Oregon Administrative Code

409-021-0005 Introduction This division defines the access to the health data collected from various sources and stored at the Office for Oregon Health Policy and Research. Statutory/Other Authority: ORS 442.420(3)(d) Statutes/Other Implemented: ORS 192.410 - 192.440 & 442.420(3)…

409-021-0010 Definitions As used in this division: (1) “Computer” means a desktop personal computer physically located in the Office. (2) “Data use agreement” means the terms, conditions, restrictions, and other rules governing the use of health data as specified in Form D-1 (Res…

409-021-0115 Calculation of Fees The Office shall charge fees necessary to fully recover the reasonable costs of responding to data requests and requests to examine health data maintained by the Office. (1) The costs that the Office shall recover include, but are not limited to: …

409-021-0120 Inspection of Health Data (1) An inspection of the health data that are maintained at the Office shall be only by appointment during the normal working days and business hours of the Office. (2) Requests to inspect health data that are maintained by the Office may, a…

409-021-0130 Requests to Obtain Copies of Public Use Health Data Files (1) Any requestor who wishes to obtain copies of public use health data files maintained by the Office shall provide all of the following: (a) Form D-1 (Research Data Request). (b) Form D-2 (Data Order Form). …

409-021-0140 Requests and Requirements to Obtain Restricted Health Data Sets (1) The Office may authorize the disclosure of health data in accordance with an approved data use agreement entered into by both the Office and a researcher, pursuant to which the Office may disclose a …

409-021-0150 Denial of Requests to Inspect or Obtain Copies of Health Data The Office shall deny requests to inspect health data, receive copies of public use health data sets, and receive copies of restricted health data sets in order to prevent uses that are not consistent with…

409-022-0010 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 p…

409-022-0015 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 …

409-022-0020 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 hospit…

409-022-0025 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 manne…

409-022-0035 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.…

409-022-0070 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…

409-023-0100 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”…

409-023-0105 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 fr…

409-023-0110 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…

409-023-0115 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 …

409-023-0120 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. Pro…

409-023-0125 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 t…

409-024-0000 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 treat…

409-024-0110 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 th…

409-024-0120 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 mu…

409-024-0130 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 calen…

409-025-0100 Definitions The following definitions apply to OAR 409-025-0100 to 409-025-0190 (1) “Accident policy” means an insurance policy that provides benefits only for a loss due to accidental bodily injury. (2) “Allowed amount” means the actual amount of charges for healthc…

409-025-0110 General Reporting Requirements (1) Determination of “mandatory reporter”: (a) For carriers, dental carriers and licensed third-party administrators, the Authority shall identify mandatory reporters using information collected by DCBS including, but not limited to, da…

409-025-0120 Data File Layout, Format, and Coding Requirements (1) All mandatory reporters shall submit claims-based data for all claims where the subscriber’s residence is in Oregon or the subscriber is enrolled in a plan for which the State of Oregon is the payer. (2) Claims-ba…

409-025-0125 Payment Arrangement Reporting: File Layout, Format, and Coding Requirements (1) All mandatory reporters other than PBMs shall report payment arrangements for all contracts sitused in Oregon. For contracts issued at the group level, the contract is considered sitused …

409-025-0130 Data Submission Requirements (1) Mandatory reporters shall submit data files as specified in the Data Submission Schedule. Voluntary reporters may consult with the Authority to submit healthcare claims data files on an alternative schedule. (2) Mandatory and voluntar…

409-025-0140 Waivers, Exemptions and Extensions (1) The Authority may grant a waiver, deadline extension, or exemption to the reporting and validation requirements. (2) A mandatory reporter is required by law and rule to submit all required data files no later than the submission…

409-025-0150 Compliance and Enforcement (1) Unless approved by a waiver or extension, failure to comply with general reporting requirements includes but is not limited to: (a) Failure to submit data files for a required line of business; or (b) Submitting health information for a…

409-025-0160 Data Access and Release (1) The Authority shall comply with all relevant state and federal data privacy, security, and antitrust regulations, including The Health Insurance Portability and Accountability Act (HIPAA), when sharing APAC data. (2) The Authority may coll…

409-025-0170 Public Disclosure The Authority and applicable contractors, shall perform data analyses and publish data and reports that serve the public’s interest. This may include, but is not limited to: (1) Comparing healthcare cost and quality; (2) Assessing health care utiliz…

