Chapter 581 Oregon Laws 1999

Session Law

AN ACT

HB 2146

Relating to the duties of the Oregon Health Council; creating new provisions; amending ORS 442.045, 442.120, 442.325, 442.405, 442.420, 442.425, 442.445, 442.460 and 442.463; and repealing ORS 442.410, 442.415, 442.435, 442.465 and 442.469.

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

SECTION 1. ORS 442.045 is amended to read:

442.045. The Oregon Health Council shall perform the following functions:

(1) Act as the policy-making body for a statewide data clearinghouse established within the Department of Human Resources or among other state agencies as appropriate for the acquisition, compilation, correlation and dissemination of data from health care providers, other state and local agencies including the state Medicaid program, third-party payers and other appropriate sources in furtherance of the purpose and intent of the Legislative Assembly as expressed in ORS 442.025.

(2) Review reports provided at least biennially by the Administrator of the Office for Oregon Health Plan Policy and Research on the findings, trends and long-term implications arising from data collected pursuant to ORS 442.120 and 442.400 to 442.450 and by the statewide data clearinghouse authorized by subsection (1) of this section.

[(2)] (3) Provide a forum for discussion of health care issues facing the citizens of the State of Oregon.

[(3)] (4) Identify and analyze significant health care issues affecting the state and make policy recommendations to the Governor.

[(4)] (5) [Annually prepare, review, revise as necessary, and adopt a state health plan which shall be made up of such state agency health plans as the council deems appropriate.] Prepare and submit to the Governor and the Legislative Assembly resolutions relating to health care reform.

[(5)] (6) Act as the primary advisory committee to the Office for Oregon Health Plan Policy and Research, the Governor and the Legislative Assembly.

[(6)] (7) Perform all other functions authorized or required by state law.

SECTION 2. ORS 442.120 is amended to read:

442.120. In order to provide data essential for health planning programs:

(1) The Office for Oregon Health Plan Policy and Research may request, by July 1 of each year, each general hospital to file with the office [hospital] ambulatory surgery and inpatient discharge abstract records covering all [inpatients] patients discharged during the preceding calendar year. The [hospital] ambulatory surgery and inpatient discharge abstract record for each patient [shall] must include [at least] the following information, and may include other information deemed necessary by the office for developing or evaluating statewide health policy:

(a) Date of birth;

(b) Sex;

(d) Inpatient admission date or outpatient service date;

(e) Inpatient discharge date;

(f) Type of discharge;

(g) Diagnostic related group or diagnosis;

(h) Type of [surgical] procedure performed;

(i) Expected source of payment, if available;

(j) Hospital identification number; and

(k) Total hospital charges.

(2) By July 1 of each year, the office may request from ambulatory surgery centers licensed under ORS 441.015 ambulatory surgery discharge abstract records covering all patients admitted during the preceding year. Ambulatory surgery discharge abstract records must include information similar to that requested from general hospitals under subsection (1) of this section.

[(2)] (3) In lieu of abstracting and compiling the [discharge abstract] records itself, the office may solicit the voluntary submission of such data from Oregon hospitals or other sources to enable it to carry out its responsibilities under this section. If such data is not available to the office on an annual and timely basis, the office may establish by rule a [hospital discharge] fee to be charged each hospital.

[(3)] (4) Subject to prior approval of the Oregon Department of Administrative Services and a report to the Emergency Board, if the Legislative Assembly is not in session, prior to adopting the fee, and within the budget authorized by the Legislative Assembly as the budget may be modified by the Emergency Board, the fee established under subsection [(2)] (3) of this section shall not exceed the cost of abstracting and compiling the [discharge abstract] records.

[(4)] (5) The office may specify by rule the form in which the [hospital discharge abstract] records are to be submitted. If the form adopted by rule requires conversion from the form regularly used by a hospital, reasonable costs of such conversion shall be paid by the office.

[(5)] (6) [No patient identifier shall be included with the hospital discharge abstract record to insure that patient confidentiality is maintained] Abstract records must include a patient identifier that allows for the statistical matching of records over time to permit public studies of issues related to clinical practices, health service utilization and health outcomes. Provision of such a patient identifier must not allow for identification of the individual patient.

[(6)] (7) In addition to the records required in subsection (1) of this section, the office may obtain [hospital discharge] abstract records for each patient [which] that identify specific services, classified by International Classification of Disease Code, for special studies on the incidence of specific health problems or diagnostic practices. However, nothing in this subsection shall authorize the publication of [such] specific data [with patient, physician or hospital identifiers] in a form that allows identification of individual patients or licensed health care professionals.

[(7)] (8) The office may provide by rule for the submission of records for enrollees in a health maintenance organization from a hospital associated with such an organization in [such] a form [as] the office determines appropriate to the office's needs for such data and the organization's record keeping and reporting systems for charges and services.

SECTION 3. ORS 442.405 is amended to read:

442.405. 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) That cost containment programs be established and implemented by health care facilities in such manner as to both enable and motivate such facilities to control rapidly increasing costs;]

[(2)] (1) To require health care facilities to file for public disclosure [such] reports [under systems of accounting as] that will enable both private and public purchasers of services from such facilities to make informed decisions in purchasing such services; and

[(3)] (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.

SECTION 4. ORS 442.420 is amended to read:

442.420. (1) The Office for Oregon Health Plan Policy and Research 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) [In cooperation with the appropriate health systems agency and the appropriate professional review organizations,] The Administrator of the Office for Oregon Health Plan Policy and Research 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 442.450 and sources of public and private financing of financial requirements of such facilities.

