or inform the licensed health care facility in writing of any corrections required within 30 days of the submission of an annual report by a health care facility.

Statutory/Other Authority: ORS 442.420, 442.463
Statutes/Other Implemented: ORS 442.463
History:
OHP 1-2020, amend filed 01/10/2020, effective 01/10/2020
OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018

Hospital Reporting Requirements

(1) All hospitals must submit the following, in a form and manner prescribed by the Authority:
(a) Inpatient hospital discharge data; and
(b) Emergency department discharge data, and
(c) Ambulatory surgical discharge data in the hospital outpatient setting.
(2) Inpatient hospital discharge data submitted must include the following data elements if the data elements are available:
(a) Patient name;
(b) Patient date of birth;
(c) Patient race;
(d) Patient ethnicity;
(e) Patient sex;
(f) Patient residential address;
(g) Hospital identifier;
(h) Admission date and hour;
(i) Discharge date and hour;
(j) Admitting diagnosis or chief complaint;
(k) Principle diagnosis;
(L) Secondary diagnoses;
(m) Principle procedure performed;
(n) Secondary procedures performed;
(o) Dates of procedures performed;
(p) External cause of injury codes;
(q) Patient disposition or discharge status;
(r) Admission source or point of origin;
(3) Emergency department discharge data must include the following data elements if the data elements are available:
(a) Patient name;
(b) Patient date of birth;
(c) Patient race;
(d) Patient ethnicity;
(e) Patient sex;
(f) Patient residential address;
(g) Hospital identifier;
(h) Admission date and hour;
(i) Discharge date and hour;
(j) Principle diagnosis;
(k) Secondary diagnoses;
(L) Procedures performed;
(m) Dates of procedures performed;
(n) External cause of injury codes;
(o) Patient disposition or discharge status;
(p) Admission source or point of origin;
(q) Admission type;
(r) Total billed charges;
(s) Revenue codes; and
(t) Units of service.
(4) Ambulatory surgical discharge data submitted for hospital outpatient services must include the following data elements if the data elements are available:
(a) Patient name;
(b) Patient date of birth;
(c) Patient race;
(d) Patient ethnicity;
(e) Patient sex;
(f) Patient residential address;
(g) Hospital identifier;
(h) Admission date;
(i) Discharge date;
(j) Principle diagnosis;
(k) Secondary diagnoses;
(L) Procedures performed;
(m) Dates of procedures performed;
(n) External cause of injury codes;
(o) Patient disposition or discharge status;
(p) Admission source or point of origin;
(q) Admission type;
(r) Total billed charges;
(s) Revenue codes; and
(t) Units of service.

Ambulatory Surgical Centers Requirements

(1) On and after January 1, 2020, all licensed Ambulatory Surgical Centers that bill any public or private insurance on behalf of the patient must submit ambulatory surgical discharge data to the Authority, in a form and manner prescribed by the Authority.
(2) Data submitted must include the following data elements if the data elements are available:
(a) Patient name;
(b) Patient date of birth;
(c) Patient race;
(d) Patient ethnicity;
(e) Patient sex;
(f) Patient residential address;
(h) Facility name;
(i) Admission date;
(j) Discharge date;
(k) Principle diagnosis;
(L) Secondary diagnoses;
(m) Procedures performed;
(n) Dates of procedures performed;
(o) External cause of injury codes;
(p) Patient disposition or discharge status;
(q) Admission source or point of origin;
(r) Admission type; and
(s) Total billed charges;
(3) Mandatory reporters shall submit data following standard file layout and data values as prescribed by the Authority.

Statutory/Other Authority: ORS 442.120
Statutes/Other Implemented: ORS 442.120
History:
OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018

Ambulatory Surgical Center Fees

(1) The Authority shall assess a fee pursuant to ORS 442.120 that shall not exceed the total cost of receiving, processing, analyzing and maintaining ambulatory surgical discharge data.
(2) The fee shall not exceed $1.75 per discharge.
(3) The fee shall be calculated by totaling the costs of receiving, processing, analyzing and maintaining the data in the previous two quarters and dividing the total by the number of records received to derive a per record fee.
(4) The Authority shall invoice ambulatory surgical centers every six months based on the calculated per record fee and the number of records submitted. Fees assessed for January 1 through June 30 shall be invoiced no later than December 1 of the same year. Fees assessed for July 1 through December 31 shall be invoiced no later than June 1 of the subsequent year.

Statutory/Other Authority: ORS 442.120
Statutes/Other Implemented: ORS 442.120
History:
OHP 14-2018, adopt filed 11/20/2018, effective 12/01/2018

Health Care Facility Utilization and Discharge Data Use and Disclosure

The Authority may use and disclose data submitted to it under these rules in accordance with ORS 442.120 and OAR 943.014.

Statutory/Other Authority: ORS 442.120
Statutes/Other Implemented: ORS 442.120
History:
OHP 14-2018, amend filed 11/20/2018, effective 12/01/2018
OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15
OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

Hospital Capital Project Reporting Statutes

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 surgical 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.

(d) An ambulatory surgical center as defined in ORS 442.015. [2009 c.595 §1197; 2023 c.9 §39]

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.

Reporting of proposed capital projects by hospitals and ambulatory surgical centers. The Oregon Health Authority 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 home page 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 authority of the posting in the manner prescribed by the authority.

(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 authority of the publication in the manner prescribed by the authority.

(3) Establish a publicly available resource for information collected under this section. [2009 c.595 §1198; 2015 c.318 §30]

Note: See note under 442.361.

