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

 

 DIVISION 40

COMMUNITY-BASED HEALTH CARE IMPROVEMENT PROGRAM

409-040-0100

Scope

These rules (OAR 409-040-0100 to 409-040-0115) establish criteria for approval of a community-based health care initiative to implement a community-based health care improvement program.

Stat. Auth.: ORS 413.042 & 735.723
Stats. Implemented: ORS 735.721, 735.723, 735.725 & 735.727
Hist.: OHP 5-2009, f. 12-23-09, cert. ef. 1-1-10

409-040-0105

Definitions

The following definitions apply to OAR 409-040-0100 to 409-040-0115:

(1) “Administrator” means the Administrator of the Office for Oregon Health Policy and Research (OHPR).

(2) “Approved initiatives” means a community based health care initiative that has completed and submitted an OHPR approved Community-based Health Care Initiative Certification Application (CBI-1) or Community-based Health Care Improvement Certification Renewal Form (CBI-2).

(3) “Community-based health care initiative” (initiative) means a locally governed non-profit corporation that is located in the community it serves and is approved by OHPR.

(4) “Community-based Health Care Improvement Program” (program) means a program where the initiative contracts with community health care professionals for a set of health care services determined by the initiative and reimbursed through a combination of employer, employee, and community contributions.

(5) “Qualified employer” means an employer that offers community-based health care services through a community-based health care improvement program.

(6) “Qualified employee” means an individual who is employed by a qualified employer.

Stat. Auth.: ORS 413.042 & 735.723
Stats. Implemented: ORS 735.721
Hist.: OHP 5-2009, f. 12-23-09, cert. ef. 1-1-10

409-040-0110

Community-based Health Care Improvement Requirements and Certification Process

(1) An initiative must meet the following requirements for approval:

(a) The board of directors must be comprised of representatives including but not limited to payers, health care professionals, and qualified employers from the community.

(b) An initiative must have multi-organizational stakeholder representation and may not be comprised of a single health care organization or health insurance organization.

(c) An initiative must represent a geographical or municipal boundary such as a city, county, or multi-county area.

(2) An initiative must submit an application for certification using approved Community-based Health Care Initiative Certification Application (CBI-1) to OHPR. Approved initiatives shall be certified for one year.

(3) An approved initiative must apply for annual recertification using the approved Community-based Health Care Improvement Certification Renewal Form (CBI-2). The form must be submitted to OHPR no later than 90 days prior to expiration of current certification. Approved initiatives shall be recertified for one year.

(4) OHPR may not approve community-based health care initiatives for more than three communities during the period beginning January 1, 2010 and ending June 30, 2013.

(5) There is no limit on the number of recertifications.

Stat. Auth.: ORS 413.042 & 735.723
Stats. Implemented: ORS 735.721, 735.723 & 735.725
Hist.: OHP 5-2009, f. 12-23-09, cert. ef. 1-1-10

409-040-0115

Program Reporting Requirements

(1) No later than 30 days following the end of each calendar year quarter, an approved initiative must provide the Administrator information required by OHPR using a Community-based Health Care Improvement Program Report Form (CBI-3) including but not limited to:

(a) The financial status of the program including but not limited to the costs per enrollee per month, number of claims made, number of claims paid, number of claims denied, amount of dues collected, and administrative expenses.

(b) The average time for resolution of complaints, which must specify the number of complaints resolved in over 45 days and the number of complaints resolved in less than 45 days.

(2) An approved initiative must report to the Legislative Assembly no later than October 1 of each year with the elements reported to OHPR using a CBC-3 form. The elements include but are not limited to:

(a) Description of the return on investments.

(b) Program satisfaction of enrolled employees, enrolled employers, and participating health care providers.

Stat. Auth.: ORS 413.042 & 735.723
Stats. Implemented: ORS 735.721, 735.723, 735.725 & 735.727
Hist.: OHP 5-2009, f. 12-23-09, cert. ef. 1-1-10

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Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

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