Or. Admin. Code § 410-125-1070

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

Section 410-125-1070 - Type A and Type B Hospitals

(1) Type A and Type B hospitals must submit the following information to the Division of Medical Assistance Programs (Division):

(a) The aggregate percent increase in patient charges and the effective date of the increase within 30 days following the end of their fiscal year for increases in the preceding year. Aggregate percent increase in patient charges is defined as the percent increase in patient revenues due to charge increases; and

(b) The amount of payment received by the hospital, from each Division contracted managed care plan and third-party payers, for inpatient and outpatient hospital services provided to managed care members, within the hospital's fiscal year.

(2) When a hospital is contracted with a Prepaid Health Plan (PHP), within thirty (30) days of the Division request the hospital will supply the Division the following information:

(a) The name of the contracting PHP; and

(b) The dates for which the contract will be effective; and

(c) The contracted services and reimbursement rates.

(3) The hospital and PHP must coordinate payment information to verify and return the PHP payment data file sent by the Division within ninety (90) days from date the data file is received by the hospital.

(4) Failure to supply the requested information within timelines stated may result in a discretionary sanction or fine (see OAR 410-120-1440). No sanction or fine will be imposed if the Division determines, at its sole discretion, that the hospital was unable to coordinate payment information with the PHP through no fault of the hospital's own.

Or. Admin. Code § 410-125-1070

OMAP 12-2001, f. 3-30-01, cert. ef. 4-1-01; OMAP 31-2005, f. 6-20-05, cert. ef. 7-1-05; DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065