Oregon Administrative Code

409-070-0050 Retention of Outside Advisors (1) Pursuant to ORS 415.501(14), the Authority or the Department of Justice may retain at the expense of the parties to a material change transaction any actuaries, accountants, consultants, legal counsel and other advisors not otherwise…

409-070-0055 Preliminary 30-Day Review of a Notice of Material Change Transaction (1) Pursuant to ORS 415.501(5) and after receipt of a complete notice of material change transaction in accordance with OAR 409-070-0030(1)(a) and OAR 409-070-0045(5), the Authority must complete a …

409-070-0060 Comprehensive Review of a Notice of a Material Change Transaction (1) Pursuant to ORS 415.501(7), the Authority must conduct a comprehensive review of a proposed transaction if the Authority determines not to approve the transaction at the conclusion of its prelimina…

409-070-0062 Community Review Board (1) The Authority may appoint and convene a community review board to participate in the comprehensive review of a material change transaction, pursuant to ORS 415.501(11). A community review board must: (a) Advise the Authority on the impact o…

409-070-0065 Conditional Approval; Suspension of Proposed Material Change Transaction (1) Following completion of a preliminary review pursuant to OAR 409-070-0055 or a comprehensive review pursuant to OAR 409-070-0060, which may include the appointment of a community review boar…

409-070-0070 Confidentiality; Permitted Disclosures (1) An applicant for review of a material change transaction may designate portions of a notice and any documents thereafter submitted by the applicant in support of the notice as confidential. Any portion or portions of a notic…

409-070-0075 Contested Case Hearings (1) Contested case hearings must be conducted pursuant to ORS 183.411 through ORS 183.497 and the Attorney General's Uniform and Model Rules of Procedure for the Office of Administrative Hearings, OAR 137-003-0501 through OAR 137-003-0700, and…

409-070-0080 Compliance with Conditions; Information Requests (1) Following approval of a material change transaction, the Authority may verify compliance with any conditions that the Authority included in its approval of the transaction and issue such additional orders, followin…

409-070-0082 Follow-up Analyses After the Material Change Transaction (1) Following approval of a material change transaction, the Authority must conduct follow-up analyses one year, two years, and five years after the material change transaction is completed, in accordance with …

409-070-0085 Information Requests The Authority may request additional information, or clarification of submitted information, from parties to proceed with its review of a material change transaction under these rules. The Authority must notify the parties of the information or c…

410-001-0000 Model Rules of Procedure The Oregon Health Authority (Authority), Health Systems Division (Division), chapter 410, shall adhere to Authority rules in chapter 943 regarding Model Rules of Procedure, Notices of Rulemaking, Adoption of Temporary Rules, and Delegation of…

410-001-0005 Notice of Proposed Rulemaking and Adoption of Temporary Rules Oregon Health Authority (Authority), Division of Medical Assistance Programs, chapter 410, will comply with Authority rules in chapter 943 for Notices of Rulemaking and adoption of Temporary rules. Statuto…

410-001-0020 Delegation of Rulemaking Authority Oregon Health Authority (Authority), Division of Medical Assistance Programs, chapter 410, will comply with Authority rules in chapter 943 for Delegation of Rulemaking Authority. Statutory/Other Authority: ORS 183.335, 183.341 & 413…

410-050-0700 Definitions The following definitions apply to OAR 410-050-0700 to 410-050-0870: (1) “Assessment Rate” means assessment applied to assessment paying facility’s inpatient or outpatient net patient revenue. (2) “Authority” means the Oregon Health Authority. (3) "Bad De…

410-050-0710 General Administration (1) The purpose of these rules is to implement the assessment imposed on hospitals in Oregon. (2) The Authority shall administer, enforce, and collect the hospital assessment. The Authority may assign employees, auditors, and other agents as de…

410-050-0720 Disclosure of Information (1) Except as otherwise provided by law, the Authority may not publicly divulge or disclose the amount of income, expense, or other particulars set forth or disclosed in any report or return required in the administration of the assessments.…

410-050-0730 Entities Subject to the Hospital Assessment Each hospital in Oregon is subject to the hospital assessment except: (1) Hospitals operated by the United States Department of Veterans Affairs; (2) Public academic medical centers; (3) Specialty Psychiatric Hospitals; (4)…

