Chapter 875 Oregon Laws 2001

AN ACT

HB 2516

Relating to rural health care; amending ORS 414.065, 442.315 and 442.470; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 414.065 is amended to read:

414.065. (1) With respect to medical and remedial care and services to be provided in medical assistance during any period, and within the limits of funds available therefor, the Department of Human Services shall determine, subject to such revisions as it may make from time to time and with respect to the “health services” defined in ORS 414.705, subject to legislative funding in response to the report of the Health Services Commission:

(a) The types and extent of medical and remedial care and services to be provided to each eligible group of recipients of medical assistance.

(b) Standards to be observed in the provision of medical and remedial care and services.

(c) The number of days of medical and remedial care and services toward the cost of which public assistance funds will be expended in the care of any person.

(d) Reasonable fees, charges and daily rates to which public assistance funds will be applied toward meeting the costs of providing medical and remedial care and services to an applicant or recipient.

(e) Reasonable fees for professional medical and dental services which may be based on usual and customary fees in the locality for similar services.

(f) The amount and application of any copayment or other similar cost-sharing payment that the department may require a recipient to pay toward the cost of medical and remedial care or services.

(2) The types and extent of medical and remedial care and services and the amounts to be paid in meeting the costs thereof, as determined and fixed by the department and within the limits of funds available therefor, shall be the total available for medical assistance and payments for such medical assistance shall be the total amounts from public assistance funds available to providers of medical and remedial care and services in meeting the costs thereof.

(3) Except for payments under a cost-sharing plan, payments made by the department for medical assistance shall constitute payment in full for all medical and remedial care and services for which such payments of medical assistance were made.

(4) Medical benefits, standards and limits established pursuant to subsection (1)(a), (b) and (c) of this section for the eligible medically needy, except for the aged served under ORS chapter 413 and for the blind and disabled served under ORS chapter 412, may be less but shall not exceed medical benefits, standards and limits established for the eligible categorically needy, except that, in the case of a research and demonstration project entered into under ORS 411.135, medical benefits, standards and limits for the eligible medically needy may exceed those established for specific eligible groups of the categorically needy.

(5) Notwithstanding the provisions of this section, the department shall cause Type A hospitals, [and] Type B hospitals and rural critical access hospitals, as [defined] described in ORS 442.470, identified by the Office of Rural Health as rural hospitals to be reimbursed for the cost of covered services as follows:

(a) For services provided to persons entitled to receive medical assistance, based on the Medicare determination of reasonable cost as derived from the Hospital and Hospital Health Care Complex Cost Report, referred to as the Medicare Report.

(b) In accordance with the terms of the agreement for services provided to persons whose medical assistance benefits are administered by the contracting health care provider under an agreement between the hospital and a health care provider contracting with the Department of Human Services under ORS 414.725 (1) for reimbursement other than that specified by ORS 414.727 (1). Hospitals reimbursed under the terms of this paragraph are entitled to no additional reimbursement for services provided.

(c) Hospitals that have been reimbursed by health care providers contracting with the Department of Human Services under ORS 414.725 (1) in accordance with ORS 414.727 (1), are entitled to full reimbursement from the department for the cost of covered services provided to persons whose medical assistance benefits are administered by the contracting health care provider according to paragraph (a) of this subsection.

SECTION 2. ORS 442.470 is amended to read:

442.470. As used in ORS 442.470 to 442.507:

(1) “Acute inpatient care facility” means a licensed hospital with an organized medical staff, with permanent facilities that include inpatient beds, and with comprehensive medical services, including physician services and continuous nursing services under the supervision of registered nurses, to provide diagnosis and medical or surgical treatment primarily for but not limited to acutely ill patients and accident victims.

(2) “Council” means the Rural Health Coordinating Council.

(3) “Office” means the Office of Rural Health.

(4) “Primary care physician” means a doctor licensed under ORS chapter 677 whose specialty is family practice, general practice, internal medicine, pediatrics or obstetrics and gynecology.