Definitions

The following definitions apply to OAR 409-024-0000 to 409-024-0130:

(1) “Authority" means the Oregon Health Authority.

(2) “Capital project" has the meaning described in ORS 442.361.

(3) “Community benefits" mean programs or activities that provide treatment or promote health and healing as a response to identified community needs and are not provided primarily for marketing purposes or to increase market share.

(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.

(d) An ambulatory surgical center as defined in ORS 442.015.

(e) Any Type A, Type B, or DRG hospital as defined in (4)(a) through (c) above that is certified as a Critical Access Hospital by the Centers for Medicare and Medicaid Services.

Statutory/Other Authority: ORS 442.362
Statutes/Other Implemented: ORS 442. 361 & 442.362
History:
OHP 7-2015, f. & cert. ef. 9-24-15
OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10

Capital Project Report

(1) Each reporting entity must submit to the Authority a report of pending or proposed capital projects using a Capital Project Reporting Form CPR-1 as defined by the Authority. The report must be completed in accordance with instructions in the capital project reporting guidelines published on the Authority's website.

(2) The Capital Project Reporting Form CPR-1 shall include but is not limited to:

(a) A summary of the information posted by the reporting entity under ORS 442.362.

(b) The procedure that the reporting entity used to collect public comment.

(d) The estimated cost of the project.

(3) Capital project reports must be submitted to the Authority no later than 30 days after financing for a project that has been approved for ambulatory surgical centers or within 30 days after the project has been approved by the hospital's board of directors or other governing body for hospitals. The report shall be considered submitted on the date the report is postmarked or electronically delivered to the Authority, whichever is first.

(4) The Authority shall maintain on its website a publicly available resource to enable interested parties to view capital project reports filed with the Authority.

Statutory/Other Authority: ORS 442.362
Statutes/Other Implemented: ORS 442.361 & 442.362
History:
OHP 7-2015, f. & cert. ef. 9-24-15
OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10

Public Comments

(1) Each reporting entity must make available a means for interested persons to submit public comments on the capital project either on their website or by posting public notice in a major newspaper for a period of no less than seven days. Comments must be collected for a period of no less than 30 days and made available for public review.

(2) The hospital or ambulatory care center shall then notify the Authority after the 30 day public comment if the hospital or ambulatory care center chooses to complete the project as is or if the project has changed and an expected completion date. The Authority shall post this update on its website for 30 days.

Statutory/Other Authority: ORS 442.362
Statutes/Other Implemented: ORS 442.361 & 442.362
History:
OHP 7-2015, f. & cert. ef. 9-24-15
OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10

Civil Penalties

(1) If the Authority learns that any reporting entity has failed to file a capital project report, the Authority shall contact the reporting entity by certified mail requesting the unfiled report. If the reporting entity fails to reply within 30 calendar days or continues to be non-compliant with the reporting requirements, the Authority shall assess a civil penalty pursuant to the following schedule:

(a) $250 per day for the first five days of failure to file in accordance with ORS 442.991; and

(b) $500 per day from the sixth day until filing in accordance with ORS 442.991 is completed.

(2) Any amount of civil penalty assessed by the Authority may not be allowed as a reimbursable cost item and may not be recoverable from any category of payment source or patient.

Statutory/Other Authority: ORS 442.362
Statutes/Other Implemented: ORS 442.361, 442.362 & 442.991
History:
OHP 7-2015, f. & cert. ef. 9-24-15
OHP 3-2010, f. 6-24-10, cert. ef. 7-1-10

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

Oregon Administrative Rule (OAR) 409-023-0100

Oregon Administrative Rule (OAR) 409-023-0105

Oregon Administrative Rule (OAR) 409-023-0110

Oregon Administrative Rule (OAR) 409-023-0115

Oregon Administrative Rule (OAR) 409-023-0120

Oregon Administrative Rule (OAR) 409-023-0125

Hospital Financial & Utilization Reporting Statutes

Oregon Revised Statutes (ORS) 442.400

Oregon Revised Statutes (ORS) 442.405

Oregon Revised Statutes (ORS) 442.420

Oregon Revised Statutes (ORS) 442.425

Oregon Revised Statutes (ORS) 442.430

Oregon Revised Statutes (ORS) 442.450

Oregon Revised Statutes (ORS) 442.460

Oregon Revised Statutes (ORS) 442.463

Oregon Administrative Rule (OAR) 409-015-0005

Oregon Administrative Rule (OAR) 409-015-0010

Oregon Administrative Rule (OAR) 409-015-0012

Oregon Administrative Rule (OAR) 409-015-0015

Oregon Administrative Rule (OAR) 409-015-0022

Oregon Administrative Rule (OAR) 409-015-0030

Oregon Administrative Rule (OAR) 409-015-0035

Hospital Discharge Data Reporting Statutes

Oregon Revised Statutes ORS 442.370

Oregon Administrative Rule (OAR) 409-022-0010

Oregon Administrative Rule (OAR) 409-022-0015

Oregon Administrative Rule (OAR) 409-022-0020

Oregon Administrative Rule (OAR) 409-022-0025

Oregon Administrative Rule (OAR) 409-022-0035

Oregon Administrative Rule (OAR) 409-022-0070

Hospital Capital Project Reporting Statutes

Oregon Revised Statutes (ORS) 442.361

Oregon Revised Statutes (ORS) 442.362

Oregon Administrative Rule (OAR) 409-024-0000

Oregon Administrative Rule (OAR) 409-024-0110

Oregon Administrative Rule (OAR) 409-024-0120

Oregon Administrative Rule (OAR) 409-024-0130