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The Oregon Administrative Rules contain OARs filed through August 15, 2014
 
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OREGON HEALTH AUTHORITY, OFFICE FOR OREGON HEALTH POLICY AND RESEARCH

 

DIVISION 22

REQUIREMENTS FOR SUBMISSION OF HEALTH CARE FACILITY
UTILIZATION DATA; AMBULATORY SURGERY

409-022-0005

Annual Reports

(1) By December 31 of each year, each licensed health care facility shall file with the Office for Oregon Health Policy and Research an annual report on the facility's utilization. The report will consist of properly completed copies of any of the office's Forms AR-1 to AR-3 which relate to services offered by the facility.

(2) Within 15 days of the submission of an annual report by a facility, the office will either acknowledge in writing that the annual report has been completed, or will inform the facility verbally or in writing of any incomplete or incorrectly completed items.

(3) Pursuant to ORS 442.445(2), the office adopts the following schedule of civil penalties:

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

(b) $500.00 per day from the sixth day until filing in accord with this rule is satisfactorily accomplished.

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

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

Stat. Auth.: ORS 442.420(3)(d), 442.445(2) & 442.463
Stats. Implemented: ORS 442.445 & ORS 442.463
Hist.: HP 2-1988, f. & cert. ef. 3-25-88; 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

Ambulatory Surgical Data Reporting Program

409-022-0010

Definitions

Pursuant to ORS 442.120, the Office for Oregon Health Policy and Research has established an ambulatory surgical data reporting program. These definitions apply to the rules adopted in this Division and to OAR 409-22-020 to 409-22-080.

(1) "Office" as defined in ORS 442.011

(2) "Ambulatory surgery data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a surgical or diagnostic procedure treatment in a hospital outpatient setting or an ambulatory surgical facility setting into a data record.

(3) "Hospital" means a facility with an organized medical staff, with permanent facilities that include inpatient beds and with medical services, including physician services and continuous nursing services under the supervision of registered nurses, to provide diagnosis and medical or surgical treatment that is licensed under ORS 441.015.

(4) "Ambulatory surgical facility" means a facility that performs outpatient surgery not routinely or customarily performed in a physician's or dentist's office, and that is licensed under ORS 441.015.

(5) "Electronic media" means a magnetic tape, CD or other electronic data storage medium.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0020

Reporting Source of Ambulatory Surgical Data

The reporting sources for ambulatory surgery data are Oregon licensed general acute care hospitals and ambulatory surgical facilities.

(1) A general acute care hospital shall file with the Office for Oregon Health Policy and Research (OHPR), or its designee, ambulatory surgery data records for each surgical outpatient discharged from its facility.

(2) An ambulatory surgical facility shall file with the Office for Oregon Health Policy and Research (OHPR), or its designee, ambulatory surgical data records for each patient discharged from its facility.

(3) Each hospital and ambulatory surgical facility is responsible for compliance with the rule. Use of a designated intermediary does not relieve the hospital or ambulatory surgical facility of its reporting responsibility. Failure to comply may, at the sole discretion of the Office, result in civil penalties according to the schedule published in OAR 409-015-035.

(4) Each hospital and ambulatory surgical facility shall designate a department and a person within the department who is responsible for submitting the discharge data records. This person shall also be responsible for communicating with the Office.

(5) Each hospital and ambulatory surgical facility shall submit a completed registration form to the Office. The registration form shall be included with each data submission. The registration form shall include facility name, mailing address, administrator name, email and phone number and contact name, email, and phone number (if different than the administrator). The registration form (AS-1) is available at the Office's web site at: http://www.oregon.gov/oha/OHPR/RSCH/ASC/NewASC_RegForm.pdf.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0030

Electronic File Transfer Schedule

Each hospital and ambulatory surgical facility shall submit to the Office a single outpatient surgical data record for each patient discharged in the preceding quarter. Such records shall be assembled in the format described in Table A. The reporting schedule for submission of such data shall be determined by July 1 of each year, or on a schedule mutually agreed upon by the Office and hospital or ambulatory surgical facility. Table A is available from OHPR and on its web site at http://www.oregon.gov/OHA/OHPR/RSCH/Pages/Ambulatory_Surgery_Reporting.aspx

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0040

Confidentiality and Data Security

(1) Ambulatory surgery data required to be provided to OHPR or its designee under this rule 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, and other uses authorized to be made by OHPR by law. In addition, OHPR may obtain records for each patient that identifies specific services, classified by International Classification of Disease Code, for special studies on the incidence of specific health problems or diagnostic practices.

(2) This rule authorizes OHPR to require general acute care hospitals and ambulatory surgical facilities to provide a patient identifier consisting of the first 4 letters of the patient's last name, the first 3 letters of the patient's first name and the last 4 digits of the patient's Social Security Number.

(3) OHPR, including any designee, shall not use any patient identifying information for purposes other than those directly connected with the purposes stated in subsection (1). Nothing in these rules authorizes the disclosure or publication of specific data in a form that allows identification of individual patients or individual licensed health care professionals.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0050

Fees

(1) Pursuant to ORS 442.120(3), the Office for Oregon Health Policy and Research (OHPR) has established a fee schedule to cover the cost of abstracting and compiling ambulatory surgery data. Fees are assessed on a per record basis.

(2) Intent. The intent of the fee schedule is to recover reasonable costs necessary to abstract, compile and maintain the data. Total assessed fees shall not exceed the total costs necessary to abstract, compile, and maintain the data.

(3) Per Record Fee Calculation. The per record fee shall be calculated by summing the costs necessary to abstract, compile, and maintain the data for the most recent quarter and dividing these costs by the total number of ambulatory surgery discharges during the same semi-annual period.