409-025-0180 APAC Technical Advisory Group The Oregon Health Authority shall convene a technical advisory group to advise the Authority on submission specifications including but not limited to file layouts, the Data Submission Schedule, and any additional data submission require…

409-025-0190 Data Review Committee (1) The Authority shall convene a Data Review Committee (DRC) to evaluate completed applications. (2) The Authority may accept nominations for and make appointments to the DRC. The DRC shall include at least one mandatory reporter to serve in an…

409-026-0100 Definitions The following definitions apply to OAR 409-026-0100 to 409-026-0140: (1) “Authority” means the Oregon Health Authority. (2) “Electronic media” means an electronic data storage medium. (3) “Health care workforce information” means data collected using the …

409-026-0110 Data Elements (1) Pursuant to ORS 676.410, a health care workforce regulatory board must collaborate with the Oregon Health Authority to collect health care workforce information. The information may include but is not limited to the following: (a) Gender; (b) Race; …

409-026-0120 Reporting Schedule and Format (1) Health care licensing boards shall include data collection set forth OAR 409-026-0110 in the license renewal process, using the Authority’s provided data collection tool or other tool agreed upon by the Authority. (2) Collection of t…

409-026-0130 Fees (1) The Authority shall establish a per-license fee to cover the cost of collecting and reporting health care workforce information. The fee shall be calculated by adding the costs necessary to compile, maintain, and analyze the health care workforce information…

409-026-0140 Data Access (1) For purposes of planning or analysis, the Authority may share de-identified, individual-level health care workforce data with other state agencies, including but not limited to: (a) Agencies, offices, or contractors of the Authority. (b) The Oregon Em…

409-030-0100 Purpose These rules (OAR 409-030-0100 to 409-030-0250) establish standards for administrative requirements for health professional student placements in clinical training settings within the state of Oregon. The purpose of these rules is to mitigate inconsistencies t…

409-030-0110 Definitions The following definitions apply to OAR 409-030-0100 to 409-030-0250: (1) “Administrative requirements” means those requirements that must be documented and verified before health professions program students may begin clinical placements, and includes cri…

409-030-0120 General applicability (1) These rules apply to all students who: (a) Plan to undergo clinical training at a setting listed in OAR 409-030-0140 within the state of Oregon; regardless of the location of the health profession or health-related profession program in whic…

409-030-0130 Health Professional Disciplines (1) Except as provided in OAR 409-030-0150, these rules apply to students of the following health professions: (a) Audiologists, as defined in ORS 681.205; (b) Clinical laboratory science specialists, including medical technologists, m…

409-030-0140 Clinical Settings (1) Except as provided in OAR 409-030-0140(2) and 409-030-0150, these rules apply to the following clinical facilities hosting health professions students in the disciplines described in OAR 409-030-0130: (a) Ambulatory care settings, including but …

409-030-0150 Exceptions (1) In addition to the exceptions listed in OAR 409-030-0130(2) and 409-030-0140(2), the standards in these rules: (a) Only apply to students who engage in direct patient care as part of their clinical placement. (b) Do not apply to students who are underg…

409-030-0160 Regular Review of Clinical Placement Standards (1) The Authority shall convene an advisory group that may include representatives of affected students, health profession programs, clinical settings, and healthcare boards that regulate health profession programs. The …

409-030-0170 Administrative Requirements for Clinical Placement (1) In order to be eligible for a clinical placement at a covered site within the state of Oregon, students subject to these rules must satisfy requirements for each of the following categories, as further described …

409-030-0180 Immunization Standards (1) Evidence of immunizations required or recommended in OAR 409-030-0150, Table 1, may be demonstrated through the following: (a) A document appropriately signed or officially stamped and dated by a qualified medical professional or an authori…

409-030-0190 Screening Standards Table 1 in OAR 409-030-0150 provides detailed information related to required screenings for students’ clinical placements. Required screenings consist of: (1) Tuberculosis (OAR 409-030-0200); (2) Substance abuse or misuse (OAR 409-030-0210); and …

409-030-0200 Tuberculosis Screening (1) A student must obtain and provide documentation for TB screening consistent with the requirements for immunization in OAR 409-030-0180. (2) TB screening must be conducted in a manner consistent with the CDC guidelines available at https://w…