410-050-0740 The Hospital Assessment: Calculation, Report, Due Date (1) The amount of the assessment equals the assessment rate multiplied by the hospital’s net revenue, consistent with OAR 410-050-0750, 410-050-0860, and 410-050-0861. The assessment shall be imposed on net reven…

410-050-0750 Reporting Total Net Revenue, Use of Estimated Revenue for Quarterly Reports (1) A hospital shall submit quarterly reports and quarterly payments for the calendar quarters for which an assessment is due consistent with sections (2) and (5) of this rule, and shall subm…

410-050-0760 Filing an Amended Report (1) A hospital that submits a fiscal year reconciliation report without an audited financial statement shall submit an amended fiscal year reconciliation report, an audited financial statement, and such additional fiscal year reconciliation p…

410-050-0770 Determining the Date Filed (1) For the purposes of these rules, any reports, requests, appeals, payments, or other response by the hospital shall be received by the Authority either: (a) Before the close of business on the date due; or (b) If mailed, postmarked befor…

410-050-0780 Records Audit by the Authority (1) The hospital shall maintain financial records necessary and adequate to determine the net revenue for any calendar period for which an assessment may be due. (2) The Authority or its designee may audit the hospital's records at any …

410-050-0790 Determining Assessment for Hospital Failure to File (1) The law places an affirmative duty on the hospital to file a timely and correct report. (2) In the case of a failure by the hospital to file a report or to maintain necessary and adequate records, the Authority …

410-050-0800 Financial Penalty for Failure to File a Report or Failure to Pay Tax When Due (1) A hospital that fails to file a quarterly report or pay a quarterly assessment when due shall be subject to a penalty of up to $500 per day of delinquency. The Authority, in its sole di…

410-050-0810 Notice of Proposed Action (1) Prior to issuing a notice of proposed action, the Authority shall notify the hospital of the potential deficiency or failure to report that could give rise to the imposition of a penalty. The Authority shall issue a notification letter w…

410-050-0820 Required Notice (1) The Authority shall send any required notice to the address and contact person identified by the hospital on its most recently filed report. (2) Any notice required to be sent to the Authority shall be sent to the point of contact identified on th…

410-050-0830 Hearing Process (1) Any hospital that receives a notice of proposed action may request a contested case hearing under ORS 183. (2) The hospital may request a hearing by submitting a written request within 20 days of the date of the notice of proposed action. (3) Prio…

410-050-0840 Final Order of Payment A final order of payment is a final Authority action, expressed in writing, based on a notice of proposed action where a payment amount is due to the Authority. The Authority shall issue a final order of payment for deficiencies or penalties wh…

410-050-0850 Remedies Available after Final Order of Payment Any amounts due and owing under the final order of payment and any interest thereon may be recovered by Oregon as a debt to the state, using any available legal and equitable remedies. These remedies include, but are no…

410-050-0860 Director Determines Assessment Rate (1) The Director shall determine the inpatient and outpatient assessment rate separately. (2) The rate of assessment shall be imposed on the net revenue of each hospital subject to the assessment. The Director shall consult with re…

410-050-0861 Assessment Rate (1) DRG Hospital Assessment rate. (a) The assessment rate for the period beginning January 1, 2005, and ending June 30, 2006, is .68 percent. (b) The assessment rate for the period beginning July 1, 2006, and ending December 31, 2007, is .82 percent. …

410-050-0870 Sunset Provisions (1) The hospital assessment applies to net revenue received by hospitals on or after January 1, 2004, and before October 1, 2025. (2) The Type A and B hospital assessment applies to net revenue received by hospitals on or after January 1, 2018, and …

410-110-0025 Scope These rules establish criteria for awarding grants under the Safety Net Capacity Grant Program, which was established to ensure that safety net providers have capacity to serve vulnerable and underserved children in Oregon. Statutory/Other Authority: ORS 413.22…

410-110-0030 Definitions The following definitions apply to OAR 409-110-0025 to 409-110-0045: (1) “Authority” means the Oregon Health Authority. (2) “Community-sponsored Clinic” means a non-profit, community-based clinic that does not receive state or federal funding and is spons…

