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442.372 Definitions for ORS 442.372 and 442.373. As used in this section and ORS 442.373, “reporting entity” means:
(1) An insurer as defined in ORS 731.106 or fraternal benefit society as described in ORS 748.106 required to have a certificate of authority to transact health insurance business in this state.
(2) A health care service contractor as defined in ORS 750.005 that issues medical insurance in this state.
(3) A third party administrator required to obtain a license under ORS 744.702.
(4) A pharmacy benefit manager or fiscal intermediary, or other person that is by statute, contract or agreement legally responsible for payment of a claim for a health care item or service.
(5) A coordinated care organization as defined in ORS 414.025.
(6) An insurer providing coverage funded under Part A, Part B or Part D of Title XVIII of the Social Security Act, subject to approval by the United States Department of Health and Human Services. [Formerly 442.464]
Note: 442.372 and 442.373 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 442 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
442.373 Health care data reporting by health insurers. (1) The Oregon Health Authority shall establish and maintain a program that requires reporting entities to report health care data for the following purposes:
(a) Determining the maximum capacity and distribution of existing resources allocated to health care.
(b) Identifying the demands for health care.
(c) Allowing health care policymakers to make informed choices.
(d) Evaluating the effectiveness of intervention programs in improving health outcomes.
(e) Comparing the costs and effectiveness of various treatment settings and approaches.
(f) Providing information to consumers and purchasers of health care.
(g) Improving the quality and affordability of health care and health care coverage.
(h) Assisting the authority in furthering the health policies expressed by the Legislative Assembly in ORS 442.310.
(i) Evaluating health disparities, including but not limited to disparities related to race and ethnicity.
(2) The authority shall prescribe by rule standards that are consistent with standards adopted by the Accredited Standards Committee X12 of the American National Standards Institute, the Centers for Medicare and Medicaid Services and the National Council for Prescription Drug Programs that:
(a) Establish the time, place, form and manner of reporting data under this section, including but not limited to:
(A) Requiring the use of unique patient and provider identifiers;
(B) Specifying a uniform coding system that reflects all health care utilization and costs for health care services provided to Oregon residents in other states; and
(C) Establishing enrollment thresholds below which reporting will not be required.
(b) Establish the types of data to be reported under this section, including but not limited to:
(A) Health care claims and enrollment data used by reporting entities and paid health care claims data;
(B) Reports, schedules, statistics or other data relating to health care costs, prices, quality, utilization or resources determined by the authority to be necessary to carry out the purposes of this section; and
(C) Data related to race, ethnicity and primary language collected in a manner consistent with established national standards.
(3) Any third party administrator that is not required to obtain a license under ORS 744.702 and that is legally responsible for payment of a claim for a health care item or service provided to an Oregon resident may report to the authority the health care data described in subsection (2) of this section.
(4) The authority shall adopt rules establishing requirements for reporting entities to train providers on protocols for collecting race, ethnicity and primary language data in a culturally competent manner.
(5)(a) The authority shall use data collected under this section to provide information to consumers of health care to empower the consumers to make economically sound and medically appropriate decisions. The information must include, but not be limited to, the prices and quality of health care services.
(b) The authority shall, using only data collected under this section from reporting entities described in ORS 442.372 (1) to (3), post to its website health care price information including the median prices paid by the reporting entities to hospitals and hospital outpatient clinics for, at a minimum, the 50 most common inpatient procedures and the 100 most common outpatient procedures.
(c) The health care price information posted to the website must be:
(A) Displayed in a consumer friendly format;
(B) Easily accessible by consumers; and
(C) Updated at least annually to reflect the most recent data available.
(d) The authority shall apply for and receive donations, gifts and grants from any public or private source to pay the cost of posting health care price information to its website in accordance with this subsection. Moneys received shall be deposited to the Oregon Health Authority Fund.
(e) The obligation of the authority to post health care price information to its website as required by this subsection is limited to the extent of any moneys specifically appropriated for that purpose or available from donations, gifts and grants from private or public sources.
(6) The authority may contract with a third party to collect and process the health care data reported under this section. The contract must prohibit the collection of Social Security numbers and must prohibit the disclosure or use of the data for any purpose other than those specifically authorized by the contract. The contract must require the third party to transmit all data collected and processed under the contract to the authority.
(7) The authority shall facilitate a collaboration between the Department of Human Services, the authority, the Department of Consumer and Business Services and interested stakeholders to develop a comprehensive health care information system using the data reported under this section and collected by the authority under ORS 442.370 and 442.400 to 442.463. The authority, in consultation with interested stakeholders, shall:
(a) Formulate the data sets that will be included in the system;
(b) Establish the criteria and procedures for the development of limited use data sets;
(c) Establish the criteria and procedures to ensure that limited use data sets are accessible and compliant with federal and state privacy laws; and
(d) Establish a time frame for the creation of the comprehensive health care information system.
(8) Information disclosed through the comprehensive health care information system described in subsection (7) of this section:
(a) Shall be available, when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal laws, as a resource to insurers, employers, providers, purchasers of health care and state agencies to allow for continuous review of health care utilization, expenditures and performance in this state;
(b) Shall be available to Oregon programs for quality in health care for use in improving health care in Oregon, subject to rules prescribed by the authority conforming to state and federal privacy laws or limiting access to limited use data sets;
(c) Shall be presented to allow for comparisons of geographic, demographic and economic factors and institutional size; and
(d) May not disclose trade secrets of reporting entities.
(9) The collection, storage and release of health care data and other information under this section is subject to the requirements of the federal Health Insurance Portability and Accountability Act. [Formerly 442.466]
Note: See note under 442.372.
(Temporary provisions relating to statewide strategic plan for collection and use of health care data)
Note: Sections 1 and 16, chapter 389, Oregon Laws 2015, provide:
Sec. 1. (1) The Oregon Health Policy Board, in consultation with the Public Employees’ Benefit Board, the Oregon Educators Benefit Board, the Oregon Health Authority and the Department of Consumer and Business Services shall develop a statewide strategic plan for the collection and use of health care data. The plan must:
(a) Include clear objectives for how health care data will be used, and what types of data are needed, in state health care programs to support health system transformation efforts and promote value;
(b) Allow for alignment of performance metrics across state health care programs;
(c) Ensure that the state’s efforts in the collection and use of health care data encourage integrated and coordinated care, promote improved quality, health outcomes and patient satisfaction and help reduce costs;
(d) Include strategies to ensure that the state’s collection, use and measurement of health care data advance payment reform and allow for alternative payment methodologies;
(e) To the extent practicable, allow for alternative reporting and measurement mechanisms that are not claims-based or that are for payers and providers who are moving away from fee-for-service based reimbursement;
(f) Identify appropriate and inappropriate uses of health care data, including safeguards to ensure privacy and ensure that data is not used for marketing or other inappropriate purposes; and
(g) Outline a five-year vision including implementation timelines in sufficient detail that health care stakeholders can plan for expected new data reporting requirements and uses.
(2) The Oregon Health Policy Board shall submit the plan developed under subsection (1) of this section to the interim committees of the Legislative Assembly related to health care no later than September 1, 2016.
(3) The performance measures developed by the Health Plan Quality Metrics Committee established under ORS 413.017 (4) must be aligned with the statewide strategic plan adopted under this section. [2015 c.389 §1]
Sec. 16. Section 1 of this 2015 Act is repealed on January 2, 2021. [2015 c.389 §16]
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