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The Oregon Administrative Rules contain OARs filed through July 15, 2016
 
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OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS

 

DIVISION 15

HEALTH CARE FACILITY FINANCIAL REPORTING

409-015-0005

Definitions

The following definitions apply to OAR 409-015-0005 through 409-015-0040:

(1) “Authority” means the Oregon Health Authority.

(2) "Charity care" means the uncollectible value, at the hospital's full established rates, of services provided to financially indigent patients. The uncollectible portion may vary from a very small percentage of the regular charges for some patients, up to 100 percent for other patients.

(3) "Health care facility" means a hospital, including any special inpatient care facility, and an ambulatory surgical facility. The following facilities are not covered:

(a) Institutions providing only domiciliary care;

(b) Infirmaries of state institutions, colleges and universities;

(c) Federal facilities; and

(d) Long-term care facilities, or hospital-based long-term care service.

(4) "Medicare and Medicaid deductions" means the uncollectible differences between the hospital's full established charges for individual services and the rates paid by Medicare or Medicaid for composite services.

(5) "Other contractual deductions" means the uncollectible differences between full established charges for individual services and the contractual rates paid by a third-party payer for composite services, usually on a per diem, per discharge or capitation basis.

(6) "Provision for bad debts" means the estimated amount of accounts receivable expected to result in credit losses.

(7) "Unreimbursed care" means the sum of the provision for bad debts plus charity service, Medicare deductions, Medicaid deductions and contractual deductions.

Stat. Auth.: ORS 442.400 & 442.420
Stats. Implemented: ORS 442.400 & 442.420
Hist.: SHPD 1-1979, f. & ef. 6-1-79; SHPD 6-1981, f. & ef. 10-2-81; SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; SHPD 1-1987, f. & ef. 2-3-87; HP 2-1988, f. & cert. ef. 3-25-88; HP 2-1992, f. & cert. ef. 10-19-92; HP 2-1994, f. & cert. ef. 4-22-94; HP 1-1996, f. & cert. ef. 1-2-96; OHP 1-1997, f. & cert. ef. 8-25-97; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 1-2002, f. & cert. ef. 1-2-02; OHP 4-2016, f. & cert. ef. 3-28-16

409-015-0010

Report Forms

(1) All health care facilities shall file the required reports and data on forms provided or approved by the Authority.

(2) The Authority adopts and incorporates by reference the Patient Revenue and Unreimbursed Care form, Form FR-3.

(3) The Authority shall not accept obsolete forms.

[ED. NOTE: Forms referenced are available from the agency.]

Stat. Auth.: ORS 442.405, 442.420 & 442.425
Stats. Implemented: ORS 442.425
Hist.: SHPD 1-1979, f. & ef. 6-1-79; SHPD 6-1981, f. & ef. 10-2-81; SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; SHPD 18-1984, f. & ef. 12-20-84; SHPD 12-1986, f. & ef. 7-7-86; HP 2-1988, f. & cert. ef. 3-25-88; HP 2-1990, f. & cert. ef. 2-12-90; HP 2-1992, f. & cert. ef. 10-19-92; HP 2-1994, f. & cert. ef. 4-22-94; HP 1-1996, f. & cert. ef. 1-2-96; OHP 1-1997, f. & cert. ef. 8-25-97; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 1-2002, f. & cert. ef. 1-2-02; OHP 3-2011, f. 2-8-11, cert. ef. 3-1-11; OHP 4-2016, f. & cert. ef. 3-28-16

409-015-0012

Filing Date

The date of filing for the Databank Monthly Data electronically, is the date of receipt by the Oregon Association of Hospitals and Health Systems. The date of filing for the Patient Revenue and Unreimbursed Care (Form FR-3) is the postmark date.

[ED. NOTE: Forms referenced are available from the agency.]