(5)(a) “Rural hospital” means a hospital characterized [by] as one of the following:

[(a)] (A) A type A [hospitals are] hospital, which is a small and remote[, have] hospital that has 50 or fewer beds and [are greater] is more than 30 miles from another acute inpatient care facility;

[(b)] (B) A type B [hospitals are] hospital, which is a small and rural [and have] hospital that has 50 or fewer beds[,] and [are] is 30 miles or less from another acute inpatient care facility;

[(c)] (C) A type C [hospitals are] hospital, which is considered to be a rural hospital and [have] has more than 50 beds, but [are] is not a referral center; or

(D) A rural critical access hospital as defined in ORS 316.143.

[(d)] (b) “Rural hospital” [of any class] does not include a hospital of any class that was designated by the federal government as a rural referral hospital before January 1, 1989.

SECTION 3. ORS 442.315 is amended to read:

442.315. (1) Any new hospital or new skilled nursing or intermediate care service or facility not excluded pursuant to ORS 441.065 shall obtain a certificate of need from the Health Division prior to an offering or development.

(2) The division shall adopt rules specifying criteria and procedures for making decisions as to the need for such new services or facilities.

(3)(a) An applicant for a certificate of need shall apply to the division on forms provided for this purpose which forms shall be established by division rule.

(b) An applicant shall pay a fee prescribed as provided in this section. Subject to the approval of the Oregon Department of Administrative Services, the division shall prescribe application fees, based on the complexity and scope of the proposed project.

(4) The division shall be the decision-making authority for the purpose of certificates of need.

(5)(a) An applicant or any affected person who is dissatisfied with the proposed decision of the division is entitled to an informal hearing in the course of review and before a final decision is rendered.

(b) Following a final decision being rendered by the division, an applicant or any affected person may request a reconsideration hearing pursuant to ORS 183.310 to 183.550.

(c) In any proceeding brought by an affected person or an applicant challenging a division decision under this subsection, the division shall follow procedures consistent with the provisions of ORS 183.310 to 183.550 relating to a contested case.

(6) Once a certificate of need has been issued, it may not be revoked or rescinded unless it was acquired by fraud or deceit. However, if the division finds that a person is offering or developing a project that is not within the scope of the certificate of need, the division may limit the project as specified in the issued certificate of need or reconsider the application. A certificate of need is not transferable.

(7) Nothing in this section applies to any hospital, skilled nursing or intermediate care service or facility that seeks to replace equipment with equipment of similar basic technological function or an upgrade that improves the quality or cost-effectiveness of the service provided. Any person acquiring such replacement or upgrade shall file a letter of intent for the project in accordance with the rules of the division if the price of the replacement equipment or upgrade exceeds $1 million.

(8) Except as required in subsection (1) of this section for a new hospital or new skilled nursing or intermediate care service or facility not operating as a Medicare swing bed program, nothing in this section requires a rural hospital as defined in ORS 442.470 [(5)(a) and (b)] (5)(a)(A) and (B) to obtain a certificate of need.

(9) Nothing in this section applies to basic health services, but basic health services do not include:

(a) Magnetic resonance imaging scanners;

(b) Positron emission tomography scanners;

(d) Megavoltage radiation therapy equipment;

(e) Extracorporeal shock wave lithotriptors;

(f) Neonatal intensive care;

(g) Burn care;

(h) Trauma care;

(i) Inpatient psychiatric services;

(j) Inpatient chemical dependency services;

(k) Inpatient rehabilitation services;

(L) Open heart surgery; or

(m) Organ transplant services.

(10) In addition to any other remedy provided by law, whenever it appears that any person is engaged in, or is about to engage in, any acts which constitute a violation of this section, or any rule or order issued by the division under this section, the division may institute proceedings in the circuit courts to enforce obedience to such statute, rule or order by injunction or by other processes, mandatory or otherwise.

(11) As used in this section, “basic health services” means health services offered in or through a hospital licensed under ORS chapter 441, except skilled nursing or intermediate care nursing facilities or services and those services specified in subsection (9) of this section.

SECTION 4. This 2001 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2001 Act takes effect on its passage.

Approved by the Governor July 31, 2001

Filed in the office of Secretary of State July 31, 2001

Effective date July 31, 2001

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