Chapter 442 — Health
Planning
2011 EDITION
HEALTH PLANNING
PUBLIC HEALTH AND SAFETY
ADMINISTRATOR OF THE OFFICE FOR OREGON
HEALTH POLICY AND RESEARCH
442.011 Office
for Oregon Health Policy and Research created; appointment of administrator
ADMINISTRATION
442.015 Definitions
442.025 Findings
and policy
442.120 Ambulatory
surgery and inpatient discharge abstract records; alternative data; rules; fees
442.200 Definitions
for ORS 442.205
442.205 Community
benefit reporting; rules
442.210 Patient
centered primary care home program
CERTIFICATES OF NEED FOR HEALTH SERVICES
442.315 Certificate
of need; rules; fees; enforcement; exceptions; letter of intent
442.325 Certificate
for health care facility of health maintenance organization; exempt activities;
policy relating to health maintenance organizations
442.342 Waiver
of requirements; rules; penalties
442.344 Exemptions
from requirements
442.347 Rural
hospital required to report certain actions
442.361 Definitions
for ORS 442.361, 442.362 and 442.991
442.362 Reporting
of proposed capital projects by hospitals and ambulatory surgical centers
HEALTH CARE COSTS
(Standardized Payment Methodologies)
442.392 Uniform
payment methodology for hospital and ambulatory surgical center services; rules
442.394 Acceptance
by facilities as payment in full
442.396 Attestation
of compliance by insurers; rules
(Cost Reporting by Health Care
Facilities)
442.400 “Health
care facility” defined
442.405 Legislative
findings and policy
442.420 Application
for financial assistance; financial analysis and investigation authority; rules
442.425 Authority
over reporting systems of facilities
442.430 Investigations;
confidentiality of data
442.445 Civil
penalty for failure to perform
442.450 Exemption
from cost review regulations
442.460 Information
about utilization and cost of health care services
442.463 Annual
utilization report; contents; approval; rules
HEALTH CARE DATA REPORTING
442.464 Definitions
for ORS 442.464 and 442.466
442.466 Health
care data reporting by health insurers
442.468 Health
care workforce data reporting
RURAL HEALTH
442.470 Definitions
for ORS 442.470 to 442.507
442.475 Office
of Rural Health
442.480 Rural
Health Care Revolving Account
442.485 Responsibilities
of Office of Rural Health
442.490 Rural
Health Coordinating Council; membership; terms; officers; compensation and
expenses
442.495 Responsibilities
of council
442.500 Technical
and financial assistance to rural communities
442.502 Determination
of size of rural hospital
442.503 Eligibility
for economic development grants
442.505 Technical
assistance to rural hospitals
442.507 Assistance
to rural emergency medical service systems
442.515 Rural
hospitals; findings
442.520 Risk
assessment formula; relative risk of rural hospitals
NURSING SERVICES PROGRAM
442.535 Definitions
for ORS 442.540 and 442.545
442.540 Nursing
Services Program created; criteria for participation; rules
442.545 Conditions
of participation in Nursing Services Program
PRIMARY CARE SERVICES PROGRAM
442.550 Definitions
for ORS 442.550 to 442.570
442.555 Primary
Care Services Program created; rules; criteria for participation
442.560 Conditions
of participation in Primary Care Services Program; rules
442.561 Certifying
individuals licensed under ORS chapter 679 for tax credit
442.562 Certifying
podiatric physicians and surgeons for tax credit
442.563 Certifying
certain individuals providing rural health care for tax credit; rules
442.564 Certifying
optometrists for tax credit
442.566 Certifying
emergency medical services providers for tax credit
442.568 Oregon
Health and Science University to recruit persons interested in rural practice
442.570 Primary
Care Services Fund; matching funds
PRIMARY HEALTH CARE LOAN FORGIVENESS
PROGRAM
442.573 Fund
established
442.574 Eligibility;
requirements; rules
MISCELLANEOUS
442.600 Policy
on maternity care
442.625 Emergency
Medical Services Enhancement Account; distribution of moneys in account
COOPERATIVE PROGRAM ON HEART AND KIDNEY
TRANSPLANTS
442.700 Definitions
for ORS 442.700 to 442.760
442.705 Legislative
findings; goals
442.710 Application
for approval of cooperative program; form; content; review; modification; order
442.715 Authorized
practices under approved cooperative program
442.720 Board
of governors for cooperative program
442.725 Annual
report of board of governors
442.730 Review
and evaluation of report; modification or revocation of order of approval
442.735 Complaint
procedure
442.740 Powers
of director over action under cooperative program
442.745 Disclosure
of confidential information not waiver of right to protect information
442.750 Status
of actions under cooperative program; effect on other liability
442.755 Rules;
costs; fees
442.760 Status
to contest order
ADVISORY COMMITTEE ON PHYSICIAN
CREDENTIALING INFORMATION
442.800 Advisory
Committee on Physician Credentialing Information; membership; terms
442.805 Committee
recommendations
442.807 Implementation
of recommendations; rules
OREGON PATIENT SAFETY COMMISSION
442.819 Definitions
for ORS 442.819 to 442.851
442.820 Oregon
Patient Safety Commission
442.825 Funds
received by commission
442.830 Oregon
Patient Safety Commission Board of Directors
442.831 Powers
of board relating to Oregon Patient Safety Reporting Program; rules;
confidentiality of patient safety data
442.835 Appointment
of administrator
442.837 Oregon
Patient Safety Reporting Program
442.839 Commission
as central patient safety organization
442.844 Patient
safety data; use; disclosure
442.846 Patient
safety data not admissible in civil actions
442.850 Fees
442.851 Limit
on amounts collected to fund Oregon Patient Safety Reporting Program
HEALTH CARE ACQUIRED INFECTIONS
(Temporary provisions relating to health
care acquired infections are compiled as notes
following ORS 442.851)
PENALTIES
442.991 Civil
penalties for failure to report proposed capital projects
442.993 Civil
penalties for failure to report health care data of health insurers
442.005 [1955
c.533 §2; 1973 c.754 §1; repealed by 1977 c.717 §23]
442.010
[Amended by 1955 c.533 §3; 1971 c.650 §20; repealed by 1977 c.717 §23]
ADMINISTRATOR OF THE OFFICE FOR OREGON
HEALTH POLICY AND RESEARCH
442.011 Office for Oregon Health Policy
and Research created; appointment of administrator.
There is created in the Oregon Health Authority the Office for Oregon Health
Policy and Research. The Administrator of the Office for Oregon Health Policy
and Research shall be appointed by the Director of the Oregon Health Authority.
The administrator shall be an individual with demonstrated proficiency in
planning and managing programs with complex public policy and fiscal aspects
such as those involved in the medical assistance program. [1993 c.725 §33; 1997
c.683 §16; 2001 c.69 §1; 2003 c.784 §5; 2007 c.697 §§14,15; 2009 c.595 §§747,748;
2011 c.720 §197]
ADMINISTRATION
442.015 Definitions.
As used in ORS chapter 441 and this chapter, unless the context requires
otherwise:
(1)
“Acquire” or “acquisition” means obtaining equipment, supplies, components or
facilities by any means, including purchase, capital or operating lease, rental
or donation, with intention of using such equipment, supplies, components or
facilities to provide health services in Oregon. When equipment or other
materials are obtained outside of this state, acquisition is considered to
occur when the equipment or other materials begin to be used in Oregon for the
provision of health services or when such services are offered for use in
Oregon.
(2)
“Affected persons” has the same meaning as given to “party” in ORS 183.310.
(3)(a)
“Ambulatory surgical center” means a facility or portion of a facility that
operates exclusively for the purpose of providing surgical services to patients
who do not require hospitalization and for whom the expected duration of
services does not exceed 24 hours following admission.
(b)
“Ambulatory surgical center” does not mean:
(A)
Individual or group practice offices of private physicians or dentists that do
not contain a distinct area used for outpatient surgical treatment on a regular
and organized basis, or that only provide surgery routinely provided in a
physician’s or dentist’s office using local anesthesia or conscious sedation;
or
(B)
A portion of a licensed hospital designated for outpatient surgical treatment.
(4)
“Budget” means the projections by the hospital for a specified future time
period of expenditures and revenues with supporting statistical indicators.
(5)
“Develop” means to undertake those activities that on their completion will
result in the offer of a new institutional health service or the incurring of a
financial obligation, as defined under applicable state law, in relation to the
offering of such a health service.
(6)
“Expenditure” or “capital expenditure” means the actual expenditure, an
obligation to an expenditure, lease or similar arrangement in lieu of an
expenditure, and the reasonable value of a donation or grant in lieu of an
expenditure but not including any interest thereon.
(7)
“Freestanding birthing center” means a facility licensed for the primary
purpose of performing low risk deliveries.
(8)
“Governmental unit” means the state, or any county, municipality or other
political subdivision, or any related department, division, board or other
agency.
(9)
“Gross revenue” means the sum of daily hospital service charges, ambulatory
service charges, ancillary service charges and other operating revenue. “Gross
revenue” does not include contributions, donations, legacies or bequests made
to a hospital without restriction by the donors.
(10)(a)
“Health care facility” means:
(A)
A hospital;
(B)
A long term care facility;
(C)
An ambulatory surgical center;
(D)
A freestanding birthing center; or
(E)
An outpatient renal dialysis center.
(b)
“Health care facility” does not mean:
(A)
A residential facility licensed by the Department of Human Services or the
Oregon Health Authority under ORS 443.415;
(B)
An establishment furnishing primarily domiciliary care as described in ORS
443.205;
(C)
A residential facility licensed or approved under the rules of the Department
of Corrections;
(D)
Facilities established by ORS 430.335 for treatment of substance abuse
disorders; or
(E)
Community mental health programs or community developmental disabilities
programs established under ORS 430.620.
(11)
“Health maintenance organization” or “HMO” means a public organization or a
private organization organized under the laws of any state that:
(a)
Is a qualified HMO under section 1310 (d) of the U.S. Public Health Services
Act; or
(b)(A)
Provides or otherwise makes available to enrolled participants health care
services, including at least the following basic health care services:
(i)
Usual physician services;
(ii)
Hospitalization;
(iii)
Laboratory;
(iv)
X-ray;
(v)
Emergency and preventive services; and
(vi)
Out-of-area coverage;
(B)
Is compensated, except for copayments, for the provision of the basic health
care services listed in subparagraph (A) of this paragraph to enrolled
participants on a predetermined periodic rate basis; and
(C)
Provides physicians’ services primarily directly through physicians who are
either employees or partners of such organization, or through arrangements with
individual physicians or one or more groups of physicians organized on a group
practice or individual practice basis.
(12)
“Health services” means clinically related diagnostic, treatment or
rehabilitative services, and includes alcohol, drug or controlled substance
abuse and mental health services that may be provided either directly or
indirectly on an inpatient or ambulatory patient basis.
(13)
“Hospital” means:
(a)
A facility with an organized medical staff and a permanent building that is
capable of providing 24-hour inpatient care to two or more individuals who have
an illness or injury and that provides at least the following health services:
(A)
Medical;
(B)
Nursing;
(C)
Laboratory;
(D)
Pharmacy; and
(E)
Dietary; or
(b)
A special inpatient care facility as that term is defined by the Oregon Health
Authority by rule.
(14)
“Institutional health services” means health services provided in or through
health care facilities and includes the entities in or through which such
services are provided.
