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| OAR 409-015-0005 to 0040 |
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Health Care Facility Financial Reporting
409-015-0005
Definitions
As used in this division:
(1) "Health care facility" (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) Shriners Hospital;
(d) Federal facilities; and
(e) Long-term care facilities, or hospital-based long-term care service.
(2) "Office" means the Office for Oregon Health Policy and Research.
(3) "Unreimbursed care" means the sum of the provision for bad debts plus charity service, Medicare deductions, Medicaid deductions and contractual deductions.
(4) The "provision for bad debts" is the estimated amount of accounts receivable expected to result in credit losses.
(5) "Charity care" is 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.
(6) "Medicare and Medicaid deductions" are the uncollectible differences between the hospital's full established charges for individual services and the rates paid by Medicare or Medicaid for composite services.
(7) "Other contractual deductions" are 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.
Stat. Auth.: ORS 442.400 & ORS 442.420(3)(d)
Stats. Implemented: ORS 442.400 & ORS 442.420(3)(d)
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
409-015-0010
Report Forms
(1) All health care facilities shall file the required reports and data on forms provided or approved by the office.
(2) The following forms are adopted by the office:
(a) Databank Monthly Data Input Form, Form FR-1;
(b) Certificate of Authenticity, Form FR-2; and
(c) Patient Revenue and Unreimbursed Care, Form FR-3.
(3) Obsolete forms will not be accepted.
[ED. NOTE: Forms referenced are available from the agency.]
Stat. Auth.: ORS 442.405(1), ORS 442.420(3)(d) & ORS 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
409-015-0012
Filing Date
The date of filing for the Databank Monthly Data Input Form (Form FR-1), is the date of receipt by the Oregon Association of Hospitals and Health Systems. The date of filing for the Certificate of Authenticity (Form FR-2) the Patient Revenue and Unreimbursed Care (Form FR-3) is the postmark date.
[ED. NOTE: The forms referenced in this rule are not printed in the OAR Compilation. Copies are available from the agency.]
Stat. Auth.: ORS 442.405(1), ORS 442.420(3)(d) & ORS 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
409-015-0015
Reports Required
(1) Each health care facility shall file with the office 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. If a facility is not required by either state or federal statute or municipal ordinances to obtain a certification of audit of its financial reports, and elects not to obtain such certification of audit, a certificate of authenticity, Form FR-2, signed by an officer of the corporation, partner or owner under penalty of perjury, shall be attached to the financial statements.
(2) Each health care facility shall file an accurately completed Databank Monthly Data Input Form (Form FR-1) with the Oregon Association of Hospitals and Health Systems for receipt by OAHHS on or before the 23rd day of each month. This form will transmit data for the preceding month. The office 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 office 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 office may annually require that each health care facility provide the office with 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 office a breakdown of its gross patient service revenue into inpatient revenue and outpatient revenue, and other applicable categories specified by Form FR-3.
[ED. NOTE: The forms referenced in this rule are not printed in the OAR Compilation. Copies are available from the agency.]
Stat. Auth.: ORS 442.405(1), ORS 442.420(3)(d) & ORS 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
409-015-0030
Modification of Reporting Requirements
(1) The office, upon request of a health care facility and for good cause, may relieve or modify the reporting requirements provided for in Division 15 of this chapter when such reporting requirement is proven to the satisfaction of the office to impose an undue hardship.
(2) Unless otherwise specified by the office, 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 shall not be construed to relieve any other reporting requirements of the health care facility.
Stat. Auth.: ORS 442.405(2), ORS 442.410, ORS 442.415, ORS 442.420(3)(d) & ORS 442.425
Stats. Implemented: ORS 442.410, ORS 442.415 & 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
409-015-0035
Civil Penalties
(1) 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 ORS 442.425; and
(b) $500.00 per day from the sixth day until filing in accord with ORS 442.425 is satisfactorily accomplished.
(2) 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.
Stat. Auth.: ORS 442.405(1), ORS 442.420(3)(d) & ORS 442.445(2)
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
409-015-0040
Cited from: http://arcweb.sos.state.or.us/rules/OARS_400/OAR_409/409_015.html
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| OAR 409-021-005 to 0150 |
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Access to Data and Fees for Data Research
409-021-0005
Introduction
This division defines the access to the health data collected from various sources and stored at the Office for Oregon Health Policy and Research.
Stat. Auth.: ORS 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; 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 1-2002, f. & cert. ef. 1-2-02
409-021-0010
Definitions
As used in this division:
(1) "Computer" means a desktop personal computer physically located in the Office.
(2) "Data use agreement" means the terms, conditions, restrictions, and other rules governing the use of health data as specified in Form D-1 (Research Data Request) and in Form D-3 (OHPR Data Use Agreement).
(3) "Electronic media" means the consumer media commonly used to store and transport up to 4.7 GB of data. This includes, but is not limited to, floppy diskettes, CDs, DVDs, and other forms of removable storage media.
