Or. Admin. Code § 409-065-0028

Current through Register Vol. 63, No. 8, August 1, 2024

Section 409-065-0028 - General Reporting Requirements for Provider Organizations

(1) Determination of a provider organization that is required to report data.

(a) The Authority must identify provider organizations with 10,000 or more attributed patients in at least one market using the annual report titled Health Care Cost Trends, which is set forth on the Program website.

(b) The Authority must make annual determinations regarding which provider organizations are required to report data. The Authority must provide written notification no later than April 30 of each year to all provider organizations required to report data for the current year.

(c) A provider organization may appeal the Authority's determination of the status as a provider organization required to report data pursuant to the procedure outlined in OAR 409-065-0050.

(2) Provider organizations with less than 10,000 attributed patients in a given market, pediatric provider organizations, or federally qualified health centers, as identified by the Authority in the annual report titled Health Care Cost Trends and set forth on the Program website, may voluntarily submit a complete CGT-4 to the Authority.

(3) Data submission requirements.

(a) Annual data submission dates are provided in the CGT-4; the data must not be submitted before September 1st of each year, subject to section (7) of this rule.

(b) The Authority must review a submitted CGT-4 within 90 calendar days after confirming receipt. If the Authority finds errors during its review through edit checks or validation, the Authority must issue a notice of the error(s) to the provider organization. Provider organizations must correct and resubmit data within 30 calendar days after the date the Authority issues notice of the error(s). The Authority will consider the annual data submission complete after the provider organization submits all necessary corrections and resubmissions, as determined by the Authority. Voluntary reporters may correct and resubmit data, as applicable.

(4) Data submission waivers

(a) The Authority may grant a waiver or deadline extension to the data submission requirements.

(b) If a provider organization believes they are eligible for a waiver of all or part of the data submission requirements they may request a waiver of reporting requirements by submitting a CGT-3 to the Authority.

(A) A provider organization must submit a CGT-3 form to request a waiver as follows:

(i) To request a partial waiver to the data submission requirements, provider organizations must submit a completed CGT-3 form to the Authority no later than 14 calendar days before the annual reporting deadline.

(ii) To request a waiver of all data submission or validation requirements, a provider organization must submit a completed CGT-3 form to the Authority no later than 60 calendar days before the annual reporting deadline.

(B) The Authority must approve or deny the waiver request and provide written notification to the requestor within 14 calendar days following receipt of the request.

(c) If a provider organization believes they need a deadline extension for the data submission requirements, they may request a deadline extension by submitting a CGT-3 form to the Authority.

(A) Provider organizations may submit a CGT-3 form to request a deadline extension as follows:

(i) To request a deadline extension for data submission, provider organizations must submit a completed CGT-3 form to the Authority no later than 14 calendar days before the annual reporting deadline.

(ii) To request a deadline extension for data correction, resubmission, or validation requirements, mandatory reporters must submit a completed CGT-3 form to the Authority no later than seven calendar days after the date of the notice issued by the Authority requesting data correction, resubmission, or validation.

(B) The Authority must issue its determination on a provider organization's CGT-3 deadline extension request within 14 calendar days after the date of the request.

(d) If the Authority denies a CGT-3 request, the mandatory reporter may request a contested case hearing following the procedure outlined in OAR 409-065-0050.

(e) The Authority will only grant CGT-3 requests for one data submission cycle at a time.

(5) Data submission Compliance and Enforcement

(a) Unless the Authority approves a waiver submitted pursuant to section (4) of this rule, a provider organization fails to comply with data submission requirements under section (3) of this rule when a provider organization fails to submit data files by the specified submission date.

(b) Unless the Authority approves a waiver submitted pursuant to section (4) of this rule, a provider organization fails to comply with data file requirements when a provider organization:

(A) Submits a data file in an unapproved layout;

(B) Submits a data element in an unapproved format;

(C) Submits a data element with unapproved coding;

(D) Fails to submit a required data element; or

(E) Fails to comply with validation and quality control efforts, including resubmitting or correcting data in a timely fashion as requested by the Authority.

(c) The Authority must issue a notice of noncompliance to provider organizations before imposing a civil penalty under section (6) of this rule. Provider organizations must come into compliance within 30 calendar days from the date the Authority issues its notice of noncompliance.

(6) The Authority may impose a civil penalty on a provider organization for a violation of this rule if the provider organization does not come into compliance as required under section (5) of this rule. Civil penalties must be imposed in the manner provided in ORS 183.745. Pursuant to ORS 442.993, the Authority adopts the following schedule of civil penalties:

(a) Up to $500 per day starting from the date of the notice in (5)(c) of this rule for each violation of (5)(a) of this rule;

(b) Up to $400 per day starting from the date of the notice in (5)(c) of this rule for each violation of (5)(b) of this rule.

(7) For calendar year 2024, the Authority will notify provider organizations that are required to submit a CGT-4 file under section (1) of this rule no later than July 31, 2024, with submissions due to the Authority no later than December 6, 2024. Annual data submissions for subsequent years must comply with the requirements of section (3) of this rule.

Or. Admin. Code § 409-065-0028

OHP 4-2024, adopt filed 07/22/2024, effective 7/22/2024

Statutory/Other Authority: ORS 442.386

Statutes/Other Implemented: ORS 442.385 & 442.386