(15)
“Intermediate care facility” means a facility that provides, on a regular
basis, health-related care and services to individuals who do not require the
degree of care and treatment that a hospital or skilled nursing facility is
designed to provide, but who because of their mental or physical condition
require care and services above the level of room and board that can be made
available to them only through institutional facilities.
(16)
“Long term care facility” means a facility with permanent facilities that
include inpatient beds, providing medical services, including nursing services
but excluding surgical procedures except as may be permitted by the rules of
the Director of Human Services, to provide treatment for two or more unrelated
patients. “Long term care facility” includes skilled nursing facilities and
intermediate care facilities but may not be construed to include facilities
licensed and operated pursuant to ORS 443.400 to 443.455.
(17)
“New hospital” means a facility that did not offer hospital services on a
regular basis within its service area within the prior 12-month period and is
initiating or proposing to initiate such services. “New hospital” also includes
any replacement of an existing hospital that involves a substantial increase or
change in the services offered.
(18)
“New skilled nursing or intermediate care service or facility” means a service
or facility that did not offer long term care services on a regular basis by or
through the facility within the prior 12-month period and is initiating or
proposing to initiate such services. “New skilled nursing or intermediate care
service or facility” also includes the rebuilding of a long term care facility,
the relocation of buildings that are a part of a long term care facility, the
relocation of long term care beds from one facility to another or an increase
in the number of beds of more than 10 or 10 percent of the bed capacity,
whichever is the lesser, within a two-year period.
(19)
“Offer” means that the health care facility holds itself out as capable of
providing, or as having the means for the provision of, specified health
services.
(20)
“Outpatient renal dialysis facility” means a facility that provides renal
dialysis services directly to outpatients.
(21)
“Person” means an individual, a trust or estate, a partnership, a corporation
(including associations, joint stock companies and insurance companies), a
state, or a political subdivision or instrumentality, including a municipal
corporation, of a state.
(22)
“Skilled nursing facility” means a facility or a distinct part of a facility,
that is primarily engaged in providing to inpatients skilled nursing care and
related services for patients who require medical or nursing care, or an
institution that provides rehabilitation services for the rehabilitation of
individuals who are injured or sick or who have disabilities. [1977 c.751 §1;
1979 c.697 §2; 1979 c.744 §31; 1981 c.693 §1; 1983 c.482 §1; 1985 c.747 §16;
1987 c.320 §233; 1987 c.660 §4; 1987 c.753 §2; 1989 c.708 §5; 1989 c.1034 §5;
1991 c.470 §9; 2001 c.100 §1; 2001 c.104 §181a; 2001 c.900 §179; 2003 c.75 §91;
2003 c.784 §11; 2005 c.22 §300; 2007 c.70 §242; 2009 c.595 §749; 2009 c.792 §63]
442.020
[Amended by 1955 c.533 §4; 1973 c.754 §2; repealed by 1977 c.717 §23]
442.025 Findings and policy.
(1) The Legislative Assembly finds that the achievement of reasonable access to
quality health care at a reasonable cost is a priority of the State of Oregon.
(2)
Problems preventing the priority in subsection (1) of this section from being
attained include:
(a)
The inability of many citizens to pay for necessary health care, being covered
neither by private insurance nor by publicly funded programs such as Medicare
and Medicaid;
(b)
Rising costs of medical care which exceed substantially the general rate of
inflation;
(c)
Insufficient price competition in the delivery of health care services that
would provide a greater cost consciousness among providers, payers and
consumers;
(d)
Inadequate incentives for the use of less costly and more appropriate
alternative levels of health care;
(e)
Insufficient or inappropriate use of existing capacity, duplicated services and
failure to use less costly alternatives in meeting significant health needs;
and
(f)
Insufficient primary and emergency medical care services in medically
underserved areas of the state.
(3)
As a result of rising health care costs and the concern expressed by health
care providers, health care users, third-party payers and the general public,
there is an urgent need to abate these rising costs so as to place the cost of
health care within reach of all Oregonians without affecting the quality of
care.
(4)
To foster the cooperation of the separate industry forces, there is a need to
compile and disseminate accurate and current data, including but not limited to
price and utilization data, to meet the needs of the people of Oregon and
improve the appropriate usage of health care services.
(5)
It is the purpose of this chapter to establish area-wide and state planning for
health services, staff and facilities in light of the findings of subsection
(1) of this section and in furtherance of health planning policies of this
state.
(6)
It is further declared that hospital costs should be contained through improved
competition between hospitals and improved competition between insurers and
through financial incentives on behalf of providers, insurers and consumers to
contain costs. As a safety net, it is the intent of the Legislative Assembly to
monitor hospital performance. [1977 c.751 §2; 1981 c.693 §2; 1983 c.482 §2;
1985 c.747 §1; 1987 c.660 §3]
442.030
[Amended by 1955 c.533 §5; 1961 c.316 §8; 1967 c.89 §4; repealed by 1977 c.717 §23]
442.035 [1977
c.751 §3; 1979 c.697 §3; 1981 c.693 §3; 1983 c.482 §3; 1985 c.747 §4; 1987
c.660 §1; 1995 c.727 §20; 1997 c.683 §17; 2001 c.280 §1; 2003 c.784 §1; 2005
c.771 §2; repealed by 2009 c.595 §1204]
442.040
[Amended by 1955 c.533 §6; 1973 c.754 §3; repealed by 1977 c.717 §23]
442.045 [1977
c.751 §4; 1981 c.693 §4; 1983 c.482 §4; 1985 c.187 §1; 1985 c.747 §5; 1987
c.660 §2; 1991 c.470 §17; 1995 c.727 §22; 1997 c.683 §18; 1999 c.581 §1; 2003
c.784 §3; repealed by 2009 c.595 §1204]
442.050
[Amended by 1957 c.697 §3; 1969 c.535 §2; 1973 c.754 §4; 1977 c.284 §50;
repealed by 1977 c.717 §23]
442.053 [1955
c.533 §7; 1973 c.754 §5; repealed by 1977 c.717 §23]
442.055 [1955
c.533 §8; repealed by 1973 c.754 §8]
442.057 [1977
c.751 §15; 1981 c.693 §5; 2003 c.784 §4; repealed by 2009 c.595 §1204]
442.060
[Amended by 1963 c.92 §1; repealed by 1977 c.717 §23]
442.070
[Amended by 1961 c.316 §9; 1967 c.89 §5; repealed by 1971 c.734 §21]
442.075 [1971
c.734 §58; repealed by 1973 c.754 §6 (442.076 enacted in lieu of 442.075)]
442.076 [1973
c.754 §7 (enacted in lieu of 442.075); repealed by 1977 c.717 §23]
442.080
[Repealed by 1977 c.717 §23]
442.085 [1977
c.751 §5; 1981 c.693 §6; repealed by 1987 c.660 §40]
442.090
[Repealed by 1955 c.533 §10]
442.095 [1977
c.751 §6; 1981 c.693 §7; 1983 c.482 §5; 1985 c.747 §7; 1987 c.660 §5; 1993
c.754 §6; repealed by 1995 c.727 §48]
442.100 [1977
c.751 §7; repealed by 1981 c.693 §31]
442.105 [1977
c.751 §38; 1981 c.693 §8; 1983 c.482 §6; repealed by 1987 c.660 §40]
442.110
[Formerly 431.250 (3), (4); repealed by 1987 c.660 §40]
442.120 Ambulatory surgery and inpatient
discharge abstract records; alternative data; rules; fees.
In order to provide data essential for health planning programs:
(1)
The Office for Oregon Health Policy and Research may request, by July 1 of each
year, each general hospital to file with the office ambulatory surgery and
inpatient discharge abstract records covering all patients discharged during
the preceding calendar year. The ambulatory surgery and inpatient discharge
abstract record for each patient must include 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;
(c)
Zip code;
(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 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 surgical 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.
(3)
In lieu of abstracting and compiling the 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
are not available to the office on an annual and timely basis, the office may
establish by rule a fee to be charged to each hospital.
(4)
Subject to prior approval of the Oregon Health Policy Board 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 (3) of this section may not exceed the cost of abstracting and
compiling the records.
(5)
The office may specify by rule the form in which the 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.
(6)
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.
(7)
In addition to the records required in subsection (1) of this section, the
office may obtain abstract records for each patient 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
specific data in a form that allows identification of individual patients or
licensed health care professionals.
(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 a form 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. [Formerly 442.355; 1991 c.703 §7; 1993 c.754 §7; 1995
c.727 §23; 1997 c.683 §19; 1999 c.581 §2; 2007 c.71 §128; 2009 c.595 §750]
442.150 [1977
c.751 §10; repealed by 1987 c.660 §40]
442.155 [1977
c.751 §11; 1983 c.482 §7; 1985 c.747 §6; repealed by 1987 c.660 §40]
442.160 [1977
c.751 §12; repealed by 1987 c.660 §40]
442.165 [1977
c.751 §13; 1981 c.693 §9; repealed by 1983 c.482 §23]
442.170 [1977
c.751 §14; repealed by 1983 c.482 §23]
442.200 Definitions for ORS 442.205.
As used in this section and ORS 442.205:
(1)
“Charity care” means free or discounted health services provided to persons who
cannot afford to pay and from whom a hospital has no expectation of payment. “Charity
care” does not include bad debt, contractual allowances or discounts for quick
payment.
(2)
“Community benefit” means a program or activity that provides treatment or
promotes health and healing in response to an identified community need. “Community
benefit” includes:
(a)
Charity care;
(b)
Losses related to Medicaid, Medicare, State Children’s Health Insurance Program
or other publicly funded health care program shortfalls;
(c)
Community health improvement services;
(d)
Research;
(e)
Financial and in-kind contributions to the community; and
(f)
Community building activities affecting health in the community. [2007 c.384 §2]
Note:
442.200 and 442.205 were added to and made a part of ORS chapter 442 by
legislative action but were not added to any smaller series therein. See
Preface to Oregon Revised Statutes for further explanation.
442.205 Community benefit reporting; rules.
(1) The Administrator of the Office for Oregon Health Policy and Research shall
by rule adopt a cost-based community benefit reporting system for hospitals
operating in Oregon that is consistent with established national standards for
hospital reporting of community benefits.
(2)
Within 90 days of filing a Medicare cost report, a hospital must submit a
community benefit report to the Office for Oregon Health Policy and Research of
the community benefits provided by the hospital, on a form prescribed by the
administrator.
(3)
The administrator shall produce an annual report of the information provided
under subsections (1) and (2) of this section. The report shall be submitted to
the Governor, the President of the Senate and the Speaker of the House of Representatives.
The report shall be presented to the Legislative Assembly during each
odd-numbered year regular session and shall be made available to the public.
(4)
The administrator may adopt all rules necessary to carry out the provisions of
this section. [2007 c.384 §3; 2011 c.545 §56]
Note: See
note under 442.200.
442.210 Patient centered primary care home
program. (1) There is established in the Office
for Oregon Health Policy and Research the patient centered primary care home
program. Through this program, the office shall:
(a)
Define core attributes of the patient centered primary care home to promote a
reasonable level of consistency of services provided by patient centered
primary care homes in this state. In defining core attributes related to
ensuring that care is coordinated, the office shall focus on determining
whether these patient centered primary care homes offer comprehensive primary
care, including prevention and disease management services;
(b)
Establish a simple and uniform process to identify patient centered primary
care homes that meet the core attributes defined by the office under paragraph
(a) of this subsection;
(c)
Develop uniform quality measures that build from nationally accepted measures
and allow for standard measurement of patient centered primary care home
performance;
(d)
Develop uniform quality measures for acute care hospital and ambulatory
services that align with the patient centered primary care home quality
measures developed under paragraph (c) of this subsection; and
(e)
Develop policies that encourage the retention of, and the growth in the numbers
of, primary care providers.