Stat. Auth.: ORS 442.405, 442.420 & 442.425
Stats. Implemented: ORS 442.425
Hist.: SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; SHPD 18-1984, f. & ef. 12-20-84; HP 2-1988, f. & cert. ef. 3-25-88; HP 2-1990, f. & cert. ef. 2-12-90; HP 1-1996, f. & cert. ef. 1-2-96; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10

409-015-0015

Reports Required

(1) Each health care facility shall file with the Authority financial statements, with attached certification of audit, not later than 120 days following the close of each fiscal year. If the financial statements of the facility are a part of the combining of a for-profit or not-for-profit corporation, the combining financial statements and attached certification of audit shall be filed.

(2) Each health care facility shall file an accurately completed Databank Monthly Data electronically with the Oregon Association of Hospitals and Health Systems (OAHHS) for receipt by OAHHS on or before the 23rd day of each month. This form will transmit data for the preceding month. The Authority may, at its discretion, exempt a special inpatient care facility, ambulatory surgical facility or other health care facility from the requirements of this section. The Authority may, by oral or written notification, require a health care facility to use an express mail service to submit the Databank Monthly Data Input Form to OAHHS.

(3) The Authority may annually require that each health care facility provide a breakdown of its unreimbursed care into bad debts, charity care, Medicare deductions, Medicaid deductions and other contractual deductions, using Form FR-3.

(4) Each health care facility may be required to annually submit to the Authority a breakdown of its gross patient service revenue into inpatient revenue and outpatient revenue, and other applicable categories specified by Form FR-3.

(5) Documents filed with the Authority under these rules are to be addressed to the Oregon Health Authority, Health Systems Research & Data, 500 Summer St. NE E-64, Salem, Oregon 97301-1079.

[ED. NOTE: Forms referenced are available from the agency.]

Stat. Auth.: ORS 442.405, 442.420 & 442.425
Stats. Implemented: ORS 442.425
Hist.: SHPD 1-1979, f. & ef. 6-1-79; SHPD 6-1981, f. & ef. 10-2-81; SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; SHPD 18-1984, f. & ef. 12-20-84; SHPD 12-1986, f. & ef. 7-7-86; HP 2-1988, f. & cert. ef. 3-25-88; HP 2-1990, f. & cert. ef. 2-12-90; HP 1-1996, f. & cert. ef. 1-2-96; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 5-2010, f. 9-23-10, cert. ef. 10-1-10; OHP 4-2016, f. & cert. ef. 3-28-16

409-015-0030

Modification of Reporting Requirements

(1) The Authority, upon request of a health care facility and for good cause, may relieve or modify the reporting requirements provided for in these rules when the reporting requirement is proven to the satisfaction of the Authority to impose an undue hardship.

(2) Unless otherwise specified by the Authority, any relief or modification granted under section (1) of this rule is restricted to the specific instance or occasion for which relief was sought, and may not be construed to relieve any other reporting requirements of the health care facility.

Stat. Auth.: ORS 442.405, 442.420 & 442.425
Stats. Implemented: ORS 442.425
Hist.: SHPD 1-1979, f. & ef. 6-1-79; SHPD 6-1981, f. & ef. 10-2-81; SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; HP 2-1988, f. & cert. ef. 3-25-88; OHP 4-2016, f. & cert. ef. 3-28-16

409-015-0035

Civil Penalties

(1) Pursuant to ORS 442.445, the Authority adopts the following schedule of civil penalties:

(a) $250.00 per day for the first five days of failure to file in accord with ORS 442.425; and

(b) $500.00 per day from the sixth day until filing in accordance with ORS 442.425 is satisfactorily accomplished.

(2) Any amount of civil penalty imposed by the Authority may not be allowed as a reimbursable cost item and may not be recoverable from any category of payment source or patient.

Stat. Auth.: ORS 442.405, 442.420 & 442.445
Stats. Implemented: ORS 442.445(2)
Hist.: SHPD 1-1979, f. & ef. 6-1-79; SHPD 6-1981, f. & ef. 10-2-81; SHPD 9-1982(Temp), f. & ef. 12-30-82; SHPD 21-1983, f. & ef. 6-28-83; HP 2-1988, f. & cert. ef. 3-25-88; HP 2-1991, f. & cert. ef. 11-8-91; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 4-2016, f. & cert. ef. 3-28-16

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