Or. Admin. Code § 410-050-0700

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

Section 410-050-0700 - Definitions

The following definitions apply to OAR 410-050-0700 to 410-050-0870:

(1) "Authority" means the Oregon Health Authority.

(2) "Bad Debt" means the current period charge for actual or expected uncollectible accounts resulting from the extension of credit on inpatient and outpatient hospital services. Bad debt charges shall be offset by any recoveries received on accounts receivable during that current period, subject to final assessment reporting and reconciliation processes required in these rules.

(3) "Charges for Inpatient Care" means gross inpatient charges generated from room, board, general nursing, and ancillary services provided to patients who are expected to remain in the hospital at least overnight and occupy a bed (as distinguished from categories of health care items or services identified in 42 CFR 433.56(a)(2)-(19) that are not charges for inpatient hospital services). Charges for inpatient care include all payers, and are not limited to Medicaid patients.

(4) "Charges for Outpatient Care" means gross outpatient charges generated from services provided by the hospital to a patient who is not confined overnight. These services include all ancillary and clinic facility charges (as distinguished from categories of health care items or services identified in 42 CFR 433.56(a)(1) and (3)-(19) that are not charges for outpatient hospital services). Charges of outpatient care include all payers and are not limited to Medicaid charges.

(5) "Charity Care" means costs for providing inpatient or outpatient care services free of charge or at a reduced charge because of the indigence or lack of health insurance of the patient receiving the care services. Charity care results from a hospital's policy as reflected in its official financial statements to provide inpatient or outpatient hospital care services free of charge or at a reduced charge to individuals who meet financial criteria. Charity care does not include any amounts above the payments by the Authority that constitute payment in full under ORS 414.065(3), or above the payment rate established by contract with a prepaid managed care health services organization or health insurance entity for inpatient or outpatient care provided pursuant to such contract, or above the payment rate established under ORS 414.743 for inpatient or outpatient care reimbursed under that statute.

(6) "Contractual Adjustments" means the difference between the amounts charged based on the hospital's full, established charges and the amount received or due from the payer.

(7) "Declared Fiscal Year" means the fiscal year declared to the Internal Revenue Service (IRS).

(8) "Deficiency" means the amount by which the assessment, as correctly computed, exceeds the assessment, if any, reported and paid by the hospital. If, after the original deficiency is assessed, subsequent information shows the correct amount of assessment to be greater than previously determined, an additional deficiency arises.

(9) "Delinquency" means the hospital fails to file a report when due as required under these rules or fails to pay the assessment as correctly computed when the assessment was due.

(10) "Director" means the Director of the Authority.

(11) "Hospital" means a hospital licensed under ORS chapter 441. Hospital, as used in this section, does not include special inpatient care facilities as that term is defined in ORS 442.015, hospitals that provide only psychiatric care, pediatric specialty hospitals providing care to children at no charge, and public hospitals other than hospitals created by health districts under ORS 440.315 to 440.410. For purposes of these rules, the hospital shall be identified by using the federal payer identification number for the hospital.

(12) "Net Revenue" means the total amount of charges for inpatient or outpatient care provided by the hospital to patients, less charity care, bad debts, and contractual adjustments. Net revenue does not include revenue derived from sources other than inpatient or outpatient operations including but not limited to interest and guest meals and any revenue that is taken into account in computing a long-term care assessment under the long-term facility assessment.

(13) "Type A Hospital" means a small remote hospital that has 50 or fewer beds and is more than 30 miles from another acute inpatient care facility.

(14) "Type B Hospital" means a small and rural hospital that has 50 or fewer beds and is 30 miles or less from another acute inpatient care facility.

Or. Admin. Code § 410-050-0700

OMAP 86-2004(Temp), f. & cert. ef. 11-9-04 thru 5-7-05; OMAP 25-2005, f. 4-15-05, cert. ef. 5-7-05; DMAP 3-2008, f. & cert. ef. 1-25-08; DMAP 33-2009, f. & cert. ef. 10-1-09; DMAP 52-2015, f. 9-22-15, cert. ef. 10/1/2015; DMAP 64-2017, amend filed 12/29/2017, effective 1/1/2018

Note: Publications referenced are available from the agency.

Statutory/Other Authority: 413.042

Statutes/Other Implemented: 2017 HB 2391