(2)(a)
The Director of the Oregon Health Authority shall appoint an advisory committee
to advise the office in carrying out subsection (1) of this section.
(b)
The director shall appoint to the advisory committee 15 individuals who
represent a diverse constituency and are knowledgeable about patient centered
primary care home delivery systems and health care quality.
(c)
Members of the advisory committee are not entitled to compensation, but may be
reimbursed for actual and necessary travel and other expenses incurred by them
in the performance of their official duties in the manner and amounts provided
for in ORS 292.495. Claims for expenses shall be paid out of funds appropriated
to the office for the purposes of the advisory committee.
(d)
The advisory committee shall use public input to guide policy development.
(3)
The office will also establish, as part of the patient centered primary care
home program, a learning collaborative in which state agencies, private health
insurance carriers, third party administrators and patient centered primary
care homes can:
(a)
Share information about quality improvement;
(b)
Share best practices that increase access to culturally competent and
linguistically appropriate care;
(c)
Share best practices that increase the adoption and use of the latest
techniques in effective and cost-effective patient centered care;
(d)
Coordinate efforts to develop and test methods to align financial incentives to
support patient centered primary care homes;
(e)
Share best practices for maximizing the utilization of patient centered primary
care homes by individuals enrolled in medical assistance programs, including
culturally specific and targeted outreach and direct assistance with
applications to adults and children of racial, ethnic and language minority
communities and other underserved populations;
(f)
Coordinate efforts to conduct research on patient centered primary care homes
and evaluate strategies to implement the patient centered primary care home to
improve health status and quality and reduce overall health care costs; and
(g)
Share best practices for maximizing integration to ensure that patients have
access to comprehensive primary care, including preventative and disease
management services.
(4)
The Legislative Assembly declares that collaboration among public payers,
private health carriers, third party purchasers and providers to identify appropriate
reimbursement methods to align incentives in support of patient centered
primary care homes is in the best interest of the public. The Legislative
Assembly therefore declares its intent to exempt from state antitrust laws, and
to provide immunity from federal antitrust laws, the collaborative and
associated payment reforms designed and implemented under subsection (3) of
this section that might otherwise be constrained by such laws. The Legislative
Assembly does not authorize any person or entity to engage in activities or to
conspire to engage in activities that would constitute per se violations of
state or federal antitrust laws including, but not limited to, agreements among
competing health care providers or health carriers as to the prices of specific
levels of reimbursement for health care services.
(5)
The office may contract with a public or private entity to facilitate the work
of the learning collaborative described in subsection (3) of this section and
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 or agency or from any other public or
private corporation or person for the purpose of establishing and maintaining
the collaborative. [2009 c.595 §1163]
Note:
442.210 was enacted into law by the Legislative Assembly but was 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.
442.300
[Formerly 441.010; repealed by 1981 c.693 §31]
CERTIFICATES OF NEED FOR HEALTH SERVICES
442.315 Certificate of need; rules; fees;
enforcement; exceptions; letter of intent. (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 Oregon Health Authority prior to an offering or development.
(2)
The authority shall adopt rules specifying criteria and procedures for making
decisions as to the need for the new services or facilities.
(3)(a)
An applicant for a certificate of need shall apply to the authority on forms
provided for this purpose by authority 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 authority
shall prescribe application fees, based on the complexity and scope of the
proposed project.
(4)
The authority 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 authority 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 authority, an applicant or any
affected person may request a reconsideration hearing pursuant to ORS chapter
183.
(c)
In any proceeding brought by an affected person or an applicant challenging an
authority decision under this subsection, the authority shall follow procedures
consistent with the provisions of ORS chapter 183 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 authority finds that
a person is offering or developing a project that is not within the scope of
the certificate of need, the authority 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 authority 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)(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;
(c)
Cardiac catheterization equipment;
(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 that constitute a
violation of this section, or any rule or order issued by the authority under
this section, the authority 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. [1989 c.1034 §2; 1993 c.722 §3;
1995 c.727 §39; 2001 c.875 §3; 2003 c.14 §258; 2009 c.595 §751]
442.320
[Formerly 441.090; 1979 c.697 §4; 1981 c.693 §10; 1983 c.482 §8; 1985 c.747 §31;
1987 c.660 §6; 1989 c.708 §6; repealed by 1989 c.1034 §11]
442.325 Certificate for health care
facility of health maintenance organization; exempt activities; policy relating
to health maintenance organizations. (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 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 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 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 Oregon Health Authority 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. [1977 c.751 §56; 1981 c.693 §11; 1995
c.727 §40; 1999 c.581 §9; 2009 c.595 §752]
442.330
[Formerly 441.092; 1979 c.697 §5; repealed by 1981 c.693 §31]
442.335 [1977
c.751 §8; 1981 c.693 §12; 1983 c.482 §9; 1987 c.660 §7; repealed by 1989 c.1034
§11]
442.340
[Formerly 441.095; 1979 c.174 §1; 1979 c.285 §2; 1979 c.697 §6; 1981 c.693 §13;
1983 c.482 §10; 1985 c.747 §33; 1987 c.660 §8; repealed by 1989 c.1034 §11]
442.342 Waiver of requirements; rules; penalties.
(1) Notwithstanding any other provision of law, a hospital licensed under ORS
441.025, in accordance with rules adopted by the Oregon Health Authority, may
apply for waiver from the provisions of ORS 442.325 and section 9, chapter
1034, Oregon Laws 1989, and the authority shall grant such waiver if, for the
most recently completed hospital fiscal year preceding the date of application
for waiver and each succeeding fiscal year thereafter, the percentage of
qualified inpatient revenue is not less than that described in subsection (2)
of this section.
(2)(a)
The percentage of qualified inpatient revenue for the first year in which a
hospital is granted a waiver under subsection (1) of this section shall not be
less than 60 percent.
(b)
The percentage in paragraph (a) of this subsection shall be increased by five
percentage points in each succeeding hospital fiscal year until the percentage
of qualified inpatient revenue equals or exceeds 75 percent.
(3)
As used in this section:
(a)
“Qualified inpatient revenue” means revenue earned from public and private
payers for inpatient hospital services approved by the authority pursuant to
rules, including:
(A)
Revenue earned pursuant to Title XVIII, United States Social Security Act, when
such revenue is based on diagnostic related group prices which include
capital-related expenses or other risk-based payment programs as approved by
the authority;
(B)
Revenue earned pursuant to Title XIX, United States Social Security Act, when
such revenue is based on diagnostic related group prices which include
capital-related expenses;
(C)
Revenue earned under negotiated arrangements with public or private payers
based on all-inclusive per diem rates for one or more hospital service
categories;
(D)
Revenue earned under negotiated arrangements with public or private payers
based on all-inclusive per discharge or per admission rates related to
diagnostic related groups or other service or intensity-related measures;
(E)
Revenue earned under arrangements with one or more health maintenance
organizations; or
(F)
Other prospectively determined forms of inpatient hospital reimbursement
approved in advance by the authority in accordance with rules.
(b)
“Percentage of qualified inpatient revenue” means qualified inpatient revenue
divided by total gross inpatient revenue as defined by administrative rule of
the authority.
(4)(a)
The authority shall hold a hearing to determine the cause if any hospital granted
a waiver pursuant to subsection (1) of this section fails to reach the
applicable percentage of qualified inpatient revenue in any subsequent fiscal
year of the hospital.
(b)
If the authority finds that the failure was without just cause and that the
hospital has undertaken projects that, except for the provisions of this
section would have been subject to ORS 442.325 or section 9, chapter 1034,
Oregon Laws 1989, the authority shall impose one of the penalties outlined in
paragraph (c) of this subsection.
(c)(A)
A one-time civil penalty of not less than $25,000 or more than $250,000; or
(B)
An annual civil penalty equal to an amount not to exceed 110 percent of the net
profit derived from such project or projects for a period not to exceed five years.
(5)
Nothing in this section shall be construed to permit a hospital to develop a
new inpatient hospital facility or provide new services authorized by
facilities defined as “long term care facility” under ORS 442.015 under a
waiver granted pursuant to subsection (1) of this section. [1985 c.747 §35;
1987 c.660 §9; 1991 c.470 §18; 1995 c.727 §41; 2009 c.595 §753]
Note:
442.342 was enacted into law by the Legislative Assembly and added to or made a
part of ORS chapter 442 by legislative action but not to any series therein.
See Preface to Oregon Revised Statutes for further explanation.
442.344 Exemptions from requirements.
In furtherance of the purpose and intent of the Legislative Assembly as
expressed in ORS 442.025 to achieve reasonable access to quality health care at
a reasonable cost, the requirements of ORS 442.325 shall not apply to
ambulatory surgical centers performing only ophthalmic surgery. [1987 c.723 §1]
Note:
442.344 was enacted into law by the Legislative Assembly but was 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.
442.345 [1977
c.751 §33; 1981 c.693 §14; 1985 c.747 §36; repealed by 1989 c.1034 §11]
442.347 Rural hospital required to report
certain actions. A rural hospital exempted from
the certificate of need requirement by ORS 442.315 (8) shall report any action
taken by the hospital that would have required a certificate of need if the
exemption did not exist. [1993 c.722 §4]
Note:
442.347 was enacted into law by the Legislative Assembly but was 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.
442.350 [Formerly
441.140; repealed by 1989 c.1034 §11]
442.355 [1983
c.482 §12; 1985 c.747 §14; renumbered 442.120]
442.360 [1977
c.751 §9; 1979 c.697 §7; 1981 c.693 §25; 1985 c.747 §37; repealed by 1989
c.1034 §11]
442.361 Definitions for ORS 442.361,
442.362 and 442.991. As used in this section and ORS
442.362 and 442.991:
(1)(a)
“Capital project” means:
(A)
The construction, development, purchase, renovation or any construction
expenditure by or on behalf of a reporting entity, for which the cost:
(i)
For type A hospitals, exceeds five percent of gross revenue.
(ii)
For type B hospitals, exceeds five percent of gross revenue.
(iii)
For DRG hospitals, exceeds 1.75 percent of gross revenue.
(iv)
For ambulatory surgery centers, exceeds $2 million.
(B)
The purchase or lease of, or other comparable arrangement for, a single piece
of diagnostic or therapeutic equipment for which the cost or, in the case of a
donation, the value exceeds $1 million. The acquisition of two or more pieces
of diagnostic or therapeutic equipment that are necessarily interdependent in
the performance of ordinary functions shall be combined in calculating the cost
or value of the transaction.
(b)
“Capital project” does not include a project financed entirely through
charitable fundraising.
(2)
“DRG hospital” means a hospital that is not a type A or type B hospital and
that receives Medicare reimbursement based upon diagnostic related groups.
(3)
“Gross revenue” has the meaning given that term in ORS 442.015.
(4)
“Reporting entity” includes the following if licensed pursuant to ORS 441.015:
(a)
A type A hospital as described in ORS 442.470.
