Or. Admin. Code § 409-065-0050

Current through Register Vol. 63, No. 12, December 1, 2024

Section 409-065-0050 - Cost Growth Target Accountability Request for Consideration and Contested Case Hearings

(1) A payer or provider organization may request that the Authority reconsider any Notice of Intent or determination made under OAR 409-065-0000 through OAR 409-065-0055.

(a) A request for reconsideration must be submitted in writing to OHA, via email to HealthCare.CostTarget@oha.oregon.gov, within 30 days of the date of OHA's written Notice of Intent or determination. This request must include a detailed explanation of why the payer or provider organization believes OHA's decision is in error along with any supporting documentation. This request for reconsideration initiates an informal review process.

(b) New information may be provided by the payer or provider organization, or may be requested by the Authority, as part of the reconsideration process.

(c) A reconsideration may result in a modified Notice or in the reaffirmation of the original Notice. A request for reconsideration, supporting documentation and additional information, and OHA's determination must be posted on the Program website, although any information determined to be a trade secret and confidential under OAR 409-065-0042 must be maintained as confidential.

(2) A payer or provider organization is entitled to an informal conference and contested case hearing as provided in this rule regarding Notices of Intent and determinations made under OAR 409-065-0000 through 409-065-0055.

(3) This section solely applies to informal conferences and contested case hearings requested on notices of intent and determinations made under OAR 409-065-0010 through 409-065-0030.

(a) An entity that wishes to contest a determination of mandatory reporter status or provider organization must submit a request a hearing within 20 calendar days after the Authority issues the determination of mandatory reporter status as outlined in OAR 409-065-0010.

(b) A payer or provider organization that wishes to contest a denial of waiver or extension request must request a hearing within 20 calendar days after the Authority issues its determination pursuant to OAR 409-065-0020.

(c) A payer or provider organization that wishes to contest a notice of intent to impose a civil penalty issued by the Authority regarding data submission or data filing requirements must request a hearing within 20 calendar days after the Authority issues the notice of intent pursuant to OAR 409-065-0025.

(4) This section applies to informal conferences and contested case hearings requested on notices of intent and determinations made under OAR 409-065-0035 through 409-065-0045.

(a) A payer or provider organization that wishes to contest a determination that cost growth is not due to an acceptable reason(s) must request a hearing within 20 calendar days after the Authority issues the determination.

(b) A payer or provider organization that wishes to contest a notice of intent to impose a financial penalty issued by the Authority must request a hearing within 20 calendar days after the Authority issues the notice of intent pursuant to OAR 409-065-0045.

(5) Informal Conference Request.

(a) Upon receipt of a notice of intent and/or determination outlined in section (3) or (4) of this rule, a payer or provider organization may request an informal conference with the Authority via email to HealthCare.CostTarget@oha.oregon.gov.

(b) The Authority will schedule an informal conference with the payer or provider organization. The purposes of this informal conference are to:

(A) Provide an opportunity to settle the matter;

(B) Give the parties and the Authority an opportunity to review the information which is the basis for the action; and

(C) Give the parties and the Authority the chance to correct any misunderstandings of the facts.

(c) If the payer or provider organization request a contested case hearing, the payer or provider organization may, at any time prior to the hearing date, request an additional informal conference with the Authority, which may be granted if the Authority finds at its sole discretion that the additional informal conference will facilitate the resolution of disputed issues.

(d) An informal conference may result in a modified notice of intent or determination or in the reaffirmation of the original notice of intent or determination.

(6) Contested Case Hearing.

(a) In a contested case conducted pursuant to this rule, an Administrative Law Judge (ALJ) assigned by the Office of Administrative Hearings must conduct the contested case hearing pursuant to ORS 183.411 through 183.497, the Attorney General's Model Rules at OAR 137-003-0501 to 137-003-0700, and the provisions of these rules.

(b) The Authority's contested case hearings governed by this rule must be open to the public.

(c) The issues to be considered in a contested case conducted pursuant to this rule must be limited in scope to the facts and conclusions contained in the order or determination.

(7) Proposed and Final Orders. The ALJ is authorized to serve a proposed order on all parties and the Authority unless prior to the hearing, the Authority notifies the ALJ that a final order may be served by the ALJ.

(a) If the ALJ issues a proposed order, and the proposed order is adverse to a party, the party may file written exceptions to the proposed order to be considered by the Authority, or the ALJ when the ALJ is authorized to issue the final order. The exceptions must be in writing and received by the Authority, or the ALJ when the ALJ is authorized to issue the final order, not later than 10 calendar days after the date of the proposed order is issued by the ALJ. No additional evidence may be submitted without prior approval of the Authority.

(b) The Authority must issue a final order within 30 calendar days of receipt of the proposed order, which may adopt some or all of the proposed order, as the Authority must determine in its sole discretion. The final order is effective immediately upon being signed or as otherwise provided in the order.

(c) After receiving the exceptions or argument, if any, the Authority may adopt the proposed order as the final order or may prepare a new order. Prior to issuing the final order, the Authority may issue an amended proposed order.

(8) The time limits established in this rule may be waived or shortened by agreement among the parties and the Authority.

(9) All contested case hearing decisions are subject to judicial review under ORS 183.482 in the Court of Appeals.

Or. Admin. Code § 409-065-0050

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

Statutory/Other Authority: ORS 442.386

Statutes/Other Implemented: ORS 442.386