(4) "Format" means the way health data appears in a display, on electronic media, on printed copy, or in output or data files produced by the Office's computer software.
(5) "Health data" means an electronic or printed copy of a document, book, paper, file, or other materials, regardless of mode received, that is filed or maintained in pursuit of law or in connection with the transaction of public business. Health data reported to the Office from hospitals and other health care facilities may include information that is protected health information when it is maintained at the hospital or health care facility. The Office obtains such information because it is required by law, and because the Office acts in the capacity of a health oversight agency. The Office is not a covered entity or a business associate of a covered entity. Health data may include, but is not limited to:
(a) The socioeconomic and demographic characteristics of a population;
(b) The incidence of specific diseases or injuries;
(c) The severity of the diseases and injuries;
(d) The supply of health care services;
(e) Characteristics of the health care providers;
(f) The utilization of health care services; or
(g) Determining the need for health care services.
(6) "HIPAA" means the federal Health Insurance Portablity and Accountability Act of 1996 and the regulations published Title 45, Parts 160 and 164, of the Code of Federal Regulations.
(7) "Office" means the Office for Oregon Health Policy and Research.
(8) "Person" means any natural person, corporation, partnership, firm, association or member or committee of the Legislative Assembly.
(9) "Public use health data file" means an aggregation of health data without personal identifiers that are publicly available for download, available through electronic mail, or available for delivery on electronic media, and at the Office's discretion may require an approved data use agreement.
(10) "Requestor" means the person who:
(a) Requests to inspect health data as provided in OAR 409.021.0120.
(b) Requests one or more copies of one or more public use health data files as provided in OAR 409.021.0130.
(c) Requests one or more copies of one or more limited health data sets as provided in OAR 409.021.0140.
(11) "Restricted health data set" means health data, other than routinely available public use data files, provided exclusively for purposes that are specified in an approved data use agreement. Limited data sets as defined by HIPAA shall be considered restricted health data sets.
(12) "Software" means a proprietary package of written programming language that instructs a computer to perform certain tasks.
(13) "Staff time" means the total time required by staff to complete a data request starting from initial contact to final contact with requestor, including searching for information, summarizing, duplicating, accessing the data, or any other time required by staff to complete the request.
(14) "State" means the State of Oregon.
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; 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 1-2002, f. & cert. ef. 1-2-02; OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-021-0015 [Renumbered to 409-021-0130]
409-021-0020 [Renumbered to 409-021-0120]
409-021-0025 [Renumbered to 409-021-0115]
409-021-0030 [Renumbered to 409-021-0140]
409-021-0115
Calculation of Fees
The Office shall charge fees necessary to fully recover the reasonable costs of responding to data requests and requests to examine health data maintained by the Office.
(1) The costs that the Office shall recover include, but are not limited to:
(a) Cost of materials and copying as provided in OAR 409-909-0020.
(b) Cost of staff time necessary to respond to the request.
(c) Administrative costs necessary to process the request.
(d) Any reasonable additional costs the Office deems necessary to respond to the request.
(2) Upon receipt of a completed form D-1, the Office shall provide a written estimate of fees within a reasonable period of time, unless the complete fees for the data request are the published fees for obtaining copies of public use health data files.
(3) The Office reserves the right to discount or waive fees for State agencies or at the discretion of the Administrator of the Office.
(4) The Office may develop contractual agreements for routinely providing data to a person at a discounted fee, upon approval of the Administrator of the Office.
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; HP 2-1988, f. & cert. ef. 3-25-88; HP 1-1996, f. & cert. ef. 1-2-96; Renumbered from 409-021-0025, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-021-0120
Inspection of Health Data
(1) An inspection of the health data that are maintained at the Office shall be only by appointment during the normal working days and business hours of the Office.
(2) Requests to inspect health data that are maintained by the Office may, at the Office's discretion, require an approved data use agreement as provided in OAR 409-021-0130(1).
(3) The inspection shall take place at the Office; on a case-by-case basis, other reasonable locations may be designated at the sole discretion of the Administrator of the Office.
(4) The inspection of the requested data shall be in a format commonly employed by the Office for maintaining the requested data.
(5) Recovery of fees, if any, shall take place at the time of inspection.
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; HP 2-1988, f. & cert. ef. 3-25-88; HP 1-1996, f. & cert. ef. 1-2-96; Renumbered from 409-021-0020, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-021-0130
Requests to Obtain Copies of Public Use Health Data Files
(1) Any requestor who wishes to obtain copies of public use health data files maintained by the Office shall provide all of the following:
(a) Form D-1 (Research Data Request)
(b) Form D-2 (Data Order Form)
(c) Full payment of fees.
(2) All requests for public use health data files require the written approval of the Research and Data Manager.
(3) Upon approval and receipt of full payment of fees, one copy of the requested public use health data file will be provided to the requestor.
(4) The Office shall respond to public use health data file requests within a reasonable period of time, except that the Office's response may be delayed so that critical operations and activities are not unduly disrupted. The Office shall notify the requestor in writing if an extensive delay is anticipated.