(3) The administrator 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 administrator considers material or relevant in connection with functions of the office subject to the provisions of ORS 183.310 to 183.550;

(c) Exercise, subject to the limitations and restrictions imposed by ORS 442.400 to 442.450, all other powers which are reasonably necessary or essential to carry out the express objectives and purposes of ORS 442.400 to 442.450; and

(d) Adopt rules in accordance with ORS 183.310 to 183.550 necessary in the administrator's judgment for carrying out the functions of the office.

SECTION 5. ORS 442.425 is amended to read:

442.425. (1) The Administrator of the Office for Oregon Health Plan Policy and Research by rule may specify one or more uniform systems of [accounting and] financial reporting[,] necessary to meet the requirements of ORS 442.400 to 442.450. 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 administrator'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 administrator. The administrator 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 administrator.

(2) Existing systems of [accounting and] reporting used by health care facilities shall be given due consideration by the administrator in carrying out the duty of specifying the systems of [accounting and uniform] reporting required by ORS 442.400 to 442.450. The administrator insofar as reasonably possible shall adopt [accounting and] reporting systems and requirements [which] that will not unreasonably increase the administrative costs of the facility.

(3) The administrator may allow and provide for modifications in the [accounting and] reporting [system] 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 442.450.

(4) The administrator 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 441.055 and 442.400 to 442.450, such facilities shall be authorized to utilize established accounting systems and to report costs and revenues in a manner [which is] 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, [they] 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.

SECTION 6. ORS 442.445 is amended to read:

442.445. (1) Any health care facility that fails to perform as required in ORS 442.400 to 442.450 and rules of the Office for Oregon Health Plan Policy and Research may be subject to a civil penalty.

(2) The Administrator of the Office for Oregon Health Plan Policy and Research shall adopt a schedule of penalties [which shall] not to exceed [$100] $500 per day of violation, determined by the severity of the violation.

(3) Civil penalties under this section shall be imposed as provided in ORS 183.090.

(4) [The penalty] Civil penalties imposed under this section may be remitted or mitigated upon such terms and conditions as the administrator considers proper and consistent with the public health and safety.

(5) Civil penalties incurred under any law of this state are not allowable as costs for the purpose of rate determination or for reimbursement by a third-party payer.

SECTION 7. ORS 442.460 is amended to read:

442.460. In order to obtain regional or statewide data about [physician charges for nonhospital-based services] the utilization and cost of health care services, the Office for Oregon Health Plan Policy and Research [shall request information about physician charges for the 25 major diagnosis-related groups] may accept information relating to the utilization and cost of health care services identified by the Administrator of the Office for Oregon Health Plan Policy and Research from physicians, insurers or other third-party payers or employers or other purchasers of health care. [Compliance with the request is voluntary on the part of such physicians, insurers and payers.]

SECTION 8. ORS 442.463 is amended to read:

442.463. (1) [By December 31 of each year,] Each licensed health facility shall file with the Office for Oregon Health Plan Policy and Research an annual report containing such information related to the facility's utilization as may be required by the Administrator of the Office for Oregon Health Plan Policy and Research, in such form as the administrator prescribes by rule.

[(2) The Department of Human Resources shall withhold medical assistance payments not to exceed 10 percent of such payments from any licensed health facility upon notice from the administrator that the facility has failed to submit an annual report until the report is filed or if the report is filed after it is disapproved.]

[(3)] (2) The annual report shall contain such information as may be required by rule of the administrator and must be approved by the administrator.

SECTION 9. ORS 442.325 is amended to read:

442.325. (1) A certificate of need shall be required for the development or establishment of a health care facility of any new health maintenance organization.

(2) Any activity of a health maintenance organization which does not involve the direct delivery of health services, as distinguished from arrangements for indirect delivery of health services through contracts with providers, shall be exempt from certificate of need review.

(3) Nothing in ORS 244.050, 431.250, 441.015 to 441.087, 442.015 to 442.420[, 442.435] and 442.450 applies to any decision of a health maintenance organization involving its organizational structure, its arrangements for financing health services, the terms of its contracts with enrolled beneficiaries or its scope of benefits.

(4) With the exception of certificate of need requirements, when applicable, the licensing and regulation of health maintenance organizations shall be controlled by ORS 750.005 to 750.095 and statutes incorporated by reference therein.

(5) It is the policy of ORS 244.050, 431.250, 441.015 to 441.087, 442.015 to 442.420[, 442.435] and 442.450 to encourage the growth of health maintenance organizations as an alternative delivery system and to provide the facilities for the provision of quality health care to the present and future members who may enroll within their defined service area.

(6)(a) It is also the policy of ORS 244.050, 431.250, 441.015 to 441.087, 442.015 to 442.420[, 442.435] and 442.450 to consider the special needs and circumstances of health maintenance organizations. Such needs and circumstances include the needs of and costs to members and projected members of the health maintenance organization in obtaining health services and the potential for a reduction in the use of inpatient care in the community through an extension of preventive health services and the provision of more systematic and comprehensive health services. The consideration of a new health service proposed by a health maintenance organization shall also address the availability and cost of obtaining the proposed new health service from the existing providers in the area that are not health maintenance organizations.

(b) The Health Division shall issue a certificate of need for beds, services or equipment to meet the needs or reasonably anticipated needs of members of health maintenance organizations when beds, services or equipment are not available from nonplan providers.

SECTION 10. ORS 442.460 and 442.463 are added to and made a part of ORS 442.400 to 442.450.

SECTION 11. ORS 442.410, 442.415, 442.435, 442.465 and 442.469 are repealed.

Approved by the Governor July 12, 1999

Filed in the office of Secretary of State July 12, 1999

Effective date October 23, 1999

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