(4) Review. If the per record fee calculation equals or exceeds fifty cents ($0.50), the process for establishing the fee schedule shall be reviewed with a stakeholder group representing both hospital-based and freestanding ambulatory surgery facilities.

(5) Assessment. The total assessed fees shall be calculated by multiplying the per-record fee by the anticipated number of ambulatory surgery discharges during the calendar year for each ambulatory surgical facility.

(6) Collection of Fees. Fees shall be paid to the Office for Oregon Health Policy and Research semi-annually. Fees for January 1 through June 30 shall be due no later than December 31; fees for July 1 through December 31 shall be due no later than June 30 of the following year. Payments must be delivered to the address provided on the billing notice. Payments are due no later than the close of business on the due date.

(7) Compliance. Late payments are subject to recovery in accordance with the laws of the State of Oregon.

(8) Revenue. Fees and revenue received by OHPR from assessments and permitted uses of the collected data shall be used to pay the calculated costs necessary to abstract, compile, and maintain the data.

(9) Other Funding. Grants, donations, or other funding, if any, obtained by OHPR specifically to abstract, compile, and maintain the data shall be first used to offset the calculated costs necessary to abstract, compile, and maintain the data.

Stat. Auth.: ORS 420.120
Stats. Implemented: ORS 420.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07; OHP 2-2014, f. & cert. ef. 2-24-14

409-022-0060

Access to Health Data

(1) An inspection or examination of a Limited Data Set derived from the health data that are filed at the Office for Oregon Health Policy and Research shall be allowed during the normal working days and business hours of the office.

(2) The inspection or examination shall take place at the Office for Oregon Health Policy and Research or other reasonable locations designated by the Administrator of the Office for Oregon Health Policy and Research.

(3) Health data reported to OHPR from hospitals and facilities may include information that is protected health information when it is maintained at the hospital or facility. OHPR obtains such information because it is required by law, and because OHPR acts in the capacity of a health oversight agency. OHPR is not a covered entity or a business associate of a covered entity. The terms used in this rule have the same meaning as those terms in the HIPAA Privacy Rules, 45 CFR Parts 160 and 164.

(4) Except under rules outlined in OAR 409-22-0070 for access to a Limited Data Set, access to health data reported to OHPR will be limited to health data that does not identify any individual patient, or permit the identification of any patient when used alone or in combination with other information, or individual licensed health care professionals.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0070

Limited Data Sets with a Data Use Agreement

(1) OHPR may authorize the disclosure of health data in accordance with a data use agreement entered into by both OHPR and a researcher, pursuant to which OHPR may disclose a limited data set to a researcher for research, public health, or health care operations. The intent of this rule is to generally apply the legal standard established in the HIPAA Privacy Rule applicable to limited data sets, 45 CFR 164.514(e).

(2) A limited data set excludes specified direct identifiers of the individual or of relatives, employers, or household members of the individual. The data use agreement must:

(a) Establish the permitted uses and disclosures of the limited data set by the recipient, consistent with the purposes of the research, and which may not include any use or disclosure that would violate the data use agreement;

(b) Limit who can use or receive the data; and

(c) Require the recipient to agree to the following:

(A) Not to use or disclose the information other than as permitted by the data use agreement or as otherwise required by law;

(B) Use appropriate safeguards to prevent the use or disclosure of the information other than as provided for in the data use agreement;

(C) Report to the covered entity any use or disclosure of the information not provided for by the data use agreement of which the recipient becomes aware;

(D) Ensure that any agents, including a subcontractor, to whom the recipient provides the limited data set agrees to the same restrictions and conditions that apply to the recipient with respect to the limited data set; and

(E) Not to identify the information or contact the individual.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

409-022-0080

Exemptions, Extensions and Waivers

(1) Hospitals and ambulatory surgical facilities may submit requests for exemptions or waivers to OHPR at least 60 calendar days prior to the due date as listed in the data submittal schedule as published by July 1. Exemptions or waivers to the requirements of this rule may be granted for a maximum of one calendar year. A hospital or ambulatory surgical facility wishing an exemption or waiver for more than one year must submit a request annually.

(2) Requests for extensions must be submitted to the Office at least ten working days prior to the due date as listed in the data submittal schedule. Extensions to the submittal schedule may be granted for a maximum of 30 calendar days. The hospital or ambulatory surgical facility must separately request each additional 30 calendar day extension.

(3) OHPR may grant extensions when the hospital or ambulatory surgical facility documents that technical or unforeseen difficulties prevent compliance. A petitioner requesting an exemption, extension, or waiver shall make the request in writing. A request for exemption, extension, or waiver must contain the following information:

(a) The petitioner's name, mailing address, telephone number, and contact person;

(b) The date the exemption, extension, or waiver is to start and end;

(c) A description of the relief sought, including reference to the specific sections of the rule;

(d) A statement of facts, or reasons in support of the request; and

(e) A proposed alternative to the requirement.

(4) A form for exemption, extension, or waiver can be found at the OHPR website: http://www.oregon.gov/oha/OHPR/RSCH/Pages/Hospital_Reporting.aspx.. Exemptions, extensions, or waivers may be granted for the following:

(a) Hospital or ambulatory surgical facility exemption: All hospitals and ambulatory surgical facilities are subject to the reporting requirements. Reasons justifying an exemption might be such as a circumstance where the hospital makes no effort to charge any patient for service.

(b) Reportable data element exemption: Each request for a data element exemption must be made separately.

(c) Submission media exemption: This exemption allows variation in the submission media.

(d) Submittal schedule extension: The request must specifically document the technical or unforeseen difficulties that prevent compliance.

(e) Submission format waiver: This waiver allows variation in the submission format. Each request must state an alternative transfer electronic media, its format, and the record layout for the discharge data records. Granting of this waiver is dependent on OHPR's ability to process the submittal media and format with available computer resource.

Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07

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