Or. Admin. Code § 409-023-0115

Current through Register Vol. 63, No. 11, November 1, 2024

Section 409-023-0115 - Annual reports of financial assistance policies and nonprofit status

(1) For purposes of this rule:

(a) "Health care facility" means:

(A) A hospital;

(B) An ambulatory surgical center;

(C) A freestanding birthing center;

(D) An outpatient renal dialysis facility; or

(E) An extended stay center.

(b) "Reportable affiliated clinic" means an outpatient clinic located in Oregon that:

(A) Is operating under the common control of a hospital; or

(B) Is owned in whole or part by the hospital; or

(C) Is operating under the same brand of the hospital.

(2) A hospital or health system designee must submit a health care facility and reportable affiliated clinic report using the Hospital Facility and Clinic Report form (form HFCR) to the Authority, annually, by June 30 of each calendar year. The report shall identify its health care facilities and reportable affiliated clinics on form HFCR and provide the following:

(a) The health care facility name and street address for the facility location;

(b) The reportable affiliated clinic name and street address for the clinic location;

(c) The non-profit status of each health care facility or reportable affiliated clinic; and

(d) An attestation, signed by an officer of the hospital, that the hospital's financial assistance policy as developed under ORS 442.614 has been posted in the health care facilities and reportable affiliated clinics, and has been made available to patients of the facility and reportable affiliated clinic.

(3) Effective for hospital fiscal years that begin on or after January 1, 2025, hospitals must submit the Hospital Financial Assistance Report form (form HFAR) no later than 150 days after the end of the hospital's fiscal year, for certain financial assistance data from the most recently completed fiscal year. Data on form HFAR must include:

(a) Total number of financial assistance applications received in the fiscal year, and of the received applications, the number approved and denied by the following payer types:

(A) Uninsured;

(B) Medicare and Medicare Advantage;

(C) State medical assistance programs including out-of-state Medicaid;

(D) Commercial or private health insurance; and

(E) All other payers.

(b) Total number of patients who received cost adjustments based on:

(A) Completing a hospital's financial assistance application; and

(B) Without completing a hospital's financial assistance application, but instead as a result of the hospital's presumptive eligibility process as specified in OAR 409-023-0120.

(c) Total number of patient accounts referred to a debt collector or collection agency;

(d) Total number of patient accounts in which extraordinary collection activities (ECA) occurred, listed by the following categories, as described in 26 C.F.R. 1.501(r)-6(b) :

(A) Selling of an individual's debt to another party (except for those sales not considered an ECA as described in 26 C.F.R. 1.501(r)-6(b)(2));

(B) Reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus;

(C) Deferring or denying, or requiring a payment before providing, medically necessary care because of an individual's nonpayment of one or more bills for previously provided care covered under the hospital's financial assistance policy, as described in 26 C.F.R. 1.501(r)-6(b)(iii); and

(D) Taking actions that require a legal or judicial process including, but not limited to, liens, judgements, garnishments, foreclosures, or other action related to collection of a debt owed to the hospital as described in 26 CFR 1.501(r)-6(b)(iv)(A)-(G).

(e) The average and median per person debt, as well as the total amount of debt owed to the hospital by patients whose accounts were either placed in collections or referred to a collection agency during the reporting period.

(4) The Authority shall provide the necessary data reporting templates and make them available on its website no later than September 30th of each year for the upcoming fiscal year reporting.

(5) Data collected on form HFCR and form HFAR shall be made publicly available on the Hospital Reporting Program of the Authority's website. Prior to posting on its website, the Authority shall suppress information as necessary to protect patient confidentiality in accordance with applicable laws and regulations, as well as with the Authority's policies regarding small number reporting.

(6) A hospital that fails to report as required in OAR 409-023-0115 may be subject to a civil penalty not to exceed $500 per day.

Or. Admin. Code § 409-023-0115

OHP 5-2020, adopt filed 12/21/2020, effective 12/21/2020; OHP 1-2024, amend filed 05/07/2024, effective 5/7/2024

Statutory/Other Authority: ORS 442.618

Statutes/Other Implemented: ORS 442.618