(b)
A type B hospital as described in ORS 442.470.
(c)
A DRG hospital.
(d)
An ambulatory surgical center as defined in ORS 442.015. [2009 c.595 §1197]
Note:
442.361 and 442.362 were added to and made a part of ORS chapter 442 by
legislative action but were not added to any smaller series therein. See
Preface to Oregon Revised Statutes for further explanation.
442.362 Reporting of proposed capital
projects by hospitals and ambulatory surgical centers.
The Office for Oregon Health Policy and Research may adopt rules requiring
reporting entities within the state to publicly report proposed capital
projects. Rules adopted under this section must:
(1)
Require a reporting entity to establish on the homepage of its website a
prominently labeled link to information about proposed or pending capital
projects. The information posted must include but is not limited to a report of
the community benefit for the project, its estimated cost and a means for
interested persons to submit comments. When a reporting entity posts the
information required under this subsection, the reporting entity must notify
the Office for Oregon Health Policy and Research of the posting in the manner
prescribed by the office.
(2)
If a reporting entity does not have a website, require the reporting entity to
publish notice of the proposed capital project in a major newspaper or online
equivalent serving the region in which the proposed capital project will be
located. The notice must include but is not limited to a report of the
community benefit for the project, its estimated cost and a means for
interested persons to submit comments. When a reporting entity publishes the
information required under this subsection, the reporting entity must notify
the Office for Oregon Health Policy and Research of the publication in the
manner prescribed by the office.
(3)
Establish a publicly available resource for information collected under this
section. [2009 c.595 §1198]
Note: See
note under 442.361.
HEALTH CARE COSTS
(Standardized Payment Methodologies)
442.392 Uniform payment methodology for
hospital and ambulatory surgical center services; rules.
(1) The Oregon Health Authority shall prescribe by rule a uniform payment
methodology for hospital and ambulatory surgical center services that:
(a)
Incorporates the most recent Medicare payment methodologies established by the
Centers for Medicare and Medicaid Services, or similar payment methodologies,
for hospital and ambulatory surgical center services;
(b)
Includes payment methodologies for services and equipment that are not fully
addressed by Medicare payment methodologies; and
(c)
Allows for the use of alternative payment methodologies, including but not
limited to pay-for-performance, bundled payments and capitation.
(2)
In developing the payment methodologies described in this section, the
authority shall convene and be advised by a work group consisting of providers,
insurers and consumers of the types of health care services that are subject to
the methodologies. [2011 c.418 §3]
Note:
442.392 to 442.396 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.
Note:
Section 12, chapter 418, Oregon Laws 2011, provides:
Sec. 12. (1)
Except as provided in subsection (2) of this section, sections 3 to 8 of this
2011 Act [243.256, 243.879, 442.392, 442.394] and the amendments to ORS 243.125
and 243.864 by sections 10 and 11 of this 2011 Act apply to:
(a)
Claims by a hospital for reimbursement of services provided by the hospital on
or after January 1, 2012; and
(b)
Claims by an ambulatory surgical center for reimbursement of services provided
by the ambulatory surgical center on or after January 1, 2013.
(2)
Sections 3 to 9 of this 2011 Act [243.256, 243.879, 442.392, 442.394, 442.396]
and the amendments to ORS 243.125 and 243.864 by sections 10 and 11 of this
2011 Act apply to reimbursement paid under contracts entered into or renewed on
or after the effective date of this 2011 Act [June 17, 2011]. [2011 c.418 §12]
442.394 Acceptance by facilities as
payment in full. (1) A hospital or ambulatory
surgical center shall bill and accept as payment in full an amount determined
in accordance with the payment methodology prescribed by the Oregon Health
Authority under ORS 442.392.
(2)
This section does not apply to type A or type B hospitals as described in ORS
442.470 or rural critical access hospitals as defined in ORS 315.613. [2011
c.418 §4]
Note: See
notes under 442.392.
442.396 Attestation of compliance by
insurers; rules. An insurer, as defined in ORS
731.106, that contracts with the Oregon Health Authority, including with the
Public Employees’ Benefit Board and the Oregon Educators Benefit Board, to
provide health insurance coverage for state employees, educators or medical
assistance recipients must annually attest, on a form and in a manner
prescribed by the authority, to its compliance with ORS 243.256, 243.879,
442.392 and 442.394. A contract with an insurer subject to the requirements of
this section may not be renewed without the attestation required by this section.
[2011 c.418 §9]
Note: See
notes under 442.392.
(Cost Reporting by Health Care
Facilities)
442.400 “Health care facility” defined.
As used in ORS 442.400 to 442.463, unless the context requires otherwise, “health
care facility” or “facility” means such facility as defined by ORS 442.015,
exclusive of a long term care facility, and includes all publicly and privately
owned and operated health care facilities, but does not include facilities
described in ORS 441.065. [Formerly 441.415; 1979 c.697 §8; 1981 c.693 §15]
442.405 Legislative findings and policy.
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)
To require health care facilities to file for public disclosure reports that
will enable both private and public purchasers of services from such facilities
to make informed decisions in purchasing such services; and
(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. [Formerly 441.420; 1999 c.581 §3]
442.410 [1977
c.751 §45; 1981 c.693 §16; 1983 c.482 §13; 1985 c.747 §38; 1995 c.727 §24; 1997
c.683 §20; repealed by 1999 c.581 §11]
442.415 [1977
c.751 §46; 1983 c.482 §14; 1995 c.727 §25; 1997 c.683 §21; repealed by 1999
c.581 §11]
442.420 Application for financial
assistance; financial analysis and investigation authority; rules.
(1) The Office for Oregon Health 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)
The Administrator of the Office for Oregon Health 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 442.463 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 chapter 183;
(c)
Exercise, subject to the limitations and restrictions imposed by ORS 442.400 to
442.463, all other powers which are reasonably necessary or essential to carry
out the express objectives and purposes of ORS 442.400 to 442.463; and
(d)
Adopt rules in accordance with ORS chapter 183 necessary in the administrator’s
judgment for carrying out the functions of the office. [Formerly 441.435; 1981
c.693 §17; 1983 c.482 §15; 1985 c.747 §39; 1995 c.727 §26; 1997 c.683 §22; 1999
c.581 §4]
442.425 Authority over reporting systems
of facilities. (1) The Administrator of the Office for
Oregon Health Policy and Research by rule may specify one or more uniform
systems of financial reporting necessary to meet the requirements of ORS
442.400 to 442.463. 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 reporting used by health care facilities shall be given due
consideration by the administrator in carrying out the duty of specifying the
systems of reporting required by ORS 442.400 to 442.463. The administrator
insofar as reasonably possible shall adopt reporting systems and requirements
that will not unreasonably increase the administrative costs of the facility.
(3)
The administrator may allow and provide for modifications in the reporting
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 442.463.
(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 442.400 to 442.463, such facilities
shall be authorized to utilize established accounting systems and to report
costs and revenues in a manner 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, 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. [Formerly 441.440; 1981 c.693 §18;
1995 c.727 §27; 1997 c.683 §23; 1999 c.581 §5; 2009 c.792 §40]
442.430 Investigations; confidentiality of
data. (1) Whenever a further investigation is
considered necessary or desirable by the Office for Oregon Health Policy and
Research to verify the accuracy of the information in the reports made by
health care facilities, the office may make any necessary further examination
of the facility’s records and accounts. Such further examinations include, but
are not limited to, requiring a full or partial audit of all such records and
accounts.
(2)
In carrying out the duties prescribed by ORS 442.400 to 442.463, the office may
utilize its own staff or may contract with any appropriate, independent,
qualified third party. No such contractor shall release or publish or otherwise
use any information made available to it under its contractual responsibility
unless such permission is specifically granted by the office. [Formerly
441.445; 1995 c.727 §28; 1997 c.683 §24; 2009 c.792 §41]
442.435
[Formerly 441.460; 1983 c.482 §16; 1987 c.660 §27; 1995 c.727 §29; 1997 c.683 §25;
repealed by 1999 c.581 §11]
442.440
[Formerly 441.465; 1983 c.482 §17; 1983 c.740 §161; repealed by 1987 c.660 §40]
442.442 [1979
c.697 §10; repealed by 1981 c.693 §31]
442.445 Civil penalty for failure to
perform. (1) Any health care facility that fails
to perform as required in ORS 442.205 and 442.400 to 442.463 or section 3,
chapter 838, Oregon Laws 2007, and rules of the Office for Oregon Health Policy
and Research may be subject to a civil penalty.
(2)
The Administrator of the Office for Oregon Health Policy and Research shall
adopt a schedule of penalties not to exceed $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 183.745.
(4)
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. [Formerly 441.480; 1981 c.693 §19; 1983 c.482 §18; 1983 c.696 §21; 1991
c.734 §24; 1993 c.18 §110; 1995 c.727 §30; 1997 c.683 §26; 1999 c.581 §6; 2007
c.384 §4; 2007 c.838 §7]
Note: The
amendments to 442.445 by section 8, chapter 838, Oregon Laws 2007, become
operative January 2, 2018. See section 9, chapter 838, Oregon Laws 2007. The
text that is operative on and after January 2, 2018, is set forth for the user’s
convenience.
442.445. (1)
Any health care facility that fails to perform as required in ORS 442.205 and
442.400 to 442.463 and rules of the Office for Oregon Health Policy and
Research may be subject to a civil penalty.
(2)
The Administrator of the Office for Oregon Health Policy and Research shall
adopt a schedule of penalties not to exceed $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 183.745.
(4)
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.
442.450 Exemption from cost review
regulations. The following are not subject to ORS
442.400 to 442.463:
(1)
Physicians in private practice, solo or in a group or partnership, who are not
employed by, or hold ownership or part ownership in, a health care facility; or
(2)
Health care facilities described in ORS 441.065. [1977 c.751 §55]
442.460 Information about utilization and
cost of health care services. In order to
obtain regional or statewide data about the utilization and cost of health care
services, the Office for Oregon Health Policy and Research may accept
information relating to the utilization and cost of health care services
identified by the Administrator of the Office for Oregon Health Policy and
Research from physicians, insurers or other third-party payers or employers or
other purchasers of health care. [1985 c.747 §15; 1995 c.727 §31; 1997 c.683 §27;
1999 c.581 §7]
442.463 Annual utilization report; contents;
approval; rules. (1) Each licensed health
facility shall file with the Office for Oregon Health 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 Policy
and Research, in such form as the administrator prescribes by rule.
(2)
The annual report shall contain such information as may be required by rule of
the administrator and must be approved by the administrator. [1985 c.747 §§18,19;
1995 c.727 §32; 1997 c.683 §28; 1999 c.581 §8]
HEALTH CARE DATA REPORTING
442.464 Definitions for ORS 442.464 and
442.466. As used in this section and ORS
442.466, “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. [2009 c.595 §1200; 2011 c.602 §54]
Note:
442.464 to 442.468 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.
442.465 [1985
c.747 §22; 1987 c.660 §10; 1989 c.1034 §6; 1995 c.727 §33; 1997 c.683 §29;
repealed by 1999 c.581 §11]
442.466 Health care data reporting by
health insurers. (1) The Administrator of the
Office for Oregon Health Policy and Research 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 administrator in furthering the health policies expressed by the
Legislative Assembly in ORS 442.025.
(i)
Evaluating health disparities, including but not limited to disparities related
to race and ethnicity.
