Or. Admin. Code § 409-065-0010
Current through Register Vol. 63, No. 12, December 1, 2024
Section 409-065-0010 - General Reporting Requirements for Mandatory Reporters(1) Determination of a mandatory reporter. (a) For payers or licensed third-party administrators, the Authority must identify mandatory reporters using health insurance enrollment data from DCBS and Medicaid enrollment reports from the Authority. (A) The Authority must aggregate the most recent four (4) quarters of data.(B) The Authority must calculate the mean total lives for each payer and licensed third-party administrator for each reporting year.(b) All payers or licensed third-party administrators with calculated mean total lives of 1,000 or more across all lines of business must be mandatory reporters.(c) The Authority must make annual mandatory reporter determinations and provide written notification no later than April 30 of each year to all mandatory reporters subject to the reporting requirements of OAR 409-065-0010 to 409-065-0030 for the current year.(2) All Mandatory reporters must submit data files in a manner and form as prescribed by 409-065-0015.(3) The Authority must identify voluntary reporters that have calculated mean total lives of 1,000 or higher across all lines of business and invite them to participate in the annual data submission.(4) New mandatory reporters submitting for the first time, or mandatory reporters that did not submit data in the previous year, must attend a data submission training session prior to their first submission of data, as provided by the Authority.(5) A mandatory reporter may submit a waiver of reporting in compliance with OAR 409-065-0020.(6) An entity may appeal the Authority's determination of mandatory reporter status pursuant to the procedure outlined in OAR 409-065-0050.Or. Admin. Code § 409-065-0010
OHP 2-2021, temporary adopt filed 06/02/2021, effective 6/2/2021 through 11/27/2021; OHP 5-2021, adopt filed 11/19/2021, effective 11/19/2021; OHP 4-2024, amend filed 07/22/2024, effective 7/22/2024Statutory/Other Authority: ORS 442.386
Statutes/Other Implemented: ORS 442.385 & 442.386