410-110-0035 Program Administration (1) The Program is intended to ensure that the target population has access to primary physical, oral, mental, behavioral, and vision health services. (2) The Authority shall award grants to safety net providers through the Program. (3) Service…

410-110-0040 Grant Award Process (1) The Authority shall advertise grant proposals through publication on its website and through communication to eligible entities. (2) All proposals must be submitted in a form specified by the Program and by the date specified in the solicitati…

410-110-0045 Monitoring and Reporting Requirements (1) A grantee shall: (a) Submit grant reports to the Authority on a periodic basis. Grant reports will indicate progress to achieve grant benchmarks and goals and report on the expenditure of grant dollars. Failure to comply with…

410-115-0000 Purpose The Purpose of this Chapter 410, Division 115, is to establish uniform standards for the Authority’s administration of Oregon Health Plan (OHP) Bridge (as defined in OAR 410-115-0005 below). The rules set forth below in this Chapter 410, Division 115 apply ex…

410-115-0005 Acronyms and Definitions (1) The acronyms and definitions within this rule specifically pertain to OHP Bridge. This rule does not include an exhaustive list of acronyms and definitions that apply to OHP Bridge. Other acronyms and definitions that may apply to OHP Bri…

410-115-0010 Application. (1) The Authority shall conduct the application process for OHP Bridge in accordance with the provisions outlined in OAR 410-200-0110. (2) Consistent with 42 C.F.R. 435.905(b), the Authority must provide assistance to all individuals who apply or want to…

410-115-0015 Eligibility and Enrollment. (1) Eligibility requirements for OHP Bridge – Basic Medicaid and OHP Bridge – Basic Health Program are described in OAR 410-200-0437 and in OAR 410-200-0438. (2) Effective start dates for OHP Bridge – Basic Medicaid and OHP Bridge – Basic …

410-115-0020 Continuity of Health Care The agency shall coordinate eligibility and enrollment between the Oregon Health Authority (Authority), the Department of Human Services (Department), and the Federally Facilitated Marketplace as set forth in OAR 410-200-0110 – Coordinated E…

410-115-0025 Grievances and Appeals: Managed Care Entities Obligations; OHP Bridge Program Member Rights. (1) In administering OHP Bridge, Managed Care Entities must comply with the grievance, appeal, and contested case administrative rules set forth in OARs 410-141-3875 through …

410-115-0030 OHP Bridge Covered Services. (1) OHP Bridge members shall be eligible for the Oregon Health Plan (OHP) Bridge benefit package. (a) Benefit Package identifier: BRG (b) Coverage for the OHP Bridge benefit package includes: (A) Coverage of the ten (10) essential health …

410-115-0035 No Premiums or Copayments. OHP Bridge members are not and shall not be required to pay any premiums, copayments and they do not and shall not have to pay any provider to receive covered services. Statutory/Other Authority: ORS 413.042, 414.065, 414.241, 42 CFR 600.50…

410-115-0040 Service Authorization. The service authorization provisions for OHP Bridge are described in OAR 410-141-3835. Statutory/Other Authority: ORS 413.042, 414.065, 414.241, 414.615, 414.625, 414.635, 414.651 & 42 CFR 600 Statutes/Other Implemented: ORS 413.042, 414.065, 4…

410-115-0045 CCO Administration of OHP Bridge – Basic Health Program; OHP Bridge Enrollment and Choice of CCO. (1) OHP Bridge – Basic Health Program shall be administered by Coordinated Care Organizations (CCOs) pursuant to an OHP Bridge – Basic Health Program CCO Contract entere…

410-115-0050 OHP Bridge - BHP Trust Fund. The Authority shall maintain an OHP Bridge - BHP Trust Fund for the receipt of the federal funds and other non-federal funds the Authority is required to use to pay for the Basic Health Program. Pursuant to 42 CFR 600.705, the Authority d…

410-120-0000 Acronyms and Definitions Identification of acronyms and definitions within this rule specifically pertain to their use within the Oregon Health Authority (Authority), Health Systems Division (Division) administrative rules, applicable to the medical assistance progra…

410-120-0001 Interpreter Services (1) Health care providers are required to provide health care language interpreter services for Medicaid members with Limited English Proficiency (LEP) and communication services for people who are deaf and hard of hearing pursuant to Title VI of…