(5) This rule shall not apply to health data that the Office routinely makes available for direct download from the Office's web site.
[ED. NOTE: Forms referred are available from the agency.]
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440, 192.496, 192.501 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; 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 1-2002, f. & cert. ef. 1-2-02; Renumbered from 409-021-0015, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-021-0140
Requests and Requirements to Obtain Restricted Health Data Sets
(1) The Office may authorize the disclosure of health data in accordance with an approved data use agreement entered into by both the Office and a researcher, pursuant to which the Office may disclose a restricted health 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) Any requestor who wishes to obtain restricted health data sets from the Office shall provide all of the following:
(a) Form D-1 (Research Data Request)
(b) Form D-2 (Data Order Form)
(c) Form D-3 (Data Use Agreement)
(d) Full payment of fees.
(3) All requests for restricted health data sets require the written approval of the Research and Data Manager.
(4) Upon approval and receipt of full payment of fees, the Office is authorized to provide one copy of the requested restricted health data set to the requestor.
(5) The Office shall respond to restricted health data set requests within a reasonable period of time, except that the Office's response may be delayed so that critical operations and activities are not unduly disrupted. The Office shall notify the requestor in writing if an extensive delay is anticipated.
[ED. NOTE: Forms referred are available from the agency.]
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: SHPD 5-1986, f. & ef. 1-24-86; 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 1-2002, f. & cert. ef. 1-2-02; Renumbered from 409-021-0030, OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
409-021-0150
Denial of Requests to Inspect or Obtain Copies of Health Data
The Office shall deny requests to inspect health data, receive copies of public use health data sets, and receive copies of restricted health data sets in order to prevent uses that are not consistent with current agreements, policies, rules, regulations, or statutes.
(1) The Office shall deny requests to examine health data or receive copies of health data for reasons that include, but are not limited to:
(a) Fulfilling the request violates one or more of the Office's current data use agreements with one or more other persons.
(b) Fulfilling the request requires unreasonable interference with the Office's regular discharge of duties.
(c) Fulfilling the request requires disclosures that violate HIPAA privacy rules (45CFR parts 160 and 164).
(d) Fulfilling the request requires disclosures that are an unreasonable invasion of privacy. If a request is denied for this reason, the burden is on the requestor to provide the Office clear and convincing evidence that fulfilling the data request is not an unreasonable invasion of privacy and that the public interest requires disclosing the requested data.
(2) Nothing in these rules authorizes the Office to disclose health data in a form that allows easy and precise identification of individual patients or individual licensed health care professionals.
Stat. Auth.: ORS 192.440 & 442.420(3)(d)
Stats. Implemented: ORS 192.410 - 192.440 & 442.420(3)(d)
Hist.: OHP 1-2007, f. 1-29-07, cert. ef. 2-1-07
Cited from: http://arcweb.sos.state.or.us/rules/OARS_400/OAR_409/409_021.html
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| OAR 409-022-0005 to 0080 |
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Ambulatory Surgery Data Reporting Program
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), ORS 442.445(2), ORS 442.463 & Section 10, Ch. 581, OL 1999
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 414.021
(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 420.120
Stats. Implemented: ORS 420.120
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/OHPPR/RSCH/research_data.shtml.
Stat. Auth.: ORS 420.120
Stats. Implemented: ORS 420.120
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/OHPPR/RSCH/research_data.shtml. [Table not included. See ED. NOTE.]
[ED. NOTE: Table referenced are available from the agency.]
Stat. Auth.: ORS 420.120
Stats. Implemented: ORS 420.120
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 420.120
Stats. Implemented: ORS 420.120
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) Start Date. A per record fee shall be assessed beginning on the first business day of January 2007.
(4) 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 quarter.
(5) 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.
(6) 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.
(7) Collection of Fees. Fees shall be paid to the Oregon Department of Administrative Services, the Office for Oregon Health Policy and Research, on a quarterly basis. Fees for the quarter January 1 through March 31 shall be due no later than April 30; fees for the quarter April 1 through June 30 shall be due no later than July 30; fees for the quarter July 1 through September 30 shall be due no later than October 30 and fees for the quarter October 1 though December 31 shall be due no later than January 30. Payments must be delivered to OHPR at the following address: 255 Capitol Street NE, 5th floor, Salem, OR 97310. Payments are due no later than the close of business on the due date.
(8) Compliance. Late payments are subject to recovery in accordance with the laws of the State of Oregon.
(9) 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.
(10) 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
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 420.120
Stats. Implemented: ORS 420.120
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 420.120
Stats. Implemented: ORS 420.120
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/OHPPR/RSCH/research_data.shtml. 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 420.120
Stats. Implemented: ORS 420.120
Hist.: OHP 3-2006, f. 12-14-06, cert. ef. 1-1-07
Cited from: http://arcweb.sos.state.or.us/rules/OARS_400/OAR_409/409_022.html
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