(2)
The Administrator of the Office for Oregon Health Policy and Research 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 administrator 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
Administrator of the Office for Oregon Health Policy and Research the health
care data described in subsection (2) of this section.
(4)
The Administrator of the Office for Oregon Health Policy and Research 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)
The Administrator of the Office for Oregon Health Policy and Research 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.
(6)
The Administrator of the Office for Oregon Health Policy and Research 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 Office for Oregon Health Policy and
Research.
(7)
The Administrator of the Office for Oregon Health Policy and Research shall
facilitate a collaboration between the Department of Human Services, the Oregon
Health 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 office
under ORS 442.120 and 442.400 to 442.463. The administrator, 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
Administrator of the Office for Oregon Health Policy and Research 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. [2009 c.595 §1201]
Note: See
note under 442.464.
442.467 [1985
c.747 §23; repealed by 1989 c.1034 §11]
442.468 Health care workforce data reporting.
(1) Using data collected from all health care professional licensing boards,
including but not limited to boards that license or certify chemical dependency
and mental health treatment providers and other sources, the Office for Oregon
Health Policy and Research shall create and maintain a healthcare workforce
database that will provide information upon request to state agencies and to
the Legislative Assembly about Oregon’s healthcare workforce, including:
(a)
Demographics, including race and ethnicity.
(b)
Practice status.
(c)
Education and training background.
(d)
Population growth.
(e)
Economic indicators.
(f)
Incentives to attract qualified individuals, especially those from
underrepresented minority groups, to healthcare education.
(2)
The Administrator for the Office for Oregon Health Policy and Research may
contract with a private or public entity to establish and maintain the database
and to analyze the data. The office is not subject to the requirements of ORS
chapters 279A, 279B and 279C with respect to the contract. [2009 c.595 §1174;
2011 c.602 §30]
Note: See
note under 442.464.
442.469 [1985
c.747 §24; 1987 c.660 §11; 1989 c.1034 §7; 1995 c.727 §34; 1997 c.683 §30;
repealed by 1999 c.581 §11]
RURAL HEALTH
442.470 Definitions for ORS 442.470 to
442.507. 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 as one of the following:
(A)
A type A hospital, which is a small and remote hospital that has 50 or fewer
beds and is more than 30 miles from another acute inpatient care facility;
(B)
A type B hospital, which is a small and rural hospital that has 50 or fewer
beds and is 30 miles or less from another acute inpatient care facility;
(C)
A type C hospital, which is considered to be a rural hospital and has more than
50 beds, but is not a referral center; or
(D)
A rural critical access hospital as defined in ORS 315.613.
(b)
“Rural hospital” does not include a hospital of any class that was designated
by the federal government as a rural referral hospital before January 1, 1989. [1979
c.513 §1; 1987 c.660 §12; 1987 c.918 §5; 1989 c.893 §8a; 1991 c.947 §1; 2001
c.875 §2]
442.475 Office of Rural Health.
There is created the Office of Rural Health in the Oregon Health and Science
University. [1979 c.513 §2; 1987 c.660 §13; 1989 c.708 §4]
442.480 Rural Health Care Revolving
Account. (1) There is established the Rural
Health Care Revolving Account in the General Fund.
(2)
All moneys appropriated for the purposes of ORS 442.470 to 442.507 and all
moneys paid to the Office of Rural Health by reason of loans, fees, gifts or
grants for the purposes of ORS 442.470 to 442.507 shall be credited to the
Rural Health Care Revolving Account.
(3)
All moneys contained in the Rural Health Care Revolving Account are
continuously appropriated to the Oregon Department of Administrative Services
for the Office of Rural Health and shall be used for the purposes of ORS
442.470 to 442.507. [1979 c.513 §3; 1987 c.660 §14; 1989 c.708 §1; 2005 c.755 §37]
442.485 Responsibilities of Office of
Rural Health. The responsibilities of the Office of
Rural Health shall include but not be limited to:
(1)
Coordinating statewide efforts for providing health care in rural areas.
(2)
Accepting and processing applications from communities interested in developing
health care delivery systems. Application forms shall be developed by the
agency.
(3)
Through the agency, applying for grants and accepting gifts and grants from
other governmental or private sources for the research and development of rural
health care programs and facilities.
(4)
Serving as a clearinghouse for information on health care delivery systems in
rural areas.
(5)
Helping local boards of health care delivery systems develop ongoing funding
sources.
(6)
Developing enabling legislation to facilitate further development of rural
health care delivery systems. [1979 c.513 §4; 1983 c.482 §19; 1987 c.660 §15]
442.490 Rural Health Coordinating Council;
membership; terms; officers; compensation and expenses.
(1) In carrying out its responsibilities, the Office of Rural Health shall be
advised by the Rural Health Coordinating Council. All members of the Rural
Health Coordinating Council shall have knowledge, interest, expertise or
experience in rural areas and health care delivery. The membership of the Rural
Health Coordinating Council shall consist of:
(a)
One primary care physician who is appointed by the Oregon Medical Association
and one primary care physician appointed by the Oregon Osteopathic Association;
(b)
One nurse practitioner who is appointed by the Oregon Nursing Association;
(c)
One pharmacist who is appointed by the State Board of Pharmacy;
(d)
Five consumers who are appointed by the Governor as follows:
(A)
One consumer representative from each of the three health service areas; and
(B)
Two consumer representatives at large from communities of less than 3,500
people;
(e)
One representative appointed by the Conference of Local Health Officials;
(f)
One volunteer emergency medical services provider from a community of less than
3,500 people appointed by the Oregon State EMT Association;
(g)
One representative appointed by the Oregon Association for Home Care;
(h)
One representative from the Oregon Health and Science University, appointed by
the president of the Oregon Health and Science University;
(i)
One representative from the Oregon Association of Hospitals, appointed by the
Oregon Association of Hospitals;
(j)
One dentist appointed by the Oregon Dental Association;
(k)
One optometrist appointed by the Oregon Association of Optometry;
(L)
One physician assistant who is appointed by the Oregon Society of Physician
Assistants; and
(m)
One naturopathic physician appointed by the Oregon Association of Naturopathic
Physicians.
(2)
The Rural Health Coordinating Council shall elect a chairperson and vice
chairperson.
(3)
A member of the council is entitled to compensation and expenses as provided in
ORS 292.495.
(4)
The chairperson may appoint nonvoting, advisory members of the Rural Health
Coordinating Council. However, advisory members without voting rights are not
entitled to compensation or reimbursement as provided in ORS 292.495.
(5)
Members shall serve for two-year terms.
(6)
The Rural Health Coordinating Council shall report its findings to the Office
of Rural Health. [1979 c.513 §5; 1981 c.693 §20; 1983 c.482 §19a; 1989 c.708 §2;
2011 c.703 §40]
442.495 Responsibilities of council.
The responsibilities of the Rural Health Coordinating Council shall be to:
(1)
Advise the Office of Rural Health on matters related to the health care
services and needs of rural communities;
(2)
Develop general recommendations to meet the identified needs of rural
communities; and
(3)
View applications and recommend to the office which communities should receive
assistance, how much money should be granted or loaned and the ability of the
community to repay a loan. [1979 c.513 §6; 1981 c.693 §21; 1983 c.482 §20; 2007
c.71 §129]
442.500 Technical and financial assistance
to rural communities. (1) The Office of Rural Health
shall provide technical assistance to rural communities interested in developing
health care delivery systems.
(2)
Communities shall make application for this technical assistance on forms
developed by the office for this purpose.
(3)
The office shall make the final decision concerning which communities receive
the money and whether a loan is made or a grant is given.
(4)
The office may make grants or loans to rural communities for the purpose of
establishing or maintaining medical care services.
(5)
The office shall provide technical assistance and coordination of rural health
activities through staff services which include monitoring, evaluation,
community needs analysis, information gathering and disseminating, guidance,
linkages and research. [1979 c.513 §8; 1981 c.693 §22; 1983 c.482 §21]
442.502 Determination of size of rural
hospital. (1) For purposes of determining the
size of a rural hospital, beds certified by the Oregon Health Authority on the
license of the hospital as special inpatient care beds shall not be included.
(2)
As used in this section, “special inpatient care beds” means beds that:
(a)
Are used for the treatment of patients with mental illness or for the treatment
of alcoholism or drug abuse, or are located in a rehabilitation center, a
college infirmary, a chiropractic facility, a freestanding hospice facility, an
infirmary for the homeless or an inpatient care facility described in ORS
441.065;
(b)
Are physically separate from acute inpatient care beds, at least by being
located on separate floors or wings of the same building;
(c)
Are never used for acute patient care;
(d)
Are staffed by dedicated direct care personnel for whom separate employment
records are maintained;
(e)
Have separate medical directors; and
(f)
Maintain separate admission, discharge and patient records. [1993 c.765 §55;
2007 c.70 §243; 2009 c.595 §754]
442.503 Eligibility for economic
development grants. In addition to any other
authorized uses of funds for economic development available from the
Administrative Services Economic Development Fund, economic development grants
may be made for the purpose of constructing, equipping, refurbishing,
modernizing and making other capital improvements for type A and B rural
hospitals, as defined under ORS 442.470. [1989 c.893 §10]
Note:
442.503 was enacted into law by the Legislative Assembly but was 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.
442.505 Technical assistance to rural
hospitals. The Office of Rural Health shall
institute a program to provide technical assistance to hospitals defined by the
office as rural. The Office of Rural Health shall be primarily responsible for
providing:
(1)
A recruitment and retention program for physicians and other primary care providers
in rural areas.
(2)
An informational link between rural hospitals and state and federal policies
regarding regulations and payment sources.
(3)
A system for effectively networking rural hospitals and providers so that they
may compete or negotiate with urban based health maintenance organizations.
(4)
Assistance to rural hospitals in identifying strengths, weaknesses,
opportunities and threats.
(5)
In conjunction with the Oregon Association of Hospitals, a report that
identifies models that will replace or restructure inefficient health services
in rural areas. [1987 c.918 §3; 2005 c.22 §301]
442.507 Assistance to rural emergency
medical service systems. (1) With the moneys transferred
to the Office of Rural Health by ORS 442.625, the office shall establish a
dedicated grant program for the purpose of providing assistance to rural
communities to enhance emergency medical service systems.
(2)
Communities, as well as nonprofit or governmental agencies serving those
communities, may apply to the office for grants on forms developed by the
office.
(3)
The office shall make the final decision concerning which entities receive
grants, but the office may seek advice from the Rural Health Coordinating
Council, the State Emergency Medical Service Committee and other appropriate
individuals experienced with emergency medical services.
(4)
The office may make grants to entities for the purchase of equipment, the
establishment of new rural emergency medical service systems or the improvement
of existing rural emergency medical service systems.
(5)
With the exception of printing and mailing expenses associated with the grant
program, the Office of Rural Health shall pay for administrative costs of the
program with funds other than those transferred under ORS 442.625. [1999 c.1056
§5]
442.515 Rural hospitals; findings.
The Legislative Assembly finds that Oregon rural hospitals are an integral part
of the communities and geographic area where they are located. Their impact on
the economic well-being and health status of the citizens is vast. The problems
faced by rural hospitals include a general decline in rural economies, the age
of the rural populations, older physical plants, lack of physicians and other
health care providers and a poor financial outlook. The Legislative Assembly
recognizes that the loss of essential hospital services is imminent in many
communities. [1987 c.918 §1]
442.520 Risk assessment formula; relative
risk of rural hospitals. (1) Subject to the formula set
out in subsection (2) of this section, the Office of Rural Health, in
consultation with the Oregon Association of Hospitals, shall establish a risk
assessment formula to identify the relative risk of a rural hospital, as
defined in ORS 442.470.
(2)
To assess the degree of risk faced by each rural hospital, the risk assessment
formula developed by the Office of Rural Health, in consultation with the
Oregon Association of Hospitals, shall include the following categories:
(a)
Organizational risk: The financial situation of each facility, as measured by a
nationally accepted formula that identifies the hospital’s current and future
financial viability;
(b)
Population risk: The impact that a hospital closure would have on the health
care needs of the citizens of each hospital’s respective service area, as
measured by an index that includes medically underserved, distance and target
population components; and
(c)
Economic risk: The direct and indirect economic contribution made to the
communities of each hospital’s respective service area, as measured by an index
that measures the overall economic benefit added to the service area community
by the hospital. [1991 c.947 §20]
Note:
442.520 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 442 by legislative action. See Preface to Oregon
Revised Statutes for further explanation.
442.525 [1989
c.893 §9; 1993 c.765 §50; repealed by 2005 c.806 §5]
NURSING SERVICES PROGRAM
442.535 Definitions for ORS 442.540 and
442.545. As used in ORS 442.540 and 442.545:
(1)
“Nurse” means any person who is licensed under ORS 678.010 to 678.410 as a
registered nurse.
(2)
“Nursing critical shortage area” means a locality or practice specialty
identified as such by the Oregon State Board of Nursing, in consultation with
the Office of Rural Health, under ORS 442.540.
(3)
“Qualifying loan” means any loan made to a nursing student under:
(a)
Programs under Title IV, parts B, D and E, of the Higher Education Act of 1965,
as amended; or
(b)
The Nursing Student Loan and Health Education Assistance Loan programs
administered by the United States Department of Health and Human Services. [2001
c.599 §1; 2011 c.637 §272]
Note:
442.535 to 442.545 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.
442.540 Nursing Services Program created;
criteria for participation; rules. (1) There is
created the Nursing Services Program, to be administered by the Oregon Student
Access Commission pursuant to rules adopted by the commission. The purpose of
the program is to provide loan repayments on behalf of nurses who agree to
practice in nursing critical shortage areas.
(2)
To be eligible to participate in the program, a nurse or prospective nurse
shall submit a letter of interest to the commission. Applicants who are
selected for participation according to criteria adopted by the commission
under subsection (3) of this section shall sign a letter of agreement
stipulating that the applicant agrees to abide by the terms of the program
described in ORS 442.545.
(3)
The commission shall by rule adopt, in consultation with the Oregon State Board
of Nursing and the Office of Rural Health, criteria for participation in the
program.
(4)
The Oregon State Board of Nursing by rule shall annually identify, in
consultation with the Office of Rural Health, those areas that are considered
nursing critical shortage areas.
(5)
Amounts paid to the commission as penalties under ORS 442.545 shall be credited
and deposited in the Nursing Services Account created under ORS 348.570. The
commission, in consultation with the Oregon State Board of Nursing, by rule
shall allow waiver of all or part of any fees or penalties owed to the
commission due to circumstances that prevent a nurse from fulfilling a service
obligation under ORS 442.545. [2001 c.599 §2; 2011 c.637 §273]
Note: See
note under 442.535.
442.545 Conditions of participation in
Nursing Services Program. (1) A nurse or prospective nurse
applicant who is a graduate of an accredited nursing program with a
baccalaureate or associate degree and who wishes to participate in the Nursing
Services Program established under ORS 442.540 shall agree that:
(a)
For each year of nursing school, the applicant designates an agreed amount, not
to exceed $8,800 or the amount determined under subsection (2) of this section,
as a qualifying loan for the program.
(b)
In the four years following the execution of a Nursing Services Program
agreement with the Oregon Student Access Commission, a nurse agrees to practice
for at least two full years in a nursing critical shortage area in Oregon.
(c)
For not less than two nor more than four years that the nurse practices in a
nursing critical shortage area, the commission shall annually pay:
(A)
For full-time practice, an amount equal to 25 percent of the total of all
qualifying loans made to the nurse.
(B)
For half-time practice, an amount equal to 12.5 percent of the total of all
qualifying loans made to the nurse.
(d)
If the nurse does not complete the full service obligation set forth in
paragraphs (b) and (c) of this subsection, the commission shall collect 100
percent of any payments made by the commission to the nurse under the Nursing
Services Program. In addition, the commission shall assess against the nurse a
penalty equal to 50 percent of the qualifying loans and interest paid by the
commission.
(2)(a)
On July 1 of each year, beginning in 2002 and ending in 2007, the commission
shall adjust the maximum dollar amount allowed under subsection (1)(a) of this
section as a qualifying loan by multiplying the amount by a cost-of-living
adjustment as specified in this subsection.
(b)
The cost-of-living adjustment applied on July 1 each year by the commission
shall be equal to the ratio of the seasonally adjusted United States City
Average Consumer Price Index for All Urban Consumers as published by the Bureau
of Labor Statistics of the United States Department of Labor for April of the
calendar year divided by the value of the same index for April 2001.
(c)
Beginning on July 1, 2008, the commission shall use the cost-of-living
adjustment calculated for July 1, 2007.
(d)
If the value of the dollar amount determined under paragraph (a) of this
subsection is not a multiple of $100, the commission shall round the dollar
amount to the next lower multiple of $100. [2001 c.599 §3; 2011 c.637 §274]
Note: See
note under 442.535.
PRIMARY CARE SERVICES PROGRAM
442.550 Definitions for ORS 442.550 to
442.570.
As used in ORS 442.550 to 442.570:
(1)
“Barriers to accessing health care” means being enrolled in Medicare or the
state medical assistance program or not having health insurance coverage.
(2)
“Dentist” means any person licensed to practice dentistry under ORS chapter
679.
(3)
“Naturopathic physician” means any person who holds a degree of Doctor of
Naturopathic Medicine and who is licensed to practice medicine under ORS
chapter 685.
(4)
“Nurse practitioner” means any person licensed under ORS 678.375.
(5)
“Pharmacist” means any person licensed as a pharmacist under ORS chapter 689.
(6)
“Physician” means any person who holds a degree of Doctor of Medicine or Doctor
of Osteopathy and who is licensed to practice medicine under ORS chapter 677.
(7)
“Physician assistant” means any person licensed under ORS 677.495 and 677.505
to 677.525.
(8)
“Qualifying loan” means any loan made to a student of naturopathic medicine,
medical student, physician assistant student, dental student, pharmacy student
or nursing student under:
(a)
Common School Fund loan program under ORS 348.040 to 348.090;
(b)
Programs under Title IV parts B, D and E, of the Higher Education Act of 1965,
as amended; and
(c)
The Health Professions Student Loan, Nursing Student Loan, Health Education
Assistance Loan and Primary Care Loan programs administered by the United
States Department of Health and Human Services.
(9)
“Qualifying practice site” means:
(a)
A rural hospital as defined in ORS 442.470;
(b)
A rural health clinic as defined in 42 U.S.C. 1395x(aa)(2);
(c)
A pharmacy that is located in a medically underserved rural community in Oregon
or a federally designated health professional shortage area and that is not
part of a group of six or more pharmacies under common ownership;
(d)
Another practice site in a medically underserved rural community in Oregon; or
(e)
An urban practice site at which the practitioner applying for or receiving loan
repayments under ORS 442.550 to 442.570 attests a willingness to serve patients
with barriers to accessing health care in at least the same proportion to the
practitioner’s total number of patients as the number of individuals with
barriers to accessing health care residing in the county where the practice
site is located, as determined by the Office of Rural Health, represents to the
total number of residents in the county. [1989 c.893 §16; 1991 c.947 §5; 1999
c.582 §11; 1999 c.704 §23; 2001 c.336 §1; 2005 c.357 §3; 2007 c.485 §1; 2010
c.42 §1]
Note:
442.550 to 442.570 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.
442.555 Primary Care Services Program
created; rules; criteria for participation. (1)
There is created the Primary Care Services Program, to be administered by the
Office of Rural Health, pursuant to rules adopted by the office. The purpose of
the program is to provide loan repayments on behalf of naturopathic physicians,
physicians, physician assistants, dentists, pharmacists and nurse practitioners
who agree to practice in a qualifying practice site.
(2)
To be eligible to participate in the program, a prospective naturopathic
physician, physician, physician assistant, dentist, pharmacist or nurse
practitioner shall submit an application to the office. Applicants who are
selected for participation according to criteria adopted by the office shall
sign a primary care service agreement stipulating that the applicant agrees to
abide by the terms stated in ORS 442.560.
(3)
Subject to available resources, the office may enter into primary care service
agreements with prospective naturopathic physicians, physicians, physician
assistants, dentists, pharmacists and nurse practitioners. The office may give
preference to prospective naturopathic physicians, physicians, physician
assistants, dentists, pharmacists and nurse practitioners who agree to practice
in a qualifying practice site or a community that has contributed funds to the
Primary Care Services Fund.
(4)
The office shall adopt criteria to be applied to determine medically
underserved rural communities and qualifying practice sites for purposes of ORS
442.550 to 442.570 and for the purposes of compliance with 42 U.S.C.
1395x(aa)(2), defining rural health clinics.
(5)
A qualifying practice site shall submit an application to the office to request
a designation as a qualifying practice site. The office shall make a list of
qualifying practice sites available to prospective naturopathic physicians,
physicians, physician assistants, dentists, pharmacists and nurse
practitioners. [1989 c.893 §17; 1991 c.877 §20; 1991 c.947 §6; 1993 c.765 §52;
1999 c.291 §32; 1999 c.704 §24; 2005 c.357 §1; 2007 c.485 §2; 2010 c.42 §2]
Note: See
note under 442.550.
442.560 Conditions of participation in
Primary Care Services Program; rules. (1)
Prospective naturopathic physicians, physicians, physician assistants,
dentists, pharmacists and nurse practitioners who wish to participate in the
Primary Care Services Program shall agree to practice in a qualifying practice
site in Oregon for at least three full years following completion of any
residency requirements or the execution of the primary care service agreement,
whichever comes later.
(2)
For not less than three and not more than six years, the Office of Rural Health
shall annually pay each participant in the Primary Care Services Program an
amount equal to one-third of the outstanding balances on qualifying loans made
to the participant up to a maximum of $25,000 each year. To the greatest extent
practicable, 75 percent of the moneys available for the program shall be paid
to participants practicing in rural areas and 25 percent of the moneys
available for the program shall be paid to participants practicing in urban
areas.
(3)
If the participant does not complete the full service obligation under
subsection (1) of this section, the participant shall be liable for the amount
of all payments made under subsection (2) of this section and any penalty
assessed according to criteria adopted by the office. Any amounts determined to
be due under this section shall be collected by the Collections Unit in the
Department of Revenue under ORS 293.250.
(4)
The office shall adopt criteria for waiver of all or part of the fees and
penalties owed to the office due to circumstances that prevent the participant
from fulfilling the service obligation. [1989 c.893 §18; 1991 c.877 §21; 1991
c.947 §3; 1993 c.765 §53; 1993 c.813 §13; 2005 c.357 §2; 2007 c.485 §3; 2010
c.42 §3]
Note: See
note under 442.550.
442.561 Certifying individuals licensed
under ORS chapter 679 for tax credit. The Office of
Rural Health shall establish criteria for certifying individuals who are
licensed under ORS chapter 679 as eligible for the tax credit authorized by ORS
315.616. Upon application therefor and upon a finding that the applicant is or
will be providing dental services to one or more rural communities and otherwise
meets the eligibility criteria established by the office, the office shall
certify individuals eligible for the tax credit authorized by ORS 315.616. [1995
c.746 §40; 1999 c.291 §33; 1999 c.459 §2]
Note: See
note under 442.550.
442.562 Certifying podiatric physicians and
surgeons for tax credit. The Office of Rural Health shall
establish criteria for certifying individuals who are licensed as podiatric
physicians and surgeons under ORS chapter 677 as eligible for the tax credit
authorized by ORS 315.616. Upon application therefor and upon a finding that
the applicant is or will be providing podiatric services to one or more rural
communities and otherwise meets the eligibility criteria established by the
office, the office shall certify individuals eligible for the tax credit
authorized by ORS 315.616. [1995 c.746 §41; 1999 c.291 §34; 1999 c.459 §3]
Note: See
note under 442.550.
442.563 Certifying certain individuals
providing rural health care for tax credit; rules.
(1) Subject to ORS 442.560, the Office of Rural Health shall establish criteria
for certifying individuals eligible for the tax credit authorized by ORS
315.613, 315.616 or 315.619. Upon application therefor, the office shall
certify individuals eligible for the tax credit authorized by ORS 315.613.
(2)
The classification of rural hospitals for purposes of determining eligibility
under this section shall be the classification of the hospital in effect on
January 1, 1991. [1989 c.893 §7; 1991 c.877 §19; 1995 c.746 §35; 1999 c.291 §35;
1999 c.459 §4]
Note: See
note under 442.550.
442.564 Certifying optometrists for tax
credit. The Office of Rural Health shall
establish criteria for certifying individuals who are licensed as optometrists
under ORS 683.010 to 683.340 as eligible for the tax credit authorized by ORS
315.616. Upon application therefor and upon a finding that the applicant is or
will be providing optometry services to one or more rural communities and
otherwise meets the eligibility criteria established by the office, the office
shall certify individuals eligible for the tax credit authorized by ORS
315.616. [1997 c.787 §2; 1999 c.291 §36; 1999 c.459 §5]
Note: See
note under 442.550.
442.565 [1989
c.893 §19; renumbered 442.568 in 2005]
442.566 Certifying emergency medical
services providers for tax credit. The Office of
Rural Health shall establish criteria for certifying individuals who are
licensed as emergency medical services providers under ORS chapter 682 as
eligible for the tax credit authorized by ORS 315.622. Upon application for the
credit and upon a finding that the applicant will be providing emergency
medical services in one or more rural areas and otherwise meets the eligibility
criteria established by the office, the office shall certify the individual as eligible
for the tax credit authorized by ORS 315.622. [2005 c.832 §65; 2011 c.703 §41]
Note: See
note under 442.550.
442.568 Oregon Health and Science
University to recruit persons interested in rural practice.
(1) The Oregon Health and Science University shall develop and implement a
program to focus recruitment efforts on students who reside in or who are
interested in practicing in rural areas.
(2)
The university shall reserve a number of admissions to each class at the
medical school for qualified students who agree to participate in the Primary
Care Services Program. The number of admissions under this section is not
required to exceed 15 percent of each class, but that figure is a goal
consistent with the long term intention of the Legislative Assembly to
encourage the availability of medical services in rural areas.
(3)
In the event that the university is unable to recruit the number of qualified
students required under subsection (2) of this section, after having made a
reasonable effort to do so, the university is authorized to fill the remaining
positions with other eligible candidates. [Formerly 442.565; 2010 c.42 §4]
Note: See
note under 442.550.
442.570 Primary Care Services Fund;
matching funds. (1) There is established in the
State Treasury a fund, separate and distinct from the General Fund, to be known
as the Primary Care Services Fund. Moneys in the Primary Care Services Fund are
continuously appropriated to the Oregon Department of Administrative Services
for allocation to the Office of Rural Health for investments as provided by ORS
293.701 to 293.820, for expenses and payments by the office in carrying out the
purposes of ORS 315.613, 315.616, 315.619, 353.450, 442.470, 442.503 and
442.550 to 442.570. Interest earned by the fund shall be credited to the fund.
(2)
The office shall seek matching funds from the federal government and from
communities that benefit from placement of participants under ORS 442.550 to
442.570. The office shall establish a program to enroll interested communities
in this program and deposit moneys from the matching funds and from the Primary
Care Services Program in the Primary Care Services Fund. In addition, the
office shall explore other funding sources including federal grant programs. [1989
c.893 §21; 1991 c.877 §22; 1991 c.947 §4; 2010 c.42 §5]
Note: See
note under 442.550.
PRIMARY HEALTH CARE LOAN FORGIVENESS
PROGRAM
442.573 Fund established.
The Primary Health Care Loan Forgiveness Program Fund is established in the
State Treasury, separate and distinct from the General Fund. Interest earned by
the Primary Health Care Loan Forgiveness Program Fund shall be credited to the
fund. Moneys in the fund are continuously appropriated to the Oregon Department
of Administrative Services for distribution to the Office of Rural Health for
the purposes of carrying out the provisions of ORS 442.574. [2011 c.651 §2]
Note:
442.573 and 442.574 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.
442.574 Eligibility; requirements; rules.
(1) As used in this section:
(a)
“Participant” means a person who has been selected by the Office of Rural
Health to receive a loan under subsection (4) of this section.
(b)
“Primary care practitioner” means a:
(A)
Physician licensed under ORS chapter 677;
(B)
Physician assistant licensed under ORS 677.505 to 677.525; or
(C)
Nurse practitioner licensed under ORS 678.375.
(c)
“Prospective primary care practitioner” means a person who is enrolled in a
medical education program that meets the educational requirements for licensure
as a physician, physician assistant or nurse practitioner.
(d)
“Service agreement” means the agreement executed by a prospective primary care
practitioner under subsection (3) of this section.
(2)
There is created the Primary Health Care Loan Forgiveness Program, to be
administered by the office pursuant to rules adopted by the office.
(3)
A prospective primary care practitioner who wishes to participate in the
program shall submit an application to the office in accordance with rules
adopted by the office. To be eligible to be a participant in the program, a
prospective primary care practitioner must:
(a)
Have completed the first year of the prospective primary care practitioner’s
medical education;
(b)
Be enrolled in a medical education program in Oregon that emphasizes training
rural health care practitioners and is approved by the office;
(c)
Execute a service agreement stating that, immediately upon the prospective
primary care practitioner’s completion of residency or training as established
by the office by rule, the prospective primary care practitioner will practice
as a primary care practitioner in a rural setting in this state approved by the
office for at least as many years as the number of years for which the
practitioner received loans from the Primary Health Care Loan Forgiveness
Program; and
(d)
Meet other requirements established by the office by rule.
(4)
The office may select participants from among the prospective primary care
practitioners who submit applications as provided in subsection (3) of this
section. The office shall give preference to a prospective primary care
practitioner who agrees to practice in a community that agrees to contribute
funds to the Primary Health Care Loan Forgiveness Program Fund established in
ORS 442.573.
(5)
The office shall provide an annual loan of up to $35,000 to each participant to
cover expenses related to the participant’s medical education, on terms
established by the office by rule. The loan must be evidenced by a written
obligation but no additional security may be required.
(6)
Repayment of loans provided under subsection (5) of this section is deferred
while a participant is in compliance with the service agreement.
(7)
At the end of each full year that a participant complies with the service
agreement, the office shall forgive one annual loan provided to the participant
under subsection (5) of this section.
(8)(a)
A person receiving a loan under subsection (5) of this section who fails to
complete the residency or training as required by the office by rule shall
repay the amount received to the Primary Health Care Loan Forgiveness Program
plus 10 percent interest on the unpaid balance, accrued from the date the loan
was granted.
(b)
A person receiving a loan under subsection (5) of this section who completes
the residency or training required by the office by rule but fails to fulfill
the obligations required by the service agreement shall repay the amount
received to the Primary Health Care Loan Forgiveness Program plus 10 percent
interest on the unpaid balance, accrued from the date the loan was granted.
Additionally, a penalty fee equal to 25 percent of the amount received shall be
assessed against the person. No interest accrues on the penalty. The office
shall establish rules to allow waiver of all or part of the penalty owed to the
program due to circumstances that prevent the participant from fulfilling the
service obligation.
(9)
Payments on loans provided under subsection (5) of this section shall be
deposited in the Primary Health Care Loan Forgiveness Program Fund established
in ORS 442.573.
(10)
If a participant defaults on a loan provided under section (5) of this section:
(a)
Any amounts due may be collected by the Collections Unit in the Department of
Revenue under ORS 293.250; or
(b)
The Oregon Health and Science University may contract with a collections agency
to collect any amounts due.
(11)
Any amounts collected under subsection (10) of this section shall be deposited
in the Primary Health Care Loan Forgiveness Program Fund established in ORS
442.573.
(12)
The office may accept funds from any public or private source for the purposes
of carrying out the provisions of this section. [2011 c.651 §1]
Note: See
note under 442.573.
442.575 [1993
c.754 §3; repealed by 2011 c.720 §228]
442.580 [1991
c.470 §2; 2001 c.238 §1; 2009 c.326 §9; repealed by 2011 c.720 §228]
442.581 [1991
c.470 §4; 1995 c.727 §37; 1997 c.683 §31; repealed by 2011 c.720 §228]
442.582 [1991
c.470 §5; repealed by 1993 c.754 §4 (442.583 enacted in lieu of 442.582)]
442.583 [1993
c.754 §5 (enacted in lieu of 442.582); repealed by 2011 c.720 §228]
442.584 [1991
c.470 §§7,22; 2009 c.595 §1180; repealed by 2011 c.720 §228]
442.586 [1991
c.470 §8; repealed by 1995 c.727 §48]
442.588 [1993
c.754 §10; 1995 c.727 §47; repealed by 2011 c.720 §228]
442.589 [2009
c.595 §1179; repealed by 2011 c.720 §228]
MISCELLANEOUS
442.600 Policy on maternity care.
The Legislative Assembly finds and declares that:
(1)
Maternity care is the cornerstone of health care delivery in the state. It
provides a proven, cost-effective foundation for improving the health of all
Oregonians, and a healthy start in life allows our future citizens to achieve
their full potential.
(2)
Although great strides have been made to improve maternity care, barriers
continue to exist as indicated by high rates of inadequate prenatal care and
lack of coordination between prenatal and delivery services.
(3)
Individual communities have unique combinations of barriers and resources.
Therefore, planning and solutions must be developed at the local level whenever
possible, with the state providing guidelines, standards and support.
(4)
Local resources are strained and communities need a structure and technical
assistance to assure development of access to a coordinated system of maternity
care.
(5)
There is a need for a system to assure coordination of all maternity service
providers to develop a comprehensive service system for Oregon that addresses
all barriers to guide the state’s action in this area.
(6)(a)
Therefore, it is the intent of this state that there shall be a comprehensive
system of maternity care based on the plan that includes prenatal, delivery and
postpartum care and that meets the unique needs of the individual pregnant
woman, available to all pregnant women in this state.
(b)
As used in this subsection, “plan” means the Maternity Care Access Planning
Commission’s comprehensive statewide plan for a maternity care system dated
March 1993 and titled “Comprehensive Perinatal Health Services: A Strategy
Toward Universal Access to Care in Oregon.” [1991 c.760 §1; 1993 c.514 §1]
Note:
442.600 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 442 by legislative action. See Preface to Oregon
Revised Statutes for further explanation.
442.625 Emergency Medical Services
Enhancement Account; distribution of moneys in account.
(1) The Emergency Medical Services Enhancement Account is established separate
and distinct from the General Fund. Interest earned on moneys in the account
shall accrue to the account. All moneys deposited in the account are
continuously appropriated to the Department of Revenue for the purposes of this
section.
(2)
The Department of Revenue shall distribute moneys in the Emergency Medical
Services Enhancement Account in the following manner:
(a)
35 percent of the moneys in the account shall be transferred to the Office of
Rural Health established under ORS 442.475 for the purpose of enhancing
emergency medical services in rural areas as specified in ORS 442.507.
(b)
25 percent of the moneys in the account shall be transferred to the Emergency
Medical Services and Trauma Systems Program established under ORS 431.623.
(c)
35 percent of the moneys in the account shall be transferred to the Area Health
Education Center program established under ORS 353.450.
(d)
5 percent of the moneys in the account shall be transferred to the Oregon
Poison Center referred to in ORS 431.890. [1999 c.1056 §3]
Note:
442.625 was enacted into law by the Legislative Assembly but was 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.
COOPERATIVE PROGRAM ON HEART AND KIDNEY
TRANSPLANTS
442.700 Definitions for ORS 442.700 to
442.760. As used in ORS 442.700 to 442.760:
(1)
“Board of governors” means the governors of a cooperative program as described
in ORS 442.720.
(2)
“Cooperative program” means a program among two or more health care providers
for the purpose of providing heart and kidney transplant services including,
but not limited to, the sharing, allocation and referral of physicians,
patients, personnel, instructional programs, support services, facilities,
medical, diagnostic, laboratory or therapeutic services, equipment, devices or
supplies, and other services traditionally offered by health care providers.
(3)
“Health care provider” means a hospital, physician or entity, a significant
part of whose activities consist of providing hospital or physician services in
this state. For purposes of the immunities provided by ORS 442.700 to 442.760
and 646.740, “health care provider” includes any officer, director, trustee,
employee, or agent of, or any entity under common ownership and control with, a
health care provider.
(4)
“Hospital” means a hospital, a long term care facility or an ambulatory
surgical center, as those terms are defined in ORS 442.015, that is licensed
under ORS 441.015 to 441.089. “Hospital” includes community health programs
established under ORS 430.610 to 430.695.
(5)
“Order” means a decision issued by the Director of the Oregon Health Authority
under ORS 442.710 either approving or denying an application for a cooperative
program and includes modifications of an original order under ORS 442.730
(3)(b) and ORS 442.740 (1) and (4).
(6)
“Party to a cooperative program agreement” or “party” means an entity that
enters into the principal agreement to establish a cooperative program and
applies for approval under ORS 442.700 to 442.760 and 646.740 and any other
entity that, with the approval of the director, becomes a member of a
cooperative program.
(7)
“Physician” means a physician defined in ORS 677.010 (13) and licensed under
ORS chapter 677. [1993 c.769 §3; 2001 c.104 §182; 2007 c.70 §244; 2009 c.595 §755;
2009 c.792 §42; 2011 c.720 §198]
442.705 Legislative findings; goals.
(1) The Legislative Assembly finds that direct competition among health care
providers in the field of heart and kidney transplant services may not result
in the most cost efficient and least expensive transplant services for the
citizens of this state and that it is in the public interest to allow
cooperative programs among health care providers providing heart and kidney
transplant services.
(2)
The Legislative Assembly declares that, to the extent provided in ORS 442.700
to 442.760, it is the policy and intent of this state to displace competition
among health care providers providing heart and kidney transplant services by
allowing health care providers to enter into cooperative programs governing the
provision of heart and kidney transplant services in order to achieve in each
instance the following goals:
(a)
Reduction of, or protection against, rising costs of heart and kidney
transplant services;
(b)
Reduction of, or protection against, rising prices for heart and kidney
transplant services;
(c)
Improvement or maintenance of the quality of heart and kidney transplant
services provided in this state;
(d)
Reduction of, or protection against, duplication of resources including,
without limitation, expensive medical specialists, medical equipment and sites
of service;
(e)
Improvement or maintenance of efficiency in the delivery of heart and kidney
transplant services;
(f)
Improvement or maintenance of public access to heart and kidney transplant
services;
(g)
Increase in donations of organs for transplantation; and
(h)
Improvement in the continuity of patient care.
(3)
The Legislative Assembly further declares that the goals identified in
subsection (2) of this section represent the policies of this state.
(4)
The Legislative Assembly further declares that once a cooperative program is
approved under ORS 442.700 to 442.760, there is an interest in insuring
stability in the provision of health care services by a cooperative program, to
the extent stability is consistent with achieving the goals identified in
subsection (2) of this section.
(5)
The Director of the Oregon Health Authority shall actively supervise the
cooperative program in accordance with authority under ORS 442.700 to 442.760
and 646.740. [1993 c.769 §1; 2009 c.595 §756]
442.710 Application for approval of
cooperative program; form; content; review; modification; order.
(1) The Oregon Health and Science University and one or more entities, each of
which operates at least three hospitals in a single urban area in this state,
may apply to the Director of the Oregon Health Authority for approval of a
cooperative program. The application shall include an executed written copy of
all agreements for the cooperative program.
(2)
An application for approval of a cooperative program shall be made in the form
and manner and shall set forth any information regarding the proposed
cooperative program that the director may prescribe. The information shall
include, but not be limited to:
(a)
A list of the names of all health care providers who propose to provide heart
and kidney transplant services under the cooperative program, together with
appropriate evidence of compliance with any licensing or certification
requirements for those health care providers to practice in this state. In the
case of employed physicians, the list and the information to be submitted may
be limited to the employer or organizational unit of the employer;
(b)
A description of the activities to be conducted by the cooperative program;
(c)
A description of proposed anticompetitive practices listed in ORS 442.715, any
practices that the parties anticipate will have significant anticompetitive
effects and a description of practices of the cooperative program affecting
costs, prices, personnel positions, capital expenditures and allocation of
resources;
(d)
A list of the goals identified in ORS 442.705 (2) that the cooperative program
expects to achieve;
(e)
A description of the proposed places and manner of providing heart and kidney transplant
services and services related to heart and kidney transplants under the
cooperative program;
(f)
A proposed budget for operating the cooperative program;
(g)
Satisfactory evidence of financial ability to deliver heart and kidney
transplant services in accordance with the cooperative program;
(h)
The agreement that establishes the cooperative program and policies that shall
govern it; and
(i)
Other information the director believes will assist in determining whether the
cooperative program will likely achieve the goals listed in ORS 442.705 (2).
(3)
The director shall review the application in accordance with the provisions of
this section and shall grant, deny or request modification of the application
within 90 days of the date the application is filed. The director shall hold
one or more public hearings on the application, which shall conclude no later
than 80 days after the date the application is filed. The decision of the
director on an application shall be considered an order in a contested case for
the purposes of ORS chapter 183.
(4)
The director shall approve an application made under subsection (2) of this
section after:
(a)
The applicants have demonstrated they will achieve at least six of the goals of
ORS 442.700 to 442.760 and 646.740, including at least the goals identified in
ORS 442.705 (2)(a) to (d); and
(b)
The director has reviewed and approved the specifics of the anticompetitive
activity expected to be conducted by the cooperative program.
(5)
In evaluating the application, the director shall consider whether a
cooperative program will contribute to or detract from achieving the goals
listed in ORS 442.705 (2). The director may weigh goals relating to
circumstances that are likely to occur without the cooperative program, and
relating to existing circumstances. The director may also consider whether any
alternative arrangements would be less restrictive of competition while
achieving the same goals.
(6)
An order approving a cooperative program shall identify and define the limits
of the permitted activities for purposes of granting antitrust immunity under
ORS 442.700 to 442.760.
(7)
An order approving a cooperative program shall include:
(a)
Approval of specific activities listed in ORS 442.715;
(b)
Approval of activities the director anticipates will have substantial
anticompetitive effects;
(c)
Approval of the proposed budget of the cooperative program;
(d)
The goals listed in ORS 442.705 (2) that the cooperative program is expected to
achieve; and
(e)
Approval of the cooperative program as described in the application and a
finding that the cooperative program is in the public interest.
(8)
An order denying the application for a cooperative program shall identify the
findings of fact and reasons supporting denial.
(9)
Either the director or all the parties to the cooperative program may request a
modification of an application made under this section. A request for a
modification shall result in one extension of 30 days after submission of the
modified application. The director shall issue an order under this section
within 30 days after submission of the modified application. [1993 c.769 §14;
2009 c.595 §757]
442.715 Authorized practices under approved
cooperative program. (1) To the extent permitted by
an order issued under ORS 442.710, health care providers providing heart and
kidney transplant services through a cooperative program approved under ORS
442.700 to 442.760 may engage in the following practices in order to achieve
the goals described in ORS 442.705 (2):
(a)
Set prices for heart and kidney transplants and all services directly related
to heart and kidney transplants;
(b)
Refuse to deal with competitors in the heart and kidney transplant market;
(c)
Allocate product, service, geographic and patient markets directly relating to
heart and kidney transplants;
(d)
Acquire and maintain a monopoly in heart and kidney transplant services; and
(e)
Engage in other activities that might give rise to liability under ORS 646.705
to 646.836 or federal antitrust laws.
(2)
To the extent permitted by an order issued under ORS 442.710 and in addition to
the provisions of subsection (1) of this section, physicians participating in a
cooperative program may agree among themselves on referrals of nontransplant
cardiac surgeries to the extent necessary to achieve redistribution of the
cardiac surgery cases among participating surgeons.
(3)
The Legislative Assembly intends that all persons arranging or participating in
a cooperative program approved and conducted in accordance with an order issued
under ORS 442.710 and all persons participating in good faith negotiations
conducted pursuant to ORS 442.750 shall:
(a)
Not be subject to the provisions of ORS 646.705 to 646.836 so long as the
activities of the cooperative program are regulated, lawful and approved in
accordance with ORS 442.700 to 442.760 and 646.740; and
(b)
Receive the full benefit of state action immunity under federal antitrust laws.
[1993 c.769 §2]
442.720 Board of governors for cooperative
program. (1) If the Director of the Oregon
Health Authority issues an order approving an application for a cooperative
program under ORS 442.710, the director shall establish a board of governors to
govern the cooperative program. The board of governors shall not constitute,
for any purpose, a governmental agency.
(2)
The board of governors shall consist of the president or other chief executive
officer of each health care provider that is a party to the cooperative program
agreement and the director or a designee of the director. The designee shall
serve at the pleasure of the director. The designee shall not have any economic
or other interest in any of the health care providers associated with the
cooperative program.
(3)
In governing the cooperative program, the board of governors shall develop
policy and approve budgets for the implementation of the cooperative program.
(4) The director or designee of the director may reject any operating or capital budget of